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VTE Prophylaxis in Aesthetic Surgery Patients

David Green MD, PhD
DOI: http://dx.doi.org/10.1016/j.asj.2006.04.008 317-324 First published online: 1 May 2006

David Green, MD, PhD, is a board-certified hematologist.

Dr. Young: Dr. Green, how do you assess risk for venous thromboembolism (VTE) and how do you decide what to recommend for prophylaxis?

Dr. Green: I follow the evidence-based guidelines of the Seventh American College of Chest Physician's (ACCP) Conference on Antithrombotic and Thrombolytic Therapy. These provide the levels of risk associated with deep vein thrombosis (DVT) and pulmonary embolism (PE), suggesting prevention strategies at each risk level (Table 1).1 The lowest risk would be minor surgery in a patient younger than 40 years with no other risk factors.

View this table:
Table 1

Levels of thromboembolism risk in surgical patients without prophylaxis

Dr. Young: According to those guidelines, what category do you think most plastic surgery patients would fall under?

Dr. Green: I would say “general surgery” probably comes closest, but, obviously, plastic surgery procedures vary greatly, from relatively minor surgeries to major operations under general anesthesia. So there is a lot of variability.

Dr. Young: When we were planning this interview, we were unable to find a definition in the literature for minor surgery, although this term is frequently used. Could you define a minor versus a major procedure?

Dr. Green: I would use several characteristics. First, minor procedures are usually done on an outpatient basis. Second, duration is usually less than one hour. Third, the anesthesia is usually regional as opposed to general. Usually, the patients are ambulatory immediately following the procedure, which is very important in terms of VTE prevention.

Dr. Eaves: In terms of major surgeries, there is a tremendous difference between an operation that may last 1 or 2 hours, with minimal blood loss, compared with an operation that may last 8, 10, or even 12 hours. We generally assume the more extensive the procedure, or if …

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