Antithrombotic Therapy for Venous Thromboembolism and Prevention of Thrombosis in Otolaryngology–Head and Neck Surgery: State of the Art Review. (April 2018)

• Record Type: Journal Article
• Authors: Cramer, John D.; Shuman, Andrew G.; Brenner, Michael J.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 158:Number 4(2018)
• Page Start: 627
• Page End: 636
• Publication Date: 2018-04
• Subjects: deep vein thrombosis -- pulmonary embolus -- DVT -- PE -- VTE -- thromboprophylaxis -- chemoprophylaxis -- otolaryngology -- patient safety -- quality improvement -- anticoagulation -- enoxaparin -- heparin -- head and neck cancer -- guidelines -- complications; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599818756599
• Languages: English
• ISSNs: 0194-5998

Abstract

Objective: The aim of this report is to present a cohesive evidence-based approach to reducing venous thromboembolism (VTE) in otolaryngology–head and neck surgery. VTE prevention includes deep venous thrombosis and pulmonary embolism. Despite national efforts in VTE prevention, guidelines do not exist for otolaryngology–head and neck surgery in the United States. Data Sources: PubMed/MEDLINE. Review Methods: A comprehensive review of literature pertaining to VTE in otolaryngology–head and neck surgery was performed, identifying data on incidence of thrombotic complications and the outcomes of regimens for thromboprophylaxis. Data were then synthesized and compared with other surgical specialties. Conclusions: We identified 29 articles: 1 prospective cohort study and 28 retrospective studies. The overall prevalence of VTE in otolaryngology appears lower than that of most other surgical specialties. The Caprini system allows effective individualized risk stratification for VTE prevention in otolaryngology. Mechanical and chemoprophylaxis ("dual thromboprophylaxis") is recommended for patients with a Caprini score ≥7 or patients with a Caprini score of 5 or 6 who undergo major head and neck surgery, when prolonged hospital stay is anticipated or mobility is limited. For patients with a Caprini score of 5 or 6, we recommend dual thromboprophylaxis or mechanical prophylaxis alone. Patients with a Caprini score ≤4 should receive mechanical prophylaxis alone. Implications for Practice: Otolaryngologists should consider an individualized and risk-stratified plan for perioperative thromboprophylaxis in every patient. The risk of bleeding must be weighed against the risk of VTE when deciding on chemoprophylaxis.