Guideline No. 417: Prevention of Venous Thromboembolic Disease in Gynaecological Surgery

Published:April 17, 2021DOI:



      The primary objective of this clinical practice guideline is to provide gynaecologists with an algorithm and evidence to guide the use of thromboprophylaxis in gynaecological surgery.

      Target Population

      All patients undergoing gynaecological surgery for benign or malignant indications.

      Benefits, Harms, and Costs

      The implementation of this guideline will benefit patients undergoing gynaecological surgery and provide physicians with a standard algorithm for the use of perioperative thromboprophylaxis.


      The following search terms were entered into MEDLINE, Google Scholar, and Cochrane in 2017 and 2018: VTE, PE, DVT, thromboprophylaxis, gynaecological surgery, heparin, graduated compression stocking, intermittent pneumatic stocking, obesity, pediatrics, minimally invasive surgery, heparin induced thrombocytopenia, regional anesthesia). Articles included were randomized controlled trials, meta-analyses, systematic reviews, and observational studies. Additional publications were identified from the reference lists of these articles. There were no date limits, but search results were limited to English language articles only. Searches were updated and incorporated into the guideline up to September 2018.

      Validation methods

      The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations).

      Intended Users

      Gynaecologists and other members of the surgical team.

      RECOMMENDATIONS (GRADE ratings in parentheses)

      • 1
        The risk of venous thromboembolism should be considered pre-operatively and a standard approach to prophylaxis should be encouraged through standardized order sets where available (strong, moderate). A team approach is encouraged in difficult cases.
      • 2
        Patients should be counselled about the risk of venous thromboembolism and informed discharge should include discussion of the signs and symptoms of venous thromboembolism along with the recommended course of action should these occur (strong, moderate).
      • 3
        Patients should be encouraged to ambulate as soon as possible (within the first 24 h) after surgery in order to decrease the risk of venous thromboembolism (strong, moderate).
      • 4
        Intermittent compression stockings, when available, are preferred to graduated compression stockings (strong, moderate).
      • 5
        Either low-molecular-weight heparin or low-dose unfractionated heparin is recommended as the first choice for pharmacological thromboprophylaxis in most cases (strong, high).
      • 6
        For patients undergoing gynaecological surgery for benign disease, postoperative low-dose unfractionated heparin should be administered every 12 hours (twice daily) (strong, moderate). For patients undergoing gynaecological surgery for malignant disease, postoperative low-dose unfractionated should be administered every 8 hours (3 times a day) (strong, moderate).
      • 7
        If patients with renal dysfunction require pharmacological thromboprophylaxis, low-dose unfractionated heparin is recommended (strong, high). The use of low-molecular-weight heparin or fondaparinux is not recommended when creatinine clearance is <30 mL/min (strong, high).
      • 8
        For patients at high risk for venous thromboembolism and using low-molecular-weight heparin or low-dose unfractionated heparin for thromboprophylaxis, continued dosing for 4 weeks postoperatively is recommended (strong, moderate).
      • 9
        In general, patients already on low-dose aspirin for primary or secondary cardiovascular prevention should discontinue it 5–7 days prior to surgery, and restart once hemostasis is guaranteed. Patients on antiplatelet therapy with recent cardiac stenting, coronary artery bypass graft, or other significant cardiovascular disease may continue these agents after consulting with the appropriate specialist for operative planning (strong, low).
      • 10
        Thromboprophylaxis should be implemented based on the pre-operative risk assessment as described in this guideline. For most patients, mechanical prophylaxis is recommended with or without pharmacotherapy based on risks and anticipated benefits (strong, moderate).
      • 11
        When patients are both at high risk of venous thromboembolism and at high risk for major bleeding complications, a team approach including consultation with the department of medicine is recommended (strong, moderate). There may be benefits to combining intermittent pneumatic compression and graduated compression stockings in this population (conditional, low).
      • 12
        For patients at high risk of venous thromboembolism and with contraindication to heparins, the use of fondaparinux and mechanical prophylaxis can be used (strong, moderate). Increased surveillance for bleeding complications is recommended when fondaparinux is used for thromboprophylaxis (strong, moderate).
      • 13
        Awareness of the risk of venous thromboembolism should be extended to pediatric and adolescent patients and a team approach to venous thromboembolism prophylaxis, involving a pediatrician and/or pediatric hematologist, is recommended for patients at high risk (strong, low).
      • 14
        Dose adjustment of pharmacologic thromboprophylaxis is recommended for patients with a BMI >40 kg/m2 (strong, moderate).
      • 15
        There is no indication for stopping hormone replacement therapy preoperatively, and it is not necessary to stop oral contraceptives preoperatively in patients who are at low risk for venous thromboembolism (strong, moderate).
      • 16
        Preoperative consultation with anesthesia is recommended when pharmacologic thromboprophylaxis is indicated and regional anesthesia is being considered (strong, very low).



