Head-to-Head Comparison of Bleeding and Venous Thromboembolism (VTE) Risk with Preoperative Heparin vs. Preoperative and Extended Duration Postoperative Enoxaparin in Abdominal Body Contouring Patients
Michael Trostler, MD1, Muntazim Mukit, MD1, David Restle, BA1, Alexander B. Dagum, MD1, Christopher Pannucci, MD2, Sami Khan, MD1.
1Stony Brook University, Stony Brook, NY, USA, 2University of Utah, Salt Lake City, UT, USA.
BACKGROUND: Although chemoprophylaxis for venous thromboembolism (VTE) has been found safe in several studies, there are currently no established guidelines for chemical prophylaxis among outpatient plastic surgical procedures. Abdominoplasties have one of the highest VTE rates of all plastic surgery procedures with an incidence of 0.3-9%, with the risk doubling with any additional procedure. Although many VTE are not clinically significant, it is a potentially preventable complication that can be life threatening. The aim of this study is to evaluate the safety of prescribing outpatient VTE chemoprophylaxis after body contouring surgery when compared to preoperative heparin alone.
METHODS: All abdominoplasty and panniculectomy cases performed by a single surgeon from 2007-2016 were retrospectively reviewed to assess the impact of a change in practice in VTE prophylaxis management in 2012. Group I was the initial practice of a single dose of 5000 Units of preoperative subcutaneous heparin. Group II is the current practice of preoperative subcutaneous enoxaparin 40mg followed by seven days of outpatient 40mg subcutaneous enoxaparin upon discharge. Data collection included demographics, pre-operative risk factors, and Caprini scores. Complications evaluated included bleeding/hematoma, infection, skin dehiscence/necrosis, and VTE.
RESULTS: 152 patients total with 74 in Group I and 78 in Group II. There were no significant differences between demographics or risk factors between Groups I and II. There was a statistically significant different in procedures performed with a higher number of panniculectomy in Group I and a higher number of Fleur de Lis technique in Group II. There were no significant differences in bleeding/hematoma 1.4% vs. 5.1%(p=0.3), infection 10.8% vs. 9%(p=0.7), seroma 8.1% vs. 9%(p=0.92) or major wound healing 4.1% vs. 5.1% (p=0.16) between the Group I and II. The incidence of VTE in the population was 0.66% with 1 patient, in Group I being diagnosed with a DVT/PE on postoperative day 1. The patient, who had a Caprini score of 5, was initially planned for Group II, but could not receive chemoprophylaxis due to an active bleed from a concurrent gynecologic procedure.
CONCLUSIONS: A 7 day course of post-discharge, prophylactic enoxaparin does not significantly increase risk for bleeding in elective body contouring patients, when compared to a single preoperative dose of heparin. Ongoing work in a larger population is needed to examine VTE risk reduction with extended duration enoxaparin.
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