Giannopoulos Spyridon, Kalantar Motamedi Seyed Mohammad, Athanasiadis Dimitrios I, Clapp Benjamin, Lyo Victoria, Ghanem Omar, Edwards Michael, Puzziferri Nancy, Stefanidis Dimitrios
Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Paul Foster School of Medicine, Texas Tech HSC, El Paso, Texas.
Surg Obes Relat Dis. 2023 Aug;19(8):799-807. doi: 10.1016/j.soard.2022.12.038. Epub 2023 Jan 2.
Venous thromboembolism (VTE) is the most common cause of death following metabolic/bariatric surgery (MBS), with most events occurring after discharge. The available evidence on ideal prophylaxis type, dosage, and duration after discharge is limited.
Assess metabolic/bariatric surgeon VTE prophylaxis practices and define existing variability.
Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-accredited centers.
The members of the ASMBS Research Committee developed and administered a web-based survey to MBSAQIP medical directors and ASMBS members to examine the differences in clinical practice regarding the administration of VTE prophylaxis after MBS.
Overall, 264 metabolic/bariatric surgeons (136 medical directors and 128 ASMBS members) participated in the survey. Both mechanical and chemical VTE prophylaxis was used by 97.1% of the participants, knee-high compression devices by 84.7%, enoxaparin (32.4% 40 mg every 24 hours, 22.7% 40 mg every 12 hours, 24.4% adjusted the dose based on body mass index) by 56.5%, and heparin (46.1% 5000 units every 8 hours, 22.6% 5000 units every 12 hours, 20.9% 5000 units once preoperatively) by 38.1%. Most surgeons (81.6%) administered the first dose preoperatively, while the first postoperative dose was given on the evening of surgery by 44% or the next morning by 42.2%. Extended VTE prophylaxis was prescribed for 2 weeks by 38.7% and 4 weeks by 28.9%.
VTE prophylaxis practices vary widely among metabolic/bariatric surgeons. Variability may be related to limited available comparative evidence. Large prospective clinical trials are needed to define optimal practices for VTE risk stratification and prophylaxis in bariatric surgery patients.
静脉血栓栓塞症（VTE）是代谢/减重手术后最常见的死亡原因，大多数事件发生在出院后。关于出院后理想的预防类型、剂量和持续时间的现有证据有限。
评估代谢/减重外科医生的VTE预防措施，并确定存在的差异。
代谢与减重手术认证及质量改进计划（MBSAQIP）认证的中心。
美国代谢与减重外科学会（ASMBS）研究委员会的成员开发并实施了一项基于网络的调查，对象为MBSAQIP的医学主任和ASMBS成员，以研究代谢/减重手术后VTE预防措施在临床实践中的差异。
总体而言，264名代谢/减重外科医生（136名医学主任和128名ASMBS成员）参与了调查。97.1%的参与者同时使用了机械和药物VTE预防措施，84.7%使用了膝上型加压装置，56.5%使用了依诺肝素（32.4%每24小时40毫克，22.7%每12小时40毫克，24.4%根据体重指数调整剂量），38.1%使用了肝素（46.1%每8小时5000单位，22.6%每12小时5000单位，20.9%术前一次性给予5000单位）。大多数外科医生（81.6%）在术前给予首剂，而44%的医生在术后当晚给予首剂，42.2%的医生在术后第二天早上给予首剂。38.7%的医生开具了为期2周的延长VTE预防处方，28.9%的医生开具了为期4周的处方。
代谢/减重外科医生的VTE预防措施差异很大。差异可能与可用的比较证据有限有关。需要进行大型前瞻性临床试验，以确定减重手术患者VTE风险分层和预防的最佳措施。
