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

Abstract

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.