Dr. Daniel L. Clarke-Pearson’s article, “Preventing VTE: Evidence-based perioperative tactics” (April), is another fine summary of ongoing concern about thrombo-embolism after gynecologic surgery. In the past year, articles in both ObGyn and internal medicine literature pointed out the need for attention to this issue. Prophylaxis is probably the best way to lower risk. In my own survey,1 I found a lack of consensus about or appreciation of venous thrombo-embolism and prophylaxis for C-section.
Dr. Clarke-Pearson’s remarks on laparoscopy are also appreciated. In a literature review of 179,706 laparoscopic procedures, we2 found 18 cases of thromboembolism, with 2 deaths reported. Despite apparent “low risk,” the physiologic changes due to pneumoperitoneum and venous stasis probably still necessitate prophylaxis. My choice for most patients having extended laparoscopic procedures is sequential compression devices.
Thomas P. Connolly, DO