Weight‐adjusted tinzaparin for the prevention of venous thromboembolism after bariatric surgery

Tseng, Eric; Kolesar, Emma; Handa, Pankaj; Douketis, James D.; Anvari, Mehran; Tiboni, Maria; Crowther, Mark; Siegal, Deborah

doi:10.1111/jth.14263

Cited by 16 publications

(6 citation statements)

References 29 publications

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“…26 A single, large study on tinzaparin retrospectively included 1,212 bariatric patients with a median BMI of 47.9kg/m 2 . 27 Low bleeding and VTE rates were observed with weight-based dosing of 75 IU/kg, and anti-Xa measurements showed no signs of accumulation. Notably, the utilized dose was higher than the recommended according to the product information (50 IU/kg).…”

Section: Prophylaxis In Bariatric Surgerymentioning

confidence: 95%

Dosage of Anticoagulants in Obesity: Recommendations Based on a Systematic Review

Abildgaard

Madsen

Hvas

2020

Semin Thromb Hemost

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Anticoagulants are frequently used as thromboprophylaxis and in patients with atrial fibrillation (AF) or venous thromboembolism (VTE). While obesity rates are reaching epidemic proportions worldwide, the optimal dosage for obese patients has not been established for most anticoagulants, including low-molecular-weight heparin (LMWH), non–vitamin K antagonist oral anticoagulants (NOAC), and pentasaccharides (fondaparinux). The aim of the present systematic review was to summarize the current knowledge and provide recommendations on dosage of LMWH, NOAC, and fondaparinux in obese patients (body mass index [BMI] ≥ 30 kg/m2 or body weight ≥ 100 kg). Based on a systematic search in PubMed and Embase, a total of 72 studies were identified. For thromboprophylaxis with LMWH in bariatric surgery (n = 20 studies), enoxaparin 40 mg twice daily, dalteparin 5,000 IE twice daily, or tinzaparin 75 IU/kg once daily should be considered for patients with BMI ≥ 40 kg/m2. For thromboprophylaxis with LMWH in nonbariatric surgery and in medical inpatients (n = 8 studies), enoxaparin 0.5 mg/kg once or twice daily or tinzaparin 75 IU/kg once daily may be considered in obese patients. For treatment with LMWH (n = 18 studies), a reduced weight-based dose of enoxaparin 0.8 mg/kg twice daily should be considered in patients with BMI ≥ 40 kg/m2, and no dose capping of dalteparin and tinzaparin should be applied for body weight < 140 kg. As regards NOAC, rivaroxaban, apixaban, or dabigatran may be used as thromboprophylaxis in patients with BMI < 40 kg/m2 (n = 4 studies), whereas rivaroxaban and apixaban may be administered to obese patients with VTE or AF, including BMI > 40 kg/m2, at standard fixed-dose (n = 20 studies). The limited available evidence on fondaparinux (n = 3 studies) indicated that the treatment dose should be increased to 10 mg once daily in patients weighing > 100 kg.

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Section: Prophylaxis In Bariatric Surgerymentioning

confidence: 95%

Dosage of Anticoagulants in Obesity: Recommendations Based on a Systematic Review

Abildgaard

Madsen

Hvas

2020

Semin Thromb Hemost

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“…In one prospective study, the rate of postoperative VTE and bleeding was 0% for 735 patients who underwent bariatric surgery and received extended duration (1-3 wk) thromboprophylaxis with LMWH [16]. Similarly, Tseng et al [6], in a retrospective study of 817 patients, reported a 0.5% rate of postoperative VTE in those managed with extended duration (10 days) of tinzaparin.…”

Section: Discussionmentioning

confidence: 94%

“…Obesity is an independent risk factor for VTE; a body mass index (BMI) ≥30 kg/m 2 has been shown to increase the VTE risk 2-fold [5]. The reported postoperative incidence of VTE after bariatric surgery, however, varies widely, from 0.2 to 5% [1,6]. Similarly, the rate of bleeding after surgery varies from 0% to 6% [7].…”

