BACKGROUND: Morbidly obese patients undergoing gastric bypass surgery are at risk for postoperative venous thromboembolism. Evidence-based recommendations regarding the dosing and duration of thromboprophylaxis are lacking for morbidly obese surgical patients. The aims of this study were to evaluate the safety and efficacy of an extended duration, body mass index (BMI)-stratified enoxaparin thromboprophylaxis regimen in patients undergoing Roux-en-Y gastric bypass and to determine the resultant antifactor Xa (AFXa) activity in morbidly obese surgical patients. METHODS: In this prospective open trial, 223 patients (75% female, mean BMI 50.4 kg/m2) undergoingRoux-en-Y gastric bypass were assigned to receive enoxaparin 40 mg (BMI <or=50 kg/m2), n = 124) or 60 mg (BMI >50 kg/m2), n = 99) every 12 hours during hospitalization and once daily for 10 days after discharge. The AFXa levels were monitored serially, and dose adjustments were made for results outside the target prophylactic range (.2-.4 IU/mL +/- 10%) after the third dose. The safety and efficacy outcomes were major bleeding and venous thromboembolism. RESULTS:Roux-en-Y gastric bypass was performed laparoscopically in 208 subjects (93%). The duration of surgery averaged 99.5 +/- 31 minutes, and the median length of hospitalization was 3 days. Target prophylactic AFXa concentration was achieved by 74% of patients after the third enoxaparin dose; none reached the full anticoagulation concentration. One patient developed nonfatal venous thromboembolism (.45%). Four patients required transfusion (1.79%). Bleeding was not associated with a high AFXa concentration. CONCLUSION: This BMI-stratified, extended enoxaparin dosing regimen provided well-tolerated, effective prophylaxis against venous thromboembolism in patients undergoing gastric bypass surgery.
RCT Entities:
BACKGROUND: Morbidly obesepatients undergoing gastric bypass surgery are at risk for postoperative venous thromboembolism. Evidence-based recommendations regarding the dosing and duration of thromboprophylaxis are lacking for morbidly obese surgical patients. The aims of this study were to evaluate the safety and efficacy of an extended duration, body mass index (BMI)-stratified enoxaparin thromboprophylaxis regimen in patients undergoing Roux-en-Y gastric bypass and to determine the resultant antifactor Xa (AFXa) activity in morbidly obese surgical patients. METHODS: In this prospective open trial, 223 patients (75% female, mean BMI 50.4 kg/m2) undergoing Roux-en-Y gastric bypass were assigned to receive enoxaparin 40 mg (BMI <or=50 kg/m2), n = 124) or 60 mg (BMI >50 kg/m2), n = 99) every 12 hours during hospitalization and once daily for 10 days after discharge. The AFXa levels were monitored serially, and dose adjustments were made for results outside the target prophylactic range (.2-.4 IU/mL +/- 10%) after the third dose. The safety and efficacy outcomes were major bleeding and venous thromboembolism. RESULTS: Roux-en-Y gastric bypass was performed laparoscopically in 208 subjects (93%). The duration of surgery averaged 99.5 +/- 31 minutes, and the median length of hospitalization was 3 days. Target prophylactic AFXa concentration was achieved by 74% of patients after the third enoxaparin dose; none reached the full anticoagulation concentration. One patient developed nonfatal venous thromboembolism (.45%). Four patients required transfusion (1.79%). Bleeding was not associated with a high AFXa concentration. CONCLUSION: This BMI-stratified, extended enoxaparin dosing regimen provided well-tolerated, effective prophylaxis against venous thromboembolism in patients undergoing gastric bypass surgery.
