title: Venous thromboembolism prophylaxis in the massive weight loss patient: relative risk of bleeding.
abstract: BACKGROUND
  Measures that can reduce the incidence of venous thromboembolism (VTE) are of great clinical importance. In addition to the use of sequential compression devices (SCDs), chemoprophylaxis with low-molecular-weight heparin (LMWH) has been recommended by the American College of Chest Physicians for major general surgery procedures. There remains inconclusive evidence to support guidelines for the plastic surgery population, and some surgeons hesitate to use anticoagulation due to concerns about bleeding in broad planes of dissection. The purpose of this study was to evaluate the risk of postoperative complications secondary to chemical thromboprophylaxis in massive weight loss patients.
  
  
  METHODS
  Five hundred forty-six surgical cases were enrolled in an institutional review board-approved prospective clinical database in the 2 years before and after routine LMWH use was initiated. Inclusion required weight loss of greater than 50 lb. Group 1 had SCDs only (n = 334), whereas group 2 had SCDs and LMWH 6 hours postoperatively (n = 212). Risk of VTE was calculated and complications of LMWH administration were analyzed.
  
  
  RESULTS
  The overall risk of deep venous thrombosis and pulmonary embolism was 0.18%. There was no statistical difference between the groups (P > 0.05). Overall risk of hematoma was 5.4%, in concordance with the literature. There was no difference in hematoma risk between the groups (4.6% before and 6.6% after LMWH; P = 0.3). The transfusion rate was 8.5% before use of LMWH (group 1) and 7.6% after (group 2; P = 0.7).
  
  
  CONCLUSIONS
  Strategies to reduce VTE rates remain important in all areas of plastic surgery. We have demonstrated no increased risk of transfusion or hematoma and a low overall incidence of VTE after implementing a chemoprophylaxis regimen. Postoperative LMWH can provide an excellent balance between VTE prophylaxis and the risk of bleeding complications.
authors.affiliation: From the *Private Practice, North Bethesda, MD; †Department of Plastic and Reconstructive Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD; and ‡Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Michaels
authors.forename: Devin
authors.initials: D
authors.lastname: Coon
authors.forename: Carolyn Leigh
authors.initials: CL
authors.lastname: Mulvey
authors.forename: J Peter
authors.initials: JP
authors.lastname: Rubin
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D003131:Combined Modality Therapy; D058128:Compression Bandages; D005260:Female; D006406:Hematoma / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015431:Weight Loss
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight