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Identifying the Bariatric Patient at Risk for Pulmonary Embolism: Prospective Clinical Trial Using Duplex Sonography and Blood Screening

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Abstract

Background

Thromboembolic complications continue to be one of the main reasons for perioperative mortality in bariatric surgery. There is no consensus on which is the safest and most effective thromboprophylaxis. This prospective study aims to evaluate the significance of thrombophilia screening and a venous duplex sonography in bariatric patients.

Methods

One hundred one patients were tested for coagulopathies (activated protein C (APC) resistance, factor II, antithrombin (AT)III, protein S and C). Perioperatively, the patients underwent a venous duplex sonography. A multimodal thromboprophylaxis protocol was set up: 2× 40 mg enoxaparin sodium per day and sequential pneumatic compressions of the lower extremities.

Results

In six patients, we identified previously unknown risk factors for thromboembolic complications. Protein S deficiency is found significantly more often in obese patients than in the general population. There are numerous risk factors which, in themselves, increase the risk of venous thromboembolism. In obese patients with obstructive sleep apnea or diabetes mellitus, thrombophilia is found significantly more often than in patients without these diseases. No postoperative thromboses occurred.

Conclusions

The bariatric patient is a potential high-risk patient for venous thromboembolism. Thrombophilia is found significantly more often in obese patients than in the general population. Conceivably, existing conditions such as obstructive sleep apnea and diabetes mellitus have until today been underestimated regarding the entailing thrombosis risk. Thrombophilia screening and duplex sonography are possibilities for identifying patients at risk. The advantage of a reduced risk thanks to an adapted thromboprophylaxis based on the patient’s individual risk profile justifies the relative increase in time and cost.

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Abbreviations

RYGBP:

Roux-en-Y gastric bypass

VTE:

Venous thromboembolism

DVT:

Deep venous thrombosis

PE:

Pulmonary embolism

OSAS:

Obstructive sleep apnea syndrome

LMWH:

Low molecular weight heparin

APC:

Activated protein C

AT:

Antithrombin

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Conflict of Interest

The authors have no conflict of interest or financial ties to disclose.

Statement of Informed Consent

Informed consent was obtained from all participants included in the study.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Authors and Affiliations

  1. Department of Surgery, Protestant Hospital Zweibrücken, Academic Teaching Hospital of Saarland University, Obere Himmelsbergstraße 38, 66482, Zweibrücken, Germany

    Sebastian W. Holländer, Alfred Sifft, Sarah Hess, Hans Joachim Klingen, Peter Djalali & Dieter Birk

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  1. Sebastian W. Holländer
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  2. Alfred Sifft
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  3. Sarah Hess
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  4. Hans Joachim Klingen
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  6. Dieter Birk
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Correspondence to Dieter Birk.

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Holländer, S.W., Sifft, A., Hess, S. et al. Identifying the Bariatric Patient at Risk for Pulmonary Embolism: Prospective Clinical Trial Using Duplex Sonography and Blood Screening. OBES SURG 25, 2011–2017 (2015). https://doi.org/10.1007/s11695-015-1649-z

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