Thrombotic and hemorrhagic risk in bariatric surgery with multimodal rehabilitation programs comparing 2 reduced guidelines for pharmacological prophylaxis

Calzada, Manuel; Matías, Alberto Hernández; Madriz, Alejandro Andonaegui de la; Ledesma, Raquel León; Rizo, Laura Alonso-Lambertí; Carrasco, Andrea Salazar; Adana, Juan Carlos Ruíz de; Navalón, José María Jover

doi:10.1016/j.cireng.2021.03.020

Cited by 5 publications

(6 citation statements)

References 15 publications

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“…The PRISMA diagram (Fig. 1 ) shows that of 3066 retrieved articles, 87 were included in the review [ 5 , 6 , 9 , 10 , 14 – 17 , 24 – 102 ], of which 68 were meta-analyzed. The studies excluded at full text and their reasons, as well as the included studies, and their subgroupings are available in Supplementary File 2.…”

Section: Resultsmentioning

confidence: 99%

“…The literature has shown wide variations in the incidence of VTE after MBS [ 7 , 8 ]. For instance, previous studies have reported 30-day incidences ranging from 0 to 5.66% [ 9 , 10 ]. Although the number of meta-analyses on many MBS topics continues to increase [ 11 – 13 ], there are no systematic reviews/meta-analyses of the incidence of VTE after MBS.…”

Section: Introductionmentioning

confidence: 99%

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Cumulative Incidence of Venous Thromboembolic Events In-Hospital, and at 1, 3, 6, and 12 Months After Metabolic and Bariatric Surgery: Systematic Review of 87 Studies and Meta-analysis of 2,731,797 Patients

El Ansari,

El-Menyar,

El-Ansari

et al. 2024

OBES SURG

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Systematic review/meta-analysis of cumulative incidences of venous thromboembolic events (VTE) after metabolic and bariatric surgery (MBS). Electronic databases were searched for original studies. Proportional meta-analysis assessed cumulative VTE incidences. (PROSPERO ID:CRD42020184529). A total of 3066 records, and 87 studies were included (N patients = 4,991,683). Pooled in-hospital VTE of mainly laparoscopic studies = 0.15% (95% CI = 0.13–0.18%); pooled cumulative incidence increased to 0.50% (95% CI = 0.33–0.70%); 0.51% (95% CI = 0.38–0.65%); 0.72% (95% CI = 0.13–1.52%); 0.78% (95% CI = 0–3.49%) at 30 days and 3, 6, and 12 months, respectively. Studies using predominantly open approach exhibited higher incidence than laparoscopic studies. Within the first month, 60% of VTE occurred after discharge. North American and earlier studies had higher incidence than non-North American and more recent studies. This study is the first to generate detailed estimates of the incidence and patterns of VTE after MBS over time. The incidence of VTE after MBS is low. Improved estimates and time variations of VTE require longer-term designs, non-aggregated reporting of characteristics, and must consider many factors and the use of data registries. Extended surveillance of VTE after MBS is required. Graphical Abstract

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cumulative Incidence of Venous Thromboembolic Events In-Hospital, and at 1, 3, 6, and 12 Months After Metabolic and Bariatric Surgery: Systematic Review of 87 Studies and Meta-analysis of 2,731,797 Patients

El Ansari,

El-Menyar,

El-Ansari

et al. 2024

OBES SURG

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“…The results showed no DVT or PE and 32 incidences of hemorrhage (4.7%), 15 in the fondaparinux group and 17 in the enoxaparin group ( P = .588). 44 The reported rates of VTE, following bariatric surgery are generally in the range of 0.3%–2.2%. In the bariatric surgery population, PE is a frequent cause of postoperative mortality and is a common finding at autopsy.…”