Authors: Jeroen Diepstraten; Christian M Hackeng; Simone van Kralingen; Jiri Zapletal; Eric P A van Dongen; René J Wiezer; Bert van Ramshorst; Catherijne A J Knibbe Journal: Obes Surg Date: 2012-02-01 Impact factor: 4.129
Authors: Christopher J Pannucci; Kory I Fleming; Corinne B Bertolaccini; Ann Marie Prazak; Lyen C Huang; T Bartley Pickron Journal: JAMA Surg Date: 2019-08-01 Impact factor: 14.766
Authors: A Thorell; A D MacCormick; S Awad; N Reynolds; D Roulin; N Demartines; M Vignaud; A Alvarez; P M Singh; D N Lobo Journal: World J Surg Date: 2016-09 Impact factor: 3.352
Authors: Danielle Menosi Gualandro; Pai Ching Yu; Bruno Caramelli; André Coelho Marques; Daniela Calderaro; Luciana Savoy Fornari; Claudio Pinho; Alina Coutinho Rodrigues Feitosa; Carisi Anne Polanczyk; Carlos Eduardo Rochitte; Carlos Jardim; Carolina L Z Vieira; Debora Y M Nakamura; Denise Iezzi; Dirk Schreen; Eduardo Leal Adam; Elbio Antonio D'Amico; Emerson Q de Lima; Emmanuel de Almeida Burdmann; Enrique Indalecio Pachón Mateo; Fabiana Goulart Marcondes Braga; Fabio S Machado; Flavio J de Paula; Gabriel Assis Lopes do Carmo; Gilson Soares Feitosa-Filho; Gustavo Faibischew Prado; Heno Ferreira Lopes; João R C Fernandes; José J G de Lima; Luciana Sacilotto; Luciano Ferreira Drager; Luciano Janussi Vacanti; Luis Eduardo Paim Rohde; Luis F L Prada; Luis Henrique Wolff Gowdak; Marcelo Luiz Campos Vieira; Maristela Camargo Monachini; Milena Frota Macatrão-Costa; Milena Ribeiro Paixão; Mucio Tavares de Oliveira; Patricia Cury; Paula R Villaça; Pedro Silvio Farsky; Rinaldo F Siciliano; Roberto Henrique Heinisch; Rogerio Souza; Sandra F M Gualandro; Tarso Augusto Duenhas Accorsi; Wilson Mathias Journal: Arq Bras Cardiol Date: 2017 Jan-Feb Impact factor: 2.000
Authors: André Arpad Faludi; Maria Cristina de Oliveira Izar; José Francisco Kerr Saraiva; Ana Paula Marte Chacra; Henrique Tria Bianco; Abrahão Afiune; Adriana Bertolami; Alexandre C Pereira; Ana Maria Lottenberg; Andrei C Sposito; Antonio Carlos Palandri Chagas; Antonio Casella; Antônio Felipe Simão; Aristóteles Comte de Alencar; Bruno Caramelli; Carlos Costa Magalhães; Carlos Eduardo Negrão; Carlos Eduardo Dos Santos Ferreira; Carlos Scherr; Claudine Maria Alves Feio; Cristiane Kovacs; Daniel Branco de Araújo; Daniel Magnoni; Daniela Calderaro; Danielle Menosi Gualandro; Edgard Pessoa de Mello; Elizabeth Regina Giunco Alexandre; Emília Inoue Sato; Emilio Hideyuki Moriguchi; Fabiana Hanna Rached; Fábio César Dos Santos; Fernando Henpin Yue Cesena; Francisco Antonio Helfenstein Fonseca; Henrique Andrade Rodrigues da Fonseca; Hermes Toros Xavier; Isabela Cardoso Pimentel Mota; Isabela de Carlos Back Giuliano; Jaqueline Scholz Issa; Jayme Diament; João Bosco Pesquero; José Ernesto Dos Santos; José Rocha Faria; José Xavier de Melo; Juliana Tieko Kato; Kerginaldo Paulo Torres; Marcelo Chiara Bertolami; Marcelo Heitor Vieira Assad; Márcio Hiroshi Miname; Marileia Scartezini; Neusa Assumpta Forti; Otávio Rizzi Coelho; Raul Cavalcante Maranhão; Raul Dias Dos Santos; Renato Jorge Alves; Roberta Lara Cassani; Roberto Tadeu Barcellos Betti; Tales de Carvalho; Tânia Leme da Rocha Martinez; Viviane Zorzanelli Rocha Giraldez; Wilson Salgado Journal: Arq Bras Cardiol Date: 2017-07 Impact factor: 2.000