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

Doctor Answers 11

Lovenox before surgery

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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.

Atlanta Plastic Surgeon
4.7 out of 5 stars 14 reviews

Lovenox and Tummy Tuck

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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.

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Lovenox and bleeding

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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!

David Janssen, MD, FACS
Oshkosh Plastic Surgeon
5.0 out of 5 stars 27 reviews

Lovenox or other treatment for DVT?

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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.

Brian Dorner, MD
Columbus Plastic Surgeon


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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.

Richard Kofkoff, MD, FACS
Saint Louis Plastic Surgeon
5.0 out of 5 stars 81 reviews

Lovenox Timing & Body Contouring Surgery

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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.

Lovenox and Plastic Surgery

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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.

M. Dean Vistnes, MD
Bay Area Plastic Surgeon
4.9 out of 5 stars 51 reviews

Lovenox Before Surgery or After?

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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.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Use of Lovenox with abdominoplasty is controversial.

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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.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 41 reviews

When to give lovenox

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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.

Paul W. Loewenstein, MD
Milwaukee Plastic Surgeon
4.8 out of 5 stars 32 reviews

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.