Background

Both obesity and surgical intervention are risk factors for venous thromboembolism (VTE). Vertical sleeve gastrectomy (VSG) patients have a 1% risk for VTE, but this can increase mortality by 28-fold. Aiming to decrease VTE, we used the Cleveland Clinic Bariatric and Metabolic Surgery Decision-Making Calculator to develop a discharge protocol. High/moderate risk patients were sent on 28/14 days of 40mg Lovenox BID and low risk patients on 30 days of ASA 81mg. We conducted this retrospective review to determine the efficacy of this strategy to decrease VTE in our population.

Methods

484 VSG patients from July 2021-September 2022 were reviewed retrospectively using MBSAQIP data for perioperative and discharge VTE prophylaxis received, VTE events and bleeding incidents for 30-days postoperatively.

Results

484 patients received perioperative heparin. 373 (77%) were discharged on ASA, 86 (18%) on Lovenox, 8 (2%) on other chronic regimens, and 17 (3%) on none (2 due to ASA allergy and 1 due to a bleed). 5 of the 484 (1%) patients had VTE events, 3 of which were mesenteric, portal or SMV, and 2 patients were discharged on ASA. The VTE event rate prior to this new protocol was 6/448 (1.3%): 4 mesenteric, 2 PE. Using a Fischer’s exact test, we found no significant difference in VTE rate (p=0.76) before or after the protocol.

Conclusions

The addition of discharge ASA in low-risk patients has not improved the incidence of VTE. Further analysis, including the impact of hormonal treatment and adjustment of our discharge protocol is warranted.