I Have a Question Regarding the Use of Lovenox After Breast Surgery?

Question

I am scheduled for breast lift with augmentation, dog ear revision (from previous tummy tuck), and liposuction of the flanks where the dog ear is. I take Estradiol 0.5 mg daily. My surgeon thinks I will be at greater risk for blood clots because of the Estradiol and wants me to take Lovenox for 10 days after surgery. I have no history of blood clots and did not take any blood thinners after hysterectomy or tummy tuck.

Kenneth Hughes, MD · Answer

There is a Caprini risk assessment model, which helps to gauge risk of DVT. HRT does increase the risk as well as age, BMI, and a host of other factors. If you are low risk other than HRT, I would have you stop the HRT before and after surgery and avoid the Lovenox.

David Stoker, MD · Answer

There is not a consensus among surgeons for using Lovenox during surgery. Early ambulation is probably your best protection against blood clots. I would not typically use Lovenox in the case you describe.

Eric Swanson, MD · Answer

I think your instincts are correct and I personally would have the same concerns if I were a patient. Lovenox can introduce problems of its own, specifically the risk of extra bleeding and hematomas, and even the occasional need for a blood transfusion. The risk of a blood clot should be very low in a patient like you with no history of blood clots and having the procedures you are having. I prefer to avoid muscle relaxants in surgery (no paralysis, spontaneous ventilation), avoid prone positioning, and use compressive devices on the legs (almost all surgeons do this today), and get my patients up walking right away. These habits keep the risk of a blood clot very low and don't introduce possible new problems. Be sure you are having a vertical lift, which is the most effective type of breast lift. I've attached some examples from my website.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Based on the description of the procedures that are to be performed I would not recommend Lovenox.  Taking OCP does increase a woman's chance of having a blood clot but the best way for you to combat that chance of a clot occurring would be early and often ambulation (walking).

	Dr. Es

Jeffrey Zwiren, MD · Answer

I typically use Lovenox with abdominoplasty surgery or extensive body contouring surgery. There are several factors that place a patient at an increased risk for DVT or pulmonary embolism. You did not mention your weight or any other concurrent medical problems. If you discontinue your Estradiol, have a BMI less than 30, your age is less than 40, and you have no family history or personal history of DVT or PE and no personal history of a malignancy then you really do not meet the criteria for the use of Lovenox. As physicians we always have to weigh the risks vs. the benefits of everything we do including the use of drugs in the perioperative period. Your plastic surgeon is in the best position to understand your medical condition and make recommendations in your best interests. If you disagree then you should communicate your concerns and get answers to your questions.

Jourdan Gottlieb, MD · Answer

My gut feeling is that you were at higher risk for clotting with either of your previous two surgeries. 

	There is a tool that is often used called the Caprini score, which stratifies risks base upon age, length of surgery, medication use, personal and family history, etc. Using this score, a rational approach to the use of anticoagulants is available. You can find this via Google, and then have a discussion with your surgeon. Lovenox is not without is own risks (bleeding). 

	Thanks and best wishes.

I Have a Question Regarding the Use of Lovenox After Breast Surgery?

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