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Evaluation of an Extended Outpatient Enoxaparin Regimen for Venous Thromboembolic Prophylaxis after Free Flap Breast Reconstruction
Will DeBrock, BS; Eric Pittelkow, MD; Steve Duquette, MD; Juan Socas, MD; Mary E. Lester, MD; Aladdin H. Hassanein, MD, MMSc
Indiana University School of Medicine
2019-02-11
Presenter: Will DeBrock
Affidavit:
The abstract is the student's original work with guidance from faculty and residents.
Director Name: Aladdin Hassanein, MD
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction: Patients undergoing free flap breast reconstruction (FFBR) are high risk for venous thromboembolism (VTE) based on Caprini scores. In orthopedic and surgical oncology literature, high risk patients are given several weeks of postoperative anticoagulation based on CHEST Journal guidelines for VTE. The purpose of this study was to compare outcomes of FFBR patients who received extended VTE prophylaxis to those who received standard inpatient-only prophylaxis.
Methods: Patients undergoing FFBR (2013-2016) were divided into two groups: (1) standard VTE prophylaxis and (2) extended prophylaxis. Both groups received prophylactic subcutaneous heparin or enoxaparin preoperatively and enoxaparin 40 mg daily postoperatively while inpatient. Group 2 was discharged with a home regimen of enoxaparin 40 mg daily, receiving at least 2 weeks of prophylaxis postoperatively. Outcome variables included flap loss, hematoma, or VTE event.
Results: One hundred patients (175 flaps) met inclusion criteria (34 patients in Group 1, 66 patients in Group 2). Mean Caprini score was 6.77 in Group 1 and 6.65 in Group 2 (p=.847), qualifying all patients as "high risk" for VTE. The incidence of VTE was 1.5% in Group 2 compared to 2.9% in Group 1 (p=0.6). There was no statistical difference in hematomas between Group 1 (n=0) and Group 2 (n=2) (p=.3). Total flap loss was 1.7%.
Conclusion: Patients undergoing FFBR are high risk for VTE. These patients can be safely treated with an extended prophylactic anticoagulation regimen, extrapolating the standard of care used for high risk patients in other surgical disciplines.
