Venous thromboembolism in plastic surgery: the current state of evidence in risk assessment and chemoprophylactic options.

MedStar author(s):
Citation: Journal of Plastic Surgery and Hand Surgery. 53(6):370-380, 2019 Dec.PMID: 31478782Institution: MedStar Health Research Institute | MedStar Washington Hospital CenterDepartment: Surgery/Plastic SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Anticoagulants/tu [Therapeutic Use] | *Chemoprevention | *Reconstructive Surgical Procedures/ae [Adverse Effects] | *Risk Assessment | *Venous Thromboembolism/pc [Prevention & Control] | Administration, Oral | Anticoagulants/pd [Pharmacology] | Aspirin/pd [Pharmacology] | Aspirin/tu [Therapeutic Use] | Heparin, Low-Molecular-Weight/pd [Pharmacology] | Heparin, Low-Molecular-Weight/tu [Therapeutic Use] | Humans | Incidence | Postoperative Complications | Pyrazoles/pd [Pharmacology] | Pyrazoles/tu [Therapeutic Use] | Pyridones/pd [Pharmacology] | Pyridones/tu [Therapeutic Use] | Rivaroxaban/pd [Pharmacology] | Rivaroxaban/tu [Therapeutic Use]Year: 2019ISSN:
  • 2000-6764
Name of journal: Journal of plastic surgery and hand surgeryAbstract: The application of venous thromboembolism (VTE) prophylaxis has been the topic of intense debate in plastic surgery. The overall incidence of VTE is low in plastic surgery patients as compared to other surgical subspecialties but may be higher in the inpatient rather than outpatient plastic surgery populations. The Caprini Risk Assessment Model is the most highly studied and validated tool to assess VTE risk in plastic surgery patients. However, the Caprini model lacks procedure-specific risk assessment and patient-specific risk factor calculations. Due to these limitations, such as the low incidence and the heterogeneous nature of the specialty, trials lacked the power to capture proof of benefit, except in the highest-risk inpatient population. The emerging use of aspirin and novel oral anticoagulants may provide an alternative, as noninferiority in terms of efficacy and safety has been demonstrated in other fields. In this review, the authors intend to summarize the current state of evidence for prevention and explore the modalities available for prophylaxis, including novel oral anticoagulants.All authors: Abbate O, Black CK, Camden RC, Evans KK, Fan KL, Lu KOriginally published: Journal of Plastic Surgery and Hand Surgery. :1-11, 2019 Sep 03Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2019-10-10
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Journal Article MedStar Authors Catalog Article 31478782 Available 31478782

The application of venous thromboembolism (VTE) prophylaxis has been the topic of intense debate in plastic surgery. The overall incidence of VTE is low in plastic surgery patients as compared to other surgical subspecialties but may be higher in the inpatient rather than outpatient plastic surgery populations. The Caprini Risk Assessment Model is the most highly studied and validated tool to assess VTE risk in plastic surgery patients. However, the Caprini model lacks procedure-specific risk assessment and patient-specific risk factor calculations. Due to these limitations, such as the low incidence and the heterogeneous nature of the specialty, trials lacked the power to capture proof of benefit, except in the highest-risk inpatient population. The emerging use of aspirin and novel oral anticoagulants may provide an alternative, as noninferiority in terms of efficacy and safety has been demonstrated in other fields. In this review, the authors intend to summarize the current state of evidence for prevention and explore the modalities available for prophylaxis, including novel oral anticoagulants.

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