Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.002118
Jornal Vascular Brasileiro
Review Article

O que mudou nas últimas décadas na profilaxia do tromboembolismo venoso em pacientes internados: artigo de revisão

What has changed in venous thromboembolism prophylaxis for hospitalized patients over recent decades: review article

Selma Regina de Oliveira Raymundo; Suzana Margareth Ajeje Lobo; Kassim Mohamede Kassim Hussain; Kassim Guzzon Hussein; Isabela Tobal Secches

Downloads: 55
Views: 4143

Resumo

Resumo: O tromboembolismo venoso (TEV) é uma doença frequente e de alta morbimortalidade, sendo considerada a maior causa evitável de mortalidade em pacientes hospitalizados. Apesar da incidência altíssima de TEV em todos os países e das evidências de que a tromboprofilaxia reduz as complicações tromboembólicas em pacientes clínicos e cirúrgicos, e a custo baixo, persistem grandes dúvidas quanto à segurança desse tipo de intervenção nos pacientes e quanto à tromboprofilaxia ideal. Inúmeros estudos e recomendações baseadas em evidências comprovam a eficácia da profilaxia na prevenção do TEV e/ou da morte dos pacientes, mas ainda hoje ela é subutilizada. Neste artigo, apresentamos uma ampla revisão dos métodos de profilaxia existentes até os dias atuais, publicados em diretrizes e estudos nacionais e internacionais sobre tromboprofilaxia.

Palavras-chave

tromboembolismo venoso, prevenção & controle, anticoagulantes

Abstract

Abstract: Venous thromboembolism (VTE) is a common disease with high rates of morbidity and mortality and is considered the number one cause of avoidable mortality among hospitalized patients. Although VTE incidence is extremely high in all countries and there is ample evidence that thromboprophylaxis inexpensively reduces the rate of thromboembolic complications in both clinical and surgical patients, a great deal of doubt remains with respect to patient safety with this type of intervention and in relation to the ideal thromboprophylaxis methods. Countless studies and evidence-based recommendations confirm the efficacy of prophylaxis for prevention of VTE and/or patient deaths, but it remains underutilized to this day. This article presents a wide-ranging review of existing prophylaxis methods up to the present, from guidelines and national and international studies of thromboprophylaxis.
 

Keywords

venous thromboembolism, prevention & control, anticoagulants

References

MacDougall DA, Feliu AL, Boccuzzi SJ, Lin J. Economic burden of deep vein thrombosis, pulmonary embolism, and post-thrombotic syndrome. Am J Health Syst Pharm. 2006;63(20, Suppl 6):S5-15. http://dx.doi.org/10.2146/ajhp060388. PMid:17032933.

Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 Suppl):381S-453S.

Beckman MG, Hooper WC, Critchley SE, Ortel TL. Venous thromboembolism: a public health concern. Am J Prev Med. 2010;38(4, Suppl):S495-501. http://dx.doi.org/10.1016/j.amepre.2009.12.017. PMid:20331949.

Heit JA. The epidemiology of venous thromboembolism in the community: implications for prevention and management. J Thromb. 2006;21(1):23-9. http://dx.doi.org/10.1007/s11239-006-5572-y. PMid:16475038.

Spyropoulos AC, Hussein M, Lin J, Battleman D. Rates of symptomatic venous thromboembolism in US surgical patients: a retrospective administrative database study. J Thromb Thrombolysis. 2009;28(4):458-64. http://dx.doi.org/10.1007/s11239-009-0351-1. PMid:19479199.

Heit JA, Silverstein MD, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ 3rd. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med. 2000;160(6):809-15. http://dx.doi.org/10.1001/archinte.160.6.809. PMid:10737280.

Anderson FA Jr, Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107(23, Suppl 1):I9-16. PMid:12814980.

Roderick P, Ferris G, Wilson K, Halls H, Jackson D, Collins R, Baigent C. Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis. Health Technol Assess. 2005;9(49):1-78.

Westrich GH, Rana AJ, Terry MA, Taveras NA, Kapoor K, Helfet DL. Thromboembolic disease prophylaxis in patients with hip fracture: a multimodal approach. J Orthop Trauma. 2005;19(4):234-40. http://dx.doi.org/10.1097/01.bot.0000155307.20133.95. PMid:15795571.

Kakkos SK, Caprini JA, Geroulakos G, Nicolaides AN, Stansby G, Reddy DJ. Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism in high-risk patients. Eur J Vasc Endovasc Surg. 2009;37(3):364-5. http://dx.doi.org/10.1016/j.ejvs.2008.11.033. PMid:19162515.

