Venous thromboembolism prophylaxis in the massive weight loss patient: Relative risk of bleeding

Joseph Michaels, Devin O'Brien-Coon, Carolyn Leigh Mulvey, J. Peter Rubin

Research output: Contribution to journalArticle

Abstract

Background Measures that can reduce the incidence of venous thromboembolism (VTE) are of great clinical importance. In addition to the use of sequential compression devices (SCDs), chemoprophylaxis with low-molecular-weight heparin (LMWH) has been recommended by the American College of Chest Physicians for major general surgery procedures. There remains inconclusive evidence to support guidelines for the plastic surgery population, and some surgeons hesitate to use anticoagulation due to concerns about bleeding in broad planes of dissection. The purpose of this study was to evaluate the risk of postoperative complications secondary to chemical thromboprophylaxis in massive weight loss patients. Methods Five hundred forty-six surgical cases were enrolled in an institutional review board-approved prospective clinical database in the 2 years before and after routine LMWH use was initiated. Inclusion required weight loss of greater than 50 lb. Group 1 had SCDs only (n = 334), whereas group 2 had SCDs and LMWH 6 hours postoperatively (n = 212). Risk of VTE was calculated and complications of LMWH administration were analyzed. Results The overall risk of deep venous thrombosis and pulmonary embolism was 0.18%. There was no statistical difference between the groups (P > 0.05). Overall risk of hematoma was 5.4%, in concordance with the literature. There was no difference in hematoma risk between the groups (4.6% before and 6.6% after LMWH; P = 0.3). The transfusion rate was 8.5% before use of LMWH (group 1) and 7.6% after (group 2; P = 0.7). Conclusions Strategies to reduce VTE rates remain important in all areas of plastic surgery. We have demonstrated no increased risk of transfusion or hematoma and a low overall incidence of VTE after implementing a chemoprophylaxis regimen. Postoperative LMWH can provide an excellent balance between VTE prophylaxis and the risk of bleeding complications.

Original languageEnglish (US)
Pages (from-to)699-702
Number of pages4
JournalAnnals of Plastic Surgery
Volume74
Issue number6
DOIs
StatePublished - Jan 1 2015

Fingerprint

Low Molecular Weight Heparin
Venous Thromboembolism
Weight Loss
Hemorrhage
Hematoma
Chemoprevention
Plastic Surgery
Equipment and Supplies
Research Ethics Committees
Incidence
Pulmonary Embolism
Venous Thrombosis
Dissection
Databases
Guidelines
Population

Keywords

  • body contouring
  • deep venous thrombosis
  • hematoma
  • low-molecular-weight heparin
  • massive weight loss
  • prophylaxis
  • pulmonary embolism
  • venous thromboembolism

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Venous thromboembolism prophylaxis in the massive weight loss patient : Relative risk of bleeding. / Michaels, Joseph; O'Brien-Coon, Devin; Mulvey, Carolyn Leigh; Rubin, J. Peter.

In: Annals of Plastic Surgery, Vol. 74, No. 6, 01.01.2015, p. 699-702.

Research output: Contribution to journalArticle

Michaels, Joseph ; O'Brien-Coon, Devin ; Mulvey, Carolyn Leigh ; Rubin, J. Peter. / Venous thromboembolism prophylaxis in the massive weight loss patient : Relative risk of bleeding. In: Annals of Plastic Surgery. 2015 ; Vol. 74, No. 6. pp. 699-702.
@article{7d492a031e4d4cbda50461ac2fdae294,
title = "Venous thromboembolism prophylaxis in the massive weight loss patient: Relative risk of bleeding",
abstract = "Background Measures that can reduce the incidence of venous thromboembolism (VTE) are of great clinical importance. In addition to the use of sequential compression devices (SCDs), chemoprophylaxis with low-molecular-weight heparin (LMWH) has been recommended by the American College of Chest Physicians for major general surgery procedures. There remains inconclusive evidence to support guidelines for the plastic surgery population, and some surgeons hesitate to use anticoagulation due to concerns about bleeding in broad planes of dissection. The purpose of this study was to evaluate the risk of postoperative complications secondary to chemical thromboprophylaxis in massive weight loss patients. Methods Five hundred forty-six surgical cases were enrolled in an institutional review board-approved prospective clinical database in the 2 years before and after routine LMWH use was initiated. Inclusion required weight loss of greater than 50 lb. Group 1 had SCDs only (n = 334), whereas group 2 had SCDs and LMWH 6 hours postoperatively (n = 212). Risk of VTE was calculated and complications of LMWH administration were analyzed. Results The overall risk of deep venous thrombosis and pulmonary embolism was 0.18{\%}. There was no statistical difference between the groups (P > 0.05). Overall risk of hematoma was 5.4{\%}, in concordance with the literature. There was no difference in hematoma risk between the groups (4.6{\%} before and 6.6{\%} after LMWH; P = 0.3). The transfusion rate was 8.5{\%} before use of LMWH (group 1) and 7.6{\%} after (group 2; P = 0.7). Conclusions Strategies to reduce VTE rates remain important in all areas of plastic surgery. We have demonstrated no increased risk of transfusion or hematoma and a low overall incidence of VTE after implementing a chemoprophylaxis regimen. Postoperative LMWH can provide an excellent balance between VTE prophylaxis and the risk of bleeding complications.",
keywords = "body contouring, deep venous thrombosis, hematoma, low-molecular-weight heparin, massive weight loss, prophylaxis, pulmonary embolism, venous thromboembolism",
author = "Joseph Michaels and Devin O'Brien-Coon and Mulvey, {Carolyn Leigh} and Rubin, {J. Peter}",
year = "2015",
month = "1",
day = "1",
doi = "10.1097/SAP.0000000000000009",
language = "English (US)",
volume = "74",
pages = "699--702",
journal = "Annals of Plastic Surgery",
issn = "0148-7043",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Venous thromboembolism prophylaxis in the massive weight loss patient

