Efficacy and Safety of Enoxaparin for Preventing Venous Thromboembolic Events following Urologic Laparoscopic Surgery

There is a paucity of definitive evidence that supports the use of enoxaparin to prevent venous thromboembolism (VTE) after urologic laparoscopic surgery. The purpose of this study was to evaluate the efficacy and safety of postoperative subcutaneous enoxaparin injection in patients who underwent urologic laparoscopic surgery. A total of 63 patients were evaluated from June 2010 to December 2012. All patients received postoperative prophylaxis with enoxaparin (2000 IU twice daily for 5 days). None of the patients treated with enoxaparin developed symptomatic VTE, but two cases (3.2%) of pulmonary embolism were noted before initial enoxaparin administration. Statistically significant differences were observed between the prothrombin time (PT) and activated partial thromboplastin time (APTT) values and D-dimer levels obtained at baseline and on day 7 after surgery; however, the PT and APTT values did not exceed the normal range. In addition, signs of any adverse events were not encountered in any of the patients treated with enoxaparin. The use of enoxaparin immediately after a surgery may confer valuable thromboprophylaxis benefits for urologic laparoscopic surgery. 1. Introduction Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep venous thrombosis (DVT), is a major complication in patients who have undergone surgery [1]. Although these events are rare, they can be still associated with high mortality during the early postoperative period. Several known significant risk factors are responsible for the development of VTE, including female gender, advanced age, advanced-stage cancer, prolonged surgical duration, intrapelvic surgeries, varicose veins, immobilization, obesity, history of VTE, and a high number of chronic medical comorbidities [2–4]. In particular, patients undergoing curative abdominal cancer surgery are considered to be at a high risk for VTE [5]. In recent years, numerous urologic surgical procedures have been laparoscopically performed, and these offer some advantages over conventional open　incisional surgery, including decreased pain, quicker convalescence, and improved cosmesis. Nevertheless, this technique is still associated with a distinct morbidity. Moreover, the incidence of VTE associated with laparoscopic and open incisional surgery has been reported as almost equal [6, 7], but the abdominal insufflation used during laparoscopic procedures has been proposed to cause serum hypercoagulability of varying degrees and VTE secondary to venous stasis [8, 9]. In addition, the patient’s position such as the lateral