The Efficacy of Prophylactic Low-Molecular-Weight Heparin to Prevent Pulmonary Thromboembolism in Immediate Breast Reconstruction Using the TRAM Flap

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Abstract
Background: Immediate breast reconstruction using the transverse rectus abdominis musculocutaneous (TRAM) flap is associated with multiple risk factors for pulmonary thromboembolism, the incidence of which has been reported to be as high as 6.3 percent. The authors conducted a prospective study of the efficacy of prophylactic use of low-molecular-weight heparin to prevent pulmonary thromboembolism. Methods: Six hundred fifty consecutive patients who underwent immediate breast reconstruction with TRAM flaps between August of 2001 and April of 2007 were included in this study. No medical prophylaxis was administered for the former 450 consecutive patients (group 1). Since February of 2006, enoxaparin was routinely given to the latter 200 consecutive patients (group 2) for 7 days, from the day of surgery. Fifty-four patients in group 1 (group 1c) and 68 patients in group 2 (group 2c) were routinely examined for asymptomatic pulmonary thromboembolism. Incidences of symptomatic and asymptomatic pulmonary thromboembolism, decreases in hemoglobin, and bleeding-related complications were compared. Results: Although the incidence of symptomatic pulmonary thromboembolism did not differ significantly between groups 1 and 2 (1.8 percent versus 0 percent; p = 0.107), that of asymptomatic pulmonary thromboembolism was significantly higher in group 1c than in group 2c (16.7 percent versus 0 percent; p = 0.009). The hemoglobin decrease was significantly different (2.5 g/dl in group 1 versus 2.8 g/dl in group 2; p = 0.001), but the incidences of transfusion, hematoma, and seroma showed no statistically significant difference. Conclusion: Prophylactic use of low-molecular-weight heparin was effective in preventing pulmonary thromboembolism without increasing problematic bleeding-related complications in TRAM flap immediate breast reconstruction patients.