Venous thromboembolism events after breast reconstructions with DIEP free flaps in 192 consecutive case

M, Ali; Schettini, Adriano-Valerio; Rüegg, Eva Meia; Pittet‐Cuénod, Brigitte

doi:10.1016/j.anplas.2017.11.001

Cited by 25 publications

(33 citation statements)

References 42 publications

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“…Although this difference did not reach statistical significance, our study’s 1.5% risk is lower than the historical more than 3% rate that has been found in other studies for breast reconstruction patients only receiving prophylaxis while in-house. 11 , 13 A recent retrospective review reported a VTE rate among microsurgical breast reconstruction patients as 1.3%, similar to our findings. However, specific chemoprophylaxis regimens were not assessed.…”

Section: Discussionsupporting

confidence: 91%

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Evaluation of an Extended-duration Chemoprophylaxis Regimen for Venous Thromboembolism after Microsurgical Breast Reconstruction

Pittelkow

DeBrock

Mailey

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: Patients undergoing free flap breast reconstruction are at a high risk for venous thromboembolism based upon Caprini scores. Guidelines for venous thromboembolism prophylaxis recommend high-risk groups receive extended chemoprophylaxis for several weeks after gynecological, orthopedic, and surgical oncology cases. Extended prophylaxis has not been studied in free flap breast reconstruction. The purpose of this study was to compare outcomes of free flap breast reconstruction patients who received extended venous thromboembolism (VTE) prophylaxis with those who received standard inpatient-only prophylaxis. METHODS: Patients undergoing microsurgical breast reconstruction were divided into two groups: standard VTE prophylaxis (Group I) and extended prophylaxis (Group II). Both groups received prophylactic subcutaneous heparin or enoxaparin preoperatively and enoxaparin 40 mg daily postoperatively while inpatient. Group II was discharged with a home regimen of enoxaparin 40 mg daily for an additional 14 days. RESULTS: In total, 103 patients met inclusion criteria (36 patients in Group I, 67 patients in Group II). The incidence of VTE was 1.5% in Group II compared with 2.8% in Group I ( P = 0.6). There was no difference in reoperative hematoma between Group I (n = 0) and Group II (n = 1) ( P = 0.7). Total flap loss was 2.2%. Conclusions: Although this retrospective pilot study did not show statistical significance in VTE between those receiving extended home chemoprophylaxis (1.5% incidence) compared with inpatient-only chemoprophylaxis (2.8%), the risk of bleeding complications was similar. These results indicate that a larger, higher powered study is justified to assess if an extended home chemoprophylaxis protocol should be standard of care post free flap breast reconstruction.

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Section: Discussionsupporting

confidence: 91%

“…VTE risk was assessed using the 2005 Caprini model for VTE which stratified patients into “very low” (0 points), “low” (1–2 points), “moderate” (3–4 points), and “high” (≥5 points) risk categories based upon ACCP guidelines. 2 , 11 …”

Section: Methodsmentioning

confidence: 99%

Evaluation of an Extended-duration Chemoprophylaxis Regimen for Venous Thromboembolism after Microsurgical Breast Reconstruction

Pittelkow

DeBrock

Mailey

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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“…Hospitalised patients have an increased risk of venous thromboembolic events (VTE) and the use of chemoprophylaxis in patients undergoing autologous reconstruction is well established. 36 The risk of a VTE for abdominal-based reconstructions is estimated to be around 2%-5% 37 but appears much lower for implant-based reconstructions. 38 COVID-19 appears paradoxically both to increase the risk of VTE and also of bleeding due to hepatic dysfunction.…”

Section: Clotting Complicationsmentioning

confidence: 99%

The feasibility and safety of immediate breast reconstruction in the COVID-19 era

Jallali

Hunter

Henry

et al. 2020

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…Modarressi et al found a 3.1% incidence in 192 DIEP flap patients, while Sultan et al reported a 6.8% rate after 133 abdominally based free flaps, including 68 DIEP flaps. 10,14 Both studies had a patient population with an average Caprini score (5.7 and 6.0, respectively) comparable to our cohort's average (6.0; range, 2-10). The lowest VTE incidence in literature was found in Guerra et al's study, which reported a 0.8% rate in 140 bilateral DIEP flaps.…”

Section: Discussionmentioning

confidence: 64%

Prolonged Venous Thromboembolism Prophylaxis May Not Be Necessary for DIEP Flap Breast Reconstruction: A Tertiary Center's 10-Year Experience

Huang

Bernstein

Otterburn

2022

J Reconstr Microsurg

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Background Based on the 2005 Caprini Risk Assessment Model for venous thromboembolism, the American Society of Plastic Surgeons prevention guidelines would result in prolonged chemoprophylaxis (1 week or more) for the majority of patients undergoing deep inferior epigastric perforator flap breast reconstruction. We aim to assess the necessity of prolonged prophylaxis by describing our institutional experience in thromboembolism prevention and evaluating the incidence of symptomatic VTE in our patient cohort. Methods Women who underwent DIEP flap reconstruction from August 2011 to March 2020 at a tertiary care center were included. Charts were retrospectively reviewed for patient characteristics, VTE prophylaxis regimens, and development of deep vein thrombosis and pulmonary embolism within 60 days of surgery. Caprini scores were calculated for all patients. Results Out of the 249 patients included in the study, 245 patients received chemoprophylaxis only during hospitalization, while four patients additionally received anticoagulant for at least 2 weeks after discharge for prophylactic or therapeutic indications. The cohort's average Caprini score was 6.0, with 72.7% of scores between 3 and 6 and 26.5% at 7 or higher. One patient (0.4%), who scored a 7 and received prophylaxis only while hospitalized, developed deep vein thrombosis. There were no cases of pulmonary embolism. There was no significant difference in VTE rate between patients who received chemoprophylaxis consistent with ASPS guidelines and those who did not (p = 1.000). Conclusion Despite our limited chemoprophylaxis use in DIEP flap patients, our VTE incidence is low. This current work suggests that the blanket application of prolonged prophylaxis is not warranted, and it further serves as impetus to re-evaluate the 2005 Caprini RAM in this patient population.

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Venous thromboembolism events after breast reconstructions with DIEP free flaps in 192 consecutive case

Cited by 25 publications

References 42 publications

Evaluation of an Extended-duration Chemoprophylaxis Regimen for Venous Thromboembolism after Microsurgical Breast Reconstruction

Evaluation of an Extended-duration Chemoprophylaxis Regimen for Venous Thromboembolism after Microsurgical Breast Reconstruction

The feasibility and safety of immediate breast reconstruction in the COVID-19 era

Prolonged Venous Thromboembolism Prophylaxis May Not Be Necessary for DIEP Flap Breast Reconstruction: A Tertiary Center's 10-Year Experience

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