Dying to have surgery - history of PE
There was a similar question in the last few days.
Your risk of surgery is very high, up to and including death, probably from pulmonary embolism.
Hematology is a diverse field, and depending on how exhaustive the workup was, it may or may not detect where your your coagulopathy is coming from. However make no mistake 2 PE's are not normal. You are at high risk for having another one. People die from PE's all the time.
So while you will undoubtedly find a surgeon to do your surgery if you look long enough, that is the risk.
Big risks with tummy tuck
Your risks are DVT, PE, Death.
Let's be clear, a filter protects you from a PE, it is not a guarantee that you won't get one.
If you get off coumadin cold turkey, you may just get a DVT. Tummy Tuck in your case is a high risk factor for DVT.
If you want Tummy Tuck, consult with your hematologist, switch from coumadin to something like Lovenox. If you have the surgery, walk, walk, walk, and then walk some more after surgery.
Tummy tuck is a risk for DVT or venous thrombosis
Tummy tuck is one of those procedures in cosmetic surgery which produces the highest risk for DVT, deep venous thrombosis, which occurs when blood clots form in the veins of the extremity or pelvic area. Abdominal procedures, and those over three hours seem to have a higher risk profile, though DVT can be seen with breast reduction surgery as well. The presence of DVT often goes unrecognized, but can lead to PE, pulmonary embolism, where the blood clots impede the blood flow to the lungs, sometimes with fatal consequences.
You have had two prior episodes of PE, and are on medication to prevent a recurrence, and have a protective filter in your system as well. The key to DVT and PE is to understand that the complication is preventable. Understanding your risk for the occurrence and proper medical management can prevent the repeat of PE. Let me say, that with proper management, you may consider a tummy tuck. It can be performed with safety. Your care, however, should be in a hospital with support and what we call prophylaxis, preventive medication, and resumption of coumadin as the prophylaxis is tapered. Your tummy tuck is likely to cost more that most, but the office based experience is not for you. You need not give up your hope for tummy tuck, just choose your surgeon with care.
Best of luck.
Tummy Tuck while off Coumadin for 2 weeks
To answer THE question, your risks are very high. The only place to do the operation is as an inpatient in a hospital. Also you will need a full hematology clearance. Plus you and your family need an INTENSE INFORMED CONSENT including the risk of death. I agree with Drs. Aldea & Moelleken & Soto -'WHY?' do this at the age of 28 and being on coumadin for life.
Didn't you post previously?
Having had 2 blood clots without , as yet a known reason, means that you ARE at a high risk for recurrent blood clots. This is a fact despite not having found a cause for the clotting.
I do not understand the reason of having a 28 year old woman on Coumadin for life AND placing a vena cava filter. The indications for Coumadin may have changed since I was a general surgeon but with a life expectancy of 50 additional years that puts you at a huge risk for bleeding complications in the future.
I cannot explain the bravado of doing a gallbladder removal or tubal ligation while you were anti-coagulated. If indeed true, I think it was stupid and the surgeons need to have to explain their actions to a state medical board. As regards doing a tummy tuck on you - I would personally pass. NOT because I do not like performing the operation. Not because I dislike paying for my daughter's college fund. But because I think that you may sustain major clotting (thrombosis) complications which may be life threatening. While earning a living doing what you love doing is great, I would not want to do it while knowingly risking your life. Any Plastic surgeon who feels differently must be financially harder pressed than me to care about your well being.
I concur with my other colleagues Dr. Soto and Dr. Moelleken.
Dr. P. Aldea
Do 2 previous pulmonary embolisms preclude me from having a Tummy Tuck?
While I know you would be able to find someone to do a tummy tuck on you if you search, I think it is important to maintain a healthy perspective... I would not ever want to knowingly risk a patient's life or health to make them happy with their tummy.
The risk of a pulmonary embolism in a patient with a history of prior embolisms is significantly higher than in the general population, and a tummy tuck is the plastic surgery procedure with the highest risk for this problem.
Please be careful.
You are at risk, but it is possible
I think you are at increased risk for DVT-PE, but with a filter in place and transitioning to lovenox is an option, it could be done relatively safely. You need to be well informed of the risk-benefit profile.
Recurrent DVT (clot) and Tummy Tuck or abdominoplasty
While the filter may minimize the risk of a PE, it does not prevent the possibility of a large lower extremity DVT with implications for massive venous thrombosis (phlegmasia cerulea dolens), thrombophlebitis, venous hypertension, stasis dermatitis and/or chronic venous insufficiency.
Tummy Tuck if you're on Coumadin trouble
No one will do a tummy tuck if you are on coumadin -- but then again, if you are off coumadin you are a HIGH RISK for a PE. An ugly tummy has never caused death, but pulmonary emboli do. Be careful.
Tummy Tuck while on Coumadin
Obviously the risks of anesthesia, infection, asymmetry, seroma, hypertrophic scars, hernias, abdominal wall weakness apply. In addition you have risks from the coumadin (bleeding) and from the history of emboli (PE). Limiting these risks may mean placing you on Low Molecular Weight Heparin for a period of time pre and post op. This conversation should be between your hematologist and plastic surgeon.