Postoperative Venous Thromboembolism Prophylaxis Utilizing Enoxaparin Does Not Increase Bleeding Complications After Abdominal Body Contouring Surgery

BACKGROUND: Venous thromboembolism (VTE) chemoprophylaxis warrants individualized, risk-stratified approach, and constitutes a relatively controversial topic in plastic surgery. OBJECTIVES: To determine the safety of a seven-day postoperative enoxaparin regimen for VTE prophylaxis compared to a single preoperative dose of heparin in abdominal body contouring surgery. METHODS: This single-institution pre-post study compared the safety of a seven-day enoxaparin postoperative regimen to a single preoperative dose of heparin in abdominal body contouring procedures performed by a single surgeon from 2007 to 2018. Four procedures were included: traditional panniculectomy, abdominoplasty, fleur-de-lis panniculectomy, and body contouring liposuction. Group I patients received a single dose of 5000 units subcutaneous heparin in the preoperative period, and no postoperative chemical prophylaxis was administered. Group II patients received 40 mg subcutaneous enoxaparin in the immediate preoperative period, then once-daily for seven days postoperatively. RESULTS: A total of 195 patients were included in the study, 66 in Group I and 129 in Group II. The groups demonstrated statistically similar VTE risk profiles, based on the 2005 Caprini risk assessment model. There were no statistically significant differences in the two primary outcomes: postoperative bleeding and VTE events. Group I patients had higher reoperation rates (22.7 percent versus 10.1 percent, p = 0.029), which was secondary to higher rates of revision procedures. CONCLUSIONS: A seven-day postoperative course of once-daily enoxaparin for VTE risk reduction in abdominal body contouring surgery does not significantly increase the risk of bleeding. Implementation of this regimen for post-discharge chemoprophylaxis, when indicated following individualized risk stratification, is appropriate.