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An Evaluation of a Standardized Risk-based Venous Thromboembolism Prophylaxis Protocol in the Setting of Thyroid and Parathyroid Surgery
*Ryan Macht1, *Ivy Gardner2, *Pamela Rosenkranz1, Gerard Doherty1, David McAneny1
1Boston Medical Center, Boston, MA;2Boston University School of Medicine, Boston, MA

Objective
An elevated odds ratio for postoperative venous thromboembolism (VTE) prompted the development of a standardized, mandatory risk assessment and risk-based prophylaxis protocol. This study evaluates the safety of this chemoprophylaxis program, including extended courses after discharge, in thyroid and parathyroid surgery.
Design
Retrospective case series review.
Setting
Academic, tertiary referral center.
Patients
All General Surgery patients undergoing thyroid or parathyroid operations after the implementation of the Caprini VTE assessment and prophylaxis protocol.
Main Outcome Measures
VTE and bleeding complications, risk score, and chemoprophylaxis compliance.
Results
Of 978 consecutive patients, 72% were determined to be at low to moderate-risk for VTE (Caprini score 0-4), 26% were high-risk (Caprini 5-8), and 2% were highest-risk (Caprini ≥9). Only 27% of eligible high/highest-risk patients actually received extended prophylaxis after discharge. Fifteen patients (1.5%) developed wound hematomas that required evacuations, twelve of them within 24 hours of the index operation. Among patients who developed bleeding complications, five (33%) had Caprini scores indicating low to moderate-risk for VTE, and ten (67%) were in the high/highest-risk categories. Only one patient (of 70 who received extended prophylaxis) developed a delayed (5 days later) hematoma that required a return to the hospital for evacuation; this event was associated with an EMR systems error that resulted in an incorrectly doubled dosage. No patient developed a VTE complication.
Conclusions
Although the incidence of VTE is quite low for patients undergoing thyroid and parathyroid operations, the Caprini standardized risk-based prophylaxis protocol identifies a subset of high-risk patients who may benefit from extended VTE prophylaxis without added harm. Conversely, Caprini scores might also select low-risk patients who require no chemoprophylaxis, possibly reducing risks of hemorrhage.


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