Profilaxia para tromboembolismo venoso em um hospital de ensino

Abstract

Objective: To verify whether deep venous thrombosis prophylaxis is being correctly and routinely used at a teaching hospital.Methods: A cross-sectional study of hospitalized patients on seven sectors at Conjunto Hospitalar de Sorocaba (Hospital de Ensino) was performed from August 2004 to August 2005. For the deep venous thrombosis risk stratification of each patient, clinical and surgical factors were investigated, according to the protocol recommended by Sociedade Brasileira de Angiologia e de Cirurgia Vascular. During the period, 216 medical charts were analyzed. Of these, 30 were from abdominal surgery, 30 from vascular surgery, 30 from urology, 31 from medical clinic, 31 from intensive care unit, 31 from orthopedics and 33 from obstetrics/gynecology.Results: Out of the total number of patients, deep venous thrombosis prophylaxis was performed in 57 (26%), considering that in 51 (89%) the procedure was correct and in six (11%) it did not follow the standard. The most used type of prophylaxis was drug treatment; 49 out of 57 patients used low-molecular-weight heparin. We also observed the use of elastic socks in five patients and early ambulation in seven. On the other hand, intermittent pneumatic compression was not used for any patient.Conclusion: According to the results and based on the protocol, we concluded that, during the period of the research, deep venous thrombosis prophylaxis, at Conjunto Hospitalar de Sorocaba, was routinely and correctly performed in only 23.6% of the patients (51 out of 216).Key words: Deep venous thrombosis, prophylaxis, thromboembolism. ResumoObjetivo: Verificar se a profilaxia da trombose venosa profunda está sendo utilizada de maneira correta e rotineira em um hospital de ensino. Resultados: Do total de pacientes, foi efetuada profilaxia para trombose venosa profunda em 57 (26%), sendo que, em 51 (89%), a execução foi de maneira correta e, em 6 (11%), não-preconizada. O método profilático mais utilizado foi o medicamentoso; 49 de 57 pacientes fizeram uso de heparina de baixo peso molecular. Também foi verificada a utilização de meias elásticas em cinco pacientes e deambulação precoce em sete. Já a compressão pneumática intermitente não foi utilizada em nenhum deles. Métodos e casuística: Foi realizado um estudo transversal de pacientes internados em sete setores (enfermarias) do ConjuntoConclusão: De acordo com os resultados e com base no protocolo, concluiu-se que, no período da pesquisa, a profilaxia para trombose venosa profunda, no Conjunto Hospitalar de Sorocaba, foi executada rotineiramente e de forma adequada em apenas 23,6% (51 do total de 216 pacientes). Palavras-chave:Trombose venosa profunda, profilaxia, tromboembolismo.ARTIGO ORIGINAL

Avaliação da utilização de profilaxia da trombose venosa profunda em um hospital escola

“…adequate prophylaxis; and Franco et al, 31 in an evaluation of a teaching hospital, observed that 26.4% of patients were given prophylaxis.…”

Efeito da implementação de diretriz para profilaxia de tromboembolismo venoso em pacientes cirúrgicos

“…Considering the frequency of use of post-operative prophylaxis, it was used at higher rates at HSL than at most Brazilian hospitals in previous studies. 23,24,[27][28][29][30] Graduated elastic compression stockings and intermittent pneumatic compression devices were used at higher rates at HSL than at other Brazilian institutions, [27][28][29][30][31] possibly due to the higher socioeconomic status of patients. As for frequency of use of adequate prophylaxis, considering the protocols used as reference, our data are similar to those from other centers where studies of this type were performed, both in Brazil and abroad, reaching 62.5 percent of patients treated with prophylaxis (40 percent of total patients) for orthopedic surgery and 48 percent of patients (28 percent of total) for abdominal surgery.…”

“…21,22 Various protocols seeking to classify patients according to VTE risk, doctors' warnings, and prophylaxis guidelines have been put forward, both to collect data and to standardize hospital behavior. [22][23][24][25][26][27] In 2004, a Multidisciplinary and Multiprofessional Commission was established at Hospital Sírio-Libanês (HSL), São Paulo, to develop a standard guideline for acute deep vein thrombosis and pulmonary thromboembolism prophylaxis in adult patients hospitalized for surgical or clinical care, based on controlled clinical assays, reviews, and the latest consensus of Brazilian and international literature. To that purpose, the literature from the databases MEDLINE, LILACS, the Brazilian Cochrane Center, and Brazilian and international government institutions was reviewed, using standardized search strategies to select articles relevant for the protocol.…”

Sabemos prescrever profilaxia de tromboembolismo venoso nos pacientes internados?

“…10 It can be concluded that measures for the prevention of VTE are being underutilized at our service, as is the case in other hospitals in Brazil. 1,8,15 In the teaching hospital analyzed, we also found a significant difference between clinical and surgical patients in terms of the rates of correct prophylaxis.…”

“…6,10 Several other studies have reported results in line with ours, showing underutilization of VTE prophylaxis in hospital practice. 1,8,[13][14][15] Pitta et al 8 observed that prophylaxis was not employed in 83.5% of the patients in a study conducted in 2006 at the Hospital Escola Doutor José Carneiro, in Maceió, Brazil. Panju et al 13 conducted a study at two teaching hospitals in Canada and showed that 54% of the patients who met inclusion criteria received VTE prophylaxis.…”