ReviewVenous thromboembolism in bariatric surgery patients: an update of risk and prevention
Section snippets
Incidence of VTE in bariatric surgery population
Bariatric surgical procedures are associated with 30-day overall mortality rates of .1–2% [6], [7]. Retrospective analyses spanning 16–24-year periods have reported an incidence of fatal PE after obesity surgery of .2–.3% [1], [3]. The incidence of postoperative DVT has been reported to be 0–1% [1], [4], [8], [9] and the incidence of symptomatic VTE to be .8–2.4% [1], [4].
A survey of North American bariatric surgeons found that 86% of the 128 respondents considered their patients to be at high
Risk factors for VTE in bariatric surgery patients
Patients undergoing bariatric surgery have an inherent increased risk of thromboembolism. An epidemiologic study of risk factors for VTE has shown that obesity confers an intrinsic and significant risk of symptomatic DVT [10]. Abdominal operations requiring general anesthesia for >30 minutes also confer thrombotic risk, increasing the odds ratio for the development of VTE by >10 (Table 1)[11]. Increasing age has also been identified as a risk factor for adverse events after bariatric surgery,
Options for VTE prophylaxis in bariatric surgery patients
A paucity of grade 1A thromboprophylaxis data specific to bariatric surgery patients is available, and specific recommendations from the American College of Chest Physicians (ACCP) for prophylaxis in this setting are lacking. The ACCP publishes clinical practice guidelines on the basis of a systematic review of peer-reviewed published reports [24]. The strength of the recommendations and quality of the evidence are formally graded. The guidelines undergo formal peer review before review by the
Dosing, duration, and timing of prophylaxis
Given the paucity of data from randomized, controlled clinical trials of obese surgical patients, consensus is lacking about the optimal dosing, timing, and duration of thromboprophylaxis in patients undergoing bariatric surgery.
Conclusion
All patients undergoing bariatric surgery are at a moderate to high risk of postoperative VTE. These patients warrant thromboprophylaxis in accordance with the ACCP recommendations for moderate- to high-risk patient groups. Obesity and surgery are both recognized risk factors for VTE; therefore, patients who are candidates for bariatric surgery should be assessed for additional risk factors that may elevate their VTE risk. Prophylaxis with UFH or LMWH in the peri- and postoperative period is
Acknowledgments
The authors received editorial/writing support in the preparation of this report; this was funded by Sanofi-Aventis, NJ. The authors, however, were fully responsible for the content of, and editorial decisions for, this report.
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