Citation Information :
Hassan A, Adel M, Khaled I, Gbr H, Elkerkary M. Efficacy of Prophylaxis Protocol in Prevention of Venous Thromboembolism in Bariatric Surgery Patients. World J Lap Surg 2022; 15 (1):21-25.
Background: In patients undergoing bariatric surgery, different techniques have been used to avoid venous thromboembolism (VTE), including pharmacological prophylaxis and mechanical prophylaxis. Our aim was to determine the effectiveness of the prophylaxis procedure (pharmacological and mechanical prophylaxis) to prevent VTE following bariatric surgery.
Patients and methods: We performed the present cross-sectional study on patients with morbid obesity who were scheduled to undergo bariatric surgery. The primary outcome of the present stud was the incidence of VTE. The diagnosis of VTE was based on a duplex ultrasound. Patients were followed up for 1 month after the procedure.
Results: Two patients develop pulmonary embolism (6.1%). The first patient was female aged 40-years-old who underwent a sleeve gastrectomy (SG). Her body mass index (BMI) was 43 kg/m2 and she had a history of diabetes, hypertension (HTN), and VTE 5 years ago. On the 5th postoperative day, she complained of shortness of breath and chest pain, which was followed by the diagnosis of pulmonary embolism and ICU admission. The second patient was a female aged 49-years-old who underwent one anastomosis gastric bypass (OAGB) operation. Her BMI was 55 kg/m2 and she had a history of diabetes, HTN, and chronic obstructive pulmonary disease (COPD). Twelve days after operation, she complained of chest pain, palpitations, and shortness of breath, which was followed by the diagnosis of pulmonary embolism and ICU admission.
Conclusion: In conclusion, VTE is associated with an increased risk of morbidity and mortality after bariatric surgery; however, it can be prevented using an extensive course of thromboprophylaxis. For the best regime in VTE prevention after the bariatric operation, more prospective experiments are needed.
Murphy PB, Vogt KN, Lau BD, et al. Venous thromboembolism prevention in emergency general surgery a review. JAMA Surg 2018;153(5):479–486. DOI: 10.1001/jamasurg.2018.0015.
Ortel TL, Neumann I, Ageno W, et al. American society of hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv 2020;4(19):4693–4738. DOI: 10.1182/bloodadvances.2020001830.
López-Candales A. Pulmonary embolism. In: The Right Heart. 2014.
Slyper AH. Childhood obesity, adipose tissue distribution, and the pediatric practitioner. Pediatrics 1998;102(1):e4. DOI: 10.1542/peds.102.1.e4.
Malipeddi H. Obesity-causes, treatment and in vitro antiobesity studies-a review. Int J PharmTech Res 2016;9(5):366. DOI: 10.7897/2277-4572.033142.
Taylor VH, Forhan M, Vigod SN, et al. The impact of obesity on quality of life. Best Pract Res Clin Endocrinol Metab 2013;27(2):139. DOI: 10.1016/j.beem.2013.04.004.
Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 2012;70(1):3–21. DOI: 10.1111/j.1753-4887.2011.00456.x.
Żukiewicz-Sobczak W, Wróblewska P, Zwoliński J, et al. Obesity and poverty paradox in developed countries. Ann Agric Environ Med 2014;21(3):590–594. DOI: 10.5604/12321966.1120608.
Kissler HJ, Settmacher U. Bariatric surgery to treat obesity. Semin Nephrol 2013;33(1):75–89. DOI: 10.1016/j.semnephrol.2012.12.004.
Ide P, Fitzgerald-O’Shea C, Lautz DB. Implementing a bariatric surgery program. AORN J 2013;97(2):195–206; quiz 207–209. DOI: 10.1016/j.aorn.2012.11.018.
Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults. Cochrane Database Syst Rev 2014;(8):CD003641. DOI: 10.1002/14651858.CD003641.pub4.
Schoot RA, Kremer LCM, van de Wetering MD, et al. Systemic treatments for the prevention of venous thrombo-embolic events in paediatric cancer patients with tunnelled central venous catheters. Cochrane Database Syst Rev 2013;(9):CD009160. DOI: 10.1002/14651858.CD009160.pub2.
Tamakoshi K, Yatsuya H, Kondo T, et al. The metabolic syndrome is associated with elevated circulating C-reactive protein in healthy reference range, a systemic low-grade inflammatory state. Int J Obes 2003;27(4):443–449. DOI: 10.1038/sj.ijo.0802260.
Mertens I, Van Gaal LF. Obesity, haemostasis and the fibrinolytic system. Obes Rev 2002;3(2):85–101. DOI: 10.1046/j.1467-789x.2002.00056.x.
Winegar DA, Sherif B, Pate V, et al. Venous thromboembolism after bariatric surgery performed by Bariatric Surgery Center of Excellence Participants: Analysis of the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis 2011;7(2):181–188. DOI: 10.1016/j.soard.2010.12.008.
Wu EC, Barba CA. Current practices in the prophylaxis of venous thromboembolism in bariatric surgery. Obes Surg 2000;10(1):7–13; discussion 14. DOI: 10.1381/09608920060674021.
