Clinical course of venous thromboembolism following abdominally based microsurgical breast reconstruction: A case series

Zarb, Rakel M; Ramamurthi, Aishu; Doren, Erin L.; LoGiudice, John; Hijjawi, John B.; Adamson, Karri

doi:10.1016/j.bjps.2021.03.020

Cited by 7 publications

(8 citation statements)

References 38 publications

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“…This rate is similar to what has been reported in other large retrospective studies of women who underwent microsurgical breast reconstruction. 3–6 In the current study, the vast majority of VTEs were identified after discharge from hospital, and at least 30% were diagnosed after 30 days postoperatively. The authors note that only 356 patients (1.6%) in this large sample were discharged to home with outpatient VTE chemoprophylaxis with a wide variety of anticoagulation regimens.…”

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confidence: 67%

“…One concern is that the VTE rate in this and other large retrospective studies (up to 3.1%) is lower than following major abdominal or pelvic cancer surgery, or total hip replacement (up to 14% for major abdominal or pelvic cancer surgery and up to 39% for total hip replacement without extended chemoprophylaxis). [3][4][5][6]8,9,13,14 However, the potential consequences remain significant, with a risk for mortality, right ventricular dysfunction, chronic pulmonary hypertension, and postthrombotic syndrome. 15,16 The most cited concern for chemoprophylaxis is a potential increased risk for bleeding.…”

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confidence: 99%

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Discussion: Extended Venous Thromboembolism Chemoprophylaxis following Microsurgical Breast Reconstruction: Analysis of Trends in Postoperative Anticoagulation

Berlin

Matros

2023

Plastic &Amp; Reconstructive Surgery

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confidence: 67%

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confidence: 99%

Discussion: Extended Venous Thromboembolism Chemoprophylaxis following Microsurgical Breast Reconstruction: Analysis of Trends in Postoperative Anticoagulation

Berlin

Matros

2023

Plastic &Amp; Reconstructive Surgery

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“…Our study’s 90-day VTE rate of 1.6% was consistent with prior published VTE rates of 1.1% to 3.1%. 6,29,30 Our complication rate is likely an underestimate, as only symptomatic and significant events will be recognized and recorded by providers. Therefore, providers should highly consider routine extended prophylactic anticoagulation following autologous breast reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Extended Duration Venous Thromboembolism Chemoprophylaxis Following Microsurgical Breast Reconstruction: Analysis of Trends in Postoperative Anticoagulation

Saifee

Constantine

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: Microsurgical breast reconstruction following mastectomy represents a high-risk patient group for venous thromboembolism (VTE), but there is limited consensus on postoperative prophylaxis duration. The aim of this study was to characterize the risk of VTE after microsurgical breast reconstruction, the risk reduction associated with postoperative outpatient VTE prophylaxis, the clinical factors associated with VTE events, and surgeon prescribing patterns regarding outpatient VTE prophylaxis. Methods: A commercially available database of 53 million unique patients, PearlDiver, was used to identify patients with breast cancer who underwent microsurgical breast reconstruction. Patients were grouped into those receiving any form of outpatient VTE prophylaxis at discharge and those who did not. Probability of VTE within 90 days was calculated for each group followed by absolute risk reduction and number needed to treat. A logistic regression, assuming binomial distribution, was performed to determine clinical factors associated with VTE events after surgery. Results: A total of 22,606 patients underwent microsurgical breast reconstruction from 2010 to 2020. Of these patients, 356 (1.6%) were discharged with VTE prophylaxis and 22,250 (98.4%) were discharged without. No patients developed a VTE in the prophylaxis group, and 403 (1.8%) developed a VTE in the group without prophylaxis. The number needed to prevent one VTE was 55.25 patients. Most VTE events occurred after postoperative day 10 (71.3%). Conclusions: Outpatient chemoprophylaxis following breast reconstruction is underused despite the majority of VTE events occurring after the acute postoperative period. Breast microsurgeons should consider routine outpatient chemoprophylaxis as part of their postoperative care pathway to optimize VTE prevention. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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“…Our findings demonstrate a low incidence of VTE of 2.1%, similar to historical rates reported in the literature. 9,[21][22][23][24] Caprini scores ranged from 2 to 12, demonstrating variable preoperative risk, with most patients having a score of 5 or 6. VTE incidence was between 0.8% and 1.9% for scores 3-6, was 3.3% for scores 7-8, and was 13% for scores greater than 8.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Venous Thromboembolism Based on Caprini Score in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

Raymer

Schafer

et al. 2023

J Reconstr Microsurg

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Background Deep inferior epigastric perforator (DIEP) flaps are commonly used for autologous breast reconstruction, but reported rates of venous thromboembolism (VTE) are up to 6.8%. This study aimed to determine incidence of VTE based on preoperative Caprini score following DIEP breast reconstruction. Methods This retrospective study included patients who underwent DIEP flaps for breast reconstruction between January 1, 2016 and December 31, 2020 at a tertiary-level, academic institution. Demographics, operative characteristics, and VTE events were recorded. Receiver operating characteristic (ROC) analysis was performed to determine area under curve (AUC) of Caprini score for VTE. Univariate and multivariate analyses assessed risk factors associated with VTE. Results This study included 524 patients (mean age 51.2±9.6 years). There were 123 (23.5%) patients with Caprini score of 0-4, 366 (69.8%) with scores 5-6, 27 (5.2%) with scores 7-8, and 8 (1.5%) patients with scores >8. Postoperative VTE occurred in 11 (2.1%) patients, at a median time of 9 days (range 1-30) after surgery. VTE incidence by Caprini score was 1.9% for scores 3-4, 0.8% for scores 5-6, 3.3% for scores 7-8, and 13% for scores >8. Caprini score achieved an AUC of 0.70. A Caprini score >8 was significantly predictive of VTE on multivariable analysis relative to scores 5-6 (OR 43.41, 95% CI 7.46-252.76, p<0.001). Conclusions In patients undergoing DIEP breast reconstruction, VTE incidence was highest (13%) in Caprini scores greater than 8 despite chemoprophylaxis. Future studies are needed to assess the role of extended chemoprophylaxis in patients with high Caprini scores.

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Clinical course of venous thromboembolism following abdominally based microsurgical breast reconstruction: A case series

Cited by 7 publications

References 38 publications

Discussion: Extended Venous Thromboembolism Chemoprophylaxis following Microsurgical Breast Reconstruction: Analysis of Trends in Postoperative Anticoagulation

Discussion: Extended Venous Thromboembolism Chemoprophylaxis following Microsurgical Breast Reconstruction: Analysis of Trends in Postoperative Anticoagulation

Extended Duration Venous Thromboembolism Chemoprophylaxis Following Microsurgical Breast Reconstruction: Analysis of Trends in Postoperative Anticoagulation

Incidence of Venous Thromboembolism Based on Caprini Score in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

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