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Prevención del tromboembolismo venoso en pacientes quirúrgicos

Giancarlo Agnelli¹

¹Stroke Unit & Division of Cardiovascular Medicine, Department of Internal Medicine, University of Perugia, Italy. agnellig@unipg.it

|December 16, 2004

Resumen

La profilaxis del tromboembolismo venoso (TEV) es crucial para los pacientes quirúrgicos. Varios métodos, incluidos los anticoagulantes y las intervenciones mecánicas, son efectivos dependiendo del tipo de cirugía y los factores de riesgo del paciente.

Área de la Ciencia:

Ciencias Médicas Ciencias Médicas.
Complicaciones quirúrgicas Complicaciones quirúrgicas.
Investigación de la trombosis.

Sus antecedentes:

El tromboembolismo venoso (TEV) es una complicación frecuente después de procedimientos quirúrgicos.
El riesgo de TEV está influenciado por factores específicos del paciente y el tipo de cirugía.
La profilaxis es esencial para mitigar la TEV en entornos quirúrgicos.

Objetivo del estudio:

Revisar las estrategias actuales para la profilaxis de TEV en pacientes quirúrgicos.
Para esbozar las medidas profilácticas recomendadas basadas en el riesgo quirúrgico y el tipo.
Identificar las áreas que requieren más investigación en la prevención de TEV después de la cirugía.

Principales métodos:

Revisión de la literatura existente sobre la profilaxis de TEV en la cirugía.
Categorización del riesgo de TEV basado en procedimientos quirúrgicos (por ejemplo, general, ortopédico, neurocirugía).
Análisis de las intervenciones farmacológicas (por ejemplo, heparina, LMWH, VKAs, fondaparinux) y mecánicas (por ejemplo, medias, movilización).

Principales resultados:

Se recomiendan dosis bajas de heparina no fraccionada o heparina de bajo peso molecular (LMWH) para cirugía general, ginecológica, vascular y urológica mayor.
La movilización temprana es suficiente para la cirugía urológica de bajo riesgo; los procedimientos de mayor riesgo (reemplazo de cadera / rodilla, fractura de cadera) garantizan anticoagulantes (VKAs, LMWH, fondaparinux).
Las medias elásticas graduadas, potencialmente con LMWH, son efectivas para la neurocirugía; la profilaxis está menos definida para las cirugías de columna vertebral, laparoscópica y artroscópica.

Conclusiones:

Se recomienda la profilaxis rutinaria de TEV utilizando métodos mecánicos y farmacológicos para la mayoría de los pacientes quirúrgicos.
Las estrategias profilácticas específicas deben adaptarse al tipo de cirugía y al riesgo individual del paciente.
Se necesita más investigación sobre el cribado de la trombosis venosa profunda asintomática, el momento óptimo y la duración de la profilaxis.

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