Cohen AT, Skinner JA, Warwick D, Brenkel I. The use of graduated compression stockings in association with fondaparinux in surgery of the hip. A multicenter, multinational, randomized, open-label, parallel-group comparative study. J Bone Joint Surg. 2007;89(7):887-92. http://dx.doi.org/10.1302/0301-620X.89B7.18556. PMid:17673580.

Kakkar VV, Corrigan TP, Fossard DP. Prevention of fatal postoperative pulmonary embolism by low doses of heparin. Lancet. 1975;2:45-51. PMid:49649.

Collins R, Scrimgeour A, Yusuf S, Peto R. Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin: overview of results of randomized trials in general, orthopedic and urologic surgery. N Engl J Med. 1988;318(18):1162-73. http://dx.doi.org/10.1056/NEJM198805053181805. PMid:3283548.

Mismetti P, Laporte S, Darmon JY, Buchmuller A, Decousus H. Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery. Br J Surg. 2001;88(7):913-30. http://dx.doi.org/10.1046/j.0007-1323.2001.01800.x. PMid:11442521.

Samama CM, Vray M, Barré J, et al. Extended venous thromboembolism prophylaxis after total hip replacement: a comparison of low-molecular-weight heparin with oral anticoagulant. Arch Intern Med. 2002;162(19):2191-6. http://dx.doi.org/10.1001/archinte.162.19.2191. PMid:12390061.

Turpie AG, Bauer KA, Eriksson BI, Lassen MR. Fondaparinux vs enoxaparin for the prevention of venous thromboembolism in major orthopedic surgery: a meta-analysis of 4 randomized double-blind studies. Arch Intern Med. 2002;162(16):1833-40. http://dx.doi.org/10.1001/archinte.162.16.1833. PMid:12196081.

Agnelli G, Bergqvist D, Cohen AT, Gallus AS, Gent M. Randomized clinical trial of postoperative fondaparinux versus perioperative dalteparin for prevention of venous thromboembolism in high-risk abdominal surgery. Br J Surg. 2005;92(10):1212-20. http://dx.doi.org/10.1002/bjs.5154. PMid:16175516.

Cohen AT, Davidson BI, Gallus AS, et al. Efficacy and safety of fondaparinux for prevention of venous thromboembolism in older acute medical patients: randomized placebo controlled trial. BMJ. 2006;332(7537):325-9. http://dx.doi.org/10.1136/bmj.38733.466748.7C. PMid:16439370.

Weitz JI, Hirsh J, Samama MM. New Antithrombotic drugs: American College of Chest Physicians Evidence-Based clinical Practice Guidelines (8th Edition). Chest. 2008; 133(6 Suppl):234S-56S. http://dx.doi.org/10.1378/chest.08-0673.

Van Thiel D, Kalodiki E, Wahi R, Litinas E, Haque W, Rao G. Interpretation of benefit-risk of enoxaparin as comparator in the RECORD program: rivaroxaban oral tablets (10 milligrams) for use in prophylaxis in deep vein thrombosis and pulmonary embolism in patients undergoing hip or knee replacement surgery. Clin Appl Thromb Hemost. 2009;15(4):389-94. http://dx.doi.org/10.1177/1076029609340163. PMid:19608550.

Eriksson BI, Borris LC, Friedman RJ, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthoplasty. N Engl J Med. 2008;358(26):2765-75. http://dx.doi.org/10.1056/NEJMoa0800374. PMid:18579811.

Kakkar AK, Brenner B, Dahl OE, et al. Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind, randomized controlled trial. Lancet. 2008;372(9632):31-9. http://dx.doi.org/10.1016/S0140-6736(08)60880-6. PMid:18582928.

Lassen MR, Ageno W, Borris LC, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med. 2008;358(26):2776-86. http://dx.doi.org/10.1056/NEJMoa076016. PMid:18579812.

Turpie AG, Lassen MR, Davidson BL, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthoplasty (RECORD4): a randomized trial. Lancet. 2009;373(9676):1673-80. http://dx.doi.org/10.1016/S0140-6736(09)60734-0. PMid:19411100.

Samama MM, Gerotziafas GT. Newer anticoagulants in 2009. J Thromb Thrombolysis. 2010;29(1):92-104. http://dx.doi.org/10.1007/s11239-009-0392-5. PMid:19838770.

Lassen MR, Raskob GE, Gallus A, Pineo G, Chen D, Portman RJ. Apixaban or enoxaparin for thromboprophylaxis after knee replacement. N Engl J Med. 2009;361(6):594-604. http://dx.doi.org/10.1056/NEJMoa0810773. PMid:19657123.

