BARIATRIC SURGERY: HEMORRHAGIC VS THROMBOEMBOLIC COMPLICATIONS — TOWARDS A BALANCED STRATEGY ale-orekhov@yandex.ru

311-04

BARIATRIC SURGERY: HEMORRHAGIC VS THROMBOEMBOLIC COMPLICATIONS — TOWARDS A BALANCED STRATEGY

7

 

 

 

 

Russia

Oral only

Bariatric surgery is associated with a substantial risk of both venous thromboembolism (VTE) and hemorrhagic complications. Inadequate thromboprophylaxis may lead to fatal embolic events, while excessive anticoagulation increases the risk of bleeding, particularly in the early postoperative period. Balancing efficacy and safety remains a key issue in metabolic surgery.

We analyzed data from 450 patients who underwent sleeve gastrectomy or Roux-en-Y gastric bypass. The risk of venous thromboembolism was assessed using the classic Caprini scale and a modified Caprini-B scale proposed by our team, including weight, D-dimer index, and visceral fat area. Risk factors for bleeding included age, hypertension, coagulopathy, and liver or kidney dysfunction. Cases of venous thromboembolism and bleeding were recorded within 30 days after surgery, as well as the timing of their occurrence and association with risk models.

The Caprini-B model showed better predictive performance for VTE (AUC 0.81 vs. 0.69). Early hemorrhagic events (within 1–3 days) occurred in up to 3.8% of patients; late bleeding (day 4–30) occurred in 1.7%. Notably, 79% of all hemorrhages developed within 72 hours post-surgery. Risk stratification using both models allowed us to identify four patient groups: low VTE/low bleeding, high VTE/low bleeding, low VTE/high bleeding, and high VTE/high bleeding, enabling a tailored prophylactic algorithm.

Integrating Caprini-B and bleeding risk parameters offers a promising approach to individualized prophylaxis after bariatric surgery. This model may enhance safety and guide dosing and duration of anticoagulation. Prospective validation is warranted.