A simple venous thromboembolism prophylaxis protocol for patients undergoing bariatric surgery.
OBJECTIVE
Pulmonary embolism is a leading cause of death for bariatric patients. Numerous regimens have been proposed, but a comprehensive, simple approach is lacking. This study provides a simple, easily implemented prophylaxis regimen.


METHODS
One hundred fifty bariatric surgery patients were evaluated. Patients considered at high risk for venous thromboembolism had heart failure, a BMI of >/=50 kg/m(2), or a history of venous thromboembolism or pelvic surgery. Preoperatively and postoperatively, all patients received subcutaneous enoxaparin or unfractionated heparin. High-risk patients received either preoperatively inserted inferior vena cava filters or continuous heparin infusions intraoperatively. All high-risk patients were anticoagulated with warfarin (Coumadin; Bristol Myers-Squibb, Princeton, NJ) for at least 3 months postoperatively. Initially, some patients experienced significant hemorrhage; to prevent this, sutures were oversewn into staple lines.


RESULTS
No patient experienced venous thromboembolism; a binomial test showed that the regimen reduced the risk of this complication to less than 2% (p < 0.05). Hemorrhage sufficient to require transfusion occurred in 4 of the first 20 patients; of the remaining 130 patients, into whose staple lines sutures were oversewn, none required transfusion (p < 0.05).


CONCLUSIONS
Patients should be divided into those who are at high risk and those who are at low risk for venous thromboembolism. All patients should receive pre- and postoperative anticoagulation. High-risk patients should also receive either an inferior vena cava filter or intraoperative heparin infusions, as well as at least 3 months of Coumadin therapy. Oversewing of staple lines may reduce the risk of hemorrhage.
Frezza
Eldo E
EE
Department of Surgery, Division of General Surgery, Texas Tech University Health Sciences Center, MOP Building, Suite 380, 3502 9th Street, Lubbock, TX 79415, USA. eldo.frezza@ttuhsc.edu
Wachtel
Mitchell S
MS
D000925:Anticoagulants / Q000008:administration & dosage*; D050110:Bariatric Surgery / Q000009:adverse effects*; D015992:Body Mass Index; D017984:Enoxaparin / Q000008:administration & dosage; D006470:Hemorrhage / Q000517:prevention & control; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage
D000925:Anticoagulants; D017984:Enoxaparin; D014859:Warfarin; D006493:Heparin