Fatores de risco e profilaxia para tromboembolismo venoso em hospitais da cidade de Manaus

Abstract

Objective: To identify and classify risk factors for venous thromboembolism (VTE) in hospitalized patients, as well as to evaluate medical practices regarding prophylaxis for the disease. Methods: An observational crosssectional study, carried out between January and March of 2006, involving inpatients at three hospitals in the city of Manaus, Brazil. Risk stratification for VTE was based on the criteria established by the Brazilian Society of Angiology and Vascular Surgery and by the International Union of Angiology. Clinical, surgical and medicationrelated risk factors were analyzed. The statistical analysis of the data obtained was conducted, adopting an alpha error of 5% and 95% CI. Qualitative data were analyzed using the chi-square test, whereas quantitative data were analyzed using Student's t-test. Results: Of the 1,036 patients included (total number of admissions, 1,051), 515 (49.7%) were male, and 521 (50.3%) were female. A total of 23 risk factors for VTE were identified (total number of occurrences, 2,319). The stratified risk for VTE was 50.6%, 16.6% and 30.8% among the admissions of high-, moderate-and low-risk cases, respectively. In 73.3% of the admissions, nonpharmacological prophylaxis was not employed at any point during the study period. In 74% of those classified as high-or moderate-risk cases, no prophylactic medications were administered. Conclusions: This study showed that, in the population studied, risk factors were common and that prophylactic measures were not employed in patients prone to developing VTE and its complications.Keywords: Venous thromboembolism; Risk factors; Venous thrombosis/prevention & control. ResumoObjetivo: Identificar e classificar os fatores de risco para tromboembolismo venoso (TEV) em pacientes internados, avaliando as condutas médicas adotadas para a profilaxia da doença. Métodos: Estudo observacional, de corte transversal no período de janeiro a março de 2006, envolvendo uma população de pacientes internados em três hospitais na cidade de Manaus (AM). A estratificação do risco para TEV foi feita com base nos critérios da Sociedade Brasileira de Angiologia e Cirurgia Vascular e da International Union of Angiology. Foram avaliados variáveis sobre os fatores de risco clínicos, cirúrgicos e medicamentosos, assim como os métodos profiláticos para TEV. Os dados foram analisados estatisticamente, adotando-se um alfa de 5% e IC95%. Os dados qualitativos foram analisados pelo teste do qui-quadrado e os dados quantitativos pelo teste t de Student. Resultados: Foram estudados 1.036 pacientes num total de 1.051 internações, sendo 515 (49,7%) homens e 521 (50,3%) mulheres. Um total de 23 de fatores de risco para TEV foram identificados (número total de eventos, 2.319). O risco estratificado para TEV foi de 50,6%, 18,6% e 30,8% das internações para risco alto, moderado e baixo, respectivamente. Em 73,3% das internações, não foram adotadas medidas profiláticas não-medicamentosas durante o período do estudo, e em 74% das internações que apresentavam risco moderado ...

Prevenção de tromboembolismo venoso em hospital com perfil oncológico: como melhorá-la?

“…20,21 The risk of death after an acute thrombotic event is four to eight times greater in patients with cancer than in patients without cancer and VTE is the second most common cause of death among cancer patients. 22,23 Studies by Fuzinatto et al, 6 Engerhorn et al, 7 Pereira et al, 9 Andrade et al, 10 Rocha et al 11 and Franco et al, 24 all observed that prophylaxis against VTE was under-utilized in patients in hospital, and practically all of the patients analyzed at the hospitals involved had high VTE risk, but less than half of them were given the appropriate prophylaxis. As such, the correct prophylactic measures were not taken, even in patients with potential risk factors for development of VTE and its complications.…”

“…Over the last 20 years, studies have been conducted to determine the situation in Brazilian hospitals with relation to VTE prophylaxis and the findings show that among both medical and surgical patients appropriate prophylactic measures are not being taken, even when risk factors for VTE are present. [7][8][9][10][11] However, few studies have been conducted with the objective of formulating strategies and providing guidance in the form of hospital-wide thromboprophylaxis programs. 11,12 Machado 13 recommends that a multidisciplinary team should be assembled made up of people who understand the importance of pharmacological prophylaxis, in order to improve the frequency and quality of provision of VTE prophylaxis.…”

Tromboprofilaxia: recomendações médicas e programas hospitalares

“…O risco para TEV foi alto em 50,6% das internações, moderado em 18,6% das internações e baixo em 30,8% dos pacientes. Em 74% dos pacientes que apresentavam risco moderado ou alto, não se utilizou tromboprofilaxia medicamentosa 74 .…”

A novel method for predicting the risk of thrombosis and thromboembolism

“…Andrade et al (2009) reported 23 risk factors for the developing of venous thromboembolism: surgery time exceeding half an hour, systemic blood pressure (SBP), major abdominal or pelvic surgery, immobilization in bed, limited ambulation, cancer, fracture of the lower limbs, varicose veins in the lower limbs, neurological disease, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), obesity, contraceptive use, atrial fibrillation, placement of orthopedic prosthesis, hormone replacement, nephrotic syndrome, use of a central venous catheter, peripheral venous thrombosis, thrombotic disease, inflammatory bowel diseases, postoperative intensive care unit (ICU) stay and congenital heart disease.…”

“…In addition to the factors cited by Andrade et al (2009), the literature reports other risk factors, such as blood transfusion (Geerts et al, 1994), Chagas disease (Arteaga Fernández et al, 1989) and cigarette smoking (Hioki et al, 2001;Moreira et al, 2009;Pamplona et al, 1997).…”