Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.008417
Jornal Vascular Brasileiro
Original Article

Profilaxia da trombose venosa profunda em cirurgia bariátrica: estudo comparativo com doses diferentes de heparina de baixo peso molecular

Deep venous thrombosis prevention in bariatric surgery: comparative study of different doses of low weight molecular heparin

Carlos José Goslan, Giórgio Alfredo Pedroso Baretta, Hemuara Grasiela Pestana de Souza, Bruna Zanin Orsi, Esdras Camargo A. Zanoni, Marco Antonio Gimenez Lopes, Carlos Alberto Engelhorn

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Resumo

Contexto: A cirurgia bariátrica é considerada a melhor opção para o tratamento da obesidade, cujos pacientes são considerados de alto risco para fenômenos tromboembólicos. Objetivos: Comparar o uso de doses diferentes de heparina de baixo peso molecular (HBPM) na profilaxia da trombose venosa profunda (TVP) em pacientes candidatos à cirurgia bariátrica em relação ao risco de TVP, alteração na dosagem do fator anti-Xa e sangramento pré ou pós-operatório. Métodos: Estudo comparativo transversal em pacientes submetidos à cirurgia bariátrica distribuídos em dois grupos, que receberam doses de HBPM de 40 mg (grupo controle, GC) e 80 mg (grupo de estudo, GE). Foram avaliados por ultrassonografia vascular e dosagem de KPTT, TAP, plaquetas e fator anti-Xa. Resultados: Foram avaliados 60 pacientes, sendo 34 no GC e 26 no GE. Foi observada diferença significativa somente no peso (p = 0,003) e índice de massa corporal (p = 0,018) no GE em relação ao GC. Não houve diferença na dosagem de KPTT, TAP, plaquetas e fator anti-Xa entre os grupos. Não foram detectados TVP ou sangramentos significativos em ambos os grupos. Conclusões: Não houve diferença estatisticamente significativa na utilização de doses maiores de HBPM na profilaxia da TVP em pacientes candidatos à cirurgia bariátrica em relação ao risco de TVP, dosagem do fator anti-Xa e sangramento pré ou pós-operatório.

Palavras-chave

profilaxia; trombose venosa; obesidade.

Abstract

Background: Bariatric surgery is considered the best treatment option for patients with obesity who are classed as high risk for thromboembolic events. Objectives: To compare two different doses of low weight molecular heparin (LWMH) for prevention of deep venous thrombosis (DVT) in candidates for bariatric surgery, in terms of DVT risk, abnormal anti-Xa levels, and preoperative and/or postoperative bleeding. Methods: A cross-sectional comparative study of bariatric surgery patients divided into two groups given different doses of LWMH; 40 mg of LWMH (control group, CG) and 80 mg of LWMH (study group, SG), both evaluated by vascular ultrasonography (VU) and according to the results of PTT, PT, platelets, and anti-Xa factor assays. Results: Sixty patients were evaluated, 34 in the CG and 26 in the SG. The only significant differences between the patients in the SG and the CG were weight (p = 0.003) and body mass index (p = 0.018). There were no differences between the groups in PTT, PT, platelets, or anti-Xa factor levels. There was no DVT or significant bleeding in either group. Conclusions: There were no statistical differences when higher doses of LWMH were used for prevention of DVT in bariatric surgery patients, in terms of DVT risk, anti-Xa factor levels, or preoperative and postoperative bleeding.

Keywords

prevention; venous thrombosis; obesity.

References

1. Sanches GD, Gazoni FM, Konishi RK, Guimarães HP, Vendrame LS, Lopes RD. Cuidados intensivos para pacientes em pós-operatório de cirurgia bariátrica. Rev Bras Ter Intensiva. 2007;19(2):205-9. http://dx.doi.org/10.1590/S0103-507X2007000200011. PMid:25310781.

2. Piché MÈ, Auclair A, Harvey J, Marceau S, Poirier P. How to choose and use bariatric surgery in 2015. Can J Cardiol. 2015;31(2):153-66. http://dx.doi.org/10.1016/j.cjca.2014.12.014. PMid:25661550.

3. Neff KJ, Olbers T, Le Roux CW. Bariatric surgery: the challenges with candidate selection, individualizing treatment and clinical outcomes. BMC Med. 2013;11(1):8. http://dx.doi.org/10.1186/1741-7015-11-8. PMid:23302153.

4. Stroh C, Michel N, Luderer D, et al. Risk of thrombosis and thromboembolic prophylaxis in obesity surgery: data analysis from the German Bariatric Surgery Registry. Obes Surg. 2016;26(11):2562-71. http://dx.doi.org/10.1007/s11695-016-2182-4. PMid:27112588.

5. Branco AJ Fo, Castro HF Fo, Castro HF No. Cirurgia bariátrica. In: Saad JR, Salles RA, Carvalho WR, Maia AM. Tratado de cirurgia do CBC. São Paulo: Atheneu; 2009. p. 941-7.

6. Abdeen G, Le Roux CW. Mechanism underlying the weight loss and complications of Roux-en-Y gastric bypass: review. Obes Surg. 2016;26(2):410-21. http://dx.doi.org/10.1007/s11695-015-1945-7. PMid:26530712.

