Implementation of a Venous Thromboembolism Prophylaxis Protocol Using the Caprini Risk Assessment Model in Patients Undergoing Mastectomy
- 431 Downloads
Guidelines for venous thromboembolism (VTE) prophylaxis are not well-established for breast surgery patients. An individualized VTE prophylaxis protocol using the Caprini score was adopted at our institution for patients undergoing mastectomy ± implant-based reconstruction. In this study, we report our experience during the first year of implementation.
In August 2016, we adopted a VTE prophylaxis protocol for patients undergoing mastectomy ± implant-based reconstruction. We used the Caprini score, a validated risk assessment tool for VTE, to determine each patient’s perioperative prophylaxis regimen. Detailed chart review was performed to record patient and treatment details, the Caprini score, pharmacologic VTE prophylaxis administration, and 30-day incidence of VTE and bleeding complications. We performed univariate analysis to identify factors associated with protocol compliance.
Overall, 522 patients met the inclusion criteria. Median age was 51 years, 486 (93.1%) patients had malignancy, 234 (44.8%) underwent bilateral mastectomy, and 350 (67.0%) underwent reconstruction. Caprini scores ranged from 2 to 11, with 431 (82.6%) patients having a score from 5 to 7. Overall protocol compliance was 60.5%, and was associated with bilateral mastectomy (p = 0.02), reconstruction (p = 0.03), and longer procedures (p < 0.001). The rate of VTE was 0.2% (95% confidence interval [CI] 0.03–1.1%), rate of reoperation for hematoma was 2.7% (95% CI 1.6–4.5%), and rate of blood transfusion was 0.4% (95% CI 0.1–1.4%).
The implementation of an individualized VTE prophylaxis protocol for patients undergoing mastectomy ± implant-based reconstruction is safe and feasible. Despite a high-risk cohort, the incidence of VTE was very low and bleeding complications were consistent with reported rates for breast surgery. Continued evaluation of this strategy is warranted.
Alison Laws, Kathryn Anderson, Jiani Hu, Kathleen McLean, Lara Novak, Laura S. Dominici, Faina Nakhlis, Matthew Carty, Stephanie Caterson, Yoon Chun, Margaret Duggan, William Barry, Nathan Connell, Mehra Golshan, and Tari A. King have no disclosures to declare.
- 1.Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e227S–e77S.CrossRefPubMedPubMedCentralGoogle Scholar
- 3.National Clinical Guideline Centre—Acute and Chronic Conditions (UK). Venous thromboembolism: reducing the risk of venous thromboemolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital. London: Royal College of Physicians (UK); 2010.Google Scholar
- 4.Prevention of fatal postoperative pulmonary embolism by low doses of heparin. An international multicentre trial. Lancet. 1975;2:45–51.Google Scholar
- 14.The American Society of Breast Surgeons. Consensus guideline of venous thromboembolism (VTE) prophylaxis for patients undergoing breast operations. v11.30.2016. 2016. Available at: https://www.breastsurgeons.org/new_layout/about/statements/PDF_Statements/VTE_Statement.pdf.