دورية أكاديمية
Pharmacologic and mechanical strategies for preventing venous thromboembolism after bariatric surgery: a systematic review and meta-analysis.
| العنوان: | Pharmacologic and mechanical strategies for preventing venous thromboembolism after bariatric surgery: a systematic review and meta-analysis. |
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| المؤلفون: | Brotman DJ; Department of Medicine, The Johns Hopkins School of Medicine, The Johns Hopkins University, Baltimore, Maryland 21287, USA. brotman@jhmi.edu, Shihab HM, Prakasa KR, Kebede S, Haut ER, Sharma R, Shermock K, Chelladurai Y, Singh S, Segal JB |
| المصدر: | JAMA surgery [JAMA Surg] 2013 Jul; Vol. 148 (7), pp. 675-86. |
| نوع المنشور: | Journal Article; Meta-Analysis; Research Support, U.S. Gov't, P.H.S.; Review; Systematic Review |
| اللغة: | English |
| بيانات الدورية: | Publisher: American Medical Association Country of Publication: United States NLM ID: 101589553 Publication Model: Print Cited Medium: Internet ISSN: 2168-6262 (Electronic) Linking ISSN: 21686254 NLM ISO Abbreviation: JAMA Surg Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Chicago, IL : American Medical Association, [2013]- |
| مواضيع طبية MeSH: | Bariatric Surgery*, Postoperative Complications/*prevention & control , Venous Thromboembolism/*prevention & control, Anticoagulants/therapeutic use ; Comparative Effectiveness Research ; Enoxaparin/therapeutic use ; Heparin, Low-Molecular-Weight/therapeutic use ; Humans ; Pulmonary Embolism/prevention & control ; Vena Cava Filters |
| مستخلص: | We sought to assess the comparative effectiveness and safety of pharmacologic and mechanical strategies to prevent venous thromboembolism (VTE) in patients undergoing bariatric surgery. We searched (through August 2012) for primary studies that had at least 2 different interventions. Of 30,902 citations, we identified 8 studies of pharmacologic strategies and 5 studies of filter placement. No studies randomized patients to receive different interventions. One study suggested that low-molecular-weight heparin is more efficacious than unfractionated heparin in preventing VTE (0.25% vs 0.68%, P < .001), with no significant difference in bleeding. One study suggested that prolonged therapy (after discharge) with enoxaparin sodium may prevent VTE better than inpatient treatment only. There was insufficient evidence supporting the hypothesis that filters reduce the risk of pulmonary embolism, with a point estimate suggesting increased rates with filters (pooled relative risk [RR], 1.21 95% CI, 0.57-2.56). There was low-grade evidence that filters are associated with higher mortality (pooled RR, 4.30 95% CI, 1.60-11.54) and higher deep vein thrombosis rates (2.94 1.35-6.38). There was insufficient evidence to support that augmented subcutaneous enoxaparin doses (>40 mg daily or 30 mg twice daily) are more efficacious than standard dosing, with a trend toward increased bleeding. Of note, for both filters and augmented pharmacologic dosing strategies, patients at highest risk for VTE were more likely to receive more intensive interventions, limiting our ability to attribute outcomes to prophylactic strategies used. |
| معلومات مُعتمدة: | HHSA-290-2007-100611 United States PHS HHS |
| المشرفين على المادة: | 0 (Anticoagulants) 0 (Enoxaparin) 0 (Heparin, Low-Molecular-Weight) |
| تواريخ الأحداث: | Date Created: 20130612 Date Completed: 20130926 Latest Revision: 20181202 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1001/jamasurg.2013.72 |
| PMID: | 23754086 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 2168-6262 |
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| DOI: | 10.1001/jamasurg.2013.72 |