Skip to main content

Advertisement

SpringerLink
Log in

Is LMWH Sufficient for Anticoagulant Prophylaxis in Bariatric Surgery? Prospective Study

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

The objective of this study was to evaluate the coagulation profile by thromboelastography in morbidly obese patients who undergo bariatric surgery. Morbid obesity entails increased risk for thromboembolic events. There is no clear protocol for thromboembolic prophylaxis, regarding timing and length of treatment, in bariatric surgery. Thromboelastography provides data on a coagulation process from creation of the clot until the fibrinolysis.

Methods

Ninety-three morbidly obese patients were prospectively recruited within a 2-year period. Coagulation profile was measured by thromboelastography before surgery, in the immediate postoperative period, within 3 h from surgery, and in the late postoperative period, within 10–14 days after surgery. Venous thromboembolic prophylaxis was achieved by giving low molecular weight heparin (LMWH), once a day.

Results

Of the eligible patients, 67 underwent sleeve gastrectomy while 23 underwent Roux-en-Y gastric bypass. Normal values of coagulation factor function, clotting time, and fibrin function, as measured by R, K, and α (angle), were demonstrated in addition to higher maximal amplitude (MA) values, reflecting increased function of platelets. The average MA value before the surgery was above normal and continued rising consistently in the immediate postoperative as well as in the early postoperative period.

Conclusions

Morbidly obese patients have a strong tendency toward thrombosis, as demonstrated by pathologically elevated MA values. Altered coagulation profiles were demonstrated 2 weeks postoperatively; thus, prophylaxis that continued at least for 2 weeks after bariatric surgery should be considered. Since LMW heparin is not sufficient alone as thromboembolic prophylaxis, we recommend adding antiplatelet therapy. Further evaluation of appropriate thromboprophylaxis is warranted.

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. Rocha AT, de Vasconcellos ÂG, da Luz Neto ER, et al. Risk of venous thromboembolism and efficacy of thromboprophylaxis in hospitalized obese medical patients and in obese patients undergoing bariatric surgery. Obes Surg. 2006;16(12):1645–55.

    Article  PubMed  Google Scholar 

  2. Sapala JA, Wood MH, Schuhknecht MP, et al. Fatal pulmonary embolism after bariatric operations for morbid obesity: a 24-year retrospective analysis. Obes Surg. 2003;13(6):819–25.

    Article  PubMed  Google Scholar 

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

  4. Schwenk W, Bohm B, Fugener A, et al. Intermittent pneumatic sequential compression (ISC) of the lower extremities prevents venous stasis during laparoscopic cholecystectomy. A prospective randomized study. Surg Endosc. 1998;12(1):7–11.

    Article  CAS  PubMed  Google Scholar 

  5. Westling A, Bergqvist D, Bostrom A, et al. Incidence of deep venous thrombosis in patients undergoing obesity surgery. World J Surg. 2002;26(4):470–3.

    Article  PubMed  Google Scholar 

  6. Eriksson S, Backman L, Ljungstrum KG. The incidence of clinical postoperative thrombosis after gastric surgery for obesity during 16 years. Obes Surg. 1997;7(4):332–5.

    Article  CAS  PubMed  Google Scholar 

  7. Pivalizza EG, Pivalizza PJ, Weavind LM. Perioperative thromboelastography and sonoclot analysis in morbidly obese patients. Can J Anaesth. 1997;44(9):942–5.

    Article  CAS  PubMed  Google Scholar 

  8. Whitten CW, Greilich PE. Thromboelastography®: past, present, and future. J Am Soc Anesthesiol. 2000;92(5):1226.

    Article  Google Scholar 

  9. Dai Y, Lee A, Critchley LAH, et al. Does thromboelastography predict postoperative thromboembolic events? A systematic review of the literature. Anesth Analg. 2009;108(3):734–42.

    Article  PubMed  Google Scholar 

  10. Traverso CI, Arcelus JI, Gomez E, et al. Prospective assessment of the risk of deep vein thrombosis in elective abdominal surgery. Predictive role of thromboelastography. Thromb Haemorrh Disord. 1993;7(1):9–15.

