Evidence-based practices for thromboembolism prevention: summary of the ASPS Venous Thromboembolism Task Force Report.
ABSTRACT In July of 2011, the American Society of Plastic Surgeons Executive Committee approved the Venous Thromboembolism Task Force Report. The report includes a summary of the scientific literature relevant to venous thromboembolism and plastic surgery along with five evidence-based recommendations. The recommendations are divided into two sections: risk stratification and prevention. The risk stratification recommendations are based on the 2005 Caprini Risk Assessment Module, which has been validated in the scientific literature as an effective tool for risk-stratifying plastic and reconstructive surgery patients based on individual risk factors for 60-day venous thromboembolism. The three prophylaxis recommendations are dependent on an individual patient's 2005 Caprini Risk Assessment Module score.
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ABSTRACT: Chemoprophylaxis has been recommended for plastic surgery patients judged to be at increased risk for venous thromboembolism. Several investigators have encountered this complication in patients despite anticoagulation therapy. An increased rate of complications related to postoperative bleeding has been reported. This article examines the efficacy and safety of this intervention, along with ethical considerations, in an attempt to determine whether any benefits of chemoprophylaxis justify the additional risks. The statistical methods and conclusion of the Venous Thromboembolism Prevention Study are challenged. Other preventative measures that do not cause negative side effects are discussed as safer alternatives.Plastic and reconstructive surgery. Global open. 06/2013; 1(3):e23.
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ABSTRACT: Massive weight loss following bariatric surgery causes unwanted excess skin and subcutaneous tissue. Intraoperative abdominal wall exposure during abdominal contouring surgery provides the possibility for concurrent ventral, umbilical, or inguinal hernia repair. The authors evaluated the incidence of postoperative complications following abdominal contouring surgery with or without concurrent hernia repair and the impact of surgical specialty.Plastic and reconstructive surgery. 10/2014; 134(4):539e-50e.
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ABSTRACT: The Venous Thromboembolism Prevention study concludes that anticoagulation is effective in reducing the risk of thromboembolism in patients who are identified as higher risk by Caprini scores. This report critically assesses the statistics used in the Venous Thromboembolism Prevention study, its method of data presentation, and its conclusions. The usefulness of risk stratification and the value of anticoagulation-both prevailing concepts in risk reduction today-are challenged. Actual data show that chemoprophylaxis has no proven benefit in plastic surgery. Complications of anticoagulation predictably include excessive bleeding and hematomas, which may be serious and life-threatening. Several large published series of patients undergoing elective plastic surgery under total intravenous anesthesia have shown a much reduced risk of thromboembolism. A SAFE (Spontaneous breathing, Avoid gas, Face up, Extremities mobile) anesthesia method is discussed as a safer and more effective alternative to traditional general endotracheal anesthesia and anticoagulation. The choice for plastic surgeons is not between a venous thromboembolism and a hematoma. The choice is between a thromboembolism and adjusting our anesthesia and surgery habits to reduce the risk to a baseline level.Plastic and reconstructive surgery. Global open. 06/2014; 2(6):e160.