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Efficacy of VTE chemoprophylaxis in otolaryngology patients varied by subgroup
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The efficacy and safety of venous thromboembolism chemoprophylaxis for individuals undergoing otolaryngologic surgery varied based on Caprini risk score and the type of surgical procedure required, according to results of a retrospective cohort study.
Patients with high Caprini risk scores, as well as those undergoing microvascular free tissue transfer, appeared to benefit the most, results showed.
The analysis included 3,498 adults admitted to an academic tertiary care medical center for otolaryngologic surgery between Sept. 1, 2003, and June 30, 2010. Of these patients, 1,482 received venous thromboembolism (VTE) chemoprophylaxis with either unfractionated or low–molecular-weight heparin. The other 2,016 patients received no VTE prophylaxis.
Researchers documented VTE and bleeding events at 30 days. They also analyzed VTE outcomes based on Caprini risk scores, which account for genetic and clinical characteristics, as well as presenting illness and the type of procedure patients must undergo.
Eighteen patients (1.2%) who underwent chemoprophylaxis and 27 patients (1.3%) who received no prophylaxis developed a VTE (P=.75).
Chemoprophylaxis reduced risk for VTE among patients with Caprini risk scores >7 (5.3% vs. 10.4%; P=.06), as well as among patients undergoing microvascular free tissue transfer (2.1% vs. 7.7%; P=.002). Chemoprophylaxis did not significantly influence the likelihood of VTE in any other patient group (1% vs. 0.6%; P=.12).
Results showed chemoprophylaxis was associated with higher rates of bleeding complications overall (3.5% vs. 1.2%; P<.001). The effect of chemoprophylaxis on bleeding complications was most apparent among patients who underwent microvascular free tissue transfer (11.9% vs. 4.5%; P=.01). Chemoprophylaxis did not significantly influence the likelihood of bleeding among patients who underwent other procedures (1.5% vs. 0.9%; P=.15).
Researchers observed an association between bleeding complications and the concomitant use of antiplatelet medications and VTE prophylaxis.
“Free tissue transfer patients merit special analysis when developing recommendations for VTE prophylaxis because of the high risk of both VTE and bleeding,” the researchers concluded. “Further tests of the incidence of VTE by risk level, and of the effectiveness and safety of chemoprophylaxis, should be conducted for other otolaryngology patients in populations large enough to produce sufficiently powered analyses.”
Disclosure: The researchers report no relevant disclosures.
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