Weight-adjusted versus fixed dose heparin thromboprophylaxis in hospitalized obese patients: A systematic review and meta-analysis

Ceccato, Davide; Vincenzo, Angelo Di; Pagano, Claudio; Pesavento, Raffaele; Prandoni, Paolo; Vettor, Roberto

doi:10.1016/j.ejim.2021.03.030

Cited by 7 publications

(6 citation statements)

References 28 publications

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“…The American College of Chest Physicians guidelines recommend weight-based rather than fixed dosing in this patient population, 13 although a 2021 meta-analysis did not find a difference in efficacy and safety based on dosing approach for unfractionated and low molecular weight heparin. 14 There is also indirect evidence from orthopaedic surgery patients that the use of aspirin may be appropriate for VTE prophylaxis in nonorthopaedic surgery patients. 13 The need for chemoprophylaxis should be balanced with the risk of postoperative bleeding after TSS.…”

Section: Discussionmentioning

confidence: 99%

Significant Variability in Postoperative Thromboprophylaxis in Cushing's Disease Patients: A Survey of the North American Skull Base Society and the AANS/CNS Joint Tumor Section

White,

Almeida,

Petitt

et al. 2023

J Neurol Surg B Skull Base

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Introduction Cushing's disease (CD) is associated with hypercoagulability which is associated with an increased risk of venous thromboembolic events (VTEs) perioperatively. This risk persists even after successful transsphenoidal surgery (TSS). However, there are no current guidelines for pharmacologic thromboprophylaxis in this patient population. Objective Characterize existing thromboprophylaxis management practices in patients undergoing TSS for CD. Methods An anonymous RedCap survey comprised of questions about perioperative thromboprophylaxis in CD patients was distributed via the American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) Joint Tumor Section and the North American Skull Base Society (NASBS) email lists. Results The survey was distributed to 554 members of the AANS/CNS Joint Tumor Section and 1,094 members of NASBS asking that members who surgically treat CD respond. Sixty responses (3.0% response rate) were received. Fifty-two (86.7%) respondents are involved in the postoperative management of CD patients. Thirty-six (69.2%) treat all patients with postoperative VTE chemoprophylaxis, 8 (15.4%) treat some patients, while 8 (15.4%) do not use chemoprophylaxis. Preferred chemoprophylaxis varies as 26 (59.1%) administer low molecular weight heparin, 14 (31.8%) give unfractionated heparin, 1 (2.3%) give direct oral anticoagulants, and 3 (6.8%) give aspirin. Most (28, 53.8%) of the respondents perceive the VTE risk in this patient population to be 0 to 5%, 16 (30.8%) perceive the risk to be 6 to 10%, and 8 (15.4%) perceive it to be 11 to 20%. Conclusion There is great variability in VTE detection and postoperative prevention practice patterns in CD patients. This study highlights the need for prospective studies to clarify optimal pharmacologic chemoprophylaxis strategies and duration in this patient population.

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Section: Discussionmentioning

confidence: 99%

Significant Variability in Postoperative Thromboprophylaxis in Cushing's Disease Patients: A Survey of the North American Skull Base Society and the AANS/CNS Joint Tumor Section

White,

Almeida,

Petitt

et al. 2023

J Neurol Surg B Skull Base

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“…For patients assigned to rivaroxaban, 10 mg was administered orally once daily. For patients assigned to nadroparin, a weight‐based dosing, rather than fixed dosing, was employed in our center, since weight‐based prophylactic dosing is preferable for patients with extreme body weight 29–32 . Under the guidance of the nadroparin drug specifications, 38 units/kg was subcutaneously administered once daily for 3 days postoperatively, and increased to 57 units/kg once daily from fourth postoperative day until discharge.…”

Section: Methodsmentioning

confidence: 99%

“…For patients assigned to nadroparin, a weight-based dosing, rather than fixed dosing, was employed in our center, since weight-based prophylactic dosing is preferable for patients with extreme body weight. [29][30][31][32] Under the guidance of the nadroparin drug specifications, 38 units/kg was subcutaneously administered once daily for 3 days postoperatively, and increased to 57 units/kg once daily from fourth postoperative day until discharge. The administration of the study drugs started 12-24 h after surgery and continued once daily every 24 h within a window of ±2 h until discharge from the hospital.…”

