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
