Retrospective Analysis of Venous Thromboembolism Prophylaxis Prescribing Practices and Outcomes at Two Academic Medical Centers

Background: Bariatric surgery is the most effective treatment for morbid obesity, resulting in sustained weight loss as well as pronounced beneficial effects on obesityrelated comorbidities. However, postoperative venous thromboembolism (VTE) remains a leading cause of morbidity and mortality post Laparoscopic Sleeve Gastrectomy (LSG).

Objective: To evaluate inpatient and outpatient VTE prophylaxis prescribing trends in relation to VTE and bleeding outcomes post LSG.

Setting: Two academic medical centers.

Method: Retrospective chart review was performed of all adult patients who underwent primary LSG at two academic medical centers between May 30, 2015 and April 30, 2017.

Results: Majority of patients received perioperative VTE prophylaxis with unfractionated heparin (UFH) and was continued throughout hospital admission. On discharge, only 9% of patients were prescribed VTE chemoprophylaxis. Based on a regression analysis, a Body Mass Index (BMI) of greater than or equal to 50 kg/m² (odds ratio [95%CI], 59.44 [27.6-127.9]) and a history of VTE (odds ratio [95%CI], 18.0 [5.35-60.36]) demonstrated a trend towards physicians prescribing VTE prophylaxis more at discharge. Rates of VTE and bleeding were low (0.5% and 0.8% respectively).

Conclusion: Chemoprophylaxis for high risk patients, such as those with BMI greater than or equal to 50 kg/m² or a history of VTE event, may be considered for a 28-day regimen of therapy.

Author(s): Christine Gillis*, Marjan Sadegh, Kevin Day,  Jessica Rimsans, Scott Shikora

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