AT9 VTE risk category/Caprini score
Estimated baseline risk without prophylaxis (%)
Risk of VTE with prophylaxis (%)
Very low/0–2
NA
<0.5
Low/3–4
0.6
1.5
Moderate/5–6
1.3
3
High/>6
2.7
6
While there have been few randomized controlled trials of perioperative DVT prophylaxis in patients undergoing reconstructive surgery as a whole, the general consensus of recommendations is based upon a general surgical population. The degree of thrombophylaxis is commensurate with overall risk and includes external compression stockings, intermittent pneumatic compression boots (IPC), low-dose ultrafractionated heparin (LDUH), low molecular weight heparinoids (LMWH), fondaparinux, and aspirin. Table 4.2 lists the recommendations for perioperative thrombophylaxis based on risk.
Table 4.2
Recommendations for thrombophylaxis
Risk of VTE | Risk of major bleeding complication | |
|---|---|---|
Average | High/severe | |
Very low (<0.5 %) | No prophylaxis | |
Low (1.5 %) | Mechanical/IPC | |
Moderate (3 %) | LDUH, LMWH, or IPC | IPC alone |
High (6 %) | LDUH or LMWH plus ES or IPC | IPC with pharmacologic prophylaxis when bleeding risk subsides |
High-risk cancer surgery | LDUH or LMWH plus IPC/ES and extended-duration prophylaxis with LMWH post discharge
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