Preventing vascular complications after gastric bypass.
As the problem of morbid obesity has increased over the past several years in the United States, gastric bypass has become a viable option for many people seeking treatment. The risk of a venous thromboembolic event after gastric bypass is significant and linked to several factors. As the gastric bypass program at this southeastern hospital progressed, the number of thromboembolic complications increased. Because of the increase in postoperative thromboembolic events, a program was developed to improve outcomes and reduce the number of these events. The program currently uses a protocol that includes research-based preventive measures in conjunction with warfarin (Coumadin, Bristol Myers Squibb, Princeton, NJ) 1 mg daily for 30 days postoperatively with a target international normalized ratio of 1.8 or less. Before the initiation of the program, the event rate was 6.9%. The event rate for the evaluation period after initiation of the protocol was 1.3%. Further studies are needed to determine the full benefit of this type of program and whether the improvements gained were related to the use of warfarin (Coumadin).
Heffline
Melody S
MS
Vascular Surgery and Anticoagulation Clinic, Southern Surgical Group, West Columbia, South Carolina, USA.
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D001458:Bandages; D002985:Clinical Protocols; D016903:Drug Monitoring; D004434:Early Ambulation; D019317:Evidence-Based Medicine; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery; D011182:Postoperative Care / Q000379:methods* / Q000451:nursing / Q000592:standards; D015397:Program Evaluation; D012307:Risk Factors; D013022:South Carolina / Q000453:epidemiology; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin; D001241:Aspirin