Portal venous system thrombosis after bariatric surgery
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The incidence of portal venous system thrombosis after bariatric surgery is rare but can be potentially lethal, finds a recent review in the Journal of Surgery. Considering this, the researchers suggest the consideration of extended prophylactic anticoagulation protocol in patients at high risk of developing a portal venous system thrombosis after bariatric surgery.

PubMed, EMBASE, and Cochrane Library databases were searched. The incidence of portal venous system thrombosis after bariatric surgery was pooled by a random-effect model. Subgroup analyses were performed to explore the incidence of portal venous system thrombosis according to the average duration of prophylactic anticoagulation. Meta-regression and sensitivity analyses were performed to explore the source of heterogeneity.

Among 2,714 papers initially screened, 68 studies were included.

--Among 100,964 patients undergoing bariatric surgery, 300 developed portal venous system thrombosis. The pooled overall incidence of portal venous system thrombosis after bariatric surgery was 0.419%.

--The pooled incidence of portal venous system thrombosis after bariatric surgery was numerically lower in patients who received extended prophylactic anticoagulation protocol after bariatric surgery than those who received short-term prophylactic anticoagulation protocol.

--Meta-regression analyses demonstrated that sample size, type of surgery, and average duration of prophylactic anticoagulation might be sources of heterogeneity, but not region, publication year, history of bariatric surgery, follow-up duration, or use of prophylactic anticoagulation.

--Sensitivity analyses could not identify any source of heterogeneity. The estimated mortality of portal venous system thrombosis after bariatric surgery was 1.33%.

Portal venous system thrombosis after bariatric surgery is rare but lethal. An extended prophylactic anticoagulation protocol may be considered in patients at a high risk of developing portal venous system thrombosis after bariatric surgery.

Source: https://doi.org/10.1016/j.surg.2021.03.005
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