Risk of thrombosis and thromboembolic prophylaxis in obesity surgery: data analysis from the German Bariatric Surgery Registry.
Evidence-based data on optimal approach for prophylaxis of deep venous thrombosis (VTE) and pulmonary embolism (PE) in bariatric operations is discussed. Using antithrombotic prophylaxis, weight adjusted the risk of VTE and its complications have to be balanced with the increased bleeding risk.



Since 2005, the current situation for bariatric surgery has been examined by quality assurance study in Germany. As a prospective multicenter observational study, data on the type, regimen, and time course of VTE prophylaxis were documented. The incidences of clinically diagnosed VTE or PE were derived during the in-hospital course and follow up.



Overall, 31,668 primary bariatric procedures were performed between January 2005 and December 2013. Most performed operations were 3999 gastric banding (GB); 13,722 Roux-en-Y-gastric bypass (RYGBP); and 11,840 sleeve gastrectomies (SG). Gender (p = 0.945), surgical procedure (p = 0.666), or administration of thromboembolic prophylaxis (p = 0.272) had no statistical impact on the DVT incidence. By contrast, BMI (p = 0.116) and the duration of thromboembolic prophylaxis (p = 0.127) did impact the frequency of onset of DVT.



Age, BMI, male gender, and a previous history of VTE are the most important risk factors. The drug of choice for VTE is heparin. LMWH should be given preference over unfractionated heparins due to their improved pharmacological properties, i.e., better bioavailability and longer half-life as well as ease of use. Despite the low incidence of VTE and PE, there is a lack of evidence. Therefore, prospective randomized studies are necessary to determine the optimal VTE prophylaxis for bariatric surgical patients.
SRH Wald Klinikum Gera, Gera, Germany. christine.stroh@wkg.srh.de.|Institute for Quality Assurance in Operative Medicine, Otto-von-Guericke University, Magdeburg, Germany. christine.stroh@wkg.srh.de.|Department of General, Visceral and Paediatric Surgery, SRH Wald Klinikum Gera, Strasse des Friedens 122, D-07548, Gera, Germany. christine.stroh@wkg.srh.de.
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Stroh
SRH Wald Klinikum Gera, Gera, Germany.
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Michel
SRH Wald Klinikum Gera, Gera, Germany.
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Luderer
Institute for Quality Assurance in Operative Medicine, Otto-von-Guericke University, Magdeburg, Germany.|Otto-von-Guericke University Hospital, Magdeburg, Germany.
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Wolff
Vivantes Hospital, Berlin-Spandau, Germany.
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Lange
Vivantes Hospital, Berlin-Spandau, Germany.
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Köckerling
StatConsult GmbH, Magdeburg, Germany.
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Knoll
SRH Wald Klinikum Gera, Gera, Germany.|Institute for Quality Assurance in Operative Medicine, Otto-von-Guericke University, Magdeburg, Germany.
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Manger
D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000379:methods; D018890:Chemoprevention; D015897:Comorbidity; D005260:Female; D005858:Germany; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000601:surgery*; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D011785:Quality Assurance, Health Care; D012042:Registries; D012307:Risk Factors; D020246:Venous Thrombosis / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*
Gastric bypass; Gender; Obesity surgery; Sleeve gastrectomy; Thromboembolism