Venous thrombo-embolism (VTE) is the most common cause of death following bariatric surgery; >80% of events occur after discharge. The available evidence on ideal prophylaxis type, dosage, and duration after discharge is limited. Our aim was to assess bariatric surgeon VTE prophylaxis practices and define existing variability.


Members of the ASMBS research committee developed and administered a web-based anonymous survey in October 2021 to MBSAQIP medical directors regarding their VTE prophylaxis practices including risk stratification, type, dosage, and duration. Responses were analyzed using descriptive statistics.


136 MBSAQIP medical directors participated in the survey (response rate: 63.3%). 98% reported using both mechanical and chemical VTE prophylaxis: 85.5% of surgeons used knee-high compression devices, whereas 58.4% used Enoxaparin (47.3% 40 mg every 12 hours, 38.9% 40 mg every 24 hours, 13.8% other), and 38.1% Heparin (56.6% 5000 units every 8 hours, 13.3% 5000 units every 12 hours, 18.1% only once preoperatively, 12% other). 81% administered the first dose preoperatively, while the first postoperative dose was given on the evening of surgery by 44.2% or the next morning by 41.3%. 85% used extended chemoprophylaxis for all or select patients, while 15.2% did not. Extended VTE prophylaxis was prescribed for 2 weeks by 38.1% and 4 weeks by 27.3% (Figure 1). Only 11.7% used a risk calculator.


VTE prophylaxis practices vary widely among bariatric surgeons. Variability may be related to limited available comparative evidence. Large prospective clinical trials are needed to define optimal practices for VTE risk stratification and prophylaxis in bariatric surgery patients.