A Review of Venous Thromboembolism Risk Assessment and Prophylaxis in Plastic Surgery

Nikhil A. Agrawal, M.D.; Kirsty Hillier, M.D.; Riten Kumar, M.D., M.Sc.; Shayan A. Izaddoost, M.D., Ph.D.; Rod J. Rohrich, M.D.


Plast Reconstr Surg. 2022;149(1):121e-129e. 

In This Article


This special topic article represents a review of current evidence of venous thromboembolism in plastic surgery patients. While we have made great strides in understanding the science behind venous thromboembolism, risk stratification for patients, and prophylactic regimens, there is still more research to be done. Currently, the most validated risk assessment model is the 2005 modification of the Caprini score. Other factors to evaluate more closely are the effects of muscle relaxation, long flights immediately after surgery, estrogen use, the type of surgery, and the use of tranexamic acid. Ways to mitigate that risk in high-risk patients include mechanical prophylaxis, avoiding tranexamic acid, chemical prophylaxis, avoiding general anesthesia with endotracheal intubation, and understanding how to optimally deliver hormone therapy. Ultimately, through research, we will optimize venous thromboembolism risk assessment models and decrease venous thromboembolism complications as close to zero as possible.