SELECTION OF THE OPTIMAL METHOD FOR PREVENTING THROMBOTIC COMPLICATIONS IN PATIENTS WITH MORBID OBESITY UNDERGOING BARIATRIC SURGERY AS AN INTEGRAL COMPONENT OF PERIOPERATIVE MANAGEMENT
DOI:
https://doi.org/10.32782/2411-9164.22.1-8Keywords:
bariatric surgery, venous thromboembolism, morbid obesity, hemostasis, prevention, thromboelastographyAbstract
Introduction. Venous thromboembolism (VTE) is a serious complication of bariatric surgery, particularly in patients with morbid obesity. This condition is associated with hemostatic system disorders, which are further aggravated by postoperative changes.Objective. To evaluate the efficacy of combined therapy with enoxaparin sodium and pentoxifylline compared to enoxaparin monotherapy for the prevention of VTE in patients with morbid obesity undergoing bariatric surgery, and to determine the role of low-frequency piezoelectric thromboelastography (LPTEG) in monitoring the hemostatic system.Materials and Methods. The study included 50 patients with a body mass index (BMI) > 35 kg/m² undergoing bariatric surgery. Patients were divided into two groups: Group 1 (n=25): received combined therapy (enoxaparin sodium 0.4 mL twice daily + pentoxifylline 100 mg twice daily); Group 2 (n = 25): received enoxaparin sodium monotherapy at the same dosage.Hemostasis assessment was performed using LPTEG preoperatively and on postoperative days 1, 3, and 5.Results. Before treatment, all patients showed significant deviations in hemostatic parameters: the intensity of contact coagulation (ICC) increased by 23.76%, the intensity of coagulation drive (ICD) by 33.07%, maximum clot density (MA) by 74.58%, and the intensity of retraction and clot lysis (IRCL) by 91.21%. By postoperative day 5, combined therapy led to normalization of coagulation and fibrinolysis parameters: ICC decreased by 16.21%, and MA and IRCL reached reference values. In the monotherapy group, ICC remained elevated (+14.37%), MA +18.44%, and IRCL +31.17% above normal. No episodes of VTE were recorded.Conclusions. Combined therapy with enoxaparin sodium and pentoxifylline is more effective in preventing VTE in patients with morbid obesity than anticoagulant monotherapy. The use of LPTEG enables timely assessment of thrombotic risk and adjustment of therapy.
References
Carvalho L., Almeida R.F., Nora M., Guimarães M. Thromboembolic Complications After Bariatric Surgery: Is the High Risk Real? Cureus. 2023 Jan 6;15(1):e33444. doi: 10.7759/cureus.33444. PMID: 36628392; PMCID: PMC9817412.
Winegar D.A. Venous thromboembolism after bariatric surgery performed by Bariatric Surgery Center of Excellence Participants: analysis of the Bariatric Outcomes Longitudinal Database / Winegar D.A., Sherif B., Pate V., DeMaria E.J. // Surg. Obes. Relat. Dis. – 2011 Mar-Apr. – 7(2). – Р. 181–8. – Epub 2010 Dec 29 [PubMed: 21421182].
Арселус Х.І., Гуен-Тібо І., Самама Ш.М. Хірургічне втручання в пацієнтів з ожирінням. Європейські рекомендації з періопераційної профілактики венозної тромбоемболії: перше оновлення // Хірургія. Ортопедія. Травматологія. Інтенсивна терапія. – 2024. – № 4(61).
Flum D.R., Belle S.H. Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. Perioperative safety in the longitudinal assessment of bariatric surgery / Flum D.R., Belle S.H., King W.C., Wahed A.S., Berk P., Chapman W. et al. // N. Engl. J. Med. – 2009 Jul 30. – 361(5). – Р. 445–54. [PubMed: 19641201].
Juodeikis Ž, Brimas G. Thromboembolic Complications after Bariatric and Metabolic Surgery: A Single-Center Experience, Two Case Reports and a Literature Review. Acta Med Litu. 2024;31(2):409–415. doi: 10.15388/Amed.2024.31.2.23. Epub 2024 Dec 4. PMID: 40060244; PMCID: PMC11887819.
Тарабрін, О.О., Кірпічнікова, К.П., & Бугаєнко, Є.П. Наш досвід корекції венозної тромбоемболії в баріатричній хірургії під контролем тромбоеластографії. Клінічна анестезіологія, інтенсивна терапія та медицина невідкладних станів, (1), 65–71. (2024). https://doi.org/10.32782/2411-9164.20.1-8