      ACCP (American College of Clinical Pharmacy), ASRA (American Society of Regional Anesthesia and Pain Medicine), DVT (deep vein thrombosis), GCS (graduated compression stockings), HIT (heparin-induced thrombocytopenia), HRT (hormone replacement therapy), IPC (intermittent pneumatic compression), LDUH (low-dose unfractionated heparin), LMWH (low-molecular-weight heparin), PE (pulmonary embolism), VTE (venous thromboembolism)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Obstetrics and Gynaecology Canada
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bergqvist D
        • Mätzsch T
        • Burmark US
        • Frisell J
        • Guilbaud O
        • Hallböök T
        • et al.
        Low molecular weight heparin given the evening before surgery compared with conventional low-dose heparin in prevention of thrombosis.
        Br J Surg. 1988; 75: 888-891
        • Gao J
        • Zhang ZY
        • Li Z
        • Liu CD
        • Zhan YX
        • Qiao BL
        • et al.
        Two mechanical methods for thromboembolism prophylaxis after gynaecological pelvic surgery: a prospective, randomised study.
        Chin Med J (Engl). 2012; 125: 4259-4263
        • Geerts WH
        • Bergqvist D
        • Pineo GF
        • Heit JA
        • Samama CM
        • Lassen MR
        • et al.
        Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).
        Chest. 2008; 133: 381S-453S
        • Zhan C
        • Miller MR
        Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization.
        JAMA. 2003; 290: 1868-1874
        • Heit JA
        Epidemiology of venous thromboembolism.
        Nat Rev Cardiol. 2015; 12: 464-474
        • Søgaard KK
        • Schmidt M
        • Pedersen L
        • Horváth-Puhó E
        • Sørensen HT
        30-year mortality after venous thromboembolism: a population-based cohort study.
        Circulation. 2014; 130: 829-836
        • Piran S
        • Schulman S
        Incidence and risk factors for venous thromboembolism in patients with acute spinal cord injury: A retrospective study.
        Thromb Res. 2016; 147: 97-101
        • Geerts W
        • Diamantouros A
        Venous Thromboembolism Prevention: Getting Started Kit: Canadian Patient Safety Institute.
        2017 (Available from:)
        • Cohen AT
        • Tapson VF
        • Bergmann JF
        • Goldhaber SZ
        • Kakkar AK
        • Deslandes B
        • et al.
        Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study.
        Lancet. 2008; 371: 387-394
      1. Canadian Venous Thromboembolism Audit: National Snapshot 2014.
        Canadian Patient Safety Institute, 2014
      2. Canadian Medical Protective Association. Anticoagulant, antiplatelet agent and thrombolytic therapy: A medico-legal perspective. CMPA Perspective, June 2009.

