Value of pharmacologic thromboprophylaxis for prevention of thromboembolic complications in bariatric surgery

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Abstract

Objective
The objective of this study was to assess safety and efficacy of pharmacologic thromboprophylaxis in morbidly obese patients undergoing bariatric surgery for prevention of silent deep vein thrombosis (DVT).
Patients and methods
This prospective study included 50 morbidly obese patients scheduled for primary one-stage laparoscopic bariatric surgery randomly allocated into one of two treatment groups according to the method of thromboprophylaxis. Group M (=25) was subjected to mechanical prophylaxis with bilateral graduated compression stockings. Group MC (=25) was subjected to mechanical plus pharmacologic prophylaxis using 40 mg of the low-molecular-weight heparin enoxaparin subcutaneously, 12 h before surgery, and postoperatively daily for 2 weeks. Bilateral lower limb venous duplex was done to detect silent DVT (the primary outcome measure), before discharge and after 2 weeks.
Results
Three patients developed silent DVT (6%); all of them were among group M (=0.235, relative risk: 0.47, 95% confidence interval: 0.35–0.64). There was no significant difference between patients with DVT and those without DVT regarding age, BMI, operative time, comorbidities, or type of surgery. No bleeding complications were recorded in the two studied groups.
Conclusion
Perioperative low-molecular-weight heparin extending for 2 weeks postoperatively combined with graduated compression stockings is safe and effective for the prevention of silent DVT following laparoscopic bariatric surgery.

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