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TOPLINE:

A US database analysis found that 2.5% of patients with obesity developed venous thromboembolism (VTE) within 90 days of major surgery despite enoxaparin prophylaxis.

METHODOLOGY:

• Obesity may increase VTE risk after major surgery, but no consensus exists regarding the optimal dose or duration of thromboprophylaxis in this population.
• Researchers conducted an observational study using a US-based database to characterize enoxaparin thromboprophylaxis dosing and duration in hospitalized patients with obesity undergoing elective or emergency abdominal or pelvic, orthopedic, or thoracic surgery and to assess risk factors and time trends for postoperative VTE and major bleeding.
• Patients were excluded if they had VTE or major bleeding within 90 days before the index date (defined as initiation of enoxaparin thromboprophylaxis), underwent major surgery 2-90 days before the index date, had ongoing anticoagulant or dual antiplatelet therapy, atrial fibrillation, or chronic kidney disease stages IV and V, or required dialysis.
• Outcomes included new-onset VTE (deep vein thrombosis or pulmonary embolism, identified in inpatient or outpatient settings) and major bleeding (inpatient only) over a 90-day follow-up period.

TAKEAWAY:

• Researchers included 30,492 patients (24.4% aged ≥ 65 years; 67.6% female), of whom 12,058 received standard doses (≤ 40 mg/d), and 18,300 received higher doses (> 40 mg/d).
• At 90 days, the cumulative rates of VTE and major bleeding were 2.5% and 1.2%, respectively. Patients undergoing thoracic surgery had the highest rates of both VTE (4.9%) and major bleeding (2.5%).
• Abdominal or pelvic procedures were associated with the lowest 90-day VTE rate (1.7%), and orthopedic procedures had the lowest 90-day major bleeding rate (0.7%).
• A history of VTE was the strongest predictor of postsurgery VTE (adjusted hazard ratio [aHR], 5.62), whereas a history of major bleeding was the strongest predictor of postsurgery major bleeding (aHR, 2.62).
• Thoracic surgery (vs abdominal or pelvic surgery; aHR, 2.61), a history of cancer (aHR, 1.6), and age over 75 years (vs 18-39 years; aHR, 1.87) were also associated with an increased risk for VTE.

IN PRACTICE:

“Our findings support the need for individualized risk stratification to identify surgical patients with obesity who may benefit from extended prophylaxis beyond hospital discharge,” the authors of the study wrote.

SOURCE:

The study was led by Walter Ageno, University of Padua, Padua, Italy. It was published online in Obesity Surgery.

LIMITATIONS:

The study included only individuals in the US with commercial or Medicare Advantage health plans. Identification of VTE and major bleeding relied on diagnosis codes and database algorithms. The database did not capture over-the-counter medication use, including antiplatelets.

DISCLOSURES:

The study was funded by Sanofi. Three authors reported being employees of Sanofi, and another reported being a consultant for the company. Additional authors reported receiving grants, personal fees, or advisory roles with various pharmaceutical companies, including Sanofi.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.