A review of available medical literature suggests there is insufficient evidence to support the use of intra-vascular filters or augmented dosing of anti-clotting medication in patients undergoing bariatric surgery to prevent venous thromboembolism (VTE, blood clots), according to a report published Online First by JAMA Surgery, a JAMA Network publication.
Prophylaxis to prevent VTE is recommended for patients undergoing abdominal surgery, according to the study background.
Daniel J. Brotman, M.D., and colleagues of The Johns Hopkins University, Baltimore, included 13 studies in their review; five of the studies had patients with and without filters placed in the inferior vena cava, the large vein through which blood from the legs and pelvis flows back to the heart and eight had patients receiving different pharmacologic regimens.
The authors note they found no randomized clinical trials addressing the comparative effectiveness of different interventions to prevent VTE among patients undergoing bariatric surgery so all the studies were observational in nature.
“Overall, our findings support the use of ‘standard’ doses of pharmacotherapy as prophylaxis for patients undergoing bariatric surgery, consistent with current American College of Chest Physicians guidelines, which do not distinguish between patients undergoing bariatric surgery and those undergoing other types of abdominal surgery,” the authors conclude. “We found no evidence to support filter placement as prophylaxis in patients undergoing bariatric surgery, with a trend toward higher DVT [deep vein thrombosis] rates and higher mortality in patients receiving filters.”
JAMA Surg. Published online May 29, 2013. doi:10.1001/jamasurg.2013.72.