Obesity Surgery

, Volume 29, Issue 2, pp 729–734 | Cite as

A New Protocol for Venous Thromboembolism Prophylaxis in Bariatric Surgery

  • Hacı Hasan AbuogluEmail author
  • M. A. Tolga Müftüoğlu
  • Mehmet Odabaşı
New Concept



Morbidly obese patients are at high risk for developing venous thromboembolism (VTE). The aim of this study was to evaluate the effect of a new VTE prophylaxis protocol (low dosage, low-molecular-weight heparin [LMWH]) with a pneumatic compression device (PCD) in patients undergoing bariatric surgery.

Materials and Methods

Between November 2015 and December 2017, 368 patients underwent surgery due to obesity. The patients received 0.2 ml of nadroparin (Fraxiparine, GlaxoSmithKline) 12 h before the operation. A PCD (Kendall SCD Compression System) was applied to the patient during the operation and left on the patient during the subsequent 24 h. Nadroparin 0.4 ml was started subcutaneously after the PCD was removed from the patient and the same dosage of nadroparin was given daily for 15 days following the bariatric operation. Ambulation within 2 h of surgery was encouraged and was performed frequently.


A total of 368 patients underwent laparoscopic bariatric surgery. The median age was 34.1 years (range, 18–61), the median weight was 128 kg (range, 90–182), and the median body mass index (BMI) was 47.2 kg/m2 (range, 36–72). No thrombotic events were observed postoperatively or at the 1-, 3-, and 6-month follow-up visits. Four bleedings occurred requiring transfusions. None of these patients required a re-laparotomy for hemorrhage control. The mortality rate was 0% at 30 and 90 days and during the hospitalization.


Low dosage LMWH with PCD is very effective for VTE prophylaxis in bariatric surgery.


Bariatric surgery Venous thromboembolism Chemoprevention Hemorrhage 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Studies with Human Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Ethical consideration

An approval from the local ethics committee of Haydarpaşa Numune Training and Research Hospital (HNTARH) was obtained for this study, and written informed consent was obtained in accordance with the Declaration of Helsinki from all patients. Privacy rights of the patients have been observed.


  1. 1.
    Froehling DA, Daniels PR, Mauck KF, et al. Incidence of venous thromboembolism after bariatric surgery: a population-based cohort study. Obes Surg. 2013;23(11):1874–9.Google Scholar
  2. 2.
    Gould MK, Garcia DA, Wren SM, 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(2):227–77.Google Scholar
  3. 3.
    Cottam DR, Mattar SG, Schauer PR. Laparoscopic era of operations for morbid obesity. Arch Surg. 2003;138(4):367–75.Google Scholar
  4. 4.
    Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest. 2004;126(Suppl):338–400.Google Scholar
  5. 5.
    Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism. American College Of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest. 2008;133(6):381–453.Google Scholar
  6. 6.
    Richardson WS, Hamad GG, Stefanidis D. SAGES VTE prophylaxis for laparoscopic surgery guidelines: an update. Surg Endosc. 2017;31(2):501–3.Google Scholar
  7. 7.
    Kakkar VV, Howe CT, Nicolaides AN, et al. Deep vein thrombosis of the leg: is there a high-risk group? Am J Surg. 1970;120(4):527–30.Google Scholar
  8. 8.
    Lowe GD, Osborne DH, McArdle BM, et al. Prediction and selective prophylaxis of venous thrombosis in elective gastrointestinal surgery. Lancet. 1982;319(8269):409–12.Google Scholar
  9. 9.
    Kakkos SK, Caprini JA, Geroulakos G, et al. Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism. Cochrane Database Syst Rev. 2016;9:CD005258.Google Scholar
  10. 10.
    American Society for Metabolic and Bariatric Surgery Clinical Issues Committee. ASMBS updated position statement on prophylactic measures to reduce the risk of venous thromboembolism in bariatric surgery patients. Surg Obes Relat Dis. 2013;9(4):493–7.Google Scholar
  11. 11.
    Eisele R, Kinzl L, Koelsch T. Rapid-inflation intermittent pneumatic compression for prevention of deep venous thrombosis. J Bone Joint Surg Am. 2007;89(5):1050–6.Google Scholar
  12. 12.
    Becattini C, Agnelli G, Manina G, et al. Venous thromboembolism after laparoscopic bariatric surgery for morbid obesity: clinical burden and prevention. Surg Obes Relat Dis. 2012;8(1):108–15.Google Scholar
  13. 13.
    Clements RH, Yellumahanthi K, Ballem N, et al. Pharmacologic prophylaxis against venous thromboembolic complications is not mandatory for all laparoscopic Roux-en-Y gastric bypass procedures. J Am Coll Surg. 2009;208(5):917–21.Google Scholar
  14. 14.
    Gonzalez QH, Tishler DS, Plata-Munoz JJ, et al. Incidence of clinically significant deep venous thrombosis after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2004;18(7):1082–4.Google Scholar
  15. 15.
    Magee CJ, Barry J, Javed S, et al. Extended thromboprophylaxis reduces incidence of postoperative venous thromboembolism in laparoscopic bariatric surgery. Surg Obes Relat Dis. 2010;6(3):322–5.Google Scholar
  16. 16.
    Javanainen MH, Scheinin T, Mustonen H, et al. Retrospective analysis of 3 different antithrombotic prophylaxis regimens in bariatric surgery. Surg Obes Rel Dis. 2015;12(3):675–80.Google Scholar
  17. 17.
    Frantzides CT, Welle SN, Ruff TM, et al. Routine anticoagulation for venous thromboembolism prevention following laparoscopic gastric bypass. JSLS. 2012;16:33–7.Google Scholar
  18. 18.
    Brasileiro AL, Miranda Jr F, Ettinger JE, et al. Incidence of lower limbs deep vein thrombosis after open and laparoscopic gastric bypass: a prospective study. Obes Surg. 2008;18:52–7.Google Scholar
  19. 19.
    Hamad GG, Choban PS. 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;15:1368–74.Google Scholar
  20. 20.
    Cotter SA, Cantrell W, Fisher B, et al. Efficacy of venous thromboembolism prophylaxis in morbidly obese patients undergoing gastric bypass surgery. Obes Surg. 2005;15:1316–20.Google Scholar
  21. 21.
    Miller MT, Rovito PF. An approach to venous thromboembolism prophylaxis in laparoscopic Roux-en-Y gastric bypass surgery. Obes Surg. 2004;14:731–7.Google Scholar
  22. 22.
    Kothari SN, Lambert PJ, Mathiason MA. A comparison of thromboembolic and bleeding events following laparoscopic gastric bypass in patients treated with prophylactic regimens of unfractionated heparin or enoxaparin. Am J Surg. 2007;194:709–11.Google Scholar
  23. 23.
    Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative, nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. 2013 update. Obesity. 2013;21(1):1–27.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Haydarpaşa Numune Training and Research Hospital General Surgery ClinicÜsküdar/İstanbulTurkey
  2. 2.BAU Medical Park Göztepe HospitalKadıköy/İstanbulTurkey

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