Intro: Prophylactic use of low molecular weight heparins has been shown to be efficacious in decreasing thromboembolism. Low molecular weight heparins are associated with increased rates of bleeding. We reviewed perioperative blood pressure dynamics for patients who experienced hematomas while undergoing body contouring procedures on Lovenox, compared to similar patients who did not develop a postoperative hematoma. Methods: A retrospective chart review was performed examining two patient groups: Ten patients who experienced a hematoma after excisional body contouring surgery with perioperative Lovenox; and ten similar patients with respect to sex, surgery type, and Lovenox administration, who did not have a hematoma. Pre- and post-operative blood pressures were recorded, as were blood pressures during the last two hours of surgery. Mean arterial pressures were calculated for all time points, and mean intraoperative MAP was statistically compared to pre- and post-operative MAP, for the two groups. Results: The mean pre-operative MAP for each group was the same (97.5 mmHg vs. 95.8 mmHg; p = 0.61). The mean MAP for the last two hours of each case was significantly lower in the hematoma group (66.7 mmHg vs. 82.4 mmHg; p < 0.0001), and a higher mean post-operative MAP reached significance in the hematoma group (96.3 mmHg vs. 88.5 mmHg; p = 0.05). Both the difference between intra- and pre-op blood pressure (30.7 mmHg vs. 13.4 mmHg; p < 0.0001), and between intra- and post-op blood pressure (29.6 mmHg vs. 7.0 mmHg; p < 0.0001) were increased in the hematoma group versus the non-hematoma group. Conclusions: Many patients undergoing excisional body contouring surgery are at risk for VTE and may need perioperative chemoprophylaxis. However, maintaining a relatively normotensive intraoperative blood pressure, and vigilance in recognizing and treating post-operative hypertension, surgeons may reduce the hematoma rate seen with perioperative LMWH administration.
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