        • Caprini JA
        • Arcelus JI
        • Hasty JH
        • Tamhane AC
        • Fabrega F
        Clinical assessment of venous thromboembolic risk in surgical patients.
        Semin Thromb Hemost. 1991; 17: 304-312
        • Rahn DD
        • Mamik MM
        • Sanses TV
        • Matteson KA
        • Aschkenazi SO
        • Washington BB
        • et al.
        Venous thromboembolism prophylaxis in gynecologic surgery: a systematic review.
        Obstet Gynecol. 2011; 118: 1111-1125
        • Bahl V
        • Hu HM
        • Henke PK
        • Wakefield TW
        • Campbell DA
        • Caprini JA
        A validation study of a retrospective venous thromboembolism risk scoring method.
        Ann Surg. 2010; 251: 344-350
        • Gould MK
        • Garcia DA
        • Wren SM
        • Karanicolas PJ
        • Arcelus JI
        • Heit JA
        • et al.
        Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
        Chest. 2012; 141 (e227S-e77S)
        • Mismetti P
        • Laporte S
        • Darmon JY
        • Buchmüller A
        • Decousus H
        Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery.
        Br J Surg. 2001; 88: 913-930
        • Pai M
        • Douketis J
        Prevention of venous thromboembolism in adult orthopedic surgical patients.
        UpToDate [Internet]. 2019; (Available from:)
        • Bustos Merlo AB
        • Arcelus Martínez JI
        • Turiño Luque JD
        • Valero B
        • Villalobos A
        • Aibar M
        • et al.
        Form of presentation, natural history and course of postoperative venous thromboembolism in patients operated on for pelvic and abdominal cancer. Analysis of the RIETE registry.
        Cir Esp. 2017; 95: 328-334
        • Sweetland S
        • Green J
        • Liu B
        • Berrington de González A
        • Canonico M
        • Reeves G
        • et al.
        Duration and magnitude of the postoperative risk of venous thromboembolism in middle aged women: prospective cohort study.
        BMJ. 2009; 339: b4583
        • Barber EL
        • Gehrig PA
        • Clarke-Pearson DL
        Venous Thromboembolism in Minimally Invasive Compared With Open Hysterectomy for Endometrial Cancer.
        Obstet Gynecol. 2016; 128: 121-126
        • Pearse EO
        • Caldwell BF
        • Lockwood RJ
        • Hollard J
        Early mobilisation after conventional knee replacement may reduce the risk of postoperative venous thromboembolism.
        J Bone Joint Surg Br. 2007; 89: 316-322
        • Sadeghi B
        • Romano PS
        • Maynard G
        • Strater AL
        • Hensley L
        • Cerese J
        • et al.
        Mechanical and suboptimal pharmacologic prophylaxis and delayed mobilization but not morbid obesity are associated with venous thromboembolism after total knee arthroplasty: a case-control study.
        J Hosp Med. 2012; 7: 665-671
        • Lassen K
        • Soop M
        • Nygren J
        • Cox PBW
        • Hendry PO
        • Spies C
        • et al.
        Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations.
        Archives of Surgery. 2009; 144: 961-969
        • Padula CA
        • Hughes C
        • Baumhover L
        Impact of a nurse-driven mobility protocol on functional decline in hospitalized older adults.
        Journal of nursing care quality. 2009; 24: 325-331
        • Pashikanti L
        • Von Ah D
        Impact of early mobilization protocol on the medical-surgical inpatient population: an integrated review of literature.
        Clinical Nurse Specialist. 2012; 26: 87-94
        • Clarke-Pearson DL
        • Synan IS
        • Dodge R
        • Soper JT
        • Berchuck A
        • Coleman RE
        A randomized trial of low-dose heparin and intermittent pneumatic calf compression for the prevention of deep venous thrombosis after gynecologic oncology surgery.
        Am J Obstet Gynecol. 1993; 168 (discussion 53-4): 1146-1153
        • Feng JP
        • Xiong YT
        • Fan ZQ
        • Yan LJ
        • Wang JY
        • Gu ZJ
        Efficacy of intermittent pneumatic compression for venous thromboembolism prophylaxis in patients undergoing gynecologic surgery: A systematic review and meta-analysis.
        Oncotarget. 2017; 8: 20371-20379
        • Ho KM
        • Tan JA
