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.
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.
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.
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.
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; email@example.com