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Efficacy and safety of venous thromboembolism prophylaxis in highest risk plastic surgery patients.
Plast Reconstr Surg. 2008 Dec; 122(6):1701-8.PR

Abstract

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.

Authors+Show Affiliations

Department of Plastic Surgery, Georgetown University Hospital, Washington, DC 20007, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19050522

Citation

Seruya, Mitchel, et al. "Efficacy and Safety of Venous Thromboembolism Prophylaxis in Highest Risk Plastic Surgery Patients." Plastic and Reconstructive Surgery, vol. 122, no. 6, 2008, pp. 1701-8.
Seruya M, Venturi ML, Iorio ML, et al. Efficacy and safety of venous thromboembolism prophylaxis in highest risk plastic surgery patients. Plast Reconstr Surg. 2008;122(6):1701-8.
Seruya, M., Venturi, M. L., Iorio, M. L., & Davison, S. P. (2008). Efficacy and safety of venous thromboembolism prophylaxis in highest risk plastic surgery patients. Plastic and Reconstructive Surgery, 122(6), 1701-8. https://doi.org/10.1097/PRS.0b013e31818dbffd
Seruya M, et al. Efficacy and Safety of Venous Thromboembolism Prophylaxis in Highest Risk Plastic Surgery Patients. Plast Reconstr Surg. 2008;122(6):1701-8. PubMed PMID: 19050522.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy and safety of venous thromboembolism prophylaxis in highest risk plastic surgery patients. AU - Seruya,Mitchel, AU - Venturi,Mark L, AU - Iorio,Matthew L, AU - Davison,Steven P, PY - 2008/12/4/pubmed PY - 2009/1/8/medline PY - 2008/12/4/entrez SP - 1701 EP - 8 JF - Plastic and reconstructive surgery JO - Plast. Reconstr. Surg. VL - 122 IS - 6 N2 - 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. SN - 1529-4242 UR - https://www.unboundmedicine.com/medline/citation/19050522/Efficacy_and_safety_of_venous_thromboembolism_prophylaxis_in_highest_risk_plastic_surgery_patients_ L2 - http://Insights.ovid.com/pubmed?pmid=19050522 DB - PRIME DP - Unbound Medicine ER -