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2007, Number S1

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Gac Med Mex 2007; 143 (S1)

Prevención de la enfermedad tromboembólica venosa en cirugía

Zaragoza-Delgadillo JC, Sauri-Arce JCA, Ochoa-Carrillo FJ, Fuentes-del-Toro S

Language: Spanish
References: 31
Page: 35-39
PDF size: 51.47 Kb.


ABSTRACT

In surgical patients, if thromboprophylaxis is not indicated, median incidence of deep vein thrombosis (DVT) is 42% while pulmonary thromboembolism (PT) reaches 700,000 cases/year with a global mortality close to 200,000 fatalities. In patients with knee or hip orthopedic surgery without thromboprophylaxis DVT has an incidence of 45 to 60% while PT rises up to 7%. Extended thromboprophylaxis lowers symptomatic DVT incidence to 1.3% vs. 3.3% without thromboprophylaxis. Between 20 and 25% of patients in general surgery will develop DVT "!"and 0.8% will have a fatal PT; in these last, diagnosis is never made in 60% of the cases. All surgical patients are at risk of DVT therefore, the risk level should always be evaluated because thromboprophylactic measures depend on the risk level. This is classified in low, moderate, high and very high, an evaluation that allows to define the duration and intensity of thromboprophylaxis. Among main risk factors it has to be mentioned diabetic cetoacidosis, nephrotic syndrome, heart and lung failure, lung infections, cancer, advanced age, obesity, history of thrombosis, immobilization, pregnancy and high estrogen levels, surgical time, type of anesthesia and the magnitude of the surgical trauma. Early mobilization is the most important thromboprophylactic indication because it is effective and non-expensive. Other important aspects are optimal hydration, minimization of surgical trauma including the use of endoscopic procedures, and shortness of surgical time. Occasionally, intermittent pneumatic compression avoids the use of antithrombotic drugs; it acts rising the blood flow velocity in pelvic and femoral veins. In this section, several suggestions are done for the thromboprophylactic management of the surgical patient in different fields of surgery: general, laparoscopic, bariatric, gynecologic, urologic, orthopedical, and neurosurgical, as well as liposuction procedures and patients with burns or polytraumatized.


REFERENCES

  1. Stawicki SP, Grossman MD, Cipolla J, Hoff WS, Hoey BA, Wainwright G, et al. Deep venous thrombosis and pulmonary embolism in trauma patients: An overstatement of the problem. Am Surg 2005;71:387-392.

  2. Hirsh J, Hull RD. Venous Thromboembolism: Natural history, diagnosis, and management. CRC Press, Boca Raton, Florida, 1988.

  3. Bergqvist D. Postoperative thromboembolism: Frequency, aethiology, prophylaxis. Springer Verlag, New York, 1983.

  4. Caprini JA, Arcelus JI, Reyna JJ. Effective risk stratification of surgical and nonsurgical patients for venous thromboembolic disease. Semin Hematol 2001;38(suppl 5):12-19.

  5. Gensini GF, Prisco D, Falciani M, Comeglio M, Colella A. Identification of candidates for prevention of venous thromboembolism. Semin Thromb Hemost 1997;23;55-67.

  6. Geerts WH, Pineo GF, Heit JA, Bergquist D, Lassen MR, Colwell CW, et al. Prevention of venous thromboembolism. Chest 2004;126:338S-400S.

  7. Keenan CR, White RH. Age as a risk factor for venous thromboembolism after major surgery. Curr Op Pulmon Med 2005;11:398-402.

  8. Christen Y, Wutschert R, Weimer D, de Moerloose P, Kruithof EK, Bounameaux H. Effects of intermittent pneumatic compression on venous haemodynamics and fibrinolytic activity. Blood Coagul Fibrinolysis 1997;8:185-190.

  9. Comerota AJ, Chouhan V, Harda RN, Sun L, Hosking J, Veermansunemi R, Comerota AJ Jr, et al. The fibrinolytic effects of intermittent pneumatic compression: Mechanism of enhanced fibrinolysis. Ann Surg 1997;226:306-313.

