PMID- 30713119
OWN - NLM
STAT- MEDLINE
DCOM- 20200320
LR  - 20200320
IS  - 1878-7533 (Electronic)
IS  - 1550-7289 (Linking)
VI  - 15
IP  - 3
DP  - 2019 Mar
TI  - Anticoagulant activity of enoxaparin and unfractionated heparin for venous 
      thromboembolism prophylaxis in obese patients undergoing sleeve gastrectomy.
PG  - 363-373
LID - S1550-7289(18)31097-9 [pii]
LID - 10.1016/j.soard.2018.12.014 [doi]
AB  - BACKGROUND: One risk of bariatric surgery is venous thromboembolism and the 
      optimal strategy to reduce risk requires further clarification. OBJECTIVES: The 
      objectives of this study were to identify antiXa goal attainment with the 
      institutional standard chemoprophylaxis, analyze discordance between antiXa and 
      thrombin generation assay (TGA) in terms of adequacy of anticoagulation, and to 
      identify correlations between patient characteristics or covariates and markers 
      of coagulation status. SETTING: Large academic medical center in Northeastern 
      United States. METHODS: A total of 60 sleeve gastrectomy patients were enrolled 
      in this institutional review board-approved, prospective cohort study. Patients 
      received the institutional standard prophylactic therapy (subcutaneous enoxaparin 
      40 mg twice daily or unfractionated heparin [UFH]). The UFH dose was weight 
      based, 5000 units (<120 kg) or 7500 units (>/=120 kg) every 8 hours. Various 
      measures of coagulation status were measured at or near steady state. RESULTS: 
      Patients receiving enoxaparin achieved goal antiXa more frequently compared with 
      the UFH group, and statistical significance was demonstrated (93.8 % versus 4.5%, 
      respectively; P < .0001). Target endogenous thrombin potential reduction from 
      baseline was more frequently obtained in the enoxaparin group versus UFH (50% 
      versus 27.7%, respectively; P = .12). AntiXa was below the limit of detection for 
      the majority of UFH patients; while TGA suggested patients did experience 
      anticoagulation at some level of effectiveness. Endogenous thrombin potential 
      change in the enoxaparin group was correlated to several measures of body 
      composition. CONCLUSIONS: Patients receiving enoxaparin achieved goal antiXa more 
      often versus UFH. There was discordance between antiXa and TGA-based assessment 
      of coagulation status. TGA may provide a more robust assessment of the adequacy 
      of chemoprophylaxis.
CI  - Copyright (c) 2018 American Society for Bariatric Surgery. Published by Elsevier 
      Inc. All rights reserved.
FAU - Brunetti, Luigi
AU  - Brunetti L
AD  - Department of Pharmacy Practice, Rutgers, The State University of New Jersey, 
      Piscataway, New Jersey; Department of Pharmaceutics, Rutgers, The State 
      University of New Jersey, Piscataway, New Jersey. Electronic address: 
      brunetti@pharmacy.rutgers.edu.
FAU - Wassef, Andrew
AU  - Wassef A
AD  - Advanced Surgical and Bariatrics of New Jersey, Somerset, NJ; Department of 
      General Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New 
      Jersey; Bariatric Center of Excellence, Robert Wood Johnson Barnabas University 
      Hospital, New Brunswick, New Jersey.
FAU - Sadek, Ragui
AU  - Sadek R
AD  - Advanced Surgical and Bariatrics of New Jersey, Somerset, NJ; Department of 
      General Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New 
      Jersey; Bariatric Center of Excellence, Robert Wood Johnson Barnabas University 
      Hospital, New Brunswick, New Jersey.
FAU - Deshpande, Kiran
AU  - Deshpande K
AD  - Department of Pharmaceutics, Rutgers, The State University of New Jersey, 
      Piscataway, New Jersey.
FAU - Ziegler, Jane
AU  - Ziegler J
AD  - Department of Clinical and Preventive Nutrition Sciences, Rutgers, The State 
      University of New Jersey, Newark, New Jersey.
FAU - Na, Sung Shin
AU  - Na SS
AD  - Department of Pharmacy Practice, Rutgers, The State University of New Jersey, 
      Piscataway, New Jersey.
FAU - Riley, Paul
AU  - Riley P
AD  - Diagnostica Stago, Inc., Parsippany, New Jersey.
FAU - Kagan, Leonid
AU  - Kagan L
AD  - Department of Pharmaceutics, Rutgers, The State University of New Jersey, 
      Piscataway, New Jersey.
LA  - eng
PT  - Journal Article
DEP - 20181220
PL  - United States
TA  - Surg Obes Relat Dis
JT  - Surgery for obesity and related diseases : official journal of the American 
      Society for Bariatric Surgery
JID - 101233161
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
SB  - IM
MH  - Adult
MH  - Anticoagulants/*therapeutic use
MH  - Enoxaparin/*therapeutic use
MH  - Female
MH  - Gastrectomy/*adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Obesity, Morbid/*surgery
MH  - Prospective Studies
MH  - Treatment Outcome
MH  - Venous Thromboembolism/etiology/*prevention & control
OTO - NOTNLM
OT  - Body composition
OT  - Enoxaparin
OT  - Prophylaxis
OT  - Sleeve gastrectomy
OT  - Unfractionated heparin
OT  - Venous thromboembolism
EDAT- 2019/02/05 06:00
MHDA- 2020/03/21 06:00
CRDT- 2019/02/05 06:00
PHST- 2018/09/28 00:00 [received]
PHST- 2018/12/02 00:00 [revised]
PHST- 2018/12/12 00:00 [accepted]
PHST- 2019/02/05 06:00 [pubmed]
PHST- 2020/03/21 06:00 [medline]
PHST- 2019/02/05 06:00 [entrez]
AID - S1550-7289(18)31097-9 [pii]
AID - 10.1016/j.soard.2018.12.014 [doi]
PST - ppublish
SO  - Surg Obes Relat Dis. 2019 Mar;15(3):363-373. doi: 10.1016/j.soard.2018.12.014. 
      Epub 2018 Dec 20.