Reconsidering the Role of Routine Anticoagulation for Venous Thromboembolism Prevention in Plastic Surgery

Abandoning Caprini Scores and Chemoprophylaxis (“Bloodletting 2.0”): A Call for Action

“…The corresponding author and former journal editor-in-chief writes: “The authors would like to express great appreciation to Dr. Pannucci for his valuable and constructive suggestions during the development of the manuscript, as well as his overall contribution to studying venous thromboembolism. His dedication to the safety of our patients is very much appreciated.” 7 Remarkably, none of the references cited by Dahmus et al 1 are to articles that are critical of risk stratification and chemoprophylaxis or recommend an alternative treatment strategy, despite numerous references in the literature over the last decade, 3,5,11,15–25 including the only prospective study in a large number (n = 1,000) of patients all screened with Doppler ultrasound 11 and the only published Level 1 randomized trial 20 …”

Perioperative Transgender Hormone Management: Avoiding Venous Thromboembolism and Other Complications

“…Postoperative chemoprophylaxis is not without risk-hematoma rates are increased with postoperative heparin use. 11,66,67 A recent meta-analysis examining plastic surgery patients noted no significant venous thromboembolism risk reduction with the use of chemoprophylaxis 11 ; however, increased rates of reoperation for hematoma were noted. This led to recommendations that the routine use of chemoprophylaxis is not recommended in the general, non-risk-stratified plastic surgery population, and that the increased risk of bleeding must be weighed against the risk of venous thromboembolism.…”

“…Routine lower extremity assessment can help with early identification of postoperative venous thromboembolism, and some surgeons recommend its routine use as an alternative to routine Plastic and Reconstructive Surgery • April 2021 postoperative anticoagulation. 66,69,70 The senior author (L.S.) currently uses routine postoperative duplex ultrasound screening on postoperative day 4 following all vaginoplasty procedures in place of routine chemoprophylaxis.…”

A New Approach for Venous Thromboembolism Prevention in Plastic Surgery

“…Importantly, chemoprophylaxis is not approved by the U.S. Food and Drug Administration (FDA) for VTE prophylaxis in plastic surgery patients. 3,12 By contrast, ultrasound is FDA-approved, and anticoagulation (including oral anticoagulants) is FDA approved for patients with ultrasound evidence of thromboses. Oral medications are better tolerated by patients than enoxaparin injections, improving compliance.…”

“…23 For example, Caprini scores are underestimated in retrospective chart reviews. 3 The length of hospitalization is not a VTE risk factor. 4,6 Therefore, controlling for median Caprini scores and hospital stays to force a P value under 0.05 is not justified.…”