Routine extended (30 days) chemoprophylaxis for patients undergoing laparoscopic sleeve gastrectomy may reduce Portomesenteric vein thrombosis rates

Dylan Cuva; Eduardo Somoza; Moyosore Alade; John K Saunders; Julia Park; Jeffrey Lipman; Peter Einersen; Patricia Chui; Manish Parikh

doi:10.1016/j.soard.2023.12.006

Routine extended (30 days) chemoprophylaxis for patients undergoing laparoscopic sleeve gastrectomy may reduce Portomesenteric vein thrombosis rates

Surg Obes Relat Dis. 2023 Dec 10:S1550-7289(23)00840-7. doi: 10.1016/j.soard.2023.12.006. Online ahead of print.

Authors

Dylan Cuva¹, Eduardo Somoza², Moyosore Alade², John K Saunders², Julia Park², Jeffrey Lipman², Peter Einersen², Patricia Chui², Manish Parikh²

Affiliations

¹ Department of Surgery, NYU Langone Medical Center, Bellevue Hospital Center, New York, New York. Electronic address: dcuva12@gmail.com.
² Department of Surgery, NYU Langone Medical Center, Bellevue Hospital Center, New York, New York.

PMID: 38195313
DOI: 10.1016/j.soard.2023.12.006

Abstract

Background: Venous thromboembolism (VTE), including Portomesenteric vein thrombosis (PMVT), is a major complication of sleeve gastrectomy (SG). We changed our practice in July 2021 to routinely discharge all SG patients postoperatively with extended chemoprophylaxis for 30 days.

Objectives: Evaluate the efficacy and safety of routine extended chemoprophylaxis compared to 2 prior timeframes using selective extended chemoprophylaxis.

Setting: University Hospital.

Methods: Between 2012-2018, SG patients were discharged on extended chemoprophylaxis for patients deemed "high-risk" for VTE, including patients with body mass index (BMI) >50, and previous VTE. Between 2018-2021, extended chemoprophylaxis was broadened to include patients with positive preoperative thrombophilia panels (including Factor VIII). After 2021, all SG were routinely discharged on extended chemoprophylaxis. The typical regimen was 30 days Lovenox BID (40-mg twice daily for BMI> 40, 60-mg twice daily for BMI >60). Outcomes evaluated were rate of VTE/PMVT and postoperative bleed, including delayed bleed.

Results: A total of 8864 patients underwent SG. Average age and BMI were 37.5 years and 43.0 kg/m², respectively. The overall incidence of PMVT was 33/8864 (.37%). Converting from selective extended chemoprophylaxis (Group 1) to routine extended chemoprophylaxis (Group 3) decreased the rate of PMVT from .55% to .21% (P = .13). There was a significantly higher overall bleeding rate (.85%), including delayed bleeds (.34%) in the routine extended chemoprophylaxis patients (P < .05). These bleeds were mainly managed nonoperatively.

Conclusions: Routine extended (30 day) chemoprophylaxis for all SG may reduce PMVT rate but lead to a higher bleeding rate post-operatively. The vast majority of the increased bleeds are delayed and can be managed non-operatively.

Keywords: Bariatric complication; Bariatric surgery; Chemoprophylaxis; Extended chemoprophylaxis; Portomesenteric vein thrombosis; Sleeve gastrectomy; Venous thromboembolism.