24 iul. 2008 PROFILAXIA EVENIMENTELOR TROMBOEMBOLICE
I. Păun*, D. G. Mogoş*, Mariana Păun**, M. Teodorescu*, Sidonia Marinescu***, M. Florescu*
* Clinica Chirurgie IV, Spitalul Universitar C. F. Craiova
** Clinica Obstetrică-Ginecologie, Spitalul de Urgenţă Craiova
*** Secţia ATI, Spitalul Universitar C. F. Craiova
Rezumat
Tromboflebita profundă a membrelor inferioare reprezintă o complicaţie frecventă a numeroase intervenţii chirurgicale şi prin caracterul său evolutiv poate avea un deznodământ letal (cazul unor embolii pulmonare) sau poate genera sechele cu caracter infirmizant (cazul sindroamelor posttrombotice).
Material şi metodă. Lucrarea analizează un lot de 17453 pacienţi supuşi unor intervenţii chirurgicale diverse in intervalul 1992 – 2005 şi care prezentau, în proporţii diverse, factori de risc cu potenţial de producere a unor evenimente tromboembolice.
Rezultate. În ciuda profilaxiei corect instituite la toţi pacienţii prezentând factori de risc tromboembolic, în postoperator au existat cazuri complicate cu tromboflebită profundă la nivelul membrelor inferioare, microembolii pulmonare suspicionate clinic si chiar embolii pulmonare masive (3 cazuri) soldate cu decese. Pe de altă parte, utilizarea medicaţiei anticoagulante în scop profilactic a generat la un număr de 74 pacienţi complicaţii hemoragice manifestate clinic divers.
Concluzii. Fiecărui pacient care urmează a fi supus unei intervenţii chirurgicale trebuie să i se evalueze factorii de risc tromboembolic funcţie de care se va stabili o strategie profilactică specifică şi individualizată, care, în ciuda tuturor eforturilor actuale, încă mai poate eşua, fapt ce trebuie comunicat şi pacientului.
Abstract – Trombembolic events profilaxy an aim in general surgery
Deep vein thrombosis (DVT) of the lower extremities is a frequent complication of numerous surgical interventions and DVT associated morbidity (due to its spontaneously evolving character) includes both acute (e.g. pulmonary embolus –PE – known as the most common preventable cause of death among hospitalized patients in the civilized world) and chronic consequences (i.e. postphlebitic syndromes – as long-term disabling sequelae).
Material and method. This paper examines preoperative, intraoperative and postoperative risk factors that increase the risk of venous thromboembolism (VTE) in a series of 17453 diverse surgical patients operated upon in our clinic between 1992 and 2005. Based on detection of such risk factors, different methods of treatment to prevent DVT will be discussed in detail.
Results. Despite routine administration of specific treatments to prevent VTE in all our at risk surgical patients, postoperative failures of these prophylactic measures were still recorded and were represented by DVT of the lower extremities and (at least) clinically suspected PE that was also held responsible for 3 fatalities (due to massive emboli). Furthermore, VTE prophylaxis by anticoagulation drugs caused hemorrhagic complications in 74 patients.
Conclusions. VTE is a major and serious source of morbidity and mortality in general surgery. The mainstay of prevention of these events begins with identifying risk factors that are associated with VTE including specific risks to the patient and risk of the surgery the patient will undergo. After calculating a person risk it is important to implement a prophylaxis that is specific to that risk. However, prophylactic measures can fail in spite of best efforts to prevent VTE and it is important for the patient to be aware of that possibility.