Abdominal Contouring Procedures are Associated with a Physiologic Hypercoagulable State

Abdominal Contouring Procedures Are Associated with a Physiologic Hypercoagulable State

Background: One of the most serious complications from cosmetic surgery is a thromboembolic event, and the incidence ranges from 1-9% in truncal contouring procedures. Little physiologic data exists to correlate with the observed hypercoagulable state.  This is the first study to assess physiological markers of hypercoagulability, and one of few prospective studies addressing thromboembolic risk and prophylaxis in body contouring patients.

Methods: Twenty-one consecutive patients were enrolled prospectively in a non-randomized study to assess baseline, intra-op, and post-op thrombin generation.

Thrombin generation is the preferred clinically relevant approach to assess the global activity of the coagulation cascade and has been shown to correlate with the risk of venous thromboembolism¹.  Intra-op and post-op thrombin measurements were normalized to the patient's baseline thrombin generation, which was measured prior to surgery and prior to heparin administration.

Results: Nine patients (average age 44, range 24-64) and a mean BMI of 25 (21-31) underwent abdominoplasty without DVT chemoprophylaxis. Seventy-eight percent had liposuction and 67% had simultaneous procedures. The average operative time was 3.7 hours. Total thrombin generation increased a mean of 972 intra-operatively (1.3 fold increase, p<0.004), and postoperative thrombin generation increased a mean of 1406 (1.4 fold increase, p<0.001) (Figure 1). Twelve patients (average age 46, range 35-60) and a mean BMI of 30.8 (22.2-39.9) underwent abdominoplasty with DVT chemoprophylaxis due to the higher risk profile.  Two-thirds had massive weight loss. Fifty percent of patients had liposuction and 75% had simultaneous procedures. The average operative time was 5 hours. In this group receiving heparin chemoprophylaxis, the mean thrombin generation increase was not significant (p=0.3). The intraoperative and postoperative thrombin generation were significantly less in patients receiving heparin chemoprophylaxis compared to those who received no prophylaxis (p<0.02 for each). There were no thromboembolic events or bleeding complications.

Conclusions: There is a significant increase in activity of the coagulation cascade in patients undergoing abdominal contouring procedures without chemoprophylaxis. Giving perioperative chemoprophylaxis with unfractionated heparin decreases the coagulation potential. Further studies may help define the hypercoagulable perioperative state and elucidate the optimal course of perioperative chemoprophylaxis.

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1. Hron G, Kollars M, Binder BR, Eichinger S, Kyrle PA. Identification of Patients at Low Risk for Recurrent Venous Thromboembolism by Measuring Thrombin Generation. JAMA 2006: 296:397-402.