DVTs (deep vein thrombosis) are no joke. If they dislodge, they can cause a pulmonary embolus and death. So we do everything we can to prevent them. My staff has a multipoint plan we do on every patient, and I adhere to the Caprini score and treat high risk patients with blood thinners as warranted by their score. This was an abstract in the October 2021 Aesthetic Surgery Journal, “Deep Vein Thrombosis (DVT) and Abdominoplasty: A Holistic 8 Point Protocol Based Approach to Prevent DVT.” They did 1078 tummy tucks with no reported DVTs.
So what did they do?
8 point plan
- one month prior must stop smoking
- one month prior no hormone replacement or contraception
- BMI less than 40
- Wear compression stockings
- Sequential compression devices (the squeezing calf massagers we use during surgery) were given
- Lovenox
- If you had a history of a clot, you needed to be 1 year treatment free prior to surgery
- You must walk within 4 hours after surgery.
My thoughts?
We do most of these things. The one I am not sure about is Lovenox for everyone. Lovenox is an injectable blood thinner. We do use the injection of blood thinner for patients who score at high risk in the Caprini DVT risk scoring. I am just not sure I would use it on everyone, because adding blood thinner has risks of its own- bleeding in the surgical site, GI bleeding, etc.
I add things like Exparel (an injectable medication placed during surgery which helps with pain control, therefore usually my patients are up and about sooner), a focus on pain control, a pillow behind the knee during surgery to help with blood flow, and going home, where they have to get out of bed to go to the bathroom, get food, etc.
It’s a good reminder though, and no diagnosed cases of DVT? Bravo!