Routine extended (30 days) chemoprophylaxis for patients undergoing laparoscopic sleeve gastrectomy may reduce Portomesenteric vein thrombosis rates
Copyright © 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved..
BACKGROUND: Venous thromboembolism (VTE), including Portomesenteric vein thrombosis (PMVT), is a major complication of sleeve gastrectomy (SG). We changed our practice in July 2021 to routinely discharge all SG patients postoperatively with extended chemoprophylaxis for 30 days.
OBJECTIVES: Evaluate the efficacy and safety of routine extended chemoprophylaxis compared to 2 prior timeframes using selective extended chemoprophylaxis.
SETTING: University Hospital.
METHODS: Between 2012-2018, SG patients were discharged on extended chemoprophylaxis for patients deemed "high-risk" for VTE, including patients with body mass index (BMI) >50, and previous VTE. Between 2018-2021, extended chemoprophylaxis was broadened to include patients with positive preoperative thrombophilia panels (including Factor VIII). After 2021, all SG were routinely discharged on extended chemoprophylaxis. The typical regimen was 30 days Lovenox BID (40-mg twice daily for BMI> 40, 60-mg twice daily for BMI >60). Outcomes evaluated were rate of VTE/PMVT and postoperative bleed, including delayed bleed.
RESULTS: A total of 8864 patients underwent SG. Average age and BMI were 37.5 years and 43.0 kg/m2, respectively. The overall incidence of PMVT was 33/8864 (.37%). Converting from selective extended chemoprophylaxis (Group 1) to routine extended chemoprophylaxis (Group 3) decreased the rate of PMVT from .55% to .21% (P = .13). There was a significantly higher overall bleeding rate (.85%), including delayed bleeds (.34%) in the routine extended chemoprophylaxis patients (P < .05). These bleeds were mainly managed nonoperatively.
CONCLUSIONS: Routine extended (30 day) chemoprophylaxis for all SG may reduce PMVT rate but lead to a higher bleeding rate post-operatively. The vast majority of the increased bleeds are delayed and can be managed non-operatively.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2023 |
|---|---|
| Enthalten in: |
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery - (2023) vom: 10. Dez. |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Cuva, Dylan [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Bariatric complication |
|---|
| Anmerkungen: |
Date Revised 09.01.2024 published: Print-Electronic Citation Status Publisher |
|---|
| doi: |
10.1016/j.soard.2023.12.006 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM366859072 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM366859072 | ||
| 003 | DE-627 | ||
| 005 | 20240114233614.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240114s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.soard.2023.12.006 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1255.xml |
| 035 | |a (DE-627)NLM366859072 | ||
| 035 | |a (NLM)38195313 | ||
| 035 | |a (PII)S1550-7289(23)00840-7 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Cuva, Dylan |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Routine extended (30 days) chemoprophylaxis for patients undergoing laparoscopic sleeve gastrectomy may reduce Portomesenteric vein thrombosis rates |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Revised 09.01.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a Copyright © 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Venous thromboembolism (VTE), including Portomesenteric vein thrombosis (PMVT), is a major complication of sleeve gastrectomy (SG). We changed our practice in July 2021 to routinely discharge all SG patients postoperatively with extended chemoprophylaxis for 30 days | ||
| 520 | |a OBJECTIVES: Evaluate the efficacy and safety of routine extended chemoprophylaxis compared to 2 prior timeframes using selective extended chemoprophylaxis | ||
| 520 | |a SETTING: University Hospital | ||
| 520 | |a METHODS: Between 2012-2018, SG patients were discharged on extended chemoprophylaxis for patients deemed "high-risk" for VTE, including patients with body mass index (BMI) >50, and previous VTE. Between 2018-2021, extended chemoprophylaxis was broadened to include patients with positive preoperative thrombophilia panels (including Factor VIII). After 2021, all SG were routinely discharged on extended chemoprophylaxis. The typical regimen was 30 days Lovenox BID (40-mg twice daily for BMI> 40, 60-mg twice daily for BMI >60). Outcomes evaluated were rate of VTE/PMVT and postoperative bleed, including delayed bleed | ||
| 520 | |a RESULTS: A total of 8864 patients underwent SG. Average age and BMI were 37.5 years and 43.0 kg/m2, respectively. The overall incidence of PMVT was 33/8864 (.37%). Converting from selective extended chemoprophylaxis (Group 1) to routine extended chemoprophylaxis (Group 3) decreased the rate of PMVT from .55% to .21% (P = .13). There was a significantly higher overall bleeding rate (.85%), including delayed bleeds (.34%) in the routine extended chemoprophylaxis patients (P < .05). These bleeds were mainly managed nonoperatively | ||
| 520 | |a CONCLUSIONS: Routine extended (30 day) chemoprophylaxis for all SG may reduce PMVT rate but lead to a higher bleeding rate post-operatively. The vast majority of the increased bleeds are delayed and can be managed non-operatively | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Bariatric complication | |
| 650 | 4 | |a Bariatric surgery | |
| 650 | 4 | |a Chemoprophylaxis | |
| 650 | 4 | |a Extended chemoprophylaxis | |
| 650 | 4 | |a Portomesenteric vein thrombosis | |
| 650 | 4 | |a Sleeve gastrectomy | |
| 650 | 4 | |a Venous thromboembolism | |
| 700 | 1 | |a Somoza, Eduardo |e verfasserin |4 aut | |
| 700 | 1 | |a Alade, Moyosore |e verfasserin |4 aut | |
| 700 | 1 | |a Saunders, John K |e verfasserin |4 aut | |
| 700 | 1 | |a Park, Julia |e verfasserin |4 aut | |
| 700 | 1 | |a Lipman, Jeffrey |e verfasserin |4 aut | |
| 700 | 1 | |a Einersen, Peter |e verfasserin |4 aut | |
| 700 | 1 | |a Chui, Patricia |e verfasserin |4 aut | |
| 700 | 1 | |a Parikh, Manish |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery |d 2005 |g (2023) vom: 10. Dez. |w (DE-627)NLM16493006X |x 1878-7533 |7 nnns |
| 773 | 1 | 8 | |g year:2023 |g day:10 |g month:12 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.soard.2023.12.006 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |j 2023 |b 10 |c 12 | ||