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Venous thromboembolism (VTE) prophylaxis after bariatric surgery: a national survey of MBSAQIP director practices

Published:January 02, 2023DOI:https://doi.org/10.1016/j.soard.2022.12.038

      Highlights

      • Most surgeons (97.1%) administered mechanical and chemical VTE prophylaxis in the perioperative period.
      • Knee-high sequential compression devices were used by 84.7% of surgeons.
      • Enoxaparin was administered by 56.5% and Heparin by 38.1% of the participants.
      • Post discharge VTE prophylaxis was prescribed for 2 weeks by 38.7% and 4 weeks by 28.9%.

      Abstract

      Background

      Venous thromboembolism (VTE) is the most common cause of death following metabolic/bariatric surgery (MBS), with most events occurring after discharge. The available evidence on ideal prophylaxis type, dosage, and duration after discharge is limited.

      Objectives

      Assess metabolic/bariatric surgeon VTE prophylaxis practices and define existing variability.

      Setting

      Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-accredited centers.

      Methods

      The members of the ASMBS Research Committee developed and administered a web-based survey to MBSAQIP medical directors and ASMBS members to examine the differences in clinical practice regarding the administration of VTE prophylaxis after MBS.

      Results

      Overall, 264 metabolic/bariatric surgeons (136 medical directors and 128 ASMBS members) participated in the survey. Both mechanical and chemical VTE prophylaxis was used by 97.1% of the participants, knee-high compression devices by 84.7%, enoxaparin (32.4% 40 mg every 24 hours, 22.7% 40 mg every 12 hours, 24.4% adjusted the dose based on body mass index) by 56.5%, and heparin (46.1% 5000 units every 8 hours, 22.6% 5000 units every 12 hours, 20.9% 5000 units once preoperatively) by 38.1%. Most surgeons (81.6%) administered the first dose preoperatively, while the first postoperative dose was given on the evening of surgery by 44% or the next morning by 42.2%. Extended VTE prophylaxis was prescribed for 2 weeks by 38.7% and 4 weeks by 28.9%.

      Conclusions

      VTE prophylaxis practices vary widely among metabolic/bariatric surgeons. Variability may be related to limited available comparative evidence. Large prospective clinical trials are needed to define optimal practices for VTE risk stratification and prophylaxis in bariatric surgery patients.

      Keywords

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