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Lovenox or Arixtra?

My PS suggested I take Lovenox due to a past DVT in my leg and my MTHFR gene. I have read a few posts on here about Arixtra and wanted to know if that is a better alternative? My PS says the only real complication with adding Lovenox is addtional bruising and he does a no drain TT. Does that sound correct or is he minimalizing it?

Doctor Answers 8

March 24th, 2013

Tummy tuck and genetic predisposition for blood clots

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Of all the operations we do in plastic surgery, tummy tuck surgery is at or near the top in terms of risk of blood clots developing.  And that's in someone without mutations in the MTHFR gene.  You're probably aware, if you have mutations in the MTHFR gene and have already had a DVT, that you may also be at elevated risk of coronary artery disease and potential heart attack.  Your plastic surgeon clearly knows your medical history and your physical findings better than anyone on the internet does.  From the information you've provided it strikes me that the real issue for you may not be the difference between Lovenox and Arixtra but whether you should be considering a tummy tuck at all.  So, I am not giving advice to you; your medical history is too complex.  However, if I were to see someone with this story, I would at least have that person visit with a hematologist.  A hematologist could provide the best information regarding risks related to the specific genetic mutations a person has and perhaps provide guidance with the question about the best anticoagulation methods.  Your plastic surgeon may have a lot of experience in doing surgery on people with your specific issues, but most of us do not.  Ask him or her about their experience in patients with mutations in the MTHFR gene.  This is a big operation.  The potential results can be tremendous, but in some cases the risks outweigh the potential benefits.


Fort Worth Plastic Surgeon

March 29th, 2013

Lovenox

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Each surgeon has their own opinion and protocol regarding use of Lovenox post op in tummy tucks. Personally, I do not because of the risk of bleeding. If you have further questions about the MTFHS gene, and its implications in your particular case, consider a consult with a hematologist.

Learn more: http://edelsonplastic.com/body/tummy-tuck/

Ronald J. Edelson, MD
March 24th, 2013

Your surgeon and hematoligist are best to answer this question

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There is no one right answer and each specialist may have a little different approach.  Both medicines are effective in lowereing the risk of DVT in high risk patients and each has advantages and disadvantages.

 

I have used Lovenox many times in high risk patients with no bleeding problems and no complications related to the medicine, but that does not mean it is a superior drug.

 

Your hematologist will have the best insight to what will work best for you and your surgeon will want to consider their input.  Good luck on your upcoming surgery.

Michael S. Hopkins, MD (retired)
Albuquerque Plastic Surgeon

March 24th, 2013

Lovenox vs. Arixtra

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Both medications are effective at reducing the risk of DVT in high risk patients in combination with mechanical prophylaxis such as compression stockings and early ambulation. Both do, however, increase the risk of post-operative bleeding complications, even life-threatening bleeding. One advantage to arixtra is that it is more effective when the first dose is given after surgery, allowing your surgeon to assess the surgical site post-operatively and make the decision to use or not use anticoagulation based on your exam, thus avoiding a major bleeding episode, but also increasing your risk of a clot.  Your enzyme deficiency and history of prior DVT do make you a high risk for DVT/PE, so you should carefully consider any elective surgeries. 

Tamir Mosharrafa, MD
March 24th, 2013

Blood Thinners for Tummy Tuck

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Since you know your history so well, I assume you have been followed by a Hematologist and your plastic surgeon has discussed your upcoming surgery to plan your care. If so, the Lovonox would be their choice. This drug has both advantages and disadvantages. It is less expensive than Arixtra but can cause other problems with clotting in a small number of people.  The Arixtra is also an excellent choice. Without knowing anything about you other than your clotting history and that you are having an abdominoplasty, it is certain that you need drug prophylaxis to reduce the incidence of DVT and pulmonary embolus.  There are several techniques to prevent fluid or blood accumulation after surgery. All work about the same.

Robert T. Buchanan, MD
Highlands Plastic Surgeon

March 24th, 2013

Arixtra Vs Lovenox

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Arixtra and Lovenox are both effective for chemo-prophylaxis for a blood clot.  Lovenox is a form of low molecular weight heparin and does have a small risk of heparin induced thrombocytopenia (HIT) which is a serious medication reaction that can cause clotting.  With a history of having had a blood clot and having received heparin in the past, you could have been sensitized immunologically to heparin.  I would recommend Arixtra for prophylaxis because it does not have a risk of HIT.  If the blood thinner is used 6-8 hours after surgery, your risk of a blood clot can be reduced without a significantly increased risk of bleeding.  Nonetheless, the risk of bleeding after surgery is not zero and should not be minimized. You should go into surgery with a good understanding to the issues at hand. All the best.

Learn more: http://www.bitarinstitute.com/tummy-tuck/

George Bitar, MD
March 24th, 2013

TT with history of DVT and + MTHFR gene

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I coldnt agree more iwth Dr. Kunkel. All patients I see with history of DVT are sent to a hematologist for evaluation for baseline hypercoagulability and to discuss prophylaxis. It is possible that a TT  may not be for you.

Mark D. Epstein, MD
March 24th, 2013

Consider consultation

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Given your history I would recommend a consultation with a hematologist prior to having your surgery to get best advise on how long and at what dose you need to take anticlotting medication.  You are certainly at increased risk and I would not operate on you with this history without hematology assistance in management.  Tummy tucks are the #1 cause of DVT in plastic surgery.

Evan Sorokin, MD

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.