        Stratified meta-analysis of intermittent pneumatic compression of the lower limbs to prevent venous thromboembolism in hospitalized patients.
        Circulation. 2013; 128: 1003-1020
        • Morris RJ
        • Woodcock JP
        Intermittent pneumatic compression or graduated compression stockings for deep vein thrombosis prophylaxis?: A systematic review of direct clinical comparisons.
        Annals of surgery. 2010; 251: 393-396
        • Clarke-Pearson DL
        • Creasman WT
        • Coleman RE
        • Synan IS
        • Hinshaw WM
        Perioperative external pneumatic calf compression as thromboembolism prophylaxis in gynecologic oncology: report of a randomized controlled trial.
        Gynecol Oncol. 1984; 18: 226-232
        • Barber EL
        • Clarke-Pearson DL
        Prevention of venous thromboembolism in gynecologic oncology surgery.
        Gynecol Oncol. 2017; 144: 420-427
        • Brady MA
        • Carroll AW
        • Cheang KI
        • Straight C
        • Chelmow D
        Sequential compression device compliance in postoperative obstetrics and gynecology patients.
        Obstet Gynecol. 2015; 125: 19-25
        • Byrne B
        Deep vein thrombosis prophylaxis: the effectiveness and implications of using below-knee or thigh-length graduated compression stockings.
        J Vasc Nurs. 2002; 20: 53-59
        • Sachdeva A
        • Dalton M
        • Amaragiri SV
        • Lees T
        Graduated compression stockings for prevention of deep vein thrombosis.
        Cochrane Database Syst Rev. 2014; CD001484
        • Grosse SD
        • Nelson RE
        • Nyarko KA
        • Richardson LC
        • Raskob GE
        The economic burden of incident venous thromboembolism in the United States: a review of estimated attributable healthcare costs.
        Thrombosis research. 2016; 137: 3-10
        • Sajid MS
        • Desai M
        • Morris RW
        • Hamilton G
        Knee length versus thigh length graduated compression stockings for prevention of deep vein thrombosis in postoperative surgical patients.
        Cochrane Database Syst Rev. 2012; CD007162
        • Wade R
        • Sideris E
        • Paton F
        • Rice S
        • Palmer S
        • Fox D
        • et al.
        Graduated compression stockings for the prevention of deep-vein thrombosis in postoperative surgical patients: a systematic review and economic model with a value of information analysis.
        Health Technol Assess. 2015; 19: 1-220
        • Wade R
        • Paton F
        • Woolacott N
        Systematic review of patient preference and adherence to the correct use of graduated compression stockings to prevent deep vein thrombosis in surgical patients.
        J Adv Nurs. 2017; 73: 336-348
        • Ballard RM
        • Bradley-Watson PJ
        • Johnstone FD
        • Kenney A
        • McCarthy TG
        Low doses of subcutaneous heparin in the prevention of deep vein thrombosis after gynaecological surgery.
        J Obstet Gynaecol Br Commonw. 1973; 80: 469-472
        • Clarke-Pearson DL
        • Coleman RE
        • Synan IS
        • Hinshaw W
        • Creasman WT
        Venous thromboembolism prophylaxis in gynecologic oncology: a prospective, controlled trial of low-dose heparin.
        Am J Obstet Gynecol. 1983; 145: 606-613
        • Clark-Pearson D
        • DeLONG E
        • Synan IS
        • Soper JT
        • Creasman WT
        • Coleman RE
        A controlled trial of two low-dose heparin regimens for the prevention of postoperative deep vein thrombosis.
        Obstetrics and gynecology. 1990; 75: 684-689
        • Cantrell LA
        • Garcia C
        • Maitland HS
        Thrombosis and Thromboprophylaxis in Gynecology Surgery.
        Clin Obstet Gynecol. 2018; 61: 269-277
        • Selby LV
        • Sovel M
        • Sjoberg DD
        • McSweeney M
        • Douglas D
        • Jones DR
        • et al.
        Preoperative Chemoprophylaxis is Safe in Major Oncology Operations and Effective at Preventing Venous Thromboembolism.
        J Am Coll Surg. 2016; 222: 129-137
        • Linkins LA
        • Dans AL
        • Moores LK
        • Bona R
        • Davidson BL
        • Schulman S
        • et al.
        Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
