The Efficacy of Prophylactic Low-Molecular-Weight Heparin to Prevent Pulmonary Thromboembolism in Immediate Breast Reconstruction Using the TRAM Flap

Kim, Eun Key; Eom, Jin Sup; Ahn, Sei Hyun; Son, Byung Ho; Lee, Taik Jong

doi:10.1097/prs.0b013e3181904be7

Cited by 71 publications

(50 citation statements)

References 22 publications

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“…[121][122][123] Based on this limited evidence, we consider most plastic and reconstructive surgery patients to be at average risk for bleeding complications, recognizing In low-risk patients, rate of symptomatic VTE was 0%.…”

Section: Baseline Risk Risk Factors and Risk Stratifi Cation For Mamentioning

confidence: 99%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,857

744

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(Grade 2C) prophylaxis be used other than early ambulation. For patients at low risk for VTE ( ‫ف‬ 1.5%), we suggest mechanical prophylaxis, preferably with intermittent pneumatic compression (IPC), over no prophylaxis (Grade 2C). For patients at moderate risk for VTE ( ‫ف‬ 3%) who are not at high risk for major bleeding complications, we suggest low-molecular-weight heparin (LMWH) (Grade 2B), low-dose unfractionated heparin (Grade 2B), or mechanical prophylaxis with IPC (Grade 2C) over no prophylaxis. For patients at high risk for VTE ( ‫ف‬ 6%) who are not at high risk for major bleeding complications, we recommend pharmacologic prophylaxis with LMWH (Grade 1B) or low-dose unfractionated heparin (Grade 1B) over no prophylaxis. In these patients, we suggest adding mechanical prophylaxis with elastic stockings or IPC to pharmacologic prophylaxis (Grade 2C). For patients at high risk for VTE undergoing abdominal or pelvic surgery for cancer, we recommend extended-duration, postoperative, pharmacologic prophylaxis (4 weeks) with LMWH over limited-duration prophylaxis (Grade 1B). For patients at moderate to high risk for VTE who are at high risk for major bleeding complications or those in whom the consequences of bleeding are believed to be particularly severe, we suggest use of mechanical prophylaxis, preferably with IPC, over no prophylaxis until the risk of bleeding diminishes and pharmacologic prophylaxis may be initiated (Grade 2C). For patients in all risk groups, we suggest that an inferior vena cava fi lter not be used for primary VTE prevention (Grade 2C) and that surveillance with venous compression ultrasonography should not be performed (Grade 2C). We developed similar recommendations for other nonorthopedic surgical populations. Conclusions: Optimal thromboprophylaxis in nonorthopedic surgical patients will consider the risks of VTE and bleeding complications as well as the values and preferences of individual patients. CHEST 2012; 141(2)(Suppl):e227S-e277SAbbreviations: CABG 5 coronary artery bypass graft; ES 5 elastic stockings; ICH 5 intracranial hemorrhage; IPC 5 intermittent pneumatic compression; IVC 5 inferior vena cava; LDUH 5 low-dose unfractionated heparin; LMWH 5 low-molecular-weight heparin; PE 5 pulmonary embolism; QALY 5 quality-adjusted life year; RR 5 risk ratio; VCU 5 venous compression ultrasonography

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Section: Baseline Risk Risk Factors and Risk Stratifi Cation For Mamentioning

confidence: 99%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,857

744

View full text Add to dashboard Cite

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“…15%. [34][35][36] This study did not screen routinely for asymptomatic VTE. Thus, our reported VTE rates likely underestimate the true VTE burden.…”

