Thromboembolic Events In Bariatric Surgery
DOI:
https://doi.org/10.34635/rpc.960Keywords:
bariatric surgery, thromboembolism, thrombosisAbstract
Background: The escalating prevalence of obesity demands an effective but also safe approach of the patients. The physician has the challenging task of selecting the most adequate approach for each patient. Bariatric surgery is the treatment with the highest success rate in severe cases of obesity. However, like every surgical procedure, is not risk-free and complications often occur, such as venous thromboembolism. Thromboembolic events, such as deep vein thrombosis and pulmonary embolism, contribute to the increase of morbimortality rate. In furtherance of preventing this deadly complication, it is imperative to establish an optimal prophylactic plan. Nonetheless, this preventive approach remains debatable. This review aims to analyse the previous literature to identify the risk factors for venous thromboembolic events, determine the clinical approach according to the risk and establish the ideal prophylaxis protocol after bariatric surgery.
Methods: A literature search was performed in PubMed, with “bariatric surgery”, “thromboembolism” and “thrombosis” as search terms. Then, exclusion and inclusion criteria were applied for the final selection of studies.
Results: The most significant risk factors for venous thromboembolism are high body mass index, previous history of venous thromboembolism, presence of congestive heart failure, laparoscopic Roux-en-Y gastric bypass operation, a long operative time and receiving a transfusion. Using a risk calculator, it is possible to sum up all the risks for each individual and attribute a score. With the thromboembolic risk score and the haemorrhagic risk, it is possible to determine the most appropriate prophylactic plan for each patient. Risk calculators specific for bariatric surgery are not yet validated. Regarding prophylactic approaches, preoperative assessment with duplex ultrasound should only be performed in high-risk patients. Early ambulation and the use of mechanical prophylaxis (use of compression stockings and/or intermittent pneumatic compression) are recommended in all patients. Pharmacological prophylaxis is recommended for all patients in whom the bleeding risk does not exceed the risk of thromboembolism. The dose of pharmacological prophylaxis, its initiation and duration are topics of controversy. The use of inferior vena cava filters should be evaluated on a case-by-case basis, in patients with high thromboembolic risk. In the long term, there is a decrease in the risk of thromboembolism that compensates for the surgical intervention and the short-term risk.
Conclusion: The patient’s approach should be based on the set of individual risk factors. The recommended prophylaxis for all patients includes early ambulation and mechanical prophylaxis. Depending on the patient’s risk, pharmacological prophylaxis, the use of inferior vena cava filters and preoperative assessment with duplex ultrasound may be considered.
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References
1. Mechanick JI, Apovian C, Brethauer S, Garvey WT, Joffe AM, Kim J, et al. Clinical Practice Guidelines For The Perioperative Nutrition, Metabolic, And Nonsurgical Support Of Patients Undergoing Bariatric Procedures - 2019 Update: Cosponsored By American Association Of Clinical Endocrinologists/American College Of Endocrinology, The Obesity Society, American Society For Metabolic & Bariatric Surgery, Obesity Medicine Association, And American Society Of Anesthesiologists - Executive Summary. Endocr Pract. 2019;25(12):1346-59.
2. Kröll D, Nett PC, Borbély YM, Schädelin S, Bertaggia Calderara D, Alberio L, et al. The effect of bariatric surgery on the direct oral anticoagulant rivaroxaban: the extension study. Surg Obes Relat Dis. 2018;14(12):1890-6.
3. Bellen B, Godoy Ide B, Reis AA, Bertevello P. Venous insufficiency and thromboembolic disease in bariatric surgery patients. Arq Gastroenterol. 2013;50(3):191-5.
4. Gambhir S, Inaba CS, Alizadeh RF, Nahmias J, Hinojosa M, Smith BR, et al. Venous thromboembolism risk for the contemporary bariatric surgeon. Surg Endosc. 2020;34(8):3521-6.
5. Bartlett MA, Mauck KF, Daniels PR. Prevention of venous thromboembolism in patients undergoing bariatric surgery. Vasc Health Risk Manag. 2015;11:461-77.
