Abstract
Background
Morbidly obese patients are at high risk for developing venous thromboembolism (VTE). The aim of this study was to evaluate the effect of a new VTE prophylaxis protocol (low dosage, low-molecular-weight heparin [LMWH]) with a pneumatic compression device (PCD) in patients undergoing bariatric surgery.
Materials and Methods
Between November 2015 and December 2017, 368 patients underwent surgery due to obesity. The patients received 0.2 ml of nadroparin (Fraxiparine, GlaxoSmithKline) 12 h before the operation. A PCD (Kendall SCD Compression System) was applied to the patient during the operation and left on the patient during the subsequent 24 h. Nadroparin 0.4 ml was started subcutaneously after the PCD was removed from the patient and the same dosage of nadroparin was given daily for 15 days following the bariatric operation. Ambulation within 2 h of surgery was encouraged and was performed frequently.
Results
A total of 368 patients underwent laparoscopic bariatric surgery. The median age was 34.1 years (range, 18–61), the median weight was 128 kg (range, 90–182), and the median body mass index (BMI) was 47.2 kg/m2 (range, 36–72). No thrombotic events were observed postoperatively or at the 1-, 3-, and 6-month follow-up visits. Four bleedings occurred requiring transfusions. None of these patients required a re-laparotomy for hemorrhage control. The mortality rate was 0% at 30 and 90 days and during the hospitalization.
Conclusion
Low dosage LMWH with PCD is very effective for VTE prophylaxis in bariatric surgery.
Similar content being viewed by others
References
Froehling DA, Daniels PR, Mauck KF, et al. Incidence of venous thromboembolism after bariatric surgery: a population-based cohort study. Obes Surg. 2013;23(11):1874–9.
Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2):227–77.
Cottam DR, Mattar SG, Schauer PR. Laparoscopic era of operations for morbid obesity. Arch Surg. 2003;138(4):367–75.
Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest. 2004;126(Suppl):338–400.
Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism. American College Of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest. 2008;133(6):381–453.
Richardson WS, Hamad GG, Stefanidis D. SAGES VTE prophylaxis for laparoscopic surgery guidelines: an update. Surg Endosc. 2017;31(2):501–3.
Kakkar VV, Howe CT, Nicolaides AN, et al. Deep vein thrombosis of the leg: is there a high-risk group? Am J Surg. 1970;120(4):527–30.
Lowe GD, Osborne DH, McArdle BM, et al. Prediction and selective prophylaxis of venous thrombosis in elective gastrointestinal surgery. Lancet. 1982;319(8269):409–12.
Kakkos SK, Caprini JA, Geroulakos G, et al. Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism. Cochrane Database Syst Rev. 2016;9:CD005258.
American Society for Metabolic and Bariatric Surgery Clinical Issues Committee. ASMBS updated position statement on prophylactic measures to reduce the risk of venous thromboembolism in bariatric surgery patients. Surg Obes Relat Dis. 2013;9(4):493–7.
Eisele R, Kinzl L, Koelsch T. Rapid-inflation intermittent pneumatic compression for prevention of deep venous thrombosis. J Bone Joint Surg Am. 2007;89(5):1050–6.
Becattini C, Agnelli G, Manina G, et al. Venous thromboembolism after laparoscopic bariatric surgery for morbid obesity: clinical burden and prevention. Surg Obes Relat Dis. 2012;8(1):108–15.
Clements RH, Yellumahanthi K, Ballem N, et al. Pharmacologic prophylaxis against venous thromboembolic complications is not mandatory for all laparoscopic Roux-en-Y gastric bypass procedures. J Am Coll Surg. 2009;208(5):917–21.
Gonzalez QH, Tishler DS, Plata-Munoz JJ, et al. Incidence of clinically significant deep venous thrombosis after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2004;18(7):1082–4.
Magee CJ, Barry J, Javed S, et al. Extended thromboprophylaxis reduces incidence of postoperative venous thromboembolism in laparoscopic bariatric surgery. Surg Obes Relat Dis. 2010;6(3):322–5.
Javanainen MH, Scheinin T, Mustonen H, et al. Retrospective analysis of 3 different antithrombotic prophylaxis regimens in bariatric surgery. Surg Obes Rel Dis. 2015;12(3):675–80.
Frantzides CT, Welle SN, Ruff TM, et al. Routine anticoagulation for venous thromboembolism prevention following laparoscopic gastric bypass. JSLS. 2012;16:33–7.
Brasileiro AL, Miranda Jr F, Ettinger JE, et al. Incidence of lower limbs deep vein thrombosis after open and laparoscopic gastric bypass: a prospective study. Obes Surg. 2008;18:52–7.
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.
Cotter SA, Cantrell W, Fisher B, et al. Efficacy of venous thromboembolism prophylaxis in morbidly obese patients undergoing gastric bypass surgery. Obes Surg. 2005;15:1316–20.
Miller MT, Rovito PF. An approach to venous thromboembolism prophylaxis in laparoscopic Roux-en-Y gastric bypass surgery. Obes Surg. 2004;14:731–7.
Kothari SN, Lambert PJ, Mathiason MA. A comparison of thromboembolic and bleeding events following laparoscopic gastric bypass in patients treated with prophylactic regimens of unfractionated heparin or enoxaparin. Am J Surg. 2007;194:709–11.
Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative, nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. 2013 update. Obesity. 2013;21(1):1–27.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Studies with Human Participants
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.
Ethical consideration
An approval from the local ethics committee of Haydarpaşa Numune Training and Research Hospital (HNTARH) was obtained for this study, and written informed consent was obtained in accordance with the Declaration of Helsinki from all patients. Privacy rights of the patients have been observed.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Abuoglu, H.H., Müftüoğlu, M.A.T. & Odabaşı, M. A New Protocol for Venous Thromboembolism Prophylaxis in Bariatric Surgery. OBES SURG 29, 729–734 (2019). https://doi.org/10.1007/s11695-018-03643-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-018-03643-0