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Heparin obesity

Pierre-Antoine Moulin, Anne Dutour, Patricia Ancel, Pierre-Emmanuel Morange, Thierry Bege, Olivier Ziegler, Stéphane Berdah, Corinne Frère, Bénédicte Gaborit
BACKGROUND: Venous thromboembolism (VTE) is a leading cause of death in obese patients undergoing bariatric surgery (BS), but there is neither consensus nor high-level guidelines yet on VTE prophylaxis in this specific population. OBJECTIVE: We aimed to evaluate patterns of BS perioperative thromboprophylaxis practices. SETTING: French obesity specialized care centers (CSO), which are tertiary care referral hospitals for the most severe cases of obesity METHODS: A detailed questionnaire survey (11 opened, 15 closed questions) investigating their prophylactic schemes of anticoagulation (molecule, dose, weight-adjustment, duration, associated measures, follow-up) was sent to the 37 CSO...
September 1, 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Neil J Turco
I would like to thank Joy et al for their recent article, "Safety and Efficacy of High-dose Unfractionated Heparin for Prevention of Venous Thromboembolism in Overweight and Obese Patients," which contributed more to the body of literature in VTE prophylaxis for patients with obesity.(1) This study provided evidence against the use of high-dose unfractionated heparin (UFH) thromboprophylaxis for obese patients. These results differ from those of a previous study by Wang et al, which found a lower incidence of VTE for patients on high-dose UFH...
October 7, 2016: Pharmacotherapy
Ashwini Bennett, Sanjeev Chunilal
Pregnancy-associated venous thromboembolism (PAVTE) consists of deep vein thrombosis and pulmonary embolism (PE) occurring during pregnancy or in the postpartum period. This condition is common and is a major source of morbidity in a population which is young and otherwise relatively healthy. Timely diagnosis and treatment are crucial in ensuring satisfactory patient outcomes. Diagnostic strategies for pregnancy-associated PE in particular require careful consideration of maternal and fetal risks. Low-molecular-weight heparins currently form the mainstay of treatment; however, there are uncertainties around optimal dosing of these agents in certain settings (e...
September 22, 2016: Seminars in Thrombosis and Hemostasis
Jingyang Fan, Billee John, Emily Tesdal
PURPOSE: Results of a study to determine whether heparin dosing based on adjusted body weight (BWAdj) instead of actual body weight (ABW) can lead to faster achievement of therapeutic activated partial thromboplastin time (aPTT) values in obese patients are presented. METHODS: A single-center retrospective cohort study was conducted to assess aPTT outcomes before and after implementation of a revised heparin protocol specifying BWAdj-based dosing for obese patients...
October 1, 2016: American Journal of Health-system Pharmacy: AJHP
Jaime Ruiz-Tovar, Carolina Llavero
Obesity itself is associated with an increased risk of thromboembolic events. Moreover, most bariatric procedures actually are performed by laparoscopic approach, implying an increased intraabdominal pressure during the surgical procedure that may favor the development of thrombus. Therefore, bariatric surgery is considered a high-risk procedure for thromboembolic events. Actual recommendations are to include low molecular weight heparins (LMWH) and compression stockings in the primary prophylaxis of thromboembolic events...
September 15, 2016: Advances in Experimental Medicine and Biology
Daniel Cuevas-Ramos, Carlos A Aguilar-Salinas
Fibroblast growth factors (FGFs) are a superfamily of 22 proteins related to cell proliferation and tissue repair after injury. A subgroup of three proteins, FGF19, FGF21, and FGF23, are major endocrine mediators. These three FGFs have low affinity to heparin sulfate during receptor binding; in contrast they have a strong interaction with the cofactor Klotho/β-Klotho. FGF21 has received particular attention because of its key role in carbohydrate, lipids, and energy balance regulation. FGF21 improves glucose and lipids metabolism as well as increasing energy expenditure in animal models and humans...
June 20, 2016: Hormone Molecular Biology and Clinical Investigation
Jeffrey Beall, Ashley Woodruff, Carolyn Hempel, Margaret Wovkulich, Kimberly Zammit
BACKGROUND: Obese patients experience a higher risk of venous thromboembolism (VTE) than their nonobese counterparts, which may warrant a more aggressive approach to thromboprophylaxis in this population. OBJECTIVE: The purpose of this study was to compare rates of nosocomial VTE in obese patients treated with high-dose versus conventional-dose subcutaneous unfractionated heparin sodium (UFH) for thromboprophylaxis. METHODS: A retrospective, single-center, cohort study was conducted to evaluate obese, adult, hospitalized patients admitted between April 2011 and April 2014 who received heparin 5,000 or 7,500 units subcutaneously every 8 hours for thromboprophylaxis...
