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The Timing of Preoperative Prophylactic Low-Molecular-Weight Heparin Administration in Breast Reconstruction

Keith, Jerrod N. M.D.; Chong, Tae W. M.D.; Davar, Diwakar M.D.; Moore, Alexander G. B.S.; Morris, Alison M.D., M.S.; Gimbel, Michael L. M.D.

Plastic & Reconstructive Surgery: August 2013 - Volume 132 - Issue 2 - p 279–284
doi: 10.1097/PRS.0b013e318295870e
Breast: Original Articles

Background: Venous thromboembolism continues to be problematic despite increased recognition and advancements in venous thromboembolism prophylaxis. Although migration toward preoperative chemoprophylaxis increases, plastic surgeons seem reticent to adopt this practice. This study evaluates preoperative enoxaparin administration in breast reconstruction patients.

Methods: Patients undergoing breast reconstruction performed by a single surgeon over a 5-year period were evaluated retrospectively. The authors introduced preoperative chemoprophylaxis with enoxaparin in all breast reconstructions during this time. Prosthetic-based and microsurgical breast reconstructions were examined. Patients were divided into two groups: those who did and those who did not receive preoperative enoxaparin. The authors reviewed patient demographics, comorbidities, and complications, focusing on bleeding complications.

Results: Three hundred patients (450 breasts) were included. One hundred fifty-four patients (244 breasts) underwent reconstruction with tissue expanders, and 146 (206 breasts) underwent free flap reconstructions. One hundred seventy-nine of 300 were given preoperative enoxaparin. Eleven hematomas occurred, eight (4.5 percent) in the enoxaparin group and three (2.5 percent) without enoxaparin (p = 0.399). Blood transfusions were given to four patients (2.2 percent) who received enoxaparin and one patient (0.8 percent) who did not (p = 0.652). Finally, any type of bleeding complication occurred in 11 patients (6.1 percent) with enoxaparin and in four (3.3 percent) without (p = 0.419). Larger breasts were more likely to receive enoxaparin (p = 0.011), which did not result in higher bleeding complications.

Conclusion: In this retrospective study, the authors found that preoperative chemoprophylaxis in breast reconstruction was associated with an acceptable rate of postoperative bleeding complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Iowa City, Iowa; Dallas, Texas; and Pittsburgh, Pa.

From the Department of Surgery, Division of Plastic Surgery, University of Iowa Hospitals and Clinics; the Department of Plastic Surgery, University of Texas Southwestern Medical Center; and the Departments of Medicine and Plastic Surgery, University of Pittsburgh School of Medicine.

Received for publication February 4, 2013; accepted February 26, 2013.

Disclosure: The authors have no financial interest in any of the products, devices, or drugs mentioned in this article. The authors have no relevant commercial associations or financial disclosures related to this article.

Michael L. Gimbel, M.D., 5750 Centre Avenue, Suite 180, Pittsburgh, Pa. 15206, gimbelml@upmc.edu

©2013American Society of Plastic Surgeons