Venous thromboembolism, a serious post-surgical risk, is a major concern for women undergoing extensive gynecological procedures. Without proper prevention, deep vein thrombosis (DVT) can develop in up to 15% of patients, often progressing to potentially fatal pulmonary embolism (PE). However, with effective prophylactic strategies, these events can be significantly reduced, making them one of the most preventable causes of postoperative complications and deaths.
Evidence suggests that targeted prophylaxis, such as systemic anticoagulants or non-pharmacological measures like compression devices, can greatly lower the frequency and severity of venous thromboembolism (VTE) at a reasonable cost. These non-pharmacological methods are particularly beneficial as they are user-friendly, have minimal complications, and pose virtually no bleeding risk.
Despite existing guidelines on VTE prophylaxis, diagnosis, treatment, and management, most studies focus on patients with malignant gynecological diseases or the safety of gynecological surgeries. There is a lack of research assessing the hemostatic imbalance in terms of coagulation and fibrinolysis, which is crucial for guiding perioperative and postoperative management of DVT, especially in benign gynecological cases undergoing minimal invasion surgery.
This study aims to fill this gap by examining the effect of mechanical compression on coagulation and fibrinolysis and the occurrence of DVT in Chinese patients with benign gynecological conditions who underwent minimal invasive gynecological surgery. The primary outcomes assessed include changes in coagulation blood tests and the rate of DVT incidence.
The study was conducted at the Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, and was approved by the Ethics Committee of Guangdong Provincial Hospital of Chinese Medicine. A total of 119 Chinese adult female patients with benign gynecological diseases, such as uterine fibroids or ovarian cysts, were included. The patients were divided into two groups: a Device group, where an intermittent pneumatic compression (IPC) device was applied to the lower extremities, and a Non-device group, where no IPC was used.
The results showed that surgical intervention alone increased certain coagulation parameters, indicating a procedure-related slowing of clot formation. However, the increase was smaller in the Device group, suggesting that the IPC device tempered this delay and may reduce bleeding propensity. Interestingly, the study found that the application of IPC resulted in smaller changes in certain coagulation and fibrinolysis markers, implying a partial attenuation of surgery-induced coagulation and fibrinolysis.
In terms of DVT incidence, the study detected distal lower-limb DVT in approximately 3.3% of controls and 3.2% of patients given pneumatic compression, reflecting a low post-operative incidence. While the study has limitations, such as a small cohort size and the need for further research on the correlation between hemostatic parameters and DVT occurrence, the results suggest that mechanical calf-ankle compression can modestly attenuate early coagulation and fibrinolytic activation.
In conclusion, this study provides valuable insights into the dynamic changes of coagulation and fibrinolytic parameters in response to IPC application after surgery. While the occurrence of distal DVT in benign gynecological patients is low, the regulatory effects of IPC can guide clinicians and nurses in early DVT risk identification, leading to better perioperative and postoperative care for patients undergoing gynecological laparoscopy.
Further prospective trials with larger sample sizes are needed to confirm the effectiveness of IPC as a stand-alone prophylaxis in minimally invasive gynecologic surgery.
