European guidelines on peri-operative venous thromboembolism prophylaxis: first update.

European Guidelines on perioperative Venous Thrombo Embolim Prophylaxis – First Update- Plastic Surgery section We recommend the 2005 Caprini Risk Assessment Model (RAM) as a reference point for DVT/PE risk stratification in plastic surgery. (Grade 1C). We suggest that abdominal contouring procedures (especially abdominoplasty combined with liposuction or with hernia) be considered at higher VTE/PE risk. (Grade 2B).Patients with a hypercoagulable pattern are at an increased risk of flap failure caused by microvascular thrombosis. We suggest using prevention with selective therapeutic anticoagulation. (Grade 2C). We suggest the use of low molecular weight heparin (LMWH) in the postoperative period once daily. (Grade 2B). We suggest that in surgery with an indication for VTE prophylaxis, a higher prophylactic dose of LMWH (3000–4000 anti-Xa IU every 12 h subcutaneously) should be considered for morbidly obese patients with a BMI of more than 40 kg m2 undergoing plastic surgery. (Grade 2C). We suggest using a duration of anticoagulation ranging from 7 to 30 days, according to DVT/PE risk stratification, as described in 2005 Caprini RAM. (Grade 2C). Clinical practice statement: There is insufficient evidence to support specific preoperative or postoperative blood parameters, including haemoglobin and haematocrit level for reducing flap thrombosis and failure in microsurgical procedures. Clinical practice statement: Weight-based LMWH (Enoxaparin 0.5 mg/ 50 IU per kg) for thromboembolic prophylaxis in the postoperative period for plastic surgery patients deserves further research which should incorporate both a multicentre and randomised design. Simple statement: There is no evidence to support the use of DOACs over LWMH because we do not know if DOACs are non-inferior to LMWH for thromboembolic prophylaxis in plastic surgery patients. Clinical practice statement: The use of Infection Prevention and Control (IPC) might play a role in VTE risk reduction in plastic surgery patients, either in combination with chemoprophylaxis, or alone, in patients where LMWH is contraindicated, but further evidence is needed.