![]() 3, 12 Enoxaparin doses greater than 40 mg daily exceed dosing guidelines, are not FDA-approved, 3, 12 and cause overdoses in 27% of patients and an unacceptable bleeding risk of 6.8%. 1 As any surgeon will attest, anticoagulation is not needed to identify bleeders! 1 Impractical antifactor Xa assays provide no direct information regarding the development of a deep venous thrombosis. Not surprisingly, preoperative anticoagulation significantly increases the risk of bleeding. 4 A level 1 randomized study reveals no increased fibrinolytic activity in plastic surgery outpatients treated with sequential compression devices. 4 Abdominoplasty with rectus plication does not significantly increase intra-abdominal pressure, 10 and does not independently correlate with VTE risk. 4 Hormonal supplementation does not correlate with VTE risk. Risk mitigation is recommended, 1 but supportive evidence is lacking. 2, 4 The existing literature already makes clear the increased VTE risk of surgery under general anesthesia with paralysis. 2, 3 The authors state that the odds ratio for VTE risk when undergoing general anesthesia in comparison with monitored anesthesia care needs to be studied, again referencing publications that made no such recommendation. 1 The authors write, “the Caprini score was validated in patients who had general endotracheal anesthesia,” erroneously referencing two studies that in fact refute the validity of Caprini scores. How have these methods performed? Is a safer and more effective alternative available?Ī 2021 review of this topic endorses individual risk assessment for VTE prevention. Today, with more information available, it is appropriate to review the evidence. ![]() Individual risk stratification and chemoprophylaxis for venous thromboembolism (VTE) prevention have been promoted in the plastic surgery literature for over a decade. ![]()
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