Venous thromboembolism chemoprophylaxis regimens in trauma and surgery patients with obesity: A systematic review
CONCLUSION Weight-based and high fixed-dose chemoprophylaxis regimens achieved target anti-Xa concentrations more frequently than standard fixed-dose regimens but were not associated with a reduction in VTE. Additionally, high fixed-dose approaches are associated with increased bleeding complications. Further evaluation with large randomized trials is warranted in trauma and surgery patients with obesity. LEVEL OF EVIDENCE Systematic review, level III.
In a recent  retrospective analysis in 325 non-valvular atrial fibrillation (NVAF) patients treated with novel oral anticoagulants (NOAC), authors suggested a higher risk of thrombosis in obese/overweight vs. other patients, particularly those treated with dabigatran; and a higher risk of bleeding, particularly related to factor Xa inhibitors (rivaroxaban, apixaban). They proposed that obesity moderated the NOAC effects, differently for different NOACs. However a) the study did not test for moderation [(warfarin vs.
This study aimed to evaluate the risk of venous thromboembolism (VTE), prophylactic use of enoxaparin and clinical outcomes in patients undergoing primary and revisional LAGB procedures. A retrospective study evaluated the prophylactic use of enoxaparin in adult patients who underwent primary and revisional (band and port) LAGB procedures. The incidence of VTE and major bleeding was investigated during a 90-day follow-up period. Descriptive and inferential statistics were used for data analysis. We included 112 and 100 patients who had undergone primary and revisional (24 band procedures and 76 port procedures) LAGB surg...
In this issue of Surgery of Obesity and Related Diseases, Parikh et al. examined the prevalence of undiagnosed thrombophilia in patients seeking laparoscopic sleeve gastrectomy and sought to determine if extended chemoprophylaxis after surgery would reduce the incidence of portomesenteric vein thrombosis (PMVT). The authors performed a retrospective study in which thrombophilia panels were collected on 1075 patients. These patients were then discharged on extended chemoprophylaxis, and PMVT rates and bleeding were recorded.
In this issue of Surgery of Obesity and Related Diseases, *** et al examined the prevalence of undiagnosed thrombophilia in patients seeking laparoscopic sleeve gastrectomy and sought to determine if extended chemophrophylaxis following surgery would reduce the incidence of portomesenteric vein thrombosis (PMVT). The authors performed a retrospective study in which thrombophilia panels were collected on 1,075 patients. These patients were then discharged on extended chemoprophylaxis and PMVT rates and bleeding was recorded.
CONCLUSIONS: Thromboprophylaxis reduces the incidence of VTE in CRC surgical patients but may increase the chances of bleeding. Several risk factors can influence VTE incidence. PMID: 32286764 [PubMed - as supplied by publisher]
CONCLUSIONS: In patients with VTE, the risk for death during anticoagulation was about one third lower in morbidly obese patients than in those with normal weight, independently of the presence of cancer. PMID: 32004553 [PubMed - as supplied by publisher]
Publication date: Available online 22 January 2020Source: Nutrition, Metabolism and Cardiovascular DiseasesAuthor(s): Giuseppe De Luca, Monica Verdoia, Stefano Savonitto, Luca A. Ferri, Luigi Piatti, Daniele Grosseto, Nuccia Morici, Irene Bossi, Paolo Sganzerla, Giovanni Tortorella, Michele Cacucci, Maurizio Ferrario, Ernesto Murena, Girolamo Sibilio, Stefano Tondi, Anna Toso, Sergio Bongioanni, Amelia Ravera, Elena Corrada, Matteo MarianiAbstractBackgroundElderly patients are at increased risk of hemorrhagic and thrombotic complications after an acute coronary syndrome (ACS). Frailty, comorbilities and low body weight hav...
ConclusionTo our knowledge, this is the largest clinical study to date showing that patients with obesity can be effectively and safely treated with a DOAC compared with warfarin for acute VTE. Thus, DOACs should be considered as a reasonable alternative to warfarin for treatment of acute VTE in obese patients.
CONCLUSIONS: We report the first case of a patient with acquired GT due to ITP with FcγRIIa mediated platelet desialylation, independent of platelet activation. Treatment with neuraminidase inhibitor may prevent platelet clearance by anti-αIIb β3 antibodies. PMID: 31869497 [PubMed - as supplied by publisher]
Venous thromboembolism is a cause of morbidity and mortality in hospitalized patients, and morbid obesity increases this risk. Various prophylaxis dosing strategies have been investigated. However, it is unclear if high-fixed dose enoxaparin or high-fixed dose unfractionated heparin thromboprophylaxis is optimal for minimizing the incidence of major bleeding and reducing hospital-acquired venous thromboembolism.