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Vte prophylaxis, morbid obesity

Matthew Sloan, Neil Sheth, Gwo-Chin Lee
BACKGROUND: Deep venous thrombosis (DVT) and pulmonary embolus (PE) remain an important cause of morbidity and mortality after THA and TKA. Prior recommendations have advocated for more aggressive prophylaxis for patients with obesity, whereas the evidence supporting these recommendations is conflicting and often based on underpowered studies. QUESTIONS/PURPOSES: (1) What is the association between obesity and DVT and PE after primary and revision THA and TKA? (2) Is there a body mass index (BMI) threshold beyond which DVT and PE risk is elevated? METHODS: We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2008 to 2016 to evaluate the reported 30-day rates of DVT, PE, and combined venous thromboembolism (VTE) after primary THA, primary TKA, revision THA, and revision TKA according to BMI as a continuous variable and a categorical variable as defined by the World Health Organization cutoffs for underweight, normal weight, overweight, and obesity...
January 3, 2019: Clinical Orthopaedics and related Research
Hacı Hasan Abuoglu, M A Tolga Müftüoğlu, Mehmet Odabaşı
BACKGROUND: Morbidly obese patients are at high risk for developing venous thromboembolism (VTE). The aim of this study was to evaluate the effect of a new VTE prophylaxis protocol (low dosage, low-molecular-weight heparin [LMWH]) with a pneumatic compression device (PCD) in patients undergoing bariatric surgery. MATERIALS AND METHODS: Between November 2015 and December 2017, 368 patients underwent surgery due to obesity. The patients received 0.2 ml of nadroparin (Fraxiparine, GlaxoSmithKline) 12 h before the operation...
December 12, 2018: Obesity Surgery
Tyler C Lewis, Jennifer Cortes, Diana Altshuler, John Papadopoulos
Venous thromboembolism (VTE) is a major health concern associated with significant morbidity and mortality. Critically ill patients are at an increased risk of VTE compared to general medical patients due to unique risk factors: prolonged immobilization, invasive lines and devices, certain medications, and acquired thrombophilia. Furthermore, VTE in the critically ill is associated with increased duration of mechanical ventilation, increased length of intensive care unit and hospital stay, and a trend toward increased mortality...
August 30, 2018: Journal of Intensive Care Medicine
Audrey De Jong, Daniel Verzilli, Marie Geniez, Gérald Chanques, David Nocca, Samir Jaber
Obesity is often associated with obstructive sleep apnea (OSA), which increases the risk of intraoperative and postoperative complications. The role of preoperative screening of OSA is crucial, with adequate management based on continuous positive pressure before, during and after surgery. The obese patient is at risk of postoperative complications: difficult airway management, acute respiratory failure following extubation due to atelectasis and airway obstruction, added to morphine overdosing. Optimal management of difficult mask ventilation and intubation, protective ventilation, combined to the reduction of sedatives and analgesics and the sitting position as soon as possible with a postoperative monitoring should decrease the occurrence of complications...
May 2018: La Presse Médicale
W Schijns, M J Deenen, E O Aarts, J Homan, I M C Janssen, F J Berends, K A H Kaasjager
BACKGROUND: Morbidly obese patients are at increased risk to develop venous thromboembolism (VTE), especially after bariatric surgery. Adequate postoperative thrombosis prophylaxis is of utmost importance. It is assumed that morbidly obese patients need higher doses of low molecular weight heparin (LMWH) compared to normal-weight patients; however, current guidelines based on relative efficacy in obese populations are lacking. OBJECTIVES: First, we will evaluate the relationship between body weight descriptors and anti-Xa activity prospectively...
July 2018: Obesity Surgery
Hamzeh M Halawani, Charis F Ripley-Hager, Mary C Naglak, Fernando Bonanni, Gintaras Antanavicius
BACKGROUND: Venous thromboembolism (VTE) is a feared complication after bariatric surgery. Biliopancreatic diversion with duodenal switch (BPD-DS) is a complex bariatric procedure that is offered typically to super morbidly obese patients. Scarce data exist in reporting VTE outcome and identifying the risk factors associated with it after BPD-DS. OBJECTIVE: To determine the risk factors for VTE after BPD-DS at 90-day follow-up. SETTING: A nonprofit regional referral center and teaching hospital in Pennsylvania...
December 2017: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Sibylle Kozek-Langenecker, Christian Fenger-Eriksen, Emmanuel Thienpont, Giedrius Barauskas
: The risk for postoperative venous thromboembolism (VTE) is increased in patients aged more than 70 years and in elderly patients presenting with co-morbidities, for example cardiovascular disorders, malignancy or renal insufficiency. Therefore, risk stratification, correction of modifiable risks and sustained perioperative thromboprophylaxis are essential in this patient population. Timing and dosing of pharmacoprophylaxis may be adopted from the non-aged population. Direct oral anti-coagulants are effective and well tolerated in the elderly; statins may not replace pharmacological thromboprophylaxis...
