Journal of the American Pharmacists Association : JAPhA · 2025
Perioperative management of alpha-gal syndrome in bariatric surgery: A case study of venous thromboembolism prophylaxis.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
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Glaze Kaelen, Ancayan Sareidenn, Dodge Susan
Аннотация
BACKGROUND: Alpha-gal syndrome (AGS) is a tick-borne allergic condition triggered by galactose-alpha-1,3-galactose, a carbohydrate found in mammalian products. This case report highlights the perioperative challenges of managing AGS in a patient undergoing Roux-en-Y gastric bypass, a common bariatric surgical procedure.
CASE SUMMARY: A 53-year-old male with AGS was scheduled for robotic-assisted Roux-en-Y gastric bypass with potential hiatal hernia repair. The patient exhibited severe sensitivity to beef but lower reactivity to pork products, complicating the use of porcine-derived heparin for venous thromboembolism prophylaxis. After careful evaluation, low-molecular-weight heparin (enoxaparin) was selected as the anticoagulant, with 40 mg administered preoperatively. The patient underwent surgery without adverse reactions or bleeding complications.
PRACTICE IMPLICATIONS: This case underscores the complexities of AGS management in surgical settings, particularly regarding the selection of anticoagulants. While nonporcine alternatives exist, their safety and efficacy in bariatric surgery remain underexplored. The successful use of enoxaparin in this case suggests that a tailored approach, supported by multidisciplinary collaboration, can mitigate risks. This report highlights the need for further research to establish guidelines for anticoagulation in patients with AGS undergoing surgery. Enhanced awareness and individualized care are critical to ensuring optimal outcomes in this unique patient population.
CASE SUMMARY: A 53-year-old male with AGS was scheduled for robotic-assisted Roux-en-Y gastric bypass with potential hiatal hernia repair. The patient exhibited severe sensitivity to beef but lower reactivity to pork products, complicating the use of porcine-derived heparin for venous thromboembolism prophylaxis. After careful evaluation, low-molecular-weight heparin (enoxaparin) was selected as the anticoagulant, with 40 mg administered preoperatively. The patient underwent surgery without adverse reactions or bleeding complications.
PRACTICE IMPLICATIONS: This case underscores the complexities of AGS management in surgical settings, particularly regarding the selection of anticoagulants. While nonporcine alternatives exist, their safety and efficacy in bariatric surgery remain underexplored. The successful use of enoxaparin in this case suggests that a tailored approach, supported by multidisciplinary collaboration, can mitigate risks. This report highlights the need for further research to establish guidelines for anticoagulation in patients with AGS undergoing surgery. Enhanced awareness and individualized care are critical to ensuring optimal outcomes in this unique patient population.