Summary
Background
Venous thrombo-embolism (VTE) prophylaxis is of paramount importance in the management
of surgical patients. Mechanical as well as pharmacologic modalities may be used.
With the use of anticoagulative agents, there is a potential for increased operative
and postoperative bleeding.
Aim
To assess the safety of perioperative use of low-molecular-weight heparin (LMWH) in
the setting of breast reduction surgery.
Methods
Retrospective assessment of the reoperation rate due to haematoma formation for breast
reductions performed under a regimen of preoperative and postoperative administration
of LMWH during a 10-year period.
Results
A total of 720 patients (1358 breasts) received preoperative and postoperative treatment
with LMWH. Reoperation due to haematoma formation was required for 37 breasts in 37
patients (5.1% of patients and 2.7% of breasts). Eight patients (1.1%) required transfusion.
No patient or operative factors were associated with the need for reoperation. There
were no documented cases of deep vein thrombosis or VTE.
Conclusion
The use of a pre- and postoperative LMWH prophylaxis regimen is associated with a
reoperation rate for haematoma that is in the upper range reported in the literature.
Keywords
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References
- Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).Chest. 2008; 133: 381S-453S
- Executive summary: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).Chest. 2008; 133: 71S-109S
- Prevention of venous thromboembolism in the plastic surgery patient.Plast Reconstr Surg. 2004; 114: 43E-51E
- Validation of the Caprini risk assessment model in plastic and reconstructive surgery patients.J Am Coll Surg. 2011; 212: 105-112
- MOC-PS(SM) CME article: venous thromboembolism prophylaxis in plastic surgery patients.Plast Reconstr Surg. 2008; 122: 1-9
- The current evidence-based guidelines regarding prophylaxis of venous thromboembolism and their relevance for plastic surgery.Handchirurgie, Mikrochirurgie, plastische Chirurgie: Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie: Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse: Organ der Vereinigung der Deutschen Plastischen Chirurgen. 2010; 42: 251-259
- Thromboembolic risk assessment and the efficacy of enoxaparin prophylaxis in excisional body contouring surgery.Plast Reconstr Surg. 2008; 122: 269-279
- The need for venous thromboembolism (VTE) prophylaxis in plastic surgery.Aesthet Surg J. 2006; 26: 157-175
- The effect of post-operative enoxaparin on risk for re-operative hematoma.Plast Reconstr Surg. 2011;
- The impact of intraoperative hypotension on the development of wound haematoma after breast reduction.Br J Plast Surg. 2001; 54: 517-522
- The effect of blood pressure on hematoma formation with perioperative Lovenox in excisional body contouring surgery.Aesthet Surg J. 2007; 27: 589-593
- Incidence of hematoma complication with heparin venous thrombosis prophylaxis after TRAM flap breast reconstruction.Plast Reconstr Surg. 2008; 121: 1101-1107
- Prevention of venous thromboembolism in the plastic surgery patient: current guidelines and recommendations.Aesthet Surg J. 2009; 29: 421-428
- VTE prophylaxis in aesthetic surgery patients.Aesthet Surg J. 2006; 26: 317-324
- Controversies in timing of the first dose of anticoagulant prophylaxis against venous thromboembolism after major orthopedic surgery.Chest. 2003; 124: 379S-385S
- Preoperative or postoperative start of prophylaxis for venous thromboembolism with low-molecular-weight heparin in elective hip surgery?.Arch Intern Med. 2002; 162: 1451-1456
- Deep venous thrombosis prophylaxis practice and treatment strategies among plastic surgeons: survey results.Plast Reconstr Surg. 2007; 119: 157-174
- Venous thromboembolism in plastic surgery patients: survey results of plastic surgeons.Aesthet Surg J. 2006; 26: 522-529
- Thromboembolism in high-risk aesthetic surgery: experience with 17 patients in a review of 3871 consecutive cases.Aesthet Surg J. 2008; 28: 648-655
- Analysis of breast reduction complications derived from the BRAVO study.Plast Reconstr Surg. 2005; 115: 1597-1604
- Risk factors and complications in reduction mammaplasty: novel associations and preoperative assessment.Plast Reconstr Surg. 2009; 124: 1040-1046
- Reduction mammaplasty in Reykjavik, Iceland 1984–1993; an outcome analysis.Laeknabladid. 2002; 88: 915-919
- The efficacy of prophylactic low-molecular-weight heparin to prevent pulmonary thromboembolism in immediate breast reconstruction using the TRAM flap.Plast Reconstr Surg. 2009; 123: 9-12
- Low-molecular-weight heparin and postoperative bleeding in rhytidectomy.Plast Reconstr Surg. 2006; 118 ([discussion 8–9]): 502-507
- Silent pulmonary embolism in patients with deep venous thrombosis: a systematic review.Am J Med. 2010; 123: 426-431
- Resident participation does not affect surgical outcomes, despite introduction of new techniques.J Am Coll Surg. 2010; 211: 540-545
- Hematoma risk should not preclude the use of venous thromboembolism prophylaxis.Aesthet Surg J. 2009; 29 (author reply 9): 338
- Our complication, your problem.Plast Reconstr Surg. 2007; 120: 1428-1429
Article info
Publication history
Published online: June 25, 2012
Accepted:
May 26,
2012
Received:
December 18,
2011
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
