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Literature Review: Venous Thromboembolism Prophylaxis in Plastic Surgery

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Abstract

Venous thromboembolism (VTE) is a postoperative complication experienced in all branches of surgery, including plastic surgery. Its occurrence can be lowered with adequate prophylaxis in the light of the patient's risk category and the type of surgery that will be performed. Nevertheless, thromboembolic prophylaxis is not routinely administered in plastic surgery. The prevention of VTE has gained significant attention in the past 5 years due to increased knowledge about the disease process and the alarming incidence rates. This literature review is specifically aimed at carrying out a synopsis of VTE prophylaxis trials conducted on plastic surgery patients. Antithrombotic agents have generally been avoided by plastic surgeons due to the increased risk of bleeding or hematomas; however, the prevalence of clinically important bleeding has not been found to increase with their use, as it emerges from numerous studies. VTE events can lead to increased morbidity and mortality rates, as well as a rise in healthcare costs. As it emerges from multiple studies, as a preventive measure against VTE, it is strongly advised to use mechanical prophylaxis along with low-molecular-weight heparin as the primary treatment option for plastic surgery patients who are at a greater risk. Up to date though, this practice is not commonly embraced by physicians. Preventing VTE is crucial, and measures to do so are necessary. However, there is no clear evidence to support the use of anticoagulation for plastic surgery patients, and some surgeons are hesitant to use it due to potential bleeding in extensive dissection areas.

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References

  1. Venturi ML, Davison SP, Caprini JA (2009) Prevention of venous thromboembolism in the plastic surgery patient: current guidelines and recommendations. Aesthet Surg J 29(5):421–428. https://doi.org/10.1016/j.asj.2009.04.008. (PMID: 19825474)

    Article  PubMed  Google Scholar 

  2. Hawkins D (2004) Pharmacoeconomics of thrombosis management. Pharmacotherapy 24(7Pt2):95S-99S. https://doi.org/10.1592/phco.24.10.95s.36123. (PMID: 15317405)

    Article  PubMed  Google Scholar 

  3. Spyropoulos AC, Lin J (2007) Direct medical costs of venous thromboembolism and subsequent hospital readmission rates: an administrative claims analysis from 30 managed care organizations. J Manag Care Pharm 13(6):475–486. https://doi.org/10.18553/jmcp.2007.13.6.475. (PMID: 17672809)

    Article  PubMed  Google Scholar 

  4. White AJ, Kanapathy M, Nikkhah D, Akhavani M (2021) Systematic review of the venous thromboembolism risk assessment models used in aesthetic plastic surgery. JPRAS Open. 30:116–127. https://doi.org/10.1016/j.jpra.2021.07.010. (PMID:34522758;PMCID:PMC8427088)

    Article  PubMed  PubMed Central  Google Scholar 

  5. Valsami S, Asmis LM (2013) A brief review of 50 years of perioperative thrombosis and hemostasis management. Semin Hematol 50(2):79–87. https://doi.org/10.1053/j.seminhematol.2013.04.001. (Epub 2013 Jun 11 PMID: 24216167)

    Article  CAS  PubMed  Google Scholar 

  6. Pannucci CJ, Wachtman CF, Dreszer G, Bailey SH, Portschy PR, Hamill JB, Hume KM, Hoxworth RE, Kalliainen LK, Rubin JP, Pusic AL, Wilkins EG (2012) The effect of postoperative enoxaparin on risk for reoperative hematoma. Plast Reconstr Surg 129(1):160–168. https://doi.org/10.1097/PRS.0b013e318236215c. (PMID:21915085;PMCID:PMC3246075)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Pannucci CJ, Dreszer G, Wachtman CF, Bailey SH, Portschy PR, Hamill JB, Hume KM, Hoxworth RE, Rubin JP, Kalliainen LK, Pusic AL, Wilkins EG (2011) Postoperative enoxaparin prevents symptomatic venous thromboembolism in high-risk plastic surgery patients. Plast Reconstr Surg 128(5):1093–1103. https://doi.org/10.1097/PRS.0b013e31822b6817. (PMID:22030491;PMCID:PMC4496157)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Pannucci CJ (2019) Venous thromboembolism in aesthetic surgery: risk optimization in the preoperative, intraoperative, and postoperative settings. Aesthet Surg J 39(2):209–219. https://doi.org/10.1093/asj/sjy138. (PMID: 29846505)

    Article  PubMed  Google Scholar 

  9. Pannucci CJ, MacDonald JK, Ariyan S, Gutowski KA, Kerrigan CL, Kim JY, Chung KC (2016) Benefits and risks of prophylaxis for deep venous thrombosis and pulmonary embolus in plastic surgery: a systematic review and meta-analysis of controlled trials and consensus conference. Plast Reconstr Surg 137(2):709–730. https://doi.org/10.1097/01.prs.0000475790.54231.28. (PMID: 26818311)

