Highlights
- •Bariatric surgery patients are at an increased risk to venous thromboembolism (VTE).
- •Weight-adjusted heparin regimes for VTE prophylaxis remain heterogenous.
- •We analyzed a weight-adjusted tinzaparin regime in patients weighing 160 kg or more.
- •VTE rates were 0.57% while bleeding rates were 1.43%.
- •Weight-adjusted tinzaparin was associated with a low risk of bleeding and VTE events.
Abstract
Introduction
Bariatric surgery patients experience an increased risk of venous thromboembolism
(VTE), however, the optimal dose of low-molecular-weight heparin for VTE prophylaxis
remains uncertain. Currently, St. Joseph's Healthcare Hamilton utilizes a weight-adjusted
tinzaparin dosage (50 to 75 units/kg rounded to nearest pre-filled syringe) for postoperative
VTE prophylaxis.
Objectives
This study analyzed the safety of weight-adjusted tinzaparin for VTE prophylaxis in
bariatric surgery patients weighing ≥160 kg.
Methods
This was a retrospective study involving patients weighing ≥160 kg that underwent
bariatric surgery from September 2015 to September 2019. Patients received a single
dose of weight-adjusted subcutaneous unfractionated heparin (UFH) [5000 or 7500 IU]
immediately prior to surgery, subcutaneous UFH [5000 IU, 7500 IU, or unspecified]
immediately postoperatively, and either 10,000 or 14,000 IU of tinzaparin, beginning
on the day after surgery, for 10 days. Intra-operative sequential compression devices
could be used at the attending surgeon's discretion. Occurrence of VTE and major bleeding
within 30 days of surgery were assessed.
Results
A total of 389 patients were included for analysis, all patients received in-hospital
follow-up while 349 patients had also 30-day follow-up. For the primary safety and
efficacy analysis of in-hospital events, VTE and major bleeding rates were 0.26% [95%
CI 0.01%–1.44%] (1/389) and 0.77% [95% CI 0.21%–2.24%] (3/389) respectively. For patients
with 30-day follow-up VTE and major bleeding rates were 0.57% [95% CI 0.1%–2.07%]
(2/349) and 1.43% [95% CI 0.61%–3.3%] (5/349) respectively.
Conclusions
Weight-adjusted tinzaparin was associated with a low risk of bleeding and VTE events,
supporting its use for VTE prophylaxis for patients weighing ≥160 kg.
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Article info
Publication history
Published online: November 21, 2020
Accepted:
November 19,
2020
Received in revised form:
October 31,
2020
Received:
August 4,
2020
Footnotes
☆This study was conducted at St. Joseph's Healthcare Hamilton and McMaster University and was presented as a poster during the International Society on Thrombosis and Haemostasis 2020 Virtual Congress.
Identification
Copyright
© 2020 Published by Elsevier Ltd.
