Skip to main content
SpringerLink
Log in

The effect of extended post-discharge chemical thromboprophylaxis on venous thromboembolism rates after bariatric surgery: a prospective comparison trial

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The effect of extended post-discharge thromboprophylaxis (ETP) on venous thromboembolism (VTE) rates following bariatric surgery (BS) is unknown.

Methods

308 consecutive patients who underwent BS between 2003 and 2007 and who had >1 month of follow-up were included. In-hospital-only VTE prophylaxis (group A), or extended 10-day ETP (group B) was used in 132 and 176 patients, respectively. All patients underwent bilateral lower extremity venous Doppler studies (BLEVDS) prior to discharge. Primary endpoint was the incidence of VTE within 30 days postoperatively. VTE was defined as a clinically evident deep vein thrombosis or pulmonary embolism documented by positive BLEVDS, or computed chest tomography. The primary safety endpoint was bleeding associated with ≥2 g/dL decrease in hemoglobin compared with baseline, transfusion or reoperation.

Results

The incidence of VTE was 1.9% (6/308); 66.6% (4/6) of cases occurred after cessation of thromboprophylaxis. There were no deaths in either group. With the exception of percentage open surgical approach (A: 3% versus B: 0%, p = 0.03), percentage conversions (A: 0 versus B: 3.8%, p = 0.01), and hospital stay (A: 3 versus B: 2.2 days, p < 0.0001), the two groups were comparable in relation to age, sex, body mass index, percentage revision surgery, operative time, and history of VTE. VTE rate was significantly higher in group A (A: 4.5% versus B: 0%, p = 0.006). Although morbidity was higher in group A (A: 12.1% versus B: 1.1%, p < 0.0001), no VTE event occurred in patients who had other complications. The incidence of significant bleeding was lower in group B (A: 5.3% versus B: 0.56%, p = 0.02).

Conclusions

ETP is safe and effective in reducing the incidence of VTE as compared with in-hospital thromboprophylaxis only.

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

Similar content being viewed by others

References

  1. Arnold DM, Kahn SR, Shrier I (2001) Missed opportunities for prevention of venous thromboembolism: an evaluation of the use of thromboprophylaxis guidelines. Chest 120:1964–1971

    Article  PubMed  CAS  Google Scholar 

  2. Goldhaber SZ (2004) Pulmonary embolism. Lancet 363:1295–1305

    Article  PubMed  Google Scholar 

  3. Sapala JA, Wood MH, Schuknecht MP, Sapala MA (2003) Fatal pulmonary embolism after Bariatric operations for morbid obesity: a 24-year retrospective analysis. Obes Surg 13:819–825

    Article  PubMed  Google Scholar 

  4. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM (2006) Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 295:1549–1555

    Article  PubMed  CAS  Google Scholar 

  5. Data from the website of the American Society for Metabolic and Bariatric Surgery (ASMBS). Accessed 15 April 2008

  6. Raftopoulos I, Ercole J, Udekwu AO, Luketich JD, Courcoulas AP (2005) Outcome of Roux-en-Y gastric bypass stratified by a body mass index of 70 kg/m2. A comparative analysis of 825 procedures. J Gastrointest Surg 9:44–53

    Article  PubMed  Google Scholar 

  7. Wu EC, Barba CA (2000) Current practices in the prophylaxis of venous thromboembolism in bariatric surgery. Obes Surg 10(1):7–14

    Article  PubMed  CAS  Google Scholar 

  8. Rocha AT, de Vasconcellos AG, da Luz Neto ER, Araújo DM, Alves ES, Lopes AA (2006) Risk of venous thromboembolism and efficacy of thromboprophylaxis in hospitalized obese medical patients and in obese patients undergoing bariatric surgery. Obes Surg 16(12):1645–1655

    Article  PubMed  Google Scholar 

  9. Hamad G, Choban PS (2005) 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 15:1368–1374

    Article  PubMed  Google Scholar 

  10. Bergqvist D, Agnelli G, Cohen AT, Eldor A, Nillson PE, Le Moigne-Amrani A, Dietrich-Neto F (2002) Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med 346:975–980

    Article  PubMed  CAS  Google Scholar 

  11. Kearon C (2003) Duration of venous thromboembolism prophylaxis after surgery. Chest 124:386S–392S

    Article  PubMed  Google Scholar 

  12. Position statement (2007) Prophylactic measures to reduce the risk of venous thromboembolism in Bariatric surgery patients. SOARD 3:494–495

    Google Scholar 

  13. Raftopoulos I, Awais O, Courcoulas AP (2007) Laparoscopic revision of open vertical banded gastroplasty to Roux-en-Y gastric bypass. Surg Endosc 21(Suppl 1):S280

