ENTtoday
  • Home
  • COVID-19
  • Practice Focus
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Departments
    • Issue Archive
    • TRIO Best Practices
      • Allergy
      • Facial Plastic/Reconstructive
      • Head and Neck
      • Laryngology
      • Otology/Neurotology
      • Pediatric
      • Rhinology
      • Sleep Medicine
    • Career Development
    • Case of the Month
    • Everyday Ethics
    • Health Policy
    • Legal Matters
    • Letter From the Editor
    • Medical Education
    • Online Exclusives
    • Practice Management
    • Resident Focus
    • Rx: Wellness
    • Special Reports
    • Tech Talk
    • Viewpoint
    • What’s Your O.R. Playlist?
  • Literature Reviews
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Events
    • Featured Events
    • TRIO Meetings
  • Contact Us
    • About Us
    • Editorial Board
    • Triological Society
    • Advertising Staff
    • Subscribe
  • Advertise
    • Place an Ad
    • Classifieds
    • Rate Card
  • Search

Chemoprophylaxis for VTE following Head and Neck Surgery

by Christine G. Gourin, MD • February 10, 2015

  • Tweet
  • Email
Print-Friendly Version

Does venous thromboembolism prophylaxis reduce the incidence of venous thromboembolism after head and neck surgery?

Background: Venous thromboembolism (VTE) is a common complication in surgical patients and a significant cause of morbidity and mortality. Prophylaxis guidelines for otolaryngology patients have been extrapolated from guidelines for other surgical populations and include subcutaneous unfractionated heparin or low molecular weight heparin. Because many head and neck surgery patients undergo free flap reconstruction and receive anticoagulation or antiplatelet therapy, the safety and effectiveness of VTE prophylaxis in this specific population has been understudied.

You Might Also Like

No related posts.

Explore This Issue
February 2015

Study design: Retrospective chart review of adult patients hospitalized after otolaryngologic surgery between 2003 and 2010. Caprini risk score—a measure of VTE risk, VTE and bleeding outcomes—within 30 days of surgery were evaluated. VTE was confirmed by venous duplex ultrasound, CT scan, ventilation-perfusion scan, or post-mortem.

Setting: University of Michigan.

Synopsis: There were 3,498 patients who met study criteria, with VTE prophylaxis administered to 1,482 patients. Microvascular reconstruction was performed in 522 (15%). The incidence of VTE was 1.2% in patients who received VTE prophylaxis and 1.3% in patients who did not (P=0.75). Patients with a higher Caprini risk score were more likely to receive VTE prophylaxis and were more likely to also be treated with sequential compression devices. When stratified by Caprini risk score, VTE prophylaxis was more effective in patients with a score higher than 8, in whom the incidence of VTE was 18.3% without prophylaxis and 10.7% with prophylaxis. Patients undergoing microvascular reconstruction had a higher incidence of VTE without prophylaxis (7.6%) compared with all other patients (0.6%), which remained elevated after stratifying by Caprini score. VTE prophylaxis was associated with a reduced incidence of VTE after microvascular reconstruction (2.1%). Bleeding complications were higher in microvascular reconstruction patients who received VTE prophylaxis (11.9%) compared with those who did not (4.5%, P=0.01). In patients receiving VTE prophylaxis, intraoperative antiplatelet drugs (ketorolac and aspirin) were associated with a significantly increased risk of bleeding complications on multivariate analysis.

Bottom line: The efficacy of VTE chemoprophylaxis is greatest in patients with a Caprini risk score higher than eight; however, in patients receiving intraoperative antiplatelet therapy, VTE chemoprophylaxis was associated with a significant increase in bleeding complications.

Citation: Bahl V, Shuman AG, Hu HM, et al. Chemoprophylaxis for venous thromboembolism in otolaryngology. JAMA Otolaryngol Head Neck Surg. 2014;140:999-1005

—Reviewed by Christine G. Gourin, MD

Filed Under: Head and Neck, Literature Reviews Tagged With: chemoprophylaxis, venous thromboembolismIssue: February 2015

You Might Also Like:

The Triological SocietyENTtoday is a publication of The Triological Society.

The Laryngoscope
Ensure you have all the latest research at your fingertips; Subscribe to The Laryngoscope today!

Laryngoscope Investigative Otolaryngology
Open access journal in otolaryngology – head and neck surgery is currently accepting submissions.

Classifieds

View the classified ads »

TRIO Best Practices

View the TRIO Best Practices »

Top Articles for Residents

  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Why More MDs, Medical Residents Are Choosing to Pursue Additional Academic Degrees
  • What Physicians Need to Know about Investing Before Hiring a Financial Advisor
  • Tips to Help You Regain Your Sense of Self
  • Should USMLE Step 1 Change from Numeric Score to Pass/Fail?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Some Studies Predict a Shortage of Otolaryngologists. Do the Numbers Support Them?
    • Vertigo in the Elderly: What Does It Mean?
    • Complications for When Physicians Change a Maiden Name
    • Neurogenic Cough Is Often a Diagnosis of Exclusion
    • Vertigo in the Elderly: What Does It Mean?
    • New Developments in the Management of Eustachian Tube Dysfunction
    • Some Laryngopharyngeal Reflux Resists PPI Treatment
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Eustachian Tuboplasty: A Potential New Option for Chronic Tube Dysfunction and Patulous Disease
    • Tympanoplasty Tips: Otology Experts Give Advice on the Procedure
    • How Treatment for Obstructive Sleep Apnea (OSA) Is Evolving to Give Patients a Better Night’s Sleep
    • Vestibular Schwannoma Position Relative to Internal Auditory Canal Helps Predict Postoperative Facial Function
    • Vocal Fold Lipoaugmentation Provides Long-Term Voice Improvements for Glottal Insufficiency
    • Upper Lateral Cartilage Mucosal Flap Enables the Successful Closure of Larger Septal Perforations

Polls

Do you think there will be a shortage of otolaryngologists in the next five to 10 years?

View Results

Loading ... Loading ...
  • Polls Archive
  • Home
  • Contact Us
  • Advertise
  • Privacy Policy
  • Terms of Use

Visit: The Triological Society • The Laryngoscope • Laryngoscope Investigative Otolaryngology

Wiley
© 2022 The Triological Society. All Rights Reserved.
ISSN 1559-4939

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.