Profilaxia do tromboembolismo venoso em viagens aéreas

Abstract

Resumo A aviação civil vem apresentando aumento progressivo do número de voos regulares nos últimos 10 anos e, em função disso, mais passageiros estão sendo transportados em viagens aéreas (VAs). Associado a isso, há um aumento das doenças relacionadas às VAs, especialmente naquelas de longa duração. Uma das complicações mais temidas dos voos é o tromboembolismo venoso (TEV), mas a sua real incidência é de difícil mensuração devido à falta de consenso sobre, por exemplo, quanto tempo após o pouso podemos considerar que o TEV possa estar relacionado à VA realizada ou mesmo quanto tempo de voo pode ser considerado como de longa duração. Muito tem se discutido sobre os mecanismos fisiopatológicos do TEV relacionado às VAs, quais passageiros são os de maior risco e quais medidas profiláticas podemos adotar com segurança e eficácia. O objetivo desta revisão é esclarecer esses pontos e as condutas consensuais atuais.

Recommendations from the ICM-VTE: General

“…No consensus has been reached in regards to pharmacologic prophylaxis, and this should be prescribed on a case-by-case basis. Antiplatelets did not prove to be an effective prophylactic agent for primary or secondary long-haul flight-related VTE 309,315 , cited in 313,316 ; cited in 317 . While the LONFIT-3 study suggested that the risk of VTE could be eliminated by taking low-molecular-weight heparin (LMWH), there is still a lack of evidence supporting its widespread use in this situation 315,318 , cited in 313 .…”

“…Antiplatelets did not prove to be an effective prophylactic agent for primary or secondary long-haul flight-related VTE 309,315 , cited in 313,316 ; cited in 317 . While the LONFIT-3 study suggested that the risk of VTE could be eliminated by taking low-molecular-weight heparin (LMWH), there is still a lack of evidence supporting its widespread use in this situation 315,318 , cited in 313 . Direct-oral anticoagulants (DOAC) have theoretical benefits given their short half-lives, rapid onset of action and oral administration.…”

“…Prophylaxis: The ninth edition of the ACCP guidelines from 2012 suggested the following preventive measures for patients deemed to be at risk of VTE on long-haul flights: walking, calf muscle exercises, and aisle seating (evidence level 2C) 312 cited in 313 . A recent Cochrane review of 11 randomized studies with a total of 2,906 patients (1,273 high-risk patients) on flights lasting more than 5 hours concluded that there was high-quality evidence demonstrating a reduction in the incidence of asymptomatic DVT, and moderate-quality evidence demonstrating a reduction in superficial venous thrombosis following the use of graduated elastic compression stockings 314 .…”

Development and validation of an informative manual on venous thromboembolism for the lay population

“…The texts were based on scientific articles published on PubMed ® and Scientific Electronic Library Online (SciELO) databases, from 2014 to 2018. (19)(20)(21)(22)(23) The non-systematized search was performed using the terms "tromboembolismo venoso" and "venous thromboembolism", in the fields "title or abstract". Studies addressing the definition of the disease, signs and symptoms, risk factors and preventive measures were selected.…”

Meias elásticas de compressão graduada como medida profilática de tromboembolismo venoso e edema de membros inferiores desencadeados por viagens aéreas: uma revisão sistemática de ensaios clínicos

“…Studies show that 3.8 billion people travel by air annually and that 300 million of them take longduration flights, [1][2][3] thereby increasing the risk of diseases associated with flights lasting more than 3 hours, the most important of which are deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE). 4 Both DVT and PTE are part of the spectrum of a single disease: venous thromboembolism (VTE). DVT primarily occurs in the lower limbs, caused by coagula that form in the deep vein system.…”