        Chest. 2012; 141: e495S-e530S
        • Whitworth JM
        • Schneider KE
        • Frederick PJ
        • Finan MA
        • Reed E
        • Fauci JM
        • et al.
        Double prophylaxis for deep venous thrombosis in patients with gynecologic oncology who are undergoing laparotomy: does preoperative anticoagulation matter?.
        Int J Gynecol Cancer. 2011; 21: 1131-1134
        • Baglin T
        • Barrowcliffe TW
        • Cohen A
        • Greaves M
        • Haematology BCfSi
        Guidelines on the use and monitoring of heparin.
        Br J Haematol. 2006; 133: 19-34
        • Bergqvist D
        • Burmark US
        • Frisell J
        • Hallböök T
        • Lindblad B
        • Risberg B
        • et al.
        Low molecular weight heparin once daily compared with conventional low-dose heparin twice daily. A prospective double-blind multicentre trial on prevention of postoperative thrombosis.
        Br J Surg. 1986; 73: 204-208
        • Yang BL
        • Zhang ZY
        • Guo SL
        [Clinical significance of preventive treatment of thrombosis for patients undergoing gynecological surgery with high risk factors].
        Zhonghua Fu Chan Ke Za Zhi. 2009; 44: 570-573
        • Corr BR
        • Winter AM
        • Sammel MD
        • Chu CS
        • Gage BF
        • Hagemann AR
        Effectiveness and safety of expanded perioperative thromboprophylaxis in complex gynecologic surgery.
        Gynecol Oncol. 2015; 138: 501-506
        • Martino MA
        • George JG
        • Chen CC
        • Galic V
        • Kapoor R
        • Murray KC
        • et al.
        Preoperative enoxaparin is safe to use in major gynecologic surgery for prophylaxis of venous thromboembolism: a retrospective cohort study.
        Int J Gynecol Cancer. 2012; 22: 681-685
        • Zaghiyan KN
        • Sax HC
        • Miraflor E
        • Cossman D
        • Wagner W
        • Mirocha J
        • et al.
        Timing of Chemical Thromboprophylaxis and Deep Vein Thrombosis in Major Colorectal Surgery: A Randomized Clinical Trial.
        Ann Surg. 2016; 264: 632-639
        • Paikin JS
        • Hirsh J
        • Chan NC
        • Ginsberg JS
        • Weitz JI
        • Eikelboom JW
        Timing the First Postoperative Dose of Anticoagulants: Lessons Learned From Clinical Trials.
        Chest. 2015; 148: 587-595
        • Schmeler KM
        • Wilson GL
        • Cain K
        • Munsell MF
        • Ramirez PT
        • Soliman PT
        • et al.
        Venous thromboembolism (VTE) rates following the implementation of extended duration prophylaxis for patients undergoing surgery for gynecologic malignancies.
        Gynecol Oncol. 2013; 128: 204-208
        • Samama MM
        • Cohen AT
        • Darmon JY
        • Desjardins L
        • Eldor A
        • Janbon C
        • et al.
        A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in Medical Patients with Enoxaparin Study Group.
        N Engl J Med. 1999; 341: 793-800
        • Turpie AG
        Thrombosis prophylaxis in the acutely ill medical patient: insights from the prophylaxis in MEDical patients with ENOXaparin (MEDENOX) trial.
        Am J Cardiol. 2000; 86: 48M-52M
        • Bergqvist D
        • Agnelli G
        • Cohen AT
        • Eldor A
        • Nilsson PE
        • Le Moigne-Amrani A
        • et al.
        Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer.
        N Engl J Med. 2002; 346: 975-980
        • Rasmussen MS
        • Jørgensen LN
        • Wille-Jørgensen P
        Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery.
        Cochrane Database Syst Rev. 2009; CD004318
        • Chalmers E
        • Ganesen V
        • Liesner R
        • Maroo S
        • Nokes T
        • Saunders D
        • et al.
        Guideline on the investigation, management and prevention of venous thrombosis in children.
        Br J Haematol. 2011; 154: 196-207
        • Walsh JJ
        • Bonnar J
        • Wright FW.
        A study of pulmonary embolism and deep leg vein thrombosis after major gynaecological surgery using labelled fibrinogen-phlebography and lung scanning.
        J Obstet Gynaecol Br Commonw. 1974; 81: 311-316
        • Crandon AJ
        • Koutts J.
        Incidence of post-operative deep vein thrombosis in gynaecological oncology.
