Semin Plast Surg 2006; 20(4): 225-232
DOI: 10.1055/s-2006-951580
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Venous Thromboembolism Prophylaxis

Patrick Hsu1 , C. Bob Basu1 , Mark Venturi2 , Steven Davison3
  • 1Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
  • 2University of Texas, M.D. Anderson Cancer Center, Houston, Texas
  • 3Georgetown University Medical Center, Washington, DC
Further Information

Publication History

Publication Date:
18 October 2006 (online)

ABSTRACT

The term venous thromboembolism (VTE) has been coined to refer to the collective diseases of deep vein thrombosis (DVT) and pulmonary embolism (PE). Each year, an estimated 150,000 to 200,000 deaths are attributed to PE. Although the incidence appears to be lower in plastic surgery, with little published in the literature, it is a subject of great concern to specialty surgeons who operate on a purely elective aesthetic basis. Recently, increasing attention has been paid to the prevention of VTE in plastic surgery. This is evident in the numerous articles being published to educate physicians on this very preventable disease. This article is a part of that mission, embarking on identifying risk factors and establishing prophylaxis guidelines. At the end of this article, readers should have an understanding of the pathophysiology, incidence, and risk factors associated with VTE as well as the current prophylactic recommendations that should be considered in the aesthetic patient.

REFERENCES

  • 1 Stein P D. Observations in venous thromboembolism.  Am J Med. 2001;  110 69-70
  • 2 Kearon C. Natural history of venous thromboembolism.  Circulation. 2003;  107(23 Suppl 1) I22-I30
  • 3 Geerts W H, Heit J A, Clagett G P et al.. Prevention of venous thromboembolism.  Chest. 2001;  119(Suppl) 132S-175S
  • 4 Havig O. Deep vein thrombosis and pulmonary embolism. An autopsy study with multiple regression analysis of possible risk factors.  Acta Chir Scand Suppl. 1977;  478 1-120
  • 5 Wells P S, Owen C, Doucette S, Fergusson D, Tran H. Does this patient have deep vein thrombosis?.  JAMA. 2006;  295 199-207
  • 6 Poponick J, Bosker G. The current challenge of venous thromboembolism (VTE) in the hospitalized patient. Part III: national guidelines for DVT prevention and their implications for hospital practice. Clin Cardiol Consensus Rep Aug 1, 2002
  • 7 Young V L, Watson M E. The need for venous thromboembolism (VTE) prophylaxis in plastic surgery.  Aesthetic Surgery Journal. 2006;  26 157-175
  • 8 Lee A Y, Levine M N, Baker R I et al.. Low molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer.  N Engl J Med. 2003;  349 146-153
  • 9 Voss S C, Sharp H C, Scott J R. Abdominoplasty combined with gynecologic surgical procedures.  Obstet Gynecol. 1986;  67 181-185
  • 10 Hirsh J, Lee A Y. How we diagnose and treat deep vein thrombosis.  Blood. 2002;  99 3102-3110
  • 11 Davidson B L. Controversies in pulmonary embolism and deep venous thrombosis.  Am Fam Physician. 1999;  60 1969-1980
  • 12 Feied C F. Pulmonary chest pain, cor pulmonale, and pulmonary embolism. In: Gibler WB, Aufderheide TP Emergency Cardiac Care. St. Louis, MO; Mosby 1994: 243-303
  • 13 Anderson F A, Wheeler H B, Goldberg R J et al.. A population-based perspective of the hospital incidence and case fatality rates of deep vein thrombosis and pulmonary embolism: the Worcester DVT Study.  Arch Intern Med. 1991;  151 933-938
  • 14 Dalen J E, Alpert J S. Natural history of pulmonary embolism.  Prog Cardiovasc Dis. 1975;  17 259-270
  • 15 Silverstein M D, Heit J A, Mohr D N et al.. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study.  Arch Intern Med. 1998;  158 585-593
  • 16 Anderson Jr F A, Wheeler H B. Venous thromboembolism: risk factors and prophylaxis.  Clin Chest Med. 1995;  16 235-251
