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Moeinvaziri N, Sadeghi A. Massive pulmonary embolism post sleeve gastrectomy treated with systemic thrombolytic: A case report. Clin Case Rep 2023; 11:e8211. [PMID: 38028104 PMCID: PMC10645601 DOI: 10.1002/ccr3.8211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Prompt diagnosis and management of massive pulmonary embolism after bariatric surgery is crucial, but thrombolytic therapy may increase the risk of complications such as anastomotic leakage and bleeding. Individualized management is needed.
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Affiliation(s)
- Nader Moeinvaziri
- Minimally Invasive Surgery Research CenterShiraz University of Medical SciencesShirazIran
| | - Alireza Sadeghi
- Minimally Invasive Surgery Research CenterShiraz University of Medical SciencesShirazIran
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2
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Ikesaka R, Kaur B, Crowther M, Rajasekhar A. Efficacy and safety of pre-operative insertion of inferior vena cava filter in patients undergoing bariatric surgery: a systematic review. J Thromb Thrombolysis 2022; 54:502-523. [PMID: 35960423 DOI: 10.1007/s11239-022-02689-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 10/15/2022]
Abstract
Prophylactic placement of inferior vena cava (IVC) filters prior to performing bariatric surgery is an intervention of unclear safety and efficacy with disagreement between current practice guidelines. To better characterize the risk and benefit of IVC filter insertion prior to bariatric surgery based on the current evidence. A systematic review of the literature of patients with prophylactic IVC filter insertion prior to bariatric surgery was performed and 32 studies were identified for inclusion into the review, of which none were randomized controlled trials. Meta-analysis was performed including the high-quality included studies. Seven high quality studies reported thrombotic events in patients undergoing bariatric surgery who had an IVCF and a control group which allowed for meta-analysis. The pooled odds ratio of venous thrombotic events in the IVC filter population versus the group without IVC filters was 1.57 (95%CI 0.89, 2.76). Among high quality studies 5 reported major bleeding with a rate of 0.76% and 6 reported on IVC filter complications with a rate of 0.67%. Overall no significant reduction in the rate of venous thrombosis was found with prophylactic IVC filter insertion. Use of IVC filters for prophylaxis remains a concern given the lack of clear efficacy in this setting and a small but present complication risk.
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Affiliation(s)
| | - Bhagwanpreet Kaur
- Health Research Methodology, McMaster University, Hamilton, ON, Canada
| | | | - Anita Rajasekhar
- Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
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3
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Surve A, Potts J, Cottam D, Roslin M, Medlin W, Uchal M, Richards C, Belnap L. The Safety and Efficacy of Apixaban (Eliquis) in 5017 Post-bariatric Patients with 95.3% Follow-up: a Multicenter Study. Obes Surg 2022; 32:1-6. [PMID: 35478402 DOI: 10.1007/s11695-022-06051-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/29/2022] [Accepted: 04/07/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Thromboprophylaxis in bariatric surgery is widely debated; however, few large articles evaluate treatment plans and their efficacy. Herein, we make the first large-scale report of the safety and efficacy of apixaban (Eliquis) for thrombus prevention following bariatric surgery. PURPOSE To evaluate the safety and efficacy of apixaban following bariatric surgery. SETTING Three private institutes, USA. MATERIALS AND METHODS Data from 5017 consecutive bariatric patients that were placed on postoperative apixaban for thromboprophylaxis were used for retrospective analysis. The dose prescribed to patients was 2.5 mg PO BID for a total of 30 days starting on day 3 postoperatively. RESULTS In total, of the 5017 patients, 59.7%, 31.2%, 4.4%, 2.5%, 1.8%, and 0.1% of the patients had undergone sleeve gastrectomy (SG), single-anastomosis duodeno-ileal bypass with SG (SADI-S), Roux-en-Y gastric bypass (RYGB), conversion from SG to SADI, small bowel reconstruction, and RYGB reversal, respectively. The 30-day follow-up rate was 95.3%. In total, 1.7% of patients experienced apixaban-related side effects. The most common side effects were menorrhagia and rash. Two (0.03%) side effects developed into Clavien-Dindo grade II complications. Overall, 10 (0.1%) patients experienced thromboembolic complications (five (0.09%) PVTs and five (0.09%) PEs). In each case, the protocol was not followed for extenuating circumstances. There were no deaths or thromboembolic events in cases where the protocol was able to be fully followed. CONCLUSIONS In conclusion, 30 days of postoperative apixaban appears to be safe and effective with minimal side effects while preventing thromboembolic events.