        Aust N Z J Obstet Gynaecol. 1983; 23: 216-219
        • Canada Thombosis
        Thromboprophylaxis: Non-Orthopedic Surgery.
        Thrombosis Canada. 2018; (Available at:)
        • Baykal C
        • Al A
        • Demirta¸s E
        • Ayhan A
        Comparison of enoxaparin and standard heparin in gynaecologic oncologic surgery: a randomised prospective double-blind clinical study.
        Eur J Gynaecol Oncol. 2001; 22: 127-130
        • Borstad E
        • Urdal K
        • Handeland G
        • Abildgaard U
        Comparison of low molecular weight heparin vs. unfractionated heparin in gynecological surgery.
        Acta Obstet Gynecol Scand. 1988; 67: 99-103
        • Borstad E
        • Urdal K
        • Handeland G
        • Abildgaard U
        Comparison of low molecular weight heparin vs. unfractionated heparin in gynecological surgery. II: Reduced dose of low molecular weight heparin.
        Acta Obstet Gynecol Scand. 1992; 71: 471-475
        • Fricker JP
        • Vergnes Y
        • Schach R
        • Heitz A
        • Eber M
        • Grunebaum L
        • et al.
        Low dose heparin versus low molecular weight heparin (Kabi 2165, Fragmin) in the prophylaxis of thromboembolic complications of abdominal oncological surgery.
        Eur J Clin Invest. 1988; 18: 561-567
        • Ward B
        • Pradhan S
        Comparison of low molecular weight heparin (Fragmin) with sodium heparin for prophylaxis against postoperative thrombosis in women undergoing major gynaecological surgery.
        Aust N Z J Obstet Gynaecol. 1998; 38: 91-92
        • Bauer KA
        New pentasaccharides for prophylaxis of deep vein thrombosis: pharmacology.
        Chest. 2003; 124: 364S-370S
        • Donat F
        • Duret JP
        • Santoni A
        • Cariou R
        • Necciari J
        • Magnani H
        • et al.
        The pharmacokinetics of fondaparinux sodium in healthy volunteers.
        Clinical pharmacokinetics. 2002; 41: 1-9
        • Grand'Maison A
        • Charest AF
        • Geerts WH
        Anticoagulant use in patients with chronic renal impairment.
        American journal of cardiovascular drugs. 2005; 5: 291-305
        • Dong K
        • Song Y
        • Li X
        • Ding J
        • Gao Z
        • Lu D
        • et al.
        Pentasaccharides for the prevention of venous thromboembolism.
        Cochrane Database Syst Rev. 2016; 10CD005134
        • Turpie AG
        • Bauer KA
        • Caprini JA
        • Comp PC
        • Gent M
        • Muntz JE
        • et al.
        Fondaparinux combined with intermittent pneumatic compression vs. intermittent pneumatic compression alone for prevention of venous thromboembolism after abdominal surgery: a randomized, double-blind comparison.
        J Thromb Haemost. 2007; 5: 1854-1861
        • Agnelli G
        • Bergqvist D
        • Cohen AT
        • Gallus AS
        • Gent M
        • investigators P
        Randomized clinical trial of postoperative fondaparinux versus perioperative dalteparin for prevention of venous thromboembolism in high-risk abdominal surgery.
        Br J Surg. 2005; 92: 1212-1220
        • Jenny JY
        • Pabinger I
        • Samama CM
        • Force EVGT
        European guidelines on perioperative venous thromboembolism prophylaxis: Aspirin.
        Eur J Anaesthesiol. 2018; 35: 123-129
        • Falck-Ytter Y
        • Francis CW
        • Johanson NA
        • et al.
        Prevention of VTE in orthopedic surgery patients: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines.
        Chest. 2012; 141: e278S-e325S
        • Vinazzer H
        • Loew D
        • Simma W
        • Brücke P
        Prophylaxis of postoperative thromboembolism by low dose heparin and by acetylsalicylic acid given simultaneously. A double blind study.
        Thrombosis research. 1980; 17: 177-184
        • Streiff MB
        NCNN Clinical Practice Guidelines in Oncology. Cancer-Associated Venous Thromboembolic Disease: National Comprehensive Cancer Network.
        • Devereaux PJ
        • Mrkobrada M
        • Sessler DI
        • Leslie K
        • Alonso-Coello P
        • Kurz A
        • et al.
        Aspirin in patients undergoing noncardiac surgery.
        N Engl J Med. 2014; 370: 1494-1503
