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

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.