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

Published:January 02, 2023DOI:


      • 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%.



      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.


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


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


      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.


      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%.


      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.


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        • Carlsson L.M.S.
        • Sjöholm K.
        • Jacobson P.
        • et al.
        Life expectancy after bariatric surgery in the Swedish obese subjects study.
        N Engl J Med. 2020; 383: 1535-1543
        • Sjöström L.
        Review of the key results from the Swedish Obese Subjects (SOS) trial–a prospective controlled intervention study of bariatric surgery.
        J Intern Med. 2013; 273: 219-234
        • Cardoso L.
        • Rodrigues D.
        • Gomes L.
        • Carrilho F.
        Short- and long-term mortality after bariatric surgery: a systematic review and meta-analysis.
        Diabetes Obes Metab. 2017; 19: 1223-1232
        • Chang S.-H.
        • Stoll C.R.T.
        • Song J.
        • Varela J.E.
        • Eagon C.J.
        • Colditz G.A.
        The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012.
        JAMA Surg. 2014; 149: 275-287
        • Aminian A.
        • Brethauer S.A.
        • Kirwan J.P.
        • Kashyap S.R.
        • Burguera B.
        • Schauer P.R.
        How safe is metabolic/diabetes surgery?.
        Diabetes Obes Metab. 2015; 17: 198-201
        • Barba C.A.
        • Harrington C.
        • Loewen M.
        Status of venous thromboembolism prophylaxis among bariatric surgeons: have we changed our practice during the past decade?.
        Surg Obes Relat Dis. 2009; 5: 352-356
        • Wesley Vosburg R.
        • Druar N.M.
        • Kim J.J.
        Factors associated with increased risk for pulmonary embolism after metabolic and bariatric surgery: analysis of nearly one million patients.
        Obes Surg. 2022; 32: 2433-2437
        • Morino M.
        • Toppino M.
        • Forestieri P.
        • Angrisani L.
        • Allaix M.E.
        • Scopinaro N.
        Mortality after bariatric surgery: analysis of 13,871 morbidly obese patients from a national registry.
        Ann Surg. 2007; 246: 1002-1009
        • Smith M.D.
        • Patterson E.
        • Wahed A.S.
        • et al.
        Thirty-day mortality after bariatric surgery: independently adjudicated causes of death in the longitudinal assessment of bariatric surgery.
        Obes Surg. 2011; 21: 1687-1692
        • Dang J.T.
        • Switzer N.
        • Delisle M.
        • et al.
        Predicting venous thromboembolism following laparoscopic bariatric surgery: development of the BariClot tool using the MBSAQIP database.
        Surg Endosc. 2019; 33: 821-831
        • Aminian A.
        • Andalib A.
        • Khorgami Z.
        • et al.
        Who should get extended thromboprophylaxis after bariatric surgery?: a risk assessment tool to guide indications for post-discharge pharmacoprophylaxis.
        Ann Surg. 2017; 265: 143-150
        • Steele K.E.
        • Schweitzer M.A.
        • Prokopowicz G.
        • et al.
        The long-term risk of venous thromboembolism following bariatric surgery.
        Obes Surg. 2011; 21: 1371-1376
        • Helm M.C.
        • Simon K.
        • Higgins R.
        • Kindel T.L.
        • Gould J.C.
        Perioperative complications increase the risk of venous thromboembolism following bariatric surgery.
        Am J Surg. 2017; 214: 1135-1140
        • Winegar D.A.
        • Sherif B.
        • Pate V.
        • DeMaria E.J.
        Venous thromboembolism after bariatric surgery performed by bariatric surgery center of excellence participants: analysis of the bariatric outcomes longitudinal database.
        Surg Obes Relat Dis. 2011; 7: 181-188
        • Wu E.C.
        • Barba C.A.
        Current practices in the prophylaxis of venous thromboembolism in bariatric surgery.
        Obes Surg. 2000; 10 (discussion 4): 7-13
        • Aminian A.
        • Vosburg R.W.
        • Altieri M.S.
        • Hinojosa M.W.
        • Khorgami Z.
        The American Society for Metabolic and Bariatric Surgery (ASMBS) updated position statement on perioperative venous thromboembolism prophylaxis in bariatric surgery.
        Surg Obes Relat Dis. 2022; 18: 165-174
        • Finks J.F.
        • English W.J.
        • Carlin A.M.
        • et al.
        Predicting risk for venous thromboembolism with bariatric surgery: results from the Michigan Bariatric Surgery Collaborative.
        Ann Surg. 2012; 255: 1100-1104
        • Caprini J.A.
        Risk assessment as a guide for the prevention of the many faces of venous thromboembolism.
        Am J Surg. 2010; 199: S3-S10
        • Anderson D.R.
        • Morgano G.P.
        • Bennett C.
        • et al.
        American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients.
        Blood Adv. 2019; 3: 3898-3944
        • Mechanick J.I.
        • Apovian C.
        • Brethauer S.
        • et al.
        Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists - Executive Summary.
