Unfractionated Heparin Infusion for Thromboprophylaxis in Highest Risk Gastric Bypass Surgery

Abstract

For highest risk gastric bypass patients, an UFH prophylactic continuous infusion protocol was effective in preventing postoperative thromboembolic events. Hemorrhagic complications were easily managed and did not result in long-term sequelae.

The effect of extended post-discharge chemical thromboprophylaxis on venous thromboembolism rates after bariatric surgery: a prospective comparison trial

“…Although the choice of prophylactic dose used in our study was arbitrary and not based on patient's weight or anti-factor-Xa activity it appears to be safe and effective. In contrast, previous studies that used an in-hospital-only VTE prevention protocol based on anti-factor-Xa activity not only still reported a PE rate of 0.4%, but also observed a frequency of perioperative hemorrhagic complications as high as 10.5% [24,25].…”

Safety and efficacy of intravascular ultrasound-guided inferior vena cava filter in super obese bariatric patients

“…The widespread use of DVT prophylaxis and the increased frequency of laparoscopic gastric bypass have not decreased the rate of PE. The inadequacy of non-weight-based regiments of heparin and LMWH might have contributed to this limited success [1,4,6,9,[17][18][19]38]. Our patients were given 40 mg of LMWH twice daily for 2 weeks, rather than the standard 40 mg once-daily dose [16,18,38].…”

“…It would seem logical that a higher dose of anticoagulant would lead to lower PE rates, despite a lack of conclusive evidence supporting this idea. Several studies have demonstrated that the increased risks of bleeding from weight-based heparin and LMWH regimens are minimal [17,18,38]. Given the low risk and potential for benefit, we have chosen to use a greater than standard dose of LMWH.…”

Evidence of Thromboembolism Prophylaxis in Bariatric Surgery—Results of a Quality Assurance Trial in Bariatric Surgery in Germany from 2005 to 2007 and Review of the Literature

“…Derived from this, there is a risk of overdosage in obese patients if a body-weight-adapted dosage is chosen [35]. Therefore, monitoring of Factor Xa is recommended for heparin administration in high-risk patients [36].…”