Verolino Pasquale, Sagnelli Caterina, Grella Roberto, Nicoletti Giovanni Francesco, Sica Antonello, Faenza Mario
Multidisciplinary Department of Medical Surgical and Dental Specialties, Unit of Plastic Surgery, University of Campania "Luigi Vanvitelli", 80120 Naples, Italy.
Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
Healthcare (Basel). 2022 Mar 3;10(3):476. doi: 10.3390/healthcare10030476.
Congenital or acquired thrombophilia is observed in 10-15% of the general population; therefore, careful screening is carried out in patients at higher risk of venous thrombo-embolism (VTE). High risk of VTE is a contraindication in patients undergoing abdominoplasty. We evaluated rivaroxaban, an oral Xa inhibitor, with enoxaparin, a subcutaneously low molecular weight heparin (LMWH), in 48 female patients with documented thrombophilia, undergoing thrombo-prophylaxis after abdominoplasty. Patients were stratified into two groups according to thrombo-prophylaxis procedure: enoxaparin Group ( = 28) and rivaroxaban Group ( = 20). Hematologic outcomes were evaluated including VTE and hematoma. No episodes of VTE occurred in both groups; two patients during their course of enoxaparin presented severe hematoma for drainage and hemostasis revision. This study suggests that abdominoplasty, in patients with thrombophilia, in combination with thrombo-prophylaxis can be performed safely. Rivaroxaban was as effective as LMWH for preventing VTE, with only a moderate risk of clinically relevant bleeding. More research is needed to determine the optimal timing and duration of prophylaxis in patients undergoing plastic surgery.
在普通人群中，10%-15%的人存在先天性或获得性血栓形成倾向；因此，对于静脉血栓栓塞（VTE）风险较高的患者需进行仔细筛查。VTE高风险是腹部整形手术患者的禁忌证。我们在48例有血栓形成倾向记录且接受腹部整形术后血栓预防的女性患者中，对比了口服Xa因子抑制剂利伐沙班与皮下注射低分子肝素（LMWH）依诺肝素的效果。根据血栓预防方案，患者被分为两组：依诺肝素组（n = 28）和利伐沙班组（n = 20）。评估了包括VTE和血肿在内的血液学结果。两组均未发生VTE事件；依诺肝素治疗过程中有2例患者出现严重血肿，需进行引流和止血修复。本研究表明，对于有血栓形成倾向的患者，腹部整形手术联合血栓预防可以安全进行。利伐沙班在预防VTE方面与LMWH效果相当，临床相关出血风险仅为中度。需要更多研究来确定整形外科手术患者预防的最佳时机和持续时间。