6. Alsina E, Ruiz-Tovar J, Alpera MR, Ruiz-García JG, Lopez-Perez ME, Ramon-Sanchez JF, et al. Incidence of deep vein thrombosis and thrombosis of the portal-mesenteric axis after laparoscopic sleeve gastrectomy. J Laparoendosc Adv Surg Tech A. 2014;24(9):601-5.
7. Moussa O, Ardissino M, Tang A, Lazzari L, Millar O, Ziprin P, et al. Long-term Impact of Bariatric Surgery on Venous Thromboembolic Risk: A Matched Cohort Study. Ann Surg. 2019.
8. Shamian B, Chamberlain RS. The role for prophylaxis inferior vena cava filters in patients undergoing bariatric surgery: replacing anecdote with evidence. Am Surg. 2012;78(12):1349-61.
9. El Ansari W, El-Ansari K. Missing something? A scoping review of venous thromboembolic events and their associations with bariatric surgery. Refining the evidence base. Ann Med Surg (Lond). 2020;59:264-73.
10. Al-Mazrou AM, Cruz MV, Dakin G, Bellorin O, Pomp A, Afaneh C. Stratification of Readmission after Bariatric Surgery by Day of Post-Discharge Presentation. Obes Surg. 2021;31(4):1496-504.
11. Almarshad FM, Almegren M, Alshuaibi T, Alobaodi N, Almutawa A, Basunbl H, et al. Thromboprophylaxis after bariatric surgery. Blood Res. 2020;55(1):44-8.
12. Tseng EK, Kolesar E, Handa P, Douketis JD, Anvari M, Tiboni M, et al. Weight-adjusted tinzaparin for the prevention of venous thromboembolism after bariatric surgery. J Thromb Haemost. 2018;16(10):2008-15.
13. Dang JT, Switzer N, Delisle M, Laffin M, Gill R, Birch DW, et al. Predicting venous thromboembolism following laparoscopic bariatric surgery: development of the BariClot tool using the MBSAQIP database. Surg Endosc. 2019;33(3):821-31.
14. Haskins IN, Rivas L, Ju T, Whitlock AE, Amdur RL, Sidawy AN, et al. The association of IVC filter placement with the incidence of postoperative pulmonary embolism following laparoscopic bariatric surgery: an analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project. Surg Obes Relat Dis. 2019;15(1):109-15.
15. Moaad F, Zakhar B, Anton K, Moner M, Wisam S, Safy F, et al. Is LMWH Sufficient for Anticoagulant Prophylaxis in Bariatric Surgery? Prospective Study. Obes Surg. 2017;27(9):2331-7.
16. Haskins IN, Amdur R, Sarani B, Vaziri K. Congestive heart failure is a risk factor for venous thromboembolism in bariatric surgery. Surg Obes Relat Dis. 2015;11(5):1140-5.
17. Stroh C, Michel N, Luderer D, Wolff S, Lange V, Köckerling F, et al. Risk of thrombosis and thromboembolic prophylaxis in obesity surgery: data analysis from the German Bariatric Surgery Registry. Obes Surg. 2016;26(11):2562-71.
18. Moulin PA, Dutour A, Ancel P, Morange PE, Bege T, Ziegler O, et al. Perioperative thromboprophylaxis in severely obese patients undergoing bariatric surgery: insights from a French national survey. Surg Obes Relat Dis. 2017;13(2):320-6.
19. Stein PD, Matta F. Pulmonary embolism and deep venous thrombosis following bariatric surgery. Obes Surg. 2013;23(5):663-8.
20. Bartlett MA, Mauck KF, Stephenson CR, Ganesh R, Daniels PR. Perioperative Venous Thromboembolism Prophylaxis. Mayo Clin Proc. 2020;95(12):2775-98.
21. Stroh C, Luderer D, Weiner R, Horbach T, Ludwig K, Benedix F, et al. Actual situation of thromboembolic prophylaxis in obesity surgery: data of quality assurance in bariatric surgery in Germany. Thrombosis. 2012;2012:209052.
22. Villagrán R, Smith G, Rodriguez W, Flores C, Cariaga M, Araya S, et al. Portomesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy: Incidence, Analysis and Follow-Up in 1236 Consecutive Cases. Obes Surg. 2016;26(11):2555-61.