Section: Recent Advances In the Use Of Fondaparinux Sodiummentioning

confidence: 99%

Fondaparinux Sodium: Recent Advances in the Management of Thrombosis

Bauersachs

2023

J Cardiovasc Pharmacol Ther

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Fondaparinux sodium is a chemically synthesized selective factor Xa inhibitor approved for the prevention and treatment of venous thromboembolic events, that is, deep vein thrombosis, pulmonary embolism, and superficial vein thrombosis, in acutely ill (including those affected by COVID-19 or cancer patients) and those undergoing surgeries. Since its approval in 2002, the efficacy and safety of fondaparinux is well demonstrated by many clinical studies, establishing the value of fondaparinux in clinical practice. Some of the advantages with fondaparinux are its chemical nature of synthesis, minimal risk of contamination, 100% absolute bioavailability subcutaneously, instant onset of action, a long half-life, direct renal excretion, fewer adverse reactions when compared with direct oral anticoagulants, and being an ideal alternative in conditions where oral anticoagulants are not approved for use or in patients intolerant to low molecular weight heparins (LMWH). In the last decade, the real-world use of fondaparinux has been explored in other conditions such as acute coronary syndromes, bariatric surgery, in patients developing vaccine-induced immune thrombotic thrombocytopenia (VITT) and in pregnant women with heparin-induced thrombocytopenia (HIT), or those intolerant to LMWH. The emerging data from these studies have culminated in recent updates in the guidelines that recommend the use of fondaparinux under various conditions. This paper aims to review the recent data and the subsequent updates in the recommendations of various guidelines on the use of fondaparinux sodium.

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“…The escalating prevalence of obesity corresponds with an increment in metabolic surgeries, necessitating a rise in perioperative complications, including bleeding [1]. Managing bleeding and preventing venous thromboembolic (VTE) instances are significant challenges in metabolic surgery [2,3]. Around 3% of obese cases subjected to laparoscopic sleeve gastrectomy (LSG) experience bleeding occurrences after surgery [4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

The Role of Tranexamic Acid in Sleeve Gastrectomy: A Systematic Review and Meta-Analysis

Al-Juhani,

Sharaf,

Aseri

et al. 2024

Cureus

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Tranexamic acid (TXA) is an essential procoagulant drug used in various intra- and postoperative situations. Its efficacy and safety profile in obese cases undergoing laparoscopic sleeve gastrectomy (LSG) is still unresolved. Therefore, this meta-analysis evaluated and investigated the current intra- and postoperative effects and hazards of TXA on patients undergoing LSG. As for methodology, Web of Science, Cochrane Library, Scopus, and PubMed were thoroughly searched for relevant studies. Retrieved results were prepared for screening through Endnote, helping to identify eligible studies. Relevant patient characteristics and outcomes were extracted. The methodological quality of the relevant studies was appraised using the respected appraisal tool. Six studies of different designs were enrolled, comprising 753 cases that underwent LSG and administered TXA. Their mean BMI and age went from 37.3 to 56.25 kg/m 2 and 33.5 to 43.25 years, respectively. Tranexamic acid significantly linked to reduction in intraoperative bleeding instances, operative blood loss, and operative duration, compared to placebo ((RR = 0.66, 95% CI [0.44, 0.98], P=0.04, I 2 = 81%); (MD = -39.64, 95%CI [-75.49, -3.78], P=0.03, I 2 =94%); (MD=-5.84, 95%CI [-9.62, -2.05], P=0.003, I 2 =73%)). Tranexamic acid also significantly showed superiority regarding postoperative bleeding events and duration of hospitalization compared to the control group ((RR= 0.45, 95%CI [0.29, 0.69], P=0.0002, I 2 =0%); (MD=-0.24, 95%CI [-0.32, -0.17], P< 0.0000, I 2 =0%)). Moreover, follow-up of the enrolled patients for a minimum of three to six months resulted in no reported thromboembolic instances, suggesting a negligible risk for thromboembolism among patients undergoing LSG and receiving TXA. In conclusion, tranexamic acid demonstrates a robust safety and efficacy profile for its use in patients undergoing LSG, with no reported instances of thromboembolism. Variations in TXA administration regimens, bleeding definitions, procedural techniques, and potential confounding medications could not be accounted for, necessitating additional large-scale RCTs to address and bridge knowledge gaps.

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Thrombotic and hemorrhagic risk in bariatric surgery with multimodal rehabilitation programs comparing 2 reduced guidelines for pharmacological prophylaxis

Cited by 5 publications

References 15 publications

Cumulative Incidence of Venous Thromboembolic Events In-Hospital, and at 1, 3, 6, and 12 Months After Metabolic and Bariatric Surgery: Systematic Review of 87 Studies and Meta-analysis of 2,731,797 Patients

Cumulative Incidence of Venous Thromboembolic Events In-Hospital, and at 1, 3, 6, and 12 Months After Metabolic and Bariatric Surgery: Systematic Review of 87 Studies and Meta-analysis of 2,731,797 Patients

Fondaparinux Sodium: Recent Advances in the Management of Thrombosis

The Role of Tranexamic Acid in Sleeve Gastrectomy: A Systematic Review and Meta-Analysis

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