        • Committee on Practice Bulletins–Gynecology
        • American College of Obstetricians and Gynecologists
        ACOG Practice Bulletin No. 84: Prevention of deep vein thrombosis and pulmonary embolism.
        Obstet Gynecol. 2007 Aug; 110 (Erratum in: Obstet Gynecol. 2016 Jan;127(1):166): 429-440
        • Kotaska A
        Venous thromboembolism prophylaxis may cause more harm than benefit: an evidence-based analysis of Canadian and international guidelines.
        Thromb J. 2018; 16: 25
        • Obi AT
        • Pannucci CJ
        • Nackashi A
        • Abdullah N
        • Alvarez R
        • Bahl V
        • et al.
        Validation of the Caprini Venous Thromboembolism Risk Assessment Model in Critically Ill Surgical Patients.
        JAMA Surg. 2015; 150: 941-948
        • Pannucci CJ
        • Bailey SH
        • Dreszer G
        • Fisher Wachtman C
        • Zumsteg JW
        • Jaber RM
        • et al.
        Validation of the Caprini risk assessment model in plastic and reconstructive surgery patients.
        J Am Coll Surg. 2011; 212: 105-112
        • Shuman AG
        • Hu HM
        • Pannucci CJ
        • Jackson CR
        • Bradford CR
        • Bahl V
        Stratifying the risk of venous thromboembolism in otolaryngology.
        Otolaryngol Head Neck Surg. 2012; 146: 719-724
        • Maxwell GL
        • Synan I
        • Dodge R
        • Carroll B
        • Clarke-Pearson DL
        Pneumatic compression versus low molecular weight heparin in gynecologic oncology surgery: a randomized trial.
        Obstet Gynecol. 2001; 98: 989-995
        • O'Connell S
        • Bashar K
        • Broderick BJ
        • Sheehan J
        • Quondamatteo F
        • Walsh SR
        • et al.
        The Use of Intermittent Pneumatic Compression in Orthopedic and Neurosurgical Postoperative Patients: A Systematic Review and Meta-analysis.
        Ann Surg. 2016; 263: 888-889
        • Pavon JM
        • Adam SS
        • Razouki ZA
        • McDuffie JR
        • Lachiewicz PF
        • Kosinski AS
        • et al.
        Effectiveness of Intermittent Pneumatic Compression Devices for Venous Thromboembolism Prophylaxis in High-Risk Surgical Patients: A Systematic Review.
        J Arthroplasty. 2016; 31: 524-532
        • Nagata C
        • Tanabe H
        • Takakura S
        • Narui C
        • Saito M
        • Yanaihara N
        • et al.
        Randomized controlled trial of enoxaparin versus intermittent pneumatic compression for venous thromboembolism prevention in Japanese surgical patients with gynecologic malignancy.
        J Obstet Gynaecol Res. 2015; 41: 1440-1448
        • Einstein MH
        • Pritts EA
        • Hartenbach EM
        Venous thromboembolism prevention in gynecologic cancer surgery: a systematic review.
        Gynecol Oncol. 2007; 105: 813-819
        • Kakkos SK
        • Caprini JA
        • Geroulakos G
        • Nicolaides AN
        • Stansby G
        • Reddy DJ
        • et al.
        Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism.
        Cochrane Database Syst Rev. 2016; 9CD005258
        • Salter BS
        • Weiner MM
        • Trinh MA
        • Heller J
        • Evans AS
        • Adams DH
        • Fischer GW
        Heparin-induced thrombocytopenia: a comprehensive clinical review.
        Journal of the American College of Cardiology. 2016 May 31; 67: 2519-2532
        • Thombosis Canada
        Thromboprophylaxis: Non-orthopedic surgery.
        Thrombosis Canada, 2016 (Available at)
        • Stroud W
        • Whitworth JM
        • Miklic M
        • Schneider KE
        • Finan MA
        • Scalici J
        • et al.
        Validation of a venous thromboembolism risk assessment model in gynecologic oncology.
        Gynecol Oncol. 2014; 134: 160-163
        • Barber EL
        • Clarke-Pearson DL
        The limited utility of currently available venous thromboembolism risk assessment tools in gynecological oncology patients.
        Am J Obstet Gynecol. 2016; 215 (445.e1-9)
        • Freeman AH
        • Barrie A
        • Lyon L
        • Littell RD
        • Garcia C
        • Conell C
        • et al.
        Venous thromboembolism following minimally invasive surgery among women with endometrial cancer.
        Gynecol Oncol. 2016; 142: 267-272
