Randomized Trial of Deep Vein Thrombosis Chemoprophylaxis with Bemiparin and Enoxaparin in Patients with Moderate to High Thrombogenic Risk Undergoing Plastic and Reconstructive Surgery Procedures.

BACKGROUND: Deep vein thrombosis (DVT) is a common complication during postoperative convalescence characterized by hypercoagulability, vascular endothelium damage and blood stasis. It increases noticeably in peri/postoperative phases of surgery procedures. Pulmonary embolism secondary to iliofemoral DVT is a frequent cause of death. METHODS: Adult patients scheduled for plastic and reconstructive surgery (PRSx) with moderate to high thrombogenic risk were selected. We evaluated the efficacy and safety of bemiparin compared to enoxaparin as chemoprophylaxis for DVT. Following balanced general anesthesia techniques, patients were randomly assigned for subcutaneous enoxaparin 40 IU (Group-E) or bemiparin 3500 IU (Group-B) q24h starting 6 h after procedure conclusion for at least 10 days. All patients were evaluated for DVT through Doppler ultrasound mapping of the lower limbs. RESULTS: Seventy-eight patients were evaluated, mostly women (83%), physical status ASA II (59%), ASA III (10%); Caprini's thrombogenic risk score 3-4 (moderate) 58%, 5-6 (high) 29%, > 6 (too high) 13%; demographics, clinical variables and scores were similar between groups. Median drainage time in breast surgery was 4 days in both groups (p = 0.238). In the case of abdominal surgery, median was 14 days in Group-E versus 13 days in Group-B (p = 0.059). No DVT was detected in either group. CONCLUSIONS: DVT was prevented with bemiparin, without significant bleeding increase nor adverse events; moreover, the cost of bemiparin is lower than enoxaparin. Bemiparin can be considered as alternative drug for DVT chemoprophylaxis in PRSx procedures. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Situación actual de los implantes mamarios / Present state of mammary implants

A consecuencia de informes en los que relaciona a los implantes mamarios con enfermedades e inclusive con el cáncer de mama, en los Estados Unidos de Norteamérica, en 1992, se solicitó la moratoria en la utilización de implantes mamarios. Medios de difusión no oficiales crearon un ambiente de ansiedad y cancerofobia en pacientes ya operadas, lo cual desencadenó demandas contra los fabricantes de implantes. En respuesta, estas compañías crearán un fondo con la intensión de negociar un arreglo con los demandantes, ya que el proceso de litigio eventualmente resultaría más costoso, independientemente del resultado de los juicios. Esta situación promovió la investigación de estudios retrospectivos sobre efecto de los implantes de mama en cuerpo humano; sin embargo, la relación implantes-enfermedad no pudo ser sustentada. En este artículo pretendemos ofrecer a la comunidad médica en general otro panorama respecto a la controversia del uso de implantes mamarios, así como estimular la publicación de trabajos