Readmission after hysterectomy and prophylactic low molecular weight heparin: Retrospective case-control study

Abstract

Objective: To determine whether use of tinzaparin, a low molecular weight heparin introduced for prophylactic management of deep vein thrombosis, increases the risk of serious postoperative bleeding leading to a higher than expected 28 day readmission rate after discharge for hysterectomy. Design: Retrospective case-control study using computerised hospital inpatient data and review of case notes. Setting: District general hospital. Subjects: 2108 patients undergoing hysterectomy between August 1997 and March 2003 Main outcome measures: Readmission and reoperation associated with bleeding. Results: 54 cases of serious postoperative bleeding were identified, 46 of which were readmissions. These 54 cases were compared with 179 controls. Regression analysis indicated a positive relation between prophylaxis with tinzaparin and serious postoperative bleeding. There was a significant twofold increase in odds (odds ratio 2.02,95% confidence interval 1.02 to 4.05) after adjustment for type of operation, age, and type of pain relief. Conclusions: In the prophylactic treatment of thromboembolic disease after hysterectomy, compared with calci-heparin, tinzaperin is associated with a twofold increase in risk of serious postoperative bleeding.