  10. Clagett GP, Reisch JS. Prevention of venous thromboembolism in general surgical patients: results of meta-analysis. Ann Surg 1998;208:227-240

  11. Mismetti P, Laporte S, Darmon JY, Buchmuller A, Decousus H. Metaanalysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery. Br J Surg 2001;88:913-930.

  12. Bergqvist D, Agnelli G, Cohen AT, Eldor A, Nilsson PE, Le Moigne-Amrani A, et al. ENOXACAN II Investigators. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med 2002;346:975-980.

  13. Kakkar VV, Stringer MD. Prophylaxis of venous thromboembolism. World J Surg 1990;14:670-678.

  14. Kearon C. Duration of venous thromboembolism prophylaxis after surgery. Chest 2003;124:386-392.

  15. Society of American Gastrointestinal Endoscopic Surgeons: Global statement on deep venous thrombosis prophylaxis during laparoscopic surgery. www.sages.org/sg_pub_c.html.

  16. Bounameaux H, Didier D, Polat O. Antithrombotic prophylaxis in patients undergoing laparoscopic cholecystectomy. Thromb Res 1997;86:271-273.

  17. Sapala JA, Wood MH, Schuhknecht MP, Sapala MA. Fatal pulmonary embolism after bariatric operations for morbid obesity: a 24-year retrospective analysis. Obes Surg 2003;13:819-825.

  18. Westling A, Bergqvist D, Bostrom A, Karacagil S, Gustavsson S. Incidence of deep venous thrombosis in patients undergoing obesity surgery. World J Surg 2002;26:470-473.

  19. Sauerland S, Angrisani L, Belachew M, Chevallier JM, Favretti F, Finer N, et al. European Association for Endoscopic Surgery. Obesity surgery: Evidencebased guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 2005;19:200–221.

  20. Choudhary AM, Graver D, Nelson A. Current practices in the prophylaxis of venous thromboembolism in bariatric surgery. Obes Surg 2000;10:7-14.

  21. Baykal C, Al A, Demirtas E, Anyhan A. Comparison of enoxaparin and standard heparin in gynecologic oncologic surgery: A randomized prospective double-blind clinical study. Eur J Gynaecol Oncol 2001;22:127-130.

  22. Samuelsson E, Hagg S. Incidence of venous thromboembolism in young Swedish women and possibly preventable cases among combined oral contraceptive users. Acta Obstet Gynecol Scand 2004;83:674-681.

  23. Oates-Whitehead RM, D’Angelo A, Mol B. Anticoagulant and aspirin prophylaxis for preventing thromboembolism after major gynaecological surgery. The Cochrane library. The Cochrane Collaboration; Volume 3, 2005.

  24. Evidence Based Guidelines Group American Burn Association. Deep venous thrombosis prophylaxis in burns. J Burn Care Rehabil 2001;22(suppl):67S-69S.

  25. Norwood SH, McAuley CE, Berne JD, Vallina VL, Kerns DB, Grahm TW, et al. A potentially expanded role for enoxaparin in preventing venous thromboembolism in high-risk blunt trauma patients J Am Coll Surg 2001;192:161-167.

  26. Goldhaber SZ, Dunn K, Gerhad-Herman M, Park JK, Black PM. Low rate of venous thromboembolism after craniotomy for brain tumor using multimodality prophylaxis. Chest 2002;122:1933-1937.

  27. Macouillard G, Castagnera L, Claviere JP. Prevention of deep venous thrombosis in spinal surgery: Comparison of intermittent sequential pneumatic compression versus low molecular weight heparin. Thromb Haemost 1993;69:646.

  28. Bounameaux H, Didier D, Polat O. Antithrombotic prophylaxis in patients undergoing laparoscopic cholecystectomy. Thromb Res 1997;86:271-273.

  29. Samuelsson E, Hagg S. Incidence of venous thromboembolism in young Swedish women and possibly preventable cases among combined oral contraceptive users. Acta Obstet Gynecol Scand 2004;83:674-681.

  30. Kearon C. Duration of venous thromboembolism prophylaxis after surgery. Chest 2003;124:386-392.

  31. Kakkar VV, Stringer MD. Prophylaxis of venous thromboembolism. World J Surg 1990;14:670-678.




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