Low Molecular Weight Heparin Versus Rivaroxaban for Thromboprophylaxis in Body Contouring Procedures
Methods/Technique:
We performed a retrospective, single center chart review of 681 patients who underwent body contouring plastic surgery procedures between January 2012 to June 2013. All procedures were performed under general anesthesia in the same surgical outpatient center, by five surgeons. All patients received post-operative thromboprophylaxis. 235 patients (35%) received low molecular weight heparin and 445 patients (65%) received Rivaroxaban. Patient age, sex, height, BMI, smoking status, oral contraceptive or hormone replacement therapy use were recorded. The type, number, and duration of the procedures were recorded. The relative risk score as described by Caprini was evaluated for comparison. Major complications associated with thromboprophylaxis were reviewed including hematomas requiring surgical evacuation, acute blood loss anemia requiring transfusions, and thrombotic or hemorrhagic events.
Results/Complications:
The average age of patients receiving low molecular weight heparin was 40 years old and 39 years old for Rivaroxaban. 94% and 91% of patients were female taking low molecular weight heparin or Rivaroxaban, respectively. The average patient BMI was 27.1 kg/m2 on low molecular weight heparin and 27.4 kg/m2 on Rivaroxaban. The calculated average Caprini scores for low weight molecular heparin and Rivaroxaban were 5.13 and 4.92, respectively (p=0.037). The overall incidence of drug related adverse events related complications occurred in 0.847% of patients who received low molecular weight heparin and 1.57% who received Rivaroxaban. The complications encountered by the 235 patients on low molecular weight heparin consisted of 1 patient (0.4%) with a hematoma and 1 patient (0.4%) with decreased hemoglobin requiring tranfusions. The complications encountered by 445 patients on with Rivaroxaban consisted of 5 patients (1.1%) with hematomas, and 3 patients (0.7%) with decreased hemoglobin requiring transfusions. There were no cases of pulmonary embolic events, deep vein thrombosis, or hemorrhagic events.
Conclusion:
Rivaroxaban is comparable to low molecular weight heparin for thromboprophylaxis after body contouring procedures with similar rates of drug related complications. There were no cases of major thrombotic or hemorrhagic events. Factors such as cost, medication administration, compliance, and availability may be taken in to account in medication selection. Further investigation is warranted with more clinical cases in order to recommend the use of this medication for routine postoperative thromboprophylaxis after body contouring procedures.