Goals: Reduction in the incidence of VTE is of high clinical importance. In addition to the use of sequential compression devices (SCDs), chemoprophylaxis with low molecular-weight heparin (LMWH) has been recommended by the American College of Chest Physicians (ACCP) for major surgery. Although these recommendations were not specific to plastic surgery procedures, some plastic surgeons physicians remain tentative to use postoperative anticoagulation due to the risk of bleeding. The purpose of this study was to review the risk of VTE and to evaluate the risk of postoperative complications secondary to chemical thromboprophylaxis in MWL patients.
Methods:  474 surgical cases were enrolled in an IRB-approved prospective clinical database in the two years before and after routine LMWH use was initiated. Inclusion required weight loss ³ 50 pounds. Group 1 was SCD-only (n=318) while Group 2 had SCDs and LMWH 6h postoperatively (n=156). Risk of VTE was calculated and complications of LMWH administration were analyzed.
Results: The overall risk of deep venous thrombosis and pulmonary embolism was 0.2%. There was no statistical difference between the groups (p > 0.05). The transfusion rate was 8.9% prior to use of LMWH and 6.4% after (p = 0.35). Overall risk of hematoma was 5.1%, in concordance with the literature. There was no difference in transfusion rate and hematoma risk between the groups (4.8% before and 5.8% after LMWH; p = 0.7).
Conclusions: The prevention of VTE remains a high priority in MWL patients. In accordance with ACCP guidelines, all of our MWL receive postop LMWH. Our protocol begins 6h postop and is administered Q12h. In our large cohort, we have demonstrated no increased risk of tranfusion or hematoma. Although we showed low incidence of VTE, the power was not strong enough to demonstrate statistical significance. In our opinion, LMWH administered 6h postop provides an excellent balance between VTE prophylaxis and the risk of bleeding complications.