Implementation of a Novel Protocol for Preventing Venous Thromboembolism in Otolaryngology Patients

Lirit Levi*, Galia Spectre, Ofir Nesichi, Avi Leader, Pia Raanani, Yonatan Reuven, Hilla Schindel, Thomas Shpitzer, Ella Reifen, Gideon Bachar, Aviram Mizrachi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective: Venous thromboembolism (VTE) is a preventable cause of postoperative morbidity and mortality. The Caprini risk assessment model (CRAM) is a validated tool for estimating the risk for postoperative VTE. Previous studies demonstrated a low risk of VTE among otorhinolaryngology–head and neck surgery (ORL-HNS). Hence, our objective was to modify the CRAM-based protocol to be applicable for otolaryngology patients and assess protocol efficacy and safety. Study Design: Observational pilot study conducted on ORL-HNS patients undergoing surgery. Setting: University-affiliated tertiary care center. Methods: We constructed a modified protocol based on the CRAM and previous reports in the ORL-HNS literature using a reduced postoperative anticoagulation regimen. Primary end point was symptomatic VTE up to 3 months after surgery. Main secondary outcome was postoperative bleeding. Results: A total of 508 patients were enrolled. Of them, 48% underwent head and neck surgery, 18% direct laryngoscopy and transoral robotic surgery, 15% endoscopic sinus surgery, and 11% otology surgery. Adherence to the protocol was 79%. Mean follow-up time was 115 days (range, 30-448 days). Only 1 patient developed deep vein thrombosis, and none developed pulmonary embolism. Two patients had major bleeding not related to the use of anticoagulation. Conclusions: Our novel CRAM-based protocol appears to be efficacious and safe for VTE prevention in otolaryngology. A larger-scale study is required to validate these findings. Level of Evidence: Level 2b.

Original languageEnglish
Pages (from-to)297-304
Number of pages8
JournalOtolaryngology - Head and Neck Surgery
Issue number2
StatePublished - Feb 2022


  • Caprini
  • bleeding
  • chemoprophylaxis
  • prevention
  • venous thromboembolism


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