Deep vein thrombosis prophylaxis: Are we overdoing? An Asian survey on trends in bariatric surgery with a systematic review of literature

Abstract

Background:Obesity is a risk factor for deep vein thrombosis (DVT) and venous thromboembolism (VTE). VTE is the most common cause of mortality in patients undergoing bariatric surgery. There is considerable variation in practice regarding methods, dosages and duration of prophylaxis in this patient population. Most of the literature is based on Western patients and specific guidelines for Asians do not exist.Methods:We conducted a web-based survey amongst 11 surgeons from high-volume centres in Asia regarding their DVT prophylaxis measures in patients undergoing bariatric surgery. We collected and analysed the data.Results:The reported incidence of DVT and VTE ranged from 0% to 0.2%. Most surgeons (63.64%) preferred to use both mechanical and chemoprophylaxis with low-molecular-weight heparin being the most preferred form of chemoprophylaxis (81.82%). There was an equal distribution of weight-based, body mass index-based and fixed-dose regimens. Duration of chemoprophylaxis ranged from 3–5 days after surgery to 2 weeks after surgery. For high-risk patients, 60% surgeons preferred to start chemoprophylaxis at least 1 week before surgery. Routine use of inferior vena cava filters in high-risk patients was not preferred with some surgeons adopting a selective use (36.36%).Conclusion:The purpose of this survey was to understand the trends in DVT prophylaxis amongst different high-volume bariatric centres in Asia and to relate the same with the existing literature on the different steps in prophylaxis. There is, however, a need for consensus guidelines for DVT prophylaxis in Asian obese.

Pharmacological prophylaxis versus none- pharmacological prophylaxis in prevention of clinical venous thromboembolic complications in morbid obese patients following bariatric surgery: a retrospective observational case-control study

“…Furthermore, Bhattacharya et al in a web-based survey investigated the DVT prophylaxis measures amongst 11 surgeons from high-volume centers in Asia in patients undergoing bariatric surgery. In this published systematic review, it has been indicated that the VTE incidence reported by Asian surgeons ranged from 0% to 0.2% [5]. This incidence is considerably lower than what is reported in Western literature that ranged from 0.5 and 2% [19,20].…”

“…On the other hand, there is some evidence suggesting that VTE complications are relatively less common amongst Asians as compared to their Western counterparts [4]. Therefore, due to ethnic variations in VTE risk, Asian patients may, possibly, require a lower dosage of thromboprophylaxis but the risk-benefit ratio needs to be determinate [5]. There is no agreement on the standard of care for prophylactic regiment [6], which some surgeons advocating chemoprophylaxis, some mechanical prophylaxis, and some using both.…”

“…There is no agreement on the standard of care for prophylactic regiment [6], which some surgeons advocating chemoprophylaxis, some mechanical prophylaxis, and some using both. Standardization of the prophylaxis based on individually VTE risk factor and ethnic variations is an important issue, because the under treatment may lead to increased incidence of VTE and overtreatment may lead to bleedingrelated complications and higher financial burden on the health-care system [5]. Because of the lack of uniform guideline, we reviewed our experience since changing our postoperative protocol from routine chemoprophylaxis with clexan or heparin to mechanical measures including whole leg compression stockings (LCS), an emphasis on early ambulation, adequate hydration and short operation time to avoid the VTE incidence and potential risk of anticoagulant medication adverse effects.…”