7. Gonçalvez CG, Shauer PR. Cirurgia de obesidade mórbida. In: Coelho JCU. Manual de clínica cirúrgica: cirurgia geral e especialidades. São Paulo: Atheneu Editora; 2009. p. 959-71.

8. Maffei FHA, Rollo HÁ. Trombose veniosa profunda dos membros inferiores: incidência, patogenia, patologia, fisiopatologia e diagnóstico. In: Maffei FHA. Doenças vasculares periféricas. 5. ed. Rio de Janeiro: Guanabara Koogan; 2016. p. 1776-95.

9. Ginsberg J. Doenças venosas periféricas. In: Ausiello D, Cecil RL, Goldman HM. Cecil medicina. Rio de Janeiro: Elsevier; 2009. p. 669-79.

10. De Maeseneer MGR, Bochanen N, Van Rooijen G, Neglén P. Analysis of 1,338 patients with acute lower limb Deep Venous Thrombosis (DVT) supports the inadequacy of the term “Proximal DVT”. Eur J Vasc Endovasc Surg. 2016;51(3):415-20. http://dx.doi.org/10.1016/j.ejvs.2015.11.001. PMid:26777542.

11. Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2, Supl):326-50. http://dx.doi.org/10.1378/chest.11-2298. PMid:22315266.

12. Richards WO, Shirmer BD. Obesidade mórbida. In: Mattox KL, Townsend CM, Beauchamp RD, Evers BM. Sabiston: tratado de cirurgia. São Paulo: Elsevier; 2010. p. 374-404.

13. Wu EC, Barba CA. Current practices in the prophylaxis of venous thromboembolism in bariatric surgery. Obes Surg. 2000;10(1):7-13. http://dx.doi.org/10.1381/09608920060674021. PMid:10715636.

14. Froehling DA, Daniels PR, Mauck KF, et al. Incidence of venous thromboembolism after bariatric surgery: a population-based cohort study. Obes Surg. 2013;23(11):1874-9. http://dx.doi.org/10.1007/s11695-013-1073-1. PMid:24022324.

15. Vandiver JW, Ritz LI, Lalama JT. Chemical prophylaxis to prevent venous thromboembolism in morbid obesity: literature review and dosing recommendations. J Thromb Thrombolysis. 2016;41(3):475-81. http://dx.doi.org/10.1007/s11239-015-1231-5. PMid:25982217.

16. Escalante-Tattersfield T, Tucker O, Fajnwaks P, Szomstein S, Rosenthal RJ. Incidence of deep vein thrombosis in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4(2):126-30. http://dx.doi.org/10.1016/j.soard.2007.12.015. PMid:18359453.

17. Safdie FM, Dip F, Ardila-Gatas J, et al. Incidence and clinical implications of upper extremity deep vein thrombosis after laparoscopic bariatric procedures. Obes Surg. 2015;25(6):1098-101. http://dx.doi.org/10.1007/s11695-015-1646-2. PMid:25802065.

18. Prystowsky JB, Morasch MD, Eskandari MK, Hungness ES, Nagle AP. Prospective analysis of the incidence of deep venous thrombosis in bariatric surgery patients. Surgery. 2005;138(4):759-63. PMid:16269306.

19. Stein PD, Matta F. Pulmonary embolism and deep venous thrombosis following bariatric surgery. Obes Surg. 2013;23(5):663-8. http://dx.doi.org/10.1007/s11695-012-0854-2. PMid:23404239.

20. Scholten DJ, Hoedema RM, Scholten SE. A comparison of two different prophylactic dose regimens of low molecular weight heparin in bariatric surgery. Obes Surg. 2002;12(1):19-24. http://dx.doi.org/10.1381/096089202321144522. PMid:11868291.

21. Borkgren-Okonek MJ, Hart RW, Pantano JE, et al. Enoxaparin thromboprophylaxis in gastric bypass patients: extended duration, dose stratification, and antifactor Xa activity. Surg Obes Relat Dis. 2008;4(5):625-31. http://dx.doi.org/10.1016/j.soard.2007.11.010. PMid:18261965.

22. Egan G, Ensom MHH. Measuring anti-factor Xa activity to monitor low-molecular-weight heparin in obesity: a critical review. Can J Hosp Pharm. 2015;68(1):33-47. http://dx.doi.org/10.4212/cjhp.v68i1.1423. PMid:25762818.

23. Laffan M, Manning R. Laboratory control of anticoagulant, thrombolytic, and antiplatelet therapy. Dacie and Lewis Practical Haematology. 2006;18:465-79. http://dx.doi.org/10.1016/B0-44-306660-4/50022-2.

24. Gerlach AT, Pickworth KK, Seth SK, Tanna SB, Barnes JF. Enoxaparin and bleeding complications: a review in patients with and without renal insufficiency. Pharmacotherapy. 2000;20(7):771-5. http://dx.doi.org/10.1592/phco.20.9.771.35210. PMid:10907967.

25. Rosborough TK. Comparison of anti-factor Xa heparin activity and activated partial thromboplastin time in 2,773 plasma samples from unfractionated heparin-treated patients. Am J Clin Pathol. 1997;108(6):662-8. http://dx.doi.org/10.1093/ajcp/108.6.662. PMid:9384448.

26. Levine MN, Planes A, Hirsh J, Goodyear M, Vochelle N, Gent M. The relationship between anti-factor Xa level and clinical outcome in patients receiving enoxaparine low molecular weight heparin

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