Preoperative GLP-1 Receptor Agonists and Thromboinflammatory Markers in Patients Undergoing Abdominoplasty: A...

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.

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.

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).

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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