Kothari Shanu N, Lambert Pamela J, Mathiason Michelle A
Department of Minimally Invasive Bariatric Surgery, Gundersen Lutheran Medical Foundation, Gundersen Lutheran Health System, 1900 South Ave, La Crosse, WI 54601, USA.
Am J Surg. 2007 Dec;194(6):709-11. doi: 10.1016/j.amjsurg.2007.08.018.
We prospectively evaluated 30-day thromboembolic and bleeding events in 2 groups of laparoscopic gastric bypass patients receiving different anticoagulation regimens.
The first cohort of patients received enoxaparin 40 mg subcutaneously preoperatively, 40 mg subcutaneously on postoperative day 0, and twice daily until discharge. The second cohort of patients received unfractionated heparin 5,000 units subcutaneously preoperatively, nothing on postoperative day 0, and 5,000 units 3 times per day until discharge.
The incidence of deep venous thrombosis in both cohorts was 0. There was 1 pulmonary embolism in the heparin cohort (P = .999). Fourteen patients (5.9%) in the enoxaparin cohort required postoperative transfusions compared with 3 patients (1.3%) in the heparin cohort (P = .011). Four patients (1.7%) in the enoxaparin cohort required re-exploration for bleeding.
Both enoxaparin and heparin are effective at preventing thromboembolic events following laparoscopic gastric bypass. Heparin is the preferred agent due to the excessive bleeding complications encountered with enoxaparin.
我们前瞻性评估了两组接受不同抗凝方案的腹腔镜胃旁路手术患者的30天血栓栓塞和出血事件。
第一组患者术前皮下注射依诺肝素40mg，术后第0天皮下注射40mg，然后每天两次直至出院。第二组患者术前皮下注射普通肝素5000单位，术后第0天不注射，然后每天3次，每次5000单位直至出院。
两组深静脉血栓形成的发生率均为0。肝素组有1例肺栓塞（P = 0.999）。依诺肝素组有14例患者（5.9%）术后需要输血，而肝素组有3例患者（1.3%）需要输血（P = 0.011）。依诺肝素组有4例患者（1.7%）因出血需要再次手术探查。
依诺肝素和肝素在预防腹腔镜胃旁路手术后的血栓栓塞事件方面均有效。由于依诺肝素出现过多出血并发症，肝素是首选药物。
