Review article
Extended thromboprophylaxis reduces incidence of postoperative
venous thromboembolism in laparoscopic bariatric surgery
Conor J. Magee, M.D., F.R.C.S., Jonathan Barry, M.Ch., F.R.C.S.,
Shafiq Javed, M.Sc., F.R.C.S., Robert Macadam, Ph.D., F.R.C.S.,
David Kerrigan, M.D.(Hons.), F.R.C.S., F.R.C.S.(Ed.)*
Gravitas Bariatric Surgical Unit, Bourne End, United Kingdom
Received October 14, 2009; revised December 22, 2009; accepted February 10, 2010
Abstract Background: Venous thromboembolism (VTE) after laparoscopic bariatric surgery is a significant
cause of morbidity and mortality. The objective of the present study was to study the incidence of
symptomatic VTE in extended thromboprophylaxis regimens using dalteparin at an independent
hospital in England, United Kingdom.
Methods: A prospective database of all patients undergoing bariatric surgery was retrospectively
analyzed. All patients underwent VTE prophylaxis regimen using perioperative and extended
postoperative low-molecular-weight heparin (dalteparin 2500 IU preoperatively, followed by 5000
IU daily postoperatively). The treatment period was 1 week for laparoscopic gastric banding or 3
weeks for all other procedures. Inferior vena cava filters were used in selected patients with
thrombophilia, a history of pulmonary embolism, or 1 episode of deep vein thrombosis. The
endpoint was the incidence of symptomatic VTE.
Results: A total of 735 patients underwent laparoscopic bariatric surgery, all of whom received
dalteparin. The postoperative VTE incidence was 0%. The 30-day and 90-day all-cause mortality
rate was 0%. A total of 3 adverse bleeding events occurred.
Conclusion: An extended VTE prophylaxis regimen using low-molecular-weight heparin is simple and
effective and was associated with a low incidence of bleeding complications. (Surg Obes Relat Dis 2010;
6:322–325.) © 2010 American Society for Metabolic and Bariatric Surgery. All rights reserved.
Keywords: Thromboprophylaxis; Laparoscopic; Bariatric surgery
Venous thromboembolism (VTE) is a significant cause
of postoperative morbidity and mortality, presenting as ei-
ther deep vein thrombosis (DVT) or pulmonary embolism
(PE). Patients undergoing bariatric surgery are at an in-
creased risk of VTE because of obesity- and nonobesity-
related factors (e.g., prolonged duration of surgery). DVT in
the morbidly obese can be clinically silent and can progress
to fatal PE rapidly and unexpectedly, representing the most
common cause of postoperative death in these patients [1,2].
The published data in bariatric surgery have suggested a
VTE incidence of 2.4%, PE incidence of .2–.3%, and a
30-day mortality rate of .1–2% [1,2]. Moreover, the inci-
dence of VTE in laparoscopic bariatric surgery has been
greater, occurring in as many as 3.5% of patients [3,4], with
an incidence of PE of almost 1% [3].
Although the incidence of VTE has been modest, the
widespread increase in bariatric surgery and the adoption
of laparoscopic techniques could lead to a relatively large
number of patients developing (and possibly dying of)
VTE. Because these are potentially preventable deaths,
primary prevention is the key to reducing the morbidity
and mortality of VTE.
Despite universal agreement on the need for thrombo-
prophylaxis, no clear consensus has been reached regarding
the best regimen and treatment duration.
*Reprint requests: David Kerrigan, M.D.(Hons.), F.R.C.S., F.R.C.S.
(Ed.), Gravitas Bariatric Surgical Unit, P.O. Box 3627, Bourne End, Buck-
inghamshire SL8 5GQ United Kingdom.
E-mail: david.kerrigan@gravitas-ltd.co.uk
Surgery for Obesity and Related Diseases 6 (2010) 322–325
1550-7289/10/$ – see front matter © 2010 American Society for Metabolic and Bariatric Surgery. All rights reserved.
doi:10.1016/j.soard.2010.02.046