Comparative evaluation of anticoagulant prophylaxis regimens in patients with malignant tumors of the pelvic organs in the perioperative period

Objective. To conduct a comparative analysis of the impact of different anticoagulant therapy regimens on the dynamics of laboratory markers of the hemostasis system (D-dimer, thrombin-antithrombin complex [TAC], prothrombin fragments F1+2) and the frequency of thrombohemorrhagic complications in the perioperative period in patients with malignant neoplasms of the pelvic organs.

Materials and methods. A prospective, comparative, randomized, interventional study was conducted involving 964 patients with squamous cell carcinoma of the cervix, endometrial cancer, ovarian cancer, and squamous cell carcinoma of the vulva. All patients were subject to radical surgical treatment and were randomized into four groups depending on the anticoagulant therapy regimen: Groups I and II received low molecular weight heparin (LMWH) 10 and 1 day before surgery and then 10 days after surgery, respectively; Groups III and IV – only in the postoperative period (LMWH and unfractionated heparin, respectively). The comparison group (n=75) did not receive anticoagulant prophylaxis. To assess the activation of the coagulation cascade and fibrinolysis, quantitative methods for determining D-dimer, TAC complex, and F1+2 fragments were used. Statistical processing was performed using the Mann–Whitney criterion (p<0.05).

Results. In the study group, the incidence of deep vein thrombosis was 3.3–4.3%, pulmonary embolism – 1.1%, while in the comparison group these figures reached 13.3 and 6.7%, respectively (p<0.01). In groups I and II, no cases of moderate bleeding were recorded in the postoperative period. The most pronounced decrease in hemostasis markers (D-dimer, TAC, F1+2) was observed in group I, where LMWH was used 10 days before surgery. In the comparison group, on the contrary, persistent hypercoagulation with wave-like dynamics of markers and their significantly higher values throughout the postoperative observation period was revealed.

Conclusion. Preoperative administration of LMWH provides a significant reduction in the risk of thrombotic complications and promotes rapid normalization of hemostasis parameters while maintaining a high safety profile. The absence of anticoagulant prophylaxis is associated with pronounced activation of the coagulation system and a higher risk of deep vein thrombosis and pulmonary embolism in oncogynecological patients in the postoperative period.