23. Altieri MS, Yang J, Hajagos J, Spaniolas K, Park J, Gasparis AP, et al. Evaluation of VTE prophylaxis and the impact of alternate regimens on post-operative bleeding and thrombotic complications following bariatric procedures. Surg Endosc. 2018;32(12):4805-12.
24. Celik F, Bounif F, Fliers JM, Kersten BE, van Dielen FM, Cense HA, et al. The impact of surgical complications as a main risk factor for venous thromboembolism: a multicenter study. Obes Surg. 2014;24(10):1603-9.
25. Karas LA, Nor Hanipah Z, Cetin D, Schauer PR, Brethauer SA, Daigle CR, et al. Assessment of empiric body mass index-based thromboprophylactic dosing of enoxaparin after bariatric surgery: evidence for dosage adjustment using anti-factor Xa in high-risk patients. Surg Obes Relat Dis. 2021;17(1):153-60.
26. Jamal MH, Corcelles R, Shimizu H, Kroh M, Safdie FM, Rosenthal R, et al. Thromboembolic events in bariatric surgery: a large multi-institutional referral center experience. Surg Endosc. 2015;29(2):376-80.
27. Bhattacharya S, Kumar SS, Swamy PDK, Palanivelu C, Raj PP. Deep vein thrombosis prophylaxis: Are we overdoing? An Asian survey on trends in bariatric surgery with a systematic review of literature. J Minim Access Surg. 2018;14(4):285-90.
28. Safdie FM, Dip F, Ardila-Gatas J, Moon S, Lo Menzo E, Szomstein S, et al. Incidence and clinical implications of upper extremity deep vein thrombosis after laparoscopic bariatric procedures. Obes Surg. 2015;25(6):1098-101.
29. Holländer SW, Sifft A, Hess S, Klingen HJ, Djalali P, Birk D. Identifying the Bariatric Patient at Risk for Pulmonary Embolism: Prospective Clinical Trial Using Duplex Sonography and Blood Screening. Obes Surg. 2015;25(11):2011-7.
30. Chan MM, Hamza N, Ammori BJ. Duration of surgery independently influences risk of venous thromboembolism after laparoscopic bariatric surgery. Surg Obes Relat Dis. 2013;9(1):88-93.
31. Gagner M, Selzer F, Belle SH, Bessler M, Courcoulas AP, Dakin GF, et al. Adding chemoprophylaxis to sequential compression might not reduce risk of venous thromboembolism in bariatric surgery patients. Surg Obes Relat Dis. 2012;8(6):663-70.
32. Wilhelm BJ, Markelov A, Sakharpe AK, Baccaro LM, Singhal V. The efficacy of prophylactic IVC filters in gastric bypass surgery. Surg Endosc. 2015;29(4):882-9.
33. Nielsen AW, Helm MC, Kindel T, Higgins R, Lak K, Helmen ZM, et al. Perioperative bleeding and blood transfusion are major risk factors for venous thromboembolism following bariatric surgery. Surg Endosc. 2018;32(5):2488-95.
34. Samuels J, Lawson PJ, Morton AP, Moore HB, Hansen KC, Sauaia A, et al. Prospective assessment of fibrinolysis in morbid obesity: tissue plasminogen activator resistance improves after bariatric surgery. Surg Obes Relat Dis. 2019;15(7):1153-9.
35. Steele KE, Canner J, Prokopowicz G, Verde F, Beselman A, Wyse R, et al. The EFFORT trial: Preoperative enoxaparin versus postoperative fondaparinux for thromboprophylaxis in bariatric surgical patients: a randomized double-blind pilot trial. Surg Obes Relat Dis. 2015;11(3):672-83.
36. Caruso F, Cesana G, Lomaglio L, Cioffi S, Ciccarese F, Uccelli M, et al. Is Portomesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy Related to Short-Course Prophylaxis of Thromboembolism? A Monocentric Retrospective Analysis About an Infrequent but Not Rare Complication and Review of the Literature. J Laparoendosc Adv Surg Tech A. 2017;27(10):987-96.
