Risk of Thromboembolic Disease in Patients Undergoing Laparoscopic Gynecologic Surgery

Nick, Alpa M.; Schmeler, Kathleen M.; Frumovitz, Michael; Soliman, Pamela T.; Spannuth, Whitney A.; Burzawa, Jennifer K.; Coleman, Robert L.; Wei, Caimiao; Reis, Ricardo dos; Ramírez, Pedro T.

doi:10.1097/aog.0b013e3181f240f7

Cited by 55 publications

(28 citation statements)

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“…De la misma manera, las células tumorales pueden secretar factores procoagulantes (factor tisular), factores que afectan la permeabilidad vascular como el factor de crecimiento endotelial (VEFG) y promover la deposición de fibrina 24 . Existe incertidumbre sobre el riesgo atribuido de tromboembolismo venoso después de procedimientos laparoscópicos, siendo controvertida la recomendación de tromboprofilaxis en este campo, porque existe un menor trauma quirúrgico, uso infrecuente de separadores abdominales, menor activación del sistema de coagulación 4 . En contraste, la cirugía laparoscópica puede estar asociada con mayor tiempo quirúrgico, incremento de la presión intraabdominal provocada por el pneumoperitoneo, características que alteran los factores hemodinámicos vasculares favoreciendo la estasis venosa en las extremidades inferiores [25][26][27] .…”

Section: Fisiopatología Y Factores De Riesgounclassified

“…Entre las pacientes llevadas a procedimientos quirúrgicos que no recibieron profilaxis, el riesgo de TVP puede ser entre 17% y 40%; con profilaxis la incidencia de tromboembolismo fue de 1.4% en mujeres con enfermedad ginecológica, del 0.7% en las pacientes llevadas a cirugía ginecológica laparoscópica, de 0.3% en las pacientes llevadas a cirugía uroginecológica y 4% en las pacientes con cáncer ginecológico [3][4][5][6][7] . En Estados Unidos la incidencia de un primer evento tromboembólico venoso es entre 1 y 2 por cada 1.000 pacientes por año 8,9 .…”

Section: Introductionunclassified

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Tromboprofilaxis en cirugía ginecológica laparoscópica

Ortega¹

2016

rcslibre

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r e v i s t a c o l o m b i a n a salud libre 102Revista Colombiana Salud Libre. 2016; 11 (Supl.): 102-110 r e v i s t a c o l o m b i a n a salud libre 102 Tromboprofilaxis en cirugía ginecológica laparoscópica Thromboprophylaxis in laparos copic gynecologic surgeryGilzan Javier narváez OrteGa ResumenDentro de los eventos tromboembólicos considerados están: la trombosis venosa profunda y el embolismo pulmonar, principales complicaciones que se pueden presentar durante y después de una cirugía ginecológica, por vía abierta o laparoscópica. Existe incertidumbre sobre el riesgo atribuido de tromboembolismo venoso después de procedimientos laparoscópicos, siendo controvertida la recomendación de tromboprofilaxis en este campo. El American College of Chest Physicians y el American Congress of Obstetricians and Gynecologist sugieren la clasificación de riesgo en 4 categorías: bajo, medio, alto y muy alto de las pacientes programadas para cirugía ginecológica. El riesgo de evento tromboembólico va a depender del tipo de procedimiento, tiempo quirúrgico, edad y la presencia de otros factores de riesgo. Hasta tener mayor evidencia, las pacientes llevadas a cirugía laparoscópica deberán ser estratificadas por categoría de riesgo y proveer profilaxis similar a pacientes llevadas a laparotomía. En mujeres de alto riesgo (mayores de 60 años, historia de trombosis venosa profunda, embolismo pulmonar o cáncer) se pueden beneficiar de la profilaxis dual y de prolongar su profilaxis hasta por 28 días. Palabras clave: Embolismo pulmonar, Laparoscopia, Tromboprofilaxis, Trombosis venosa profunda. AbstractWithin the considered thromboembolic events are: the deep vein thrombosis and the pulmonary embolism, being these the principal problems that can be presented during and after an opened or laparoscopic gynecological surgery. There is uncertainty about the referable risk of venous thromboembolism after laparoscopic procedures, being the recommendation of thromboprophylaxis controversial in this field. The American College of Chest Physicians and the American Congress of Obstetrician and Gynecologists suggest the risk classification into 4 categories, these are: low, medium, high and very high to the gynecological surgery scheduled patients. The thromboembolic risk event will depend on the type of procedure, surgical time, age and other risk factors presence. Until more evidence is shown, patients taken to laparoscopic surgery should be stratified by the risk category and should also be provided prophylaxis similar to those patients who are taken to laparotomy. In high-risk patients (over 60 years, deep vein thrombosis, the pulmonary embolism or cancer history) may benefit from dual prophylaxis and extend it for up to 28 days.

