Prevention of venous thromboembolism with enoxaparin in bariatirc surgery.

Purpose: Venous thromboembolism (VTE) after bariatric surgery is a significant cause of morbidity and mortality. Current modalities of thromboprophylaxis include subcutaneous injection of unfractionated or low-molecular-weight heparin (LMWH), pneumatic compression, elastic stockings, and inferior vena cava filters. Despite universal agreement on the need for thromboprophylaxis, no clear consensus has been reached regarding the best regimen and treatment duration of bariatric surgery.

Methods: From April, 2009 to December, 2011, we performed 200 bariatric surgery (191 with primary intent, 9 with revisional intent). There was no history of VTE prior to surgery. Clexane therapy was done with 4000 U SQ once daily for 2 weeks to the day before surgery. Development of VTE was assessed by direct interview, physical examination in out-patient clinic, and phone calls to patients for history taking if needed. The history taking was presented in questionnaire format. The patients were asked to state their symptoms of VTE by answering the questionnaire. The patients were followed up for a minimum of 6 months after surgery to determine the incidence of clinical VTE.

Results: Two-week Clexane therapy was completed in 193 patients. Clexane was stopped in 5 due to surgical related complications (4 bleeding, 1 reoperation due to leak), in 2 due to Clexane related complications (1 epistaxis, 1 metrorrhagia). Follow-up of out-patient clinic were 68%, those who could follow up by telephone were 89%. There was no evidence of VTE.

Conclusion: A 2-week VTE prophylaxis regimen using LMWH is simple, effective and associated with a low incidence of complications.