37. Raj PP, Gomes RM, Kumar S, Senthilnathan P, Parathasarathi R, Rajapandian S, et al. Role of routine pre-operative screening venous duplex ultrasound in morbidly obese patients undergoing bariatric surgery. J Minim Access Surg. 2017;13(3):205-7.
38. Strong AT, Sharma G, Nor Hanipah Z, Tu C, Brethauer SA, Schauer PR, et al. Adjustments to warfarin dosing after gastric bypass and sleeve gastrectomy. Surg Obes Relat Dis. 2018;14(5):700-6.
39. Schijns W, Deenen MJ, Aarts EO, Homan J, Janssen IMC, Berends FJ, et al. The Effect of Obesity on Anti-Xa Concentrations in Bariatric Patients. Obes Surg. 2018;28(7):1997-2005.
40. Ikesaka R, Delluc A, Le Gal G, Carrier M. Efficacy and safety of weight-adjusted heparin prophylaxis for the prevention of acute venous thromboembolism among obese patients undergoing bariatric surgery: a systematic review and meta-analysis. Thromb Res. 2014;133(4):682-7.
41. Brotman DJ, Shihab HM, Prakasa KR, Kebede S, Haut ER, Sharma R, et al. Pharmacologic and mechanical strategies for preventing venous thromboembolism after bariatric surgery: a systematic review and meta-analysis. JAMA Surg. 2013;148(7):675-86.
42. Imberti D, Baldini E, Pierfranceschi MG, Nicolini A, Cartelli C, De Paoli M, et al. Prophylaxis of venous thromboembolism with low molecular weight heparin in bariatric surgery: a prospective, randomised pilot study evaluating two doses of parnaparin (BAFLUX Study). Obes Surg. 2014;24(2):284-91.
43. Clark LN, Helm MC, Gould JC. Practice patterns regarding post-discharge chemoprophylaxis for venous thromboembolism following bariatric surgery in the United States. Surg Obes Relat Dis. 2019;15(5):703-7.
44. Rowland SP, Dharmarajah B, Moore HM, Lane TR, Cousins J, Ahmed AR, et al. Inferior vena cava filters for prevention of venous thromboembolism in obese patients undergoing bariatric surgery: a systematic review. Ann Surg. 2015;261(1):35-45.
45. Kaw R, Pasupuleti V, Wayne Overby D, Deshpande A, Coleman CI, Ioannidis JP, et al. Inferior vena cava filters and postoperative outcomes in patients undergoing bariatric surgery: a meta-analysis. Surg Obes Relat Dis. 2014;10(4):725-33.
46. Reddy S, Zack CJ, Lakhter V, Aggarwal V, Pitt HA, Edwards MA, et al. Prophylactic Inferior Vena Cava Filters Prior to Bariatric Surgery: Insights From the National Inpatient Sample. JACC Cardiovasc Interv. 2019;12(12):1153-60.
47. Li W, Gorecki P, Semaan E, Briggs W, Tortolani AJ, D'Ayala M. Concurrent prophylactic placement of inferior vena cava filter in gastric bypass and adjustable banding operations in the Bariatric Outcomes Longitudinal Database. J Vasc Surg. 2012;55(6):1690-5.
48. Birkmeyer NJ, Finks JF, English WJ, Carlin AM, Hawasli AA, Genaw JA, et al. Risks and benefits of prophylactic inferior vena cava filters in patients undergoing bariatric surgery. J Hosp Med. 2013;8(4):173-7.
49. Vaziri K, Devin Watson J, Harper AP, Lee J, Brody FJ, Sarin S, et al. Prophylactic inferior vena cava filters in high-risk bariatric surgery. Obes Surg. 2011;21(10):1580-4.
2. Kröll D, Nett PC, Borbély YM, Schädelin S, Bertaggia Calderara D, Alberio L, et al. The effect of bariatric surgery on the direct oral anticoagulant rivaroxaban: the extension study. Surg Obes Relat Dis. 2018;14(12):1890-6.
3. Bellen B, Godoy Ide B, Reis AA, Bertevello P. Venous insufficiency and thromboembolic disease in bariatric surgery patients. Arq Gastroenterol. 2013;50(3):191-5.
