Thromboembolic Complications After Bariatric Surgery: Is the High Risk Real?

introductionNowadays, a large number of bariatric surgery (BS) procedures are undertaken worldwide as surgery has become an efficient strategy to treat the obesity epidemic. The risk of venous thromboembolism (VTE) is increased in patients undergoing BS not only due to the intrinsic surgical risk but also because patients with obesity have a 2-3-fold higher risk of VTE. The optimal strategy for VTE prevention in BS setting, including optimal dose and thromboprophylaxis regimen, is still not fully clarified. The aim of this study was to report a bariatric high-volume center experience and to propose a practical thromboprophylaxis protocol for this population.

methodsA single-center, observational, retrospective, and longitudinal study was conducted from January 2018 to December 2020, a total of 901 patients who underwent primary and revisional bariatric surgery were included.

resultsThe overall frequency of VTE events was 0.44% (n=4), one patient had pulmonary embolism (PE) during index hospital admission; another patient had simultaneous deep venous thrombosis (DVT) and PE, two months after surgery; and two other patients had DVT, nine and 16 months after surgery. The median time for VTE was four months. The incidence of females was 75% (n=3) and the median age was 57 years. Only one female patient was using oral contraception. None had a previous history of thromboembolic events, chronic venous insufficiency, or other known diseases that could increase the VTE risk.

conclusionConsidering the outcomes reported by this experienced center with low rates of thromboembolic events, we suggest a thromboprophylaxis protocol that can be easily applied to the majority of bariatric patients.