    Google Scholar 

  11. Melinek J, Livingston E, Cortina G, et al. Autopsy findings following gastric bypass surgery for morbid obesity. Arch Pathol Lab Me. 2002;126(9):1091–5.

    Google Scholar 

  12. 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(10):1368–74.

    Article  PubMed  Google Scholar 

  13. Rondina MT, Wheeler M, Rodgers GM, et al. Weight-based dosing of enoxaparin for VTE prophylaxis in morbidly obese, medically-ill patients. Thromb Res. 2010;125(3):220–3.

    Article  CAS  PubMed  Google Scholar 

  14. Kaye SM, Pietiläinen KH, Kotronen A, et al. Obesity-related derangements of coagulation and fibrinolysis: a study of obesity-discordant monozygotic twin pairs. Obesity. 2012;20(1):88–94.

    Article  CAS  PubMed  Google Scholar 

  15. Nguyen NT, Owings JT, Gosselin R, et al. Systemic coagulation and fibrinolysis after laparoscopic and open gastric bypass. Arch Surg. 2001;136(8):909–16.

    Article  CAS  PubMed  Google Scholar 

  16. Anfossi G, Russo I, Trovati M. Platelet dysfunction in central obesity. Nutr Metab Cardiovasc Dis. 2009;19(6):440–9.

    Article  CAS  PubMed  Google Scholar 

  17. Lijnen HR. Role of fibrinolysis in obesity and thrombosis. Thromb Res 2009;123(S4)

  18. McCrath DJ, Cerboni E, Frumento RJ, et al. Thromboelastography maximum amplitude predicts postoperative thrombotic complications including myocardial infarction. Anesth Analg. 2005;100(6):1576–83.

    Article  PubMed  Google Scholar 

  19. Forfori F, Ferro B, Mancini B, et al. Role of thrombolestagrophy in monitoring perioperative coagulation status and effect of thromboprophylaxis in bariatric surgery. Obes Surg. 2012;22(1):113–8.

    Article  PubMed  Google Scholar 

  20. Wu EC, Barba CA. Current practices in the prophylaxis of venous thromboembolism in bariatric surgery. Obes Surg. 2000;10(1):7–13.

    Article  CAS  PubMed  Google Scholar 

  21. Polanco-García M, Cubas MG, Rivas E, et al. Can preorerative thromboelastography be useful managing pharmacologic thromboembolic prophylaxis in bariatric surgery? Eur J Anaesthesiol. 2012;29:94.

    Article  Google Scholar 

  22. Taura P, Rivas E, Martinez-Palli G, et al. Clinical markers of the hypercoagulable state by rotational thrombelastometry in obese patients submitted to bariatric surgery. Surg Endosc. 2014;28(2):543–51.

    Article  PubMed  Google Scholar 

  23. Kashuk JL, Moore EE, Sabel A, et al. Rapid thrombelastography (r-TEG) identifies hypercoagulability and predicts thromboembolic events in surgical patients. Surgery. 2009;146(4):764–74.

    Article  PubMed  Google Scholar 

  24. Gonzalez E, Kashuk JL, Moore EE, et al. Differentiation of enzymatic from platelet hypercoagulability using the novel thrombelastography parameter delta (Δ). J Surg Res. 2010;163(1):96–101.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Pickering E, Menazzi-Moretti A, Ahmed A, et al. Determination of peri-operative hypercoagulability in bariatric surgery using thromboelastography: interim results. Anesthesia. 2011;66:148–9.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. General Surgery B, Galilee Medical Center, Rama Village, Upper Galilee, POB-379, 30055, Nahariya, Israel

    Farraj Moaad, Bramnik Zakhar, Kvasha Anton, Merie Moner, Sbeit Wisam, Farraj Safy & Waksman Igor

Authors
  1. Farraj Moaad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bramnik Zakhar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kvasha Anton
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Merie Moner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sbeit Wisam
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Farraj Safy
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Waksman Igor
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Farraj Moaad.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Statement of Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. No animals were used in this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moaad, F., Zakhar, B., Anton, K. et al. Is LMWH Sufficient for Anticoagulant Prophylaxis in Bariatric Surgery? Prospective Study. OBES SURG 27, 2331–2337 (2017). https://doi.org/10.1007/s11695-017-2638-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-017-2638-1

Keywords

Search

Navigation