One discussion this week included the rate of bleeding complications after pharmacologic DVT prophylaxis.
Reference: Leonardi MJ, McGory ML, Ko CY. The rate of bleeding complications after pharmacologic deep venous thrombosis prophylaxis: a systematic review of 33 randomized controlled trials. Archives of Surgery. 2006 Aug;141(8):790-797.
Summary: In a systematic review of 33 RCTs with 33,813 patients, Leonardi et al (2006) concluded that there is a small, but measurable, rate of minor bleeding complications associated with pharmacologic DVT prophylaxis: injection site bruising (6.9%), wound hematoma (5.7%), drain site bleeding (2.0%), and hematuria (1.6%).
The rate of major complications, such as GI tract (0.2%) or RP (<0.1%) bleeding, was extremely low in this review. Complications requiring a change in care, such as subsequent operation (0.7%) or discontinuation of prophylaxis (2.0%), were also infrequent. The subsequent operation rate for bleeding problems for pharmacologic prophylaxis vs placebo was identical, at 0.7%.
Additional Reading: Leonardi MJ, McGory ML, Ko CY. A systematic review of deep venous thrombosis prophylaxis in cancer patients: implications for improving quality. Annals of Surgical Oncology. 2007 Feb;14(2):929-936.