Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Dec;32(12):4805-4812.
doi: 10.1007/s00464-018-6231-z. Epub 2018 May 15.

Evaluation of VTE prophylaxis and the impact of alternate regimens on post-operative bleeding and thrombotic complications following bariatric procedures

Maria S Altieri  1 , Jie Yang  2 , Janos Hajagos  3 , Konstantinos Spaniolas  4 , Jihye Park  5 , Antonios P Gasparis  6 , Andrew T Bates  4 , Salvatore Docimo  4 , Mark Talamini  4 , A Laurie Shroyer  7 , Aurora D Pryor  4
Affiliations

Evaluation of VTE prophylaxis and the impact of alternate regimens on post-operative bleeding and thrombotic complications following bariatric procedures

Maria S Altieri et al. Surg Endosc. 2018 Dec.

Abstract

Background: Studies examining utilization and impact of venous thromboembolism (VTE) chemoprophylaxis for patients undergoing bariatric surgery are limited. Determination of the optimal prophylactic regimen to minimize complications is crucial.

Methods: The Cerner Health Facts database from 2003 to 2013 was queried using ICD-9 codes to identify patients undergoing laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB). VTE chemoprophylaxis regimens were divided into pre-operative alone (PreP), post-operative alone (PostP), both pre-operative and post-operative (PPP), or no prophylaxis (NP). Specific chemoprophylaxis agents were compared. Comparisons in inpatient clinical outcomes were based on univariate analysis and multivariable logistic regression when appropriate.

Results: We identified 11,860 patients who underwent LSG and RYGB. 634 (5.35%) had PreP, 4593 (38.73%) had PostP, 2646 (22.31%) had PPP, and 3987 (33.62%) had NP. The overall rates of transfusion, DVT, and PE were 2.48, 0.27, and 0.18%, respectively. Patients without chemoprophylaxis had higher rate of DVT compared to any chemoprophylaxis (0.58 vs 0.11%, p < 0.0001), without any significant difference in PE rate. Patients with pre-operative chemoprophylaxis were more likely to receive transfusion compared to patients with post-operative prophylaxis alone (OR 1.98, 95% CI 1.28-3), without significant difference in having VTE. When examining heparin versus enoxaparin versus mixed regimen in the PostP group, mixed regimen was associated with increased transfusion requirements (p < 0.001).

Conclusions: Bariatric surgical VTE chemoprophylaxis utilization is inconsistent. In this study, post-operative VTE chemoprophylaxis was associated with decreased VTE events compared to NP, while minimizing bleeding compared to PreP. Mixed therapy using heparin and enoxaparin was associated with more bleeding.

Keywords: Bariatric surgery; VTE events.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Surg Obes Relat Dis. 2012 Nov-Dec;8(6):663-70 - PubMed
    1. Surg Obes Relat Dis. 2012 Jan-Feb;8(1):108-15 - PubMed
    1. Vasc Health Risk Manag. 2015 Aug 17;11:461-77 - PubMed
    1. Surg Endosc. 2015 Feb;29(2):376-80 - PubMed
    1. Obes Surg. 2013 May;23(5):663-8 - PubMed

MeSH terms

LinkOut - more resources