    Article  CAS  PubMed  Google Scholar 

  10. Campbell W, Pierson J, Cohen-Shohet R, Mast BA (2014) Maximizing chemoprophylaxis against venous thromboembolism in abdominoplasty patients with the use of preoperative heparin administration. Ann Plast Surg 72(6):S94–S96. https://doi.org/10.1097/SAP.0000000000000132. (PMID: 24691325)

    Article  CAS  PubMed  Google Scholar 

  11. Hatef DA, Kenkel JM, Nguyen MQ et al (2008) Thromboembolic risk assessment and the efficacy of enoxaparin prophylaxis in excisional body contouring surgery. Plast Reconstr Surg 122(1):269–279. https://doi.org/10.1097/prs.0b013e3181773d4a. (PMID: 18594417)

    Article  CAS  PubMed  Google Scholar 

  12. Keith JN, Chong TW, Davar D, Moore AG, Morris A, Gimbel ML (2013) The timing of preoperative prophylactic low-molecular-weight heparin administration in breast reconstruction. Plast Reconstr Surg 132(2):279–284. https://doi.org/10.1097/PRS.0b013e318295870e. (PMID: 23897327)

    Article  CAS  PubMed  Google Scholar 

  13. Gupta R, John J, Gupta M, Shaheen K (2022) Venous thromboembolism prophylaxis in plastic surgery patients undergoing facelift. Aesthet Surg J Open Forum 4:ojac024. https://doi.org/10.1093/asjof/ojac024. (PMID: 35601235; PMCID: PMC9119342)

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ross SW, Kuhlenschmidt KM, Kubasiak JC et al (2020) Association of the risk of a venous thromboembolic event in emergency vs elective general surgery. JAMA Surg 155(6):503–511. https://doi.org/10.1001/jamasurg.2020.0433

    Article  PubMed  PubMed Central  Google Scholar 

  15. Christopher J, Pannucci MD (2019) Venous thromboembolism in aesthetic surgery: risk optimization in the preoperative intraoperative, and postoperative settings. Aesth Surg J 39(2):209–219. https://doi.org/10.1093/asj/sjy138

    Article  Google Scholar 

  16. Sarhaddi D, Xu K, Wisbeck A, Deigni O, Kaswan S, Prada C, Lund H (2019) Fondaparinux significantly reduces postoperative venous thromboembolism after body contouring procedures without an increase in bleeding complications. Aesthet Surg J 39:1214–1221

    Article  PubMed  Google Scholar 

  17. Vasilakis V, Klein GM, Trostler M, Mukit M, Marquez JE, Dagum AB, Pannucci CJ, Khan SU (2019) Postoperative venous thromboembolism prophylaxis utilizing enoxaparin does not increase bleeding complications after abdominal body contouring surgery. Aesthet Surg J 40:989–995

    Article  Google Scholar 

  18. Young VL, Watson ME (2006) The need for venous thromboembolism (VTE) prophylaxis in plastic surgery. Aesthet Surg J 26(2):157–175. https://doi.org/10.1016/j.asj.2006.02.001. (PMID: 19338896)

    Article  CAS  PubMed  Google Scholar 

  19. Seruya M, Venturi ML, Iorio ML, Davison SP (2008) Efficacy and safety of venous thromboembolism prophylaxis in highest risk plastic surgery patients. Plast Reconstr Surg 122(6):1701–1708. https://doi.org/10.1097/PRS.0b013e31818dbffd. (PMID: 19050522)

    Article  CAS  PubMed  Google Scholar 

  20. Michaels J, Coon D, Mulvey CL, Rubin JP (2015) Venous thromboembolism prophylaxis in the massive weight loss patient: relative risk of bleeding. Ann Plast Surg 74(6):699–702. https://doi.org/10.1097/SAP.0000000000000009. (PMID: 24727447)

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Reconstructive and Aesthetic Plastic Surgery School, Humanitas Clinical and Research Hospital, University of Milan, Via Manzoni 56, Rozzano, 20090, Milan, Italy

    Stefano Vaccari, Stefania Andreoletti & Riccardo Fondrini

  2. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy

    Arianna Balza, Edoardo Caimi & Valeriano Vinci

  3. Department of Health Sciences, Ospedale San Paolo, University of Milan, Via Antonio di Rudinì, 8, 20142, Milan, Italy

    Francesco Klinger

  4. Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano, 20089, Milan, Italy

    Valeriano Vinci

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  1. Stefano Vaccari
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  2. Arianna Balza
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  3. Stefania Andreoletti
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  4. Riccardo Fondrini
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Correspondence to Arianna Balza.

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The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Vaccari, S., Balza, A., Andreoletti, S. et al. Literature Review: Venous Thromboembolism Prophylaxis in Plastic Surgery. Aesth Plast Surg 47, 2902–2906 (2023). https://doi.org/10.1007/s00266-023-03508-7

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  • DOI: https://doi.org/10.1007/s00266-023-03508-7

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