Lovenox or heparin have an excellent safety profile and may be indicated for your surgery. However, surgeons are still trying to determine where and how to best use these drugs.
Lovenox Before Surgery or After? Any Major Bleeding Complication if Before in Your Personal Experience?
Doctor Answers 11
Lovenox and Tummy Tuck
Abdominoplasty does increase the risk of deep venous thrombosis (DVT). However, in most people, surgery can be done without the benefit of chemoprophylaxis. Inpeople with an increased risk otherwise of DVT, Lovenox or another similar drug is indicated. Since the risks starts on the operating table I generally give the Lovenox just before surgery. This does somewhat raised the risk of bleeding. However, with careful surgery and bleeding can be controlled well usually. In this case, I would not consider doing the procedure without using drains. Over the years, as we have become more aware of the risk of DVT, and patient's her on blood thinners for other problems, I have simply change my technique slightly and it found that bleeding postoperatively generally has not increased.
Lovenox and bleeding
I use lovenox preoperatively in all patients who are going to have abdominoplasty with muscle tightening. This is true for the last 6 years. It is given one hour prior to the surgery and in combination with knee flexion, preoperative and intraoperative warming, sequential compression devices, postoperative pain management through the use of a pain pump, and early ambulation I have never had a deep vein thrombosis nor pulmonary embolus with this procedure. I use this even if I am doing Breast augmentation or liposuction at the same procedure. I have had 1 postoperative bleed from the abdomen with this technique. I can handle bleeding better than a big clot in the lungs!
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Lovenox or other treatment for DVT?
I use postoperative Lovenox or heparin, but send my patients home with their own sequential compression devices. I have seen a few significant bleeds with chemical anticoagulation so I prefer mechanical anticoagulants.
There is debate in the plastic surgery community as to whom should receive anticoagulation and also when to begin the medication and for how long to continue it. I begin Lovenox on the morning following surgery provided there does not appear to be any bleeding issues. I think it is likely appropriate to begin prior to surgery as well if that is the surgeon's preference. Obviously, giving an anticoagulant around the time of surgery increases the risk of bleeding but we generally believe this increased risk is worth the reduction in the risk of a dangerous blood clot or embolus to the lung.
Lovenox Timing & Body Contouring Surgery
Lovenox and Plastic Surgery
Certainly there is an increased risk of bleeding with Lovenox after surgery especially with liposuction or procedures where you can't see inside to cauterize blood vessels. With "open" procedures there is still a risk but it is less. Using drains may lessen the risk of post op blood collections if the bleeding is minimal.
Lovenox Before Surgery or After?
Most surgeons begin Lovenox after surgery, either on the day of surgery, or the following day. Anyone who has used this frequently has had a bleeding complication, myself included. But no clotting complications in patients who were treated with Lovenox.
Use of Lovenox with abdominoplasty is controversial.
Patients that are at high risk for pulmonary embolism may be placed on Lovenox in the early postoperative period. In my own practice I discourage patients from having abdominoplasty if the risk of pulmonary embolism is inordinately high.
When to give lovenox
Most of the papers in orthopedics and recommendations in plastic surgery are to give lovenox starting 8 hours after surgery. There is a higher incidence of bleeding complications if given before. Each individual surgeon must decided the risk/benefit ratio about when to give it, since this is an area where there are no absolutes.
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