Thromboprophylaxis in obesity: an overview of current recommendations | Ukrainian Medical Journal

Klygunenko E.N.,Krishtafor D.A.

Main
Publications
Thromboprophylaxis in obesity: an overview of current recommendations

Thromboprophylaxis in obesity: an overview of current recommendations

May 29, 2019

885

Keywords :

venous thromboembolism

Resume

General disregulation of metabolic homeostasis (metabolic syndrome), which accompanies obesity, leads to insulin resistance, atherogenic dislipoproteinemia and arterial hypertension, which contribute to the development of venous thromboembolism. Obesity increases the risk of thromboembolic complications after surgical interventions by 2–5 times, which requires special approaches to thromboprophylaxis. Modern worldwide guidelines suggest multimodality of thromboprophylaxis with early activation of the patient and a combination of mechanical and pharmacological agents. Low molecular weight heparins are preferable, and their dose is increased according to the body mass index and risk degree. It is recommended that in patients with obesity and high risk of venous thromboembolism pharmacological prophylaxis continue to 10–15 days after hospital discharge.

DOI 10.32471/umj.1680-3051.131.157638

Published: 29.05.2019

References:

Ageno W., Becattini C., Brighton T. et al. (2008) Cardiovascular risk factors and venous thromboembolism: a meta-analysis. Circulation, 117: 93–102.
Almeida M.I., Reis R.M., Calin G.A. (2011) MicroRNA history: discovery, recent applications, and next frontiers. Mutat. Res., 717: 1–8.
Balistreri C.R., Caruso C., Candore G. (2010) The role of adipose tissue and adipokines in obesity-related inflammatory diseases. Mediators Inflamm., 2010: 802078.
Bartlett M.A., Mauck K.F., Daniels P.R. (2015) Prevention of venous thromboembolism in patients undergoing bariatric surgery. Vasc. Health Risk Manag., 11: 461–477.
Birkmeyer N.J., Finks J.F., Carlin A.M. et al. (2012) Comparative effectiveness of unfractionated and low-molecular-weight heparin for prevention of venous thromboembolism following bariatric surgery. Arch. Surg., 147: 994–998.
Birkmeyer N.J., Finks J.F., English W.J. et al. (2013) Risks and benefits of prophylactic inferior vena cava filters in patients undergoing bariatric surgery. J. Hosp. Med., 8: 173–177.
Birkmeyer N.J., Share D., Baser O. et al. (2010) Preoperative placement of inferior vena cava filters and outcomes after gastric bypass surgery. Ann. Surg., 252: 313–318.
Blokhin I.O., Lentz S.R. (2013) Mechanisms of thrombosis in obesity. Curr. Opin. Hematol., 20(5): 437–444.
Brodsky J.B., Lemmens H.J.M. (2012) Anesthetic management of the obese surgical patient. Cambridge, University Press, 137 p.
Chen Y., Zhou H.X., Hu Y.H. et al. (2017) Risk factors of pulmonary embolism in senile and non-senile inpatients and the predictive value of Caprini risk assessment model in these two populations. Zhonghua Yi Xue Za Zhi, 97(10): 755–760.
Cossu M.L., Pilo L., Piseddu G. et al. (2007) Prophylaxis of venous thromboembolism in bariatric surgery. Chir. Ital., 59: 331–335.
Dahl T.B., Holm S., Aukrust P., Halvorsen B. (2012) Visfatin/NAMPT: a multifaceted molecule with diverse roles in physiology and pathophysiology. Ann. Rev. Nutr., 32: 229–243.
Dahl T.B., Yndestad A., Skjelland M. et al. (2007) Increased expression of visfatin in macrophages of human unstable carotid and coronary atherosclerosis: possible role in inflammation and plaque destabilization. Circulation, 115: 972–980.
de Leal V.O., Mafra D. (2013) Adipokines in obesity. Clin. Chim. Acta, 419: 87–94.
Dellas C., Schafer K., Rohm I.K. et al. (2007) Leptin signalling and leptin-mediated activation of human platelets: importance of JAK2 and the phospholipases Cgamma2 and A2. Thromb. Haemost., 98: 1063–1071.
Department of Health, Australia (2016) Guideline for anticoagulation and prophylaxis using low molecular weight heparin (LMWH) in adult inpatients. Queensland, 15 p.
