Retrospective analysis of 3 different antithrombotic prophylaxis regimens in bariatric surgery

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. (C) 2016 American Society for Metabolic and Bariatric Surgery. All rights reserved.