title: Identifying the Bariatric Patient at Risk for Pulmonary Embolism: Prospective Clinical Trial Using Duplex Sonography and Blood Screening.
abstract: BACKGROUND
  Thromboembolic complications continue to be one of the main reasons for perioperative mortality in bariatric surgery. There is no consensus on which is the safest and most effective thromboprophylaxis. This prospective study aims to evaluate the significance of thrombophilia screening and a venous duplex sonography in bariatric patients.
  
  
  METHODS
  One hundred one patients were tested for coagulopathies (activated protein C (APC) resistance, factor II, antithrombin (AT)III, protein S and C). Perioperatively, the patients underwent a venous duplex sonography. A multimodal thromboprophylaxis protocol was set up: 2× 40 mg enoxaparin sodium per day and sequential pneumatic compressions of the lower extremities.
  
  
  RESULTS
  In six patients, we identified previously unknown risk factors for thromboembolic complications. Protein S deficiency is found significantly more often in obese patients than in the general population. There are numerous risk factors which, in themselves, increase the risk of venous thromboembolism. In obese patients with obstructive sleep apnea or diabetes mellitus, thrombophilia is found significantly more often than in patients without these diseases. No postoperative thromboses occurred.
  
  
  CONCLUSIONS
  The bariatric patient is a potential high-risk patient for venous thromboembolism. Thrombophilia is found significantly more often in obese patients than in the general population. Conceivably, existing conditions such as obstructive sleep apnea and diabetes mellitus have until today been underestimated regarding the entailing thrombosis risk. Thrombophilia screening and duplex sonography are possibilities for identifying patients at risk. The advantage of a reduced risk thanks to an adapted thromboprophylaxis based on the patient's individual risk profile justifies the relative increase in time and cost.
authors: Department of Surgery, Protestant Hospital Zweibrücken, Academic Teaching Hospital of Saarland University, Obere Himmelsbergstraße 38, 66482, Zweibrücken, Germany. sebastian.hollaender@gmx.de.
authors: Sebastian W
authors: SW
authors: Holländer
authors: Department of Surgery, Protestant Hospital Zweibrücken, Academic Teaching Hospital of Saarland University, Obere Himmelsbergstraße 38, 66482, Zweibrücken, Germany. a.sifft@evkhzw.de.
authors: Alfred
authors: A
authors: Sifft
authors: Department of Surgery, Protestant Hospital Zweibrücken, Academic Teaching Hospital of Saarland University, Obere Himmelsbergstraße 38, 66482, Zweibrücken, Germany. s.hess@evkhzw.de.
authors: Sarah
authors: S
authors: Hess
authors: Department of Surgery, Protestant Hospital Zweibrücken, Academic Teaching Hospital of Saarland University, Obere Himmelsbergstraße 38, 66482, Zweibrücken, Germany. HJ.Klingen@evkhzw.de.
authors: Hans Joachim
authors: HJ
authors: Klingen
authors: Department of Surgery, Protestant Hospital Zweibrücken, Academic Teaching Hospital of Saarland University, Obere Himmelsbergstraße 38, 66482, Zweibrücken, Germany. p.djalali@evkhzw.de.
authors: Peter
authors: P
authors: Djalali
authors: Department of Surgery, Protestant Hospital Zweibrücken, Academic Teaching Hospital of Saarland University, Obere Himmelsbergstraße 38, 66482, Zweibrücken, Germany. d.birk@evkhzw.de.
authors: Dieter
authors: D
authors: Birk
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D001774:Blood Chemical Analysis; D001780:Blood Coagulation Tests; D017984:Enoxaparin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices; D035002:Lower Extremity / Q000098:blood supply / Q000000981:diagnostic imaging; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D011655:Pulmonary Embolism / Q000097:blood* / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors; D018616:Ultrasonography, Doppler, Duplex; D054556:Venous Thromboembolism / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control
chemical_list: D017984:Enoxaparin
keywords: Bariatric surgery; Clinical trial; Deep vein thrombosis (DVT); Pulmonary embolism (PE); Thrombophilia screening; Thromboprophylaxis