Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492008000100005
Jornal Vascular Brasileiro
Original Article

Profilaxia da trombose venosa profunda: aplicação prática e conhecimento teórico em um hospital geral

Deep venous thrombosis prophylaxis: practical application and theoretical knowledge in a general hospital

Cristiano Almeida Pereira; Sérgio Soares de Brito; Antonio Sansevero Martins; Christiany Moreira Almeida

http://dx.doi.org/10.1590/S1677-54492008000100005 J Vasc Bras, vol.7, n1, p.18-27, 2008
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Resumo

CONTEXTO: Trabalho realizado na área de cirurgia vascular, porém relevante a todas as especialidades clínicas e cirúrgicas devido à importância clínica da trombose venosa profunda e sua principal complicação, a embolia pulmonar. OBJETIVOS: Verificar se a profilaxia para a trombose venosa profunda está sendo utilizada de forma adequada e rotineira em nosso serviço e avaliar o conhecimento dos médicos sobre as indicações de profilaxia medicamentosa. MÉTODOS: Foi realizado um estudo prospectivo com 850 pacientes internados de março a maio de 2007 no Hospital Geral de Roraima. Foram pesquisados fatores clínicos, medicamentosos e cirúrgicos. A estratificação de risco e a avaliação da profilaxia foram estabelecidas conforme a classificação recomendada pela Sociedade Brasileira de Angiologia e Cirurgia Vascular e o protocolo realizado por Caiafa em 2002. Os médicos responderam a um questionário e analisaram três casos clínicos hipotéticos. Os dados foram tabulados e analisados estatisticamente usando o programa de computador Epi-Info 2002®. RESULTADOS: Dos 850 pacientes estudados, 557 (66,66%) eram clínicos e 293 (33,34%) cirúrgicos. Do total, 353 pacientes (41,56%) foram classificados como baixo risco, 411 (48,32%) como médio risco e 86 (10,12%) como alto risco para desenvolver trombose venosa profunda. Dos 497 pacientes que necessitavam receber profilaxia medicamentosa para trombose venosa profunda, apenas 120 (24%) a receberam; destes, 102 (85%) a receberam de forma correta. Dos que não necessitavam de profilaxia, nenhum a recebeu. Os clínicos prescreveram mais e de forma mais correta a profilaxia em relação aos cirurgiões, apesar de estes terem demonstrado possuir um melhor conhecimento teórico do tema. No geral, o conhecimento teórico sobre trombose venosa profunda foi insuficiente. CONCLUSÕES: Em nosso serviço, a profilaxia medicamentosa da trombose venosa profunda é subutilizada em pacientes com indicação para recebê-la, tornando necessária a implementação de um programa de educação continuada sobre o tema.

Palavras-chave

Tromboembolismo, trombose venosa profunda, fatores de risco, profilaxia

Abstract

BACKGROUND: Although this work belongs to the area of vascular surgery, it is relevant to all clinical and surgical specialties due to the clinical importance of deep venous thrombosis and its main complication, pulmonary embolism. OBJECTIVES: To verify whether pharmacological prophylaxis of deep venous thrombosis is being adequately and routinely used in our service and to evaluate physicians' knowledge about the indications of deep venous thrombosis chemoprophylaxis. METHODS: A prospective study was accomplished including 850 patients hospitalized from March to May 2007 at Hospital Geral de Roraima. Clinical, pharmacological and surgical factors were researched. Risk stratification and evaluation of prophylaxis were established according to the classification suggested by the Brazilian Society of Angiology and Vascular Surgery and to the protocol developed by Caiafa in 2002. Physicians answered a questionnaire and analyzed three hypothetical clinical cases. Data were tabled and statistically analyzed with the support of the software Epi-Info 2002®. RESULTS: Of the 850 patients surveyed, 557 (66.66%) were clinical and 293 (33.34%) were surgical patients. Of the total, 353 (41.56%) had low risk, 411 (48.32%) medium risk and 86 (10.12%) high risk for development of deep venous thrombosis. Of the 497 patients that needed to receive chemoprophylaxis for deep venous thrombosis, only 120 (24%) received it and of these, 102 (85%) received it adequately. Any patient who did not need prophylaxis received it. Clinical physicians prescribed prophylaxis more frequently and correctly than surgeons, although the latter have demonstrated better theoretical knowledge of the theme. In general, theoretical knowledge on deep venous thrombosis was insufficient. CONCLUSIONS: In our hospital, chemoprophylaxis for deep venous thrombosis is underused in patients indicated for receiving it. Therefore, it is necessary to implement a continuous education program about this theme.

Keywords

Thromboembolism, deep venous thrombosis, risk factors, prophylaxis

Referências

Brouwer JL, Veeger NJ, Kluin-Nelemans HC, van der Meer J. The pathogenesis of venous thromboembolism: evidence for multiple interrelated causes. Ann Intern Med. 2006;145:807-15.

