title: Practical guidelines for venous thromboembolism chemoprophylaxis in elective plastic surgery.
abstract: Venous thromboembolism is a complication that results in a wide range of patient morbidity and potential mortality. Awareness of this risk has led to recent advances in both the perioperative planning of chemoprophylaxis and the stratification of risk factors. Together, these modifications have helped reduce the incidence and severity of venous thromboembolism. Major hospital-based initiatives to decrease the overall rate of venous thromboembolism and halt the progression of severe complications, including pulmonary embolism, are one such change. However, surgeon reluctance based on the potential for bleeding complications continues to decrease the use of these algorithms, despite several reports that fail to demonstrate an increase in postoperative bleeding or hematoma formation with chemoprophylaxis administered at appropriate dosages. This review summarizes the current recommendations and procedure-specific strategies for venous thromboembolism prophylaxis with a focus on elective or aesthetic surgery-based procedures. The authors will recommend which patients are appropriate, what doses are appropriate, and when the doses should be administered for aesthetic and elective surgery.
authors: Seattle, Wash.; and Washington, D.C. From the Division of Plastic Surgery, University of Washington Medical Center; the Department of Plastic Surgery, Georgetown University Medical Center; and DAVinci Plastic Surgery.
authors: Matthew L
authors: ML
authors: Iorio
authors: Mark L
authors: ML
authors: Venturi
authors: Steven P
authors: SP
authors: Davison
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D050110:Bariatric Surgery; D016063:Blood Loss, Surgical; D058128:Compression Bandages; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects; D017558:Elective Surgical Procedures; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011229:Preanesthetic Medication; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control; D019651:Plastic Surgery Procedures; D040242:Risk Reduction Behavior; D012720:Severity of Illness Index; D019851:Thrombophilia / Q000150:complications; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D003278:Contraceptives, Oral, Hormonal; D005343:Fibrinolytic Agents
references: Gold A. Deep vein thrombosis chemoprophylaxis in plastic surgery. Clin Plast Surg. 2013;40:399–404
references: Pannucci CJ, Wachtman CF, Dreszer G, et al. The effect of postoperative enoxaparin on risk for reoperative hematoma. Plast Reconstr Surg. 2012;129:160–168
references: Broughton G II, Rios JL, Rohrich RJ, Brown SA. Deep venous thrombosis prophylaxis practice and treatment strategies among plastic surgeons: Survey results. Plast Reconstr Surg. 2007;119:157–174
references: Young VL, Watson ME. The need for venous thromboembolism (VTE) prophylaxis in plastic surgery. Aesthet Surg J. 2006;26:157–175
references: Weitz JI, Hirsh J, Samama MM. New anticoagulant drugs: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(Suppl):265S–286S
references: Gómez-Outes A, Terleira-Fernández AI, Suárez-Gea ML, Vargas-Castrillón E. Dabigatran, rivaroxaban, or apixaban versus enoxaparin for thromboprophylaxis after total hip or knee replacement: Systematic review, meta-analysis, and indirect treatment comparisons. BMJ. 2012;344:e3675
references: Caprini JA. Risk assessment as a guide for the prevention of the many faces of venous thromboembolism. Am J Surg. 2010;199(Suppl):S3–S10
references: Caprini JA, Arcelus JI, Reyna JJ. Effective risk stratification of surgical and nonsurgical patients for venous thromboembolic disease. Semin Hematol. 2001;38(Suppl 5):12–19
references: Pannucci CJ, Barta RJ, Portschy PR, et al. Assessment of postoperative venous thromboembolism risk in plastic surgery patients using the 2005 and 2010 Caprini Risk score. Plast Reconstr Surg. 2012;130:343–353
