Assessment of empiric body mass index-based thromboprophylactic dosing of enoxaparin after bariatric surgery: evidence for dosage adjustment using anti-factor Xa in high-risk patients

被引:8
作者
Karas, Linden A. [1 ,2 ]
Hanipah, Zubaidah Nor [1 ,3 ]
Cetin, Derrick [1 ]
Schauer, Philip R. [1 ,4 ]
Brethauer, Stacy A. [1 ,5 ]
Daigle, Christopher R. [1 ,6 ]
Aminian, Ali [1 ]
机构
[1] Cleveland Clin, Dept Gen Surg, Bariatr & Metab Inst, Cleveland, OH 44195 USA
[2] Avita Hlth Syst, Dept Surg, Galion, OH USA
[3] Univ Putra Malaysia, Fac Med & Hlth Sci, Dept Surg, Seri Kembangan, Selangor, Malaysia
[4] Pennington Biomed Res Ctr, 6400 Perkins Rd, Baton Rouge, LA 70808 USA
[5] Ohio State Univ, Dept Surg, Wexner Med Ctr, Columbus, OH 43210 USA
[6] Cleveland Clin Akron Gen, Bariatr Ctr, Akron, OH USA
关键词
Bariatric surgery; Body mass index; Deep vein thrombosis; Pulmonary embolism; Thromboembolism; Prophylaxis; Antifactor Xa; Enoxaparin; Heparin; Low molecular weight heparin;
D O I
10.1016/j.soard.2020.08.016
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Despite thromboprophylaxis, postoperative deep vein thrombosis and pulmonary embolism occur after bariatric surgery, perhaps because of failure to achieve optimal prophylactic levels in the obese population. Objectives: The aim of this study was to evaluate the adequacy of prophylactic dosing of enoxaparin in patients with severe obesity by performing an antifactor Xa (AFXa) assay. Setting: An academic medical center Methods: In this observational study, all bariatric surgery cases at an academic center between December 2016 and April 2017 who empirically received prophylactic enoxaparin (adjusted by body mass index [BMI] threshold of 50 kg/m(2)) were studied. The AFXa was measured 3-5 hours after the second dose of enoxaparin. Results: A total of 105 patients were included; 85% were female with a median age of 47 years. In total, 16 patients (15.2%) had AFXa levels outside the prophylactic range: 4 (3.8%) cases were in the subprophylactic and 12 (11.4%) cases were in the supraprophylactic range. Seventy patients had a BMI <50 kg/m2 and empirically received enoxaparin 40 mg every 12 hours; AFXa was subprophylactic in 4 (5.7%) and supraprophylactic in 6 (8.6%) of these patients. Of the 35 patients with a BMI >= 50 who empirically received enoxaparin 60 mg q12h, no AFXa was subprophylactic and 6 (17.1%) were supraprophylactic. Five patients (4.8%) had major bleeding complications. One patient developed pulmonary embolism on postoperative day 35. Conclusion: BMI-based thromboprophylactic dosing of enoxaparin after bariatric surgery could be suboptimal in 15% of patients with obesity. Overdosing of prophylactic enoxaparin can occur more commonly than underdosing. AFXa testing can be a practical way to measure adequacy of pharmacologic thromboprophylaxis, especially in patients who are at higher risk for venous thromboembolism or bleeding. (C) 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
引用
收藏
页码:153 / 160
页数:8
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