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Affiliation(s)
- Amit Surve
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, USA
| | - James Potts
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, USA
| | - Daniel Cottam
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, USA.
| | - Mitchell Roslin
- Northwell Health-Lenox Hill Hospital, New York City, NY, USA
| | - Walter Medlin
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, USA
| | - Miro Uchal
- North Florida Surgeons, Jacksonville, FL, USA
| | - Christina Richards
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, USA
| | - Legrand Belnap
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, USA
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Martin AM, Polistena P, Mahmud A, Bettridge B, Morling A, Chuah H, Yong ASM, Leahy MF. Optimal enoxaparin dosing strategies for venous thromboembolism prophylaxis and treatment of high body weight patients. Thromb Res 2021; 207:116-122. [PMID: 34619448 DOI: 10.1016/j.thromres.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/23/2021] [Accepted: 09/05/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Obesity is a risk factor for developing venous thromboembolism (VTE). Optimal dosage of enoxaparin has not been established in the obese population. We aimed to study clinical outcomes and complications with enoxaparin in obese patients. METHODS A retrospective, single centre observational study of obese patients treated with enoxaparin for VTE (n = 47) using a body mass index (BMI)-stratified dosing, thromboprophylaxis (n = 46), and non-obese controls (n = 20) was performed. Anti-Xa was used to measure enoxaparin efficacy. RESULTS Patients with a median BMI of 36.3 kg/m2 (range 30-52.7) with a median weight of 136 kg (range 68-240) received therapeutic enoxaparin at median 120 mg BID (range 60-200). A median targeted anti-Xa level of 0.79 (95% CI 0.72-1.03) IU/mL was achieved in 58% of patients. Dose reduction, or increase was needed in 25%, and 16% patients respectively. Mild or major haemorrhage, or VTE occurred in 10%, 2% and 2% patients respectively. Patients with a median weight of 160 kg (range 130-245) received thromboprophylaxis with 40 mg BID enoxaparin. Targeted median anti-Xa of 0.22 IU/mL (95% CI 0.19-0.24) was achieved in 59% patients. Mild haemorrhage was seen in 2%, while none developed major haemorrhage or VTE. Control patients who received enoxaparin 40 mg daily did not develop VTE; 5% had minor bleeding events. CONCLUSIONS BMI-stratified therapeutic enoxaparin dosing regimen is safe and effective therapy in obese patients. Fixed dosing without monitoring may not be appropriate. Thromboprophylaxis with 40 mg BID in obese patients was efficacious in preventing VTE without excess bleeding compared to control patients.
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Affiliation(s)
- Annalise M Martin
- Royal Perth Hospital, Perth, Western Australia, Australia; School of Cancer Biology, University of Western Australia, Western Australia, Australia.
| | | | - Asma Mahmud
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Brett Bettridge
- PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Alan Morling
- PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Hun Chuah
- Royal Perth Hospital, Perth, Western Australia, Australia; School of Cancer Biology, University of Western Australia, Western Australia, Australia
| | - Agnes S M Yong
- Royal Perth Hospital, Perth, Western Australia, Australia; Division of Pathology and Laboratory, University of Western Australia Medical School, Western Australia, Australia
| | - Michael F Leahy
- Royal Perth Hospital, Perth, Western Australia, Australia; PathWest Laboratory Medicine, Perth, Western Australia, Australia; Division of Pathology and Laboratory, University of Western Australia Medical School, Western Australia, Australia
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5
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El Ansari W, El-Ansari K. Missing something? A scoping review of venous thromboembolic events and their associations with bariatric surgery. Refining the evidence base. Ann Med Surg (Lond) 2020; 59:264-273. [PMID: 33133579 PMCID: PMC7588328 DOI: 10.1016/j.amsu.2020.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/09/2020] [Accepted: 08/09/2020] [Indexed: 11/01/2022] Open
Abstract
Background Venous thromboembolic events (VTE) post-bariatric surgery (BS) lead to morbidity and mortality. Methods This scoping review assessed whether reported VTE post-BS could be under/over-estimated; suggested a possible number of VTE post-BS; appraised whether VTE are likely to decrease/increase; examined BS as risk/protective factor for VTE; and mapped the gaps, proposing potential solutions. Results VTE appears under-estimated due to: identification/coding of BS and VTE; reporting of exposure (BS); and reporting of outcomes (VTE). The review proposes a hypothetical calculation of VTE post-BS. VTE are unlikely to decrease soon. BS represents risk and protection for VTE. Better appreciation of VTE-BS relationships requires longer-term strategies. Conclusion VTE are underestimated. Actions are required for understanding the VTE-BS relationships to in order to crease VTE by better-informed prevention strategy/ies.
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Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad General Hospital, 3050, Doha, Qatar.,College of Medicine, Qatar University, Doha, Qatar.,Schools of Health and Education, University of Skovde, Skövde, Sweden
| | - Kareem El-Ansari
- Volunteer, Hamad General Hospital, Hamad Medical Corporation, 3050, Doha, Qatar
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Li X, D'Amico G, Quintini C, Uso TD, Gadani S, Romero-Marrero C, Martin C, Partovi S. Intravascular ultrasound in the diagnosis and treatment of central venous diseases. VASA 2020; 50:2-10. [PMID: 33138741 DOI: 10.1024/0301-1526/a000914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Intravascular ultrasound (IVUS) has been used extensively in coronary applications. Its use in venous applications has increased as endovascular therapy has increasingly become the mainstay therapy for central venous diseases. IVUS has been used for both diagnostic and therapeutic purposes in managing venous stenotic disease, venous occlusive disease, and IVC filter placement and removal. IVUS has been proven to be effective in providing detailed measurement of the venous anatomy, which aid in determining the appropriate size and the approach for venous stent placement. In IVC filter placement, IVUS can provide detailed measurement and guide IVC filter placement in emergent and critical care settings. It also has certain utility in filter removal. At any rate, to date there are only a few studies examining its impact on patient outcomes. Prospective randomized controlled trials are warranted in the future.
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Affiliation(s)
- Xin Li
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Giuseppe D'Amico
- Department of Transplant Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Cristiano Quintini
- Department of Transplant Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Teresa Diago Uso
- Department of Transplant Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sameer Gadani
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Carlos Romero-Marrero
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Charles Martin
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Sasan Partovi
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
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El Ansari W, Sathian B, El-Menyar A. Venous thromboembolic events after bariatric surgery: Protocol for a systematic review and meta-analysis. Int J Surg Protoc 2020; 22:10-14. [PMID: 32613151 PMCID: PMC7317231 DOI: 10.1016/j.isjp.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 12/02/2022] Open
Abstract
Venous Thromboembolic Events after Bariatric Surgery. This protocol undertakes a systematic review and metanalysis of venous thromboembolic events after bariatric surgery. Methodology, searches, eligibility, and data extraction for analysis are described. Following the PRISMA guidelines, it describes the approach for pooled estimates. Findings will have key clinical consequences for patient care.
Introduction Considerably large numbers of bariatric surgery (BS) procedures are undertaken globally, and are projected to increase with the obesity epidemic. Venous thromboembolic events (VTE) comprise an important cause of postoperative morbidity and mortality after BS and an important issue with wide clinical and financial repercussions. Yet, a precise extent of the prevalence of VTE after BS for obesity and its mortality remains uncertain. Methods and analysis In order to respond to this knowledge gap, we will conduct a systematic review and meta-analysis of the prevalence of and mortality associated with VTE after BS. This protocol outlines the methodology that will be used and the search strategies and eligibility criteria that will be utilized to identify and select studies, as well as the method by which data from the selected studies will be extracted for analysis. PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), WHO International Clinical Trials Registry Platform, Cochrane Library, MEDLINE, Scopus, clinicaltrials.gov and Google scholar will be searched from 01 January 1990 through 10th April 2020, for original studies written in English that provided prevalence estimates of VTE after BS. Articles will also be searched for mortality estimates of VTE after BS. STROCSS (Strengthening the Reporting of Cohort Studies in Surgery) criteria will evaluate the methodological quality of the selected studies. The use of fixed effect or random effects model will be subject to the findings of the statistical tests for heterogeneity. Publication bias will be visually estimated by inspecting the funnel plots. Pooled estimates will be computed. Th current protocol conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines and has been submitted to the PROSPERO International Prospective Register of systematic reviews. No ethical clearance is required for this study. This systematic review and meta-analysis will be published in a peer-reviewed journal and presented at national and international conferences.
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Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar.,College of Medicine, Qatar University, Doha 2713, Qatar.,Schools of Health and Education, University of Skovde, 541 28 Skövde, Sweden
| | - Brijesh Sathian
- Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad General Hospital, Doha 3050, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad General Hospital, Doha 3050, Qatar.,Clinical Medicine, Weill Cornell Medical School, Doha 24144, Qatar
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8
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de Meireles A, Carlin AM, Cain-Nielsen A, Stricklen A, Ross R, Finks JF, Varban OA, Ghaferi AA. Association Between Surgeon Practice Knowledge and Venous Thromboembolism. Obes Surg 2020; 30:2274-2279. [PMID: 32062847 DOI: 10.1007/s11695-020-04468-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The most common cause of mortality following bariatric surgery is venous thromboembolism. Our study aimed to (1) determine the practice patterns of venous thromboembolism (VTE) chemoprophylaxis among bariatric surgeons participating in a large statewide quality collaborative and (2) compare the results of surgeon self-reported chemoprophylaxis practices to actual practices from abstracted chart data. METHODS We administered a 13-question survey to 66 surgeons across a statewide collaborative aimed at revealing VTE practice patterns such as medication type, dosage, timing, duration, and level of trainee involvement (response rate 93%). We conducted on-site data audits to examine the charts of all patients that had developed VTE during the study period and 15 other randomly selected patient charts per site. We then evaluated both the ordered perioperative chemoprophylaxis and the actual administered chemoprophylaxis from nursing and electronic records. RESULTS There was 31% overall discordance between self-reported and abstracted chart data for pre-operative VTE dosing regimens. Among patients who had a VTE, 39% of administered chemoprophylaxis did not match surgeon responses. Conversely, among patients who did not have a VTE, only 29% were discordant (p = 0.03). In contrast, for post-operative VTE dosing, there was no significant difference in the rate of discordance in patients with and without a VTE (47% discordance vs 38%, p = 0.0552, respectively). CONCLUSIONS Greater discordance between surgeon self-reported and actual perioperative VTE chemoprophylaxis is associated with significantly increased risk of VTE. Further understanding of the system characteristics associated with these practices may yield insights into how best to improve appropriate VTE chemoprophylaxis.
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Affiliation(s)
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | | | | | - Rachel Ross
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Jonathan F Finks
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.,Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Oliver A Varban
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.,Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Amir A Ghaferi
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA. .,Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA. .,Institute for Healthcare Policy & Innovation, University of Michigan, 2800 Plymouth Avenue Building 16, Rm 140-E, Ann Arbor, MI, 48109-2800, USA.
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Experience of King Abdullah Medical City in Placement of Inferior Vena Cava Filter Prior to Bariatric Surgery in Extremely High-Risk Patients for Thromboembolic Events. Obes Surg 2019; 30:2050-2052. [PMID: 31732861 DOI: 10.1007/s11695-019-04281-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Bariatric surgery is used to treat morbid obese patients. Venous thromboembolism (VTE) is considered to be one of the leading causes of postoperative morbidity and mortality. Therefore, inferior vena cava filter (IVCF) is used to minimize the risk of VTE in high-risk patients. MATERIALS AND METHODS Medical information was collected for the preoperative, operative and postoperative stages for all patients underwent bariatric surgery at KAMC from March 2013 to July 2017. RESULTS Five cases with IVCF were included in this study. Age ranged from 35 to 66 years old; 4 (80%) were female. Preoperative body mass index ranged from 42 to 64 kg/m2. Postoperative findings were reported. CONCLUSION IVCF seems to be beneficial for patients undergoing bariatric surgery.
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Brañes A, Orellana M, Muñoz R. Systemic thrombolysis for acute submassive pulmonary embolism after laparoscopic Roux-en-Y bypass: A case report. Int J Surg Case Rep 2019; 55:66-68. [PMID: 30703719 PMCID: PMC6354619 DOI: 10.1016/j.ijscr.2019.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/23/2018] [Accepted: 01/15/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Venous thromboembolism (VTE) in bariatric surgery is a low incidence disease; however, it is the first cause of morbimortality in this group of patients. PRESENTATION OF THE CASE We present the case of a female patient with morbid obesity who was readmitted due to an acute submassive bilateral pulmonary embolism (PE) nineteen days after a laparoscopic Roux-en-Y gastric bypass (RYGB). After diagnosis, anticoagulation was initiated, and decision to add mechanical and pharmacological thrombolysis was made with the patient been successfully treated, as shown by normalization of pulmonary hypertension. DISCUSSION VTE in bariatric surgery is rare but contributes to significant morbidity and mortality in patients undergoing bariatric surgery. CONCLUSION It is necessary to have a high index of suspicion to make a timely diagnosis and initiate an early treatment. In selected cases, adding mechanical and pharmacological thrombolysis could increase chance of reverse pulmonary hypertension.
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Affiliation(s)
- Alejandro Brañes
- Digestive Surgery Department, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Matias Orellana
- Affiliate to Digestive Surgery Department, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Rodrigo Muñoz
- Digestive Surgery Department, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.
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Giorgi M, Ryder BA, Chong T, Malek J, Sangisetty S, Roye GD, Stafford T, Vithiananthan S. Safety of Retrievable Inferior Vena Cava Filter Placements in High-Risk Bariatric Surgery Patients. Bariatr Surg Pract Patient Care 2018. [DOI: 10.1089/bari.2017.0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marcoandrea Giorgi
- Department of Surgery, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Beth A. Ryder
- Department of Surgery, Brown University, The Miriam Hospital, Providence, Rhode Island
| | - Tec Chong
- Department of Surgery, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Junaid Malek
- Department of Surgery, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Suma Sangisetty
- Department of Surgery, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Gary Dean Roye
- Department of Surgery, Brown University, The Miriam Hospital, Providence, Rhode Island
| | - Todd Stafford
- Department of Surgery, Brown University, Rhode Island Hospital, Providence, Rhode Island
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Abstract
Obesity is a worldwide epidemic, and those suffering from obesity have increased morbidity and mortality rates. There are various causes of obesity and many treatment options for patients suffering from obesity, including nonsurgical treatments. However, bariatric surgery is often the best choice for optimal weight loss and the attenuation of comorbidities. Currently, laparoscopic sleeve gastrectomy is the most common type of bariatric surgery in the United States due to its technical simplicity, feasibility, and overall positive outcomes. This article discusses bariatric surgical criteria and selection, expected perioperative course, potential complications after surgery, and nursing implications for the care of bariatric patients. A case report is used to exemplify stages of surgical care and follow-up treatment for patients who undergo laparoscopic sleeve gastrectomy.
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Affiliation(s)
- Aura Petcu
- Aura Petcu is Nurse Practitioner, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Mail Code UHS 8W, Portland, OR 97239
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13
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Khan S, Rock K, Baskara A, Qu W, Nazzal M, Ortiz J. Trends in bariatric surgery from 2008 to 2012. Am J Surg 2015; 211:1041-6. [PMID: 26762828 DOI: 10.1016/j.amjsurg.2015.10.012] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/09/2015] [Accepted: 10/28/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Obesity is a global epidemic that has been increasing in prevalence. The only treatment method for durable weight loss is bariatric surgery. The aim of this study was to observe trends in usage and outcomes of bariatric operations used in the United States from 2008 to 2012. METHODS Analysis was performed on bariatric surgery admissions from 2008 to 2012 based off of the Nationwide Inpatient Sample database. Data were selected from using International Classification of Disease, 9th Revision codes correlating to bariatric procedures for the purpose of obesity. Annual estimates and trends were reviewed for patient demographics, procedure type, patient outcomes, and length of stay (LOS). RESULTS A total of 598,756 bariatric procedures were examined. Laparoscopic gastric bypass was the most commonly used surgical method in 2008 (58.2%). A decreasing trend in its use, and the use of laparoscopic gastric banding (LGB), was equipoised with increasing use of laparoscopic sleeve gastrectomy (LSG). Use of LSG accounted for 8.2% of procedures in 2011 and 39.6% in 2012. LGB and LSG had the lowest rates of complications, in-hospital morbidity and mortality, and the shortest LOS whereas open bypass and duodenal switch had the highest rates of complications, in-hospital morbidity and mortality, and longest LOSs. Overall rates of venous thromboembolism increased from .08% in 2008 to .215% in 2012. Respiratory complications decreased from 6.1% to 3.9%. There were no observed trends in rates of renal complications, visceral injury, bleeding, and infections. In-hospital morbidity decreased, whereas mortality rates were stable at .1%. CONCLUSIONS The utilization of bariatric procedures has reached a plateau in the United States. Changes in the composition of procedural types suggest that LSG has become a popular alternative to gastric bypass and LGB.
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Affiliation(s)
- Sohaib Khan
- The University of Toledo Medical Centerm, 3000 Arlington Ave, Toledo, OH 43614, USA
| | - Kathryn Rock
- The University of Toledo Medical Centerm, 3000 Arlington Ave, Toledo, OH 43614, USA
| | - Arunkumar Baskara
- The University of Toledo Medical Centerm, 3000 Arlington Ave, Toledo, OH 43614, USA
| | - Weikai Qu
- The University of Toledo Medical Centerm, 3000 Arlington Ave, Toledo, OH 43614, USA
| | - Munier Nazzal
- The University of Toledo Medical Centerm, 3000 Arlington Ave, Toledo, OH 43614, USA
| | - Jorge Ortiz
- The University of Toledo Medical Centerm, 3000 Arlington Ave, Toledo, OH 43614, USA.
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Rowland SP, Dharmarajah B, Moore HM, Lane TRA, Cousins J, Ahmed AR, Davies AH. Inferior Vena Cava Filters for Prevention of Venous Thromboembolism in Obese Patients Undergoing Bariatric Surgery. Ann Surg 2015; 261:35-45. [DOI: 10.1097/sla.0000000000000621] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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15
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Correlation of intravascular ultrasound and computed tomography scan measurements for placement of intravascular ultrasound-guided inferior vena cava filters. J Vasc Surg 2014; 59:1066-72. [DOI: 10.1016/j.jvs.2013.10.071] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/12/2013] [Accepted: 10/10/2013] [Indexed: 11/22/2022]
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16
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Affiliation(s)
- Sebastian Lucas
- Department of Histopathology, St Thomas' Hospital, London, UK
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17
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De Cesare A, Cangemi B, Fiori E, Bononi M, Cangemi R, Basso L. Early and long-term clinical outcomes of bilio-intestinal diversion in morbidly obese patients. Surg Today 2014; 44:1424-33. [PMID: 24519396 DOI: 10.1007/s00595-014-0856-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 07/18/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate the early and long-term postoperative results of malabsorptive surgery in morbidly obese patients. METHODS Between 2000 and 2007, 102 morbidly obese patients were referred to the Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Policlinico "Umberto I°", Rome, Italy for malabsorptive surgery. All patients underwent derivative biliodigestive surgery after they had been reviewed by a team of surgeons, physicians, dieticians, and psychologists. RESULTS There were no intra-operative complications, but two patients suffered postoperative pulmonary embolisms, which resolved with medical treatment. The mean postoperative hospital stay was 7 days, with no early or late mortality. Maximum weight loss was reached 12-24 months after surgery, while the mean percentage excess weight loss at 3-5 years ranged from 45 to 64 %. Specific postoperative complications in the first 2 years after surgery were abdominal abscess (n = 2), gastroduodenal reflux (n = 4), and incisional hernia (n = 6). Diabetes resolved in 98 % of the diabetic patients within a few weeks after surgery and blood pressure normalised in 86.4 % of those who had had hypertension preoperatively. Obstructive sleep apnoea and obesity hypoventilation syndrome also improved significantly in 92 % of the patients. CONCLUSIONS Morbidly obese patients can undergo biliodigestive surgery safely with good long-term weight loss and quality of life expectancy.
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Affiliation(s)
- Alessandro De Cesare
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Faculty of Medicine and Dentistry, viale del Policlinico 155, 00161, Rome, Italy
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ASMBS updated position statement on prophylactic measures to reduce the risk of venous thromboembolism in bariatric surgery patients. Surg Obes Relat Dis 2013; 9:493-7. [DOI: 10.1016/j.soard.2013.03.006] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 03/18/2013] [Indexed: 01/08/2023]
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Birkmeyer NJ, Finks JF, English WJ, Carlin AM, Hawasli AA, Genaw JA, Wood MH, Share DA, Birkmeyer JD. Risks and benefits of prophylactic inferior vena cava filters in patients undergoing bariatric surgery. J Hosp Med 2013; 8:173-7. [PMID: 23401464 DOI: 10.1002/jhm.2013] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 12/18/2012] [Accepted: 12/23/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND The United States Food and Drug Administration recently issued a warning about adverse events in patients receiving inferior vena cava (IVC) filters. OBJECTIVE To assess relationships between IVC filter insertion and complications while controlling for differences in baseline patient characteristics and medical venous thromboembolism prophylaxis. DESIGN Propensity-matched cohort study. SETTING The prospective, statewide, clinical registry of the Michigan Bariatric Surgery Collaborative. PATIENTS Bariatric surgery patients (n=35,477) from 32 hospitals during the years 2006 through 2012. INTERVENTION Prophylactic IVC filter insertion. MEASUREMENTS Outcomes included the occurrence of complications (pulmonary embolism, deep vein thrombosis, and overall combined rates of complications by severity) within 30 days of bariatric surgery. RESULTS There were no significant differences in baseline characteristics among the 1,077 patients with IVC filters and in 1,077 matched control patients. Patients receiving IVC filters had higher rates of pulmonary embolism (0.84% vs 0.46%; odds ratio [OR], 2.0; 95% confidence interval [CI], 0.6-6.5; P=0.232), deep vein thrombosis (1.2% vs 0.37%; OR, 3.3; 95% CI, 1.1-10.1; P=0.039), venous thromboembolism (1.9% vs 0.74%; OR, 2.7; 95% CI, 1.1-6.3, P=0.027), serious complications (5.8% vs 3.8%; OR, 1.6; 95% CI, 1.0-2.4; P=0.031), permanently disabling complications (1.2% vs 0.37%; OR, 4.3; 95% CI, 1.2-15.6; P=0.028), and death (0.7% vs 0.09%; OR, 7.0; 95% CI, 0.9-57.3; P=0.068). Of the 7 deaths among patients with IVC filters, 4 were attributable to pulmonary embolism and 2 to IVC thrombosis/occlusion. CONCLUSIONS We have identified no benefits and significant risks to the use of prophylactic IVC filters among bariatric surgery patients and believe that their use should be discouraged.
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Affiliation(s)
- Nancy J Birkmeyer
- Center for Healthcare Outcomes and Policy and Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109, USA.
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Abstract
Bariatric surgery is gaining in popularity in the United States and around the world as a treatment for morbid obesity. Patients seek surgery in order to lose weight and limit the long-term effects of insulin-resistant diabetes, heart disease and lung disease, including risk of sudden death. While gastric bypass in patients with morbid obesity can reduce the risk of diabetes and myocardial infarction to population levels, the risk of death remains increased. These patients may die suddenly and unexpectedly as a direct result of surgery, as an indirect result of surgery, or of end-organ damage wrought by years of obesity, completely unrelated to the surgery. Proper forensic pathologic assessment of these patients requires an understanding of the anatomic changes caused by bariatric surgery, the complications and the metabolic consequences of the different procedures. In order to better understand this subgroup of patients, a search of the peer-reviewed medical literature at the National Library of Medicine was conducted for articles using the keywords bariatric, surgery, gastric bypass, autopsy, review, toxicology, alcohol, drug, ethanol, absorption, elimination, litigation, forensic, and death. This review outlines the most common laparoscopic and open surgical procedures; the common immediate post-surgical complications that lead to morbidity and mortality; forensic toxicological considerations in bariatric patients; and the long-term complications and other causes that could lead to unexpected death in these patients.
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Affiliation(s)
- Judy Melinek
- Office of the Chief Medical Examiner in San Francisco
- University of California at San Francisco
| | - Nikolas P. Lemos
- Forensic Laboratory Division, Office of the Chief Medical Examiner, City and County of San Francisco
- Department of Laboratory Medicine, School of Medicine, University of California, San Francisco
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Shamian B, Chamberlain RS. The Role for Prophylaxis Inferior Vena Cava Filters in Patients Undergoing Bariatric Surgery: Replacing Anecdote with Evidence. Am Surg 2012. [DOI: 10.1177/000313481207801227] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The number of patients choosing surgical alternatives for weight reduction continues to increase. Despite common thromboembolic preventive methods, which include perioperative subcutaneous heparin injections, early mobilization, and sequential compression devices, postoperative deep vein thrombosis/pulmonary embolism remains a devastating complication after bariatric surgery. The role prophylactic inferior vena cava (IVC) filters may play in bariatric surgery remains controversial, and this article aims to address the risks and benefits of prophylactic IVC filters in high-risk bariatric patients and suggest an evidence-based algorithm for their use.
