A comparison of thromboembolic and bleeding events following laparoscopic gastric bypass in patients treated with prophylactic regimens of unfractionated heparin or enoxaparin

Abstract 

Introduction

We prospectively evaluated 30-day thromboembolic and bleeding events in 2 groups of laparoscopic gastric bypass patients receiving different anticoagulation regimens.

Methods

The first cohort of patients received enoxaparin 40 mg subcutaneously preoperatively, 40 mg subcutaneously on postoperative day 0, and twice daily until discharge. The second cohort of patients received unfractionated heparin 5,000 units subcutaneously preoperatively, nothing on postoperative day 0, and 5,000 units 3 times per day until discharge.

Results

The incidence of deep venous thrombosis in both cohorts was 0. There was 1 pulmonary embolism in the heparin cohort (P = .999). Fourteen patients (5.9%) in the enoxaparin cohort required postoperative transfusions compared with 3 patients (1.3%) in the heparin cohort (P = .011). Four patients (1.7%) in the enoxaparin cohort required re-exploration for bleeding.

Conclusion

Both enoxaparin and heparin are effective at preventing thromboembolic events following laparoscopic gastric bypass. Heparin is the preferred agent due to the excessive bleeding complications encountered with enoxaparin.

Keywords: Laparoscopic gastric bypass, Anticoagulation, Complications, Deep venous thrombosis prophylaxis, Heparin, Enoxaparin