Updated guidelines on DVT prevention

This month, an expert group of physicians and surgeons has published their latest guidelines on preventing, diagnosing and treating blood clots – DVT’s and pulmonary emboli.  It’s a massive report, known as AT9 – even the executive summary runs 39 pages.  It can be found here.
Why do we, as plastic surgeons, need to know this stuff?  Because DVT’s and PE’s are serious, even lethal, problems that can happen after any long surgery.  So we take this stuff very seriously.  Patient safety, to steal a line from Ford Motor company, is job one.

Here are the latest recommendations for healthy plastic surgery patients:

1.  Pretty much everyone who goes to the operating room needs to be wearing sequential compression stockings (SCD’s), unless they are less than 40 years old, and having a operation less than 45 minutes long.  We already do this.
2.  Most of the bigger cases (tummy tuck, lower body lift, etc.) should receive low molecular weight heparin – also known as “Lovenox”.  We already do this too.
3.  People that are at very high risk should get both the SCD’s and the Lovenox.  The way this” high risk” label is sorted out is based on a scale called the Caprini score.  My friends from the University of Michigan have done a lot of work, researching the use of this scale in plastic surgery patients.  You can see the details of the Caprini score there – it’s a one page, easy to use system.
What’s not totally settled in this latest report is the best timing for administering the Lovenox – 12 hours before surgery, at surgery, or sometime after surgery.  Currently, we follow the recommendations initially developed in by Orthopedic surgeons – who get a lot of DVT issues after hip and knee replacement surgery – and give it 10-12 hours post-op.  I’ll be digging through the full report to see if I can find out more about this important detail.
This is one of those basic issues in plastic surgery that, although not as exciting as discussing celebrity surgery or the latest gee-whiz gadget, makes things safer for everybody.  If you are planning a big surgery, ask your surgeon about the methods he or she is going to use to prevent you from getting a DVT.