Featured Research

from universities, journals, and other organizations

Temporary blood clot filters may do more harm than good for bariatric surgery patients

Date:
May 29, 2013
Source:
Johns Hopkins Medicine
Summary:
The temporary placement of umbrella-like, metal mesh filters in abdominal veins to stop potentially lethal blood clots from traveling to the lungs during and after weight loss surgery may actually increase the risk of death in morbidly obese patients, according to new research.

The temporary placement of umbrella-like, metal mesh filters in abdominal veins to stop potentially lethal blood clots from traveling to the lungs during and after weight loss surgery may actually increase the risk of death in morbidly obese patients, according to new Johns Hopkins research.

The study's findings, reported in the journal JAMA Surgery, suggest that more tried-and-true measures to prevent venous thromboembolism (VTE) and its deadlier cousin pulmonary embolism (PE) -- such as a standard prophylactic dose of blood thinners, early ambulation, and use of leg compression devices -- are best in these patients.

The researchers also found that higher doses of blood thinners in obese patients, a group at higher risk for developing clots, were no more effective than standard doses given to patients who weigh less.

"If you're undergoing minimally invasive bariatric surgery, receive standard doses of blood thinners and get up and about as soon as possible after your operation, the chances of getting a blood clot are low," says study leader Daniel J. Brotman, M.D., an associate professor of medicine at the Johns Hopkins University School of Medicine and director of the hospitalist program at The Johns Hopkins Hospital. "And the evidence suggests that use of filters may do more harm than good."

The placement of filters in the inferior vena cava, the large vein that carries blood from the lower parts of the body to the heart, have become more common in surgery since they no longer need to be implanted permanently, like stents used to open clogged coronary arteries. The filters can be removed after the risk of clots has passed. Patients who are obese and patients who have just undergone surgery are two categories of people at increased risk for developing potentially deadly clots, statistics show.

The filters are supposed to act as a physical barrier to keep clots that form in leg veins from breaking off and reaching the heart and lungs. They may still be indicated for some patients who are at increased bleeding risk and therefore cannot tolerate blood thinners.

The researchers reviewed previously published medical literature on the comparative effectiveness and safety of pharmacological and mechanical strategies to prevent VTE in bariatric patients. Then they reanalyzed the data from eight pharmacologic studies and five studies of filter placement. Comparing outcomes, they found that filters did not reduce the risk of deadly lung clots, and saw some evidence that they are associated with higher overall mortality in the patients.

"If filters helped, we could find no evidence of that," Brotman says. "The data suggest more patients are harmed than benefit from these devices."

Brotman says the risk of fatal blood clots in bariatric surgery patients is less than 1 percent. One reason may be that the operation is becoming less invasive, allowing patients to get up and walk around sooner after surgery, another way to prevent blood clots from forming, he says.

The Johns Hopkins team's analysis suggests that increasing blood thinner doses based on weight made no obvious difference in whether bariatric surgery patients developed clots. "I was a bit surprised by this, since we do use higher doses of blood thinning medications in larger patients when we're treating clots, so one would think that larger patients would also require higher doses of these medications to prevent clots," says Brotman. "But if this was the case, we could not detect it."

The research was funded by the Agency for Healthcare Research and Quality (HHSA-290-2007-10061 I) and is part of the "Comparative Effectiveness of Pharmacologic and Mechanical Prophylaxis of Venous Thromboembolism Among Special Populations" report which looks at VTE prevention in subgroups such as trauma patients, elderly patients and burn patients.

Other Johns Hopkins researchers include Hasan M. Shihab, M.B.Ch.B., M.P.H.; Kaplana R. Prakasa, M.B.B.S., M.S.; Sosena Kebede, M.D., M.P.H.; Elliott R. Haut, M.D.; Ritu Sharma, B.Sc.; Kenneth Shermock, Pharm.D., Ph.D.; Yohalakshmi Chelladurai, M.B.B.S., M.P.H.; Sonal Singh, M.D., M.P.H.; and Jodi B. Segal, M.D., M.P.H.


Story Source:

The above story is based on materials provided by Johns Hopkins Medicine. Note: Materials may be edited for content and length.


Journal Reference:

  1. Brotman DJ, Shihab HM, Prakasa KR, et al. Pharmacologic and Mechanical Strategies for Preventing Venous Thromboembolism After Bariatric Surgery: A Systematic Review and Meta-analysis. JAMA Surgery, 2013; DOI: 10.1001/jamasurg.2013.72

Cite This Page:

Johns Hopkins Medicine. "Temporary blood clot filters may do more harm than good for bariatric surgery patients." ScienceDaily. ScienceDaily, 29 May 2013. <www.sciencedaily.com/releases/2013/05/130529190731.htm>.
Johns Hopkins Medicine. (2013, May 29). Temporary blood clot filters may do more harm than good for bariatric surgery patients. ScienceDaily. Retrieved July 22, 2014 from www.sciencedaily.com/releases/2013/05/130529190731.htm
Johns Hopkins Medicine. "Temporary blood clot filters may do more harm than good for bariatric surgery patients." ScienceDaily. www.sciencedaily.com/releases/2013/05/130529190731.htm (accessed July 22, 2014).

Share This




More Health & Medicine News

Tuesday, July 22, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Courts Conflicted Over Healthcare Law

Courts Conflicted Over Healthcare Law

AP (July 22, 2014) Two federal appeals courts issued conflicting rulings Tuesday on the legality of the federally-run healthcare exchange that operates in 36 states. (July 22) Video provided by AP
Powered by NewsLook.com
Why Do People Believe We Only Use 10 Percent Of Our Brains?

Why Do People Believe We Only Use 10 Percent Of Our Brains?

Newsy (July 22, 2014) The new sci-fi thriller "Lucy" is making people question whether we really use all our brainpower. But, as scientists have insisted for years, we do. Video provided by Newsy
Powered by NewsLook.com
Scientists Find New Way To Make Human Platelets

Scientists Find New Way To Make Human Platelets

Newsy (July 22, 2014) Boston scientists have discovered a new way to create fully functioning human platelets using a bioreactor and human stem cells. Video provided by Newsy
Powered by NewsLook.com
Gilead's $1000-a-Pill Drug Could Cure Hep C in HIV-Positive People

Gilead's $1000-a-Pill Drug Could Cure Hep C in HIV-Positive People

TheStreet (July 21, 2014) New research shows Gilead Science's drug Sovaldi helps in curing hepatitis C in those who suffer from HIV. In a medical study, the combination of Gilead's Hep C drug with anti-viral drug Ribavirin cured 76% of HIV-positive patients suffering from the most common hepatitis C strain. Hepatitis C and related complications have been a top cause of death in HIV-positive patients. Typical medication used to treat the disease, including interferon proteins, tended to react badly with HIV drugs. However, Sovaldi's %1,000-a-pill price tag could limit the number of patients able to access the treatment. TheStreet's Keris Lahiff reports from New York. Video provided by TheStreet
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins