Most CPUs do not support 128-bit integer math. They would do do 64-bit integer ops with carry. In most architectures that would be no different in code size from a 64-bit op followed by a 32-bit op.
Very complex compilers and/or cisc decoders on superscaler processors could theoretically rewrite some 128-bit to 32-bit and run the computations concurrently with other 128-bit computations.