The Venous Thromboembolism Prevention Study (VTEPS) is a multi-center study, designed to evaluate the effectiveness and safety of post-operative enoxaparin prophylaxis for venous thromboembolism (VTE) prevention. Encompassing four tertiary care facilities: the University of Pittsburgh, the University of Texas--Southwestern, Regions Hospital (St. Paul, MN), and the University of Michigan, the objective of this study was to prevent the incidence of VTE in plastic and reconstructive surgery patients.
Preoperative VTE risk was quantified using the previously validated Caprini Risk Assessment Model. In early 2009, all sites adopted an identical clinical protocol. The protocol specified that all patients with Caprini scores ≥3 would receive post-operative, prophylactic dose enoxaparin, started 6-8 hours after surgery and continued for the duration of inpatient stay.
Data from this study supports that adult plastic and reconstructive surgery patients should receive a pre-operative VTE risk stratification using the Caprini Risk Assessment Model. Prophylactic-dose enoxaparin significantly reduces 60-day VTE events in high risk patients (Caprini score ≥7) when provided post-operatively. Prophylactic-dose enoxaparin is not associated with increased rates of re-operative hematoma in the overall patient population or the high-risk breast surgery subgroups. For patients with Caprini score ≥7 who are at high risk for post-operative VTE events, clinicians should strongly consider providing post-operative, inpatient enoxaparin.
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