Skip to main content

Advertisement

Log in

Venous Thromboembolism (VTE) Prophylaxis After Abdominoplasty and Liposuction: A Review of the Literature

  • Review
  • Body Contouring
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

The aim of this review article was to study recent articles and summarise the guidelines, indications, risks and benefits of using VTE prophylaxis in patients undergoing abdominoplasty and liposuction.

Methods

A search of PubMed was performed using selected keywords related to the topic. Based on the inclusion and exclusion criteria, a total of 25 articles were included in the review.

Results

Abdominoplasty has the highest occurrence of VTE among aesthetic procedures. A higher incidence of VTE was noted when abdominoplasty was combined with liposuction. Circumferential procedures, obesity and HRT (hormone replacement therapy) were found to be independent risk factors for VTE. The 2005 Caprini/Davison risk assessment model is the most appropriate model for risk stratification in plastic surgery patients. Newer oral anticoagulants hold promise.

Conclusions

Preoperative risk stratification should be performed for all patients. Chemoprophylaxis should be considered in cases with a Caprini RAM score > 7 or in those with independent risk factors. Administering regional blocks for anaesthesia and avoiding full muscle paralysis help reduce the risk of VTE.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Shestak KC, Rios L, Pollock TA, Aly A (2018) Evidenced-based approach to abdominoplasty update. Aesthet Surg J 39:628–642

    Article  Google Scholar 

  2. GutowskiGR Singer R, Iverson RE, Nahai F (2018) Incidence and predictors of venous thromboembolism in abdominoplasty. Aesthet Surg J 38:162–173

    Article  Google Scholar 

  3. Spring MA, Gutowski KA (2006) Venous thromboembolism in plastic surgery patients: survey results of plastic surgeons. Aesthet Surg J 26:522–529

    Article  CAS  Google Scholar 

  4. Most D, Kozlow J, Heller J, Shermak MA (2005) Thromboembolism in plastic surgery. Plast Reconstr Surg 115:20e–30e

    Article  Google Scholar 

  5. Winocour J, Gupta V, Kaoutzanis C, Shi H, Shack RB, Grotting JC, Higdon KK (2017) Venous thromboembolism in the cosmetic patient: analysis of 129,007 patients. Aesthet Surg J 37:337–349

    PubMed  Google Scholar 

  6. Hafezi F, Naghibzadeh B, Nouhi AH, Salimi A, Naghibzadeh G, Mousavi SJ (2011) Epidural anesthesia as a thromboembolic prophylaxis modality in plastic surgery. Aesthet Surg J 31:821–824

    Article  Google Scholar 

  7. Broughton G 2nd, Rios JL, Rohrich RJ, Brown SA (2007) Deep venous thrombosis prophylaxis practice and treatment strategies among plastic surgeons: survey results. Plast Reconstr Surg 119:157–174

    Article  CAS  Google Scholar 

  8. Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, Samama CM (2012) Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest 141:e227S–e277S

    Article  CAS  Google Scholar 

  9. Pannucci CJ (2017) Evidence-based recipes for venous thromboembolism prophylaxis: a practical safety guide. Plast Reconstr Surg 139:520e–532e

    Article  CAS  Google Scholar 

  10. Pannucci CJ, MacDonald JK, Ariyan S, Gutowski KA, Kerrigan CL, Kim JY, Chung KC (2016) Benefits and risks of prophylaxis for deep venous thrombosis and pulmonary embolus in plastic surgery: a systematic review and meta-analysis of controlled trials and consensus conference. Plast Reconstr Surg 137:709–730

    Article  CAS  Google Scholar 

  11. Dini G, Ferreira M, Albuquerque L, Ferreira L (2012) How safe is chemoprophylaxis after abdominoplasty? Plast Reconstr Surg 130:851e–857e

    Article  CAS  Google Scholar 

  12. Hatef DA, Trussler AP, Kenkel JM (2010) Procedural risk for venous thromboembolism in abdominal contouring surgery: a systematic review of the literature. Plast Reconstr Surg 125:352–362

    Article  CAS  Google Scholar 

  13. Pannucci CJ, Bailey SH, Dreszer G, Fisher Wachtman C, Zumsteg JW, Jaber RM, Hamill JB, Hume KM, Rubin JP, Neligan PC, Kalliainen LK, Hoxworth RE, Pusic AL, Wilkins EG (2011) Validation of the Caprini risk assessment model in plastic and reconstructive surgery patients. J Am Coll Surg 212:105–112

    Article  Google Scholar 

  14. Davison SP, Venturi ML, Attinger CE, Baker SB, Spear SL (2004) Prevention of venous thromboembolism in the plastic surgery patient. Plast Reconstr Surg 114:43e–51e

    Article  Google Scholar 

  15. Rodrigues MA, Nahas FX, Reis RP et al (2015) Does diastasis width influence the variation of the intra -abdominal pressure after correction of rectus diastasis. Aesthet Plast Surg 35:583–588

