Thromboprophylaxis after bariatric surgery

BACKGROUND: Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a known cause of morbidity and mortality after bariatric surgery. However, the data concerning appropriate thromboprophylaxis after bariatric surgery is uncertain. The objective of this study was to evaluate the efficacy and safety of extended duration thromboprophylaxis in post-bariatric surgery patients.METHODS: We conducted a retrospective study of consecutive patients who underwent bariatric surgery from November 2014 to October 2018 at King Fahad General Hospital in Jeddah, Saudi Arabia. All included patients were treated with extended duration thromboprophylaxis.RESULTS: We identified 374 patients who underwent bariatric surgery during the study period. Of these, 312 patients (83%) were followed for at least 3 months. The most common type of surgery was a laparoscopic sleeve gastrectomy (N=357) and the median weight was 110 kg. The cumulative incidence of symptomatic postoperative VTE at 3 months was 0.64% (95% confidence interval, 0.20–1.52). All events occurred after hospital discharge. The most commonly used pharmacological prophylaxis (91%) for VTE prevention after bariatric surgery was enoxaparin 40 mg subcutaneously twice daily for 10–14 days after hospital discharge. There were no reported cases of bleeding or VTE related mortality after 3 months.CONCLUSION: Extended thromboprophylaxis after bariatric surgery appears to be an effective and safe strategy for VTE prevention. Large prospective studies are needed to evaluate the optimal thromboprophylaxis regimen after bariatric surgery.

Surveillance of adverse events following immunization in Oman, 2006-2015

Background: In 1996, Oman launched its surveillance programme for adverse events following immunization [AEFI] to address vaccine safety concerns. In 2010, an analysis of surveillance activities for AEFI was done for 10 years [1996-2005]. Objectives: The main objective of the study was to describe the trend of AEFI over the 10-year period, 2006-2015, and compare the findings with a previous report in Oman and reports from other countries. Methods: A descriptive record-based review of AEFI was carried out using the national AEFI surveillance database for the study period, 2006-2015. Results: A total of 890 adverse event reports were received, giving an annual rate during the review period of 21.4 per 100 000 population or 8.3 per 100 000 doses administered. The most frequently reported AEFI were BCG adenitis and local reactions - 31.1 and 4.1 per 100 000 doses respectively. There were no reported deaths. Pentavalent vaccine was responsible for the greatest proportion of adverse events [30%]. Local reaction was the most common adverse event among all vaccines administered. The Hexa vaccine caused fewer adverse events compared with the pentavalent vaccine, probably due to the acellular pertussis component – 0.8 versus 1.5 per 100 000 doses administered respectively. Conclusion: The overall rate of AEFI [8.3 per 100 000 doses administered] is comparable to the rate [10.8/100 000 doses] in the previous decade [1996-2005] in Oman. The reported rates for individual vaccines are similar to or below international rates