  • 17 Atluri P, Raper S E. Factor V Leiden and postoperative deep vein thrombosis in patients undergoing open Roux-en-Y gastric bypass surgery.  Obes Surg. 2005;  15 561-564
  • 18 Hamad G G, Choban P S. Enoxaparin for thromboprophylaxis in morbidly obese patients undergoing bariatric surgery: findings of the prophylaxis against VTE outcomes in bariatric surgery patients receiving enoxaparin (PROBE) study.  Obes Surg. 2005;  15 1368-1374
  • 19 Melinek J, Livingston E, Cortina G, Fishbein M C. Autopsy findings following gastric bypass surgery for morbid obesity.  Arch Pathol Lab Med. 2002;  126 1091-1095
  • 20 Bergqvist D. Low molecular weight heparin for the prevention of postoperative venous thromboembolism after abdominal surgery: a review.  Curr Opin Pulm Med. 2005;  11 392-397
  • 21 Grazer F M, de Jong R H. Fatal outcomes from liposuction: census survey of cosmetic surgeons.  Plast Reconstr Surg. 2000;  105 436-446
  • 22 Albin R, de Campo T. Large-volume liposuction in 181 patients.  Aesthetic Plast Surg. 1999;  23 5-15
  • 23 Commons G W, Halperin B, Chang C C. Large volume liposuction: a review of 631 consecutive cases over 12 years.  Plast Reconstr Surg. 2001;  108 1753-1763
  • 24 Gilliland M D, Commons G W, Halperin B. Safety issues in ultrasound assisted large volume lipoplasty.  Clin Plast Surg. 1999;  26 317-335
  • 25 Hughes III C E. Reduction of lipoplasty risks and mortality: an ASAPS survey.  Aesthetic Surg J. 2001;  21 120
  • 26 van Uchelen J H, Werker P MN, Kon M. Complications of abdominoplasty in 86 patients.  Plast Reconstr Surg. 2001;  107 1869-1873
  • 27 Grazer F M, Goldwyn R M. Abdominoplasty assessed by survey, with emphasis on complications.  Plast Reconstr Surg. 1977;  59 513-517
  • 28 Hester Jr T R, Baird W, Bostwick 3rd J, Nahai F, Cukic J. Abdominoplasty combined with other surgical procedures: safe or sorry?.  Plast Reconstr Surg. 1989;  83 997-1004
  • 29 Voss S C, Sharp H C, Scott J R. Abdominoplasty combined with gynecologic surgical procedures.  Obstet Gynecol. 1986;  67 181-185
  • 30 Aly A S, Cram A E, Chao M, Pang J, McKeon M. Belt lipectomy for circumferential truncal excess.  Plast Reconstr Surg. 2003;  111 398-413
  • 31 Reinisch J F, Bresnick S D, Walker J WT, Rosso R F. Deep venous thrombosis and pulmonary embolus after face lift: a study of incidence and prophylaxis.  Plast Reconstr Surg. 2001;  107 1570-1575
  • 32 White R H. The epidemiology of venous thromboembolism.  Circulation. 2003;  107(23 Suppl 1) I4-I8
  • 33 Anderson Jr F A, Spencer F A. Risk factors for venous thromboembolism.  Circulation. 2003;  107 I9-I16
  • 34 Wheeler H B. Diagnosis of deep vein thrombosis. Review of clinical evaluation and impedance plethysmography.  Am J Surg. 1985;  150 7-13
  • 35 Jimenez D, Diaz G, Marin E, Vidal R, Sueiro A, Yusen R D. The risk of recurrent venous thromboembolism in patients with unprovoked symptomatic deep vein thrombosis and asymptomatic pulmonary embolus.  Thromb Haemost. 2006;  95 562-566
  • 36 Samama M M. An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients. The Sirius study.  Arch Intern Med. 2000;  160 3415-3420
  • 37 Agnelli G, Bolis G, Capussotti L et al.. A clinical outcome-based prospective study on venous thromboembolism after cancer surgery: the RISTOS project.  Ann Surg. 2006;  243 89-95
  • 38 Vessey M, Mant D, Smith A, Yeates D. Oral contraceptives and venous thromboembolism: findings in a large prospective study.  BMJ. 1986;  292 526
  • 39 Daly E, Vessey M P, Hawkins M M, Carson J L, Gough P, Marsh S. Risk of venous thromboembolism in users of hormone replacement therapy.  Lancet. 1996;  348 977-980
  • 40 Jick H, Derby L E, Myers M W, Vasilakis C, Newton K M. Risk of hospital admission for idiopathic venous thromboembolism among users of postmenopausal oestrogen.  Lancet. 1996;  348 981-983