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Affiliation(s)
- Ben Shamian
- Department of Surgery, Saint Barnabas Medical Center, Livingston, New Jersey
| | - Ronald S. Chamberlain
- Department of Surgery, Saint Barnabas Medical Center, Livingston, New Jersey
- Department of Surgery, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
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Li W, Gorecki P, Semaan E, Briggs W, Tortolani AJ, D'Ayala M. Concurrent prophylactic placement of inferior vena cava filter in gastric bypass and adjustable banding operations in the Bariatric Outcomes Longitudinal Database. J Vasc Surg 2012; 55:1690-5. [DOI: 10.1016/j.jvs.2011.12.056] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 12/09/2011] [Accepted: 12/22/2011] [Indexed: 01/10/2023]
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Preoperative placement of inferior vena cava filters and outcomes after gastric bypass surgery. Ann Surg 2010; 252:313-8. [PMID: 20622663 DOI: 10.1097/sla.0b013e3181e61e4f] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess relationships between inferior vena cava (IVC) filter placement and complications within 30 days of gastric bypass surgery. SUMMARY OF BACKGROUND DATA IVC filters are increasingly being used as prophylaxis against postoperative pulmonary embolism in patients undergoing bariatric surgery, despite a lack of evidence of effectiveness. METHODS On the basis of data from a prospective clinical registry involving 20 Michigan hospitals, we identified 6376 patients undergoing gastric bypass surgery between 2006 and 2008. We then assessed relationships between IVC filter placement and complications within 30 days of surgery. We used propensity scores and fixed effects logistic regression to control for potential selection bias. RESULTS A total of 542 gastric bypass patients (8.5%) underwent preoperative IVC filter placement, most of whom (65%) had no history of venous thromboembolism. The use of IVC filters for gastric bypass patients varied widely across hospitals (range, 0%-34%). IVC filter patients did not have reduced rates of postoperative venous thromboembolism (adjusted odds ratio [OR], = 1.28; 95% confidence interval [CI], 0.51-3.21), serious complications (adjusted OR, = 1.40; 95% CI, 0.91-2.16), or death/permanent disability (adjusted OR, = 2.49; 95% CI, 0.99-6.26). More than half (57%) of the IVC filter patients in the latter group had a fatal pulmonary embolism or complications directly related to the IVC filter itself, including filter migration or thrombosis of the vena cava. In subgroup analyses, we were unable to identify any patient group for whom IVC filters were associated with improved outcomes. CONCLUSIONS Prophylactic IVC filters for gastric bypass surgery do not reduce the risk of pulmonary embolism and may lead to additional complications.
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Rajasekhar A, Crowther M. Inferior vena caval filter insertion prior to bariatric surgery: a systematic review of the literature. J Thromb Haemost 2010; 8:1266-70. [PMID: 20345723 DOI: 10.1111/j.1538-7836.2010.03858.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Placement of inferior vena cava filters (IVCFs) is considered in many patients undergoing bariatric surgery. Their placement is driven by a high rate of pulmonary embolism (PE), uncertainty as to the effectiveness of pharmacologic prophylaxis, and a lack of alternate methods to prevent pulmonary embolism. We performed a systematic review of the literature to evaluate the evidence supporting placement of IVCFs in patients undergoing bariatric surgery. Eleven studies were identified; none were randomized trials. Descriptive analysis suggests that IVCFs reduced PE; however, the strength of this observation is tempered by the lack of use of effective forms of prophylaxis and the failure to account for complications of IVCF placement. We conclude, pending the results of controlled studies, that the use of IVCFs cannot be recommended for routine patients undergoing bariatric surgery.