Lassen MR, Davidson BL, Gallus A, Pineo G, Ansell J, Deitchman D. The efficacy and safety of apixaban, an oral, direct factor Xa inhibitor, as thromboprophylaxis in patients following total knee replacement. J Thromb Haemost. 2007;5(12):2368-75. http://dx.doi.org/10.1111/j.1538-7836.2007.02764.x. PMid:17868430.

Lassen MR, Raskob GE, Gallus A, Pineo G, Chen D, Hornick P. Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomised double-blind trial. Lancet. 2010;375(9717):807-15. http://dx.doi.org/10.1016/S0140-6736(09)62125-5. PMid:20206776.

Fuji T, Wang CJ, Fujita S, et al. Safety and efficacy of edoxaban, an oral factor Xa inhibitor versus enoxaparin for thromboprophylaxis after knee arthroplasty: the STARS E-3 trial. Thromb Res. 2014;134(6):1198-204. http://dx.doi.org/10.1016/j.thromres.2014.09.011. PMid:25294589.

McBride BF. A preliminary assessment of the critical differences between novel oral anticoagulants currently in development. J Clin Pharmacol. 2005;45(9):1004-17. http://dx.doi.org/10.1177/0091270005278084. PMid:16100294.

Wolowacz SE, Roskell NS, Plumb JM, Caprini JA, Eriksson BI. Efficacy and safety of dabigatran etexilate for the prevention of venous thromboembolism following total hip or knee arthroplasty. A meta-analysis. Thromb Haemost. 2009;101(1):77-85. http://dx.doi.org/10.1160/TH08-07-0493. PMid:19132192.

Eikelboom JE, Weitz JI. Dabigatran etexilate for prevention of venous thromboembolism. Thromb Haemost. 2009;101(1):2-4. http://dx.doi.org/10.1160/TH08-10-0708. PMid:19132179.

Rahme E, Dasgupta K, Burman M, et al. Post discharge thromboprophylaxis and mortality risk after hip-or knee-replacement surgery. CMAJ. 2008;178(12):1545-54. http://dx.doi.org/10.1503/cmaj.071388. PMid:18519902.

Eikelboom JW, Quinlan DJ, Douketis JD. Extended-duration prophylaxis against venous thromboembolism after total hip or knee replacement: a meta-analysis of the randomized trials. Lancet. 2001;358(9275):9-15. http://dx.doi.org/10.1016/S0140-6736(00)05249-1. PMid:11454370.

Eriksson BI, Lassen MR. Duration of prophylaxis against venous thromboembolism with fondaparinux after hip fracture surgery: a multicenter, randomized, placebo-controlled, double-blind study. Arch Intern Med. 2003;163(11):1337-42. http://dx.doi.org/10.1001/archinte.163.11.1337. PMid:12796070.

Rasmussen MS, Jorgensen LN, Wille-Jorgensen P. Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery. Cochrane Database Syst Rev. 2009;1(1):1-17. PMid:19160234.

Sevitt S, Gallagher NG. Prevention of venous thrombosis and pulmonary embolism in injured patients. A trial of anticoagulant prophylaxis with phenindione in middle-aged and elderly patients with fractured necks of femur. Lancet. 1959;2(7110):981-9. http://dx.doi.org/10.1016/S0140-6736(59)91464-3. PMid:14445257.

Prevention of venous thrombosis and pulmonary embolism. Natl Inst Health Consens Dev Conf Consens Statement. 1986;6(2):1-8. PMid:3528824.

ACCP-NHLBI National Conference on Antithrombotic Therapy. American College of Chest Physicians; National Heart, Lung, and Blood Institute. ACCP-NHLBI National Conference on Antithrombotic Therapy. Chest. 1986;89(2, Suppl):1S-106S. PMid:3943407.

Hirsh J, Dalen J, Guyatt G. Sixth ACCP consensus conference on antithrombotic therapy. Chest. 2001;119(1, Suppl):1S-370S. PMid:11157638.

Guyatt GH, Cook DJ, Jaeschke R, Pauker SG, Schünemann HJ. Grades of recommendation for antithrombotic agents: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 Suppl):123S-131S.

Guyatt GH, Akl EA, Crowther M, Schünemann HJ, Gutterman DD, Lewis SZ. Introduction to the ninth edition. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed.: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl):48S-52S.

Guyatt GH, Norris SL, Schulman S, et al. Methodology for the development of antithrombotic therapy and prevention of thrombosis guidelines: A antithrombotic Therapy and Prevention of Thrombosis, 9th ed.: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):53S-70S. http://dx.doi.org/10.1378/chest.11-2288.

