Thromboserisiko und Thromboembolieprophylaxe in der Adipositas- und metabolischen Chirurgie

Zusammenfassung

Thromboembolien sind typische Komplikationen in der Adipositas-Chirurgie. Die prophylaktische Antikoagulation wird generell empfohlen, das optimale Vorgehen bei dieser Patientengruppe ist aufgrund fehlender Studien unklar. Aus dem German Bariatric Surgery Registry wurden für den Zeitraum von 2005–2013 Häufigkeit und Mortalität postoperativer Thromboembolien und Strategien der Antikoagulation ermittelt. Thromboembolien traten bei 0,1 % von 31 668 primären Eingriffen auf. Dieses Ergebnis bestätigt international Daten und wird auf die konsequente Prophylaxe zurückgeführt, denn 98% der Patienten wurden antikoaguliert. Ohne Antikoagulation war das Risiko für eine Lungenembolie dagegen 8-fach erhöht. Tritt ein Ereignis auf, ist die Mortalitätsrate groß, nach Beinvenenthrombose 4,8 % und nach Lungenembolie 12,9 %. Mittel der Wahl zur Prophylaxe sind niedermolekulare Heparine, für neue Antikoagulantien kann keine Empfehlung gegeben werden. Eine Dosiserhöhung der niedermolekularen Heparine sollte bei folgenden Risikofaktoren erwogen werden: BMI >50 kg/m², Alter >50 Jahre, männlich, venöse Insuffizienz, obstruktives Hypoventilationssyndrom, Rauchen und positive Anamnese für Thromboembolie.

Summary

Thromboembolism is a typical complication in bariatric surgery. Although prophylactic anticoagulation is recommended, optimal prophylactic procedures in these patients are unknown due to the lack of clinical trials. For the period 2005-2013, we analyzed the rate and mortality of post-surgery thromboembolism and strategies of prophylactic anticoagulation in the German Bariatric Surgery Registry. Thromboembolism occurred in 0.1 % of 31.668 primary bariatric surgical procedures. The result equals international data and is attributable to the fact that 98 % of the patients received prophylactic anticoagulation. Consequently, the risk of pulmonary embolism increased 8-fold in patients not receiving anticoagulants. Mortality of thromboembolic events is considerably large, 4.8 % after deep vein thrombosis, and 12.9 % after pulmonary embolism. Drugs of choice are low molecular weight heparins, new anticoagulants cannot be recommended at present. Increased doses of low molecular weight heparins should be considered in the case of BMI >50 kg/m², age >50 years, men, venous insufficiency, obstructive hypoventilation syndrome, smoking and positive medical history.

Schlüsselwörter

Venenthrombose - Lungenembolie - bariatrische Operation - Magenbypass - Schlauchmagen - Magenband

Keywords

Venous thrombosis - pulmonary embolism - obesity - bariatric surgery - Roux-en-Y gastric bypass - sleeve gastrectomy - gastric banding

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