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Section: Fisiopatología Y Factores De Riesgounclassified

Section: Introductionunclassified

Tromboprofilaxis en cirugía ginecológica laparoscópica

Ortega¹

2016

rcslibre

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“…The 30-day rate of venous thromboembolism following minimally invasive surgery for endometrial, cervical, and ovarian cancer without thromboprophylaxis was 0.57% 12. However, in a study by Nick et al, the 6-week rate of venous thromboembolism following high-complexity minimally invasive surgery for gynecological cancer (radical hysterectomies, pelvic, para-aortic lymphadenectomy, splenectomy or bowel surgery) without extended low molecular weight heparin thromboprophylaxis was found to be 2.8% 13. Post-operative venous thromboembolism rates in endometrial cancer patients who received extended prophylaxis following minimally invasive surgery were reported to be 0.5–0.7% 14…”

Section: Introductionmentioning

confidence: 99%

Patients’ experience and compliance with extended low molecular weight heparin prophylaxis post-surgery for gynecological cancer: a prospective observational study

Marchocki

Norris

O’Toole

et al. 2019

Int J Gynecol Cancer

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ObjectiveGynaecological cancer patients have a high risk of developing venous thromboembolism (VTE). There is limited information on patient experience and compliance with an extended low molecular weight heparin prophylaxis in this setting. The aim of this study was to assess patient compliance, satisfaction and experience with the extended low molecular weight heparin prophylaxis after major surgery for gynaecological cancer.MethodsThis was a prospective observational study conducted in a large tertiary center for gynaecological cancer between July 2017-March 2018. Consecutive patients undergoing surgery for gynaecological cancer who received low molecular weight heparin prophylaxis for four weeks following surgery were recruited. All participants received a log book to record all injections, side effects, and questionnaire to be completed at the end of the study.ResultsA total of 106 patients completed and returned the VTE prophylaxis logbook and questionnaire. Sixty-six (62%) patients received low molecular weight heparin for 28 days, twenty-five (24%) for 26-27 days, and 15 (14%) for less than 26 days. The median number of days of therapy was 28 days (range; 12-28 days). Reasons for missed or stopped injections included: forgetfulness(n=12), medical procedures (n=6), pain (n=5), incorrect prescription (n=4), patient choice (n=3), cost (n=2), physician request (n=2), non-availability of person administering the injections (n=1) or unknown (n=5). Sixty-one (58%) patients self-administered the injections. Patients who had the injection performed by a third person were twice as likely to experience pain compared to patients who self-administered (OR 2.81, p=0.003). Eighty-nine (84%) patients self-reported side effects during low molecular weight heparin prophylaxis including: bruising (75%), pain after injections (49%), itchiness (9%), swelling (9%) or other (8%). Although 83 (78%) patients were satisfied with injections, 91 (86%) admitted they would much prefer a tablet form.ConclusionsCompliance with standard recommended regimen of 28-days prophylaxis was completed by 62% of patients. Majority of patients (86%) reported a preference for a tablet form, if one was available.

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“…Limited studies have estimated the rate of VTE in patients with gynecologic cancer undergoing minimally invasive surgery, reporting results lower than 2,4% [7,19,20]and thus implying that this group of patients are at lower risk for postoperative venous thromboembolic events than their open counterparts. These lower rates could be however attributed to the use of some kind of prophylaxis.…”

Section: Risk Factorsmentioning

confidence: 99%

“…Vol.4 No.5:31 2017 2 malignancies and there are studies reporting that increasing "surgical complexity" (radical hysterectomy, pelvic and paraaortic lymphadenectomy, splenectomy, bowel surgery) might result in higher rates of VTE [19].…”

Section: British Journal Of Research Issn 2394-3718mentioning

confidence: 99%