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Prophylaxis of venous thromboembolism – The guidelines are there
Prevenção do tromboembolismo venoso – as recomendações estão aí…
Paulo Pinho
Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de S. João, Porto, Portugal
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João, Porto, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Prevenção do tromboembolismo venoso – as recomendações estão aí…" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Venous thromboembolism (VTE) in its most common forms – deep vein thrombosis (DVT) and pulmonary embolism (PE) – is a well-known problem in hospitalized patients. It is the leading preventable cause of in-hospital death and results in considerable acute and chronic morbidity.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">It is thus extremely important to apply the existing guidelines on the prevention of VTE in the most vulnerable patients, those undergoing surgery.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The multinational ENDORSE study, performed in the last decade, which assessed risk for VTE based on the American College of Chest Physicians (ACCP) guidelines, showed that in the nine randomly selected Portuguese hospitals included, 52.7% of patients were at risk of VTE (68.9% of surgical patients and 38.5% of medical patients). The rate of prophylaxis in patients at risk was 58.5%, but a third of both surgical and medical patients were also on prophylaxis despite not being at risk for VTE.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Increasing awareness of this issue has prompted various initiatives in recent years by different entities. The Directorate-General of Health includes perioperative assessment of the indication for thromboprophylaxis in its guideline “Cirurgia Segura Salva Vidas” and has produced a guideline specifically for orthopedic surgery.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> The European Respiratory Society (ERS), together with the US Joint Commission, includes thromboprophylaxis in its assessment of performance in various surgical fields.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a> More important in Portugal was the formation by the Portuguese Society of Anesthesiology of a multidisciplinary study group that produced guidelines for perioperative VTE prophylaxis,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> based on an updated bibliographic review and on the ninth edition of the ACCP guidelines (2012)<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> and the UK's National Institute for Health and Care Excellence guidelines (2010, updated 2015).<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> These recommendations have been adopted by a significant number of Portuguese medical societies.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The TREVO study<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> is an analysis of a changing clinical situation. It studied a sample of 67<span class="elsevierStyleHsp" style=""></span>635 admissions for surgery in a central university hospital between 2008 and 2012, and herein, in my opinion, lies its greatest value. It has significant limitations, which are acknowledged by its authors, but both its weaknesses and its strengths are informative. In particular, it highlights the following points:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0030" class="elsevierStylePara elsevierViewall">Routine thromboprophylaxis for surgical patients improved steadily over the study period, with reduced overall risk of TVE and orthopedic surgery no longer posing an additional risk.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">There is a clear need for protocols to assess risk of TVE and bleeding in all surgical patients.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">A multidisciplinary approach is required that includes the patient's risk factors, the risk of the specific surgery to be performed (with or without central venous catheterization), and the type of anesthesia (neuraxial vs. general).</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Prevention of thromboembolism, as pointed out in the article,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> is particularly complicated in neurosurgery, but also in cardiac surgery, in which the high bleeding risk requires specific measures.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">11,12</span></a></p></li></ul></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pinho P. Prevenção do tromboembolismo venoso – as recomendações estão aí…. Rev Port Cardiol. 2017;36:617–618.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0065" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevenção e tratamento do tromboembolismo venoso: o lugar dos novos anticoagulantes orais" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Reis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0870-2551(12)70039-2" "Revista" => array:7 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2012" "volumen" => "31" "numero" => "Suppl. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 5 | 14 |
| 2024 October | 37 | 30 | 67 |
| 2024 September | 52 | 25 | 77 |
| 2024 August | 50 | 33 | 83 |
| 2024 July | 36 | 34 | 70 |
| 2024 June | 35 | 27 | 62 |
| 2024 May | 42 | 14 | 56 |
| 2024 April | 52 | 31 | 83 |
| 2024 March | 36 | 27 | 63 |
| 2024 February | 44 | 22 | 66 |
| 2024 January | 32 | 24 | 56 |
| 2023 December | 32 | 32 | 64 |
| 2023 November | 34 | 32 | 66 |
| 2023 October | 26 | 11 | 37 |
| 2023 September | 28 | 15 | 43 |
| 2023 August | 26 | 28 | 54 |
| 2023 July | 22 | 11 | 33 |
| 2023 June | 29 | 12 | 41 |
| 2023 May | 46 | 29 | 75 |
| 2023 April | 25 | 5 | 30 |
| 2023 March | 52 | 29 | 81 |
| 2023 February | 38 | 26 | 64 |
| 2023 January | 30 | 19 | 49 |
| 2022 December | 50 | 27 | 77 |
| 2022 November | 64 | 42 | 106 |
| 2022 October | 51 | 19 | 70 |
| 2022 September | 53 | 40 | 93 |
| 2022 August | 52 | 33 | 85 |
| 2022 July | 49 | 42 | 91 |
| 2022 June | 42 | 45 | 87 |
| 2022 May | 44 | 35 | 79 |
| 2022 April | 48 | 41 | 89 |
| 2022 March | 51 | 48 | 99 |
| 2022 February | 64 | 51 | 115 |
| 2022 January | 66 | 36 | 102 |
| 2021 December | 42 | 44 | 86 |
| 2021 November | 61 | 39 | 100 |
| 2021 October | 62 | 50 | 112 |
| 2021 September | 39 | 35 | 74 |
| 2021 August | 65 | 36 | 101 |
| 2021 July | 98 | 29 | 127 |
| 2021 June | 61 | 33 | 94 |
| 2021 May | 79 | 47 | 126 |
| 2021 April | 235 | 105 | 340 |
| 2021 March | 112 | 60 | 172 |
| 2021 February | 108 | 34 | 142 |
| 2021 January | 76 | 41 | 117 |
| 2020 December | 71 | 21 | 92 |
| 2020 November | 95 | 33 | 128 |
| 2020 October | 65 | 19 | 84 |
| 2020 September | 101 | 26 | 127 |
| 2020 August | 55 | 14 | 69 |
| 2020 July | 86 | 14 | 100 |
| 2020 June | 56 | 17 | 73 |
| 2020 May | 65 | 12 | 77 |
| 2020 April | 48 | 28 | 76 |
| 2020 March | 67 | 18 | 85 |
| 2020 February | 134 | 61 | 195 |
| 2020 January | 60 | 11 | 71 |
| 2019 December | 81 | 14 | 95 |
| 2019 November | 46 | 18 | 64 |
| 2019 October | 53 | 10 | 63 |
| 2019 September | 88 | 20 | 108 |
| 2019 August | 42 | 15 | 57 |
| 2019 July | 55 | 14 | 69 |
| 2019 June | 44 | 12 | 56 |
| 2019 May | 62 | 16 | 78 |
| 2019 April | 47 | 25 | 72 |
| 2019 March | 133 | 25 | 158 |
| 2019 February | 90 | 8 | 98 |
| 2019 January | 145 | 4 | 149 |
| 2018 December | 138 | 10 | 148 |
| 2018 November | 170 | 8 | 178 |
| 2018 October | 286 | 27 | 313 |
| 2018 September | 98 | 17 | 115 |
| 2018 August | 33 | 7 | 40 |
| 2018 July | 38 | 8 | 46 |
| 2018 June | 50 | 10 | 60 |
| 2018 May | 47 | 11 | 58 |
| 2018 April | 56 | 8 | 64 |
| 2018 March | 96 | 14 | 110 |
| 2018 February | 33 | 15 | 48 |
| 2018 January | 63 | 8 | 71 |
| 2017 December | 95 | 30 | 125 |
| 2017 November | 73 | 22 | 95 |
| 2017 October | 82 | 46 | 128 |
| 2017 September | 59 | 37 | 96 |
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