May 2016: Hospital Pharmacy
Jennifer L Babin, Katie L Traylor, Daniel M Witt
Compared with older agents, low-molecular-weight heparins (LMWH) and fondaparinux offer improved bioavailability and more predictable, dose-independent clearance. While routine monitoring of coagulation parameters is not usually necessary with these agents, certain populations (including pregnant patients, children, obese patients, and patients with renal impairment) may benefit from the monitoring of anti-factor Xa activity, thromboelastography, or other coagulation assays to help guide therapy. The chromogenic anti-factor Xa assay is currently the gold standard for monitoring LMWH and fondaparinux therapy...
June 9, 2016: Seminars in Thrombosis and Hemostasis
Mishna Joy, Eileen Tharp, Heather Hartman, Sara Schepcoff, Jennifer Cortes, Adam Sieg, Mark Mariski, Yeunju Lee, Meghan Murphy, Ghazaleh Ranjbar, Sherouk Sharaf, Gin Yau, Huimahn Alex Choi, Sophie Samuel
STUDY OBJECTIVE: To determine the safety and efficacy of high-dose subcutaneous unfractionated heparin (UFH) for prevention of venous thromboembolism (VTE) in overweight and obese patients. DESIGN: Single-center retrospective observational cohort study. SETTING: Large academic tertiary care medical center. PATIENTS: A total of 1335 adults who weighed more than 100 kg on admission and received either subcutaneous UFH 7500 units every 8 hours (751 patients [high-dose group]) or 5000 units every 8 hours (584 patients [low-dose group]) for VTE prophylaxis during their hospitalization between January 1, 2013, and August 31, 2014...
July 2016: Pharmacotherapy
S Vildy, K Osmaeva, F Closs-Prophette, H Maillard
INTRODUCTION: Skin necrosis with vitamin k antagonists are rare. They affect more frequently middle-aged and obese women, often within 10 days after initiating of treatment. They occur most often in a context of thrombophilia. CASE REPORT: An 18-year-old obese woman was treated with heparin and fluindione for a lower limb deep venous thrombosis. On day 5, the patient presented fever and skin necrosis, which extended rapidly. We identified an activated protein C resistance and a major inflammatory syndrome related to Mycoplasma pneumoniae infection...
June 1, 2016: La Revue de Médecine Interne
Gretchen L Sacha, Katie M Greenlee, Jeffrey M Ketz
Therapeutic enoxaparin is commonly used over heparin because of its favorable pharmacokinetic profile and ease of administration. Monitoring of the anticoagulant response, if necessary, is done with anti-factor Xa levels. Currently, it is suggested that monitoring may be beneficial in patients who are overweight and those with renal dysfunction. This study aimed to characterize the use of enoxaparin at a large-academic medical center in patients >150 kg, <45 kg and in those with renal dysfunction, and to describe the rate of anti-factor Xa monitoring in these patients...
November 2016: Journal of Thrombosis and Thrombolysis
Ana Boban, Samuel Paulus, Catherine Lambert, Cedric Hermans
Low-molecular-weight heparin (LMWH) is the anticoagulant drug class of choice for the prevention of thrombosis during pregnancy and often used for prevention of severe obstetrical complications, yet the optimal dosage is still a matter of debate. Although several studies have evaluated LMWH dose adjustment methods based on anti-Xa levels, no definitive conclusion as yet exists. This extensive retrospective study sought to address the rationale of regular anti-Xa activity monitoring in pregnant patients given LMWH prophylaxis...
June 2, 2016: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
Savino Occhionorelli, Alessandra La Manna, Rocco Stano, Lucia Morganti, Giorgio Vasquez
AIM: To describe an acute portomesenteric venous thrombosis, with massive small bowel infarction, which is managed with small bowel resection, primary anastomosis, and open abdomen management (OAM). CASE REPORT: A 76-year-old male patient was admitted to the surgical ward, complaining spread abdominal pain. Contrast Enhanced Computed Tomography (CECT) diagnosed massive bowel ischemia, caused by portomesenteric thrombosis. He had negative coagulation tests for thrombophilia, while he presented concomitant risk factors (cancer, previous venous thrombosis, obesity)...
