Unfractionated Heparin Dosing for Venous Thromboembolism in Morbidly Obese Patients: Case Report and Review of the Literature

2010 ◽  
Vol 30 (3) ◽  
pp. 324-324 ◽  
Author(s):  
April E Myzienski ◽  
Mark F Lutz ◽  
Maureen A Smythe
Keyword(s):  
Case Report ◽  
Venous Thromboembolism ◽  
Unfractionated Heparin ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Review Of The Literature

Unfractionated heparin infusion for treatment of venous thromboembolism based on actual body weight without dose capping

2019 ◽  
Vol 25 (1) ◽  
pp. 47-54 ◽  
Author(s):  
Julia A Shlensky ◽  
Kristina M Thurber ◽  
John G O’Meara ◽  
Narith N Ou ◽  
Jennifer L Osborn ◽  
...  
Keyword(s):  
Body Weight ◽  
Venous Thromboembolism ◽  
Actual Body ◽  
Unfractionated Heparin ◽  
Obese Group ◽  
Morbidly Obese ◽  
Actual Body Weight ◽  
Bleeding Events ◽  
Heparin Infusion ◽  
Significant Difference

Controversy exists regarding the use of dose capping of weight-based unfractionated heparin (UFH) infusions in obese and morbidly obese patients. The primary objective of this study was to compare time to first therapeutic activated partial thromboplastin time (aPTT) in hospitalized patients receiving UFH for acute venous thromboembolism (VTE) among three body mass index (BMI) cohorts: non-obese (< 30 kg/m2), obese (30–39.9 kg/m2), and morbidly obese (⩾ 40 kg/m2). In this single-center, retrospective cohort study, patients were included if they ⩾ 18 years of age, had a documented VTE, and were on an infusion of UFH for at least 24 hours. Weight-based UFH doses were calculated using actual body weight. A total of 423 patients met the inclusion criteria, with 230 (54.4%), 146 (34.5%), and 47 (11.1%) patients in the non-obese, obese, and morbidly obese cohorts, respectively. Median times to therapeutic aPTT were 16.4, 16.6, and 17.1 hours in each cohort. Within 24 hours, the cumulative incidence rates for therapeutic aPTT were 70.7% for the non-obese group, 69.9% for the obese group, and 61.7% for the morbidly obese group (obese vs non-obese: HR = 1.02, 95% CI: 0.82–1.26, p = 0.88; morbidly obese vs non-obese: HR = 0.87, 95% CI: 0.62–1.21, p = 0.41). There was no significant difference in major bleeding events between BMI groups (obese vs non-obese, p = 0.91; morbidly obese vs non-obese, p = 0.98). Based on our study, heparin dosing based on actual body weight without a dose cap is safe and effective.

scholarly journals Midline Supraumbilical Incision as an Option for Morbidly Obese Patients? Case Report

2021 ◽  
Vol 11 (11) ◽  
pp. 1517-1523
Author(s):  
Janete Vettorazzi ◽  
Gabriela Françoes Rostirolla ◽  
Gabrielle Soares Behenck ◽  
Fernanda Oliveira Castilhos ◽  
Eduardo Vettorazzi-Stuczynski ◽  
...  
Keyword(s):  
Case Report ◽  
Morbidly Obese ◽  
Obese Patients

Body Contour Resculpturing after Massive Weight Loss following Gastric Bypass: A Report of 40 Consecutive Cases and a Review of the Literature

1996 ◽  
Vol 13 (3) ◽  
pp. 251-255 ◽  
Author(s):  
P. Benmeir ◽  
A. Sagi ◽  
D. Cassutto ◽  
M. Oz ◽  
I. Haruzi ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Massive Weight Loss ◽  
Morbidly Obese ◽  
Average Weight ◽  
Obese Patients ◽  
Review Of The Literature ◽  
Common Procedure ◽  
Body Contour

Forty morbidly obese patients had plastic surgery to remove redundant tissues after gastric bypass surgery (GBP). The average weight reduction was 62 kg (range 29–95 kg) and the average age at operation was 36.5 years. Abdominoplasty was the most common procedure and no mortalities were recorded. The postoperative complications were related mostly to wound healing. The average hospitalization time was 8 days (range 5–11 days) and the patient's new body image was satisfactory.

The Morbidly Obese Surgical Patient

2020 ◽  
Author(s):  
Michael A. Schweitzer ◽  
Gregory Grimberg
Keyword(s):  
Weight Loss ◽  
Obstructive Sleep Apnea ◽  
Venous Thromboembolism ◽  
Sleep Apnea ◽  
Children And Adolescents ◽  
Respiratory Insufficiency ◽  
Gastric Surgery ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Obstructive Sleep

