Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202300951
Jornal Vascular Brasileiro
Innovation

A mudança de paradigma no tratamento do tromboembolismo venoso grave

The paradigm shift in treatment of severe venous thromboembolism

Fábio Henrique Rossi; Francisco José Osse; Patricia Ellen Thorpe

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Resumo

A embolia pulmonar (EP) é a terceira maior causa de morte cardiovascular e a principal de morte evitável intra-hospitalar no mundo. O conceito PERT® (do inglês, pulmonary embolism response team) envolve seu diagnóstico e tratamento precoce e multidisciplinar. A trombose venosa profunda (TVP) é a sua causa inicial na maioria dos casos e é responsável por complicações como a recidiva tromboembólica, a síndrome pós-trombótica e a hipertensão pulmonar tromboembólica crônica. Uma abordagem inicial semelhante ao PERT nos casos de TVP ilíaco-femoral grave pode reduzir não apenas o risco imediato de EP e morte, mas também suas sequelas tardias. Novas técnicas percutâneas e aparatos de trombectomia mecânica para o tromboembolismo venoso (TEV) vêm demonstrando resultados clínicos encorajadores. Propomos o desenvolvimento de um conceito ampliado de resposta rápida ao TEV, que envolve não apenas a EP (PERT®) mas também os casos graves de TVP: o time de resposta rápida para o TEV (TRETEV®), ou do inglês Venous Thromboembolism Response Team (VTERT®).

Palavras-chave

tromboembolismo venoso, trombose venosa profunda, embolia pulmonar, multidisciplinar, trombectomia, trombólise mecânica

Abstract

Pulmonary embolism (PE) is the third leading cause of cardiovascular death and the main cause of preventable in-hospital death in the world. The PERT® (Pulmonary Embolism Response Team) concept involves multidisciplinary diagnosis and immediate treatment. Deep venous thrombosis (DVT) is the initial cause of most cases of PE and is responsible for complications such as chronic thromboembolic recurrence, postthrombotic syndrome, and chronic thromboembolic pulmonary hypertension. An aggressive approach to severe cases of iliofemoral DVT similar to the PERT® system can not only reduce the immediate risk of PE and death but can also reduce later sequelae. New percutaneous techniques and mechanical thrombectomy devices for venous thromboembolism (VTE) have shown encouraging clinical results. We propose the development of an expanded concept of rapid response to VTE, which involves not only PE (PERT®) but also severe cases of DVT: the Venous Thromboembolism Response Team (VTERT®).

Keywords

venous thromboembolism; deep vein thrombosis; pulmonary embolism; multidisciplinary; thrombectomy; mechanical thrombolysis

References

1 Maynard GA, Stein JM. Preventing hospital-acquired venous thromboembolism: a guide for effective quality improvement. Rockville: Agency for Healthcare Research and Quality, United States Department of Health and Human Services; 2008.

2 Silverstein MD, Heit JA, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ 3rd. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med. 1998;158(6):585-93. http://dx.doi.org/10.1001/archinte.158.6.585. PMid:9521222.

3 Graves EJ. National hospital discharge survey: annual summary, 1992. Vital Health Stat 13. 1994;(119):1-63. PMid:7526546.

4 National Clinical Guideline Centre - NCGC. Acute and Chronic Conditions. Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital. London: Royal College of Physicians; 2010.

5 Fleitas Sosa D, Lehr AL, Zhao H, et al. Impact of pulmonary embolism response teams on the acute pulmonary embolism: a systematic review and meta-analysis. Eur Respir Rev. 2022;31(165):220023. http://dx.doi.org/10.1183/16000617.0023-2022. PMid:35831010.

6 Provias T, Dudzinski DM, Jaff MR, et al. The Massachusetts General Hospital Pulmonary Embolism Response Team (MGH PERT®): creation of a multidisciplinary program to improve care of patients with massive and submassive pulmonary embolism. Hosp Pract. 2014;42(1):31-7. http://dx.doi.org/10.3810/hp.2014.02.1089. PMid:24566594.

7 Annabathula R, Dugan A, Bhalla V, Davis GA, Smyth SS, Gupta VA. Value-based assessment of implementing a Pulmonary Embolism Response Team (PERT). J Thromb Thrombolysis. 2021;51(1):217-25. http://dx.doi.org/10.1007/s11239-020-02188-3. PMid:32542527.

8 Patel H, Sun H, Hussain AN, Vakde T. Advances in the diagnosis of venous thromboembolism: a literature review. Diagnostics. 2020;10(6):365. http://dx.doi.org/10.3390/diagnostics10060365. PMid:32498355.

9 Rivera-Lebron BN, Rali PM, Tapson VF. The PERT® concept: a step-by-step approach to managing pulmonary embolism. Chest. 2021;159(1):347-55. http://dx.doi.org/10.1016/j.chest.2020.07.065. PMid:32758561.

10 Kakkos SK, Gohel M, Baekgaard N, et al. European Society for Vascular Surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis. Eur J Vasc Endovasc Surg. 2021;61(1):9-82. http://dx.doi.org/10.1016/j.ejvs.2020.09.023. PMid:33334670.

11 Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543-603. http://dx.doi.org/10.1093/eurheartj/ehz405. PMid:31504429.

12 Rossi FH. Thrombectomy in a severe case of iliofemoral venous thrombosis involving the deep femoral vein via a single percutaneous access from the jugular vein: case report and description of the technique. J Vasc Bras. 2022;21:e20210192. http://dx.doi.org/10.1590/1677-5449.202101921. PMid:35571521.

13 Carroll BJ, Beyer SE, Mehegan T, et al. Changes in care for acute pulmonary embolism through a multidisciplinary pulmonary embolism response team. Am J Med. 2020;133(11):1313-1321.e6. http://dx.doi.org/10.1016/j.amjmed.2020.03.058. PMid:32416175.
 


Submitted date:
07/05/2023

Accepted date:
10/02/2023

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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