The EFFORT trial: Preoperative enoxaparin versus postoperative fondaparinux for thromboprophylaxis in bariatric surgical patients: a randomized double-blind pilot trial

Steele, Kimberley E.; Canner, Joseph K.; Prokopowicz, Gregory; Verde, Franco; Beselman, Aleksandra; Wyse, Ransom J; Chen, Junnan; Streiff, Michael B.; Magnuson, Thomas; Lidor, Anne O.; Schweitzer, Michael

doi:10.1016/j.soard.2014.10.003

Cited by 45 publications

(24 citation statements)

References 41 publications

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“…Two RCTs were identified reporting on high versus standard dose low-molecular weight heparin after bariatric surgery [62,63], whereas there was no evidence on the duration of prophylaxis. Meta-analysis suggested no significant difference with regard to deep venous thrombosis or bleeding, however, relevant evidence was moderate or low, due to substantial imprecision (Supplementary Table S8).…”

Section: Justificationmentioning

confidence: 99%

Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP

et al. 2020

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Background Surgery for obesity and metabolic diseases has been evolved in the light of new scientific evidence, long-term outcomes and accumulated experience. EAES has sponsored an update of previous guidelines on bariatric surgery. Methods A multidisciplinary group of bariatric surgeons, obesity physicians, nutritional experts, psychologists, anesthetists and a patient representative comprised the guideline development panel. Development and reporting conformed to GRADE guidelines and AGREE II standards. Results Systematic review of databases, record selection, data extraction and synthesis, evidence appraisal and evidence-todecision frameworks were developed for 42 key questions in the domains Indication; Preoperative work-up; Perioperative management; Non-bypass, bypass and one-anastomosis procedures; Revisional surgery; Postoperative care; and Investigational procedures. A total of 36 recommendations and position statements were formed through a modified Delphi procedure. and Other Interventional Techniques Disclaimer This clinical practice guideline has been developed under the auspice of the European Association for Endoscopic Surgery (EAES). It is intended to be used primarily by health professionals (e.g. surgeons, anesthetists, physicians) and to assist in making informed clinical decisions on diagnostic measures and therapeutic management. It is also intended to inform individual practice of allied health professionals (e.g. surgical nurses, dietitians, physical rehabilitation therapists, psychologists); to inform strategic planning and resource management by healthcare authorities (e.g. regional and national authorities, healthcare institutions, hospital administration authorities); and to inform patients wishing to obtain an overview of the condition of interest and its management. The use of recommendations contained herein must be informed by supporting evidence accompanying each recommendation and by research evidence that might not have been published by the time of writing the present document. Users must thus base their actions informed by newly published evidence at any given point Electronic supplementary material The online version of this article (

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Section: Justificationmentioning

confidence: 99%

Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP

et al. 2020

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“…A survey of bariatric surgeons suggested that 48.3% continue anticoagulation after discharge, but the response rate to the survey was not provided [28]. Furthermore, 2 recent prospective randomized trials of anticoagulation modalities for bariatric patients limited the duration of prophylaxis to in-hospital or o10 days, respectively [29,30]. This is in contrast to a systematic review that recommended 1-month prophylaxis in patients undergoing major open or laparoscopic abdominal or pelvic surgery [15].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary embolism and gastrointestinal leak following bariatric surgery: when do major complications occur?

Spaniolas

Kasten

Sippey

et al. 2016

Surgery for Obesity and Related Diseases

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“…12,15 In a randomized study comparing fondaparinux (5 mg/day) with enoxaparin (40 mg twice a day), 16 the results for complications (VTE) during the postoperative period were similar in two groups with body mass index (BMI) > 40 kg/m 2 . However, fondaparinux was associated with better control of anti-Xa levels.…”

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confidence: 99%

“…The UFH dose recommended in the review was 7,500 IU SC (2 or 3 times a day), based on a retrospective study with a large number of patients. 20 Still with relation to the same review, the recommended dose of fondaparinux was 2.5 mg SC per day; but a study published by Steele et al 16 recommended a dose of 5 mg SC per day.…”

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Profilaxia do tromboembolismo venoso em cirurgia bariátrica

Yoshida

2017

J. vasc. bras.

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Bariatric surgery was defined as high risk for development of venous thromboembolism (VTE) in the 2012 ninth edition of the American College of Chest Physicians' (ACCP) Consensus, along with surgery for gynecological cancer, pneumonectomy, craniotomy and traumas involving the brain or spinal cord, or other major traumas.1 Without prophylaxis, the incidence of deep venous thrombosis (DVT) in this risk category ranges from 40 to 80% distally in the leg and from 10 to 20% proximally in the thigh, with a 0.2-5.0% incidence of fatal pulmonary embolism (PE).2 Data for bariatric surgery patients corroborate these findings, with DVT frequencies of 0.2-2.4% and PE rates of 1-2%, 3-6 the latter being responsible for 30-50% of mortality related to the operation. [7][8][9][10] In view of this, prophylaxis for VTE is mandatory.A meta-analysis conducted by Becattini et al. 11 found that the regimens most often used for bariatric surgery patients were as follows:1. Unfractionated heparin (UFH) -at a dosage of 5,000 international units (IU) subcutaneously (SC) 3 times a day for 15 days.2. Low molecular weight heparin (LMWH) -enoxaparin at a dosage of 30 mg SC twice a day or 40 mg twice a day for 15 days.Adjusting doses for Anti-Xa provoked an increase in the frequency of bleeding without reducing VTE.11 Irrespectively, pharmacological prophylaxis must always be managed on a case-by-case basis, considering the risk of bleeding in each case (active peptic ulcer, uncontrolled systemic arterial hypertension, coagulopathy, thrombocytopenia, renal failure, etc.). 12Enoxaparin can be administered at a dosage of 60 mg twice a day for 14 days.12 A study that compared this with a dosage of 40 mg twice a day for 14 days found that the risk of bleeding was similar in both groups. This study did not assess VTE frequency during the postoperative period.Stroh et al. 13 analyzed registry data compiled in Germany on 31,668 surgeries (13,772 Roux-en-Y-gastric bypasses, 11,840 sleeve gastrectomies and 3,999 gastric bandings) reporting DVT in 0.07% of cases and PE in 0.10% and concluding that LMWH was preferable to unfractionated heparins. These data were recently corroborated by an analysis conducted by different authors.14 In these data, around 94.4% of procedures were Roux-en-Y open surgeries and 5.6% were laparoscopies.Some authors prefer to combine HNF with mechanical prophylaxis, such as early mobilization, intermittent pneumatic compression (IPC), and graduated elastic compression stockings (GECS). 12,15In a randomized study comparing fondaparinux (5 mg/day) with enoxaparin (40 mg twice a day), 16 the results for complications (VTE) during the postoperative period were similar in two groups with body mass index (BMI) > 40 kg/m 2 . However, fondaparinux was associated with better control of anti-Xa levels. Apparently, therefore, either enoxaparin at a dosage of 40 mg twice a day or fondaparinux (5mg/day) can be recommended for patients with BMI > 40 kg/m . [18][19][20] According to the same review mentioned above, 17 the 0.5 mg/kg eno...

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The EFFORT trial: Preoperative enoxaparin versus postoperative fondaparinux for thromboprophylaxis in bariatric surgical patients: a randomized double-blind pilot trial

Cited by 45 publications

References 41 publications

Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP

Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP

Pulmonary embolism and gastrointestinal leak following bariatric surgery: when do major complications occur?

Profilaxia do tromboembolismo venoso em cirurgia bariátrica

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