February 2018: European Journal of Anaesthesiology
Young R Lee, Delilah D Blanco
To determine the efficacy of standard dose unfractionated heparin (UFH) for venous thromboembolism (VTE) prophylaxis in critically ill morbidly obese patients. Retrospective single-center observational cohort study in a single tertiary teaching hospital intensive care units (ICUs) in Multiparameter Intelligent Monitoring in Intensive Care II Clinical Database. Patients 18 years or older, admitted to the ICU, and received either UFH 5000 units subcutaneously twice daily or UFH 5000 units three times daily for VTE prophylaxis between 2001 and 2008 were included...
October 2017: Journal of Thrombosis and Thrombolysis
Nouf Al Otaib, Zohour Bootah, Maha A Al Ammari, Tariq M Aldebasi, Abdulmalik M Alkatheri, Shmeylan A Al Harbi, Salah M AbuRuz, Abdulkareem M AlBekairy
BACKGROUND: Venous thromboembolism (VTE) can be encountered by 60% of hospitalized patients. Anticoagulants have been recommended to reduce the risk of VTE in patients with risk factors. However, no specific dosing recommendations for obese patients are provided in the current practice guidelines. The purpose of this study was to determine the efficacy and safety of weight-based dosing of enoxaparin for VTE prophylaxis among morbidly obese patients undergoing surgery. METHODS: Adult patients were enrolled if they have a body mass index (BMI) of ≥35 kg/m2 and were scheduled for surgery...
July 2017: Annals of Thoracic Medicine
Alexander M Friedman, Cande V Ananth
Venous thromboembolism (VTE) is a leading cause of severe maternal morbidity and mortality. While pregnancy alone is a risk factor for VTE, additional population-based risk factors such as obesity are becoming increasingly common, particularly in the developed world. Maternal death from VTE is amenable to prevention and VTE thromboprophylaxis is the most readily implementable means of systematically reducing the maternal death rate. In the United States, prophylaxis is recommended primarily for patients at extremely high risk for thromboembolism and women undergoing cesarean delivery, whereas in the United Kingdom a larger proportion of the population is targeted...
March 2016: Seminars in Perinatology
Michael B Streiff, Bjorn Holmstrom, Aneel Ashrani, Paula L Bockenstedt, Carolyn Chesney, Charles Eby, John Fanikos, Randolph B Fenninger, Annemarie E Fogerty, Shuwei Gao, Samuel Z Goldhaber, Paul Hendrie, Nicole Kuderer, Alfred Lee, Jason T Lee, Mirjana Lovrincevic, Michael M Millenson, Anne T Neff, Thomas L Ortel, Rita Paschal, Sanford Shattil, Tanya Siddiqi, Kristi J Smock, Gerald Soff, Tzu-Fei Wang, Gary C Yee, Anaadriana Zakarija, Nicole McMillian, Anita M Engh
The NCCN Guidelines for Cancer-Associated Venous Thromboembolic Disease outline strategies for treatment and prevention of venous thromboembolism (VTE) in adult patients with a diagnosis of cancer or for whom cancer is clinically suspected. VTE is a common complication in patients with cancer, which places them at greater risk for morbidity and mortality. Therefore, risk-appropriate prophylaxis is an essential component for the optimal care of inpatients and outpatients with cancer. Critical to meeting this goal is ensuring that patients get the most effective medication in the correct dose...
September 2015: Journal of the National Comprehensive Cancer Network: JNCCN
Matthew A Bartlett, Karen F Mauck, Paul R Daniels
Bariatric surgical procedures are now a common method of obesity treatment with established effectiveness. Venous thromboembolism (VTE) events, which include deep vein thrombosis and pulmonary embolism, are an important source of postoperative morbidity and mortality among bariatric surgery patients. Due to an understanding of the frequency and seriousness of these complications, bariatric surgery patients typically receive some method of VTE prophylaxis with lower extremity compression, pharmacologic prophylaxis, or both...
2015: Vascular Health and Risk Management
Aaron M Potretzke, Kelvin S Wong, Fangfang Shi, William Christensen, Tracy M Downs, E Jason Abel
CONTEXT: Venous thromboembolism (VTE) is a common cause of postoperative morbidity and mortality in cystectomy patients. AIMS: The aim of this study is to identify variables associated with risk of developing deep venous thrombosis (DVT) or pulmonary embolism (PE) within 90 days after radical cystectomy (RC). SETTING AND DESIGN: Retrospective chart review of patients undergoing RC from 2004 to 2011 at the University of Wisconsin. SUBJECTS AND METHODS: Clinical variables collected for all RC patients...
