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Thromboembolic Risk Assessment and the Efficacy of Enoxaparin Prophylaxis in Excisional Body Contouring Surgery

Hatef, Daniel A. M.D.; Kenkel, Jeffrey M. M.D.; Nguyen, Marilyn Q. M.D.; Farkas, Jordan P. M.D.; Abtahi, Fatemeh M.D.; Rohrich, Rod J. M.D.; Brown, Spencer A. Ph.D.

Plastic and Reconstructive Surgery: July 2008 - Volume 122 - Issue 1 - p 269-279
doi: 10.1097/PRS.0b013e3181773d4a
Cosmetic: Original Articles

Background: There is a paucity of evidence within the plastic surgery literature concerning risk stratification and management of patients with respect to thromboembolic disease. A retrospective chart review was conducted to examine whether the Davison-Caprini risk-assessment model could stratify patients undergoing excisional body contouring surgery, allowing prophylaxis to be managed in an evidence-based manner.

Methods: Three hundred sixty excisional body contouring patients at the University of Texas Southwestern Medical Center in Dallas, Texas, under the senior authors’ (J.M.K. and R.J.R.) care were reviewed. Patients were stratified into groups according to the risk-assessment model and into groups based on procedure. Patient characteristics were investigated for their effects on thromboembolic risk. Complications of enoxaparin administration were analyzed. The data were analyzed using appropriate statistical procedures.

Results: The highest risk patients had a significantly increased rate of venous thromboembolism when compared with lower risk patients. Body mass index greater than 30 and hormone therapy use were associated with a significantly increased venous thromboembolism rate. Enoxaparin administration was associated with a statistically significant decrease in deep venous thrombosis in circumferential abdominoplasty patients. Enoxaparin administration was associated with higher bleeding rates.

Conclusions: Low-molecular-weight heparin may affect the incidence of postoperative thrombotic complications in some surgical populations. In this study, patients who scored greater than four risk factors were at significant risk for venous thromboembolism. Enoxaparin significantly decreased deep venous thrombosis risk in patients undergoing circumferential abdominoplasty. This demonstrates the need for a multicenter, prospective, randomized study to examine various thromboembolic therapies and associated possible complications in these patients.

Dallas, Texas

From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.

Received for publication May 24, 2007; accepted October 17, 2007.

Jeffrey M. Kenkel, M.D.; Department of Plastic Surgery; University of Texas Southwestern Medical Center; 5373 Harry Hines Boulevard; Dallas, Texas 75390;

Disclosure: There are no financial disclosures that might pose or create a conflict of interest with any of the information discussed in this article.

©2008American Society of Plastic Surgeons