references: Pannucci CJ, Bailey SH, Dreszer G, et al. Validation of the Caprini risk assessment model in plastic and reconstructive surgery patients. J Am Coll Surg. 2011;212:105–112
references: Murphy RX Jr, Alderman A, Gutowski K, et al. Evidence-based practices for thromboembolism prevention: Summary of the ASPS Venous Thromboembolism Task Force Report. Plast Reconstr Surg. 2012;130:168e–175e
references: Pannucci CJ, Dreszer G, Wachtman CF, et al. Postoperative enoxaparin prevents symptomatic venous thromboembolism in high-risk plastic surgery patients. Plast Reconstr Surg. 2011;128:1093–1103
references: Iverson RE, Gomez JL. Deep venous thrombosis: Prevention and management. Clin Plast Surg. 2013;40:389–398
references: Colwell AS, Reish RG, Kuter DJ, Damjanovic B, Austen WG Jr, Fogerty AE. Abdominal contouring procedures increase activity of the coagulation cascade. Ann Plast Surg. 2012;69:129–133
references: Miszkiewicz K, Perreault I, Landes G, et al. Venous thromboembolism in plastic surgery: Incidence, current practice and recommendations. J Plast Reconstr Aesthet Surg. 2009;62:580–588
references: Aly AS, Cram AE, Chao M, Pang J, McKeon M. Belt lipectomy for circumferential truncal excess: The University of Iowa experience. Plast Reconstr Surg. 2003;111:398–413
references: Muntz JE, Michota FA. Prevention and management of venous thromboembolism in the surgical patient: Options by surgery type and individual patient risk factors. Am J Surg. 2010;199(Suppl):S11–S20
references: Seruya M, Venturi ML, Iorio ML, Davison SP. Efficacy and safety of venous thromboembolism prophylaxis in highest risk plastic surgery patients. Plast Reconstr Surg. 2008;122:1701–1708
references: Reish RG, Damjanovic B, Colwell AS. Deep venous thrombosis prophylaxis in body contouring: 105 consecutive patients. Ann Plast Surg. 2012;69:412–414
references: Venturi ML, Davison SP, Caprini JA. Prevention of venous thromboembolism in the plastic surgery patient: Current guidelines and recommendations. Aesthet Surg J. 2009;29:421–428
references: Somogyi RB, Ahmad J, Shih JG, Lista F. Venous thromboembolism in abdominoplasty: A comprehensive approach to lower procedural risk. Aesthet Surg J. 2012;32:322–329
references: Patronella CK, Ruiz-Razura A, Newall G, et al. Thromboembolism in high-risk aesthetic surgery: Experience with 17 patients in a review of 3871 consecutive cases. Aesthet Surg J. 2008;28:648–655
references: Grover R, Jones BM, Waterhouse N. The prevention of haematoma following rhytidectomy: A review of 1078 consecutive facelifts. Br J Plast Surg. 2001;54:481–486
references: Reinisch JF, Bresnick SD, Walker JWT, Rosso RF. Deep venous thrombosis and pulmonary embolus after facelift: A study of incidence and prophylaxis. Plast Reconstr Surg. 2001;1071:1570–1577
references: Abboushi N, Yezhelyev M, Symbas J, Nahai F. Facelift complications and the risk of venous thromboembolism: A single center’s experience. Aesthet Surg J. 2012;32:413–420
references: Strazar AR, Leynes PG, Lalonde DH. Minimizing the pain of local anesthesia injection. Plast Reconstr Surg. 2013;132:675–684
references: Rees TD, Barone CM, Valauri FA, Ginsberg GD, Nolan WB III. Hematomas requiring surgical evacuation following face lift surgery. Plast Reconstr Surg. 1994;93:1185–1190
references: Girolami A, Spiezia L, Vianello F. Proposal of a flow chart for thrombosis-free oral contraceptive therapy. Clin Appl Thromb Hemost. 2003;9:33–37
references: Vessey M, Mant D, Smith A, Yeates D. Oral contraceptives and venous thromboembolism: Findings in a large prospective study. Br Med J (Clin Res Ed.). 1986;292:526
references: Hurbanek JG, Jaffer AK, Morra N, Karafa M, Brotman DJ. Postmenopausal hormone replacement and venous thromboembolism following hip and knee arthroplasty. Thromb Haemost. 2004;92:337–343
references: Parkin L, Sharples K, Hernandez RK, Jick SS. Risk of venous thromboembolism in users of oral contraceptives containing drospirenone or levonorgestrel: Nested case-control study based on UK General Practice Research Database. BMJ. 2011;342:d2139