Perioperative Tamoxifen Use and Risk of Deep Vein Thrombosis: Role of Caprini Risk Assessment Model Should Not Be Discarded
I read with great interest the article by Salibian et al1 in which investigated whether tamoxifen received at the time of free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flap breast reconstruction affects thrombotic complication rates.1 Forty-three patients (56 flaps) received tamoxifen at the time of microvascular breast reconstruction, and 185 patients (267 flaps) did not. They found that patients receiving tamoxifen during transverse rectus abdominis myocutaneous/deep inferior epigastric perforator flap breast reconstruction did not have increased rates of flap thrombosis or failure. However, they did not use the Caprini risk assessment model (RAM) for effectively stratifying plastic and reconstructive surgery patients for venous thromboembolism (VTE) risk. The guidelines of the American College of Chest Physicians for the prevention of VTE recommend that plastic surgery patients should be stratified using the Caprini RAM.2 Caprini RAM has been validated in plastic and reconstructive surgery patients by Pannucci et al.3 The higher patients had its score, the more they suffered from VTE events.Taken all together, using Caprini RAM may better stratify the patients for VTE whether they received perioperative tamoxifen or not.