PMID- 15186625
OWN - NLM
STAT- MEDLINE
DCOM- 20040907
LR  - 20091103
IS  - 0960-8923 (Print)
IS  - 0960-8923 (Linking)
VI  - 14
IP  - 5
DP  - 2004 May
TI  - Unfractionated heparin infusion for thromboprophylaxis in highest risk gastric 
      bypass surgery.
PG  - 601-5
AB  - BACKGROUND: Patients undergoing gastric bypass for obesity are at risk for 
      postoperative venous thromboembolic complications. Per our routine, these 
      patients receive unfractionated heparin (UFH) per a previously described, blood 
      volume-based, subcutaneous prophylactic UFH protocol. However, some patients have 
      additional risk factors for thromboembolism, and we consider these patients to be 
      at highest risk. To increase the predictability and reliable achievement of 
      prophylactic anti-factor Xa levels for these patients at highest risk, we 
      developed a prophylactic UFH continuous intravenous infusion protocol. METHODS: 
      An UFH prophylactic protocol was developed in which the initial UFH loading dose 
      and infusion rate were determined, based on patient blood volume and age. The 
      target prophylactic anti-factor Xa activity range was 0.15-0.20 units/mL. 19 
      patients were admitted to the hospital the day before gastric bypass surgery. A 
      prophylactic UFH infusion was initiated, and anti-factor Xa levels were checked 
      and adjusted per protocol. The patients underwent surgery the following day and 
      the UFH infusion was continued intra-operatively. RESULTS: No patients were 
      diagnosed with a deep venous thromboembolism. 2 patients experienced 
      peri-operative hemorrhagic complications in spite of anti-factor Xa activity 
      levels in, or only slightly above, the targeted range. Both patients recovered 
      without further complications. CONCLUSION: For highest risk gastric bypass 
      patients, an UFH prophylactic continuous infusion protocol was effective in 
      preventing postoperative thromboembolic events. Hemorrhagic complications were 
      easily managed and did not result in long-term sequelae.
FAU - F Shepherd, Michele
AU  - F Shepherd M
AD  - Medical Education Department, Abbott Northwestern Hospital, Minneapolis, MN 
      55407, USA. shelley.shepherd@allina.com
FAU - Rosborough, Terry K
AU  - Rosborough TK
FAU - Schwartz, Michael L
AU  - Schwartz ML
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Obes Surg
JT  - Obesity surgery
JID - 9106714
RN  - 0 (Anticoagulants)
RN  - 9000-94-6 (Antithrombin III)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Anticoagulants/*administration & dosage
MH  - Antithrombin III/analysis
MH  - Clinical Protocols
MH  - Female
MH  - *Gastric Bypass
MH  - Heparin/*administration & dosage
MH  - Humans
MH  - Infusions, Intravenous
MH  - Middle Aged
MH  - Postoperative Complications/*prevention & control
MH  - Pulmonary Embolism/*prevention & control
MH  - Risk Factors
MH  - Venous Thrombosis/*prevention & control
EDAT- 2004/06/10 05:00
MHDA- 2004/09/08 05:00
CRDT- 2004/06/10 05:00
PHST- 2004/06/10 05:00 [pubmed]
PHST- 2004/09/08 05:00 [medline]
PHST- 2004/06/10 05:00 [entrez]
AID - 10.1381/096089204323093354 [doi]
PST - ppublish
SO  - Obes Surg. 2004 May;14(5):601-5. doi: 10.1381/096089204323093354.