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Weight‐adjusted tinzaparin for the prevention of venous thromboembolism after bariatric surgery
Author(s): ,
E. K. Tseng
Affiliations:
Division of Hematology, St. Joseph's Healthcare Hamilton, Hamilton, Canada. Department of Medicine, McMaster University, Hamilton, Canada
,
E. Kolesar
Affiliations:
Division of Hematology, St. Joseph's Healthcare Hamilton, Hamilton, Canada
,
P. Handa
Affiliations:
Department of General Medicine, Tan Tock Seng Hospital, Singapore
,
J. D. Douketis
Affiliations:
Department of Medicine, McMaster University, Hamilton, Canada
,
M. Anvari
Affiliations:
Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Canada
,
M. Tiboni
Affiliations:
Department of Medicine, McMaster University, Hamilton, Canada
,
M. A. Crowther
Affiliations:
Division of Hematology, St. Joseph's Healthcare Hamilton, Hamilton, Canada. Department of Medicine, McMaster University, Hamilton, Canada
D. M. Siegal
Affiliations:
Division of Hematology, St. Joseph's Healthcare Hamilton, Hamilton, Canada. Department of Medicine, McMaster University, Hamilton, Canada. Population Health Research Institute, Hamilton, Canada
Correspondence: Deborah M. Siegal, Department of Medicine, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6, Canada|Tel.: +1 905 521 6024|E‐mail: deborah.siegal@medportal.ca
ISTH Academy. Siegal D. Oct 4, 2018; 234173
Deborah Siegal
Deborah Siegal

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Background
Patients undergoing bariatric surgery are at moderate to high risk of venous thromboembolism (VTE). The optimal dose and duration of anticoagulant prophylaxis is uncertain.
Objective
To evaluate the safety of extended‐duration weight‐adjusted tinzaparin after bariatric surgery.
Patients/methods
We conducted a single‐center retrospective cohort study of consecutive patients undergoing bariatric surgery who received weight‐adjusted tinzaparin 4500–14 000 IU daily (75 IU kg rounded to the nearest prefilled syringe) for 10 days after surgery (7–9 days post‐hospital discharge). Primary safety outcomes were the frequency of VTE and major bleeding within 30 days of surgery in patients receiving at least one dose of tinzaparin.
Results
A total of 1279 patients undergoing bariatric surgery between July 2009 and December 2012 were reviewed, of whom 1212 received weight‐adjusted tinzaparin. Safety outcomes were collected for 819 patients at 30 days, and for 1212 patients in‐hospital only. The median age was 45.0 years, median weight was 130.0 kg and 98.8% of patients underwent gastric bypass or sleeve gastrectomy. In patients completing 30 days of follow‐up, VTE occurred in 4/819 (0.5%) and major bleeding occurred in 13/819 patients (1.6%). In‐hospital rates of VTE and major bleeding during surgical admission were 3/1212 (0.2%) and 22/1212 (1.8%), respectively.
Conclusions
Extended thromboprophylaxis with weight‐adjusted tinzaparin appears to be a safe strategy after bariatric surgery, with low rates of postoperative VTE and major bleeding.
Keyword(s)
bariatric surgery, bleeding, body weight, thrombosis, tinzaparin
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