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

Research output: Contribution to journalArticlepeer-review

Abstract

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
Volume166
Issue number2
DOIs
StatePublished - Feb 2022

Keywords

  • Caprini
  • bleeding
  • chemoprophylaxis
  • prevention
  • venous thromboembolism

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