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Bariatric surgery has been proven to be an effective way to relieve obesity and related metabolic diseases. Complications after bariatric surgery mainly include postoperative bleeding, anastomotic leakage, gastroesophageal reflux, dumping syndrome and so on. Deep vein thrombosis is a rare complication, with low incidence in many literatures. However, deep vein thrombosis is an important cause of pulmonary embolism. Once pulmonary embolism occurs, the difficulty of treatment and mortality are both high. The authors summarize the related literature on venous thromboembolism after bariatric surgery, and briefly describe the strategies of prevention and treatment of venous thromboembolism.
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Objective To assess the consistencies of VerifyNow system, thrombelastography (TEG), vasodilator-stimulated phosphoprotein (VASP), and PL-11 platelet analyzer in detecting the antiplatelet function of clopidogrel, and to discuss the clinical application values. Methods Totally 98 consecutive inpatients with ST-segment elevation myocardial infarction (STEMI), non-(NSTEMI), or coronary artery in-stent restenosis (SR) were included in this study. The patients were given a loading dose of 600-mg clopidogrel for 6 hours, 300-mg clopidogrel for at 24 hours, or chronic clopidogrel therapy (75 mg daily for ≥ 7 days) before the procedure. And then the antiplatelet effects were evaluated by VerifyNow, TEG, VASP and PL-11 platelet analyzer simultaneously, with the results of VerifyNow taken as the gold standard and P2Y12 reaction unit (PRU) ≥ 208 taken as high on-clopidogel treatment platelet reactivity (HTPR). Correlation analysis was done for the four methods, and area under ROC curve (AUC) was used to evaluate the value of each method for HTPR. Results The platelet inhibition rate detected by VerifyNow was positively correlated with that by TEG (r = 0. 234, P < 0. 05); by contrast, it was negatively correlated with the platelet reactivity index (PRI) measured by VASP, the maximum platelet aggregation rate (MAR) by PL-11 and the maximum adenosine diphosphate (MA-ADP) by TEG (r = –0. 299, P<0. 01; r = –0. 330, P< 0.05; r = –0. 237, P<0. 05). The PRU values was negatively correlated with the platelet inhibition rate detected by VerifyNow (r = –0.815, P < 0. 01). The area under ROC curve of PL-11 platelet analyzer was the highest (0. 644). Conclusion TEG, VASP, and PL-11 platelet function testing systems all have consistency with the “gold standard” VerifyNow in some extent, with PL-11 platelet analyzer showing the highest sensitivity and specificity.
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Objective To investigate the clinical outcomes of alprostadil in prevention of portal vein thrombosis after splenectomy and devascularization.Methods 113 patients with PHT who were treated with prophylactic alprostadil after splenectomy and devascularization procedures from May 2009 to Apr 2013 were included into the treatment group.112 conservative patients with PHT who were treated with traditional prophylactic anticoagulants after the same operations before May 2009 were included as the control group.The postoperative complication rates,mortality,postoperative drainage volume from the abdominal cavity,blood platelet counts,prothrombin time,liver function,Child-Pugh's scores and portal vein thrombosis rates between the two groups were compared.Results When compared with the control group,the postoperative complication rate and mortality in the alprostadil group were not increased,while the postoperative drainage volume from the abdominal cavity was significantly reduced.The increase in blood platelet counts and prothrombin time were similar in the 2 groups.Furthermore,the extent of hepatic dysfunction on the 3rd and 7th after operation was significantly decreased.On short term follow-up,color droppler ultrasonography showed the portal vein thrombosis rate of the treatment group was significantly lower than the control group,with less extensive degree of thrombosis in the treatment group.Conclusion Alprostadil is a safe and effective anticoagulant which provided better prevention of portal vein thrombosis after splenectomy combined with devascularization.
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Objective To explore the complication s and management of the placement of vena caval filter in patients suffering from deep venous thrombosis (DVT). Methods From 1998 to 2005, 80 DVT patients were treated by vena caval filte r placement. Before the placement 46 cases received CTA, 27 cases did radionucli de imaging(LPS), 16 cases did color Doppler ultrasonography, 5 cases underwen t venography. Result The p rocedure was successful in all 80 cases. New DVT developed in contralateral fem oral vein in 2 patients and vena caval obliteration developed in 3 patients afte r one year. Conclusion The complications of vena caval filter placement could be prevented by correctly de fine indication and good expertise.