Section: Introductionmentioning

confidence: 99%

Thromboprophylaxis after bariatric surgery

et al. 2020

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BackgroundVenous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a known cause of morbidity and mortality after bariatric surgery. However, the data concerning appropriate thromboprophylaxis after bariatric surgery is uncertain. The objective of this study was to evaluate the efficacy and safety of extended duration thromboprophylaxis in post-bariatric surgery patients. MethodsWe conducted a retrospective study of consecutive patients who underwent bariatric surgery from November 2014 to October 2018 at King Fahad General Hospital in Jeddah, Saudi Arabia. All included patients were treated with extended duration thromboprophylaxis. ResultsWe identified 374 patients who underwent bariatric surgery during the study period. Of these, 312 patients (83%) were followed for at least 3 months. The most common type of surgery was a laparoscopic sleeve gastrectomy (N=357) and the median weight was 110 kg. The cumulative incidence of symptomatic postoperative VTE at 3 months was 0.64% (95% confidence interval, 0.20-1.52). All events occurred after hospital discharge. The most commonly used pharmacological prophylaxis (91%) for VTE prevention after bariatric surgery was enoxaparin 40 mg subcutaneously twice daily for 10-14 days after hospital discharge. There were no reported cases of bleeding or VTE related mortality after 3 months. ConclusionExtended thromboprophylaxis after bariatric surgery appears to be an effective and safe strategy for VTE prevention. Large prospective studies are needed to evaluate the optimal thromboprophylaxis regimen after bariatric surgery.

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“…VTE: Individuals with obesity are at an increased risk of VTE, though the overall rate following metabolic surgery has been reported to be < 1%[ 127 - 129 ]. A preoperative risk assessment model to stratify candidate by VTE risk was devised by Fink et al [ 130 ] using the following variables: procedure type, patient history of VTE, male sex, BMI, age, and operative time > 3 h. By this scheme, 97% were classified into low-risk groups with a predicted VTE risk of < 1%.…”

Section: Preoperative Evaluation and Optimization Of Pulmonary Functionmentioning

confidence: 99%

Expert opinion on the preoperative medical optimization of adults with diabetes undergoing metabolic surgery

Bhattacharya¹,

Kalra²,

Kapoor³

et al. 2021

WJD

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Diabetes mellitus (DM) and obesity are interrelated in a complex manner, and their coexistence predisposes patients to a plethora of medical problems. Metabolic surgery has evolved as a promising therapeutic option for both conditions. It is recommended that patients, particularly those of Asian origin, maintain a lower body mass index threshold in the presence of uncontrolled DM. However, several comorbidities often accompany these chronic diseases and need to be addressed for successful surgical outcome. Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the most commonly used bariatric procedures worldwide. The bariatric benefits of RYGB and LSG are similar, but emerging evidence indicates that RYGB is more effective than LSG in improving glycemic control and induces higher rates of long-term DM remission. Several scoring systems have been formulated that are utilized to predict the chances of remission. A glycemic target of glycated hemoglobin < 7% is a reasonable goal before surgery. Cardiovascular, pulmonary, gastrointestinal, hepatic, renal, endocrine, nutritional, and psychological optimization of surgical candidates improves perioperative and long-term outcomes. Various guidelines for preoperative care of individuals with obesity have been formulated, but very few specifically focus on the concerns arising from the presence of concomitant DM. It is hoped that this statement will lead to the standardization of presurgical management of individuals with DM undergoing metabolic surgery.

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Weight‐adjusted tinzaparin for the prevention of venous thromboembolism after bariatric surgery

Cited by 16 publications

References 29 publications

Dosage of Anticoagulants in Obesity: Recommendations Based on a Systematic Review

Dosage of Anticoagulants in Obesity: Recommendations Based on a Systematic Review

Thromboprophylaxis after bariatric surgery

Expert opinion on the preoperative medical optimization of adults with diabetes undergoing metabolic surgery

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