The rate of venous thromboembolism (VTE) and major bleeding is not different in patients who are morbidly obese who have had a bariatric procedure and received various enoxaparin regimens investigators reported in the Saudi Pharmaceutical Journal.
A retrospective cohort study assessed the efficacy and safety of enoxaparin regimens used for VTE thromboprophylaxis in patients who had a bariatric procedure at a tertiary care hospital from 2016 to 2019. Participants were adults (aged ≥18 years) with a body mass index (BMI) of 30 or more who met the eligibility criteria for a bariatric procedure and received enoxaparin with a minimum follow-up of 1 month.
The outcome of postdischarge complications was a composite of VTE or major bleeding. Treatment duration was based on the number of days that the participants received thromboprophylaxis (<14 days or ≥14 days).
A total of 1169 patients (mean age, 35.54±10.95 years; 59% women; preoperative mean BMI, 45.78±8.57) were included. The mean enoxaparin duration was 9 days, and the mean postoperative follow-up was 2.5 months. Most patients (78%) received a prophylaxis dose of 40 mg subcutaneously once daily, and 19.5% received 60 mg subcutaneously once daily.
At 90 days, the overall VTE rate was 1.4%, and 0.1% of patients had major bleeding. No statistically significant difference was observed regarding patients’ age, sex, BMI, VTE risk factors, or various enoxaparin dosing regimens in those who had VTE or bleeding compared with those who did not.
Patient’s weight was the only statistically significant risk factor that was directly associated with an increased risk for complications (P =.006) for VTE. Participants’ weight, BMI, and enoxaparin dose postdischarge were significantly different (P <.001) in those who received thromboprophylaxis for less than14 days vs 14 days or longer.
BMI was significantly associated with VTE or major bleeding (odds ratio, 1.05; 95% CI, 1.0-1.09; P =.038), according to multivariable logistics regression analysis. BMI (P <.001) and gastroesophageal reflux disease (P =.022) were statistically related to VTE prophylaxis duration in univariable and multivariable regression models.
Study limitations include the retrospective, single-center design, lack of randomization of patients to different dose requirements, and low number of complications observed.
“Patients undergoing bariatric surgery may benefit from enoxaparin thromboprophylaxis dose of 40 mg [subcutaneously] daily for a total duration of 14 days,” the study authors noted. “We recommend standardizing the current practice of VTE prophylaxis post bariatric surgery and unifying the optimal dose and duration.”
Altawil E, Alkofide H, Almohaini H, Alobeed A, Alhossan A. The use of enoxaparin as venous thromboembolism prophylaxis in bariatric surgery: a retrospective cohort study. Saudi Pharm J. Published online July 22, 2022. https://doi.org/10.1016/j.jsps.2022.07.008