Are blood clots still possible, even with blood thinners?

Question

Hello I'm having surgery (tummy tuck, lipo, and fat transfer to buttocks) my question is: can I still get blood clots even if my ps gives me blood thinners before and after surgery? Thank u in advance for response.

Robert M. Lowen, MD · Answer

The risk period for blood clots in the veins of the abdomen or legs is about a month, so unless blood thinners were used for that entire time, the risk would not be eliminated, unfortunately.  Therefore, surgical management aims for risk reduction, not elimination. There is no standard for the duration of blood thinners, so each surgeon must make an independent decision on what to use, and for how long.  Using Lovenox (low molecular heparin weight heparin) has become routine in my practice for tummy tucks, and I prescribe it for two doses post op, starting the morning after surgery. During surgery it is important to keep the blood flowing in the legs and to keep the patient warm.  This is accomplished by the use of serial compression devices for the calf or foot, and Bair Hugger warming blankets both above and below the abdomen.  I also use Exparel, long-acting bupivacaine anesthetic, that is injected throughout the surgical field during the tummy tuck. This gives excellent pain relief for three days, enhancing mobility. I also eliminate the use of drains by suturing the abdominal flap back down to the abdominal wall.  Being drain and catheter free and having less post-operative pain makes patients more likely to get up and move around, theoretically decreasing the risk of blood clots.Blood clots may produce no signs or symptoms. The risk is that the blood clot may grow and break off and go to the lungs which is known as a pulmonary embolism. This can be fatal. If there are signs and symptoms suggestive of a blood clot in the lower extremity, such as calf pain or tenderness, then a Doppler ultrasound imaging study and D-dimer blood testing could aid in diagnosis. A recent review of abdominoplasty risks stated: A combined 1316 lipo-abdominoplasty patients had results reported in the literature. Of these patients, 21 of 1316 (1.6%) developed seroma, 5 of 1032 (0.5%) experienced hematoma, 6 of 1032 (0.6%) experienced venous thromboembolism, and 3 of 1032 (0.3%) developed pulmonary embolism.Other retrospective reports have reported a much higher incidence of seroma, varying from 5-30%. In this respect the use of quilting sutures to close off the potential space in which fluid can accumulate has resulted in no seromas in my practice in the last year, except for one patient with a BMI of 38.See link below for article abstract.

Kenneth Bermudez, MD, FACS · Answer

Yes, you can still get a blood clot, called DVT (deep vein thrombosis) even if you get preventative blood thinners (i.e. enoxaparin) before your surgery.However, with the blood thinners, perioperatively, your risk will be significantly reduced.The higher risk operation are abdominally based and liposuction as you are having, so I strongly recommend prophylactic blood thinners and sequential compression devices in these cases.

Matthew H. Steele, MD · Answer

Thank you for your question.  There are a variety of factors that will increase your risk of blood clots after surgery: sex (female), age, history of cancer, use of hormones/contraceptives, length and type of surgery, use of general anesthesia, and use of compression garments.  Injectable agents such as heparin or Lovenox can definitely lower your risk of a deep vein thrombosis (DVT) and pulmonary embolism (PE) but the risk is not zero. Some patients who are having large volume liposuction and fat transfer or lower body lifts would definitely benefit from a 5-7 day course of Lovenox postoperatively.  While debatable, there is probably a small increased risk of bruising and possibly bleeding (hematoma) postop.  However, the risk of DVT/PE is higher and these agents are helpful.  We are just now in the last few years starting to pay much more attention to clotting issues after plastic surgical procedures.  Make sure you ask your board certified plastic surgery what they would recommend for you.  Good luck!

Jose Leon, MD · Answer

Hello, thank you for your question. Unfortunately, yes, DVT and PE can still occur even with blood thinners, but they do lower the risk. What is usually done is remove all predisposing factors and use thinners to minimize the chances and warrant a safer procedure. Good luck

Ronald V. DeMars, MD (Retired) · Answer

Of course that is a remote possibility, but clots are quite rare even in patients who take no blood thinners.

Are blood clots still possible, even with blood thinners?

Answers (5)

Answer: Blood thinners

Answer: Blood thinners

Answer: Are blood clots still possible, even with blood thinners?

Answer: Are blood clots still possible, even with blood thinners?

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Are blood clots still possible, even with blood thinners?

Answers (5)

Answer: Blood thinners

Answer: Blood thinners

Answer: Are blood clots still possible, even with blood thinners?

Answer: Are blood clots still possible, even with blood thinners?

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Everything you need to know about Tummy Tuck

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