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/m2 before 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. 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. Level of Evidence II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.

Preoperative GLP-1 Receptor Agonists and Thromboinflammatory Markers in Patients Undergoing Abdominoplasty: A Prospective Monocentric Study

期刊论文
发表日期：

2026年4月7日

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Agostino Bruno,
Marco Schirosi,
Riccardo Foti

摘要

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/m² before 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.

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.

Level of Evidence II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.