The Efficacy of Enoxaparin for the Prevention of a Pulmonary Thromboembolism in a Skin-sparing Mastectomy with Immediate Reconstruction in Breast Cancer

Min Sung Chung; Ho Sung Yoon; Byung Ho Son; Jung Sun Lee; Hee Jeong Kim; Eun Hwa Park; Sei Hyun Ahn; Tack Jong Lee; Jin Sup Eom; Hye Sook Choi; Beom Seok Kwak

doi:10.4048/jbc.2008.11.3.125

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Chung, Yoon, Son, Lee, Kim, Park, Ahn, Lee, Eom, Choi, and Kwak: The Efficacy of Enoxaparin for the Prevention of a Pulmonary Thromboembolism in a Skin-sparing Mastectomy with Immediate Reconstruction in Breast Cancer

Original Article

Journal of Breast Cancer

Journal of Breast Cancer 2008; 11(3): 125-132.

Published online: 30 September 2008

DOI: https://doi.org/10.4048/jbc.2008.11.3.125

The Efficacy of Enoxaparin for the Prevention of a Pulmonary Thromboembolism in a Skin-sparing Mastectomy with Immediate Reconstruction in Breast Cancer

Min Sung Chung, Ho Sung Yoon, Byung Ho Son¹, Jung Sun Lee¹, Hee Jeong Kim¹, Eun Hwa Park¹, Sei Hyun Ahn¹, Tack Jong Lee², Jin Sup Eom², Hye Sook Choi³, Beom Seok Kwak⁴

Department of Surgery, College of Medicine, Hanyang University, Seoul, Korea.

¹Department of Surgery, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea.

²Department of Plastic Surgery, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea.

³Department of Pulmonology, College of Medicine Dongguk University Pohang Hospital, Pohang, Korea.

⁴Department of Surgery, College of Medicine Dongguk University International Hospital, Goyang, Korea.

brdrson@korea.com

Received 27 May 2008 Accepted 29 August 2008

Abstract

Purpose

Performance of a skin-sparing mastectomy with immediate reconstruction provides psychological satisfaction and good cosmetic outcome for patients with breast cancer. However, this is a lengthy procedure to perform, and there is increased risk of pulmonary thromboembolism (PTE). The purpose of this study was to evaluate the efficiency of the use of low molecular weight heparins (enoxaparin) for prophylaxis against a pulmomary thromboembolism followed by mastectomy with an immediate transverse rectus abdominis myocutaneous flap (TRAM) in breast cancer.

Methods

A total of 123 patients underwent a skin-sparing mastectomy with an immediate TRAM. The "non-enoxaparin group" wore compression stockings for PTE prophylaxis and the "enoxaparin group" received enoxaparin (40 mg SC injection, once daily starting 2 hr before surgery and continuing for 6 days postoperatively) in conjunction with the use of compression stockings. Lung perfusion, inhalation scans, and serum D-dimer assays were performed on postoperative day 3. If findings were clinically suspicious or intermediate to high probability of a PTE in a lungs scan, embolism computed tomography was performed. Patients were prospectively investigated according to the clinicopathological data. We compared the incidence of PTE and hemorrhagic complications between the two groups.

Results

There were no significant clinicopathological differences between the two groups. Eleven patients developed a PTE (nine patients in the non-enoxaparin group and two patients in the enoxaparin group). The prevalence rate of a PTE was 17.3% and 3.2% for each group, respectively (p=0.01). One patient in the non-enoxaparin group required a second operation for bleeding control and three patients in the enoxaparin group needed transfusions. There were minor hemorrhagic complications in the enoxaparin group that improved after supportive management.

Conclusion

Although there were minor hemorrhagic complications, enoxaparin is safe and effective in a preventing PTE in patients that undergo immediate reconstruction after a skin-sparing mastectomy.

Keywords: Breast cancer, Pulmonary thromboembolism, Skin sparing mastectomy, Immediate reconstruction, Enoxaprin

Figures and Tables

Fig 1

Design of the study. PTE=pulmonary thromboembolism; Sx=symptom; POD=postoperative day; p.=probability; LMWH=low-molecular-weight heparin.

Table 1

Clinicopathologic characteristics of patients

BMI=body mass index; LN=lymph node.

Table 2

The incidence of PTE with diagnostic method

CT=computed tomography; PTE=pulmonary thromboembolism.

Table 3

PTE diagnosis

PTE=pulmonary thromboembolism; CT=computed tomography.

Table 4

Mean drainage volume, postoperative days of drain removed and the incidence of transfusion and re operation after the surgery

POD=postoperative day.

^*Mean drainage volume of postoperative day #1.

Table 5

PTE incidence between IPC use

PTE=pulmonary thromboembolism; IPC=intermittent pneumatic compression decive use during operation.

Table 6

Risk factors for venous thromboembolism

VTE=venous thromboembolism.

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