        • Al Otaib N
        • Bootah Z
        • Al Ammari MA
        • Aldebasi TM
        • Alkatheri AM
        • Al Harbi SA
        • et al.
        Assessment of anti-factor Xa activity of enoxaparin for venous thromboembolism prophylaxis in morbidly obese surgical patients.
        Ann Thorac Med. 2017; 12: 199-203
        • Tsai AW
        • Cushman M
        • Rosamond WD
        • Heckbert SR
        • Polak JF
        • Folsom AR
        Cardiovascular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboembolism etiology.
        Arch Intern Med. 2002; 162: 1182-1189
        • Vandiver JW
        • Ritz LI
        • Lalama JT
        Chemical prophylaxis to prevent venous thromboembolism in morbid obesity: literature review and dosing recommendations.
        J Thromb Thrombolysis. 2016; 41: 475-481
        • Robinson G
        • Burren T
        • Mackie I
        • Bounds W
        • Walshe K
        • Faint R
        • et al.
        Changes in haemostasis after stopping the combined contraceptive pill: implications for major surgery.
        Bmj. 1991; 302: 269-271
        • Douketis J
        Hormone replacement therapy and risk for venous thromboembolism: what's new and how do these findings influence clinical practice?.
        Curr Opin Hematol. 2005; 12: 395-400
        • Black A
        • Guilbert E
        • Costescu D
        • Dunn S
        • Fisher W
        • Kives S
        • et al.
        No. 329-Canadian contraception consensus part 4 of 4 chapter 9: Combined hormonal contraception.
        Journal of Obstetrics and Gynaecology Canada. 2017; 39 (e5): 229-268
        • Society of Obstetricians and Gynaecologists of Canada
        Position Statement: Hormonal Contraception and Risk of Venous Thromboembolism (VTE).
        SOGC, Ottawa, ON19 February 2013
        • Reid R
        SOGC clinical practice guideline. No. 252, December 2010. Oral contraceptives and the risk of venous thromboembolism: an update.
        Journal of obstetrics and gynaecology Canada: JOGC= Journal d'obstetrique et gynecologie du Canada: JOGC. 2010; 32: 1192-1197
        • Black A
        • Guilbert E
        • Costescu D
        • Dunn S
        • Fisher W
        • Kives S
        • et al.
        Canadian Contraception Consensus (Part 3 of 4): Chapter 8–Progestin-Only Contraception.
        Journal of Obstetrics and Gynaecology Canada. 2016; 38: 279-300
        • Grady D
        • Wenger NK
        • Herrington D
        • Khan S
        • Furberg C
        • Hunninghake D
        • et al.
        Postmenopausal hormone therapy increases risk for venous thromboembolic disease. The Heart and Estrogen/progestin Replacement Study.
        Ann Intern Med. 2000; 132: 689-696
      3. Annales francaises d'anesthesie et de reanimation. 2008;
        • Stone AV
        • Agarwalla A
        • Gowd AK
        • Jacobs CA
        • Macalena JA
        • Lesniak BP
        • et al.
        Oral Contraceptive Pills Are Not a Risk Factor for Deep Vein Thrombosis or Pulmonary Embolism After Arthroscopic Shoulder Surgery.
        Orthopaedic journal of sports medicine. 2019; 72325967118822970
        • Cushman M
        • Kuller LH
        • Prentice R
        • Rodabough RJ
        • Psaty BM
        • Stafford RS
        • et al.
        Estrogen plus progestin and risk of venous thrombosis.
        JAMA. 2004; 292: 1573-1580
        • Bélisle S
        • Blake J
        • Basson R
        • Desindes S
        • Graves G
        • Grigoriadis S
        • et al.
        Canadian consensus conference on menopause, 2006 update.
        Journal of Obstetrics and Gynaecology Canada. 2006; 28: S7-S9
        • Horlocker TT
        • Vandermeuelen E
        • Kopp SL
        • Gogarten W
        • Leffert LR
        • Benzon HT
        Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition).
        Reg Anesth Pain Med. 2018; 43: 263-309
        • Mehta A
        • Xu T
        • Hutfless S
        • Makary MA
        • Sinno AK
        • Tanner EJ
        • et al.
        Patient, surgeon, and hospital disparities associated with benign hysterectomy approach and perioperative complications.
        Am J Obstet Gynecol. 2017; 216 (497.e1-.e10)
        • Institute CPS
        Surgical Safety Checklist: Canada. CPSI.
        January 9, 2009