Moaad Farraj, Zakhar Bramnik, Anton Kvasha, Moner Merie, Wisam Sbeit, Safy Farraj, Igor Waksman
General Surgery B, Galilee Medical Center, Rama Village, Upper Galilee, POB-379, 30055, Nahariya, Israel.
Obes Surg. 2017 Sep;27(9):2331-2337. doi: 10.1007/s11695-017-2638-1.
The objective of this study was to evaluate the coagulation profile by thromboelastography in morbidly obese patients who undergo bariatric surgery. Morbid obesity entails increased risk for thromboembolic events. There is no clear protocol for thromboembolic prophylaxis, regarding timing and length of treatment, in bariatric surgery. Thromboelastography provides data on a coagulation process from creation of the clot until the fibrinolysis.
Ninety-three morbidly obese patients were prospectively recruited within a 2-year period. Coagulation profile was measured by thromboelastography before surgery, in the immediate postoperative period, within 3 h from surgery, and in the late postoperative period, within 10-14 days after surgery. Venous thromboembolic prophylaxis was achieved by giving low molecular weight heparin (LMWH), once a day.
Of the eligible patients, 67 underwent sleeve gastrectomy while 23 underwent Roux-en-Y gastric bypass. Normal values of coagulation factor function, clotting time, and fibrin function, as measured by R, K, and α (angle), were demonstrated in addition to higher maximal amplitude (MA) values, reflecting increased function of platelets. The average MA value before the surgery was above normal and continued rising consistently in the immediate postoperative as well as in the early postoperative period.
Morbidly obese patients have a strong tendency toward thrombosis, as demonstrated by pathologically elevated MA values. Altered coagulation profiles were demonstrated 2 weeks postoperatively; thus, prophylaxis that continued at least for 2 weeks after bariatric surgery should be considered. Since LMW heparin is not sufficient alone as thromboembolic prophylaxis, we recommend adding antiplatelet therapy. Further evaluation of appropriate thromboprophylaxis is warranted.
本研究的目的是通过血栓弹力图评估接受减重手术的病态肥胖患者的凝血情况。病态肥胖会增加血栓栓塞事件的风险。在减重手术中，关于血栓栓塞预防的时机和治疗时长，尚无明确的方案。血栓弹力图可提供从血栓形成到纤维蛋白溶解的凝血过程数据。
在2年时间内前瞻性招募了93例病态肥胖患者。在手术前、术后即刻（手术3小时内）以及术后晚期（术后10 - 14天）通过血栓弹力图测量凝血情况。通过每天给予低分子量肝素（LMWH）进行静脉血栓栓塞预防。
在符合条件的患者中，67例行袖状胃切除术，23例行Roux - en - Y胃旁路术。除了反映血小板功能增强的较高最大振幅（MA）值外，通过R、K和α（角度）测量的凝血因子功能、凝血时间和纤维蛋白功能的正常值也得到了证实。手术前的平均MA值高于正常水平，在术后即刻和术后早期持续持续上升。
病态肥胖患者有强烈的血栓形成倾向，MA值病理性升高证明了这一点。术后2周出现了凝血情况的改变；因此，应考虑在减重手术后至少持续2周的预防措施。由于单独使用低分子量肝素作为血栓栓塞预防不足，我们建议添加抗血小板治疗。有必要对适当的血栓预防进行进一步评估。
