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J Reconstr Microsurg 2022; 38(08): 647-653
DOI: 10.1055/s-0042-1742734
Original Article

Prolonged Venous Thromboembolism Prophylaxis May Not Be Necessary for DIEP Flap Breast Reconstruction: A Tertiary Center's 10-Year Experience

Hao Huang
1   NewYork-Presbyterian, Weill Cornell Medical Center, New York, New York
,
Jaime L. Bernstein
1   NewYork-Presbyterian, Weill Cornell Medical Center, New York, New York
2   NewYork-Presbyterian, Columbia University Irving Medical Center, New York, New York
,
David M. Otterburn
1   NewYork-Presbyterian, Weill Cornell Medical Center, New York, New York
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Abstract

Background Based on the 2005 Caprini Risk Assessment Model for venous thromboembolism, the American Society of Plastic Surgeons prevention guidelines would result in prolonged chemoprophylaxis (1 week or more) for the majority of patients undergoing deep inferior epigastric perforator flap breast reconstruction. We aim to assess the necessity of prolonged prophylaxis by describing our institutional experience in thromboembolism prevention and evaluating the incidence of symptomatic VTE in our patient cohort.

Methods Women who underwent DIEP flap reconstruction from August 2011 to March 2020 at a tertiary care center were included. Charts were retrospectively reviewed for patient characteristics, VTE prophylaxis regimens, and development of deep vein thrombosis and pulmonary embolism within 60 days of surgery. Caprini scores were calculated for all patients.

Results Out of the 249 patients included in the study, 245 patients received chemoprophylaxis only during hospitalization, while four patients additionally received anticoagulant for at least 2 weeks after discharge for prophylactic or therapeutic indications. The cohort's average Caprini score was 6.0, with 72.7% of scores between 3 and 6 and 26.5% at 7 or higher. One patient (0.4%), who scored a 7 and received prophylaxis only while hospitalized, developed deep vein thrombosis. There were no cases of pulmonary embolism. There was no significant difference in VTE rate between patients who received chemoprophylaxis consistent with ASPS guidelines and those who did not (p = 1.000).

Conclusion Despite our limited chemoprophylaxis use in DIEP flap patients, our VTE incidence is low. This current work suggests that the blanket application of prolonged prophylaxis is not warranted, and it further serves as impetus to re-evaluate the 2005 Caprini RAM in this patient population.

Keywords

deep inferior epigastric perforator flap - microsurgical breast reconstruction - venous thromboembolism - deep vein thrombosis - pulmonary embolism - prophylaxis

This work was presented in part at the American Society for Reconstructive Microsurgery Virtual Symposium on January 15-17, 2021, the Plastic Surgery Research Council Virtual Pentathlon on June 7-11, 2021, and the Plastic Surgery The Meeting on October 29-November 1, 2021, in Atlanta, Georgia.


This study was approved by the Weill Cornell Medicine Institutional Review Board.




Publication History

Received: 16 April 2021

Accepted: 27 December 2021

Article published online:
25 February 2022

© 2022. Thieme. All rights reserved.

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