title: Perioperative thromboprophylaxis in severely obese patients undergoing bariatric surgery: insights from a French national survey.
abstract: BACKGROUND
  Venous thromboembolism (VTE) is a leading cause of death in obese patients undergoing bariatric surgery (BS), but there is neither consensus nor high-level guidelines yet on VTE prophylaxis in this specific population.
  
  
  OBJECTIVE
  We aimed to evaluate patterns of BS perioperative thromboprophylaxis practices.
  
  
  METHODS
  French obesity specialized care centers (CSO), which are tertiary care referral hospitals for the most severe cases of obesity METHODS: A detailed questionnaire survey (11 opened, 15 closed questions) investigating their prophylactic schemes of anticoagulation (molecule, dose, weight-adjustment, duration, associated measures, follow-up) was sent to the 37 CSO.
  
  
  RESULTS
  Completion rate was 92%. Over 90% of respondents indicated using low molecular weight heparin. Enoxaparin was the most commonly used molecule (89%), twice daily (71%), started mostly 6 hours after BS (74%), whereas fondaparinux (9%), dalteparin (6%), and tinzaparin (6%) were less often prescribed. Dosing varied significantly according to centers from 4000 to 12,000 IU/d, with the most commonly used dose being 8000 IU once daily, 83%, as well as treatment duration (1 week, 9%; 3 weeks, 47%). Half CSO adjusted low molecular weight heparin dose to weight. Biological monitoring was performed in 88%. Only 1 center followed systematically anti-Xa activity. Associated measures such as elastic stoking or intermittent pneumatic compression were used in 32% and 26%, respectively, and both were used in 39%.
  
  
  CONCLUSIONS
  This study finds significant discrepancies in thromboprophylaxis practices in obese patients undergoing BS, particularly with respect to treatment duration and dose adjustment, highlighting the urgent need for improved implementation of existing clinical practice guidelines in this VTE high-risk population.
authors.affiliation: Hematology Department, Hôpital de la Timone, APHM, Aix-Marseille Université, Marseille, France.
authors.forename: Pierre-Antoine
authors.initials: PA
authors.lastname: Moulin
authors.affiliation: Endocrinology, Metabolic Diseases, and Nutrition Department, Pole ENDO, APHM, Aix-Marseille Université, Marseille, France; Centre Spécialisé de l'Obésité (CSO) PACA Ouest, France; Aix Marseille Univ, INSERM, INRA, NORT, Marseille, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Dutour
authors.affiliation: Endocrinology, Metabolic Diseases, and Nutrition Department, Pole ENDO, APHM, Aix-Marseille Université, Marseille, France; Centre Spécialisé de l'Obésité (CSO) PACA Ouest, France; Aix Marseille Univ, INSERM, INRA, NORT, Marseille, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Ancel
authors.affiliation: Hematology Department, Hôpital de la Timone, APHM, Aix-Marseille Université, Marseille, France; Aix Marseille Univ, INSERM, INRA, NORT, Marseille, France.
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Morange
authors.affiliation: Centre Spécialisé de l'Obésité (CSO) PACA Ouest, France; Digestive Surgery Department, Hôpital Nord, APHM, Aix-Marseille Université, Marseille, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Bege
authors.affiliation: Centre Spécialisé de l'Obésité (CSO) de Nancy, Coordination nationale des CSO, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Ziegler
authors.affiliation: Centre Spécialisé de l'Obésité (CSO) PACA Ouest, France; Digestive Surgery Department, Hôpital Nord, APHM, Aix-Marseille Université, Marseille, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Berdah
authors.affiliation: Hematology Department, Hôpital de la Timone, APHM, Aix-Marseille Université, Marseille, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Frère
authors.affiliation: Endocrinology, Metabolic Diseases, and Nutrition Department, Pole ENDO, APHM, Aix-Marseille Université, Marseille, France; Centre Spécialisé de l'Obésité (CSO) PACA Ouest, France; Aix Marseille Univ, INSERM, INRA, NORT, Marseille, France. Electronic address: benedicte.gaborit@ap-hm.fr.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Gaborit
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D050110:Bariatric Surgery / Q000379:methods*; D003430:Cross-Sectional Studies; D004334:Drug Administration Schedule; D005260:Female; D005602:France; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D019990:Perioperative Care / Q000379:methods; D019106:Postoperative Hemorrhage / Q000209:etiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D057566:Self Report; D053828:Stockings, Compression / Q000706:statistics & numerical data; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D054556:Venous Thromboembolism / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000209:etiology
chemical_list: D000925:Anticoagulants
keywords: Bariatric surgery; Obesity; Survey; Thromboprophylaxis; Venous thromboembolism