VENOUS THROMBOEMBOLISM PREVENTION IN SURGICAL PATIENTS WITH OBESITY
Keywords:
obesity, venous thromboembolism, thromboprophylaxis, POC-monitoringAbstract
Venous thromboembolism (VTE) is one of the main causes of morbidity and mortality of hospitalized patients. Evidence-based prevention methods are used where it is appropriate and the amount of VTE can be significantly reduced. Obesity is an independent risk factor for VTE for both men and women. This relates to hemostasis disorders characterized in general as a prothrombotic state and requiring adequate perioperative correction to prevent VTE. Unfortunately, fixed doses of recommended anticoagulants including unfractionated heparin, low-molecular heparins and inhibitors of Xa factor can’t provide an optimal way to prevent VTE in patients with obesity. Increasing amount of literature and evidences accumulation indicate that the dose of the drug in patients with obesity should be individually corrected to optimize pharmacodynamic activity of the anticoagulant and to reduce the risk of VTE, possibly by using “Point of Care” (POC) monitoring. However, thromboelastography (TEG) and rotational thromboelastomethry (ROTEM) are not available in everyday practice and are used more often in critical situations. To solve this issue we propose to use POC monitoring of hemostasis with low-frequency piezothromboelastography (LPTEG).
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