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Postoperative Enoxaparin Prevents Symptomatic Venous Thromboembolism in High-Risk Plastic Surgery Patients

Pannucci, Christopher J. M.D., M.S.; Dreszer, George M.D., M.S.; Wachtman, Christine Fisher M.D.; Bailey, Steven H. M.D.; Portschy, Pamela R. M.D.; Hamill, Jennifer B. M.P.H.; Hume, Keith M. M.A.; Hoxworth, Ronald E. M.D.; Rubin, J. Peter M.D.; Kalliainen, Loree K. M.D.; Pusic, Andrea L. M.D., M.H.S.; Wilkins, Edwin G. M.D., M.S.

Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e31822b6817
Reconstructive: Trunk: Original Articles
Press Release
Abstract

Background: Venous thromboembolism is a major patient safety issue. The Plastic Surgery Foundation–sponsored Venous Thromboembolism Prevention Study examined whether postoperative enoxaparin prevents symptomatic venous thromboembolism in adult plastic surgery patients.

Methods: In 2009, four sites uniformly adopted a clinical protocol. Patients with a Caprini score of 3 or higher received postoperative enoxaparin prophylaxis for the duration of inpatient stay. Venous Thromboembolism Prevention Study historical control patients had an operation between 2006 and 2008 but received no chemoprophylaxis for 60 days after surgery. The primary study outcome was symptomatic 60-day venous thromboembolism.

Results: Three thousand three hundred thirty-four patients (1876 controls and 1458 enoxaparin patients) were included. Notable risk reduction was present in patients with a Caprini score greater than 8 (8.54 percent versus 4.07 percent; p = 0.182) and a Caprini score of 7 to 8 (2.55 percent versus 1.15 percent; p = 0.230) who received postoperative enoxaparin. Logistic regression was limited to highest risk patients (Caprini score ≥7) and demonstrated that length of stay greater than or equal to 4 days (adjusted odds ratio, 4.63; p = 0.007) and Caprini score greater than 8 (odds ratio, 2.71; p = 0.027) were independent predictors of venous thromboembolism. When controlling for length of stay and Caprini score, receipt of postoperative enoxaparin was protective against venous thromboembolism (odds ratio, 0.39; p = 0.042).

Conclusions: In high-risk plastic surgery patients, postoperative enoxaparin prophylaxis is protective against 60-day venous thromboembolism when controlling for baseline risk and length of stay. Hospitalization for 4 or more days is an independent risk factor for venous thromboembolism.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Author Information

Ann Arbor, Mich.; St. Paul, Minn.; Pittsburgh and Shohola, Pa.; Dallas, Texas; Arlington Heights, Ill.; and New York, N.Y.

From the Section of Plastic Surgery, University of Michigan; Department of Plastic and Hand Surgery, Regions Hospital; Division of Plastic and Reconstructive Surgery, University of Pittsburgh; Department of Plastic Surgery, University of Texas Southwestern; JBH Consulting; American Society of Plastic Surgeons; and Plastic and Reconstructive Surgery Service, Memorial Sloan-Kettering Cancer Center.

Received for publication April 15, 2011; accepted May 16, 2011.

Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article. Dr. Pannucci receives salary support from the National Institutes of Health T32 grant program (T32 GM-08616). This study was funded by the Plastic Surgery Foundation.

Christopher J. Pannucci, M.D., M.S.; Section of Plastic Surgery, Department of Surgery, 2130 Taubman Center, Box 0340, 1500 East Medical Center Drive, Ann Arbor, Mich. 48109, cpannucc@umich.edu

©2011American Society of Plastic Surgeons