Thrombosis prophylaxis for Oral and Maxillofacial surgery patients under general anaesthesia. Suggestions for individual risk assessment model and prevention

Deep vein thrombosis (DVT) and pulmonary embolism (PE), known as venous thromboembolism (VTE), are the most preventable causes of death in surgical patients. About 10% of patients with symptomatic PE die within 60 min. Surgery, immobility, pregnancy and cancer are the most common causes, yet in 40% of cases VTE presents in previously healthy individuals with no medical history. VTE is related to patient- and procedure-specific risk factors including postoperative ambulation and risk of bleeding. Screening for individual risk factors to tailor the use of anticoagulant prophylaxis is recognised, but the cut-off point for its usage varies between the surgical specialties depending on the bleeding risk. At present, there are no national or international guidelines for VTE-prophylaxis in Oral and Maxillofacial surgery (OMS). The current guidelines for VTE are based on guidelines from the neighbouring specialties such as Ear, Nose and Throat Surgery and Plastic Surgery. This is flawed because the degree of patient- and procedure-specific risks for these patients is often higher than those encountered in OMS. The article addresses this dilemma. A proposal of risk assessment and thrombosis prophylaxis in OMS surgery is presented. Mechanical thromboprophylaxis alone or in combination with low-molecular-weight heparin (e.g., Dalteparin (Fragmin®) is advocated. Further studies within OMS are warranted.