DVT or Pulmonary Embolism (PE) Prophylaxis in Breast Surgery

  • The risk of DVT or pulmonary embolism (PE):
    • Is very low with most breast operations
    • The exception is breast operations:
      • Having long duration of general anesthesia and autologous reconstruction with flaps
  • No specific prophylaxis for DVT / PE is necessary for breast operations:
    • Performed with local or regional anesthesia
  • Ambulation and leg compression stockings:
    • Are adequate for prophylaxis of DVT / PE in the vast majority of patients undergoing breast surgery in a report from MD Anderson Cancer Center
  • Aspirin:
    • Is not considered sufficient prophylaxis for any patient at moderate to high risk for DVT / PE
  • Vena cava filters decrease the risk of PE but do not prevent DVT
  • The most effective method to decrease a repeat DVT in a patient at moderate risk:
    • Is with chemoprophylaxis with:
      • Low molecular weight heparin or low dose unfractionated heparin given preoperatively, then continued
  • References
    • Andtbacka RH, Babiera G, Singletary SE, Hunt KK, Meric-Bernstam F, Feig BW, et al. Incidence and prevention of venous thromboembolism in patients undergoing breast cancer surgery and treated according to clinical pathways. Ann Surg. 2006;243(1):96-101.
    • El-Tamer MB, Ward BM, Schifftner T, Neumayer L, Khuri S, Henderson W. Morbidity and mortality following breast cancer surgery in women: national benchmarks for standards of care. Ann Surg. 2007;245(5):665-671.
    • Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ; American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel. Executive summary: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl);7S-47S.
    • Neumayer L, Schifftner TL, Henderson WG, Khuri SF, El-Tamer M. Breast cancer surgery in Veterans Affairs and selected university medical centers: results of the patient safety in surgery study. J Am Coll Surg. 2007;204(6):1235-1241.

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