BACKGROUND: Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a known cause of morbidity and mortality after bariatric surgery. However, the data concerning appropriate thromboprophylaxis after bariatric surgery is uncertain. The objective of this study was to evaluate the efficacy and safety of extended duration thromboprophylaxis in post-bariatric surgery patients. METHODS: We conducted a retrospective study of consecutive patients who underwent bariatric surgery from November 2014 to October 2018 at King Fahad General Hospital in Jeddah, Saudi Arabia. All included patients were treated with extended duration thromboprophylaxis. RESULTS: We identified 374 patients who underwent bariatric surgery during the study period. Of these, 312 patients (83%) were followed for at least 3 months. The most common type of surgery was a laparoscopic sleeve gastrectomy (N=357) and the median weight was 110 kg. The cumulative incidence of symptomatic postoperative VTE at 3 months was 0.64% (95% confidence interval, 0.20–1.52). All events occurred after hospital discharge. The most commonly used pharmacological prophylaxis (91%) for VTE prevention after bariatric surgery was enoxaparin 40 mg subcutaneously twice daily for 10–14 days after hospital discharge. There were no reported cases of bleeding or VTE related mortality after 3 months. CONCLUSION Extended thromboprophylaxis after bariatric surgery appears to be an effective and safe strategy for VTE prevention. Large prospective studies are needed to evaluate the optimal thromboprophylaxis regimen after bariatric surgery.

The prevalence of heart failure (HF) is increasing in many regions of the world, particularly within the context of aging populations in many countries. The Heart Failure Society of America (HFSA) sought to explore areas of global HF innovation with the goal of exchanging ideas and best practices internationally. The HFSA Annual Scientific Meeting included roundtable discussions focused on the challenges faced by each of the participating regions and sharing innovative solutions. Themes identified include the lack of high-quality region-specific HF registry data that is required to accurately define patient needs and to facilitate outcome metrics; the tension between providing care that is accessible to the patient vs. concentrating highly-specialized care within tertiary centers; the need to accredit and coordinate HF care across a spectrum of healthcare delivery centers within regions; opportunities to improve the prevention and timely diagnosis of HF to enhance population outcomes, especially in communities facing healthcare disparities; and the evolution of multidisciplinary team-based care, particularly in optimizing access to guideline-directed medical therapies. This article summarizes the major themes that emerged during the roundtable sessions.