2016: Annali Italiani di Chirurgia
S Pereira, W Q Yu, J Moore, Y Mori, E Tsiani, A Giacca
The mechanisms whereby prolonged plasma free fatty acids elevation, as found in obesity, causes hepatic insulin resistance are not fully clarified. We herein investigated whether inhibition of p38 mitogen-activated protein kinase (MAPK) prevented hepatic insulin resistance following prolonged lipid infusion. Chronically cannulated rats were subdivided into one of four intravenous (i.v.) treatments that lasted 48 h: Saline (5.5 μl min(-1)), Intralipid plus heparin (IH, 20% Intralipid+20 U ml(-1) heparin; 5...
2016: Nutrition & Diabetes
C Stroh, N Michel, D Luderer, S Wolff, V Lange, F Köckerling, C Knoll, T Manger
BACKGROUND: Evidence-based data on optimal approach for prophylaxis of deep venous thrombosis (VTE) and pulmonary embolism (PE) in bariatric operations is discussed. Using antithrombotic prophylaxis, weight adjusted the risk of VTE and its complications have to be balanced with the increased bleeding risk. METHODS: Since 2005, the current situation for bariatric surgery has been examined by quality assurance study in Germany. As a prospective multicenter observational study, data on the type, regimen, and time course of VTE prophylaxis were documented...
April 25, 2016: Obesity Surgery
James Uprichard
Being overweight or obese is associated with a higher individual risk of venous thromboembolism and poorer postprocedural outcomes after hip or knee replacement surgery. In addition, there is evidence that obesity represents a significant driving factor for the current and projected prevalence of atrial fibrillation. Rivaroxaban and other direct oral anticoagulants offer fixed-dose regimens for these indications. They do not require therapeutic drug monitoring or dose adjustment according to the weight of the patient...
October 2016: Therapeutic Advances in Cardiovascular Disease
Alessandra Allione, Cornelia Di Gaetano, Nadia Dani, Davide Barberio, Sabina Sieri, Vittorio Krogh, Giuseppe Matullo
Obesity is an important health problem worldwide. Adipose tissue acts as an endocrine organ that secretes various bioactive substances, called adipokines, including pro-inflammatory biomarkers such as TNF-α, IL-6, leptin and C-reactive protein (CRP) and anti-inflammatory molecules such as adiponectin. The deregulated production of adipokines in obesity is linked to the pathogenesis of various disease processes and monitoring their variation is critical to understand metabolic diseases. The aim of this study was to determine the plasma concentration of adipokines in healthy subjects by multiplexed measurements and the effect of anticoagulants on their levels...
April 2016: Cytokine
Annukka Vahtera, Suvi Vaara, Ville Pettilä, Anne Kuitunen
BACKGROUND: Critical care patients are prone to venous thromboembolism (VTE) and, thus, pharmacological thromboprophylaxis is generally advised. Low-molecular weight heparins (LMWHs) have become the drug of choice in ICU patients, since their predictable and reproducible dose response. Monitoring their pharmacological effect is not usually necessary except in special occasions (i.e. with obese or renal failure patients), where anti-FXa level measuring is recommended. However, there is neither recommendation of adequate anti-FXa levels in critically ill patients nor is it known whether peak or trough level should be measured...
March 2016: Thrombosis Research
Matthew B Bloom, Andrea A Zaw, David M Hoang, Russell Mason, Rodrigo F Alban, Rex Chung, Nicolas Melo, Oksana Volod, Eric J Ley, Daniel R Margulies
BACKGROUND: The obese state has been linked to several immune-mediated conditions. Our objective was to examine the association of body mass index (BMI) with the diagnosis of heparin-induced thrombocytopenia (HIT). METHODS: Prospectively collected data on patients in the surgical and cardiac intensive care unit suspected of having HIT between January 2007 and August 2014 were analyzed. Patients were categorized into five discrete BMI (kg/m) groups and compared. Data collected included Warkentin 4-T scores, antiplatelet factor 4 (anti-PF4OD) values, serotonin release assay values, and thromboembolic diseases...
March 2016: Journal of Trauma and Acute Care Surgery
Emmanuel Haas, François Fischer, François Levy, Su-Emmanuelle Degirmenci, Lelia Grunebaum, Michel Kindo, Olivier Collange, Paul-Michel Mertes, Annick Steib
BACKGROUND: The heparin regimen providing anticoagulation during cardiopulmonary bypass (CPB) is usually adapted to total body weight (TBW), but may be inaccurate in obese patients in whom TBW exceeds their ideal body weight. OBJECTIVES: The objective is to compare the effects of heparin injection based on TBW on haemostatic parameters between obese and nonobese patients during cardiac surgery and to calculate the optimal heparin regimen. DESIGN: Prospective comparative study...
June 2016: European Journal of Anaesthesiology
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