Longitudinal retrospective review of three-tiered low molecular weight heparin dosing protocol to prevent thromboembolism in low-risk patients undergoing laparoscopic sleeve gastrectomy.

BACKGROUND

According to the most recent consensus guidelines from the American Society for Metabolic and Bariatric Surgery (ASMBS), almost all bariatric surgery patients are at least a moderate to high risk for the development of postoperative venous thromboembolism (VTE). The most recent update also concludes that there continues to be a lack of high-quality data on safety, efficacy, dosing, and duration of treatment for pharmacologic thromboprophylaxis in the perioperative period up to discharge. Observational data has reported VTE rate between 1.9 and 5.4% in patients undergoing bariatric surgery, and rates as low as 0.5% in less invasive surgery including laparoscopic sleeve gastrectomy (LSG). In a retrospective study of over 175,000 LSGs performed from 2015 to 2016, 0.6% were complicated by postoperative bleed. This retrospective analysis reviews results from a consistent low molecular weight heparin (LMWH) protocol over a 12-year period for safety and efficacy.

OBJECTIVE

To address the lack of long-term data associated with a consistent LMWH protocol providing long-term safety and efficacy data in bariatric surgery.

SETTING

The study was conducted at a Community Hospital, United States.

METHODS

Protocol of enoxaparin 30 mg, 40 mg, or 60 mg every 12 h for patients with a weight of < 300 lbs., 300-400 lbs., or > 400 lbs., respectively, and is initiated at least 2 h before surgery.

RESULTS

Of 1936 patients, 4 patients (0.21%) developed VTE while 3 patients (0.15%) had bleeding complications.

CONCLUSION

The thromboprophylaxis regimen utilized in this study demonstrated enoxaparin to be safe and efficacious, with incidences of thromboembolism and bleeding both below reported averages from the national quality databases.