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
Resumo
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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®).
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Referências
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.
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.
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.
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.
8 Patel H, Sun H, Hussain AN, Vakde T. Advances in the diagnosis of venous thromboembolism: a literature review. Diagnostics. 2020;10(6):365.
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.
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.
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.
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.
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.
Submetido em:
05/07/2023
Aceito em:
02/10/2023