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Blood Thinner Lowers Clot Risk in Plastic Surgery Patients

For high-risk plastic surgery patients, treatment with the blood-thinning drug enoxaparin can reduce the risk of serious blood clot-related complications called venous thromboembolism, a new study shows.

Venous thromboembolism is a potentially serious complication in which clots develop, blocking blood flow to the legs, called deep vein thrombosis, or to the lungs, called pulmonary embolism.

In addition to the serious risk of death, VTE can lead to long-term health problems and other complications. That is why the Plastic Surgery Foundation rated VTE risk assessment and prevention as its top patient safety research priority.

The recent Venous Thromboembolism Prevention Study followed 3,334 patients undergoing plastic and reconstructive surgery at four U.S. hospitals. All of the patients were considered at increased risk of VTE, scoring three or higher on a standard VTE risk scale - called a Caprini risk assessment model. The Caprini score was based on such risk factors as older age, certain types of lung or heart disease, a recent history of VTE and other medical conditions.

All patients enrolled in the study were treated with enoxaparin — a type of the blood-thinning drug heparin, which is now approved for use in patients at risk of VTE. Rates of VTE within 60 days after surgery were compared with those of patients who had plastic surgery at the same hospitals without use of the preventive drug enoxaparin.

For those patients at highest risk with a Caprini scover over 8, the enoxaparin reduced the rate of VTE. In this high-risk group, VTE occurred in about four percent of patients receiving the drug enoxaparin, compared to the 8.5 percent who did not receive it.

Patients receiving the drug were about 60 percent less likely to develop VTE, after accounting for the Caprini score and other risk factors.

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. In fact, the rates of VTE in plastic surgery are higher than previously thought, according to a new study. Studies have suggested that most plastic surgeons know how to identify patients at increased risk of VTE, but they don't always provide adequate preventive measures.

The study’s results show 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, researchers say high-risk patients should receive at least a full week of postoperative anticoagulant treatment.

The study’s authors say more research is needed to determine the optimal duration of enoxaparin therapy in patients undergoing plastic surgery.

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