I recently saw a patient who wants an abdominoplasty and she has prior histories of blood clots in her leg. We had a long discussion about elective surgery and the risks of surgery. Why do I care so much about blood clots? I wouldn’t care as much if the clot formed in the leg and stayed in the leg. The issue with blood clots is they travel, and when they travel they end up in the lung, causing a pulmonary embolus, called a PE. When this happens, if the PE is big enough, it can impair breathing. A pulmonary embolus can kill you.
To get acquainted to the issues of DVT, PE, and the Caprini risk scoring system I use, please see my prior blogs HERE .
FIVE Basic things to know:
- Tell your doctor if YOU or anyone in YOUR FAMILY has a history of a blood clot (frequently seen around pregnancy, a long plane flight, surgery)
- Your risk of blood clot is higher with age.
- Your risk of blood clot is higher with longer surgeries.
- Your risk of blood clot is higher with hormones- whether this is hormone replacement when post menopausal, or birth control pills /injections/ IUD when younger.
- The key after surgery is get up and walk. This is not doing laps around the neighborhood. This is walking to the living room or bathroom. Frequent short trips, a minimum of 3 times a day.
Recently in my Aesthetic Society News, they had some helpful advice to avoid blood clots that should be used on every patient. Most of these are easy, cost nothing, and are just good things to do for every surgery. *Please note, these are considerations. Please discuss with your doctor.
GENERAL ADVICE TO AVOID BLOOD CLOTS
- Discontinue hormone replacement therapy
- Discontinue birth control pills
- (*discuss with doctor. If you are young, no history of clots, and it is a short surgery, this is unlikely needed)
- Stop smoking at least 4 weeks prior to surgery
- Encourage oral fluids beginning 24 hours prior to surgery
- Highlight adequate hydration and frequent walking for airline travel done immediately prior to surgery
- Fluid load prior to starting anesthesia
- Apply sequential compression devices prior to induction of anesthesia
- (*this one is important. I always make sure the SCDs are going before induction, as there was a study which indicated this is the most likely time for a blood clot to form during surgery.)
- Elevate legs slightly to help venous blood return
- Use long acting local anesthetics or pain pumps to reduce early post op pain
- This also helps early walking
- Less narcotics are needed
- Improves deep breathing which helps limit lung complications/ improves atelectasis