Lovenox Before Surgery or After? Any Major Bleeding Complication if Before in Your Personal Experience?

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.

Thank you for your question. Depending on your surgeon and your Caprini score (DVT risk assessment), you may have Lovenox administered before surgery, after surgery, or both.  There is enough evidence that Lovenox does not significantly increase the risk of hematomas or bleeding and may be beneficial in reducing DVT and PE (pulmonary embolism) risks.  Best to check with your surgeon regarding your procedure and risk factors.  

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.

Lovenox increases the risk of bleeding.  Since my cosmetic tummy tuck patients go home the day of surgery, and I use compression boots intraoperatively, I do not give lovenox for tummy tuck patients.  That being said, I always give lovenox prior to a lower body lift.  Best of luck.

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.

It is appropriate to use Lovenox both before and after surgery. The risk of bleeding is slightly higher if administered before surgery but not excessively so.  If Lovenox is administered 6-8 hours after surgery and compression boots are used after surgery then you can reduce the risk of bleeding without appreciably increasing the risk of a blood clot.  Having said that, abdominoplasty does have a higher risk of a blood clot compared to other cosmetic procedures. The use of peri-operative Lovenox is not only appropriate but a good idea.  This is a medical decision that should be made with your surgeon. Best wishes.

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!

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. 

Best wishes.

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.

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.