Observations
Blood thinner lowers clot risk after surgery
Treatment duration needs more research
Venous thromboembolism (VTE), or deep vein thrombosis in the legs and pulmonary embolism in the lungs, is one of the most serious potential complications for patients undergoing major cosmetic surgical procedures.
Risk factors include heart or respiratory disease, predisposition to clotting, varicose veins, obesity and smoking. A combination of any for plastic surgery patients coupled with the type of surgery may predispose a patient to VTE.
A US study, published in the November 2011 issue of Plastic and Reconstructive Surgery, examined whether post-operative administration of the drug enoxaparin prevents VTE in adult plastic surgery patients. A total of 3334 patients were included in the study, receiving treatment in 2009 at four sites across the US.
Enoxaparin sodium is marketed by Sanofi under the trade names Lovenox in the US and Clexane in the UK. The drug is a low molecular weight heparin and anticoagulant used to prevent and treat VTE.
The drug is administered by subcutaneous or intravenous injection and has a long half-life compared with standard heparin. It can be administered by doctors, nurses or patients themselves to prevent or treat the development of blood clots.
Eligibility requirements for the study included adult patients undergoing an operation under general anaesthesia, postoperative submission to the hospital for at least one night, and a moderate to high risk for VTE, measured using the Caprini Risk Assessment Model.
The model assesses the likelihood of a patient developing clots in the deep veins of the legs or lungs following surgery. The higher the Caprini score, the more likely blood clots will develop after surgery.
For the study, patients with a score of three or more received post-operative enoxaparin prophylaxis for the duration of inpatient stay. The control group received no chemoprophylaxis for 60 days following surgery.
Results of the study show that post-operative enoxaparin was protective against venous thromboembolism events over 60 days following surgery in high-risk patients (Caprini >7).
Patients receiving the drug immediately after treatment were around 60% less likely to develop VTE. Length of patient stay greater than four days was shown to be an independent risk factor for VTE but administration of enoxaparin helps prevent the condition.
While the study followed patients for 60 days after surgery, the risk of VTE may remain elevated for up to 90 days. The authors conclude that duration of chemoprophylaxis, or drug administration, in plastic surgery patients following treatment needs more research, as optimal duration is not yet known.