T2 - Relative risk of bleeding

AU - Michaels, Joseph

AU - O'Brien-Coon, Devin

AU - Mulvey, Carolyn Leigh

AU - Rubin, J. Peter

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background Measures that can reduce the incidence of venous thromboembolism (VTE) are of great clinical importance. In addition to the use of sequential compression devices (SCDs), chemoprophylaxis with low-molecular-weight heparin (LMWH) has been recommended by the American College of Chest Physicians for major general surgery procedures. There remains inconclusive evidence to support guidelines for the plastic surgery population, and some surgeons hesitate to use anticoagulation due to concerns about bleeding in broad planes of dissection. The purpose of this study was to evaluate the risk of postoperative complications secondary to chemical thromboprophylaxis in massive weight loss patients. Methods Five hundred forty-six surgical cases were enrolled in an institutional review board-approved prospective clinical database in the 2 years before and after routine LMWH use was initiated. Inclusion required weight loss of greater than 50 lb. Group 1 had SCDs only (n = 334), whereas group 2 had SCDs and LMWH 6 hours postoperatively (n = 212). Risk of VTE was calculated and complications of LMWH administration were analyzed. Results The overall risk of deep venous thrombosis and pulmonary embolism was 0.18%. There was no statistical difference between the groups (P > 0.05). Overall risk of hematoma was 5.4%, in concordance with the literature. There was no difference in hematoma risk between the groups (4.6% before and 6.6% after LMWH; P = 0.3). The transfusion rate was 8.5% before use of LMWH (group 1) and 7.6% after (group 2; P = 0.7). Conclusions Strategies to reduce VTE rates remain important in all areas of plastic surgery. We have demonstrated no increased risk of transfusion or hematoma and a low overall incidence of VTE after implementing a chemoprophylaxis regimen. Postoperative LMWH can provide an excellent balance between VTE prophylaxis and the risk of bleeding complications.

AB - Background Measures that can reduce the incidence of venous thromboembolism (VTE) are of great clinical importance. In addition to the use of sequential compression devices (SCDs), chemoprophylaxis with low-molecular-weight heparin (LMWH) has been recommended by the American College of Chest Physicians for major general surgery procedures. There remains inconclusive evidence to support guidelines for the plastic surgery population, and some surgeons hesitate to use anticoagulation due to concerns about bleeding in broad planes of dissection. The purpose of this study was to evaluate the risk of postoperative complications secondary to chemical thromboprophylaxis in massive weight loss patients. Methods Five hundred forty-six surgical cases were enrolled in an institutional review board-approved prospective clinical database in the 2 years before and after routine LMWH use was initiated. Inclusion required weight loss of greater than 50 lb. Group 1 had SCDs only (n = 334), whereas group 2 had SCDs and LMWH 6 hours postoperatively (n = 212). Risk of VTE was calculated and complications of LMWH administration were analyzed. Results The overall risk of deep venous thrombosis and pulmonary embolism was 0.18%. There was no statistical difference between the groups (P > 0.05). Overall risk of hematoma was 5.4%, in concordance with the literature. There was no difference in hematoma risk between the groups (4.6% before and 6.6% after LMWH; P = 0.3). The transfusion rate was 8.5% before use of LMWH (group 1) and 7.6% after (group 2; P = 0.7). Conclusions Strategies to reduce VTE rates remain important in all areas of plastic surgery. We have demonstrated no increased risk of transfusion or hematoma and a low overall incidence of VTE after implementing a chemoprophylaxis regimen. Postoperative LMWH can provide an excellent balance between VTE prophylaxis and the risk of bleeding complications.

KW - body contouring

KW - deep venous thrombosis

KW - hematoma

KW - low-molecular-weight heparin

KW - massive weight loss

KW - prophylaxis

KW - pulmonary embolism

KW - venous thromboembolism

UR - http://www.scopus.com/inward/record.url?scp=84929964867&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84929964867&partnerID=8YFLogxK

U2 - 10.1097/SAP.0000000000000009

DO - 10.1097/SAP.0000000000000009

M3 - Article

C2 - 24727447

AN - SCOPUS:84929964867

VL - 74

SP - 699

EP - 702

JO - Annals of Plastic Surgery

JF - Annals of Plastic Surgery

SN - 0148-7043

IS - 6

ER -