Efficacy of venous thromboembolism prophylaxis in morbidly obese patients undergoing gastric bypass surgery.

BACKGROUND: Patients undergoing gastric bypass are at risk of developing venous thromboembolism (VTE) due to multiple risk factors including obesity and abdominal surgery. The purpose of this study is to evaluate the effectiveness of inpatient VTE prophylaxis in morbidly obese patients undergoing gastric bypass and the incidence of symptomatic VTE following discharge. METHODS: A retrospective chart review of patients undergoing gastric bypass from August 2000 to August 2001 was performed. Inpatient charts from medical records and physician outpatient office charts were reviewed. Evaluation consisted of: VTE prophylaxis utilized, acquired risk factors for VTE, BMI, development of deep venous thrombosis (DVT) or pulmonary embolism (PE) during hospitalization, outpatient office visits following discharge, and VTE after discharge. RESULTS: 107 patient charts were reviewed. There were no incidences of VTE documented during hospitalization, and only one patient developed a symptomatic DVT after discharge. During hospitalization, all patients received DVT prophylaxis consisting of medical management, external compression devices, and ambulation orders. At the time of surgery, patients had a mean age of 40 years (23-69 years) and a BMI of 51.3 kg/m2 (37-82). Surgery lasted a mean of 108.9 minutes (65-305), patients were hospitalized for a mean of 4.3 days (3-7), and had a mean of 3.4 risk factors (2-7 risk factors) for the development of VTE. After hospital discharge, 101 patients were followed for the development of VTE. CONCLUSION: Combination of medical management, early ambulation, and external compression devices adequately prevented the development of VTE in patients after gastric bypass.

Fresh frozen plasma prepared with amotosalen HCl (S-59) photochemical pathogen inactivation: transfusion of patients with congenital coagulation factor deficiencies.

BACKGROUND: Photochemical treatment (PCT) with amotosalen HCl (S-59) was developed to inactivate pathogens and white blood cells in plasma (PCT-FFP) used for transfusion support. STUDY DESIGN AND METHODS: An open-label, multicenter trial was conducted in patients with congenital coagulation factor deficiencies (factors [F]I, FII, FV, FVII, FX, FXI, and FXIII and protein C) to measure the kinetics of specific coagulation factors, hemostatic efficacy, and safety of PCT-FFP. Posttransfusion prothrombin time (PT), partial thromboplastin time (PTT), and clinical hemostasis were evaluated before and after PCT-FFP transfusions. RESULTS: Thirty-four patients received 107 transfusions of PCT-FFP for kinetic studies or therapeutic indications (mean dose, 12.8 +/- 8.5 mL/kg). Incremental factor recoveries ranged from 0.9 to 2.4 IU per dL per IU per kg (FII, FV, FVII, FX, FXI, and protein C). Mean pretransfusion PT (20.7 +/- 22.2 sec) corrected after PCT-FFP (13.8 +/- 2.4 sec, p < 0.001). Mean pretransfusion PTT (51.2 +/- 29.3 sec) corrected after PCT-FFP (32.0 +/- 5.1 sec, p < 0.001). Thirteen patients required 77 transfusions for therapeutic indications. PCT-FFP provided effective hemostasis and was well tolerated. CONCLUSIONS: Replacement coagulation factors in PCT-FFP exhibited kinetics and therapeutic efficacy consistent with conventional FFP.