title: Enoxaparin venous thromboembolism prophylaxis in bariatric surgery: A best evidence topic.
abstract: A best evidence topic in surgery was written according to a structured protocol. The question addressed was: which is the best regimen of enoxaparin thromboprophylaxis for patients undergoing bariatric surgery? One hundred and twenty-five papers were identified using the reported literature search, of which four represented the best evidence to answer the clinical question. The authors, country and date of publication, patient groups, relevant outcomes and results of these papers were tabulated. All four studies are non-randomized cohort studies examining venous thromboembolism rates and major postoperative bleeding following varying regimens of Enoxaparin thromboprophylaxis. There is no level 1 evidence which significantly favors any particular thromboprophylaxis regimen. There is some evidence that extended duration of treatment of ten days after discharge significantly reduces the incidence of VTE compared to in-hospital treatment only, and that a higher incidence of post-operative bleeding occurs with a regimen that includes a pre-operative dose of Enoxaparin. With regard to dosage, for in-hospital treatment the higher dosage of 40 mg twice daily as opposed to 30 mg seems to significantly reduce the incidence of VTE without significantly affecting bleeding rate.
authors.affiliation: North London Obesity Surgery Service (NLOSS), Whittington Hospital, London, N19 5NF, UK.
authors.forename: S G
authors.initials: SG
authors.lastname: Parker
authors.affiliation: General Surgery Department, Kingston Hospital NHS Foundation Trust, Galsworthy Road, Kingston upon Thames, Surrey, KT2 7QB, UK.
authors.forename: E R
authors.initials: ER
authors.lastname: McGlone
authors.affiliation: Upper GI Surgery Department, Guys and St Thomas' Hospital, Westminster, Bridge Road, SE1 7EH, UK.
authors.forename: W R
authors.initials: WR
authors.lastname: Knight
authors.affiliation: North London Obesity Surgery Service (NLOSS), Whittington Hospital, London, N19 5NF, UK. Electronic address: pratik.sufi@nhs.net.
authors.forename: P
authors.initials: P
authors.lastname: Sufi
authors.affiliation: North London Obesity Surgery Service (NLOSS), Whittington Hospital, London, N19 5NF, UK.
authors.forename: O A
authors.initials: OA
authors.lastname: Khan
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D050110:Bariatric Surgery / Q000009:adverse effects; D002985:Clinical Protocols; D015331:Cohort Studies; D017984:Enoxaparin / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage; D006801:Humans; D015994:Incidence; D008297:Male; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin
keywords: Bariatric surgery; Enoxaparin; Thromboembolism; VTE