O uso comparativo das diferentes tromboprofilaxias no paciente com trauma
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Jun 15, 2024
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Resumo
Objetivo: O objetivo do presente estudo é comparar o uso dos diferentes anticoagulantes na tromboprofilaxia de pacientes com trauma. Métodos: Trata-se de uma revisão sistemática, realizada nas bases de dados MEDLINE (PubMed), Cochrane e Scopus, utilizando apenas estudos observacionais analíticos ou experimentais, dos últimos 10 anos, de acordo com as recomendações dos Itens de Relatório Preferidos para Revisões Sistemáticas e Metanálises (PRISMA), e registrada no banco de dados PROSPERO. Resultados: Foram incluídos 27 artigos, em sua maioria estudo de coorte retrospectivo, com trauma de natureza ortopédica ou contusa, e com maior percentagem de pacientes de sexo masculino, com idade média entre 40 e 60 anos. O anticoagulante mais utilizado foi a Heparina de Baixo Peso Molecular (HBPM), e o método diagnóstico principal foi a ultrassonografia (USG). Por fim, observou-se um melhor prognóstico com uso da HPBM quando comparado às demais medicações tradicionais. No entanto, quando comparada à rivaroxabana, foram encontradas divergências entre os estudos. Considerações finais: Na tromboprofilaxia há predomínio do uso das heparinas, em que a HBPM reduz mais a incidência de TEV e TVP. Os DOAC possuem superioridade farmacodinâmica e efeitos adversos mais brandos sendo, assim, considerados boas alternativas na tromboprofilaxia.
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Como Citar
PaixãoJ. E. P., ArantesC. R., SouzaA. L. B. de, AmorimG. de S. P., MeloB. Y. H. de, & SilvaC. T. X. (2024). O uso comparativo das diferentes tromboprofilaxias no paciente com trauma. Revista Eletrônica Acervo Saúde, 24(6), e15433. https://doi.org/10.25248/reas.e15433.2024
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Referências
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2. ALI I, et al. Venous thromboembolism in trauma patients with lower limb cast immobilization, associated risk reduction and complication using rivaroxaban. Irish Journal of Medical Science, 2021; 190(1): 169-175.
3. BOO S, et al. Venous thromboembolism in a single korean trauma center: incidence, risk factors, and assessing the validity of VTE diagnostic tools. Yonsei Medical Journal 2021; 62(6): 520-527.
4. BURIHAN M, et al. Consenso e atualização na profilaxia e no tratamento do tromboembolismo venoso. SBACVSP, 2019.
5. CHOWDHURY S, ALRAWAJI F, LEENEN L. Incidence and Nature of Lower-Limb Deep Vein Thrombosis in Patients with Polytrauma on Thromboprophylaxis: A Prospective Cohort Study. Vascular Health and Risk Management, 2021; 17: 395-405.
6. CHU C, HAGA H. Venous thromboembolism associated with lower limb fractures after trauma: dilemma and management. Journal of Orthopaedic Science, 2015; 20(2): 364-372.
7. CRUSH J, et al. Sequential low molecular weight heparin and rivaroxaban for venous thromboprophylaxis in pelvic and acetabular trauma. Archives of Orthopaedic and Trauma Surgery, 2022; 142(11): 3271-3277.
8. DANCHEV D, PETROV N, ZIDAROVA D. The role of LMWH in prevention of deep veins thrombosis and pulmonary embolism in patients with severe multiple trauma. International Society on Thrombosis and Haemostasis, 2013; 11(3): 17.
9. DOUILLET D, et al. Prevention of venous thromboembolic events in patients with lower leg immobilization after trauma: Systematic review and network meta-analysis with meta-epsidemiological approach. PLOS Medicine, 2022; 19(7): e1004059.
10. DROEGE M, et al. Impact of antithrombin III and enoxaparin dosage adjustment on prophylactic anti-Xa concentrations in trauma patients at high risk for venous thromboembolism: a randomized pilot trial. Journal of Thrombosis and Thrombolysis, 2021; 52(4): 1117-1128.
11. ELSEBAIE M, et al. Direct oral anticoagulantes in patients with venous thromboembolism and thrombophilia: a systematic review and meta-analysis. Journal of thrombosis and hemostasis, 2019; 17(4): 645-656.
12. FLEVAS D, et al. Thromboembolism prophylaxis in orthopaedics: an update. EFORT open reviews, 2018; 3(4): 136-148.
13. FREDENBURGH J, WEITZ J. New anticoagulants: Moving beyond the direct oral anticoagulants. Journal Of Thrombosis and Haemostasis, 2021; 19(1): 20-29.
14. FU D, et al. Fondaparinux sodium and low molecular weight heparin for venous thromboembolism prophylaxis in Chinese patients with major orthopedic surgery or trauma: a real-world study. BMC Surgery, 2022; 22(1): 1-10.
15. GEERTS W, et al. A prospective study of venous thromboembolism after major trauma. The New England Journal of Medicine, 1994; 331(24): S1601-S1606, supl. 6.
16. GOH E, et al. Direct Oral Anticoagulants in the Prevention of Venous Thromboembolism Following Surgery for Hip Fracture in Older Adults: A Population-Based Cohort Study. Geriatric Orthopaedic Surgery & Rehabilitation, 2020; 11: 1-5.
17. GRITSIOUK Y, et al. A retrospective analysis of the effectiveness of low molecular weight heparin for venous thromboembolism prophylaxis in trauma patients. The American Journal of Surgery, 2014; 207(5): 648-651.
