While the CAPRINI score is an excellent modality for risk stratification in abdominoplasty, even having a low CAPRINI score does not ensure that a patient will not endure a Venous Thrombotic Event (VTE). We demonstrated risk mitigation with comprehensive VTE prophylaxis can be performed safely and protect against catastrophic PE
255 patients who underwent abdominoplasty were treated with comprehensive VTE prophylaxis consisting of preoperative heparin, intraoperative sequential compression devices and 1 week post operative Lovenox. Patients with elevated CAPRINI scores were tested for mutations and screened by a Hematologist, but were not precluded from being offered surgery. High risk patients were treated with Lovenox for 1 month. All patients were operated on in a hospital setting under general anesthesia. Rectus plication was performed on all patients.
2 patients experienced PE’s. One had a CAPRINI score of 4. She had a massive saddle embolus on post op day 5 while on Lovenox. This condition required surgical clot removal and she recovered fully. Work up revealed no genetic mutations. The second patient had a CAPRINI score of 4 and suffered a mild PE on post op day 25. She was unaware of her family risk factors which would have made her a CAPRINI score of 7. Her workup for genetic mutations was also negative. The hematoma rate for all patients was 0.7% and were managed with simple evacuation. 47% of the patients had a concomitant procedures. The average age was 46 years old (range 22 to 76 years old). The average BMI was 27.1 (range of 18 to 41)
VTE’s are a rare event and risk stratification with CAPRINI scores can be helpful in identifying those individuals who may benefit from hematology workups and prolonged chemoprophylaxis. However, the majority of PE’s occur in low risk patients and our data reflects similarly. Despite the comprehensive VTE prophylaxis, the hematoma rate was very manageably low and our prophylaxis algorithm may have provided live saving protective benefits for the low risk patient who suffered a massive PE.
