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

Abstract

RESUMOContexto: A trombose venosa profunda (TVP) é uma doença freqüente e grave. A profilaxia é o melhor meio para reduzir a sua incidência, diminuindo a morbimortalidade gerada por suas complicações. Na relação custo x efetividade, é melhor manter uma rotina profilática do que tratar a doença já instalada. Objetivo: Verificar se a profilaxia da TVP está sendo utilizada de maneira adequada e rotineira no Hospital Escola Doutor José Carneiro (HEJC), de Maceió (AL). Métodos: Foi realizado um estudo transversal descritivo no HEJC durante o período de 6 meses. A amostra foi de 298 pacientes, de diferentes especialidades. Os dados foram coletados nos prontuários, divididos em clínicos (68,5%) e cirúrgicos (31,5%). Analisou-se, em cada paciente, como se procedeu a utilização da profilaxia para a TVP. Foram pesquisados fatores clínicos, medicamentosos e cirúrgicos para todos os pacientes e, com base nesses dados, foi realizada estratificação do risco conforme a classificação recomendada pela Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV). O estudo estatístico foi realizado através do software SPSS, utilizando os testes qui-quadrado e de correção bivariada, considerando o valor de p < 0,05. Resultados: Dos 298 pacientes analisados, 204 eram da clínica médica, onde 28,9% eram de baixo risco, 60,3% médio risco e 10,8% alto risco para TVP; e 94 pacientes eram da clínica cirúrgica, onde 43,6% apresentaram baixo risco, 52,1% médio risco e 4,3% alto risco. Apenas 23% dos pacientes do grupo clínico e 2,1% para o grupo cirúrgico receberam a profilaxia de forma adequada.Conclusão: Apesar da eficácia da profilaxia para a TVP já ter sido comprovada e difundida, em nosso meio ainda não atinge os níveis desejados de utilização. Palavras-chave:Prevenção e controle, trombose venosa, avaliação. ABSTRACTBackground: Deep venous thrombosis (DVT) is a frequent and severe disease. Prophylaxis is the best means to reduce its incidence, lowering morbidity and mortality rates caused by its complications. In a cost-effectiveness ratio, it is better to maintain a prophylactic routine than to treat an established disease. Objective: To verify whether DVT prophylaxis is being properly and routinely used at Hospital Escola Doutor José Carneiro (HEJC), in Maceió, Brazil. Methods: A descriptive, cross-sectional study at HEJC was carried out for a 6-month period. The sample was composed of 298 patients within different specialties. Data were collected from medical records, and divided into clinical (68.5%) and surgical (31.5%). How DVT prophylaxis was performed was analyzed for each patient. Clinical, pharmacological and surgical factors were investigated for all patients. Based on these data, risk stratification was performed in accordance with the classification recommended by Sociedade Brasileira de Angiologia e Cirurgia Vascular. Statistical analysis was performed using software SPSS and the qui-square and bivariate correction tests, considering p value < 0.05. Results: Of the 298 patients analyzed, 204 belonged to medical clinic, ...

Profilaxia para tromboembolia venosa em um hospital geral

“…Because of the large number of patients receiving inadequate prophylaxis at our hospital, a finding that is consistent with those of previous studies, (24)(25)(26)(27) it becomes necessary to implement effective measures to improve these rates.…”

“…The best results reported are those of rates that do not reach 50% in ward patients and 60% in ICU patients. (24)(25)(26)(27) The low importance given to VTE prophylaxis might be attributable to the devaluation of VTE as a clinical entity, because VTE has a nonspecific clinical presentation and objective diagnosis is difficult. Perhaps the main reason for the limited use of preventive measures for VTE is the fear of bleeding, especially in the postoperative period.…”

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.…”

“…1,[4][5][6][7] After discharge, patients who survive a thrombotic or thromboembolic event can face physical incapacity during the chronic phase, caused by progression to postthrombotic syndrome and severe chronic venous insufficiency, increasing the socioeconomic burden. 1,8 The severity of VTE's impact on patients prompted improvements to prophylaxis and it is now consolidated as an effective method for preventing these events. 9 However, the question is whether we know how to use it correctly and effectively.…”