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Affiliation(s)
- A Rajasekhar
- Department of Medicine, University of Florida, Gainesville, FL, USA
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Agarwal R, Hecht TE, Lazo MC, Umscheid CA. Venous thromboembolism prophylaxis for patients undergoing bariatric surgery: a systematic review. Surg Obes Relat Dis 2010; 6:213-20. [DOI: 10.1016/j.soard.2009.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Revised: 11/28/2009] [Accepted: 11/30/2009] [Indexed: 10/20/2022]
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Nutescu EA, Spinier SA, Wittkowsky A, Dager WE. Anticoagulation: Low-Molecular-Weight Heparins in Renal Impairment and Obesity: Available Evidence and Clinical Practice Recommendations Across Medical and Surgical Settings. Ann Pharmacother 2009; 43:1064-83. [DOI: 10.1345/aph.1l194] [Citation(s) in RCA: 206] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective To develop practical recommendations for the use of low-molecular-weight heparins (LMWHs) as prophylaxis and treatment of venous thromboembolism and acute coronary syndromes in patients with impaired renal function or obesity. Data Sources Multiple MEDLINE searches were performed (November 2008) to identify studies for inclusion, using a comprehensive list of search terms including, but not limited to, LMWH, enoxaparin, dalteparin, tinzaparin, obesity, weight, renal, kidney, elderly, monitoring, and anti-Xa. Study Selection And Data Extraction Only articles published in English that were relevant for this review were included. Data Synthesis In the majority of patients, standardized prophylaxis or treatment doses of LMWHs can be used without the need for monitoring and adjusting regimens. For patients with severe renal impairment (estimated creatinine clearance [CrCl] <30 mL/min), doses of some LMWHs should be adjusted or unfractionated heparin should be used instead. CrCl should be estimated using the Cockcroft-Gault method. Differences are noted in the degree of accumulation of various LMWHs in patients with moderate-to-severe renal impairment, and thus, the degree of dose adjustment may differ among the various LMWHs. Increasing the prophylactic doses of LMWH may be appropriate in morbidly obese patients (body mass index ≥40 kg/m2). The use of total body weight is appropriate for therapeutic doses of LMWH in obese patients. Laboratory monitoring of the anticoagulation effect of LMWHs is generally not necessary, but should be considered in patients with morbid obesity (weight >190 kg), those with severe renal impairment, and those with moderate renal impairment with prolonged (>10 days) LMWH use. When anti-Xa activity is monitored, it should be determined using a chromogenic method and a calibration curve based on the LMWH used. Conclusions Additional data are needed for specific dose guiding in obese and renally impaired patients, who are often excluded from larger clinical trials. Practice recommendations are made based on available evidence and authors' clinical opinions.
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Affiliation(s)
- Edith A Nutescu
- Antithrombosis Center, Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago
| | - Sarah A Spinier
- Department of Pharmacy Practice, Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, Philadelphia, PA
| | - Ann Wittkowsky
- School of Pharmacy, University of Washington, Seattle, WA
| | - William E Dager
- University of California Davis Medical Center, Sacramento, CA
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Rajasekhar A, Crowther MA. ASH evidence-based guidelines: what is the role of inferior vena cava filters in the perioperative prevention of venous thromboembolism in bariatric surgery patients? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2009; 2009:302-304. [PMID: 20008214 DOI: 10.1182/asheducation-2009.1.302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 38-year-old morbidly obese male (BMI > 50 kg/m(2)) presents for an elective gastric bypass surgery. He has no personal or family history of venous thromboembolism or hypercoaguability. You are asked by his primary team whether he should receive a retrievable inferior vena cava filter preoperatively for venous thromboembolism prophylaxis.
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Affiliation(s)
- Anita Rajasekhar
- Division of Hematology/Oncology, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
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Barba CA, Harrington C, Loewen M. Status of venous thromboembolism prophylaxis among bariatric surgeons: have we changed our practice during the past decade? Surg Obes Relat Dis 2008; 5:352-6. [PMID: 19342305 DOI: 10.1016/j.soard.2008.10.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 08/24/2008] [Accepted: 10/23/2008] [Indexed: 11/17/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is considered one of the principal causes of morbidity and mortality in patients requiring bariatric surgery. A survey to all members of the American Society for Metabolic and Bariatric Surgery was conducted in 1998 and published in 2000 in the journal "Obesity Surgery." METHODS A survey was repeated to all physician members of the American Society for Metabolic and Bariatric Surgery to determine the current practices for VTE prophylaxis. The results were compared with those of the previous study. RESULTS Of the members, 35% completed the survey for a total of 332 responses. The number of cases annually per surgeon almost doubled since 1998 (145 versus 85). Laparoscopic gastric bypass has replaced open gastric bypass as the most common procedure performed, followed by laparoscopic gastric banding as the second most common procedure. Most surgeons (95%) use chemical prophylaxis to prevent VTE, but almost 60% preferred low-molecular-weight heparin compared with 13% in 1998. More than 60% of bariatric surgeons discharged their patients with chemical prophylaxis compared with 12% in 1998. Inferior vena cava filters for prophylaxis are considered by 55% compared with only 7% in 1998. The incidence of reported deep vein thrombosis was significantly lower in 2007 (2.635 versus .93), as was the incidence of pulmonary embolism (.95% versus .75%). Almost 50% of surgeons still reported > or =1 fatality because of VTE complications. CONCLUSION Chemical prophylaxis for VTE with some type of heparin is the standard of care for patients undergoing bariatric surgery. Low-molecular-weight heparin is now used by two thirds of the respondents to this survey. Most surgeons who responded to the survey discharged their patients home with heparin, and many consider the use of inferior vena cava filters for VTE prophylaxis. Our findings support the American Society for Metabolic Bariatric Surgery position statement regarding VTE prophylaxis in this patient population. Research is necessary to establish the role of inferior vena cava filters, discharging patients with chemoprophylaxis and to determine the adequate dosage and duration of prophylaxis.
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