Prevenção do tromboembolismo na cirurgia do câncer do aparelho digestivo

Abstract

-Background -The venous thromboembolism is a common complication after surgical treatment in general and, in particular, on the therapeutic management on cancer. Surgery of the digestive tract has been reported to induce this complication. Patients with digestive cancer have substantial increased risk of initial or recurrent thromboembolism. Aim -To provide to surgeons working in digestive surgery and general surgery guidance on how to make safe thromboprophylaxis for patients requiring operations in the treatment of their gastrointestinal malignancies. Methods -The guideline was based on 15 relevant clinical issues and related to the risk factors, treatment and prognosis of the patient undergoing surgical treatment of cancer on digestive tract. They focused thromboembolic events associated with operations and thromboprophylaxis. The questions were structured using the PICO (Patient, Intervention or Indicator, Comparison and Outcome), allowing strategies to generate evidence on the main primary bases of scientific information (Medline / Pubmed, Embase, Lilacs / Scielo, Cochrane Library, PreMedline via OVID). Evidence manual search was also conducted (BDTD and IBICT). The evidence was recovered from the selected critical evaluation using discriminatory instruments (scores) according to the category of the question: risk, prognosis and therapy (JADAD Randomized Clinical Trials and New Castle Ottawa Scale for studies not randomized). After defining potential studies to support the recommendations, they were selected by the strength of evidence and grade of recommendation according to the classification of Oxford, including the available evidence of greater strength. Results -A total of 53,555 papers by title and / or abstract related to issue were found. Of this total were selected (1st selection) 478 studies that were evaluated as full-text. From them to support the recommendations were included in the consensus 132 papers. The 15 questions could be answered with evidence grade of articles with 31 A, 130 B, 1 C and 0 D. Conclusion -It was possible to prepare safe recommendations as guidance for thromboembolism prophylaxis in operations on the digestive tract malignancies, addressing the most frequent topics of everyday work of digestive and general surgeons. ABCDDV/873RESUMO -Racional -Tromboembolismo venoso é complicação frequente após tratamento cirúrgico em geral e, de um modo especial, na condução terapêutica do câncer. A cirurgia do aparelho digestivo tem sido referida como potencialmente indutora desta complicação. Os pacientes com câncer digestivo, têm risco substancialmente aumentado de iniciarem ou de terem recorrência de processo tromboembólico. Objetivo -Oferecer aos cirurgiões que atuam na cirurgia digestiva e geral orientação segura sobre como efetuar a tromboprofilaxia dos pacientes que necessitam de operações no tratamento de doenças malignas digestivas. Métodos -A Diretriz foi baseada a partir da elaboração de 15 questões clínicas relevantes e relacionadas ao risco, tratamento e prognóstic...

Profilaxia para tromboembolismo venoso em pacientes cirúrgicos: quem sabe faz a hora, não espera acontecer!!!

“…This guideline is in perfect harmony with the new guidelines published by the American College of Chest Physicians (ACCP February 2012) 3 that are globally accepted and developed the most rigorous standards of evidence-based medicine by the renowned Mc Master University in Canada. Despite this similarity, Malafaia et al 2 presents adaptations to our reality. Of course, this guideline is not intended to replace the assessment, judgment and experience of the physician responsible for the patient; their goal is to help surgeons to make decisions better suited for each patient at the time of treatment.…”