Over the past few decades, the incidence of obesity has been steadily rising in the United States. The Centers for Disease Control and Prevention estimates greater than 40% of the US adult population is obese. Rising obesity rates are also increasing among children and adolescents as well, with nearly one in five children and adolescents considered obese. As a result, surgeons today face the challenge of caring for an increasing number of morbidly obese patients, and this trend is expected to worsen over time. This review covers preoperative evaluation, obesity-related comorbidities, respiratory insufficiency, anesthesia in patients with respiratory insufficiency, intraoperative management, postoperative management, complications of gastric surgery for obesity, diabetes mellitus, wound care, and other obesity-related diseases. Figures show impaired pulmonary function in the morbidly obese improved significantly after weight loss induced by bariatric surgery, significant improvement in mean pulmonary arterial pressure in 18 patients, 3 to 9 months after gastric surgery-induced weight loss of 42% ± 19% of excess weight, and a chronic venous stasis ulcer present for several years in a morbidly obese patient. The tables list evaluation and treatment of obstructive sleep apnea, and indications for extended postoperative chemoprophylaxis for venous thromboembolism in morbidly obese patients. This review contains 3 highly rendered figures, 2 tables, and 46 references Keywords: morbid obesity, obesity, metabolic surgery, venous thromboembolism chemoprophylaxis, Obstructive Sleep Apnea

Abstract 14569: Direct Oral Anticoagulants in the Treatment of Acute Venous Thromboembolism in Obese Patients: A Systematic Review With Meta-analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Vicky Mai ◽  
Emmanuelle Marceau-Ferron ◽  
Laurent BERTOLETTI ◽  
Yves Lacasse ◽  
Sebastien Bonnet ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Data Extraction ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Random Effect ◽  
Random Effect Model ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Efficacy And Safety

Background: Obesity is a real burden and its prevalence is constantly increasing. High body weight is a risk factor for developing venous thromboembolism (VTE). Direct oral anticoagulants’ (DOAC) pharmacokinetics and pharmacodynamics are affected by obesity. Their efficacy and safety in obese (BMI ≥30kg/m 2 ) and morbidly obese (BMI ≥40kg/m 2 ) patients are still unclear in the treatment of VTE. Objectives: To compare the efficacy and safety of DOAC with vitamin K antagonist (VKA)/low molecular weight heparin (LMWH) in the acute treatment of VTE in obese and morbidly obese patients. The primary efficacy outcome was VTE recurrences. The safety outcomes were major bleeding (MB) and clinically relevant non-MB (CRNMB). All-cause mortality was also assessed. Hypothesis: We hypothesized that DOAC would present the same efficacy and safety for the treatment of acute VTE in obese and morbidly obese patients compared to VKA/LMWH. Methods: A systematic literature search (MEDLINE, EMBASE, CENTRAL, Web of Science) was conducted from inception to April 15 th 2020, identifying trials studying DOAC in the treatment of acute VTE in obese patients. Studies were included if one of the outcomes was reported. Two independent reviewers performed the study selection, data extraction, risk of bias assessment and strength of body evidence evaluation using the GRADE methodology. Analyses were conducted using the Mantel-Haenszel method based on a random-effect model. Relative risks (RR) were estimated for the effect measure with 95% confidence intervals. Results: From 1240 citations screened, we included 21 studies (58,590 patients). VTE recurrences was similar with DOAC compared to VKA/LMWH in obese patients (risk ratio (RR): 1.03; 95%CI 0.93-1.15; p=0.55) and morbidly obese patients (RR 1.06; 95CI 0.94-1.19; p=0.35). DOAC was associated with a reduction in MB in obese patients (RR 0.57; 95%CI 0.34-0.94; p=0.03) and morbidly obese patients (RR 0.71; 95%CI 0.50-1.00; p=0.05) compared to VKA/LMWH. In obese patients, no difference was observed in CRNMB with DOAC compared to VKA/LMWH. Conclusion: DOAC is as effective in reducing VTE and is associated with less MB compared to VKA/LMWH in obese and morbidly obese patients.

Pulmonary embolism in a patient receiving risperidone and paliperidone: A case report and review of the literature

2013 ◽  
Vol 3 (3) ◽  
pp. 144-147
Author(s):  
Ariane Casey ◽  
Marianne Saitz ◽  
Paul R. Swaim
Keyword(s):  
Pulmonary Embolism ◽  
Case Report ◽  
Venous Thromboembolism ◽  
Atypical Antipsychotic ◽  
Antipsychotic Treatment ◽  
Review Of The Literature ◽  
Long Acting

Several cases of pulmonary embolism (PE) have been associated with antipsychotic treatment. We report a case of an otherwise healthy 27-year old male who developed a PE after receiving paliperidone long acting injection. The patient received risperidone long acting injection for over 3 months before initiating paliperidone, but was switched incorrectly. After 3 weeks on paliperidone long acting injection the patient developed a PE requiring hospitalization and a course of anticoagulation. A review of atypical antipsychotic-induced venous thromboembolism is discussed.

62 Vancomycin Dosing in Morbidly Obese Patients Under Going CVVHD –A Case Report

2011 ◽  
Vol 57 (4) ◽  
pp. B32
Author(s):  
Wei Chen ◽  
Julie Chen ◽  
Danielle Garcia ◽  
Payal Lakhani ◽  
Ladan Golestaneh
Keyword(s):  
Case Report ◽  
Morbidly Obese ◽  
Obese Patients
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