Fondaparinux Significantly Reduces Postoperative Venous Thromboembolism After Body Contouring Procedures Without an Increase in Bleeding Complications

Abstract

Background It is well established that abdominoplasty confers a uniquely high risk of venous thromboembolism (VTE) complications. However, chemoprophylaxis is not routinely utilized due to the risk of bleeding complications. Fondaparinux, a factor Xa inhibitor FDA approved in 2001 for postoperative VTE prophylaxis, has emerged as a safe option for preventing VTE complications after high-risk surgeries. Objectives The goal of this study was to examine the effectiveness and safety of fondaparinux for VTE chemoprophylaxis in patients undergoing abdominoplasty. Methods This is a single-center retrospective chart review from January 2008 to December 2014 of 492 patients who underwent abdominoplasty with or without an additional body procedure. Prior to 2011, no VTE chemoprophylaxis was utilized (n = 233). In 2011, the routine employment of postoperative chemoprophylaxis with fondaparinux was implemented (n = 259). Patient demographics and 2005 Caprini scores were evaluated. Primary outcomes included postoperative VTE and bleeding complications. Results There were no statistical differences in patient demographics or median Caprini score. The treatment group demonstrated a statistically significant reduction in the rate of VTE compared with the nontreatment group (0% vs 2.1%, respectively, P = 0.02). There was no statistically significant difference in the rate of hematoma requiring reoperation between the nontreatment and treatment groups (1.7% vs 2.3%, P = 0.76) or blood loss requiring transfusion (0% vs 0.8%, P = 0.5). Conclusions Fondaparinux for VTE chemoprophylaxis after abdominoplasty is efficacious in decreasing the risk of VTE in this susceptible patient population without increasing the risk of postoperative bleeding complications. Level of Evidence: 3

Standards and Trends in Lipoabdominoplasty

“… 58 Finally, Sarhaddi et al published a single-center retrospective review of 233 patients who received no chemoprophylaxis and 252 who received fondaparinux for 7 days after surgery. 59 They noted that a significantly fewer VTE in the group received chemoprophylaxis (2.1% versus 0%); no significant difference in hematoma requiring reoperation (2.3% versus 1.7%); and no significant increase in blood loss requiring transfusion (0% versus 0.8%). Based on these and other recent reports, 60 it appears that VTE chemoprophylaxis achieves the goal of reducing VTE risk without increasing the incidence of hematoma or the need for transfusion.…”

Reconsidering the Role of Routine Anticoagulation for Venous Thromboembolism Prevention in Plastic Surgery

“…16 Some statisticians use a Yates correction when the expected frequency is fewer than 10. 17 , 18 (In the study by Sarhaddi et al, 4 2 of the 4 group sizes were 0 and 5.) This correction is recommended to reduce the risk of a type I statistical error (ie, concluding that a real difference exists when it does not).…”

“…A χ 2 test determined a significant difference ( P = 0.02). 4 However, the study is limited by a small study population. Group sizes of just over 200 patients are small when examining a complication that typically occurs at a rate of less than 1%.…”

“…Today, many plastic surgeons prescribe routine anticoagulation (“chemoprophylaxis”) in an effort to reduce venous thromboembolism (VTE) risk in plastic surgery patients. 1 – 4 Anticoagulation has an appeal because it seems to make sense. However, its efficacy and safety have been challenged.…”

“…In a recently published study, Sarhaddi et al 4 conclude that fondaparinux reduces the risk of VTE without increasing the risk of bleeding. In a retrospective chart review, the authors compared 2 historical groups of abdominoplasty patients.…”