title: Adding chemoprophylaxis to sequential compression might not reduce risk of venous thromboembolism in bariatric surgery patients.
abstract: BACKGROUND
  Anticoagulation, the use of sequential compression devices on the lower extremities perioperatively, and early ambulation are thought to reduce the incidence of venous thromboembolism (VTE) postoperatively and are recommended to reduce VTE risk. However, the evidence on which this recommendation has been based is not particularly strong. We have demonstrated that even a large, multicenter cohort with carefully collected prospective data is inadequate to provide sufficient evidence to support, or refute, this recommendation.
  
  
  METHODS
  Longitudinal Assessment of Bariatric Surgery participants from 10 centers in the United States who underwent their first bariatric surgery between March 2005 and December 2007 constituted the study group. We examined the ability to address the question of whether anticoagulation therapy, in addition to sequential compression, reduces the 30-day incidence of VTE or death sufficiently to recommend the use of prophylactic anticoagulation, a therapy that is not without risk.
  
  
  RESULTS
  Of 4416 patients, 396 (9.0%) received sequential compression alone, and 4020 also received anticoagulation therapy. The incidence of VTE within 30 days of surgery was low (.25% among those receiving sequential compression alone and .47% when anticoagulation therapy was added), and the 30-day incidence of death was also low (.25% versus .34%, respectively, P = .76, for sequential compression alone versus sequential compression plus anticoagulation therapy). Estimates of the number of cases required to address the question of whether a difference exists in the outcome related to VTE chemoprophylaxis or whether the outcome rates are equivalent have ranged from 13,680 to ≥ 35,760 patients, depending on whether superiority or equivalence was being analyzed.
  
  
  CONCLUSIONS
  Sufficient evidence from a clinical trial study to determine whether prophylactic anticoagulation added to compression devices further prevents VTE is not available, and such a trial is likely to be impractical. The data presented are insufficient to make a final recommendation concerning prophylactic treatment to prevent VTE in the 30 days after bariatric surgery.
authors.affiliation: Florida International University, Miami, Florida, USA. gagner.michel@gmail.com
authors.forename: Michel
authors.initials: M
authors.lastname: Gagner
authors.forename: Faith
authors.initials: F
authors.lastname: Selzer
authors.forename: Steve H
authors.initials: SH
authors.lastname: Belle
authors.forename: Marc
authors.initials: M
authors.lastname: Bessler
authors.forename: Anita P
authors.initials: AP
authors.lastname: Courcoulas
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Dakin
authors.forename: Dan
authors.initials: D
authors.lastname: Davis
authors.forename: William B
authors.initials: WB
authors.lastname: Inabnet
authors.forename: James E
authors.initials: JE
authors.lastname: Mitchell
authors.forename: Alfons
authors.initials: A
authors.lastname: Pomp
authors.forename: Gladys W
authors.initials: GW
authors.lastname: Strain
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Pories
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Wolfe
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D050110:Bariatric Surgery / Q000379:methods*; D016063:Blood Loss, Surgical; D003131:Combined Modality Therapy / Q000379:methods; D058128:Compression Bandages; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000517:prevention & control; D054556:Venous Thromboembolism / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000517:prevention & control
chemical_list: D000925:Anticoagulants