Lensing AW, Prandoni P, Prins MH, Buller HR. Deep-vein thrombosis. Lancet. 1999;353:479-85.

Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med. 1998;158:585-93.

Fowkes FJ, Price JF, Fowkes FG. Incidence of diagnosed deep vein thrombosis in the general population: systematic review. Eur J Vasc Endovasc Surg. 2003;25:1-5.

White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107(^s23 Suppl 1):I4-8.

Lindblad B, Sternby NH, Bergqvist D. Incidence of venous thromboembolism verified by necropsy over 30 years. BMJ. 1991;302:709-11.

Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979-1998: an analysis using multiple-cause mortality data. Arch Intern Med. 2003;163:1711-7.

Rollo HA, Maffei FHA, Lastória S, Yoshida WB, Castiglia V. Uso rotineiro da flebografia no diagnóstico da trombose venosa profunda dos membros inferiores. Cir Vasc Angiol. 1986;2:7-12.

Bok Yoo HH, Mendes FG, Alem CER, Fabro AT, Corrente JE, Queluz TT. Achados clínicopatológicos na tromboembolia pulmonar: estudo de 24 anos de autópsias. J Bras Pneumol. 2004;30:426-32.

Menna-Barreto S, Cerski MR, Gazzana MB, Stefani SD, Rossi R. Tromboembolia pulmonar em necrópsias no Hospital das Clínicas de Porto Alegre, 1985-1995. J Pneumol. 1997;23:131-6.

Heit JA, Silverstein MD, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med. 2000;160:809-15.

Samama MM. An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients: the Sirius study. Arch Intern Med. 2000;160:3415-20.

Alikhan R, Cohen AT, Combe S. Risk factors for venous thromboembolism in hospitalized patients with acute medical illness: analysis of the MEDENOX Study. Arch Intern Med. 2004;164:963-8.

Maffei FHA, Caiafa JS, Ramacciotti E, Castro AA. Normas de orientação clínica para prevenção, diagnóstico e tratamento da trombose venosa profunda. 2005.

Geerts WH, Pineo GF, Heit JA. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(^s3):338S-400S.

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

Nicolaides AN, Breddin HK, Fareed J. Prevention of venous thromboembolism. International Consensus Statement: Guidelines compiled in accordance with the scientific evidence. Int Angiol. 2001;20:1-37.

Arnold DM, Kahn SR, Shrier I. Missed opportunities for prevention of venous thromboembolism: an evaluation of the use of thromboprophylaxis guidelines. Chest. 2001;120:1964-71.

Maffei FHA. Epidemiologia da trombose venosa profunda e de suas complicações no Brasil. Cir Vasc Angiol. 1998;14:5-8.

Garcia ACF, Souza BV, Volpato DE. Realidade do uso da profilaxia para trombose venosa profunda: da teoria à prática. J Vasc Br. 2005;4:35-41.

Marchi C, Schlup IB, Lima CA, Schlup HA. Avaliação da profilaxia da trombose venosa profunda em um Hospital Geral. J Vasc Br. 2005;4:171-5.

Rocha ATC, Braga P, Ritt G, Lopes AA. Inadequação de tromboprofilaxia venosa em pacientes clínicos Hospitalizados. Rev Assoc Med Bras. 2006;52:441-6.

Deheinzelin D, Braga AL, Martins LC. Incorrect use of thromboprophylaxis for venous thromboembolism in medical and surgical patients: results of a multicentric, observational and cross-sectional study in Brazil. J Thromb Haemost. 2006;4:1266-70.

Vallano A, Arnau JM, Miralda GP, Pérez-Bartolí J. Use of venous thromboprophylaxis and adherence to guideline recommendations: a cross-sectional study. Thromb J. 2004;2:3.

Chopard P, Dorffler-Melly J, Hess U. Venous thromboembolism prophylaxis in acutely ill medical patients: definite need for improvement. J Intern Med. 2005;257:352-7.

Kimmerly WS, Sellers KD, Deitcher SR. Graduate surgical trainee attitudes toward postoperative thromboprophylaxis. South Med J. 1999;92:790-4.

Anderson FA Jr., Wheeler HB, Goldberg RJ, Hosmer DW, Forcier A, Patwardhan NA. Prospective study of the impact of continuing medical education and quality assurance programs on use of prophylaxis for venous thromboembolism. Arch Intern Med. 1994;154:669-77.

Caiafa JS, de Bastos M, Moura LK, Raymundo S. Brazilian Registry of venous thromboembolism prophylaxis. Managing venous thromboembolism in Latin American patients: emerging results from the Brazilian Registry. Semin Thromb Hemost. 2002;28(^s3):47-50.

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