    Article  Google Scholar 

  16. Newall G, Ruiz-Razura A, Mentz HA, Patronella CK, Ibarra FR, Zarak A (2006) A retrospective study on the use of a low-molecular-weight heparin for thromboembolism prophylaxis in large-volume liposuction and body contouring procedures. Aesthet Plast Surg 30:86–95

    Article  Google Scholar 

  17. Pannucci CJ, Dreszer G, Wachtman CF, Bailey SH, Portschy PR, Hamill JB, Hume KM, Hoxworth RE, Rubin JP, Kalliainen LK, Pusic AL, Wilkins EG (2011) Postoperative enoxaparin prevents symptomatic venous thromboembolism in high-risk plastic surgery patients. Plast Reconstr Surg 128:1093–1103

    Article  CAS  Google Scholar 

  18. Morales R Jr, Ruff E, Patronella C, Mentz H 3rd, Newall G, Hustak KL, Fortes P, Bush A (2016) Safety and efficacy of novel oral anticoagulants vs low molecular weight heparin for thromboprophylaxis in large-volume liposuction and body contouring procedures. Aesthet Surg J 36:440–449

    Article  Google Scholar 

  19. Hunstad JP, Krochmal DJ, Flugstad NA, Kortesis BG, Augenstein AC, Culbertson GR (2016) Rivaroxaban for venous thromboembolism prophylaxis in abdominoplasty: a multicenter experience. Aesthet Surg J 36:60–66

    Article  Google Scholar 

  20. Hatef DA, Kenkel JM, Nguyen MQ, Farkas JP, Abtahi F, Rohrich RJ, Brown SA (2008) Thromboembolic risk assessment and the efficacy of enoxaparin prophylaxis in excisional body contouring surgery. Plast Reconstr Surg 122:269–279

    Article  CAS  Google Scholar 

  21. Gravante G, Araco A, Sorge R, Araco F, Nicoli F, Caruso R, Langiano N, Cervelli V (2008) Pulmonary embolism after combined abdominoplasty and flank liposuction: a correlation with the amount of fat removed. Ann Plast Surg 60:604–608

    Article  CAS  Google Scholar 

  22. Somogyi RB, Ahmad J, Shih JG, Lista F (2012) Venous thromboembolism in abdominoplasty: a comprehensive approach to lower procedural risk. Aesthet Surg J 32:322–329

    Article  Google Scholar 

  23. Al-Basti HB, El-Khatib HA, Taha A, Sattar HA, Bener A (2004) Intraabdominal pressure after full abdominoplasty in obese multiparous patients. Plast Reconstr Surg 113:2145–2150

    Article  Google Scholar 

  24. Huang GJ, Bajaj AK, Gupta S, Petersen F, Miles DA (2007) Increased intraabdominal pressure in abdominoplasty: delineation of risk factors. Plast Reconstr Surg 119:1319–1325

    Article  CAS  Google Scholar 

  25. Schein M, Wittmann DH, Aprahamian CC, Condon RE (1995) The abdominal compartment syndrome: the physiological and clinical consequences of elevated intra-abdominal pressure. J Am Coll Surg 180:745–753

    CAS  PubMed  Google Scholar 

  26. Pannucci CJ, Alderman AK, Brown SL, Wakefield TW, Wilkins EG (2012) The effect of abdominal wall plication on intra-abdominal pressure and lower extremity venous flow: a case report. J Plast Reconstr Aesthet Surg 65:392–394

    Article  Google Scholar 

  27. Comerota AJ, Stewart GJ, Alburger PD, Smalley K, White JV (1989) Operative venodilation: a previously unsuspected factor in the cause of postoperative deep vein thrombosis. Surgery 106:301–308

    CAS  PubMed  Google Scholar 

  28. Clayman MA, Clayman ES, Seagle BM, Sadove R (2009) The pathophysiology of venous thromboembolism: implications with compression garments. Ann Plast Surg 62:468–472

    Article  CAS  Google Scholar 

  29. Pannucci CJ, Wachtman CF, Dreszer G, Bailey SH, Portschy PR, Hamill JB, Hume KM, Hoxworth RE, Kalliainen LK, Rubin JP, Pusic AL, Wilkins EG (2012) The effect of postoperative enoxaparin on risk for reoperative hematoma. Plast Reconstr Surg 129:160–168

    Article  CAS  Google Scholar 

  30. Swanson E (2014) The case against chemoprophylaxis for venous thromboembolism prevention and the rationale for SAFE anesthesia. Plast Reconstr Surg Glob Open 2:e160

    Article  Google Scholar 

Download references

Funding

No intramural or extramural funding supported any aspect of this work.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Prerna Mittal.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest to disclose. None of the authors have a financial interest in any of the products, devices or drugs mentioned in the manuscript.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

For this type of study, informed consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mittal, P., Heuft, T., Richter, D.F. et al. Venous Thromboembolism (VTE) Prophylaxis After Abdominoplasty and Liposuction: A Review of the Literature. Aesth Plast Surg 44, 473–482 (2020). https://doi.org/10.1007/s00266-019-01576-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-019-01576-2

Keywords

Navigation