Pre, intra, and/or Post-operative arterial and venous thromboembolism prophylaxis for breast surgery: Systematic review and meta-analysis

Abstract Summary: Both thromboembolism and excessive bleeding following breast surgery could result in multiple surgical procedures, breast reconstruction failure, or even mortality. This systematic review and meta-analysis of 5617 female breast surgery patients compared pharmacologic prophylaxis to non-pharmacologic prophylaxis interventions during the pre, intra, and/or post-operative time points and evaluated associated outcomes and complications. The PubMed, EMBASE, Cochrane Library, Web of Science, and Google Scholar databases were systematically and independently searched. Patient and clinical characteristics, surgical and medical interventions, outcomes and complications were recorded. Eleven of the 344 studies queried were eligible for systematic review and meta-analysis, with results from 26 of the possible 117 outcomes and complications using strict PRISMA and Cochrane guidelines. Patients receiving intra-operative pharmacologic prophylaxis for breast surgery were found to have more reoperations and more occurrences of any bleeding, while patients receiving post-operative pharmacologic prophylaxis were found to have more occurrences of any bleeding compared to patients receiving non-pharmacologic prophylaxis. Patients were more likely to receive pre-operative pharmacologic prophylaxis if they had diabetes mellitus (DM) and post-operative chemoprophylaxis if they had higher BMIs. Patients administered pharmacologic prophylaxis during the pre, intra, and/or post-operative time period did not show a significant decrease in deep vein thrombosis (DVT) and/or pulmonary embolism (PE) or increase in hematomas compared to non-pharmacologic prophylaxis.