No evidence to support placement of filters in patients undergoing bariatric surgery


A review of the literature suggests there is insufficient evidence to support the use of intravascular filters or augmented dosing of anticlotting medication in patients undergoing bariatric surgery to prevent venous thromboembolism, according to a report published online first by JAMA Surgery.


Prophylaxis to prevent venous thromboembolism is recommended for patients undergoing abdominal surgery, according to the study background.


Daniel J Brotman and colleagues of The Johns Hopkins University, Baltimore, USA, included 13 studies in their review – five of the studies had patients with and without filters placed in the inferior vena cava and eight had patients receiving different pharmacologic regimens.


The authors noted they found no randomised clinical trials addressing the comparative effectiveness of different interventions to prevent venous thromboembolism among patients undergoing bariatric surgery so all the studies were observational in nature.


“Overall, our findings support the use of ‘standard’ doses of pharmacotherapy as prophylaxis for patients undergoing bariatric surgery, consistent with current American College of Chest Physicians guidelines, which do not distinguish between patients undergoing bariatric surgery and those undergoing other types of abdominal surgery, the authors concluded.


They added, “We found no evidence to support filter placement as prophylaxis in patients undergoing bariatric surgery, with a trend toward higher deep vein thrombosis rates and higher mortality in patients receiving filters.”