4. Gambhir S, Inaba CS, Alizadeh RF, Nahmias J, Hinojosa M, Smith BR, et al. Venous thromboembolism risk for the contemporary bariatric surgeon. Surg Endosc. 2020;34(8):3521-6.
5. Bartlett MA, Mauck KF, Daniels PR. Prevention of venous thromboembolism in patients undergoing bariatric surgery. Vasc Health Risk Manag. 2015;11:461-77.
6. Alsina E, Ruiz-Tovar J, Alpera MR, Ruiz-García JG, Lopez-Perez ME, Ramon-Sanchez JF, et al. Incidence of deep vein thrombosis and thrombosis of the portal-mesenteric axis after laparoscopic sleeve gastrectomy. J Laparoendosc Adv Surg Tech A. 2014;24(9):601-5.
7. Moussa O, Ardissino M, Tang A, Lazzari L, Millar O, Ziprin P, et al. Long-term Impact of Bariatric Surgery on Venous Thromboembolic Risk: A Matched Cohort Study. Ann Surg. 2019.
8. Shamian B, Chamberlain RS. The role for prophylaxis inferior vena cava filters in patients undergoing bariatric surgery: replacing anecdote with evidence. Am Surg. 2012;78(12):1349-61.
9. El Ansari W, El-Ansari K. Missing something? A scoping review of venous thromboembolic events and their associations with bariatric surgery. Refining the evidence base. Ann Med Surg (Lond). 2020;59:264-73.
10. Al-Mazrou AM, Cruz MV, Dakin G, Bellorin O, Pomp A, Afaneh C. Stratification of Readmission after Bariatric Surgery by Day of Post-Discharge Presentation. Obes Surg. 2021;31(4):1496-504.
11. Almarshad FM, Almegren M, Alshuaibi T, Alobaodi N, Almutawa A, Basunbl H, et al. Thromboprophylaxis after bariatric surgery. Blood Res. 2020;55(1):44-8.
12. Tseng EK, Kolesar E, Handa P, Douketis JD, Anvari M, Tiboni M, et al. Weight-adjusted tinzaparin for the prevention of venous thromboembolism after bariatric surgery. J Thromb Haemost. 2018;16(10):2008-15.
13. Dang JT, Switzer N, Delisle M, Laffin M, Gill R, Birch DW, et al. Predicting venous thromboembolism following laparoscopic bariatric surgery: development of the BariClot tool using the MBSAQIP database. Surg Endosc. 2019;33(3):821-31.
14. Haskins IN, Rivas L, Ju T, Whitlock AE, Amdur RL, Sidawy AN, et al. The association of IVC filter placement with the incidence of postoperative pulmonary embolism following laparoscopic bariatric surgery: an analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project. Surg Obes Relat Dis. 2019;15(1):109-15.
15. Moaad F, Zakhar B, Anton K, Moner M, Wisam S, Safy F, et al. Is LMWH Sufficient for Anticoagulant Prophylaxis in Bariatric Surgery? Prospective Study. Obes Surg. 2017;27(9):2331-7.
16. Haskins IN, Amdur R, Sarani B, Vaziri K. Congestive heart failure is a risk factor for venous thromboembolism in bariatric surgery. Surg Obes Relat Dis. 2015;11(5):1140-5.
17. Stroh C, Michel N, Luderer D, Wolff S, Lange V, Köckerling F, et al. Risk of thrombosis and thromboembolic prophylaxis in obesity surgery: data analysis from the German Bariatric Surgery Registry. Obes Surg. 2016;26(11):2562-71.
18. Moulin PA, Dutour A, Ancel P, Morange PE, Bege T, Ziegler O, et al. Perioperative thromboprophylaxis in severely obese patients undergoing bariatric surgery: insights from a French national survey. Surg Obes Relat Dis. 2017;13(2):320-6.
19. Stein PD, Matta F. Pulmonary embolism and deep venous thrombosis following bariatric surgery. Obes Surg. 2013;23(5):663-8.
20. Bartlett MA, Mauck KF, Stephenson CR, Ganesh R, Daniels PR. Perioperative Venous Thromboembolism Prophylaxis. Mayo Clin Proc. 2020;95(12):2775-98.
