目的:通过多模式康复计划确定减肥手术中的血栓和出血风险,比较《西班牙肥胖外科学会指南》和AEC肥胖部门推荐的2种药物预防指南。
方法:2010年1月至2019年12月的队列回顾性研究。记录垂直胃切除术或胃旁路手术的病例,系统地应用多模式康复协议。分析了两种减少的化学预防方案,手术后开始并维持10天;一种使用磺达肝素(Arixtra®),固定剂量为2.5mg/天,另一种使用依诺肝素(Clexane®),每日单次剂量调整为BMI:BMI为35-40时40mg/天,BMI为40-60时60mg/天。
结果:包括675例患者;2010-2015年期间354例使用磺达肝素-Arixtra®,2016-2019年期间321例使用依诺肝素-Clexane®。没有DVT或临床PE的病例。然而,需要再次手术的出血发生率,输血,或血红蛋白减少超过3g/dL为4.7%,组间没有差异。死亡率为零。平均住院时间为2.8天,前6个月的门诊随访率为100%,12个月为95%。
结论:由经验丰富的团队将多模式康复计划与机械和药理血栓预防相结合,可降低血栓栓塞事件的风险,并有理由减少化疗预防方案以降低术后出血风险.
OBJECTIVE: to determine the thrombotic and hemorrhagic risk in bariatric surgery with multimodal rehabilitation programs, comparing 2guidelines of pharmacological prophylaxis recommended in the Guide to the Spanish Society for Obesity Surgery and the Obesity Section of the AEC.
METHODS: Cohorts retrospective study from January-2010 to December-2019. Cases of vertical gastrectomy or gastric bypass were recorded, systematically applying multimodal rehabilitation protocols. Two reduced chemoprophylaxis regimens were analyzed, starting after surgery and maintained for 10 days; one with fondaparinux (Arixtra®) at a fixed dose of 2.5mg / day and the other with enoxaparin (Clexane®) with a single daily dose adjusted to BMI: 40mg / day for BMI of 35-40 and 60mg/day for BMI 40-60.
RESULTS: 675 patients were included; 354 with Fondaparinux-Arixtra® during the period 2010-2015 and 321 with Enoxaparin-Clexane® during the period 2016-2019. There were no cases of DVT or clinical PE. However, the incidence of hemorrhage requiring reoperation, transfusion, or a decrease of more than 3g / dL hemoglobin was 4.7%, with no difference between groups. Mortality was nil. The average stay was 2.8 days and the outpatient follow-up was 100% during the first 6 months and 95% at 12 months.
CONCLUSIONS: The combination of multimodal rehabilitation programs and mechanical and pharmacological thromboprophylaxis by experienced teams, reduces the risk of thromboembolic events and could justify reduced chemoprophylaxis regimens to decrease the risk of postoperative bleeding.