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Tummy Tuck Lovenox. Want to Request Blood Thinners. Pre-Op and Post-Op Timing For Blood Thinners?

I have fear of blood clots/PE so I've decided that at my consultation to request blood thinners to help prevent against them. I was wondering what day does it usually start (before surgery) and how many days after to put you in the clear? And do surgeons usually do blood work before these surgeries?

Doctor Answers (7)

Blood clots

+2

Blood clots after tummy tuck  are certainly among the most feared and serious complications following a tummy tuck.  certain situations increase the risk of blood clots occurring.   Among these are obesity, previous blood clots, or combining  a tummy tuck with other procedures making te operation excessively prolonged.  also, diminished mobility after surgery can contribute to the risk.  the routine use of blood thinners such as Lovenox has not become standard protocol with all tummy tucks, although many surgeons have used it.  Blood thinners can increase the risk of post-operative bleeding.  I feel that the use of blood thinners should not be routine, but can be considered in selected cases if the risk is felt to be particularly high.  The intra-operative use of sequential compression stocking is standard practice as is early mobiliIzation.  Plastic surgeons have not agreed on the routine use of blood thinners, however.  I would discuss the issue with your surgeon, find out which precautions they use, and take their advice on the issue.  Good luck!


San Diego Plastic Surgeon
5.0 out of 5 stars 12 reviews

Blood thinners and cosmetic surgery

+2

As long as you don't have any additional risk factors, you shouldn't need any excess blood thinners after cosmetic surgery.  This may put you at higher risk for bleeding complications.

Jeffrey E. Schreiber, MD, FACS
Baltimore Plastic Surgeon
5.0 out of 5 stars 77 reviews

Blood thinners for abdominoplasty

+2
You have not established a medical basis for blood thinners, only a fear of blood clotting. If you had a medical condition which required Lovenox, I would wonder whether your medical doctor would clear you for surgery. I agree that Lovenox has its own set of complications and would not prescribe it because of an inchoate fear. The risk of clotting is extremely low, well below 1%.

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 13 reviews

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Lovenox for tummy tuck

+2

I would concur with Dr. Basu about the use of Lovenox for tummy tuck patients, particularly those who need muscle plication, since this greatly increases the discomfort, and increases intra-abdominal pressures, increases inactivity, and decreases the ability to take deep breaths, thus increasing the risk of PE. We use Teds stockings and SCDs, early ambulation. I have previously used Lovenox postop, for a few days. However, since Lovenox is used widely by general surgeons and orthopedic surgeons preoperatively, I use it this way as well. I start just before the procedure, and continue for 6 days after for a total of 7 days. I have not had major complications as a result of using Lovenox for the past 5 years. I do standard preop complete blood count, and for those 50 and older an EKG is added. Some MDs add a clotting test of some sort. Even if you have Lovenox, there is still a risk of PEs. It is a reduced risk, and I believe the cost and bleeding risks associated with Lovenox are worth the reduced risk benefit.

Victor Au, MD
Chapel Hill Plastic Surgeon
5.0 out of 5 stars 6 reviews

Blood Clots and PE and Tummy Tucks

+2

First, there has 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 and 2) length of your procedure(s).   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.

There is nothing wrong with your desire to have Lovenox as part of your treatment.  However, there is no true consensus as to when or how long to administer lovenox.   On my high-risk patients, I will generally start Lovenox postoperative day 1 in the morning and will continue for 5-7 days postop.  

Please talk to your board certified plastic surgeon about your concerns.

Best of luck!

Dr. Basu

Houston, TX

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.5 out of 5 stars 124 reviews

Please don't make the mistake of trying to dictate the details of your care

+1

Hi there-

As long as you have chosen a good plastic surgeon, and you chose them for the right reasons, you need to trust them to advise you on how best to keep yourself safe and maximize the chances of being happy.

It is a mistake to think that it would be in your best interests to "request" specific interventions that are associated with their own risks and which may not be necessary in your particular case.

There's nothing wrong with asking your surgeon if Lovenox might be right for you- but do not believe it would necessarily be in your best interests to request it.

Generally speaking, it is also not in your best interests to think of you plastic surgery experience like a visit to the drive through window of a fast food restaurant, in which you tell them what you want and expect to get it. Please realize that your surgeon went to school for a very long time and trained for even longer so that they could most responsibly and safely advise nice people like you on how to get the best, most safe outcomes.

You need to choose your surgeon carefully and then trust them to help you do what is best for you.

Armando Soto, MD, FACS
Orlando Plastic Surgeon
5.0 out of 5 stars 110 reviews

Lovenox often a good idea with tummy tuck.

+1

Hi.

For most patients, we start the Lovenox twelve hours AFTER surgery, and continue it for ten days.  Of course you need medical clearance with blood work before a tummy tuck.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.