Stroh C, Michel N, Luderer D, Wolff S, Lange V, Köckerling F, Knoll C, Manger T
SRH Wald Klinikum Gera, Gera, Germany.
Institute for Quality Assurance in Operative Medicine, Otto-von-Guericke University, Magdeburg, Germany.
Obes Surg. 2016 Nov;26(11):2562-2571. doi: 10.1007/s11695-016-2182-4.
Evidence-based data on optimal approach for prophylaxis of deep venous thrombosis (VTE) and pulmonary embolism (PE) in bariatric operations is discussed. Using antithrombotic prophylaxis, weight adjusted the risk of VTE and its complications have to be balanced with the increased bleeding risk.
Since 2005, the current situation for bariatric surgery has been examined by quality assurance study in Germany. As a prospective multicenter observational study, data on the type, regimen, and time course of VTE prophylaxis were documented. The incidences of clinically diagnosed VTE or PE were derived during the in-hospital course and follow up.
Overall, 31,668 primary bariatric procedures were performed between January 2005 and December 2013. Most performed operations were 3999 gastric banding (GB); 13,722 Roux-en-Y-gastric bypass (RYGBP); and 11,840 sleeve gastrectomies (SG). Gender (p = 0.945), surgical procedure (p = 0.666), or administration of thromboembolic prophylaxis (p = 0.272) had no statistical impact on the DVT incidence. By contrast, BMI (p = 0.116) and the duration of thromboembolic prophylaxis (p = 0.127) did impact the frequency of onset of DVT.
Age, BMI, male gender, and a previous history of VTE are the most important risk factors. The drug of choice for VTE is heparin. LMWH should be given preference over unfractionated heparins due to their improved pharmacological properties, i.e., better bioavailability and longer half-life as well as ease of use. Despite the low incidence of VTE and PE, there is a lack of evidence. Therefore, prospective randomized studies are necessary to determine the optimal VTE prophylaxis for bariatric surgical patients.
讨论了关于肥胖症手术中预防深静脉血栓形成（VTE）和肺栓塞（PE）的最佳方法的循证数据。使用抗血栓预防措施时，体重调整后的VTE风险及其并发症必须与增加的出血风险相平衡。
自2005年以来，通过德国的质量保证研究对肥胖症手术的现状进行了检查。作为一项前瞻性多中心观察性研究，记录了VTE预防的类型、方案和时间过程的数据。在住院期间和随访期间得出临床诊断的VTE或PE的发生率。
总体而言，2005年1月至2013年12月期间共进行了31668例初次肥胖症手术。最常进行的手术是3999例胃束带术（GB）；13722例Roux-en-Y胃旁路术（RYGBP）；以及11840例袖状胃切除术（SG）。性别（p = 0.945）、手术方式（p = 0.666）或血栓栓塞预防措施的使用（p = 0.272）对深静脉血栓形成的发生率没有统计学影响。相比之下，体重指数（p = 0.116）和血栓栓塞预防的持续时间（p = 0.127）确实影响深静脉血栓形成的发病频率。
年龄、体重指数、男性性别和既往VTE病史是最重要的危险因素。VTE首选药物是肝素。由于低分子肝素具有更好的药理学特性，即更好的生物利用度、更长的半衰期以及使用方便，因此应优先于普通肝素使用。尽管VTE和PE的发生率较低，但缺乏证据。因此，需要进行前瞻性随机研究以确定肥胖症手术患者的最佳VTE预防措施。
