A proper bloodless field and coagulation profile represent essential elements for performing a safe, effective, and fast rhinoplasty. However, some particular conditions among patients with a high thromboembolic risk for congenital thrombophilia require antithrombotic prophylaxis using low-molecular-weight heparin. To date, the literature contains no particular indication for the management of patients undergoing rhinoseptoplasty while receiving anticoagulant therapy. The authors report their experience managing a 36-year-old man who underwent aesthetic rhinoseptoplasty while at the same time carrying a heterozygous mutation (G20210A) of prothrombin and a homozygous mutation of methylenetetrahydrofolate reductase (C677T). Special attention must be paid to balancing the prevention and reduction of thrombotic risk for excessive anticoagulation, which would make surgery unsafe and difficult to perform.
Level of evidence iv: This journal requires that authors assign a level of evidence to each article.