Abstract
Orthognathic surgery is an elective procedure that is done in healthy individuals
so complications such as thromboembolic events are rare. Pharmacological thromboprophylaxis,
which reduces the risk of these events, may also increase blood loss and potentially
the risk of life-threatening haemorrhage, so a state of clinical equipoise exists
about whether it should be given routinely. We systematically reviewed published papers
to identify the incidence of venous thromboembolism and haemorrhage in patients treated
by orthognathic surgery who were, and were not, given pharmacological thromboprophylaxis.
The pooled incidence of thromboembolic events was 0% in those who were, and 0.19%
in those who were not. Return to theatre to control bleeding was required in 2.72%
of the patients treated at centres where it was given, and in 0.55% at those where
it was not. Small sample sizes, the heterogeneity of treatment protocols, and incomplete
reporting made further statistical analysis impossible. The incidence of venous thromboembolism
in patients who have orthognathic surgery is low when compared with the rest of the
hospital population. Although pharmacological thromboprophylaxis may further reduce
this, it can also increase blood loss, and uncertainty therefore remains over the
best protocol for its routine use. The risk stratification of individual patients,
and large randomised controlled trials are now required to establish the best treatment.
Keywords
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Article info
Publication history
Published online: March 17, 2020
Accepted:
January 13,
2020
Received:
June 25,
2019
Identification
Copyright
© 2020 Published by Elsevier Ltd on behalf of The British Association of Oral and Maxillofacial Surgeons.
