Heparin Thromboprophylaxis in Gastric Bypass Surgery

Abstract

Use of a monitored, adjusted-dose unfractionated heparin prophylactic protocol in a laparoscopic gastric bypass patient population resulted in doses greater than those used in traditional fixed-dose protocols. However, bleeding and thromboembolism rates were very low and no patients died.

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

“…Many studies [172,178] also in bariatric surgery [179] have compared low molecular weight heparins (LMWH) with unfractionated heparin (UFH), without demonstrating any difference in efficiency or adverse events.…”

Evaluation of Unfractionated Heparin Dosing for Thromboprophylaxis using Anti-Xa Levels in Obese Critically Ill Patients: A Retrospective Study

“…While UFH is one of the most frequently used thromboprophylaxis in intensive care units, there is no defined therapeutic range for Anti-Xa level for this purpose. Previous study, however, had suggested that therapeutic anti-Xa levels obtained approximately 4 to 5 h after the third or fourth subcutaneous dose of UFH at 0.11-0.25 U/mL may be effective for thromboprophylaxis [10]. Our study attempted to correlate the current UFH dosing regimen (5,000 units given subcutaneously every 8 hours) with Anti-Xa levels drawn after the third dose.…”

“…Current practice of administering fixed subcutaneous heparin dosing every 8 to 12 h may be suboptimal among patients given that the pharmacokinetics of heparin depends on several patient variables, including the thickness of the adipose tissue layer [10]. While UFH is one of the most frequently used thromboprophylaxis in intensive care units, there is no defined therapeutic range for Anti-Xa level for this purpose.…”

“…Limited data are available on the effectiveness on the correlation between UFH dosing and laboratory values (such as Anti-Xa levels) as well as its effectiveness in preventing thromboembolic events among obese, critically ill patients. The suggested fixed UFH dosing of 5,000 units every 8 to 12 h subcutaneously may be suboptimal in this patient subgroup as heparin pharmacokinetics depends on a number of patient variables, including thickness of the adipose tissue layer [10]. Monitoring Anti-Xa levels may provide more appropriate therapeutic goal of heparin thromboprophylaxis, especially in severe obesity, in unexpected bleeding complications secondary to anticoagulation with use of UFH, in renal failure, and in pregnant patients in whom UFH are used for treatment or prevention of thrombosis [11,12].…”

TEMA 4-2014: Anestesia y Cirugía Bariátrica: Más Que Obesidad

“…La dosificación de la heparina según el peso actual del paciente puede sobreestimar las necesidades, sin embargo las dosis fijas suelen ser insuficientes para algunos pacientes. Scholtem y colaboradores demostraron que 40 mg subcutáneos de enoxaparina dos veces al día son efectivos para prevenir trombosis venosa profunda sin aumentar el riesgo de sangrado, sin embargo Hamada recomienda calcular la dosis de enoxaparina a 1.5 mg/kg una vez al día o 1 mg/kg dos veces al día, la terapia debe continuarse 2 a 4 semanas (14,15) .…”