Apixaban (Eliquis) for Venous Thromboembolic Prophylaxis following Abdominoplasty: Establishing a Safety and Efficacy Profile.

Abstract

Abdominoplasty and body contouring operations are responsible for a majority of venous thromboembolism (VTE) events in aesthetic surgery. Apixaban is a newer oral anticoagulant that may prevent VTE without increasing the risk for hematoma. The goal of this study is to assess the safety and efficacy of apixaban as a method of anticoagulation for abdominoplasty patients. A retrospective review was conducted on 282 consecutive abdominoplasty cases performed by the senior author between 2018 and 2023. Patient demographics, surgical details, use of anticoagulation, and postoperative complications were assessed. A total of 282 patients were included. Average body mass index was 27.5 ± 5.1 kg/m 2 (range, 17.5 to 44.1 kg/m 2 ) and average surgical duration was 227 ± 66 minutes (range, 104 to 426 minutes). Two hundred sixty-one (92.6%) patients had direct lipectomy and liposuction performed at the time of abdominoplasty. Seventy-eight (27.7%) patients underwent a concurrent breast procedure. Sixty patients had concurrent umbilical hernia repair (21.3%). Eighty-seven patients (30.9%) were prescribed prophylactic apixaban following surgery. Twenty-four patients (8.5%) were prescribed an alternative blood thinner (enoxaparin or rivaroxaban). Three patients (1.1%) developed VTE postoperatively. There was no significant difference in VTE rates between those prescribed apixaban (1.1%), enoxaparin/rivaroxaban (4.1%), or no anticoagulation (0.5%) ( P = 0.28). Four patients (1.4%) developed a postoperative hematoma within 24 hours, requiring drainage in the operating room. None of the patients who developed hematomas were on prophylactic apixaban. Apixaban is safe and effective 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.