Lovenox injections after surgery?

Question

I am concerned that my plastic surgeon isn't going to prescribe Lovenox injections after tummy tuck surgery. I did take injections after weight loss surgery but not any of the other 4 I had. Should I be concerned?

William Andrade, MD · Answer

Hello, if you have concerns about your surgeon's plan to prevent a blood clot during surgery (their DVT prophylaxis protocol) I would recommend you discuss it with them prior to surgery. Many surgeons customize their DVT prophylaxis based each person's risk; lower risk patients receive compression stockings and/or a device that keeps blood flowing in the calves (intermittent pneumatic compression), and higher risk patients receive heparin or Lovenox.

Thomas A. Mustoe, MD, FACS · Answer

The question of whether to use Lovenox or other anticoagulation after tummy tuck surgery is one that there is no consensus on.  In patients who are at very high risk, there is an increasing belief that the increased risk of hematoma is more than offset by the reduction in risk for blood clots. If you have had no history of DVT ( blood clots), are currently not tremendously over weight, and the procedure is not lengthy ( 3 hours or less), many surgeons would feel comfortable not using Lovenox.  My preference is due all tummy tucks under sedation rather than general anesthesia which largely eliminates the risk of DVT, which also negates the need for anticoagulation.

Gregory Turowski, MD, PhD, FACS · Answer

I only use Lovenox in patients that are high risk.  Usually patient's with previous DVT, or larger patients having multiple combined procedures.  I always get a history and physical from their primary care physician as well as necessary blood work. It is always necessary to keep a close watch on post operative patients to try to prevent an event like this, but using the lovenox really helps minimize the risks of a PE.  I would really talk to your surgeon about your concerns as a patient, and having a peace of mind when you are recuperating at home.  Good luck in the future, and I wish you a safe recovery.

Richard H. Tholen, MD, FACS · Answer

Risk for VTE (venous thromboembolic event) or DVT (deep venous thrombosis) leading to PE (pulmonary embolism) depends on many factors, and use of Lovenox itself can cause an increased risk of bleeding, potentially requiring re-operation.In our accredited office surgical facility we routinely use active compression booties on every patient undergoing anesthesia for any procedure, not just long operations. We rarely use Lovenox as our patients have not required them based on our assessments of each one individually, so you too may be in this majority. However, if you have other known risk factors (smoking, oral contraceptives, and certain genetic syndromes that are more common than you might think), this may be a very reasonable consideration.For additional information about your risks that you can discuss with your surgeon (rest assured s/he is no less interested in you having a blood clot than you are), click on the web reference link below. Best wishes! Dr. Tholen

Karol A. Gutowski, MD, FACS · Answer

The current recommendations are to make a risk assessment using the Caprini Risk Assessment Score. Most tummy tuck patients do NOT need Lovenox, but if you are high risk, then it would be appropriate. Discuss this with your plastic surgeon. See link below for more information.

Adrian Smith, MD · Answer

It strongly depends on your doctor's practice and his comfort level.  It also depends on how much muscle and skin tightening he is going to have to do.  There are also portable-home pneumatic compression devices you can wear.

Richard Kofkoff, MD, FACS (retired) · Answer

This is a topic that is frequently discussed amongst plastic surgeons.  You should review this issue with your surgeon.  Although it is appropriate to make the decision about Lovenox based on your specific risk factors I tend to be quite conservative and place virtually all patients on Lovenox postoperatively.  It is true that this will raise the risk of bleeding postop but I think that is a relatively small price to pay to provide further protection  against the potential for the more severe complication of a blood clot.

Lovenox injections after surgery?

Answers (7)

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