Routine drug venous thromboembolic prophylaxis (VTT) is controversial in thyroid surgery because, 1) the rate of VTE following thyroid and parathyroid surgery is lower than that of any other general surgical procedures, and 2) the potential risk postoperative bleeding in the neck area and mortality is considerable (12345678). Few surgeons therefore refrain from using routine VTT and only use if special non-surgical reasons coexist (2).

A recent study was designed to examine the advantages and disadvantages of a VTT based on the Caprini score used in general surgery (1) (Fig. 1). In 2011, the Boston Medical Center installed a standardized Caprini score-based VTT program (1). Patients with a low risk of thromboembolism (Caprini score 0–2) received mechanical (intermittent pneumatic compression) or VTT drug. Patients with moderate score (Caprini score 3–4) a mechanical prophylaxis and subcutaneously unfractionated heparin or prophylaxed low molecular weight heparin (LMWH). Patients with a high score (Caprini score >5) received mechanical and drug-based VTT on an inpatient basis, and depending on the risk, LMWH was prescribed for 7 to 10 or 30 days postoperatively. All patients received unfractionated heparin preoperatively and 8 hours early postoperatively. The drug regimen could be individually modified by the surgeon if he felt that it was indicated (1). More then 1,000 consecutive patients operated on from 2011 to 2016 were included and evaluated retrospectively. The 72% of the patients had a Caprini score <4, 17 patients (1.7%) a score of >9 (highest risk) (1). Fifteen patients had recurrent bleeding (4 arterial, 6 diffuse, 5 no active source of bleeding), 12 of them within 24 hours postoperatively. Of the 82 patients who had received prolonged VTT, only 1 patient developed re-bleeding, i.e., one of the 15 patients listed above (1). Only 1 patient, who had a Caprini score 10, developed a deep venous thrombosis after 22 days postoperatively (1).

These results suggest that the Caprini score-based VTT concept established in the above-mentioned institution can also be applied to thyroid and parathyroid surgery without an increase in bleeding (12). Patients with a low or moderately elevated Caprini score may be excluded from a routine drug regimen, and patients at high risk may be treated for prolonged VTT (12). In cases of thyroid and parathyroid surgery, routine drug-based thrombosis prophylaxis is indicated only in non-surgical exceptional cases, but an interdisciplinary list of criteria for this is still missing (2). Dralle et al. (2) well pointed out that whether the Caprini score in clinical practice is equally medically and administratively effective for the endocrine surgical area should show tests with sufficient power before the use of these scores can be recommended.