
==== Front
Plast Reconstr Surg Glob Open
Plast Reconstr Surg Glob Open
GOX
Plastic and Reconstructive Surgery Global Open
2169-7574
Lippincott Williams & Wilkins Hagerstown, MD

GOX-D-24-00774
00012
10.1097/01.GOX.0001063856.58207.88
3
PSTM Abstract Supplement
PSTM Top Abstracts/Posters 2024
Apixaban for VTE Prophylaxis Following Abdominoplasty: Establishing a Safety and Efficacy Profile
Bricker Jonathan MD 1
Ferenz Sarah BA 1
Moradian Simon MD 1
Termanini Kareem MD 1
Jackson Brandon MD 1
Kim John Y.S. MD 1
Northwestern University Feinberg School of Medicine, Chicago, IL
9 2024
18 9 2024
12 Suppl 9Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

OPEN-ACCESSTRUE
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pmcPURPOSE: Abdominoplasty is responsible for the majority of venous thromboembolic events (VTE) that occur in aesthetic surgery cases. The Caprini Risk Assessment Model is a validated tool developed to assess VTE risk and guide postoperative anticoagulation, often with a low molecular weight heparin like enoxaparin. However, many surgeons are hesitant to administer it following abdominoplasty due to concerns of postoperative hematoma. Apixaban, a newer oral anticoagulant, is emerging as a potential alternative to enoxaparin, but more research is needed to assess its association with hematoma development. Therefore, the goal of this study is to assess the safety and efficacy of apixaban as a method of anticoagulation for abdominoplasty patients.

METHODS: A retrospective chart review was conducted on 282 consecutive abdominoplasty cases performed by the senior author between 2018 and 2023. Patient demographic information and surgical details were obtained from the chart, including concurrent procedures, length of time in the operating room, and any use of postoperative anticoagulation. The primary outcome variables, venous thromboembolism and hematoma, were recorded. Data was analyzed using IBM’s SPSS Software (Armonk, NY) and statistical significance was set to p < 0.05.

RESULTS/COMPLICATIONS: 282 patients were identified, 275 female (97.5%) and 7 male (2.5%), with an average age of 42.5 years (range 25 – 77). Average preoperative weight and BMI were 75.2 kg (44.2 – 128.2) and 27.5 (17.5 – 44.1), respectively. Average surgical duration was 227 minutes (104 - 426). Two-hundred sixty-one (92.6%) patients had concurrent direct lipectomy and liposuction, 266 (94.3%) rectus muscle plication, and 78 (27.7%) a concurrent breast procedure. Average follow up time was 6 months (0 – 37).

One-hundred eleven (39.4%) patients received postoperative anticoagulation. Eighty-seven (30.9%) were prescribed prophylactic apixaban. Twenty-four patients (8.5%) were prescribed an alternative blood thinner (enoxaparin or rivaroxaban). Patients who were prescribed apixaban had greater mean age (43.9 vs 41.7, p = 0.019), surgical duration (245.1 min. vs 216.4, p < 0.001), preoperative BMI (30.4 vs 25.7, p < 0.001), and weight (82.9 kg vs 70.2, p < 0.001) compared to those who were not.

Three patients (1.1%) developed VTE postoperatively. Of these, one was prescribed two weeks of postoperative enoxaparin and developed a PE one month from surgery. The second developed a PE within 24 hours of surgery on no postoperative anticoagulation. The third patient completed two weeks of apixaban after undergoing abdominoplasty with liposuction, direct lipectomy, rectus plication and mastopexy. She returned a month later for minor debridement surgery. Given the short duration of the surgery, she was not prescribed additional postoperative anticoagulation. One week later, she was hospitalized for a saddle PE and left popliteal DVT.

Four patients (1.4%) developed a postoperative hematoma requiring drainage in the operating room. None (0%) of these patients were on prophylactic anticoagulation when they developed the hematoma.

CONCLUSION: Apixaban is a safe and effective alternative to enoxaparin for VTE prophylaxis after abdominoplasty. Further studies with larger sample sizes and direct comparisons of various anticoagulants are needed to delineate the comparative safety and efficacy profiles.
