A simple venous thromboembolism prophylaxis protocol for patients undergoing bariatric surgery

被引:34
作者
Frezza, Eldo E.
Wachtel, Mitchell S.
机构
[1] Texas Tech Univ, Hlth Sci Ctr, Dept Surg, Div Gen Surg, Lubbock, TX 79415 USA
[2] Texas Tech Univ, Hlth Sci Ctr, Dept Pathol, Lubbock, TX 79415 USA
关键词
D O I
10.1038/oby.2006.229
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: Pulmonary embolism is a leading cause of death for bariatric patients. Numerous regimens have been proposed, but a comprehensive, simple approach is lacking. This study provides a simple, easily implemented prophylaxis regimen. Research Methods and Procedures: One hundred fifty bariatric surgery patients were evaluated. Patients considered at high risk for venous thromboembolism had heart failure, a BMI of >= 50 kg/m(2), or a history of venous thromboembolism or pelvic surgery. Preoperatively and postoperatively, all patients received subcutaneous enoxaparin or unfractionated heparin. High-risk patients received either preoperatively inserted inferior vena cava filters or continuous heparin infusions intraoperatively. All high-risk patients were anticoagulated with warfarin (Coumadin; Bristol Myers-Squibb, Princeton, NJ) for at least 3 months postoperatively. Initially, some patients experienced significant hemorrhage; to prevent this, sutures were oversewn into staple lines. .Results: No patient experienced venous thromboembolism; a binomial test showed that the regimen reduced the risk of this complication to less than 2% (p < 0.05). Hemorrhage sufficient to require transfusion occurred in 4 of the first 20 patients; of the remaining 130 patients, into whose staple lines sutures were oversewn, none required transfusion (P < 0.05). Discussion: Patients should be divided into those who are at high risk and those who are at low risk for venous thromboembolism. All patients should receive pre- and postoperative anticoagulation. High-risk patients should also receive either an inferior vena cava filter or intraoperative heparin infusions, as well as at least 3 months of Coumadin therapy. Oversewing of staple lines may reduce the risk of hemorrhage.
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页码:1961 / 1965
页数:5
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