Venous thromboembolism (VTE) prophylaxis after bariatric surgery: a national survey of MBSAQIP director practices

Background: Venous thromboembolism (VTE) is the most common cause of death following meta-bolic/bariatric surgery (MBS), with most events occurring after discharge. The available evidence on ideal prophylaxis type, dosage, and duration after discharge is limited. Objectives: Assess metabolic/bariatric surgeon VTE prophylaxis practices and define existing variability. Setting: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSA-QIP)-accredited centers. Methods: The members of the ASMBS Research Committee developed and administered a web -based survey to MBSAQIP medical directors and ASMBS members to examine the differences in clinical practice regarding the administration of VTE prophylaxis after MBS. Results: Overall, 264 metabolic/bariatric surgeons (136 medical directors and 128 ASMBS mem-bers) participated in the survey. Both mechanical and chemical VTE prophylaxis was used by 97.1% of the participants, knee-high compression devices by 84.7%, enoxaparin (32.4% 40 mg every 24 hours, 22.7% 40 mg every 12 hours, 24.4% adjusted the dose based on body mass in-dex) by 56.5%, and heparin (46.1% 5000 units every 8 hours, 22.6% 5000 units every 12 hours, 20.9% 5000 units once preoperatively) by 38.1%. Most surgeons (81.6%) administered the first dose preoperatively, while the first postoperative dose was given on the evening of surgery by 44% or the next morning by 42.2%. Extended VTE prophylaxis was prescribed for 2 weeks by 38.7% and 4 weeks by 28.9%. Conclusions: VTE prophylaxis practices vary widely among metabolic/bariatric surgeons. Vari-ability may be related to limited available comparative evidence. Large prospective clinical trials are needed to define optimal practices for VTE risk stratification and prophylaxis in bariatric surgery patients. (Surg Obes Relat Dis 2023;19:799-807.) (c) 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Automated summary

Based on a web-based survey, researchers found significant variability in venous thromboembolism (VTE) prophylaxis practices among metabolic/bariatric surgeons, possibly due to limited available evidence. Controversy still exists regarding the ideal methods, dosage, and duration of VTE prophylaxis after metabolic/bariatric surgery. Large prospective clinical trials are necessary to establish optimal practices for risk stratification and prophylaxis of VTE in bariatric surgery patients.