**5. Prophylaxis of DVT/PE**

The incidence of DVT and subsequent PE can be decreased by adopting certain prophylactic mechanical and/ or pharmacologic measures, which have been proved to be safe and effective in most types of major surgeries (Martino et al., 2007; Geerts et al., 2008). Mechanical methods act by reducing stasis of venous blood and may stimulate endogenous fibrinolysis, while pharmacologic agents act by clot prevention through the various steps of the clotting cascade (Martino et al., 2007; Geerts et al., 2008).

#### **5.1 Mechanical measures**

Mechanical prophylaxis is usually simple to conduct and relatively less costy. It may be achieved through the use of graduated compression stockings, anti-embolism stocking, electrical stimulation of the leg muscles, intermittent external pneumatic calf compression and/ or the use of specific tables (Martino et al., 2007; Geerts et al., 2008; Miller, 2011).

#### **5.2 Pharmacologic measures**

These measures are very effective in most surgeries and therefore, should be made a routine practice (Agnelli, 2004). Low-dose unfractionated heparin or low-molecular-weight heparin (LMWH) are the drugs of choice in patients undergoing radical pelvic operations in the fileds of general, vascular, major urologic and gynecologic surgeries (Agnelli, 2004). In urologic patients judged as low-risk, early postoperative mobilization is the only measure needed. On the other hand, higher-risk patients should receive vitamin K antagonists, LMWH and/ or fondaparinux (Agnelli, 2004).

Some investigators recommended a double prophylaxis of mechanical measures as well as pharmacologic measures using pre- and post-operative anticoagulation, usually in the form of LMWH (Whitworthet al., 2011). They found that the use of preoperative anticoagulation seems to significantly decrease the risk of DVT in high-risk patients undergoing major gynecologic surgeries. In addition, there was no significant change in the rates of complications secondary to this protocol.
