Bartlett Matthew A, Mauck Karen F, Daniels Paul R
Division of General Internal Medicine, Mayo Clinic Thrombophilia Center, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Vasc Health Risk Manag. 2015 Aug 17;11:461-77. doi: 10.2147/VHRM.S73799. eCollection 2015.
Bariatric surgical procedures are now a common method of obesity treatment with established effectiveness. Venous thromboembolism (VTE) events, which include deep vein thrombosis and pulmonary embolism, are an important source of postoperative morbidity and mortality among bariatric surgery patients. Due to an understanding of the frequency and seriousness of these complications, bariatric surgery patients typically receive some method of VTE prophylaxis with lower extremity compression, pharmacologic prophylaxis, or both. However, the optimal approach in these patients is unclear, with multiple open questions. In particular, strategies of adjusted-dose heparins, postdischarge anticoagulant prophylaxis, and the role of vena cava filters have been evaluated, but only to a limited extent. In contrast to other types of operations, the literature regarding VTE prophylaxis in bariatric surgery is notable for a dearth of prospective, randomized clinical trials, and current professional guidelines reflect the uncertainties in this literature. Herein, we summarize the available evidence after systematic review of the literature regarding approaches to VTE prevention in bariatric surgery. Identification of risk factors for VTE in the bariatric surgery population, analysis of the effectiveness of methods used for prophylaxis, and an overview of published guidelines are presented.
减肥手术现在是一种常用的肥胖治疗方法，其有效性已得到确立。静脉血栓栓塞（VTE）事件，包括深静脉血栓形成和肺栓塞，是减肥手术患者术后发病和死亡的重要原因。由于了解这些并发症的发生频率和严重性，减肥手术患者通常会接受某种预防VTE的方法，如下肢加压、药物预防或两者兼用。然而，这些患者的最佳治疗方法尚不清楚，存在多个未解决的问题。特别是，调整剂量肝素的策略、出院后抗凝预防以及腔静脉滤器的作用已得到评估，但程度有限。与其他类型的手术不同，关于减肥手术中VTE预防的文献缺乏前瞻性、随机临床试验，目前的专业指南也反映了该文献中的不确定性。在此，我们在系统回顾有关减肥手术中VTE预防方法的文献后，总结了现有证据。介绍了减肥手术人群中VTE危险因素的识别、预防方法的有效性分析以及已发表指南的概述。
