title: The timing of preoperative prophylactic low-molecular-weight heparin administration in breast reconstruction.
abstract: BACKGROUND
  Venous thromboembolism continues to be problematic despite increased recognition and advancements in venous thromboembolism prophylaxis. Although migration toward preoperative chemoprophylaxis increases, plastic surgeons seem reticent to adopt this practice. This study evaluates preoperative enoxaparin administration in breast reconstruction patients.
  
  
  METHODS
  Patients undergoing breast reconstruction performed by a single surgeon over a 5-year period were evaluated retrospectively. The authors introduced preoperative chemoprophylaxis with enoxaparin in all breast reconstructions during this time. Prosthetic-based and microsurgical breast reconstructions were examined. Patients were divided into two groups: those who did and those who did not receive preoperative enoxaparin. The authors reviewed patient demographics, comorbidities, and complications, focusing on bleeding complications.
  
  
  RESULTS
  Three hundred patients (450 breasts) were included. One hundred fifty-four patients (244 breasts) underwent reconstruction with tissue expanders, and 146 (206 breasts) underwent free flap reconstructions. One hundred seventy-nine of 300 were given preoperative enoxaparin. Eleven hematomas occurred, eight (4.5 percent) in the enoxaparin group and three (2.5 percent) without enoxaparin (p = 0.399). Blood transfusions were given to four patients (2.2 percent) who received enoxaparin and one patient (0.8 percent) who did not (p = 0.652). Finally, any type of bleeding complication occurred in 11 patients (6.1 percent) with enoxaparin and in four (3.3 percent) without (p = 0.419). Larger breasts were more likely to receive enoxaparin (p = 0.011), which did not result in higher bleeding complications.
  
  
  CONCLUSIONS
  In this retrospective study, the authors found that preoperative chemoprophylaxis in breast reconstruction was associated with an acceptable rate of postoperative bleeding complications.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Iowa City, Iowa; Dallas, Texas; and Pittsburgh, Pa. From the Department of Surgery, Division of Plastic Surgery, University of Iowa Hospitals and Clinics; the Department of Plastic Surgery, University of Texas Southwestern Medical Center; and the Departments of Medicine and Plastic Surgery, University of Pittsburgh School of Medicine.
authors.forename: Jerrod N
authors.initials: JN
authors.lastname: Keith
authors.forename: Tae W
authors.initials: TW
authors.lastname: Chong
authors.forename: Diwakar
authors.initials: D
authors.lastname: Davar
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Moore
authors.forename: Alison
authors.initials: A
authors.lastname: Morris
authors.forename: Michael L
authors.initials: ML
authors.lastname: Gimbel
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D018890:Chemoprevention / Q000379:methods; D015331:Cohort Studies; D004334:Drug Administration Schedule; D017984:Enoxaparin / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007279:Injections, Subcutaneous; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D061214:Patient Safety; D011300:Preoperative Care / Q000379:methods; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin
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