Fleissner F., Jazbutyte V., Fiedler J. et al. (2010) Short communication: asymmetric dimethylarginine impairs angiogenic progenitor cell function in patients with coronary artery disease through a microRNA-21-dependent mechanism. Circ. Res., 107: 138–143.
Fontaine G.V., Vigil E., Wohlt P.D. et al. (2016) Venous thromboembolism in critically ill medical patients receiving chemoprophylaxis: a focus on obesity and other risk factors. Clin. Appl. Thromb. Hemost., 22: 265–273.
Frantzides C.T., Welle S.N., Ruff T.M., Frantzides A.T. (2012) Routine anticoagulation for venous thromboembolism prevention following laparoscopic gastric bypass. JSLS 2012, 16: 33–37.
Froehling D.A., Daniels P.R., Mauck K.F. et al. (2013) Incidence of venous thromboembolism after bariatric surgery: a population-based cohort study. Obes. Surg., 23: 1874–1879.
Gagner M., Selzer F., Belle S.H. et al. (2012) Adding chemoprophylaxis to sequential compression might not reduce risk of venous thromboembolism in bariatric surgery patients. Surg. Obes. Relat. Dis., 8: 663–670.
Gargiulo N.J., O’Connor D.J., Veith F.J. et al. (2010) Long-term outcome of inferior vena cava placement in patients undergoing gastric bypass. Ann. Vasc. Surg., 24: 946–949.
Han M.S., Jung D.Y., Morel C. et al. (2013) JNK expression by macrophages promotes obesity-induced insulin resistance and inflammation. Science, 339: 218–222.
Henry M.L., Abdul-Sultan A., Walker A.J. et al. (2019) Duration and magnitude of postoperative risk of venous thromboembolism after cholecystectomy: a population-based cohort study. Dig. Surg., 3: 1–7.
Hong S.N., Yun H.C., Yoo J.H., Lee S.H. (2017) Association between hypercoagulability and severe obstructive sleep apnea. JAMA Otolaryngol. Head Neck Surg., 143(10): 996–1002.
Imberti D., Baldini E., Pierfranceschi M.G. et al. (2014) Prophylaxis of venous thromboembolism with low molecular weight heparin in bariatric surgery: a prospective, randomised pilot study evaluating two doses of parnaparin (BAFLUX Study). Obes. Surg., 24: 284–291.
Jamal M.H., Corcelles R., Shimizu H. et al. (2015) Thromboembolic events in bariatric surgery: a large multiinstitutional referral center experience. Surg. Endosc., 29: 376–380.
Janmahasatian S., Dufful S.B., Ash S. et al. (2005) Quantification of lean bodyweight. Pharmacokinet., 44: 1051–1065.
Konukoglu D., Uzun H. (2017) Endothelial dysfunction and hypertension. Adv. Exp. Med. Biol., 956: 511–540.
Kothari S.N., Lambert P.J., Mathiason M.A. (2007) A comparison of thromboembolic and bleeding events following laparoscopic gastric bypass in patients treated with prophylactic regimens of unfractionated heparin or enoxaparin. Am. J. Surg., 194(6): 709–711.
Levi M., van der Poll T., Schultz M. (2012) Infection and inflammation as risk factors for thrombosis and atherosclerosis. Semin. Thromb. Hemost., 38: 506–514.
Levi M., van der Poll T., ten Cate H. (2006) Tissue factor in infection and severe inflammation. Semin. Thromb. Hemost., 32: 33–39.
Lijnen H.R. (2009) Role of fibrinolysis in obesity and thrombosis. Thromb. Res., 123(Suppl. 4): S46–S49.
Marchand A., Proust C., Morange P.E. et al. (2012) miR-421 and miR-30c inhibit SERPINE 1 gene expression in human endothelial cells. PLoS One, 7: e44532.
McLean D.L., Kim J., Kang Y. et al. (2012) Apelin/APJ signaling is a critical regulator of statin effects in vascular endothelial cells: brief report. Arterioscler. Thromb. Vasc. Biol., 32: 2640–2643.
NCEP (2001) ATP III Guidelines At-A-GlanceQuick Desk Reference (https://www.nhlbi.nih.gov/files/docs/guidelines/atglance.pdf).
Nicolay R.W., Selley R.S., Terry M.A., Tjong V.K. (2019) Body mass index as a risk factor for 30-day postoperative complications in knee, hip, and shoulder arthroscopy. Arthroscopy, 35(3): 874–882.
Ojo P., Asiyanbola B., Valin E., Reinhold R. (2008) Post discharge prophylactic anticoagulation in gastric bypass patient-how safe? Obes. Surg., 18: 791–796.
