Routine anticoagulation for venous thromboembolism prevention following laparoscopic gastric bypass.
OBJECTIVE
To compare the rates of venous thromboembolism (VTE) by using routine postoperative enoxaparin versus early ambulation, SCDs, hydration, and selective prophylactic pharmacologic anticoagulation.


METHODS
1,692 patients undergoing laparoscopic gastric bypass  from October 2001 to October 2008 were included and divided into 2 groups based on when they were operated upon. Group A (435 patients) received routine enoxaparin 12 hours after surgery. Group B (1,257 patients) received selective pharmacologic anticoagulation, in high-risk patients only.


RESULTS
Mean operating time was 144±26 minutes (Group A) and 126±15 minutes (Group B). Mean length of stay was 2.3±1.5 days for Group A and 1.4±1.2 for Group B. Intraluminal bleeding occurred in 21 patients (4.8%) in Group A and 5 (0.9%) in Group B; none  required intervention. Five pulmonary embolisms occurred in Group A (1.1%) and none in Group B. Seven patients in Group A (1.7%) and 6 (0.47%) in Group B had clinically evident DVT. Two non-VTE related deaths occurred in Group A.


CONCLUSIONS
Adequate VTE prophylaxis is achieved  using SCDs, early ambulation, emphasis on hydration, and shorter operating times. Bariatric surgery can be safely performed without pharmacologic VTE prophylaxis in all but the high-risk population. Fewer bleeding complications occur without the use of anticoagulants.
Chicago Institute of Minimally Invasive Surgery, Skokie, IL 60077, USA. cfrantzides@cimis.info
Constantine T
CT
Frantzides
Scott N
SN
Welle
Timothy M
TM
Ruff
Alexander T
AT
Frantzides
D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D004434:Early Ambulation; D017984:Enoxaparin / Q000627:therapeutic use*; D005260:Female; D015390:Gastric Bypass / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D054556:Venous Thromboembolism / Q000517:prevention & control*; D055815:Young Adult
D000925:Anticoagulants; D017984:Enoxaparin