P50: Laparoscopic bariatric surgery in patients on active anticoagulation

Abstract

LAPAROSCOPIC BARIATRIC SURGERY IN PATIENTS ON ACTIVE ANTICOAGULATION Pavlos K. Papasavas, M.D.; Daniel J. Gagne, M.D.; Kristen K. Burton; Jorge E. Urbandt, M.D.; Philip F. Caushaj, M.D.; Surgery, The Western Pennsylvania Hospital, Clinical Campus of Temple University School of Medicine, Pittsburgh, PA, USA. Background: Patients undergoing bariatric surgery while on anticoagulation are considered high risk. We describe our experience with bariatric surgery on patients on active anticoagulation. Methods: Retrospective analysis of a prospective database focusing on laparoscopic bariatric surgery in patients on active anticoagulation therapy. Type, duration and reason for anticoagulation, and perioperative management and complications were recorded. Results: 1400 patients underwent laparoscopic bariatric surgery between July 1999 and July 2007 in our institution. Thirty patients (2.1%) were on active anticoagulation preoperatively for cardiac and cardiovascular diseases (n 14), venous thromboembolic disease (VTE) (n 12) and both cardiac and VTE (n 4). All 30 patients underwent laparoscopic procedures; RYGB (n 27), conversion of VBG to RYGB (n 2), sleeve gastrectomy (n 1). Patients were on warfarin (n 23), warfarin and clopidogrel (n 4) and low molecular weight heparin (LMWH) (n 3). Twelve patients (40%) had preoperative consultation with a hematologist. Four patients had an IVC filter prior to surgery. Thirteen of 27 patients on warfarin (48%) were bridged with LMWH. The median time for discontinuing warfarin preoperatively and resuming postoperatively was 5 and 2 days respectively. There were no mortalities. Six patients (20%) developed bleeding complications, one of which required surgical intervention. Five patients presented with gastrointestinal bleeding and one patient with a soft tissue hematoma. Anticoagulation was stopped on all patients with bleeding complications and resumed after the hemoglobin was stabilized. Conclusion: Laparoscopic bariatric surgery may be safe in patients requiring active anticoagulation. Bleeding complications may be higher in this group of patients.