  • 41 Grodstein F, Stampfer M J, Goldhaber S Z et al.. Prospective study of exogenous hormones and risk of pulmonary embolism in women.  Lancet. 1996;  348 983-987
  • 42 Perez-Gutthann S, Garcia-Rodriguez L, Castellsague J, Duque-Oliart A. Hormone replacement therapy and the risk of venous thromboembolism: population-based case-control study.  BMJ. 1997;  314 796-800
  • 43 Varas-Lorenzo C, Garcia-Rodriguez L, Cattaruzzi C, Troncon M G, Agostinis L, Perez-Gutthann S. Hormone replacement therapy and the risk of hospitalization for venous thromboembolism: a population-based study in southern Europe.  Am J Epidemiol. 1998;  147 387-390
  • 44 Rosendaal F R, Vessey M, Rumley A et al.. Hormonal replacement therapy, prothrombotic mutations and the risk of venous thrombosis.  Br J Haematol. 2002;  116 851-854
  • 45 Shiffman M A. Estrogen and thromboembolic problems.  Plast Reconstr Surg. 2002;  110 713-715
  • 46 Wells P S, Lensing A W, Hirsh J. Graduated compression stockings in the prevention of postoperative venous thromboembolism: a meta-analysis.  Arch Intern Med. 1994;  154 67-72
  • 47 Janssen H, Trevino C, Williams D. Hemodynamic alterations in venous blood flow produced by external pneumatic compression.  J Cardiovasc Surg (Torino). 1993;  34 441-447
  • 48 Salzman E W, McManama G P, Shapiro A H et al.. Effect of optimization of hemodynamics on fibrinolytic activity and antithrombotic efficacy of external calf compression.  Ann Surg. 1987;  206 636-641
  • 49 Gertler J P, Abbott W M. Prothrombotic and fibrinolytic function of normal and perturbed endothelium.  J Surg Res. 1992;  52 89-95
  • 50 Urbankova J, Quiroz R, Kucher N, Goldhaber S Z. Intermittent pneumatic compression and deep vein thrombosis prevention. A meta-analysis in postoperative patients.  Thromb Haemost. 2005;  94 1181-1185
  • 51 Most D, Kozlow J, Heller J, Shermak M. Thromboembolism in plastic surgery.  Plast Reconstr Surg. 2005;  115 20-30
  • 52 Warkentin T E, Levine M N, Hirsh J et al.. Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin.  N Engl J Med. 1995;  332 1330-1335
  • 53 Koch A, Bouges S, Ziegler S et al.. Low molecular weight heparin and unfractionated heparin in thrombosis prophylaxis after major surgical intervention: update of previous meta-analyses.  Br J Surg. 1997;  84 750-759
  • 54 Dujon D G, Chatzis L A, Hart N B. Thromboembolic prophylaxis in plastic surgery: an appraisal.  Br J Plast Surg. 1992;  45 418-420
  • 55 McDevitt N B. Deep vein thrombosis prophylaxis.  Plast Reconstr Surg. 1999;  104 1923-1928
  • 56 Iverson R E. ASPS Task Force on Patient Safety in Office-based Surgery Facilities. Patient safety in office-based surgery facilities: I. Procedures in the office-based surgery setting.  Plast Reconstr Surg. 2002;  110 1337-1342
  • 57 Davison S P, Venturi M L, Attinger C E, Baker S B, Spear S L. Prevention of venous thromboembolism in the plastic surgery patient.  Plast Reconstr Surg. 2004;  114 43E-51E
  • 58 Caprini J A, Arcelus J I, Reyna J J. Effective risk stratification of surgical and nonsurgical patients for venous thromboembolic disease.  Semin Hematol. 2001;  38(2 Suppl 5) 12-19
  • 59 Levine M N, Raskob G, Beyth R J, Kearon C, Schulman S. Hemorrhagic complications of anticoagulant treatment. The seventh ACCP conference on antithrombotic and thrombolytic therapy.  Chest. 2004;  126(3 Suppl) 287S-310S
  • 60 Tapson V. Treatment of venous thromboembolism. Continuing Medical Education Series.  Am J Med. 2006; 
  • 61 The Doctors Company .Deep venous thrombosis and pulmonary embolism in plastic surgery office procedures. http://Available at: www.thedoctors.com

Patrick HsuM.D. 

Division of Plastic Surgery, Baylor College of Medicine

1709 Dryden, Suite 1600, Houston, TX 77030