Adding a Preoperative Dose of LMWH may Decrease VTE Following Bariatric Surgery
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ORIGINAL SCIENTIFIC REPORT
Adding a Preoperative Dose of LMWH may Decrease VTE Following Bariatric Surgery Ahmed Mohammed Abdelsalam1 • Ahmed Mohammed Salah Eldeen ElAnsary1 • Mohammed Abdallah Salman1 • Sahar Abdelrahman Nassef1 • Hala Mostafa Elfergany1 Hesham Ahmed Abou Aisha1
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Accepted: 28 August 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Bariatric procedures are the most effective management for obesity. There is no standard venous thromboembolism (VTE) prophylaxis for both dosing and duration of anticoagulation following laparoscopic sleeve gastrectomy. Our purpose was to assess the optimum regimen for VTE prophylaxis in bariatric procedures and to reduce the incidence of perioperative bleeding. Methods and materials This is a prospective randomized study which involved 100 morbidly obese patients, subdivided into two groups; group A received postoperative low molecular weight heparin (LMWH) prophylaxis alone starting from day 1 to day 15 in dose 1 mg/kg/day in a maximum dose 120 mg/day, and group B received both preand postoperative LMWH; at night of surgery 12 h preoperatively and postoperative starting from day 1 to day 15 with the same dose. All patients underwent mesenteric and bilateral lower limbs duplex 15 days postoperative using Philips iU machine and linear (L9-3), convex (C5-1) and sector (S5-1) probes. Results Regarding postoperative VTE, we found statistically significant increase in postoperative VTE in patients of group A (four cases) without any case complicated with VTE in patients of group B (P value = 0.041). Regarding postoperative bleeding, we found statistically insignificant percent of cases complicated with postoperative bleeding in group B compared to group A (P value 0.315). Conclusion Preoperative as well as a postoperative prophylactic anticoagulant as LMWH is recommended to prevent perioperative VTE. There was an insignificant increase in postoperative bleeding in patients who received preoperative prophylactic anticoagulants.
Introduction Venous thromboembolism (VTE) prophylaxis is a controversial issue in bariatric procedures. With already existing risk factors, bariatric procedures add more risk for VTE. Even with challenges to avoid these problems, rates of VTE events following bariatric surgery range between 0.3 and 2.2% [1]. & Ahmed Mohammed Abdelsalam [email protected] 1
To decrease the incidence of VTE in morbidly obese patients candidate for bariatric procedures, utilization of low molecular weight heparin, unfractionated heparin and/ or mechanical prophylaxis is recommended [1]. Dosing of anticoagulation can be challenging, as bleeding complications require to be well-adjusted with prevention of deep venous thrombosis or pulmonary embolism [2]. There is insufficient data regarding the use and effect of VTE chemoprophylaxis following bariatric procedures. Determination of the ideal prophylactic regimen to decrease complications is critical, and there is no level 1
Faculty of Medicine, Cairo University, Kasr Al Ainy St., Ca
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