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

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 sur-geon’s experience. Venous thromboembolism risk stratification identified pa-tients at highest risk. Records were reviewed for regimen of thromboprophylaxis and for occurrences of all-cause mortality, venous thromboembolism, and he-matoma/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. Amonghighest 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 (unfraction-ated or low-molecular-weight heparin) conferred a statistically significant re-duction 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. (Plast. Reconstr. Surg. 122: 1701