Deep vein thrombosis prophylaxis: Are we overdoing? An Asian survey on trends in bariatric surgery with a systematic review of literature

BACKGROUND: Obesity is a risk factor for deep vein thrombosis (DVT) and venous thromboembolism (VTE). VTE is the most common cause of mortality in patients undergoing bariatric surgery. There is considerable variation in practice regarding methods, dosages and duration of prophylaxis in this patient population. Most of the literature is based on Western patients and specific guidelines for Asians do not exist. METHODS: We conducted a web-based survey amongst 11 surgeons from high-volume centres in Asia regarding their DVT prophylaxis measures in patients undergoing bariatric surgery. We collected and analysed the data. RESULTS: The reported incidence of DVT and VTE ranged from 0% to 0.2%. Most surgeons (63.64%) preferred to use both mechanical and chemoprophylaxis with low-molecular-weight heparin being the most preferred form of chemoprophylaxis (81.82%). There was an equal distribution of weight-based, body mass index-based and fixed-dose regimens. Duration of chemoprophylaxis ranged from 3-5 days after surgery to 2 weeks after surgery. For high-risk patients, 60% surgeons preferred to start chemoprophylaxis at least 1 week before surgery. Routine use of inferior vena cava filters in high-risk patients was not preferred with some surgeons adopting a selective use (36.36%). CONCLUSION: The purpose of this survey was to understand the trends in DVT prophylaxis amongst different high-volume bariatric centres in Asia and to relate the same with the existing literature on the different steps in prophylaxis. There is, however, a need for consensus guidelines for DVT prophylaxis in Asian obese.