The Case against Chemoprophylaxis for Venous Thromboembolism Prevention and the Rationale for SAFE Anesthesia

Swanson, Eric MD

Plastic and Reconstructive Surgery - Global Open: June 2014 - Volume 2 - Issue 6 - p e160
doi: 10.1097/GOX.0000000000000116
Special Topics
United States

Summary: The Venous Thromboembolism Prevention study concludes that anticoagulation is effective in reducing the risk of thromboembolism in patients who are identified as higher risk by Caprini scores. This report critically assesses the statistics used in the Venous Thromboembolism Prevention study, its method of data presentation, and its conclusions. The usefulness of risk stratification and the value of anticoagulation—both prevailing concepts in risk reduction today—are challenged. Actual data show that chemoprophylaxis has no proven benefit in plastic surgery. Complications of anticoagulation predictably include excessive bleeding and hematomas, which may be serious and life-threatening. Several large published series of patients undergoing elective plastic surgery under total intravenous anesthesia have shown a much reduced risk of thromboembolism. A SAFE (Spontaneous breathing, Avoid gas, Face up, Extremities mobile) anesthesia method is discussed as a safer and more effective alternative to traditional general endotracheal anesthesia and anticoagulation. The choice for plastic surgeons is not between a venous thromboembolism and a hematoma. The choice is between a thromboembolism and adjusting our anesthesia and surgery habits to reduce the risk to a baseline level.

From the Swanson Center, Leawood, Kans.

Received for publication November 8, 2013; accepted April 11, 2014.

Presented at Plastic Surgery 2013: The 82nd Annual Scientific Meeting of the American Society of Plastic Surgeons, October 11–15, San Diego, Calif.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the author.

Eric Swanson, MD, Swanson Center, 11413 Ash Street, Leawood, KS 66211, E-mail: eswanson@swansoncenter.com

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© 2014 American Society of Plastic Surgeons