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

May 29, 2013, Johns Hopkins University School of Medicine

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 thinners, early ambulation, and use of leg compression devices—are best in these .

The researchers also found that higher doses of blood thinners in , 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 , 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 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 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 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."

Explore further: Surgical-site infections may increase risk of deadly blood clots after colorectal surgery

Related Stories

Surgical-site infections may increase risk of deadly blood clots after colorectal surgery

January 16, 2013
Despite receiving blood thinners and other clot prevention treatment, some patients still develop potentially lethal blood clots in the first month after their operations anyway, especially if they developed a surgical-site ...

Should you stop blood thinners before surgery? AAN guideline provides direction

May 27, 2013
A new guideline from the American Academy of Neurology will help people who take blood thinners decide whether or not to take them during surgery or other medical procedures. The guideline is published in the May 28, 2013, ...

Blood thinners may boost survival for prostate cancer patients

February 21, 2013
(HealthDay)—Men with advanced prostate cancer might live longer when they are taking blood-thinning medication, a small study suggests.

Commonly used catheters double risk of blood clots in ICU and cancer patients

May 20, 2013
Touted for safety, ease and patient convenience, peripherally inserted central catheters have become many clinicians' go-to for IV delivery of antibiotics, nutrition, chemotherapy, and other medications.

Certain steroids may raise risk of dangerous blood clots

April 1, 2013
(HealthDay)—People who use drugs called glucocorticoids—a class of steroids—are at increased risk for blood clots in their veins, according to a new study.

Recommended for you

Drug may help surgical patients stop opioids sooner

December 13, 2017
(HealthDay)—Opioid painkillers after surgery can be the first step toward addiction for some patients. But a common drug might cut the amount of narcotics that patients need, a new study finds.

Children best placed to explain facts of surgery to patients, say experts

December 13, 2017
Getting children to design patient information leaflets may improve patient understanding before they have surgery, finds an article in the Christmas issue of The BMJ.

Burn victim saved by skin grafts from identical twin (Update)

November 23, 2017
A man doomed to die after suffering burns across 95 percent of his body was saved by skin transplants from his identical twin in a world-first operation, French doctors said Thursday.

Is a common shoulder surgery useless?

November 21, 2017
(HealthDay)—New research casts doubt on the true effectiveness of a common type of surgery used to ease shoulder pain.

Study shows electric bandages can fight biofilm infection, antimicrobial resistance

November 6, 2017
Researchers at The Ohio State University Wexner Medical Center have shown - for the first time - that special bandages using weak electric fields to disrupt bacterial biofilm infection can prevent infections, combat antibiotic ...

Obesity increases incidence, severity, costs of knee dislocations

November 3, 2017
A new study of more than 19,000 knee dislocation cases in the U.S. between 2000 and 2012 provides a painful indication of how the nation's obesity epidemic is changing the risk, severity and cost of a traumatic injury.

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

Kavincarlson
not rated yet Jun 01, 2013
Get assured cure to all your muscular, joints and bone related issues under the guidance of proficient orthopaedic surgeons. We provide assured solutions handpicked by our orthopaedic doctors.
doktersingapura.com/orthopaedic-surgeons/

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.