        Endocr Pract. 2019; 25: 1346-1359
        • Venclauskas L.
        • Maleckas A.
        • Arcelus J.I.
        European guidelines on perioperative venous thromboembolism prophylaxis: surgery in the obese patient.
        Eur J Anaesthesiol. 2018; 35: 147-153
        • Gould M.K.
        • Garcia D.A.
        • Wren S.M.
        • et al.
        Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
        Chest. 2012; 141: e227S-e277S
        • Pannucci C.J.
        • Laird S.
        • Dimick J.B.
        • Campbell D.A.
        • Henke P.K.
        A validated risk model to predict 90-day VTE events in postsurgical patients.
        Chest. 2014; 145: 567-573
        • American Society of Metabolic and Bariatric Surgery (ASMBS) Research Committee
        ([cited 2022 Jun 6]; Available from)
        • Burns K.E.
        • Duffett M.
        • Kho M.E.
        • et al.
        A guide for the design and conduct of self-administered surveys of clinicians.
        CMAJ. 2008; 179: 245-252
        • Hing C.B.
        • Smith T.O.
        • Hooper L.
        • Song F.
        • Donell S.T.
        A review of how to conduct a surgical survey using a questionnaire.
        Knee. 2011; 18: 209-213
        • Pryor 2nd, H.I.
        • Singleton A.
        • Lin E.
        • Lin P.
        • Vaziri K.
        Practice patterns in high-risk bariatric venous thromboembolism prophylaxis.
        Surg Endosc. 2013; 27: 843-848
        • Moulin P.A.
        • Dutour A.
        • Ancel P.
        • et al.
        Perioperative thromboprophylaxis in severely obese patients undergoing bariatric surgery: insights from a French national survey.
        Surg Obes Relat Dis. 2017; 13: 320-326
        • Bhattacharya S.
        • Kumar S.S.
        • Swamy P.D.K.
        • Palanivelu C.
        • Raj P.P.
        Deep vein thrombosis prophylaxis: are we overdoing? An Asian survey on trends in bariatric surgery with a systematic review of literature.
        J Minim Access Surg. 2018; 14: 285-290
      1. ASMBS updated position statement on prophylactic measures to reduce the risk of venous thromboembolism in bariatric surgery patients.
        Surg Obes Relat Dis. 2013; 9: 493-497
      2. Prophylactic measures to reduce the risk of venous thromboembolism in bariatric surgery patients.
        Surg Obes Relat Dis. 2007; 3: 494-495
        • Birkmeyer N.J.
        • Finks J.F.
        • Carlin A.M.
        • et al.
        Comparative effectiveness of unfractionated and low-molecular-weight heparin for prevention of venous thromboembolism following bariatric surgery.
        Arch Surg. 2012; 147: 994-998
        • Hamadi R.
        • Marlow C.F.
        • Nassereddine S.
        • Taher A.
        • Finianos A.
        Bariatric venous thromboembolism prophylaxis: an update on the literature.
        Expert Rev Hematol. 2019; 12: 763-771
        • Borkgren-Okonek M.J.
        • Hart R.W.
        • Pantano J.E.
        • et al.
        Enoxaparin thromboprophylaxis in gastric bypass patients: extended duration, dose stratification, and antifactor Xa activity.
        Surg Obes Relat Dis. 2008; 4: 625-631
        • Hamad G.G.
        • Choban P.S.
        Enoxaparin for thromboprophylaxis in morbidly obese patients undergoing bariatric surgery: findings of the prophylaxis against VTE outcomes in bariatric surgery patients receiving enoxaparin (PROBE) study.
        Obes Surg. 2005; 15: 1368-1374
        • Sebastian R.
        • Ghanem O.
        • DiRoma F.
        • Milner S.M.
        • Price L.A.
        Pulmonary embolism in burns, is there an evidence based prophylactic recommendation? Case report and review of literature.
        Burns. 2015; 41: e4-e7
        • Lin H.
        • Faraklas I.
        • Cochran A.
        • Saffle J.
        Enoxaparin and antifactor Xa levels in acute burn patients.
        J Burn Care Res. 2011; 32: 1-5
        • Westfall J.M.
        • Mold J.
        • Fagnan L.
        Practice-based research--"Blue Highways" on the NIH roadmap.
        JAMA. 2007; 297: 403-406
        • Balas E.A.
        • Boren S.A.
        Managing clinical knowledge for Health care improvement.
        Yearb Med Inform. 2000; : 65-70
        • Fuentes H.E.
        • Paz L.H.
        • Al-Ogaili A.
        • et al.
        Validation of a patient-completed caprini risk score for venous thromboembolism risk assessment.
        TH Open. 2017; 1: e106-e112
        • Paz Rios L.H.
        • Fuentes H.E.
        • Oramas D.M.
        • et al.
        Validation of a patient-completed caprini risk assessment tool for Spanish, Arabic, and polish speakers.
        Clin Appl Thromb Hemost. 2018; 24: 502-512
        • Daikeler J.
        • Bošnjak M.
        • Lozar Manfreda K.
        Web versus other survey modes: an updated and extended meta-analysis comparing response rates.
        J Surv Stat Methodol. 2019; 8: 513-539
        • Banning L.B.D.
        • Meyer V.M.
        • Keupers J.
        • Lange J.F.M.
        • Pol R.A.
        • Benjamens S.
        Surveys in surgical education: a systematic review and reporting guideline.
        Eur Surg Res. 2021; 62: 61-67
        • Petchenik J.
        • Watermolen D.J.
        A cautionary note on using the internet to survey recent Hunter education graduates.
        Hum Dimensions Wildl. 2011; 16: 216-218