Systematic review of thromboprophylaxis in colorectal surgery -- an update.

Objective: The incidence of thromboembolism after colorectal surgery is higher than after general surgery. The aim of this paper is to update a systematic review addressing thrombosis prophylaxis in connection with colorectal surgery.

Methods: MEDLINE, EMBASE, LILACS, abstract books and reference lists from reviews were searched without language restrictions for randomized controlled trials or clinical controlled trials comparing prophylactic interventions and/or placebo up til August 2003. Five hundred and fifty-eight studies were identified of which 19 fulfilled the inclusion criteria. Data extraction was done by at least two of the authors. Outcome was deep venous thrombosis and/or pulmonary embolism diagnosed by various methods.

Results: Any kind of heparin is better than no treatment or placebo (11 studies) with a Peto Odds ratio (POR) at 0.32 (95% CI 0.20-0.53). Unfractionated heparin and low molecular weight heparin (4 studies) were equally effective POR 1.01 (95% CI 0.67-1.52). The combination of graduated compression stockings and LMWH is better than LMWH alone (2 studies) with a POR at 4.17 (95% CI 1.37-12.70).

Conclusion: The optimal thromboprophylaxis in colorectal surgery is the combination of graduated compression stockings and low-dose unfractionated heparin or low molecular weight heparin.