Thromboembolic Events In Bariatric Surgery

• Autor(a) principal: Araújo, Soraia
• Data de Publicação: 2024
• Outros Autores: Lázaro, André, Tralhão, José G
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
• Texto Completo: https://doi.org/10.34635/rpc.960
• topic: bariatric surgery; thromboembolism; thrombosis; cirurgia bariátrica; tromboembolismo; trombose

 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.