BACKGROUND: Abdominoplasty in patients with obesity carries a heightened risk of venous thromboembolism (VTE) due to a proinflammatory and hypercoagulable baseline. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used for weight loss and have demonstrated anti-inflammatory and antithrombotic properties, but their role in aesthetic surgery remains unexplored.
METHODS: We conducted a prospective, monocentric, observational study of 60 female patients (BMI ≥ 30 kg/mbefore weight loss) undergoing standardized abdominoplasty with rectus plication. Two cohorts were compared: (1) 30 patients treated with GLP-1 RAs (semaglutide or tirzepatide) for ≥12 weeks preoperatively, and (2) 30 patients achieving comparable weight loss through structured lifestyle intervention. Perioperative management, including VTE prophylaxis, was identical. Biomarkers (CRP, IL-6, fibrinogen, D-dimer, PAI-1) were measured at baseline and on postoperative days (POD) 1, 3, and 7. VTE incidence was assessed clinically and by routine Doppler ultrasound on POD7. 2
RESULTS: Weight loss and preoperative metabolic profiles were comparable between groups. Postoperatively, biomarker increases were significantly attenuated in the GLP-1 RA group: CRP (+ 18 vs. + 28 mg/L, p < 0.01), IL-6 (+ 12 vs. + 20 pg/mL, p < 0.01), fibrinogen (+ 40 vs. + 65 mg/dL, p = 0.02), D-dimer (+ 0.8 vs. + 1.3 µg/mL, p < 0.01), and PAI-1 (+ 5 vs. + 9 ng/mL, p < 0.05). No symptomatic VTE occurred in the GLP-1 group versus two cases (6.7%) in controls; subclinical DVT occurred in 1 (3.3%) versus 3 (10%), respectively. Hospital stay was shorter with GLP-1 therapy (1.8 vs. 2.2 days, p = 0.04).
CONCLUSIONS: Preoperative GLP-1 RA therapy was associated with reduced perioperative thromboinflammatory response and a favorable trend toward fewer VTE events and complications, despite equivalent weight loss. GLP-1 RAs may provide dual benefits-metabolic optimization and risk modulation-in high-BMI abdominoplasty candidates. Larger randomized trials are warranted.
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