<p>Choosing the Right DVT Prophylaxis in the Massive Weight Loss Patient</p><p>Alan H. Chen, M.D.; Carolyn Rogers, B.S.; Angela Song, M.D.; Lawton Tang, M.D.; James O’Toole, M.D.; Ian L. Valerio, M.D., M.S., M.B.A., and J. Peter Rubin, M.D. INTRODUCTION: There are estimated 200,000 deaths from pulmonary embolism per year in the U.S. accounting up to 5 percent of postoperative deaths (1). A study of 500 patients in five surgical specialties</p><p>(general surgery, orthopedics, gynecological surgery, genitourinary surgery and vascular surgery) indicated that the incidence of DVT in can be as high as 36% when no DVT prophylaxis was used (2).</p><p>The reported incidences of DVT and PE in plastic surgery range from 0.39% to 1.1%, and 0.16% to 0.8%, respectively (3-6). The appropriate DVT prophylaxis remains unclear in post-massive weight loss patients who undergo body contouring operations. The rich subcutaneous vascularity in these patients raises concern over bleeding risk, which may be exacerbated by chemical DVT prophylaxis. We report the efficacy of sequential compression devices and early ambulation in post-massive weight loss body contouring patients. Chemical prophylaxis was used in patients who are at high risk for DVT. </p><p>METHODS: Clinical outcomes were analyzed for all post-massive weight loss patients who underwent body contouring operations by one surgeon from December, 2002 to January, 2006. </p><p>The method of DVT prophylaxis used, and complications such as DVT/PE, post-operative bleeding, and the need for re-operation were analyzed. </p><p>RESULTS: Two-hundred ninety-nine body contouring patients with 346 anesthetic events were analyzed.</p><p>Pre-inductive sequential compression devices were employed in 323 (93.4 %) events. Intra-operative time averaged 4.52+/-3.22 hours. Eighteen patients (5.2 %) at high risk for DVT were given chemical prophylaxis preoperatively. These patients were given heparin, lovenox, or fragmin. All patients had sequential compression devices ordered postoperatively, and were encouraged to ambulate within 24 hours. Hematomas occurred after 16 (4.6 %) events. A total of 7 (2.0 %) patients required re-operation for bleeding. Two (11.1%) of the patients who received chemical prophylaxis, and 5 (1.5 %) of the patients who did not received chemical prophylaxis required re-operation for bleeding. No clinically significant</p><p>DVT/PE occurred. CONCLUSION: In this study, we found that sequential compression devices and early ambulation appear effective against development of clinically significant DVT in body contouring patients with low to moderate risk for thrombosis. However, there is a tendency toward bleeding complications in these massive weight loss patients. Therefore, routine chemical prophylaxis appears to be less desirable in this patient population. REFERENCE</p><p>1. Anderson, F. A., Wheeler, H. B., Goldberg, R. J., et al. A population-based perspective of the hospital</p><p> incidence and case fatality rates of deep vein thrombosis and pulmonary embolism: The Worcester</p><p>DVT Study. Arch. Intern. Med. 151: 933, 1991.</p><p>2. Geerts WH. Pineo GF. Heit JA. Bergqvist D. Lassen MR. Colwell CW. Ray JG. Prevention of venous</p><p> thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.</p><p>Chest. 126(3 Suppl): 338S-400S, 2004.</p><p>3. Reinish, J. F., Bresnick, S. D., and Walker, J. W., and Rosso, R. F. Deep venous thrombosis and</p><p> pulmonary embolus after face lift: A study of incidence and prophylaxis. Plast. Reconstr. Surg. 107:</p><p>1570, 2001.</p><p>4. Grazer, F. M., and Goldwyn, R. M. Abdominoplasty assessed by survey, with emphasis on</p><p> complications. Plast. Reconstr. Surg. 59: 513, 1977.</p><p>5. Hester, R. T., Jr., Baird, W., Bostwick, J., III, Nahai, F., and Cukic, J. Abdominoplasty combined with</p><p> other surgical procedures: Safe or sorry? Plast. Reconstr. Surg. 83: 997, 1989.</p><p>6. Davison SP. Venturi ML. Attinger CE. Baker SB. Spear SL. Prevention of venous thromboembolism</p><p> in the plastic surgery patient. Plast. Reconstr. Surg. 114(3): 43E-51E, 2004.</p>