ABSTRACT
BACKGROUND: The optimal amount of thromboembolic prophylaxis to use in bariatric surgery is still unresolved. OBJECTIVE: The aim of this study was to determine the optimal pharmacologic prophylaxis with minimal bleeding complications for bariatric patients. SETTING: A nonrandomized clinical study of 400 consecutive bariatric patients surgically treated between 2008 and 2013 at Peijas Hospital. METHODS: The patients, who either underwent mainly a sleeve gastrectomy or a Roux-en-Y gastric bypass, were divided consecutively into 3 subgroups with different approaches to pharmacologic enoxaparin prophylaxis. For the first 100 operated patients (high-dose group), enoxaparin was given at a dose of 40 mg twice daily, starting 1 day before the operation. The next 100 patients (intermediate-dose group) received 40 mg of enoxaparin twice daily, without the dose on the morning of the operation. The last 200 patients (low-dose group) received enoxaparin 40 mg once daily, starting 1 day before the operation and without the dose on the morning of the operation. The primary endpoints in this study were a major bleeding complication and a venous thromboembolism. RESULTS: There were no thromboembolic complications in this study. The difference in bleeding complications between the high-dose group and low-dose group was -10.5% (95% CI from -18.1% to -3.0%), and the difference between high-dose group and intermediate-dose group was -9% (95% CI from -17.4% to -.6%). Age and preoperative weight had no effect on bleeding complications, but hypertension significantly increased the amount of bleeding complications (P = .01, 95% CI from 1.55% to 29.7%). CONCLUSION: Thromboembolic complications are avoidable. Enoxaparin (40 mg) given once daily was the safest with regard to bleeding complications. High blood pressure elevates the risk for bleeding.
