Skip to main content
SpringerLink
Log in

Post Discharge Prophylactic Anticoagulation in Gastric Bypass Patient—How Safe?

  • Research Article
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

It is becoming an increasingly common practice to discharge gastric bypass (GBP) patients on prophylactic anticoagulation. This is because pulmonary embolism (PE) is a common cause of mortality postoperatively. This study was undertaken to: (1) determine the incidence of major bleeding in GBP patients discharged on prophylactic low molecular weight heparin (LMWH)—enoxaparin and, (2) correlate the bleeding risk to the dose used.

Methods

Retrospective chart review of all open GBP operation from June 2004 to August 2005. One hundred and twenty seven patients were sent home on LMWH for 2 weeks. Indications: Body mass index (BMI) ≥50 kg/m2 with chronic venous stasis and/or obstructive sleep apnea, previous history of PE or deep vein thrombosis (DVT) or BMI ≥60 kg/m2. The study group was divided into two subgroups: 40 mg twice daily (bid) and 60 mg bid LMWH. Statistical analysis was done with the chi-square. The primary outcome measure was major bleeding; defined as bleeding during the period of LMWH use associated with symptomatic decrease in hematocrit (HCT), necessitating stopping LMWH administration before the end of the study period (2 weeks), bleeding-related readmission, blood transfusion, or intervention. Excluded were patients on warfarin or treated with therapeutic LMWH.

Results

The groups were similarly matched for age, body mass index, and risk factors. No episode of major bleeding after discharge occurred in either group.

Conclusion

The use of low molecular weight heparin for prophylactic anticoagulation after open gastric bypass is not associated with risk of major bleeding.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Sapala JA, Wood MH, Schuhknecht MP, Sapala MA. Fatal pulmonary embolism after bariatric operations for morbid obesity: a 24-year retrospective analysis. Obes Surg. 2003;13:819–25.

    Article  PubMed  Google Scholar 

  2. Keeling WB, Haines K, Stone PA, Armstrong PA, Murr MM, Shames ML. Current indications for preoperative inferior vena cava filter insertion in patients undergoing surgery for morbid obesity. Obes Surg. 2005;15:1009–12.

    Article  PubMed  Google Scholar 

  3. Melinek J, Livingston E, Cortina G, Fishbein MC. Autopsy findings following gastric bypass surgery for morbid obesity. Arch Pathol Lab Med. 2002;126:1091–5.

    PubMed  Google Scholar 

  4. Martin LF, Gouda BP. What we know and don’t know about deep venous thrombosis and pulmonary embolism! Obes Surg. 2005;15:565–6.

    Article  PubMed  Google Scholar 

  5. Quebbemann B, Akhondzadeh M, Dallal R. Continuous intravenous heparin infusion prevents peri-operative thromboembolic events in bariatric surgery patients. Obes Surg. 2005;15:1221–4.

    Article  PubMed  Google Scholar 

  6. Miller MT, Rovito PF. An approach to venous thromboembolism prophylaxis in laparoscopic Roux-en-Y gastric bypass surgery. Obes Surg. 2004;14:731–7.

    Article  PubMed  Google Scholar 

  7. Wu EC, Barba CA. Current practices in the prophylaxis of venous thromboembolism in bariatric surgery. Obes Surg. 2000;10:7–13.

    Article  PubMed  CAS  Google Scholar 

  8. Scholeten DJ, Hoedema RM, Scholten SE. A comparison of two different prophylactic dose regimens of low molecular weight heparin in bariatric surgery. Obes Surg. 2002;12:19–24.

    Article  Google Scholar 

  9. Brolin RE. Complications of surgery for severe obesity. Prob Gen Surg. 2000;17:55–61.

    Google Scholar 

  10. Caprini JA, Arcelus J, Sehgal LR, et al. The use of low molecular weight heparins for the prevention of postoperative venous thromboembolism in general surgery. A survey of practice in the United States. Int Angiol. 2002;21:78–85.