Okamoto Y., Ishii S., Croce K. et al. (2013) Adiponectin inhibits macrophage tissue factor, a key trigger of thrombosis in disrupted atherosclerotic plaques. Atherosclerosis, 226: 373–377.
Oladejo A.O. (2011) Overview of the metabolic syndrome; an emerging pandemic of public health significance. Ann. Ib. Postgrad. Med., 9(2): 78–82.
Ouchi N., Parker J.L., Lugus J.J., Walsh K. (2011) Adipokines in inflammation and metabolic disease. Nat. Rev. Immunol., 11: 85–97.
Ouedraogo R., Gong Y., Berzins B. et al. (2007) Adiponectin deficiency increases leukocyte-endothelium interactions via upregulation of endothelial cell adhesion molecules in vivo. J. Clin. Invest., 117: 1718–1726.
Overby D.W., Kohn G.P., Cahan M.A. et al. (2009) Risk-group targeted inferior vena cava filter placement in gastric bypass patients. Obes. Surg., 19: 451–455.
Pannucci C.J., Shanks A., Moote M.J. et al. (2012) Identifying patients at high risk for venous thromboembolism requiring treatment after outpatient surgery. Ann. Surg., 255(6): 1093–1099.
Payne G.A., Borbouse L., Kumar S. et al. (2010) Epicardial perivascular adipose-derived leptin exacerbates coronary endothelial dysfunction in metabolic syndrome via a protein kinase C-beta pathway. Arterioscler. Thromb. Vasc. Biol., 30: 1711–1717.
Phan K., Kothari P., Lee N.J. et al. (1976) Impact of obesity on outcomes in adults undergoing elective posterior cervical fusion. Spine (Phila Pa 1976), 42(4): 261–266.
Raftopoulos I., Martindale C., Cronin A., Steinberg J. (2008) The effect of extended postdischarge chemical thromboprophylaxis on venous thromboembolism rates after bariatric surgery: a prospective comparison trial. Surg. Endosc., 22: 2384–2391.
Sebaaly J., Covert K. (2018) Enoxaparin dosing at extremes of weight: literature review and dosing recommendations. Ann. Pharmacother., 52(9): 898–909.
Shelkrot M., Miraka J., Perez M.E. (2014) Appropriate enoxaparin dose for venous thromboembolism prophylaxis in patients with extreme obesity. Hosp. Pharm., 49: 740–747.
Steele K.E. (2015) The EFFORT trial: preoperative enoxaparin versus postoperative fondaparinux for thromboprophylaxis in bariatric surgical patients: a randomized double-blind pilot trial. Surg. Obes. Relat. Dis., 11: 672–683.
Steib A., Degirmenci S.E., Junke E. et al. (2016) Once versus twice daily injection of enoxaparin for thromboprophylaxis in bariatric surgery: effects on antifactor Xa activity and procoagulant microparticles. A randomized controlled study. Surg. Obes. Relat. Dis., 12(3): 613–621.
Streiff M.B. (2015) Predicting the risk of recurrent venous thromboembolism (VTE). J. Thromb. Thrombolysis, 39: 353–366.
Tchernof A., Despres J.P. (2013) Pathophysiology of human visceral obesity: an update. Physiol Rev., 93: 359–404.
Tichelaar Y.I., Kluin-Nelemans H.J., Meijer K. (2012) Infections and inflammatory diseases as risk factors for venous thrombosis. A systematic review. Thromb. Haemost., 107: 827–837.
Van Gaal L.F., Mertens I.L., De Block C.E. (2006) Mechanisms linking obesity with cardiovascular disease. Nature, 444: 875–880.
Venclauskas L., Maleckas A., Arcelus J.I. (2018) European guidelines on perioperative venous thromboembolism prophylaxis: surgery in the obese patient. Eur. J. Anaesthesiol., 35(2): 147–153.
Westein E., Hoefer T., Calkin A.C. (2017) Westein E. Thrombosis in diabetes: a shear flow effect? Clin. Sci. (Lond)., 131(12): 1245–1260.
Woo H.D., Kim Y.J. (2013) Prevention of venous thromboembolism with enoxaparin in bariatric surgery. J. Korean Surg. Soc., 84: 298–303.
World Health Organization (2018) Who Fact Sheet: obesity and overweight (https://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight).
Zampetaki A., Kiechl S., Drozdov I. et al. (2010) Plasma microRNA profiling reveals loss of endothelial miR-126 and other microRNAs in type 2 diabetes. Circ. Res., 107: 810–817.