    Google Scholar 

  14. Raftopoulos I, Courcoulas A (2008) Revision of jejunoileal bypass to Roux-en-Y gastric bypass. Technical considerations and outcomes from 2 cases. Surg Obes Relat Dis 4(2):198–201

    Article  PubMed  Google Scholar 

  15. Raftopoulos Y, Awais O, Fernando HC, Courcoulas AP, Luketich JD (2004) Laparoscopic gastric bypass after antireflux operations for the treatment of gastroesophageal reflux disease in morbidly obese patients. Initial experience. Obes Surg 14(10):1373–1380

    Article  PubMed  Google Scholar 

  16. Carmody BJ, Sugerman HJ, Kellum JM, Jamal MK, Johnson JM, Carbonell AM, Maher JW, Wolfe LG, DeMaria E (2006) Pulmonary embolism complicating Bariatric surgery: detailed analysis of a single institution’s 24-year experience. JACS 203:831–837

    Article  Google Scholar 

  17. Hamad GG, Bergqvist D (2007) Venous thromboembolism in bariatric surgery patients: an update of risk and prevention. SOARD 3(1):97–102

    Google Scholar 

  18. Prystowski JB, Morasch MD, Eskandari MK, Hungness ES, Nagle AP (2005) Prospective analysis of the incidence of deep vein thrombosis in bariatric surgery patients. Surgery 138:759–765

    Article  Google Scholar 

  19. Kassai B, Boissel JP, Cucherat M, Sonie S, Shah NR, Leizorovicz A (2004) A systematic review of the accuracy of ultrasound in the diagnosis of deep vein thrombosis in asymptomatic patients. Thromb Haemost 91:655–666

    PubMed  CAS  Google Scholar 

  20. Nguyen NT, Silver M, Robinson M, Needleman B, Hartley G, Cooney R, Catalano R, Dostal J, Sama D, Blankenship J, Burg K, Stemmer E, Wilson SE (2006) Result of a national audit of bariatric surgery performed at academic centers: a 2004 University HealthSystem Consortium Benchmarking Project. Arch Surg 141(5):445–450

    Article  PubMed  Google Scholar 

  21. Courcoulas A, Schuchert M, Gatti G, Luketich J (2003) The relationship of surgeon and hospital volume to outcome after gastric bypass surgery in Pennsylvania: a 3-year summary. Surgery 134(4):613–623

    Article  PubMed  Google Scholar 

  22. Raftopoulos I (2007) Comparison of selective clipping vs. routine oversewing of the gastric remnant staple line on postoperative hemorrhage after laparoscopic Roux-en-Y gastric bypass. A prospective non-randomized comparison trial. Presented at the 24th annual meeting of the American Society for Bariatric Surgery, San Diego, CA

  23. Frezza EE, Wachtel MS (2006) A simple venous thromboembolism prophylaxis protocol for patients undergoing bariatric surgery. Obesity 14(11):1961–1965

    Article  PubMed  CAS  Google Scholar 

  24. Shepherd FM, Rosborough TK, Schwartz ML (2004) Unfractionated heparin infusion for thromboprophylaxis in highest risk gastric bypass surgery. Obes Surg 14(5):601–605

    Article  Google Scholar 

  25. Shepherd MF, Rosborough TK, Schwartz ML (2003) Heparin thromboprophylaxis in gastric bypass surgery. Obes Surg 13(2):249–253

    Article  PubMed  Google Scholar 

  26. Lorch H, Welger D, Wagner V, Hillner B, Strecker EP, Herrmann H, Voshage G, Zur C, Schwarzbach C, Schröder J, Gullotta U, Pleissner J, Huttner S, Siering U, Märcklin C, Chavan A, Gläser F, Apitzsch DE, Moubayed K, Leonhardi J, Schuchard UM, Weiss HD, Zwaan M (2000) Current practice of temporary vena cava filter insertion: a multicenter registry. J Vasc Interv Radiol 11:83–88

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgement

The authors would like to thank Bruce Bernstein PhD for his assistance with the statistical analysis in the manuscript.

Author information

Authors and Affiliations

  1. Bariatric Surgery Center, St Francis Hospital and Medical Center, University of Connecticut, 114 Woodland Street, Hartford, CT, 06105, USA

    Ioannis Raftopoulos, Carolyn Martindale, Andrea Cronin & Jeffrey Steinberg

Authors
  1. Ioannis Raftopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carolyn Martindale
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrea Cronin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeffrey Steinberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ioannis Raftopoulos.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Raftopoulos, I., Martindale, C., Cronin, A. et al. The effect of extended post-discharge chemical thromboprophylaxis on venous thromboembolism rates after bariatric surgery: a prospective comparison trial. Surg Endosc 22, 2384–2391 (2008). https://doi.org/10.1007/s00464-008-0031-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-008-0031-9

Keywords

Search

Navigation