    PubMed  CAS  Google Scholar 

  11. Geerts W, Heit J, Clagett GP, et al. Prevention venous thromboembolism. Chest 2001;119:132–75.

    Article  Google Scholar 

  12. Enoxacam Study group. Efficacy and safety of enoxaparin versus unfractionated heparin for prevention of deep vein thrombosis in elective cancer surgery: a double blind randomized multicenter trial with venographic assessment. Br J Surg. 1997;84:1099–103.

    Article  Google Scholar 

  13. Frederiksen SG, Hedenbro JL, Norgren L. Enoxaparin effect depends on body weight and current doses may be inadequate in obese patients. Br J Surg. 2003;90:547–8.

    Article  PubMed  CAS  Google Scholar 

  14. Le Liboux SG, et al. The pharmacokinetics and pharmacodynamics of enoxaparin in obese volunteers. Clin Pharmacol Ther. 2002;72:308–18.

    Article  PubMed  Google Scholar 

  15. Green B, Duffull S. Development of a dosing strategy for enoxaparin in obese patients. J Clin Pharm. 2003;56:96–103.

    Article  CAS  Google Scholar 

  16. Kovacs M, Cruickshank M, Mackinnon K, et al. Body weight and anti Xa levels do not predict for venous thromboembolic disease after low molecular weight heparin prophylaxis following orthopedic surgery. Blood 1995;86(Suppl):P918a.

    Google Scholar 

  17. Kalfarentzos F, Stavropoulou F, Yarmenitis S, Kehagias I, Karamesini M, Dimitrakopoulos A, et al. Prophylaxis of venous thromboembolism using two different doses of low-molecular-weight heparin (nadroparin) in bariatric surgery: a prospective randomized trial. Obes Surg. 2001;11:670–6.

    Article  PubMed  CAS  Google Scholar 

  18. Hamad GG, Choban PS. Enoxaparin for thromboprophylaxis in morbidly obese patients undergoing bariatric surgery: findings of the prophylaxis against VTE outcomes in bariatric surgery patients receiving enoxaparin (PROBE) study. Obes Surg. 2005;15:1368–74.

    Article  PubMed  Google Scholar 

  19. Hamad GG, IKramuddin S, Posner, et al. Recommended dosing of enoxaparin for thromboprophylaxis is subtherapeutic in the morbidly obese. Obes Surg. 2002;12:478.

    Google Scholar 

  20. Ernits M, Mohan PS, Fares LG II, Hardy H III. A retroperitoneal bleed induced by enoxaparin therapy. Am Surg. 2005;71:430–3.

    PubMed  Google Scholar 

  21. Abou-Nukta F, Alkoury F, Arroyo K, et al. Clinical pulmonary embolus after gastric bypass surgery. Surg Obes Relat Dis. 2006 Jan–Feb;2(1):24–8.

    Article  PubMed  Google Scholar 

  22. Warkentin TE, Levine MN, Hirsh J, et al. Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin. N Engl J Med. 1995;332:1330–5.

    Article  PubMed  CAS  Google Scholar 

  23. Wells PS, Kovacs MJ, Bormanis J, et al. Expanding eligibility for outpatient treatment of deep venous thrombosis and pulmonary embolism with low-molecular-weight heparin: a comparison of patient self-injection with homecare injection. Arch Intern Med. 1998;158:1809–12.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Hospital of Saint Raphael, New Haven, CT, 06511, USA

    Peter Ojo, Bolanle Asiyanbola, Elmer Valin & Randolph Reinhold

  2. Department of Surgery, VCUMC, MIS Center, P.O. Box 980428, Richmond, VA, 23298, USA

    Peter Ojo

Authors
  1. Peter Ojo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bolanle Asiyanbola
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elmer Valin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Randolph Reinhold
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter Ojo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ojo, P., Asiyanbola, B., Valin, E. et al. Post Discharge Prophylactic Anticoagulation in Gastric Bypass Patient—How Safe?. OBES SURG 18, 791–796 (2008). https://doi.org/10.1007/s11695-007-9382-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-007-9382-x

Keywords

Search

Navigation