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A Single-Center Comparison of Extended and Restricted THROMBOPROPHYLAXIS with LMWH after Metabolic Surgery



Morbid obesity is an important risk factor for developing a venous thromboembolic events (VTE) after surgery. Fast-track protocols in metabolic surgery can lower the risk of VTE in the postoperative period by reducing the immobilization period. Administration of thromboprophylaxis can be a burden for patients. This study aims to compare extended to restricted thromboprophylaxis with low molecular weight heparin (LMWH) for patients undergoing metabolic surgery.


In this single center retrospective cohort study, data was collected from patients undergoing a primary Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2014 and 2018. Patients operated in 2014–2017 received thromboprophylaxis for two weeks. In 2018, patients only received thromboprophylaxis during hospital admission. Patients already using anticoagulants were analyzed as a separate subgroup. The primary outcome measure was the rate of clinically significant VTEs within three months. Secondary outcome measures were postoperative hemorrhage and reoperations for hemorrhage.


3666 Patients underwent a primary RYGB or SG following the fast-track protocol. In total, two patients in the 2014–2017 cohort were diagnosed with VTE versus zero patients in the 2018 cohort. In the historic group, 34/2599 (1.3%) hemorrhages occurred and in the recent cohort 8/720 (1.1%). Postoperative hemorrhage rates did not differ between the two cohorts (multivariable analysis, p = 0.475). In the subgroup of patients using anticoagulants, 21/347(6.1%) patients developed a postoperative hemorrhage. Anticoagulant use was a significant predictor of postoperative hemorrhage (p < 0.001).


Despite the restricted use of thromboprophylaxis administration since 2018, the rate of VTEs did not increase. This may be explained by quick mobilization and hospital discharge, as encouraged by the fast-track protocol. There was no significant difference in postoperative hemorrhage rates by thromboprophylaxis protocol. Short term use of thromboprophylaxis in metabolic surgery is safe in patients at low risk of VTE.

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Fig. 1



American Society for Metabolic and Bariatric Surgery


body mass index


confidence interval


direct oral anticoagulant


deep venous thrombosis


enhanced recovery after bariatric surgery


institutional review board


low molecular weight heparin


odds ratio


pulmonary embolism


Roux-en-Y gastric bypass


sleeve gastrectomy


toetsingscommissie wetenschappelijk onderzoek Rotterdam


vitamin K antagonist


venous thromboembolic events


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Correspondence to M. Leeman.

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The authors declare that they have no conflict of interest.

Ethical Approval

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. The study protocol was approved by the institutional review board (IRB) and the regional Medical Research Ethics Committee TWOR, Rotterdam, the Netherlands (protocol number 2018–03).

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

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Leeman, M., Biter, L.U., Apers, J.A. et al. A Single-Center Comparison of Extended and Restricted THROMBOPROPHYLAXIS with LMWH after Metabolic Surgery. OBES SURG 30, 553–559 (2020). https://doi.org/10.1007/s11695-019-04188-6

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  • Roux-en-Y gastric bypass
  • Sleeve gastrectomy
  • Hemorrhage
  • Pulmonary embolism
  • Deep venous thrombosis
  • Enhanced recovery