Ultrasound Surveillance Offers a Safe and Effective Method for Venous Thromboembolism Prevention in Plastic Surgery Patients

Abandoning Caprini Scores and Chemoprophylaxis (“Bloodletting 2.0”): A Call for Action

“…The corresponding author and former journal editor-in-chief writes: “The authors would like to express great appreciation to Dr. Pannucci for his valuable and constructive suggestions during the development of the manuscript, as well as his overall contribution to studying venous thromboembolism. His dedication to the safety of our patients is very much appreciated.” 7 Remarkably, none of the references cited by Dahmus et al 1 are to articles that are critical of risk stratification and chemoprophylaxis or recommend an alternative treatment strategy, despite numerous references in the literature over the last decade, 3,5,11,15–25 including the only prospective study in a large number (n = 1,000) of patients all screened with Doppler ultrasound 11 and the only published Level 1 randomized trial 20 …”

Invited Discussion on: Mechanical Thromboprophylaxis Alone in Body Contouring Surgery for Post Massive Weight Loss Patients: Is This Good Enough?

“…There is also no control group. Clinical diagnosis of DVT is notoriously unreliable [ 2 ]. Therefore, the true incidence of DVTs is unknown in this patient group.…”

“…To make informed decisions regarding treatment recommendations, one must first set aside preconceptions handed down from other specialties using antiquated diagnostic methods in patients undergoing joint replacements and abdominal surgery [ 2 ]. Second, a reliable diagnostic device (ultrasound) is needed.…”

“…Anesthesia is an important, and often overlooked (it is not considered in the Caprini score), [ 2 , 9 ] consideration. Petersen et al [ 1 ] use general endotracheal anesthesia exclusively.…”

“…The authors are to be commended for thinking independently and not basing their VTE prophylaxis on conventional wisdom. Ultrasound surveillance allows the diagnosis to be made before the treatment, rather than the reverse [ 2 , 5 ]. DVTs may be detected in evolution, and treated before they become dangerous [ 5 ].…”