Bartlett MA, Mauck KF, Daniels PR. Prevention of venous thromboembolism in patients undergoing bariatric surgery. Vasc Health Risk Manag 2015;11:461–477. DOI: 10.2147/VHRM.S73799.
Ikesaka R, Delluc A, Le Gal G, et al. Efficacy and safety of weight-adjusted heparin prophylaxis for the prevention of acute venous thromboembolism among obese patients undergoing bariatric surgery: a systematic review and meta-analysis. Thromb Res 2014;133(4):682–687. DOI: 10.1016/j.thromres.2014.01.021.
Stein PD, Matta F. Pulmonary embolism and deep venous thrombosis following bariatric surgery. Obes Surg 2013;23(5):663–668. DOI: 10.1007/s11695-012-0854-2.
Mukherjee D, Lidor AO, Chu KM, et al. Postoperative venous thromboembolism rates vary significantly after different types of major abdominal operations. J Gastrointest Surg 2008;12(11):2015–2022. DOI: 10.1007/s11605-008-0600-1.
Schirmer B, Schauer PR. Chapter 27. The surgical management of obesity. In: Schwartz's principles of surgery. 2010.
Magee CJ, Barry J, Javed S, et al. Extended thromboprophylaxis reduces incidence of postoperative venous thromboembolism in laparoscopic bariatric surgery. Surg Obes Relat Dis 2010;6(3):322–325. DOI: 10.1016/j.soard.2010.02.046.
Tseng EK, Kolesar E, Handa P, et al. Weight-adjusted tinzaparin for the prevention of venous thromboembolism after bariatric surgery. J Thromb Haemost 2018;16(10):2008–2015. DOI: 10.1111/jth.14263.
Froehling DA, Daniels PR, Mauck KF, et al. Incidence of venous thromboembolism after bariatric surgery: a population-based cohort study. Obes Surg 2013;23(11):1874–1879. DOI: 10.1007/s11695-013-1073-1.
Sapala JA, Wood MH, Schuhknecht MP, et al. Fatal pulmonary embolism after bariatric operations for morbid obesity: a 24-year retrospective analysis. Obes Surg 2003;13(6):819–825. DOI: 10.1381/096089203322618588.
Jamal MH, Corcelles R, Shimizu H, et al. Thromboembolic events in bariatric surgery: a large multi-institutional referral center experience. Surg Endosc 2015;29(2). DOI: 10.1007/s00464-014-3678-4.
Steele KE, Schweitzer MA, Prokopowicz G, et al. The long-term risk of venous thromboembolism following bariatric surgery. Obes Surg 2011;21(9):1371–1376. DOI: 10.1007/s11695-011-0445-7.
Finks JF, English WJ, Carlin AM, et al. Predicting risk for venous thromboembolism with bariatric surgery: results from the Michigan bariatric surgery collaborative. Ann Surg 2012;255(6):1100–1104. DOI: 10.1097/SLA.0b013e31825659d4.
Birkmeyer NJ, Finks JF, English WJ, et al. Risks and benefits of prophylactic inferior vena cava filters in patients undergoing bariatric surgery. J Hosp Med 2013;8(4):173–177. DOI: 10.1002/jhm.2013.
Miller MT, Rovito PF. An approach to venous thromboembolism prophylaxis in laparoscopic Roux-en-Y gastric bypass surgery. Obes Surg 2004;14(6):731–737. DOI: 10.1381/0960892041590944.
Singh K, Podolsky ER, Um S, et al. Evaluating the safety and efficacy of BMI-based preoperative administration of low-molecular-weight heparin in morbidly obese patients undergoing Roux-en-Y gastric bypass surgery. Obes Surg 2012;22(1):47–51. DOI: 10.1007/s11695-011-0397-y.
Nguyen NT, Hinojosa MW, Fayad C, et al. Laparoscopic surgery is associated with a lower incidence of venous thromboembolism compared with open surgery. Ann Surg 2007;246(6):1021–1027. DOI: 10.1097/SLA.0b013e31815792d8.
Chan MM, Hamza N, Ammori BJ. Duration of surgery independently influences risk of venous thromboembolism after laparoscopic bariatric surgery. Surg Obes Relat Dis 2013;9(1):88–93. DOI: 10.1016/j.soard.2011.09.019.
Ahmad J, Lynch MK, Maltenfort M. Incidence and risk factors of venous thromboembolism after orthopaedic foot and ankle surgery. Foot Ankle Spec 2017;10(5):449–454. DOI: 10.1177/1938640017704944.
Gonzalez R, Haines K, Nelson LG, et al. Predictive factors of thromboembolic events in patients undergoing Roux-en-Y gastric bypass. Surg Obes Relat Dis 2006;2(1):30–35; discussion 35–36. DOI: 10.1016/j.soard.2005.10.003.
Masoomi H, Buchberg B, Reavis KM, et al. Factors predictive of venous thromboembolism in bariatric surgery. Am Surg 2011;77(10):1403–1406. PMID: 22127099.