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Randomized Trial of Deep Vein Thrombosis Chemoprophylaxis with Bemiparin and Enoxaparin in Patients with Moderate to High Thrombogenic Risk Undergoing Plastic and Reconstructive Surgery Procedures

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Abstract

Background

Deep vein thrombosis (DVT) is a common complication during postoperative convalescence characterized by hypercoagulability, vascular endothelium damage and blood stasis. It increases noticeably in peri/postoperative phases of surgery procedures. Pulmonary embolism secondary to iliofemoral DVT is a frequent cause of death.

Methods

Adult patients scheduled for plastic and reconstructive surgery (PRSx) with moderate to high thrombogenic risk were selected. We evaluated the efficacy and safety of bemiparin compared to enoxaparin as chemoprophylaxis for DVT. Following balanced general anesthesia techniques, patients were randomly assigned for subcutaneous enoxaparin 40 IU (Group-E) or bemiparin 3500 IU (Group-B) q24h starting 6 h after procedure conclusion for at least 10 days. All patients were evaluated for DVT through Doppler ultrasound mapping of the lower limbs.

Results

Seventy-eight patients were evaluated, mostly women (83%), physical status ASA II (59%), ASA III (10%); Caprini’s thrombogenic risk score 3–4 (moderate) 58%, 5–6 (high) 29%, > 6 (too high) 13%; demographics, clinical variables and scores were similar between groups. Median drainage time in breast surgery was 4 days in both groups (p = 0.238). In the case of abdominal surgery, median was 14 days in Group-E versus 13 days in Group-B (p = 0.059). No DVT was detected in either group.

Conclusions

DVT was prevented with bemiparin, without significant bleeding increase nor adverse events; moreover, the cost of bemiparin is lower than enoxaparin. Bemiparin can be considered as alternative drug for DVT chemoprophylaxis in PRSx procedures.

Level of Evidence III

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Acknowledgements

The authors declare that they have no conflict of interest. The present study was conducted within the Medical Research Doctoral Program of the National Politechnical Institute’s Superior School of Medicine (Doctorado en Investigación en Medicina, Escuela Superior de Medicina, Instituto Politécnico Nacional).

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Authors and Affiliations

  1. Anesthesiology Service, American British Cowdray Santa Fe Medical Center, No. 154 Carlos Graef Fernandez Av., Santa Fe, Del. Cuajimalpa, 053333, Mexico City, Mexico

    Francisco Revilla-Peñaloza

  2. Plastic and Reconstructive Surgery, ABC Santa Fe Medical Center, No. 154 Carlos Graef Fernandez Av., Santa Fe, Cuajimalpa, 053333, Mexico City, Mexico

    Paul Jay Olsoff-Pagovich & Jose Ramon Ochoa-Gomez

  3. Angiology and Vascular Surgery, ABC Santa Fe Medical Center, No. 154 Carlos Graef Fernandez Av., Santa Fe, Cuajimalpa, 053333, Mexico City, Mexico

    Roberto Castaneda-Gaxiola

  4. Sección de Estudios de posgrado, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, CP 11340, Mexico City, Mexico

    Francisco Revilla-Peñaloza, Ángel Iván Rubio-Gayosso & Guillermo Ceballos

  5. Pharmacology Department, Faculty of Medicine, National Autonomous University of Mexico, Av. Universidad No. 3000, Colonia Ciudad Universitaria, CP 04510, Alcaldía Coyoacan, Mexico City, Mexico

    Juan Arcadio Molina-Guarneros

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  1. Francisco Revilla-Peñaloza
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Correspondence to Juan Arcadio Molina-Guarneros.

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Conflict of interest

The authors declare that they have no conflict of interest. None of the authors was paid to include any patient in this study. No sponsoring company paid for any of the medications included in this study. No professional writing service was hired to compile this report. The study was conducted without any public or private grant. No patient or physician was paid to take part in the study.

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Authors declare that the study has been approved by the appropriate institutional and/or national research ethics committee and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Revilla-Peñaloza, F., Olsoff-Pagovich, P.J., Ochoa-Gomez, J.R. et al. Randomized Trial of Deep Vein Thrombosis Chemoprophylaxis with Bemiparin and Enoxaparin in Patients with Moderate to High Thrombogenic Risk Undergoing Plastic and Reconstructive Surgery Procedures. Aesth Plast Surg 44, 820–829 (2020). https://doi.org/10.1007/s00266-019-01573-5

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