For plastic surgery patients at high risk, treatment with the anticoagulant (blood-thinning) drug enoxaparin can reduce the risk of serious blood clot-related complications called venous thromboembolism (VTE), reports a study in the November issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
The results suggest that enoxaparin could help to meet one of the most important safety goals in plastic surgery today: preventing serious VTEs in high-risk patients. Funded by The Plastic Surgery Foundation, the study was performed by a consortium of U.S. plastic surgeons. The lead author was Dr. Christopher J. Pannucci of University of Michigan, Ann Arbor.
Enoxaparin Reduces VTE Risk in Patients at Highest Risk
Venous thromboembolism is a potentially serious complication in which clots develop, blocking blood flow to the legs (deep vein thrombosis) or lungs (pulmonary embolism). In addition to the immediate risk of death, VTE can lead to long-term complications and health problems.
The Venous Thromboembolism Prevention Study (VTEPS) included 3,334 patients undergoing plastic and reconstructive surgery at four U.S. hospitals. All were considered at increased risk of VTE, scoring three or higher on a standard VTE risk scale (Caprini risk assessment model). The Caprini score was based on a number of known risk factors such as older age, certain types of heart or lung disease, a recent history of VTE and other medical conditions.
All patients enrolled in the VTEPS were treated with enoxaparin—a type of the blood-thinning drug heparin that has been approved for use in patients at risk of VTE. Rates of VTE within 60 days after surgery were compared with those of similar patients undergoing plastic surgery at the same hospitals without preventive enoxaparin.
Enoxaparin appeared to reduce the rate of VTE among patients at highest risk: those with a Caprini score over 8. In this group, VTE occurred in about four percent of patients receiving enoxaparin, compared to 8.5 percent of similar patients who did not receive enoxaparin.
After adjustment for the Caprini score and other important risk factors, patients receiving enoxaparin were about 60 percent less likely to develop VTE.
Enoxaparin appeared to reduce the rate of VTE among patients in the highest category of risk. When the Caprini risk score was over 8, VTE occurred in about four percent of patients receiving enoxaparin, compared to 8.5 percent of patients not receiving enoxaparin.
With adjustment for other risk factors, the VTE rate was nearly tripled for patients with a Caprini score over 8. For patients with a prolonged hospital stay of four days or longer—an indicator of more severe illness—VTE risk was close to five times higher. When accounting for these two factors, treatment with enoxaparin reduced the relative risk of VTE by about 60 percent.
Venous thromboembolism is a major safety issue in surgical patients. A recent study found that rates of VTE in plastic surgery are higher than previously thought. Studies have suggested that most plastic surgeons know how to identify patients at increased risk of VTE, but don't always don't provide adequate preventive measures. In response to this concern, The Plastic Surgery Foundation rated VTE risk assessment and prevention as its top patient safety research priority.
The VTEPS results suggest that enoxaparin is effective in reducing the rate of VTE among plastic surgery patients at highest risk. Based on data from patients undergoing other types of surgery, current recommendations call for high-risk patients to receive a full week of postoperative anticoagulant treatment. Further studies will be needed to determine the optimal duration of enoxaparin therapy in patients undergoing plastic surgery.
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