The timing of preoperative prophylactic low-molecular-weight heparin administration in breast reconstruction

Jerrod N Keith; Tae W Chong; Diwakar Davar; Alexander G Moore; Alison Morris; Michael L Gimbel

doi:10.1097/PRS.0b013e318295870e

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The timing of preoperative prophylactic low-molecular-weight heparin administration in breast reconstruction

Journal article

Peer reviewed

The timing of preoperative prophylactic low-molecular-weight heparin administration in breast reconstruction

Jerrod N Keith, Tae W Chong, Diwakar Davar, Alexander G Moore, Alison Morris and Michael L Gimbel

Plastic and reconstructive surgery (1963), Vol.132(2), pp.279-284

08/2013

DOI: 10.1097/PRS.0b013e318295870e

PMID: 23897327

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Abstract

Venous thromboembolism continues to be problematic despite increased recognition and advancements in venous thromboembolism prophylaxis. Although migration toward preoperative chemoprophylaxis increases, plastic surgeons seem reticent to adopt this practice. This study evaluates preoperative enoxaparin administration in breast reconstruction patients. Patients undergoing breast reconstruction performed by a single surgeon over a 5-year period were evaluated retrospectively. The authors introduced preoperative chemoprophylaxis with enoxaparin in all breast reconstructions during this time. Prosthetic-based and microsurgical breast reconstructions were examined. Patients were divided into two groups: those who did and those who did not receive preoperative enoxaparin. The authors reviewed patient demographics, comorbidities, and complications, focusing on bleeding complications. Three hundred patients (450 breasts) were included. One hundred fifty-four patients (244 breasts) underwent reconstruction with tissue expanders, and 146 (206 breasts) underwent free flap reconstructions. One hundred seventy-nine of 300 were given preoperative enoxaparin. Eleven hematomas occurred, eight (4.5 percent) in the enoxaparin group and three (2.5 percent) without enoxaparin (p = 0.399). Blood transfusions were given to four patients (2.2 percent) who received enoxaparin and one patient (0.8 percent) who did not (p = 0.652). Finally, any type of bleeding complication occurred in 11 patients (6.1 percent) with enoxaparin and in four (3.3 percent) without (p = 0.419). Larger breasts were more likely to receive enoxaparin (p = 0.011), which did not result in higher bleeding complications. In this retrospective study, the authors found that preoperative chemoprophylaxis in breast reconstruction was associated with an acceptable rate of postoperative bleeding complications. Therapeutic, III.

Breast Neoplasms - surgery

Anticoagulants - administration & dosage

Follow-Up Studies

Humans

Middle Aged

Mastectomy - methods

Reference Values

Enoxaparin - adverse effects

Venous Thromboembolism - prevention & control

Enoxaparin - administration & dosage

Injections, Subcutaneous

Mammaplasty - methods

Patient Safety

Adult

Female

Retrospective Studies

Drug Administration Schedule

Risk Assessment

Treatment Outcome

Venous Thromboembolism - etiology

Mammaplasty - adverse effects

Breast Neoplasms - pathology

Aged

Chemoprevention - methods

Cohort Studies

Preoperative Care - methods

Details

Title: Subtitle: The timing of preoperative prophylactic low-molecular-weight heparin administration in breast reconstruction
Creators: Jerrod N Keith - Department of Surgery, Division of Plastic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Tae W Chong
Diwakar Davar
Alexander G Moore
Alison Morris
Michael L Gimbel
Resource Type: Journal article
Publication Details: Plastic and reconstructive surgery (1963), Vol.132(2), pp.279-284
Publisher: United States
DOI: 10.1097/PRS.0b013e318295870e
PMID: 23897327
ISSN: 0032-1052
eISSN: 1529-4242
Language: English
Date published: 08/2013
Academic Unit: Surgery
Record Identifier: 9984051566102771

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