The Role and Risk Profile of Rivaroxaban and Aspirin for Postoperative Venous Thromboembolism Prophylaxis in the Body Contouring Patient: A Single Center, 742 Patient Review
Patients undergoing abdominal based body contouring procedures are at an inherent increased risk of VTE complications. The use of risk stratification models combined with the use of an extended oral anticoagulant regimen postoperatively may lead to an improvement in overall patient safety without an increase in hematologic concerns.
Methods/Technique: :
A retrospective chart review from January 2022 to October 2024 was performed on patients who underwent abdominoplasty, circumferential body lift, fleur-de-lis panniculectomy, or circumferential fleur-de-lis panniculectomy at a single surgical center. Patients underwent risk stratification outlined by the ASPS VTE Task Force Report. Those patients with a Caprini score of 5 (Moderate Risk), were given a once daily oral regimen of 81mg of Aspirin for 30 days, to begin Postoperative Day 1. Patients with a Caprini score of 7 and greater (or any patient undergoing muscle plication), were given a once daily oral dose of 10mg of Rivaroxaban for one week, followed by a once daily oral dose of 81mg of Aspirin for 21 days. The primary endpoints of the study were hematologic complications including symptomatic VTE and hematoma formation.
Results/Complications: :
From January 2022 until October 2024, 795 patients underwent body contouring surgery. 690 patients received Rivaroxaban and Aspirin postoperatively either due to Caprini Score equal to or greater than seven, or if muscle plication was performed. Seventeen patients (2.1%) had their postoperative course complicated by hematoma formation (1 male, 16 female). Only 13/17 of these patients were prescribed Rivaroxaban and Aspirin postoperatively. Their average Caprini Score was considered moderate (4.65). 13/17 patients had hematoma formation within the first 24 hours of surgery, before starting their prophylaxis regimen. The remaining patients developed a hematoma at day 5, 8, 22 and 22 respectively. There were no identified symptomatic VTE events in patients undergoing abdominal body contouring procedures.
Conclusion: :
An oral regimen of Rivaroxaban and Aspirin is safe in patients with an elevated risk profile undergoing abdominal body contouring procedure. Our proposed 30 day regimen demonstrates a decreased incidence of VTE related events and bleeding complications.