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Efficacy and Safety of Venous Thromboembolism Prophylaxis in Highest Risk Plastic Surgery Patients

Seruya, Mitchel M.D.; Venturi, Mark L. M.D.; Iorio, Matthew L. M.D.; Davison, Steven P. D.D.S., M.D.

Plastic and Reconstructive Surgery: December 2008 - Volume 122 - Issue 6 - p 1701-1708
doi: 10.1097/PRS.0b013e31818dbffd
Reconstructive: Head and Neck: Original Articles

Background: The purpose of this study was to stratify plastic surgery patients into venous thromboembolism risk categories; identify patients at highest risk for venous thromboembolism; and quantify rates of postoperative all-cause mortality, venous thromboembolism, and hematoma/bleeding on different forms of thromboprophylaxis. Furthermore, this study aimed to determine the compliance and average duration of outpatient chemoprophylaxis.

Methods: A retrospective cohort study was carried out on a single plastic surgeon's experience. Venous thromboembolism risk stratification identified patients at highest risk. Records were reviewed for regimen of thromboprophylaxis and for occurrences of all-cause mortality, venous thromboembolism, and hematoma/bleeding. Outpatient compliance and duration of low-molecular-weight heparin chemoprophylaxis was also documented.

Results: During the study time period, 173 operations involved 120 patients at highest risk for venous thromboembolism. Among highest risk patients, one (0.8 percent) suffered a pulmonary embolism, eight (6.7 percent) experienced a deep vein thrombosis, and 15 (12.5 percent) endured a hematoma/bleed. Thirteen of 14 outpatients (92.9 percent) were compliant with low-molecular-weight heparin and remained on chemoprophylaxis for an average of 7.4 days.

Conclusions: Mechanical prophylaxis plus subcutaneous heparin (unfractionated or low-molecular-weight heparin) conferred a statistically significant reduction in the rate of venous thromboembolism without a significant increase in bleeding versus mechanical prophylaxis alone. Subgroup analysis of patients placed on mechanical prophylaxis plus low-molecular-weight heparin revealed similar statistically significant findings. Outpatients placed on low-molecular-weight heparin chemoprophylaxis demonstrated excellent compliance and comfort with self-administration. Therefore, the use of mechanical prophylaxis supplemented with low-molecular-weight heparin is strongly recommended as the first-line regimen for thromboprophylaxis in plastic surgery patients at highest risk for venous thromboembolism.

Washington, D.C.

From the Department of Plastic Surgery, Georgetown University Hospital.

Received for publication January 30, 2008; accepted June 9, 2008.

Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

Steven Paul Davison, D.D.S., M.D.; Georgetown University Hospital; 3800 Reservoir Road, NW; PHC Building, First Floor; Washington, D.C. 20007;

©2008American Society of Plastic Surgeons