Venous Thromboembolic Events and risk stratification: Evaluation of Short vs Prolonged Prophylaxis in Bariatric Patients

Introduction: The risk of a venous thromboembolic event (VTE) after bariatric surgery remains a significant source of morbidity, mortality, and liability. A survey of ASBS members showed the incidence of DVT/PE after open bariatric surgery to be 2.63% and 0.95% respectively. Reviews of the laparoscopic literature demonstrate a risk of symptomatic VTE to be 0.8-2.4. The purpose of this study is to identify a baseline risk profile and evaluate a short hospital-based prophylaxis protocol and a longer post-hospital protocol for bariatric surgery patients.

Methods: A retrospective database was maintained and reviewed. Patients undergoing laparoscopic gastric bypass, laparoscopic gastric sleeve, and revisional procedures were included. We stratified the patients into two groups: “Low risk” patients were age 50. All patients received postoperative enoxaparin 30 mg every 12 hours beginning 8 hours after surgery while hospitalized. All underwent treatment with compression devices. High risk patients maintained the enoxaparin therapy for 10 days postoperatively. The incidence of DVT was assessed by complete lower extremity venous Doppler preoperatively and at 2 weeks postoperatively.

Results: 390 patients met criteria to be included in the study. The “low risk” group included 147 patients (123 female, 24 male) and had an average length of stay (LOS) of 1.15 days (1-3). This group received an average of 2.2 postoperative doses of enoxaparin. There were no VTE events seen and no significant bleeding events in the low risk group. The “high risk” group included 243 patients (180 female, 63 male) and had an average LOS of 1.32 days (1-15). 3 patients had a VTE. 2 patients had a DVT and 1 patient had a DVT and nonfatal PE. There were 2 significant bleeding complications requiring transfusion. Incidence of DVT/PE of 0.77% and 0.26% overall and 1.23% and 0.41% in the high risk group.

Discussion: VTE risk stratification in surgery patients has been addressed by both SAGES and ASBS. Current recommendation includes compression devices and pharmaceutical propholaxis while hospitalized. We demonstrate a short course of enoxaparin while hospitalized (average 2.2 doses in our study) for low risk bariatric patients is safe and effective for DVT/PE prophylaxis. Prolonged prophylaxis after discharge in high risk bariatric patients (BMI or age greater than 50) is effective for achieving a low incidence of VTE and bleeding.

Session: Podium Presentation

Program Number: S111

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