THROMBOSIS PROPHYLAXIS IN HAIR TRANSPLANT SURGERY

Abstract

Objective. The aim of this report is to present a cohesive evidence-based approach to reducing venous thromboembolism (VTE) in hair transplant surgeries. VTE prevention includes deep venous thrombosis and pulmonary embolism. Despite international efforts in VTE prevention, guidelines do not exist for hair transplant surgeries worldwide. Data source. PubMed/MEDLINE. Review Methods. A comprehensive review of literature to VTE in hair transplant surgery was performed, identifying data on incidence of thrombotic complications and the outcomes of regimens for thrombo-prophylaxis. No data were available, then we compared other surgical specialties. Conclusions. We identified 17 articles, including 3 prospective cohort studies, 3 retrospective studies, 1 case-control study, and 10 systematic review studies. We did not identify any study related to hair transplant. Of the 17 articles selected, 7 are related to prophylaxis of DVT, 4 related to plastic surgeries, 4 related to otolaryngology-head and neck surgeries and 2 related to elective surgeries. The overall prevalence of VTE in otolaryngology appears lower than that of most other surgical specialties. The Caprini system allows effective individualized risk stratification for VTE prevention in otolaryngology. Mechanical and chemoprophylaxis (‘‘dual thromboprophylaxis’’) is recommended for patients with a Caprini score 7 or patients with a Caprini score of 5 or 6 who undergo to long surgeries, where an increase in surgical duration was directly associated with an increase in the risk for VTE, and when prolonged hospital stay is anticipated or mobility is limited. For patients with a Caprini score of 5 or 6, we recommend dual thromboprophylaxis or mechanical prophylaxis alone. Patients with a Caprini score 4 should receive mechanical prophylaxis alone. These finding may help inform preoperative and postoperative decision making related to surgery.