A Systematic Review of the Efficacy of Venous Thromboembolism Prevention Protocols in Abdominoplasty Patients and the Risk of Bleeding

BACKGROUND: Many surgeons have adopted chemoprophylaxis in an effort to reduce VTE risk. However, the efficacy of routine anticoagulation has been challenged. Whether chemoprophylaxis raises the risk of bleeding has been the subject of debate. This review was undertaken to evaluate the efficacy of this method and the bleeding risk. METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the literature was reviewed for publications reporting series of at least 100 abdominoplasties published from 2012 to 2025. The incidences of VTE and hematomas were tabulated. The quality of evidence was evaluated using Methodological Index for Non-Randomized Studies (MINORS) scores. RESULTS: Twenty-four publications were identified, comprising 9502 patients. All studies were retrospective, with data heterogeneity. Seventeen studies (71%) routinely used chemoprophylaxis. The overall VTE risk was 0.3% in studies using chemoprophylaxis versus 0.5% in studies not using anticoagulation (difference not significant). The hematoma rate was 4.7% for anticoagulated patients versus 0.6% for nonanticoagulated patients. The difference was highly significant (P = 0). Blood transfusions were more likely in patients receiving chemoprophylaxis (P < 0.05). Only 1 study incorporated routine Doppler ultrasound screening. Most studies (15/24, 63%) reported using sequential compression devices (SCDs). The overall VTE risk among pooled patients treated with SCDs was 0.9% versus 0.5% for patients treated without SCDs. The difference was significant (P = 0.04). DISCUSSION: Some plastic surgeons have been wary of off-label chemoprophylaxis in plastic surgery patients, concerned about its efficacy and the potential for increased bleeding. The data do not show a significant treatment benefit in abdominoplasty patients. The evidence of an increased bleeding risk appears conclusive. The unexpected finding of more, not less, VTEs among patients treated with SCDs challenges the efficacy of this common practice. Ultrasound screening allows early detection of clinical and subclinical VTEs, and anticoagulation of affected patients. CONCLUSIONS: No significant benefit derives from off-label chemoprophylaxis for VTE reduction in abdominoplasty patients. The risk of bleeding is significantly increased. SCDs appear to be of no benefit. An alternative method, using ultrasound screening, total intravenous anesthesia, and no chemoprophylaxis is safe and effective.