Abdominoplasty Patient Safety Update
If BMI>25 and Age >40, I prescribe a postoperative blood thinner.
I prescribe one week of enoxaparin after abdominoplasty to prevent venous thromboembolism (VTE) and stop oral hormones 1-2 weeks prior to surgery. These preventive measures are especially important for patients with BMI> 25 and Age> 40.
Historically, we have relied on the Caprini score > 8 for prescribing blood thinner which accounts more for the length of surgery, family history of DVT, multiple miscarriages, and oral contraceptive/hormone replacement.
This month’s Aesthetic Surgery Journal points out that a Caprini score 2-8 accounts for 95.5% of VTE in aesthetic abdominoplasty. The highest predictors are BMI>25 and/or Age >40. The overall risk of developing VTE in outpatient aesthetic abdominoplasty is 0.07% and does not increase with multiple procedures performed.
African-American patients have the significantly higher risk for VTE than other races/ethnicities.
Leg swelling, shortness of breath, and chest pain are symptoms of VTE and require urgent/emergent medical attention.
Source: Commentary on Incidence and Predictors of Venous Thromboembolism in Abdominoplasty by James C Grotting, MD, FACSK Kye Higdon, MD, FACS Varun Gupta, MD, MPHJulian Winocour, MD in Aesthetic Surgery Journal, Volume 38, Issue 2, 17 February 2018, Pages 174–175.