Section: Random Assignment and Study Interventionsmentioning

confidence: 99%

Rivaroxaban versus nadroparin for thromboprophylaxis following thoracic surgery for lung cancer: A randomized, noninferiority trial

et al. 2023

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The benefit of rivaroxaban in thromboprophylaxis after oncologic lung surgery remains unknown. To evaluate the efficacy and safety of rivaroxaban, patients who underwent thoracic surgery for lung cancer were enrolled, and randomly assigned to rivaroxaban or nadroparin groups in a 1:1 ratio; anticoagulants were initiated 12–24 h after surgery and continued until discharge. Four hundred participants were required according to a noninferiority margin of 2%, assuming venous thromboembolism (VTE) occurrence rates of 6.0% and 12.6% for patients in the rivaroxaban and nadroparin groups, respectively. The primary efficacy outcome was any VTE during the treatment and 30‐day follow‐up periods. The safety outcome was any on‐treatment bleeding event. Finally, 403 patients were randomized (intention‐to‐treat [ITT] population), with 381 included in per‐protocol (PP) population. The primary efficacy outcomes occurred in 12.5% (25/200) of the rivaroxaban group and 17.7% (36/203) of the nadroparin group (absolute risk reduction, −5.2%; 95% confidence interval [CI], [−12.2–1.7]), indicating the noninferiority of rivaroxaban in ITT population. Sensitivity analysis was performed in the PP population and yielded similar results, confirming the noninferiority of rivaroxaban. In the safety analysis population, the incidence of any on‐treatment bleeding events did not differ significantly between the groups (12.2% for rivaroxaban vs. 7.0% for nadroparin; relative risk [RR], 1.9; 95% CI, [0.9–3.7]; p = .08), including major bleeding (9.7% vs. 6.5%; RR, 1.6 [95% CI, 0.9–3.7]; p = .24), and nonmajor bleeding (2.6% vs. 0.5%; RR, 5.2 [95% CI, 0.6–45.2]; p = .13). Rivaroxaban for thromboprophylaxis after oncologic lung surgery was shown to be noninferior to nadroparin.

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“…Some authors have shown that weight-adjusted doses as compared to fixed-doses of heparins in the prevention of VTE in obese patients was not associated with a lower risk of VTE nor a higher risk of bleeding. 41 Others found that bleeding complications were significantly higher for patients in the high-dose group. 42,43 Among the 3928 obese inpatients (weight >100 kg and BMI !40 kg m À2 ), Wang showed that high-dose thromboprophylaxis approximately halved the odds of symptomatic VTE.…”

Section: Adjusted Dosementioning

confidence: 98%

European guidelines on peri-operative venous thromboembolism prophylaxis: first update.

Arcelus,

Gouin-Thibault,

Samama

2024

European Journal of Anaesthesiology

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Rationale Bariatric surgeryRisk of venous thromboembolism after bariatric surgery The incidence of symptomatic postoperative venous thromboembolism (VTE) ranges between 0.3% and 3% after bariatric surgery, 1,2 and is also increased in patients with obesity after non-bariatric procedures, compared to nonobese patients. 3,4 Almost all bariatric surgery patients are, at least, at moderate risk for VTE. Depending on their characteristics and the surgical procedure, the risk may be higher. 5

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Weight-adjusted versus fixed dose heparin thromboprophylaxis in hospitalized obese patients: A systematic review and meta-analysis

Cited by 7 publications

References 28 publications

Significant Variability in Postoperative Thromboprophylaxis in Cushing's Disease Patients: A Survey of the North American Skull Base Society and the AANS/CNS Joint Tumor Section

Significant Variability in Postoperative Thromboprophylaxis in Cushing's Disease Patients: A Survey of the North American Skull Base Society and the AANS/CNS Joint Tumor Section

Rivaroxaban versus nadroparin for thromboprophylaxis following thoracic surgery for lung cancer: A randomized, noninferiority trial

European guidelines on peri-operative venous thromboembolism prophylaxis: first update.

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