July 2015: Urology Annals
Lily Wang, Aurora D Pryor, Maria S Altieri, Jamie L Romeiser, Mark A Talamini, Laurie Shroyer, Dana A Telem
BACKGROUND: The increasing prevalence of obesity translates into a greater number of obese patients undergoing general surgery procedures. We questioned if increased awareness and recent prophylaxis guidelines impacted the incidence of venous thromboembolism (VTE) in the obese patients. METHODS: A total of 33,325 patients who underwent 4 common general surgery procedures from 2005 to 2009 were identified from the American College of Surgeons' National Surgical Quality Improvement Program database...
November 2015: American Journal of Surgery
Jeremy W Vandiver, Leticia I Ritz, Jeffrey T Lalama
Pharmacologic prophylaxis of deep vein thrombosis and venous thromboembolism (VTE) is an important aspect of medical care, particularly in the inpatient setting. Low-molecular weight heparins, heparin, and fondaparinux are commonly used agents to prevent VTE, each of which has well established dosing regimens in patients with normal body mass index. Dosing of these medications in morbidly obese populations (BMI > 40 kg/m(2)) is not as clearly defined in guidelines. This article reviews published data to support specific dosing regimens and monitoring strategies of these agents in this population...
April 2016: Journal of Thrombosis and Thrombolysis
S Vollans, A Chaturvedi, K Sivasankaran, T Madhu, Y Hadland, V Allgar, H K Sharma
INTRODUCTION: Venous thromboembolism (VTE) is a significant cause of morbidity and mortality following tibial fractures. The risk is as high as 77% without prophylaxis and around 10% with prophylaxis. Within the current literature there are no figures reported specifically for those individuals treated with circular frames. Our aim was to evaluate the VTE incidence within a single surgeon series and to evaluate potential risk factors. METHODS: We retrospectively reviewed our consecutive single surgeon series of 177 patients admitted to a major trauma unit with tibial fractures...
2015: Injury
Ivy N Haskins, Richard Amdur, Babak Sarani, Khashayar Vaziri
BACKGROUND: Venous thromboembolism (VTE) is a major complication of bariatric surgery leading to significant morbidity and mortality. We sought to identify predictive factors that increase the risk of deep venous thrombosis (DVT) and pulmonary embolism (PE) using data from the National Surgical Quality Improvement Program (NSQIP). METHODS: Patients undergoing bariatric procedures from 2005-2012 were identified in the NSQIP database. Pretreatment patient characteristics were examined by laparoscopic and open treatment groups using t tests and chi-square regression...
September 2015: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Jie Zhang, Zhihao Chen, Jilin Zheng, Steffen J Breusch, Jing Tian
INTRODUCTION: Venous thromboembolism (VTE) is a common complication after total hip arthroplasty (THA) or total knee arthroplasty (TKA) and may be the cause for a secondary PE and associated morbidity/mortality. We performed a systematic literature review of risk factors and risk reduction of VTE after THA or TKA. MATERIALS AND METHODS: A systematic search of PubMed database, the Cochrane Library, OVID MEDLINE and American Academy of Orthopaedic Surgeons (AAOS), without restriction of publication data and language, was conducted...
June 2015: Archives of Orthopaedic and Trauma Surgery
Benjamin R Bell, Pascal E Bastien, James D Douketis
PURPOSE: To review the evidence surrounding appropriate prophylaxis for venous thromboembolism (VTE) in patients undergoing surgery. PRINCIPAL FINDINGS: Appropriate prophylactic strategies for surgical patients have been defined in major society guidelines. We review the evidence behind these guidelines in a case-based format, including patients with a high risk of bleeding, history of heparin-induced thrombocytopenia, obesity, and cancer. Selecting the most suitable means for VTE prophylaxis includes evaluating patient, anesthetic, and surgical factors...
February 2015: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Alexander M Friedman, Cande V Ananth, Eri Prendergast, Suneet P Chauhan, Mary E D'Alton, Jason D Wright
OBJECTIVE: Although major international guidelines recommend venous thromboembolism (VTE) prophylaxis during vaginal delivery hospitalization for women with additional risk factors, US guidelines recommend prophylaxis for a very small number of women who are at particularly high risk for an event. The purpose of this study was to characterize practice patterns of VTE prophylaxis in the United States during vaginal delivery hospitalizations and to determine VTE incidence in this population...
February 2015: American Journal of Obstetrics and Gynecology
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