The Efficacy and Safety of Fondaparinux for Venous Thromboembolic Prophylaxis in Bariatric Patients with Different Body Mass Index

Abstract

Introduction:

Several international guidelines recommend venous thromboembolism (VTE) chemoprophylaxis post bariatric surgery, as these patients are at moderate to high risk of developing thrombosis. Nonetheless, there is no consensus on the agent to be used for these cases. Fondaparinux, an inhibitor of factor Xa, has been used for preventing VTE generally in postoperative patients, but no clear data about its role in bariatric patients.

Aim of the Study:

To study the efficacy and safety of Fondaparinux in prophylaxis against VTE in patients undergoing bariatric surgery.

Patients and Methods:

We reviewed the medical records of patients who underwent bariatric surgery in a main bariatric center between January 2015 and May 2019 and who received Fondaparinux for VTE prophylaxis. In our hospital protocol, we use pneumatic compression devices intraoperatively and Fondaparinux 2.5 mg subcutaneously once daily for 5 days starting 6 h postsurgery regardless of body mass index (BMI). Intraoperatively, we neither use hemostatic agents nor suture the staple line. We use abdominal drains in some, but not all cases.

Results:

We reviewed the files of 546 patients who received Fondaparinux postsurgery. 167 patients (30.5%) were males, while 379 patients were females (69.5%). The mean age was 34 years, and the mean BMI was 44.2. 206 had sleeve gastrectomy (37.7%), 286 one-anastomosis gastric bypass surgery (52.3%), 27 had Roux-En-Y (5%), and the remaining 27 patients (5%) had revisional surgery. 234 had patients had no drain placed (42.8%), while 296 had a drain for 1 day (54.2%), 13 had the drain for 2 days (2.3%), and three patients had a drain for 7 days (0.6%). Mean preoperative and postoperative hemoglobin was 12.56 and 12.28, respectively. Four patients (0.86%) had an increase in bloody drainage in the drain that stopped spontaneously without any need for blood transfusion or surgical intervention. No cases of VTE, bleeding requiring intervention, or mortality were reported during the 6-month follow-up.

Conclusion:

Fondaparinux, as a single daily dose for 5 days, seems to be safe and effective in patients with different BMIs after bariatric surgery. Further prospective studies are needed to determine its exact role and help establish clear guidelines.