From the Research
For patients undergoing plastic surgery, the recommended intravenous (IV) dose of heparin is not typically administered, instead, 5,000 units of unfractionated heparin is administered subcutaneously 2 hours before surgery and then every 8-12 hours postoperatively, as supported by the most recent and highest quality study 1.
Key Considerations
- The timing of the first dose is critical, as administering it too close to surgery may increase bleeding risk.
- For patients with higher thrombosis risk, such as those with multiple risk factors or undergoing lengthy procedures, the dose may be adjusted to enoxaparin 30 mg twice daily.
- Mechanical prophylaxis with sequential compression devices should be used alongside pharmacological methods.
- Patients with renal impairment require dose adjustment, typically reducing enoxaparin by 50% for creatinine clearance below 30 ml/min.
Rationale
The study by 1 compared heparin with enoxaparin for prevention of venous thromboembolism after trauma and found that heparin every 8 hours was noninferior to enoxaparin every 12 hours. This study provides the most recent and highest quality evidence for the use of heparin in preventing venous thromboembolism.
Additional Factors
- The duration of prophylaxis typically continues until the patient is fully mobile, usually 7-10 days for major procedures.
- Heparin works by enhancing antithrombin III activity, which inhibits thrombin and factor Xa, preventing clot formation.
- This prophylaxis is essential as plastic surgery patients often have restricted mobility postoperatively, increasing their risk of venous thromboembolism.
Comparison with Other Studies
While other studies, such as 2, 3, 4, and 5, provide valuable information on the use of heparin and enoxaparin in preventing venous thromboembolism, they are either older or have different patient populations, making the study by 1 the most relevant and applicable to plastic surgery patients.