“How are you cleared for surgery in a blood clot risk assessment?”

“If you are doing unnecessary surgery, you better do it damn well.” The plastics people are extremely risk averse because their surgeries are a cash business, not a life saving necessity. That being said, you may have other risk factors for blood clots. I am sure you are not taking standard oral contraceptives (because they are contraindicated in migraine) and it is unlikely you are a smoker. Those are two major risk factors for blood clot. Other risk factors are obesity and venous insufficiency in the legs. You do not have a personal or family history of clotting disorder, so those would be the things I would look for if I were doing a pre op exam. I assume you do not have any other major health problems like afib or kidney disease. Yes, it is true that migraine WITH AURA increases your risk of a blood clot to about double compared to a woman your age without migraine with aura. However, It is a low number, and doubling a low number is still a low number. And that is for clots “in general” I am not aware of percent risk that is specific to “perioperative risk” related to migraine. So generally, I would simply make the surgeon aware of that and suggest careful management and suggest proactive preventive measures. However, it is not me doing your procedure. If the surgeon wishes to cover his bases with a hematology consult, it is reasonable to ask for one. In any case, you are at higher risk of blood clot, but so are a lot of people who get surgeries. I am pretty sure the hematologist would agree that you do have increased risk. The hematologist can also check for Factor V Leiden, which might also confer risk, not sure of the exact number. I would ask the surgeon what the standard clotting risk is for his particular surgery, then double it. There is not a cut and dried predictive risk calculation for you that I am aware of. Maybe the hematologist could do a better estimate. But ultimately, you will need to choose the level of risk that you personally feel comfortable with. People with migraines, a fib, cancer, smoking, obesity, etc do get surgeries all the time. I personally have migraine with aura and have been under the knife a few times. There is always risk, sometimes it is hard to quantify.

I agree your risk seems to be very low. However your Plastic Surgeon is concerned and for that reason I would recommend you see a hematologist and receive the clearance the surgeon requests. I doubt the Plastic Surgeon would allow me to consult without seeing you.

While there is no way to predict what the hematologist might say, a small stroke in one grandparent seems highly unlikely to put you at risk for other types of blood clot problems (like those in the legs which could go to your lungs). It would be cheaper to get your pre-surgery evaluation with a better family or internal medicine doctor.