Objective  To systematically review the efficacy and safety of low molecular weight heparin (LMWH) plus physiotherapy techniques in the prevention of deep vein thrombosis (DVT) among gynecological cancer patients undergoing major abdominopelvic surgery using a network analysis. 

Methods  We electronically searched PubMed, The Cochrane Library, Embase, Web of Science, Wan-Fang Data and CNIK for randomized controlled trials (RCTs) on the efficacy and safety of LMWH plus mechanical methods for prevention DVT in gynecological cancer patients undergoing major abdom-inopelivc surgery. The duration of search was from the inception of the databases to March 2021. After literature selection, data extraction and quality assessment was conducted by two reviewers inde-pendently; and network Meta-analysis was conducted using Stata 14.0 and RevMan 5.4 software. 

Results  A total of 21 RCTs involving 4,145 patients were included. Network Meta-analysis showed that LMWH plus graduated compression stockings (GCS) or sequential compression devices (SCD) was superior to drug or physical in-tervention alone in the prevention DVT, and there was no statistically significant difference in the efficacy between LMWH plus GCS or SCD. LMWH had a similar incidence of DVT and major bleeding events compared with unfraction-ated heparin (UH). 

Conclusion  LMWH plus GCS or SCD was top-ranked for prevention of DVT, for major bleeding events LMWH was similar to UH. The above conclusions are limited by the number and quality of included studies, and need to be verified by more high-quality and multicenter studies.

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