Thrombolytic Therapy following Rhytidectomy and Blepharoplasty

Learning Objectives: After studying this article, the participant should be able to: 1. Understand the indications and contraindications for thrombolytic therapy with intravenous tissue plasminogen activator in the perioperative period. 2. Delineate the modifiable and nonmodifiable risk factors that increase a patient’s risk of stroke in the perioperative period. 3. Delineate those elements in the preoperative assessment of cosmetic surgery patients that are useful in the assessment of a patient’s perioperative stroke risk. 4. Gain familiarity with the Framingham Stroke Risk Profile. 5. Understand the additional surgical management of patients who have sequelae secondary to thrombolytic therapy in the early postoperative period following rhytidectomy and/or blepharoplasty. Acute ischemic stroke is a major cause of morbidity and mortality in the United States, yet is an uncommon event in the postoperative period. Intravenous tissue plasminogen activator is the only approved treatment of acute ischemic stroke of less than 3 hours’ duration. Surgery within 14 days is considered a contraindication to thrombolytic therapy due to the increased risk of bleeding complications. The authors report a case of acute ischemic stroke 24 hours following rhytidectomy and blepharoplasty treated with tissue plasminogen activator according to the currently accepted protocol. The patient was carefully monitored for hemorrhagic complications. She developed hematomas that were evacuated, but no life-threatening complications occurred. The facial flaps remained viable and she was discharged neurologically and cosmetically intact. The available case report literature involving thrombolytic use in the postoperative period is reviewed. The authors conclude that in selected circumstances and with adequate surveillance, systemic thrombolytic therapy can be administered safely and effectively postoperatively in rhytidectomy and blepharoplasty patients.