Risk-group targeted inferior vena cava filter placement in gastric bypass patients

D. Wayne Overby, Geoffrey P. Kohn, Mitchell A. Cahan, Robert G. Dixon, Joseph Stavas, Stephan Moll, Charles T. Burke, Karen J. Colton, Timothy M. Farrell

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: Despite a growing body of evidence guiding appropriate perioperative thromboprophylaxis in the general population, few data direct strategies to reduce deep venous thrombosis (DVT) and pulmonary embolism (PE) in the morbidly obese. We have implemented a novel protocol for venous thromboembolism (VTE) risk stratification in Roux-en-Y gastric bypass (RYGB) candidates at our institution, which augments clinical assessment with screening for thrombophilias, to guide retrievable inferior vena cava (IVC) filter utilization. Methods: A retrospective review of prospectively collected data from patients who underwent primary RYGB between 2001 and 2008 at the University of North Carolina at Chapel Hill was completed. During that time, clinical assessment of VTE risk was amplified by focused plasma screening for common thrombophilias (factors VIII, IX, and XI, d-dimer, fibrinogen). Preoperative prophylactic IVC filters were offered to high-risk patients. The database was reviewed for perioperative DVTs, PEs, and filter-related complications. Results: Of 330 patients, in 162 attempts, 160 had prophylactic IVC filters placed with four complications overall (2.47%). No patient had symptoms of PE during the planned 6-week filter period, though one had a PE occur immediately after filter removal (0.63%); in contrast, five of 170 patients (2.94%) without prophylactic IVC filters presented with symptomatic PE (p∈=∈0.216). In total, 147 (91.88%) prophylactic filters were removed. Conclusions: Risk-group targeted prophylactic inferior vena cava filter placement prior to RYGB is safe with a trend towards reduced occurrence of PE.

Original languageEnglish
Pages (from-to)451-455
Number of pages5
JournalObesity Surgery
Volume19
Issue number4
DOIs
StatePublished - Apr 2009
Externally publishedYes

Fingerprint

Vena Cava Filters
Gastric Bypass
Pulmonary Embolism
Venous Thromboembolism
Factor XI
Factor IX
Factor VIII
Venous Thrombosis
Fibrinogen
Databases
Population

All Science Journal Classification (ASJC) codes

  • Surgery
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

Cite this

Overby, D. W., Kohn, G. P., Cahan, M. A., Dixon, R. G., Stavas, J., Moll, S., ... Farrell, T. M. (2009). Risk-group targeted inferior vena cava filter placement in gastric bypass patients. Obesity Surgery, 19(4), 451-455. https://doi.org/10.1007/s11695-008-9794-2

Risk-group targeted inferior vena cava filter placement in gastric bypass patients. / Overby, D. Wayne; Kohn, Geoffrey P.; Cahan, Mitchell A.; Dixon, Robert G.; Stavas, Joseph; Moll, Stephan; Burke, Charles T.; Colton, Karen J.; Farrell, Timothy M.

In: Obesity Surgery, Vol. 19, No. 4, 04.2009, p. 451-455.

Research output: Contribution to journalArticle

Overby, DW, Kohn, GP, Cahan, MA, Dixon, RG, Stavas, J, Moll, S, Burke, CT, Colton, KJ & Farrell, TM 2009, 'Risk-group targeted inferior vena cava filter placement in gastric bypass patients', Obesity Surgery, vol. 19, no. 4, pp. 451-455. https://doi.org/10.1007/s11695-008-9794-2
Overby, D. Wayne ; Kohn, Geoffrey P. ; Cahan, Mitchell A. ; Dixon, Robert G. ; Stavas, Joseph ; Moll, Stephan ; Burke, Charles T. ; Colton, Karen J. ; Farrell, Timothy M. / Risk-group targeted inferior vena cava filter placement in gastric bypass patients. In: Obesity Surgery. 2009 ; Vol. 19, No. 4. pp. 451-455.
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AU - Stavas, Joseph

AU - Moll, Stephan

AU - Burke, Charles T.

AU - Colton, Karen J.

AU - Farrell, Timothy M.

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N2 - Background: Despite a growing body of evidence guiding appropriate perioperative thromboprophylaxis in the general population, few data direct strategies to reduce deep venous thrombosis (DVT) and pulmonary embolism (PE) in the morbidly obese. We have implemented a novel protocol for venous thromboembolism (VTE) risk stratification in Roux-en-Y gastric bypass (RYGB) candidates at our institution, which augments clinical assessment with screening for thrombophilias, to guide retrievable inferior vena cava (IVC) filter utilization. Methods: A retrospective review of prospectively collected data from patients who underwent primary RYGB between 2001 and 2008 at the University of North Carolina at Chapel Hill was completed. During that time, clinical assessment of VTE risk was amplified by focused plasma screening for common thrombophilias (factors VIII, IX, and XI, d-dimer, fibrinogen). Preoperative prophylactic IVC filters were offered to high-risk patients. The database was reviewed for perioperative DVTs, PEs, and filter-related complications. Results: Of 330 patients, in 162 attempts, 160 had prophylactic IVC filters placed with four complications overall (2.47%). No patient had symptoms of PE during the planned 6-week filter period, though one had a PE occur immediately after filter removal (0.63%); in contrast, five of 170 patients (2.94%) without prophylactic IVC filters presented with symptomatic PE (p∈=∈0.216). In total, 147 (91.88%) prophylactic filters were removed. Conclusions: Risk-group targeted prophylactic inferior vena cava filter placement prior to RYGB is safe with a trend towards reduced occurrence of PE.

AB - Background: Despite a growing body of evidence guiding appropriate perioperative thromboprophylaxis in the general population, few data direct strategies to reduce deep venous thrombosis (DVT) and pulmonary embolism (PE) in the morbidly obese. We have implemented a novel protocol for venous thromboembolism (VTE) risk stratification in Roux-en-Y gastric bypass (RYGB) candidates at our institution, which augments clinical assessment with screening for thrombophilias, to guide retrievable inferior vena cava (IVC) filter utilization. Methods: A retrospective review of prospectively collected data from patients who underwent primary RYGB between 2001 and 2008 at the University of North Carolina at Chapel Hill was completed. During that time, clinical assessment of VTE risk was amplified by focused plasma screening for common thrombophilias (factors VIII, IX, and XI, d-dimer, fibrinogen). Preoperative prophylactic IVC filters were offered to high-risk patients. The database was reviewed for perioperative DVTs, PEs, and filter-related complications. Results: Of 330 patients, in 162 attempts, 160 had prophylactic IVC filters placed with four complications overall (2.47%). No patient had symptoms of PE during the planned 6-week filter period, though one had a PE occur immediately after filter removal (0.63%); in contrast, five of 170 patients (2.94%) without prophylactic IVC filters presented with symptomatic PE (p∈=∈0.216). In total, 147 (91.88%) prophylactic filters were removed. Conclusions: Risk-group targeted prophylactic inferior vena cava filter placement prior to RYGB is safe with a trend towards reduced occurrence of PE.

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