Wu EC, Barba CA.
Current practices in the prophylaxis of venous thromboembolism in bariatric
surgery.
Obes Surg 2000 Feb;10(1):7-13; discussion 14

University of Connecticut School of Medicine, Saint Francis Hospital and Medical
Center, Department of Surgery, Hartford 06105, USA.

BACKGROUND: Morbidly obese patients undergoing bariatric surgery have commonly
been concluded to be at high risk for the development of perioperative venous
thromboembolism. Due to its clinically silent nature, primary prevention is the
key to reduce morbidity and mortality. There is no clear consensus in the
literature regarding the optimum approach to minimize this preventable
phenomenon. METHODS: Members of the American Society for Bariatric Surgery were
surveyed regarding their current practices in the prophylaxis of venous
thromboembolism in their bariatric patients. RESULTS: 31% of the members
completed the survey. 62% were in private practice, and 38% practiced in an
academic hospital. The number of bariatric surgeries done per year ranged from 5
to 325, with a mean of 85 procedures per member. The gastric bypass was the most
commonly performed procedure at 61.7%, followed by vertical banded gastroplasty
at 23.3%, biliary pancreatic diversion at 9.3%, laparoscopic gastroplasty at
4.0%, laparoscopic gastric bypass at 1.6%, and horizontal banded gastroplasty at
0.1%. 86% felt that their bariatric patients were at high risk for developing
deep vein thrombosis (DVT) and pulmonary embolism (PE) with a self-reported
incidence of 2.63% and 0.95%, respectively. 48% had at least one death due to PE.
Routine prophylaxis is used by over 95% of members. 62% ranked the various
methods of prophylaxis from most preferred to least preferred, while 38% used a
combination of 2 or more prophylactic methods simultaneously. Low-dose heparin
was the most preferred prophylaxis by 50% of members, followed by intermittent
pneumatic compression stockings at 33%, low molecular weight heparins at 13%, and
other methods at 4%. Over 83% indicated that safety with few complications, ease
of administration, and effectiveness were the most important criteria for
selecting their most preferred prophylactic method. Only 2% routinely performed
testing to rule out venous thromboembolism before discharge, and 11% routinely
discharged patients with prophylaxis. CONCLUSIONS: The prevailing opinion of
members of the American Society for Bariatric Surgery is that morbidly obese
patients are at high risk for developing perioperative venous thromboembolism. A
vast majority routinely use prophylaxis. Despite these measures, fatal PE is
still widespread. A lack of consensus in the method of prophylaxis was seen. A
multicentric randomized controlled study comparing the efficacy of the various
methods of prophylaxis will be the only manner to determine the best prophylaxis
and its usefulness. This study will be costly and probably not warranted due to
the low incidence of this condition in the morbidly obese patient.