Samama MM, Cohen AT, Darmon JY, et al. A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in Medical Patients with Enoxaprin Study Group. N Engl J Med. 1999;341(11):793-800. http://dx.doi.org/10.1056/NEJM199909093411103. PMid:10477777.

Kleber FX, Witt C, Vogel G, Koppenhagen K, Schomaker U, Flosbach CW. Randomized comparison of enoxaparin with unfractionated heparin for the prevention of venous thromboembolism in medical patients with heart failure or severe respiratory disease. Am Heart J. 2003;145(4):614-21. http://dx.doi.org/10.1067/mhj.2003.189. PMid:12679756.

Leizerovicz A, Cohen AT, Turpie AG, Olsson CG, Vaitkus PT, Goldhaber SZ. Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation. 2004;110(7):874-9. http://dx.doi.org/10.1161/01.CIR.0000138928.83266.24. PMid:15289368.

Sherman DG, Alberts GW, Bladin C, et al. The efficacy and safety of enoxaparin versus unfractionated heparin for the prevention of venous thromboembolism after acute ischaemic stroke (PREVAIL Study): an open-label randomized comparison. Lancet. 2007;369(9570):1347-55. http://dx.doi.org/10.1016/S0140-6736(07)60633-3. PMid:17448820.

Tapson VF, Decousus H, Pini M, et al. Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients: findings from the International Medical Prevention Registry on Venous Thromboembolism. Chest. 2007;132(3):936-45. http://dx.doi.org/10.1378/chest.06-2993. PMid:17573514.

Hull RD, Schellong SM, Tapson VF, et al. Extended-duration venous thromboprophylaxis in acutely ill medical patients with recently reduced mobility: a randomized trial. Ann Intern Med. 2010;153(1):8-18. http://dx.doi.org/10.7326/0003-4819-153-1-201007060-00004. PMid:20621900.

Cohen AT, Tapson VF, Bergmann JF, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008;371(9610):387-94. http://dx.doi.org/10.1016/S0140-6736(08)60202-0. PMid:18242412.

Kakkar AK, Cimminiello C, Goldhaber SZ, Parakh R, Wang C, Bergmann JF. Low-molecular-weight heparin and mortality in acutely ill medical patients. N Engl J Med. 2011;365(26):2463-72. http://dx.doi.org/10.1056/NEJMoa1111288. PMid:22204723.

Cohen AT, Spiro TE, Buller HR, et al. Extended-duration rivaroxaban thromboprophylaxis in acutely ill medical patients: MAGELLAN study protocol. J Thromb Thrombolysis. 2011;31(4):407-16. http://dx.doi.org/10.1007/s11239-011-0549-x. PMid:21359646.

Taher AT, Aoun J, Salameh P. The AVAIL ME study: a multinational survey of VTE risk and prophylaxis. J Thromb Thrombolysis. 2011;31(1):47-56. http://dx.doi.org/10.1007/s11239-010-0492-2. PMid:20549305.

Mokhtari M, Salameh P, Kouchek M, Kashani BS, Taher A, Waked M. The AVAIL ME Extension: a multinational Middle Eastern survey of venous thromboembolism risk and prophylaxis. J Thromb Haemost. 2011;9(7):1340-9. http://dx.doi.org/10.1111/j.1538-7836.2011.04336.x. PMid:21605327.

Lilly CM, Liu X, Badawi O, Franey CS, Zuckerman IH. Thrombosis prophylaxis and mortality risk among critically ill adults. Chest. 2014;146(1):51-7. http://dx.doi.org/10.1378/chest.13-2160. PMid:24722879.

Volschan A, Caramelli B, Gottschall CA, et al. Diretriz de embolia pulmonar. Arq Bras Cardiol. 2004;83(Suppl 1):1-8. http://dx.doi.org/10.1590/S0066-782X2004002000001. PMid:15311324.

Rocha T, Paiva EF, Lichtenstein A. Tromboembolismo venoso: profilaxia em pacientes clínicos: parte 1. Rev Assoc Med Bras. 2009;55(2):95-107.

Caiafa JS, Bastos M. Programa de profilaxia do tromboembolismo venoso do Hospital Naval Marcílio Dias: um modelo de educação continuada. J Vasc Bras. 2002;1(2):103-12.

Caiafa JS, Bastos M, Moura LK, Raymundo S. Managing venous thromboembolism in Latin American patients: emerging results from the Brazilian Registry. Semin Thromb Hemost. 2002;28(s3, Suppl):47-50. http://dx.doi.org/10.1055/s-2002-34076. PMid:12232824.