Section: Acknowledgmentsmentioning

confidence: 99%

A Validated Risk Model to Predict 90-Day VTE Events in Postsurgical Patients

Pannucci¹,

Laird²,

Dimick³

et al. 2014

Chest

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Background: VTE is the proximate cause of 100,000 deaths in the United States each year. Perioperative VTE risk among surgical patients varies by 20-fold, which highlights the importance of risk stratifi cation to identify high-risk patients, in whom chemoprophylaxis can decrease VTE risk, and low-risk patients, for whom the risk-benefi t relationship of prophylaxis may be unfavorable. Methods: We used data from a statewide surgical quality collaborative for surgical procedures performed between 2010 and 2012. Regression-based techniques identifi ed predictors of 90-day VTE while adjusting for procedural complexity and comorbid conditions. A weighted risk index was created and was validated subsequently in a separate, independent dataset. Results: Data were available for 10,344 patients, who were allocated randomly to a derivation or validation cohort. The 90-day VTE rate was 1.4%; 66.2% of the derivation cohort and 65.5% of the validation cohort received chemoprophylaxis. Seven risk factors were incorporated into a weighted risk index: personal history of VTE, current cancer, sepsis/septic shock/systemic infl ammatory response syndrome, age Ն 60 years, BMI Ն 40 kg/m 2 , male sex, and family history of VTE. Prediction for 90-day VTE was similar in the derivation and validation cohorts (areas under the receiver operator curve, 0.72 and 0.70, respectively). An 18-fold variation in 90-day VTE rate was identifi ed. Conclusions: A weighted risk index quantifi es 90-day VTE risk among surgical patients and identifi es an 18-fold variation in VTE risk among the overall surgical population.

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“…1 In the past decades, extensive research has been performed on enhancing skin flap viability by pharmacological manipulation including sympatholytic drugs, vasodilators, and calcium channel blockers, which however are either with conflicting results or inconsistent in the prevention of flap necrosis. [2][3][4] The administration of growth factors related to angiogenesis, such as the basic fibroblast growth factor (bFGF) and vascular endothelium growth factor (VEGF), seems promising, but is limited by their short half-life and potential side effects. [5][6][7] Recently, the stem cell therapy has aroused interest in improving flap survival.…”

mentioning

confidence: 99%

Improvement of the skin flap survival with the bone marrow‐derived mononuclear cells transplantation in a rat model

Yang

Sheng

et al. 2010

Microsurgery

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Partial necrosis of skin flaps remains a significant problem in plastic and reconstructive surgery. In this study we attempted to evaluate the effect of bone marrow-derived mononuclear cells (BM-MNCs) transplantation on improvement of skin flap survival in a rat random pattern skin flap model. Thirty Wistar rats were divided into three groups with each consisting of 10 rats. BM-MNCs and the adipose-derived stem cells (ADSCs) were transplanted into the subcutaneous tissue in the area where the flap would be dissected. The flaps were then raised two days after cells transplantation. The animals receiving the preoperative Dulbecco's Modified Eagle Medium (DMEM) treatment were used as the controls. On the 7th postoperative day, the survival areas of flaps were measured and tissues were collected for examinations. The results showed that the mean survival areas were 46.33 +/- 13.46% in the ADSCs group and 50.06 +/- 13.82% in the BM-MNCs group as the percentages of the total skin flaps, which were significantly higher than that in the control group (26.33 +/- 7.14%) (P < 0.05). Histological analysis showed increased neovascularization in the flap treated with BM-MNCs when compared with ADSCs transplantation. Survival BM-MNCs and ADSCs were detected in the flap tissues. Higher levels of the basic fibroblast growth factor (bFGF) and vascular endothelium growth factor (VEGF) were found in the BM-MNCs transplantation group (P < 0.05). The findings from this study demonstrated that preoperative treatment with BM-MNCs transplantation could promote neovascularization and improve flap survival. These effects of BM-MNCs on flap survival were comparable with ADSCs transplantation, but without necessity of in vitro cells expansion.

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The Efficacy of Prophylactic Low-Molecular-Weight Heparin to Prevent Pulmonary Thromboembolism in Immediate Breast Reconstruction Using the TRAM Flap

Abstract: : Prophylactic use of low-molecular-weight heparin was effective in preventing pulmonary thromboembolism without increasing problematic bleeding-related complications in TRAM flap immediate breast reconstruction patients.

Cited by 71 publications

References 22 publications

Prevention of VTE in Nonorthopedic Surgical Patients

Prevention of VTE in Nonorthopedic Surgical Patients

A Validated Risk Model to Predict 90-Day VTE Events in Postsurgical Patients

Improvement of the skin flap survival with the bone marrow‐derived mononuclear cells transplantation in a rat model

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