Shaul Gelikas1, Shai Meron Eldar2, Guy Lahat2. 1. Hebrew University of Jerusalem, Tel-Aviv Sourasky Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: shaime@tlvmc.gov.il. 2. Bariatric Surgery Unit, Department of General Surgery, Tel-Aviv Sourasky Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Abstract
BACKGROUND: Morbidly obese patients undergoing bariatric surgery are at risk for developing venous thromboembolic events. Data regarding the appropriate dosing strategy in this special population is limited. OBJECTIVE: To evaluate 2 different dosing regimens of enoxaparin in a prospective cohort of patients undergoing laparoscopic sleeve gastrectomy. SETTING: University hospital, Israel METHODS: The study cohort consisted of 54 patients divided into 2 groups. Group I received 40 mg enoxaparin every 24 hours, and group II received 60 mg enoxaparin every 24 hours. Anti-factor Xa (FXa) levels from each patient were obtained 3 to 4 hours after administration of the third dose of enoxaparin. Levels between .2 and 0.5 U/mL were considered appropriate. Five additional patients were selected as controls. RESULTS: There were 31 patients in group I and 23 patients in group II. There was a statistically significant difference between anti-FXa levels achieved in each group: .247 U/mL in group I (range, .15-.39) versus .346 U/mL (range, .24-.8) in group II. Both groups achieved mean anti-FXa levels in the range designated appropriate with a high proportion of patients achieving appropriate levels (group I: 80.6%; group II: 91.3%). Univariate analyses found that total weight and sex were significantly correlated with anti-FXa levels. However, a multivariate analysis including enoxaparin dose found that only enoxaparin dose remained significantly correlated with anti-FXa levels. CONCLUSION: In the absence of sufficient data regarding clinical efficacy and safety of different dosing regimens both dosing regimens studied are reasonable choices for venous thromboembolic events prophylaxis after bariatric surgery.
BACKGROUND: Morbidly obesepatients undergoing bariatric surgery are at risk for developing venous thromboembolic events. Data regarding the appropriate dosing strategy in this special population is limited. OBJECTIVE: To evaluate 2 different dosing regimens of enoxaparin in a prospective cohort of patients undergoing laparoscopic sleeve gastrectomy. SETTING: University hospital, Israel METHODS: The study cohort consisted of 54 patients divided into 2 groups. Group I received 40 mg enoxaparin every 24 hours, and group II received 60 mg enoxaparin every 24 hours. Anti-factor Xa (FXa) levels from each patient were obtained 3 to 4 hours after administration of the third dose of enoxaparin. Levels between .2 and 0.5 U/mL were considered appropriate. Five additional patients were selected as controls. RESULTS: There were 31 patients in group I and 23 patients in group II. There was a statistically significant difference between anti-FXa levels achieved in each group: .247 U/mL in group I (range, .15-.39) versus .346 U/mL (range, .24-.8) in group II. Both groups achieved mean anti-FXa levels in the range designated appropriate with a high proportion of patients achieving appropriate levels (group I: 80.6%; group II: 91.3%). Univariate analyses found that total weight and sex were significantly correlated with anti-FXa levels. However, a multivariate analysis including enoxaparin dose found that only enoxaparin dose remained significantly correlated with anti-FXa levels. CONCLUSION: In the absence of sufficient data regarding clinical efficacy and safety of different dosing regimens both dosing regimens studied are reasonable choices for venous thromboembolic events prophylaxis after bariatric surgery.
Authors: Janelle D Vaughns; Victoria C Ziesenitz; Elaine F Williams; Evan P Nadler; Gerd Mikus; Johannes van den Anker Journal: Obes Surg Date: 2020-01 Impact factor: 4.129