There are several things that need to discussed between your plastic surgeon and your hematologist. For example, how long will you be on Coumadin?
While the recommendations have changed, if you had DVTs and PEs while you were pregnant and hypercoaguable, you may only need to be on Coumadin for 6 months or a year.
If you are determined to have the surgery and need to be anticoagulated forever, you might inquire about switching to low molecular weight heparin for a brief period before and after surgery. LMWHs confer the anticoagulative effect you need but, supposedly don’t cause bleeding issues.
I say supposedly because various surgeons have differing opinions on this. Once you are out the woods for bleeding risk you can resume your coumadin. (Robert Frank, MD, Munster Plastic Surgeon)
No ethical Plastic surgeon in control of his faculties and a well-functioning moral compass would perform ANY elective surgery on you while you are on Coumdin. Such surgery is VERY likely to kill you. Of more pressing interest to me, as well as to my colleagues, would be WHY a 28 year old woman sustained a blood clot to her lungs in the first place.
You MUST have been worked up to see if you have either a disease process OR a congenital inherited family disorder which makes your blood clot faster. Either way, discussions SHOULD be held if you should have a precautionary, prophylactic placement of filter in the biggest vein in the body (the inferior Vena cava ) below the kidneys to stop any OTHER future clots from going to the lungs. Some such filters can removed – others cannot.
But, it is not totally safe to have a woman your age stay on coumadin for the rest of your life because of the risks of bleeding (into the head, or bowel). Either way – FOR YOUR SAFETY – NO elective surgery for you in the foreseeable future until this is resolved. (Peter A. Aldea, MD, Memphis Plastic Surgeon)
Liposuction should not be done if there is a history of multiple pulmonary emboli
Unfortunately, if you have already had two pulmonary embolisms, which can be fatal, you should forget the idea of subjecting yourself to such a risk, even if your coumadin can be changed temporarily to allow for surgery. It is not fair to yourself to risk possible death for an elective cosmetic procedure.
There may be fat reduction techniques available in the future that become improved and standardized, such as external ultrasound. It may not t give you the same risk, but it has to be considered seriously for its risks. (Ronald Shelton, MD, Manhattan Dermatologist)
I know this will disappoint you, but you should absolutely not have a tummy tuck with your history. The coumadin is not the issue. You just have unacceptably high risk. (George J. Beraka, MD (retired), Manhattan Plastic Surgeon)
There is NO WAY you are a candidate for elective cosmetic surgery. I believe that no internist, hematolgist would clear you to proceed with this operation in the face of your significant medical history.
Plus, even if you obtained a clearance your operation is an in hospital procedure with a 3 to 4 night stay at the minimium. Please reconsider why you are asking this type of question. (Darryl J. Blinski, MD, Miami Plastic Surgeon)
I would recommend that you be evaluated by your own personal physician regarding the idea of undergoing elective aesthetic surgery. If it is felt that the surgery would be a significant risk, then I would “get that thought out of your head.” You would need to be off anticoagulants until they have absolutely no effect and that time would be decided by your physician and your plastic surgeon. You could commence taking them again during the post-op period after the risk of post-op bleeding has diminished. Remember: Discretion is the better part of valor. (Jack A. Friedland, MD, Phoenix Plastic Surgeon)
Please entirely give up on the idea of a tummy tuck and or liposuction!! Nobody could do this on blood thinners and since you have already had PE, you could die from another one and DVT and PE are the greatest risks of a ummy tuck. So, please just put this right out of your mind, work out and watch your weight and enjoy your children! (Richard P. Rand, MD, FACS, Seattle Plastic Surgeon)
Cosmetic surgery on Coumadin
The short answer to your question is no way. Coumadin is a very strong blood thinning medicine and elective surgery, especially cosmetic surgery is 100% contraindicated. If and when you get off the coumadin or any other blood thinning medicine, then MAYBE you could have cosmetic surgery.
You’re still at high risk because of your previous history of a pulmonary embolism. At that time, you should seek a consultation with a board-certified plastic surgeon. You will also need to discuss this with your pulmonologist. Good luck! (Elan B. Singer, MD, Manhattan Plastic Surgeon)
You definitely do not want to have a tummy tuck while on Coumadin. The bleeding from surgery would probably be uncontrollable. If you have had 2 pulmonary emboli in the past, you would be at a very high risk of having another if your Coumadin were stopped for a tummy tuck. It would seem that in your case the risks would outweigh the benefits and you should have this elective surgery. (John Whitt, MD, Louisville Plastic Surgeon)