Risks and Benefits of DVT/PE Prophylaxis in Otolaryngology

Abstract

Objective: The consequences of perioperative venous thromboembolism (VTE) can be devastating. This study is designed to 1) correlate the incidence of VTE with perioperative risk assessment, 2) determine whether VTE prophylaxis effectively decreases the risk of perioperative VTE, and 3) assess if VTE prophylaxis increases bleeding complications in otolaryngology.

Method: A retrospective case-control study was conducted at a tertiary care medical center among adults presenting for otolaryngologic surgery from 2003 to 2010 (n = 3498). Patients treated before the implementation of guideline-based VTE prophylaxis protocols were compared to patients treated after implementation. Primary outcome variables were Caprini risk level, perioperative VTE, and bleeding complications.

Results: The odds of a VTE increased 1.435 times with each level increase in the Caprini VTE risk level (P = .048). The VTE rate after implementation of prophylactic protocols was significantly lower than prior to implementation (OR 0.286, P = .005). However, the type of VTE prophylaxis had no significant effect on the likelihood of developing a VTE. The likelihood of a bleeding complication was not significantly different before and after implementation. The odds of a bleeding complication increased for patients receiving twice daily enoxaparin (OR 4.546, P = .032) or a treatment (rather than prophylactic) dose of anticoagulant (OR 3.546, P < .001).

Conclusion: Perioperative VTE risk stratification based on Caprini risk assessment in otolaryngology is effective. The odds of VTE decreased after the implementation of guideline-directed VTE prophylaxis. Although perioperative bleeding complications did not increase after the implementation of VTE prophylaxis protocols, therapeutic anticoagulation is associated with a higher incidence of bleeding complications.