Pharmacologic prophylaxis does not affect DVT, PE risk after breast surgery

Pharmacologic prophylaxis before, during or after breast surgery does not seem to reduce deep vein thrombosis (DVT) or pulmonary embolism (PE), reports a new meta-analysis.

A search of the databases of PubMed, Embase, Web of Science, Google Scholar and the Cochrane Library yielded 11 articles eligible for meta-analysis. Cumulatively, the sample included 5,617 women who had breast surgery; 1,287 received preoperative prophylaxis, while 356 and 1,527 received intraoperative and postoperative prophylaxis, respectively.

In women who received preoperative prophylaxis, pharmacologic vs nonpharmacologic modalities did not result in significantly lower rates of DVT (risk ratio [RR], 2.12, 95 percent confidence interval [CI], 0.25–18.22; p=0.49) or PE (RR, 0.54, 95 percent CI, 0.05–6.38; p=0.63). The same was true for the need for blood transfusion (p=0.52) or reoperations (p=0.67), as well as for the risk of any bleeding (p=0.67) and haematomas (p=0.85).

DVT likewise occurred with similar frequencies between the pharmacologic and nonpharmacologic intraoperative prophylaxis (p=0.49). No such calculation could be performed for PE because of the lack of cases. The same was true for postoperative prophylaxis (DVT: p=0.82; PE: p=0.71).

Notably, intraoperative pharmacologic prophylaxis led to significantly greater risks of reoperation (p=0.02) and any bleeding (p=0.0002), while postoperative pharmacologic prophylaxis increased the risk of any bleeding (p=0.02).

“Our search revealed major gaps in reported data within the literature,” researchers noted. “Many relevant outcomes and complications were not reported in any of the studies. Exploring any of these would add new information to the literature. Studies did not report breast surgery for gender confirmation patients.

“Our findings are unclear and may not be applicable to male patients,” they acknowledged, adding that more primary research is needed to better understand the subject.