Venous Thromboembolism Prophylaxis in Plastic Surgery: A Literature Review

This literature review discusses the risk factors and prevention methods for venous thromboembolism in plastic surgery, including the underutilization of prophylactic modalities by health professionals. The review also highlights the economic burden and increased mortality and morbidity associated with VTE events.

Introduction:
Venous thromoembolism is one of the general complications among the patients that are to
undergo any of the surgical procedures. It is considered as one of the major concern related to
the health for the reason that it increases the risk of mortality and morbidity among the
patients after the surgeries. Pulmonary embolism (PE) is the general reason for the
preventable death among the patients who are hospitalised for the surgery processes (Al-
Tawfiq and Saadeh, 2011). Combination of the features related to the specific surgery and
predisposing factors of the individual determines the risk of the venous thromoembolism
(VTE ) among the surgery patients (Al-Tawfiq and Saadeh, 2011).
Venous thromoembolism prophylaxis in elective surgery
ACCP (American College of Chest Physicians) asserted that around one-third of the 150,000
to 200,000 deaths happens as a result of the VTE every year in the United States as a result of
the surgery (Murali, 2016). (ASPS) the American Society of Plastic Surgeons in 2001
estimated that around 18,000 DVT cases related to the plastic surgery occur every year, and
on the whole incidence related to VTE in the artificial surgery varies between 0.5% and 2%
(Sindhu et al., 2017). Though the plastic surgery incidence rate seems to be stumpy, it is
assumed that such numbers only represent the patients that are symptomatic (Murali, 2016).
Around 2/3 of patients among the VTE are silent clinically, that leads to the substantial delay
in the treatment and the diagnosis (Garritano and Andrews, 2015).
Rudolf Ludwig Karl Virchow in 1859 was one of the primary physicians who demonstrated
the formation of thrombosis was caused by certain related factors: blood hypercoagulability,
endothelial damage and venous stasis (Murali, 2016). The management of the Perioperative

thrombosis and hemostasis have changed significantly from the last 50 years to embrace the
step forward invention of anticoagulants and heparin (Garritano and Andrews, 2015). In the
late 1990s, the surgical and medical and medical literature practiced a huge number of
analysis, meta-analyses and clinical studies of the problems that pertain to the VTE (Sindhu
et al., 2017). There is 90 days risk of PE due to Proximal DVT among the affected
individuals when is not treated (Morrey, 2012). Ten percent of the mortality rate is observed
due to Symptomatic PE within the first hour with the beginning of the symptoms. Many of
the events related to the VTE are potentially considered as preventable (Morrey, 2012).
Despite the literature available, certain gaps were observed between the clinical practices and
recommendations, affecting the VTE incidence (Spruill, Wade and Leslie, 2004). The
surgeon doing plastic surgery underuse the authenticate literature and risk calculating tools
which are accessible for decreasing the VTE incidence in the surgical setting that is office
based for the reason of fear of hematoma complications or bleeding postoperatively (Morrey,
2012). Venous thromboembolism results in an economic burden on both the health care
system and the patients (Sindhu et al., 2017). The objective of the literature review is to
verify the existing risk of VTE using evaluation models accessible to support in the execution
of protocols related to VTE prevention, especially for patients with high-risk cosmetic
surgical.
The significant risk factors VTE include pain, the previous record of VTE, oral
contraceptives usage, older age, therapy relate to hormone replacement and lengthened travel
(Sindhu et al., 2017). Although VTE frequency among the patients of plastic surgery is
estimated cases less than 1% to 2 %, whereas, various patients are at modest to elevated risk
of VTE. Furthermore, the authentic incidence of VTE amongst plastic surgical treatment
patients is possibly higher, because 2/3 of cases are asymptomatic (Sindhu et al., 2017).

The frequency of VTE among plastic surgery patients is far from clear, though most studies
report a rate of less than 1% to about 2% which is small but translates to the significant
numbers of the real individuals (Sindhu et al., 2017). According to Davison 0.8%, PE and
1.1% DVT rates that are reported among the abdominoplasty patients and after calculations
644 cases related to DVT and PE 468 cases were represented.
Davison et al intended that 0.35% of the risk related to DVT that was reported in the study
related to the face lifts represent around 485 individuals having 0.14% incidence of PE
transforming into 199 cases (Sindhu et al., 2017). Abdominoplasty itself has the higher VTE
risk as compared to the other plastic surgical procedures. PE incidence is reported to be as
high as 6.6% (Sindhu et al., 2017). Aly and his colleagues reported more alarming figures
that is PE to be 9.4% of the lipectomy patient’s belt (Sindhu et al., 2017).
Many of the professional societies with the medical and surgical specialities are raising
consciousness related to the serious VTE complications among the plastic surgeons and the
members. As per the clinical evidence on which agreement statements are based, the majority
of the plastic surgery patients require the VTE prophylaxis (Sindhu et al., 2017).
Additionally, many are believed to obtain anticoagulation medications for certain portion
regarding the perioperative period. Certain guidelines are to be presented that are related to
patients categorization, risk factors and how the highly regarded prevention methods are
implemented (Sindhu et al., 2017).
Conclusion:
Prophylactic modalities which are useful to the VTE are not completely utilised by the health
professionals during the plastic surgeries in spite of all the statistics to support
thromboprophylaxis for avoidance among high-risk patients. The VTE events significantly

result in to the increased mortality and morbidity all along with the steady mount in the
expenditures of health care. Patient education is supreme and ought to embrace information
related to the individual risk factors, PE or DVT symptoms, and clarification of the risk-to-
benefit ratio by using prophylaxis anticoagulants (Spruill, Wade and Leslie, 2004). Ethnicity,
malignancy, obesity, and travel are certain patient-related factors that contribute to the
enlarged risk and are considered to be clinically relevant. Practical risk factors precise to
plastic surgery comprise large-volume liposuction exceeding 5 L, utilization of common
anesthesia, abdominoplasty, and certain lengthier procedures in combination that lasts for
more than four hours includes the abdominoplasty and mastopexy together (Spruill, Wade
and Leslie, 2004). The prevention plan of VTE is created as per the procedural and patient
risk factors. In spite of the known risk related to VTE, lesser than the 50% of the surgeons
believe consistently using the chemoprophylaxis for patients with higher risks (Spruill, Wade
and Leslie, 2004).

References
Al-Tawfiq, J. and Saadeh, B. (2011). Improving adherence to venous thromoembolism
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Garritano, F. and Andrews, G. (2015). Current practices in venous thromboembolism
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Morrey, B. (2012). Incidence of venous thromboembolism in elective foot and ankle
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Murali, G. (2016). Prospective Randomized Study on the Effectiveness of Oral
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