Maximizing Chemoprophylaxis Against Venous Thromboembolism in Abdominoplasty

Abstract

Maximizing Chemoprophylaxis Against Venous Thromboembolism in Abdominoplasty | Plastic Surgery Key https://plasticsurgerykey.com/maximizing-chemoprophylaxis-against-venous-thromboembolism-in-abdominoplasty/ 1/4 Fig. 37.1 ASPS VTE task force assessment and prevention recommendations Fig. 37.2 Venous thromboembolism risk factor assessment [21] (*Bahl et al. [25]) There is a larger body of literature in other surgical specialties that have investigated the timing of chemoprophylaxis. In procedures that are moderate to high risk for VTE, preoperative chemoprophylaxis with LMWH has shown to have a marked decrease in DVT/PE without any increase in major bleeding complications in both orthopedic surgery and surgical oncology [4, 13, 14]. Although this has not been fully investigated in the plastic surgery literature, the authors' institution adopted a protocol for preoperative chemoprophylaxis based on the existent surgical literature. Originally this consisted of 5000 units of subcutaneous unfractionated heparin given in preoperative holding within 60 min of induction of anesthesia. In the face of increased evidence showing increased efficacy of extended protocols with LMWH, we expanded our protocol to consist of enoxaparin 40 mg SQ on call to the OR and then continued daily for 2 days. Our initial publication based on this protocol did not show an increase in bleeding complications, and there were no VTE in the series which included 151 patients. This data set included 60 % of patients who also underwent another combined body-contouring procedure at the same time (i.e., lower body lift, breast reduction, etc.) (Tables 37.1 and 37.2) [22]. Table 37.1 Summary of complications n Overall complications Cellulitis Seroma Hematoma Minor wound dehiscence Reoperationa VTE Blood transfusion Heparin/SCD 101 19(19 %) 5(10 %) 4(8 %) 1(1 %) 2(2 %) 2(2 %) 0(0 %) 0(0 %) Enoxaparin 50 7(14 %) 3(6 %) 1(2 %) 0 3(6 %) 1(2 %) 0(0 %) 0(0 %) aAll three reoperations were for wound dehiscence with return to the OR for wound closure. There were no incidents of hemorrhage requiring return to the OR or bleeding requiring blood transfusion in this case series Table 37.2