I am in mid30 with csecs.I consulted with 2 drs for full TT. One said blood thinners b4 and 7days after TT alongwith comp pumps for legs during & 1 day after TT plus overnight stay. The 2nd Dr suggested no blood thinners & no compression pump & I go home the same day. No pre-op work was done and I have no hist DVT so drs know nothing about my hist. How can std of care be so diff when it comes to averting the risks of PE/DVT. What is gen guideline? Doctors come highly recomm & I like them both.
Blood Thinners and Compression Pumps?
Doctor Answers 12
DVT risk reduction and Tummy Tuck
Hi, thanks for a great question. Currently in cosmetic procedures there is no consensus for the routine use of heparins (regular or fractionated) during abdominoplasty. There are several grading scales that are currently in use that take into consideration age, weight, type of surgery, time of surgery, use of hormone replacement, smoking history, etc which help perform a risk stratification for the use of heparin during the preoperative and postoperative periods. Heparin is use is not without the risk of severe bleeding. If you are having questions about their two disparate practices, the best solution is to ask them why they do what they do. Good luck with your surgery.
Tummy Tuck and When to Add on Blood Thinners and Compression Pumps for Prevention of Blood Clots
First, I want to congratulate you for getting 2 opinions regarding your interest in Tummy Tuck surgery and for taking a proactive approach on educating yourself about the care before, during and after your surgery.
Here are some tips:
1. medical history, weight, use of hormone therapy, physical activity, smoking and length of surgery are all factors that can impact on the development of blood clots during/after surgery
2. the determination of an overnight stay at a hospital can be related to the above issues, concerns related to the length of travel to your home, the complexity of your particular surgery or may be a particular surgeon's preference in how she chooses to render care after surgery
3. let your doctors know that you have received very different opinions on this subject and would like to be educated regarding the information each shared with you- that is part of the consultation
4. blood thinners are not given to every tummy tuck patient
5. compression boots/stockings are routinely used in a hospital setting during the surgery and in the recovery room
6. patients do not always stay over night
4. the most important issues for you are to clearly understand your unique health risks and to have your expectations clarified so that YOU CAN MAKE AN INFORMED DECISIONregarding the procedure that will keep you safe and satisfy your goals
I find that healthy, average weight, nonsmoker, hormone free ladies who are a candidate for a standard full abdominoplasty can expect to have pneumatic compression boots during the surgery and in the recovery room. If the patient want to stay overnight at the hospital- that's fine- but in general, most go home that day and are seen in the office the following day.
Thanks for asking! Dr Ellen
Tummy Tuck and DVT prophylaxis
The Caprini risk assessment model should be familiar to plastic surgeons and this helps to stratify risk based upon age, BMI, length of surgery, and other patient risk factors. Most tummy tuck patients do not require chemoprophylaxis such as Lovenox if patients are selected appropriately.
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The use of sequential compression stocking is standard procedure not,only with TT but with most operations. The use of blood thinners has not been standardized in TT . I do not use blood thinners because of the concern over bleeding. You will get different answers from different surgeons. If you trust your surgeon, which I assume you do, follow whatever their instructions are regrading blood thinners.
Great question. I use the compression pumps on all patients regardless of the procedure they are having. The duration of the surgery/procedure, deep anesthesia and heavy use of paralytics common in hospitals, and predisposing factors probably contributes to the incidence of DVT
DVT (Blood clot) risk and Tummy Tuck surgery
There have been several studies on this exact topic. In fact, the American Society of Plastic Surgeons has a Venous Thromboembolism Task Force that has systematically reviewed this matter in detail. Multiple studies have shown the risk of a blood clot from a tummy tuck or related procedure is well below 1%. To help plastic surgeons select patients who may or may not need Lovenox (or some form of blood thinners to help prevent blood clots, there are published guidelines to aide in patient selection (known as the Caprini/Davison risk assessment model (RAM). Ultimately, your plastic surgeon will determine the need for Lovenox based on 1) your health status and past medical history and risk factors, 2) length of your procedure(s), and 3) ability to ambulate after surgery. Most PS utilize SCDs (massage boots) and early ambulation as the mainstay for their blood clot prophalaxis. Others also opt to add on Lovenox as well.Please talk to your board certified plastic surgeon about your concerns. Based on your exact treatment plans and aforementioned issues, your PS will give you his/her best recommendations.
Best of luck.
Being SAFE during Tummy Tucks
Tummy tucks are great procedures, but have the highest complication rate of any cosmetic surgical procedure. One of those complications is DVT/PE. There is no single guideline for prophylaxis against DVT/PE, but a surgeon should evaluate the patient, take a history (including family history) and do the requisite lab work prior to surgery. At your age, with a medical history absent of any increased risk for DVT/PE, I would use sequential pneumatic compression devices on your legs during surgery and in the Recovery Room and you would have your tummy tuck in my AAAASF-accredited facility and go home the same day. No drains and minimal discomfort. The procedure is called an Ipanema Tummy Tuck and I have been doing it since 2009 with great results. It has revolutionized my tummy tuck practice.
Although there are no absolute guidelines for 'abdominoplasty', there have been some excellent guidelines written to help surgeons to decide whether or not to use blood thinners (chemoprophylaxis). One of the best is from the Aesthetic Surgery Journal, March/April 2006, written by V. Leroy Young, MD. He notes that many previous studies looking at the outcome of large groups of abdominoplasty patients yields a risk of DVT at about 1 to 2 %.
If you are less than 40 years old, not obese, non-smoker, don't take hormone replacement, and with no history of previous DVT, severe trauma, or cancer, you are at moderate risk for DVT. Accordingly, he recommends either the latest blood thinners, like Fondaparinux, a factor Xa inhibitor, or mechanical DVT prophylaxis, which include compression stockings and intermittent compressive devices 30 minutes prior to surgery, and to be used continuously until ambulating well, usually 24 hours.
Staying in an aftercare facility does lend an increased level of safety, but I prefer them mostly for the convenience to the patients, and to relieve the potential stress and anxiety of family members taking care of the patients. I do not perform chemoprophylaxis for my moderate risk patients, but instead rely on mechanical prophylaxis and early ambulation that evening. This is much easier now that anesthetic pumps are available to significantly reduce pain and narcotic usage, the two biggest impediments to early ambulation.
Best of luck!
Blood Thinners and Compression Pumps
The standard of care is not different. Observance of the standard is different.
You can assess your risk factors by googling "Caprini score." Dr Caprini has studies factors influencing blood clots in surgical patients Some patients will have enough risk factors such that blood thinners, usually Lovenox should be used. . Almost anyone undergoing tummy tuck has enough risk factors to have SCD's recommended. That is widely held to be the standard of care. Lovenox is not without risk. SCD's are free of risk.
Thanks for your question. Good luck and best wishes.
Post Op Tummy Tuck Care
You have stumbled upon an area of plastic surgery that is somewhat in flux. Over the past several years there has been an increase in focus on the prevention of DVT and PE. Although these complications do not occur often, they can be quite dangerous if they do. As mentioned in other responses, there are objective criteria that have been developed to assess a patient's risk and then recommendations based upon that assessment. At a minimum I believe there is no reason to avoid the use of compression devices for the lower extremities. Personally, I have all patients spend the night in the surgical facility with an RN in attendance and most patients receive anticoagulation postop as well. Remember, this is cosmetic surgery so we must be very careful is managing risks for an elective procedure such as this. I suggest you return to the physicians and ask more questions, especially the physician who does not use compression hose and also make sure you will have your procedure in a certified facility that is equipped to handle all emergencies.