21. Stroh C, Luderer D, Weiner R, Horbach T, Ludwig K, Benedix F, et al. Actual situation of thromboembolic prophylaxis in obesity surgery: data of quality assurance in bariatric surgery in Germany. Thrombosis. 2012;2012:209052.
22. Villagrán R, Smith G, Rodriguez W, Flores C, Cariaga M, Araya S, et al. Portomesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy: Incidence, Analysis and Follow-Up in 1236 Consecutive Cases. Obes Surg. 2016;26(11):2555-61.
23. Altieri MS, Yang J, Hajagos J, Spaniolas K, Park J, Gasparis AP, et al. Evaluation of VTE prophylaxis and the impact of alternate regimens on post-operative bleeding and thrombotic complications following bariatric procedures. Surg Endosc. 2018;32(12):4805-12.
24. Celik F, Bounif F, Fliers JM, Kersten BE, van Dielen FM, Cense HA, et al. The impact of surgical complications as a main risk factor for venous thromboembolism: a multicenter study. Obes Surg. 2014;24(10):1603-9.
25. Karas LA, Nor Hanipah Z, Cetin D, Schauer PR, Brethauer SA, Daigle CR, et al. Assessment of empiric body mass index-based thromboprophylactic dosing of enoxaparin after bariatric surgery: evidence for dosage adjustment using anti-factor Xa in high-risk patients. Surg Obes Relat Dis. 2021;17(1):153-60.
26. Jamal MH, Corcelles R, Shimizu H, Kroh M, Safdie FM, Rosenthal R, et al. Thromboembolic events in bariatric surgery: a large multi-institutional referral center experience. Surg Endosc. 2015;29(2):376-80.
27. Bhattacharya S, Kumar SS, Swamy PDK, Palanivelu C, Raj PP. Deep vein thrombosis prophylaxis: Are we overdoing? An Asian survey on trends in bariatric surgery with a systematic review of literature. J Minim Access Surg. 2018;14(4):285-90.
28. Safdie FM, Dip F, Ardila-Gatas J, Moon S, Lo Menzo E, Szomstein S, et al. Incidence and clinical implications of upper extremity deep vein thrombosis after laparoscopic bariatric procedures. Obes Surg. 2015;25(6):1098-101.
29. Holländer SW, Sifft A, Hess S, Klingen HJ, Djalali P, Birk D. Identifying the Bariatric Patient at Risk for Pulmonary Embolism: Prospective Clinical Trial Using Duplex Sonography and Blood Screening. Obes Surg. 2015;25(11):2011-7.
30. Chan MM, Hamza N, Ammori BJ. Duration of surgery independently influences risk of venous thromboembolism after laparoscopic bariatric surgery. Surg Obes Relat Dis. 2013;9(1):88-93.
31. Gagner M, Selzer F, Belle SH, Bessler M, Courcoulas AP, Dakin GF, et al. Adding chemoprophylaxis to sequential compression might not reduce risk of venous thromboembolism in bariatric surgery patients. Surg Obes Relat Dis. 2012;8(6):663-70.
32. Wilhelm BJ, Markelov A, Sakharpe AK, Baccaro LM, Singhal V. The efficacy of prophylactic IVC filters in gastric bypass surgery. Surg Endosc. 2015;29(4):882-9.
33. Nielsen AW, Helm MC, Kindel T, Higgins R, Lak K, Helmen ZM, et al. Perioperative bleeding and blood transfusion are major risk factors for venous thromboembolism following bariatric surgery. Surg Endosc. 2018;32(5):2488-95.
34. Samuels J, Lawson PJ, Morton AP, Moore HB, Hansen KC, Sauaia A, et al. Prospective assessment of fibrinolysis in morbid obesity: tissue plasminogen activator resistance improves after bariatric surgery. Surg Obes Relat Dis. 2019;15(7):1153-9.
35. Steele KE, Canner J, Prokopowicz G, Verde F, Beselman A, Wyse R, et al. The EFFORT trial: Preoperative enoxaparin versus postoperative fondaparinux for thromboprophylaxis in bariatric surgical patients: a randomized double-blind pilot trial. Surg Obes Relat Dis. 2015;11(3):672-83.
