title: The effect of postoperative enoxaparin on risk for reoperative hematoma.
abstract: BACKGROUND
  The risk of postoperative bleeding is the chief concern expressed by plastic surgeons who do not use pharmacologic prophylaxis against venous thromboembolism. The Plastic Surgery Foundation-funded Venous Thromboembolism Prevention Study examined whether receipt of postoperative enoxaparin prophylaxis changed 60-day reoperative hematoma rates.
  
  
  METHODS
  In 2009, the study's network sites uniformly adopted a "best practice" clinical protocol to provide postoperative enoxaparin to adult plastic surgery patients at risk for perioperative venous thromboembolism. Historical control patients (2006 to 2008) received no chemoprophylaxis for 60 days after surgery. Retrospective chart review identified demographic and surgery-specific risk factors that potentially contributed to bleeding risk. The primary study outcome was 60-day reoperative hematoma. Stratified analyses examined reoperative hematoma in the overall population and among high-risk patients. Multivariable logistic regression controlled for identified confounders.
  
  
  RESULTS
  Complete data were available for 3681 patients (2114 controls and 1567 enoxaparin patients). Overall, postoperative enoxaparin did not change the reoperative hematoma rate when compared with controls (3.38 percent versus 2.65 percent, p = 0.169). Similar results were seen in subgroup analyses for breast reconstruction (5.25 percent versus 4.21 percent, p = 0.737), breast reduction (7.04 percent versus 8.29 percent, p = 0.194), and nonbreast plastic surgery (2.20 percent versus 1.46 percent, p = 0.465). In the regression model, independent predictors of reoperative hematoma included breast surgery, microsurgical procedure, and post-bariatric surgery body contouring. Receipt of postoperative enoxaparin was not an independent predictor (odds ratio, 1.16; 95 percent CI, 0.77 to 1.76).
  
  
  CONCLUSIONS
  Postoperative enoxaparin does not produce a clinically relevant or statistically significant increase in observed rates of reoperative hematoma.
  
  
  METHODS
  Risk: II.
authors.affiliation: Ann Arbor, Mich.; Pittsburgh and Shohola, Pa.; St. Paul, Minn.; Dallas, Texas; Arlington Heights, Ill.; and New York, N.Y. From the Section of Plastic Surgery, University of Michigan; Division of Plastic and Reconstructive Surgery, University of Pittsburgh; Department of Plastic and Hand Surgery, Regions Hospital; Department of Plastic Surgery, University of Texas Southwestern; JBH Consulting; American Society of Plastic Surgeons; and Plastic and Reconstructive Surgery Service, Memorial Sloan-Kettering Cancer Center.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Pannucci
authors.forename: Christine Fisher
authors.initials: CF
authors.lastname: Wachtman
authors.forename: George
authors.initials: G
authors.lastname: Dreszer
authors.forename: Steven H
authors.initials: SH
authors.lastname: Bailey
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Portschy
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Hamill
authors.forename: Keith M
authors.initials: KM
authors.lastname: Hume
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Hoxworth
authors.forename: Loree K
authors.initials: LK
authors.lastname: Kalliainen
authors.forename: J Peter
authors.initials: JP
authors.lastname: Rubin
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Pusic
authors.forename: Edwin G
authors.initials: EG
authors.lastname: Wilkins
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D050110:Bariatric Surgery; D019985:Benchmarking; D002985:Clinical Protocols; D017984:Enoxaparin / Q000627:therapeutic use*; D006406:Hematoma / Q000453:epidemiology*; D006801:Humans; D016462:Mammaplasty; D008866:Microsurgery; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D003668:Pressure Ulcer / Q000601:surgery; D019651:Plastic Surgery Procedures; D018570:Risk Assessment; D012307:Risk Factors; D034941:Upper Extremity / Q000601:surgery; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin