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Do You Reccomend Lovenox Injections for DVT/PE Prevention After TT and if So, for How Long?

Also wondering if you reccomend an overnight hospital stay.

Doctor Answers (8)

Do You Reccomend Lovenox Injections for DVT/PE Prevention After TT and if So, for How Long?

+3

My patients stay over for 1-2 nights after and if I am combining TT and Lipo, or TT in a larger patient, then I do give DVT prophylaxis.... Heparin 5000u sub Q before anesthesia and then Lovenox for several days after....I have had 7 or so patients in 20 years develop a DVT, all did well and all were associated with TT or TT/Lipo


Phoenix Plastic Surgeon
4.5 out of 5 stars 15 reviews

Lovenox for tummy tucks

+3

The previous posts all provide very good information.  I personally  prescribe Lovenox for all of my patients who are having a tummy tuck, as this procedure is the highest risk in the Plastic Surgery field for PE/DVT.  I have my patients start their first dose 3 hours prior to surgery, and I do require an overnight stay after surgery.  I have not seen an increase in post operative bleeding, and I believe that this greatly decreases the risk of a pulmonary embolism or deep vein thrombosis, so I am able to sleep better!  If a patient is adverse to using the Lovenox, it is their choice, but I always give them a Rx for it.

Amy T. Bandy, DO, FACS
Newport Beach Plastic Surgeon
5.0 out of 5 stars 82 reviews

Lovenox after tummy tucks

+3

great question. This has been discussed at great length by both plastic surgeons and all surgeons for that matter. I personally go by personal history and risk factors. If you have low risk factors and no personal history, I do not anti-coagulate, but use compression stockings and early mobilization. I perform the procedure as an outpatient, use pain pumps to permit earlier mobilization. Time under anesthesia also plays a role, as some surgeons take up to twice the amount of time to perform procedures.

I would recommend you discuss this with your surgeon. Go over your risk factors, your history, and the specifics about your case, ie time in the operating room, other procedures being performed on the same day,etc.

I also start the anti-coagulation, before the case when there is increased risk for  DVT.

Rick Rosen, MD
Norwalk Plastic Surgeon
5.0 out of 5 stars 8 reviews

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Lovenox After Tummy Tuck

+3

Dear Galena,

The complication of a Deep Venous Thrombosis or a Pulmonary Embolism is one of the most dreaded in Tummy Tuck surgery.  It can strike out of seemingly nowhere and can be fatal.  Once it has occurred, it will require at minimum months of treatment and medication which is not without its own set of risks and complications.  This is why ASPS has been working to define a set of guidelines for its member plastic surgeons to use to minimize these risks by using anticoagulation during surgery to decrease the risks of developing blood clots. 

As of September 2011, the new guidelines by the ASPS VTE Task Force strongly recommended anticoagulation  in patients undergoing major surgery lasting over a certain period of time and with certain risk factors.  These risk factors are based on a scale that accounts for the patient's age, their past medical history, their medications, their family history, and the type of procedure being performed.  The surgeon adds the point total after performing the evaluation and then determines whether to use anticoagulation or not based on the resulting numbers.  Many patients who are going to have a tummy tuck will have enough risk factors to make a strong case for anticoagulation treatment.  There are lots of options for what type of anticoagulation to use including Lovenox, Arixtra, and others.

Please discuss this very important question with your plastic surgeon who can explain your risks and their recommendations based on those risks.  While there are some risks associated with anticoagulation, none of them are commonly fatal like a PE.

Hope this helps.

Herluf G. Lund, Jr, MD
Saint Louis Plastic Surgeon
4.0 out of 5 stars 18 reviews

Tummy Tuck -DVT/PE, Lovenox and Heparin

+2

This is an excellent and timely question.  Guidelines are slowly being established through discussion and sharing of information but, at this point, you will find many different answers to these questions.  In my practice, I typically perform these procedures in my office surgical facility, under DIVA (deep intravenous anesthesia), we use compression devices for the lower legs, encourage and insist on early ambulation (including within a few hours of the surgery) AND I typically give a single dose of heparin (5000 units) just before the procedure.  Of course, this depends on individual characteristics of the patient, and applies to relatively young and healthy patients.  With increasing comorbidities (heavier, medical problems, associated procedures, longer cases) I am more likely to do the procedure in a hospital.  In that case we typically use general anesthesia and early ambulation is more difficult to achieve, so I'm more likely to use heparin initially and then several doses of Lovenox until the patient is discharged and clearly ambulatory.

So the answer is - it depends!  Which, of course, is often the case...

I hope that this helps and good luck,

Dr. E
 

Alan M. Engler, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 147 reviews

DVT/PE after tummy tuck

+2

Hello,

This a very important question as the risk of DVT/PE is perhaps the most worrisome complication of an abdominoplasty procedure.  The risks of DVT/PE are increased by a handful of factors including:

1) Dehydration: thats why you should received plenty of IV fluids during surgery and make sure you drink lots of water when you go home.

2) Lack of movement: Sequential compression devices during surgery and a pillow under the knees during surgery will help.  Movement at home including walking around the night of surgery will also help.

3) Medications:  Certain medications such as birth control pills can increase the chance of DVT/PE.  Medications such as Lovenox can help reduce the risk but increase the risk of bleeding.  Surgeons differ on how these medications are used.  Some utilize them only after surgery, others before.

4) Genetics:  Our bodys's clotting ability ranges from too little to too much and everything in between.  Certain blood abnormalities increase the chance of blood clotting and DVT/PE.  Your history or family history may hint at this which should be followed up by a workup if suspected.

I hope this helps.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 82 reviews

Lovenox after tummy tuck

+2

The risk of DVT after tummy tuck is a real risk, and the key is prevention. For all, we use sequential conpression and stockings. Lovenox can reduce the risk, and there are methods to score patients for DVT risk, and if the number is right then Lovenox is prescribed. Lovenox is started by injection 12 hours after the procedure, and continued daily for five days, and is easy to self administer with instruction. In our practice, overnight stay is not common.

Best of luck,

Peter Johnson, MD

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 26 reviews

Lovenox and Tummy Tucks

+2

This is a very good question.  The recommendations are really up and coming with regard to how often lovenox or anticoagulation in general should be used in major plastic surgery operations.  Right now most plastic surgeons go by the recommendations by the American Society of Chest/Thoracic surgeons.  Multiple category groups exist but in general a patient should be considered for anticoagulation if they meet some of these criteria: surgery expected to last longer than 2 hours, obese, on birth control or taking estrogen supplements, history of cancer of any kind, history of prior DVT, recent pregnancy or abortion to name a few.  Depending on which categories you fall into it may be very reasonable and appropriate for your plastic surgeon to suggest lovenox tx.  I typically use injections for about 5 days or until you are really up and ambulating without problems if I feel they are indicated.  At my Austin, Texas area plastic surgery practice overnight stay in the hospital is something we always have available to our patients and I often require it for anyone having over 6 + hours of surgery.  Hope that helps, Dr. Kerr

Mahlon Kerr, MD, FACS
Austin Plastic Surgeon
5.0 out of 5 stars 68 reviews

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