36. Caruso F, Cesana G, Lomaglio L, Cioffi S, Ciccarese F, Uccelli M, et al. Is Portomesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy Related to Short-Course Prophylaxis of Thromboembolism? A Monocentric Retrospective Analysis About an Infrequent but Not Rare Complication and Review of the Literature. J Laparoendosc Adv Surg Tech A. 2017;27(10):987-96.
37. Raj PP, Gomes RM, Kumar S, Senthilnathan P, Parathasarathi R, Rajapandian S, et al. Role of routine pre-operative screening venous duplex ultrasound in morbidly obese patients undergoing bariatric surgery. J Minim Access Surg. 2017;13(3):205-7.
38. Strong AT, Sharma G, Nor Hanipah Z, Tu C, Brethauer SA, Schauer PR, et al. Adjustments to warfarin dosing after gastric bypass and sleeve gastrectomy. Surg Obes Relat Dis. 2018;14(5):700-6.
39. Schijns W, Deenen MJ, Aarts EO, Homan J, Janssen IMC, Berends FJ, et al. The Effect of Obesity on Anti-Xa Concentrations in Bariatric Patients. Obes Surg. 2018;28(7):1997-2005.
40. Ikesaka R, Delluc A, Le Gal G, Carrier M. Efficacy and safety of weight-adjusted heparin prophylaxis for the prevention of acute venous thromboembolism among obese patients undergoing bariatric surgery: a systematic review and meta-analysis. Thromb Res. 2014;133(4):682-7.
41. Brotman DJ, Shihab HM, Prakasa KR, Kebede S, Haut ER, Sharma R, et al. Pharmacologic and mechanical strategies for preventing venous thromboembolism after bariatric surgery: a systematic review and meta-analysis. JAMA Surg. 2013;148(7):675-86.
42. Imberti D, Baldini E, Pierfranceschi MG, Nicolini A, Cartelli C, De Paoli M, et al. Prophylaxis of venous thromboembolism with low molecular weight heparin in bariatric surgery: a prospective, randomised pilot study evaluating two doses of parnaparin (BAFLUX Study). Obes Surg. 2014;24(2):284-91.
43. Clark LN, Helm MC, Gould JC. Practice patterns regarding post-discharge chemoprophylaxis for venous thromboembolism following bariatric surgery in the United States. Surg Obes Relat Dis. 2019;15(5):703-7.
44. Rowland SP, Dharmarajah B, Moore HM, Lane TR, Cousins J, Ahmed AR, et al. Inferior vena cava filters for prevention of venous thromboembolism in obese patients undergoing bariatric surgery: a systematic review. Ann Surg. 2015;261(1):35-45.
45. Kaw R, Pasupuleti V, Wayne Overby D, Deshpande A, Coleman CI, Ioannidis JP, et al. Inferior vena cava filters and postoperative outcomes in patients undergoing bariatric surgery: a meta-analysis. Surg Obes Relat Dis. 2014;10(4):725-33.
46. Reddy S, Zack CJ, Lakhter V, Aggarwal V, Pitt HA, Edwards MA, et al. Prophylactic Inferior Vena Cava Filters Prior to Bariatric Surgery: Insights From the National Inpatient Sample. JACC Cardiovasc Interv. 2019;12(12):1153-60.
47. Li W, Gorecki P, Semaan E, Briggs W, Tortolani AJ, D'Ayala M. Concurrent prophylactic placement of inferior vena cava filter in gastric bypass and adjustable banding operations in the Bariatric Outcomes Longitudinal Database. J Vasc Surg. 2012;55(6):1690-5.
48. Birkmeyer NJ, Finks JF, English WJ, Carlin AM, Hawasli AA, Genaw JA, et al. Risks and benefits of prophylactic inferior vena cava filters in patients undergoing bariatric surgery. J Hosp Med. 2013;8(4):173-7.
49. Vaziri K, Devin Watson J, Harper AP, Lee J, Brody FJ, Sarin S, et al. Prophylactic inferior vena cava filters in high-risk bariatric surgery. Obes Surg. 2011;21(10):1580-4.
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