Perioperative management of bariatric surgical patients receiving chronic anticoagulation requires an understanding of potential hemorrhagic and thromboembolic risks. The aim of this study is to evaluate hemorrhagic and thromboembolic complications in morbidly obese patients who are on oral anticoagulation treatment and subsequently undergo laparoscopic bariatric surgery.
The medical records of all laparoscopic Roux-en-Y gastric bypass (LRYGB) patients from June 2001 to March 2006 were retrospectively reviewed. In addition, data of patients who received chronic anticoagulation therapy with Coumadin and underwent laparoscopic Roux-en-Y gastric bypass was analyzed. Clinical parameters included length of hospitalization, hemorrhagic complications, thromboembolic complications, conversion rate, reoperation, and blood transfusion.
During the study period, 1,700 consecutive patients underwent bariatric surgery for the treatment of morbid obesity. Of these, 21 patients were treated with chronic oral anticoagulation; 3 of the 21 (14%) had hemorrhagic complications: one patient had intraluminal hemorrhage and two patients had intraabdominal hemorrhage. Two patients required blood transfusion, and one patient underwent surgical reintervention. None of the 21 laparoscopic operations were converted to open procedures. There were no postoperative mortalities, and there were no thromboembolic events in this series.
Laparoscopic bariatric surgery can be performed relatively safely in morbidly obese patients who are treated with chronic oral anticoagulation. Even in the presence of bleeding, patients can be successfully treated without the need for reoperation.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Drug Topics (2006) http://www.drugtopics.com/drugtopics/. Cited 13 August 2006.
Poirier P, Giles TD, Bray GA, et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss. Arterioscler Thromb Vasc Biol 2006;26(5):968–76.
Abramson N, Abramson S. Hypercoagulability: clinical assessment and treatment. South Med J 2001;94(10):1013–20.
Heit JD. Perioperative management of the chronically anticoagulated patient. J Thromb Thrombolysis 2001;12(1):81–7.
Hayashi H, Ochiai T, Shimada H, Gunji Y. Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc 2005;19(9):1172–6.
Lee JH, Han HS, Lee JH. A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc 2005;19(2):168–73.
Katholi RE, Nolan SP, McGuire LB. The management of anticoagulation during noncardiac operations in patients with prosthetic heart valves. A prospective study. Am Heart J 1978;96(2):163–5.
Varkarakis IM, Rais-Bahrami S, Allaf ME, et al. Laparoscopic renal–adrenal surgery in patients on oral anticoagulant therapy. J Urol 2005;174(3):1020–3.
Yoshida T, Kitano T, Matsumoto T, et al. Laparoscopic cholecystectomy in patients undergoing anticoagulant therapy. Surg Today 1998;28(3):308–12.
Mehran A, Szomstein S, Zundel N, Rosenthal R. Management of acute bleeding after laparoscopic gastric bypass. Obes Surg 2003;13(6):842–7.
Syed M, Jafri M. Periprocedural management of anticoagulation in patients on extended warfarin therapy. Semin Thromb Hemost 2004;30(6):657–64.
Travis S, Wray R, Harrison K. Perioperative anticoagulant control. Br J Surg 1989;76:1107–8.
Palareti G, Legnani C. Warfarin withdrawal. Pharmacokinetic–pharmacodynamic considerations. Clin Pharmacokinet 1996;30(4):300–13.
White RH, McKitrick T, Hutchinson R, et al. Temporary discontinuation of warfarin therapy: changes in the international normalized ratio. Ann Intern Med 1995;122(1):40–2.
Despotits GJ, Filos KS, Zoys TN, et al. Factors associated with excessive postoperative blood loss and hemostatic transfusion requirements: a multivariate analysis in cardiac surgical patients. Anesth Analg 1996;82:13–21.
Crowther MA, Julian J, McCarthy D, et al. Low dose oral vitamin K for the treatment of warfarin associated coagulopathy. Lancet 2000;356:1551–3.
Kearon C, Hirsh J. Managing oral anticoagulation before and after elective surgery. N Engl J Med 1997;336:1506–11.
Hewitt RL, Chun KL, Flint LM. Current clinical concepts in perioperative anticoagulation. Am Surg 1999;65:270–3.
About this article
Cite this article
Mourelo, R., Kaidar-Person, O., Fajnwaks, P. et al. Hemorrhagic and Thromboembolic Complications after Bariatric Surgery in Patients Receiving Chronic Anticoagulation Therapy. OBES SURG 18, 167–170 (2008). https://doi.org/10.1007/s11695-007-9290-0