Pereira CA, Brito SS, Martins AS, Almeida CM. Profilaxia da trombose venosa profunda: aplicação prática e conhecimento teórico em um hospital geral. J Vasc Bras. 2008;7(1):18-27. http://dx.doi.org/10.1590/S1677-54492008000100005.

Rocha ATC, Braga P, Ritt G, Lopes AA. Inadequação de tromboprofilaxia venosa em pacientes clínicos hospitalizados. Rev Assoc Med Bras. 2006;52(6):441-6. http://dx.doi.org/10.1590/S0104-42302006000600026. PMid:17242783.

Rocha ATC, Paiva EF, Araújo DM, et al. Impacto de um programa para profilaxia de tromboembolismo venoso em pacientes clínicos em quatro hospitais de Salvador. Rev Assoc Med Bras. 2010;56(2):197-203. http://dx.doi.org/10.1590/S0104-42302010000200019. PMid:20498995.

Okuhara A, Navarro TP, Procópio RJ, Bernardes RC, Oliveira LCC, Nishiyama MP. Incidência de trombose venosa profunda e qualidade da profilaxia para tromboembolismo venoso. Rev Col Bras Cir. 2014;41(1):2-6. http://dx.doi.org/10.1590/S0100-69912014000100002. PMid:24770766.

Lopes BAC, Teixeira IP, Souza TD, Tafarel JR. Sabemos prescrever profilaxia de tromboembolismo venoso nos pacientes internados? J Vasc Bras. 2017;16(3):199-204. http://dx.doi.org/10.1590/1677-5449.008516. PMid:29930647.

Kucher N, Puck M, Blaser J, Bucklar G, Eschmann E, Lüscher TF. Physician compliance with advanced electronic alerts for preventing venous thromboembolism among hospitalized medical patients. J Thromb Haemost. 2009;7(8):1291-6. http://dx.doi.org/10.1111/j.1538-7836.2009.03509.x. PMid:19522743.

Mazmanian PE, Davis DA, Galbraith R. Continuing medical education effect on clinical outcomes: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Education Guidelines. Chest. 2009;135(3, Suppl):49S-55S. http://dx.doi.org/10.1378/chest.08-2518. PMid:19265076.

Dexter PR, Perkins S, Overhage JM, Maharry K, Kohler BB, McDonald CJ. A computerized reminder system to increase the use of preventive care for hospitalized patients. N Engl J Med. 2001;345(13):965-70. http://dx.doi.org/10.1056/NEJMsa010181. PMid:11575289.

Shojania KG, Jennings A, Mayhew A, Ramsay C, Eccles M, Grimshaw J. Effect of point-of-care computer reminders on physician behavior: a systematic review. CMAJ. 2010;182(5):E216-25. http://dx.doi.org/10.1503/cmaj.090578. PMid:20212028.

Galanter WL, Thambi M, Rosencranz H, et al. Effects of clinical decision support on venous thromboembolism risk assessment, prophylaxis, and prevention at a university teaching hospital. Am J Health Syst Pharm. 2010;67(15):1265-73. http://dx.doi.org/10.2146/ajhp090575. PMid:20651317.

Zeidan AM, Streiff MB, Lau BD, et al. Impact of a venous thromboembolism prophylaxis “smart order set”: improved compliance, fewer events. Am J Hematol. 2013;88(7):545-9. http://dx.doi.org/10.1002/ajh.23450. PMid:23553743.

Fuzinatto F, Waldemar FS, Wajner A, et al. A clinical decision support system for venous thromboembolism prophylaxis at a general hospital in a middle-income country. J Bras Pneumol. 2013;39(2):138-46. http://dx.doi.org/10.1590/S1806-37132013000200004. PMid:23670498.

Thavarajah D, Wetherill M. Implementing NICE guidelines on risk assessment for venous thromboembolism: failure, success and controversy. Int J Health Care Qual Assur. 2012;25(7):618-24. http://dx.doi.org/10.1108/09526861211261217. PMid:23276057.

Byrne S, Weaver DT. Review of thromboembolic prophylaxis in patients attending Cork University Hospital. Int J Clin Pharm. 2013;35(3):439-46. http://dx.doi.org/10.1007/s11096-013-9760-5. PMid:23494189.

Lau BD, Haut ER. Practices to prevent venous thromboembolism: a brief review. BMJ Qual Saf. 2014;23(3):187-95. http://dx.doi.org/10.1136/bmjqs-2012-001782. PMid:23708438.
 

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5c62bacc0e8825431de1282f jvb Articles

J Vasc Bras

Share this page
Page Sections