18. HAAC B, et al. Aspirin versus low-molecular-weight heparin for venous thromboembolism prophylaxis in orthopaedic trauma patients: A patient-centered randomized controlled trial. PLoS One, 2020; 15(8): 1-13.
19. HAMIDI M, et al. Operative spinal trauma: Thromboprophylaxis with low molecular weight heparin or a direct oral anticoagulant. Journal of Thrombosis and Haemostasis, 2019; 17(6): 925-933.
20. HAUT E, et al. Predictors of Posttraumatic Deep Vein Thrombosis (DVT): Hospital Practive Versus Patient Factors – An Analysis of the National Trauma Data Bank (NTDB). The Journal of Trauma: injuty, infection, and critical care, 2009; 66(4): 994-1001.
21. HAYKAL T, et al. Thromboprophylaxis for orthopedic surgery; An updated meta-analysis. Thrombosis Research, 2021; 199: 43-53.
22. HEIT J, SPENCER F, WHITE R. The epidemiology of venous thromboembolism. Journal of Thrombosis and Thrombolysis, 2016; 41: 3-14.
23. JACOBS B, et al. Unfractionated Heparin Versus Low Molecular Weight Heparin for Venous Thromboembolism Prophylaxis in Trauma. Journal of trauma and acute care surgery, 2017; 83(1).
24. JOHN M, et al. A Prospective Randomized Controlled Trial Comparing Enoxaparin & Rivaroxaban for Venous Thromboembolism Prophylaxis in Orthopaedic Trauma. Journal of Orthopaedic Trauma, 2022; 36(12): 615-622.
25. KAY A, et al. Weight-based enoxaparin dosing and deep vein thrombosis in hospitalized trauma patients: a double-blind, randomized, pilot study. Surgery, 2018; 164(1): 144-149.
26. KHURRUM M, et al. The survival benefit of low molecular weight heparin over unfractionated heparin in pediatric trauma patients. Journal of Pediatric Surgery, 2021; 56(3): 494-499.
27. KINGDOM L, MILLER E, SAVAGE S. The Utility of Rivaroxaban as Primary Venous Thromboprophylaxis in an Adult Trauma Population. Journal Of Surgical Research, 2019; 244: 509-515.
28. KRANTZ E, et al. Retrospective Evaluation of Venous Thromboembolism Prophylaxis in Elderly, High-Risk Trauma Patients. Journal of Surgical Research, 2020; 249: 225-231.
29. LONG A, et al. Efficacy and safety of rivaroxaban versus low-molecular-weight heparin therapy in patients with lower limb fractures. Journal of Thrombosis and Thrombolysis, 2014; 38(3): 299-305.
30. NEDERPELT C, et al. Direct Oral Anticoagulants Are a Potential Alternative to Low-Molecular-Weight Heparin for Thromboprophylaxis in Trauma Patients Sustaining Lower Extremity Fractures. Journal Of Surgical Research, 2021; 258: 324-331.
31. NEIFERT S, et al. Lower Mortality and Morbidity with Low-Molecular-Weight Heparin for Venous Thromboembolism Prophylaxis in Spine Trauma. Spine, 2020; 45(23): 1613-1618.
32. O’TOOLE R, et al. Prevention of Clots in Orthopaedic Trauma (PREVENT CLOT): a randomised pragmatic trial protocol comparing aspirin versus low-molecular-weight heparin for blood clot prevention in orthopaedic trauma patients. BMJ open, 2021; 11(3): 1-9.
33. OLSON EL, et al. Heparin versus enoxaparin for prevention of venous thromboembolism after trauma: A randomized noninferiority trial. Journal of Acute and Care Surgery, 2015; 79: 961-968.
34. ONISHI A, et al. Heparin and anticoagulation. Frontiers in Bioscience-Landmark, 2016; 21(7): 1372-1392.
35. PAGE M, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 2021; 372(71): 1-9.
36. PRESTI C, et al. Trombose venosa profunda diagnóstico e tratamento. Projeto diretriz SBACV, 2015; 1-35.
37. RUSKIN K. Deep vein thrombosis and venous thromboembolism in trauma. Current Opinion in Anaesthesiology, 2018; 31(2): 215-218.
38. SAMUEL S, et al. Enoxaparin may be associated with lower rates of mortality than unfractionated heparin in neurocritical and surgical patients. Journal of Thrombosis and Thrombolysis, 2023; 55(3): 439-448.
39. SHIQING W, et al. Efficacy of low molecular weight heparin in spinal trauma patients after part concentrated screw surgery and its influence on blood parameters and the incidence of deep venous thrombosis. Medical hypotheses, 2019; 132: 1-5.
40. SILVA L, et al. Análise retrospectiva da prevalência e do perfil epidemiológico dos pacientes vítimas de trauma em um hospital secundário. Revista de Medicina, 2017; 96(4): 246-254.
41. STEVENS SM, et al. Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report. CHEST, 2021; 160: 545-608.
42. TRAN A, et al. Efficacy and Safety of Low Molecular Weight Heparin Versus Unfractionated Heparin for Prevention of Venous Thromboembolism in Trauma Patients: A Systematic Review and Meta-analysis. Annals of Surgery, 2022; 275(1): 19-28.
2. ALI I, et al. Venous thromboembolism in trauma patients with lower limb cast immobilization, associated risk reduction and complication using rivaroxaban. Irish Journal of Medical Science, 2021; 190(1): 169-175.
3. BOO S, et al. Venous thromboembolism in a single korean trauma center: incidence, risk factors, and assessing the validity of VTE diagnostic tools. Yonsei Medical Journal 2021; 62(6): 520-527.
4. BURIHAN M, et al. Consenso e atualização na profilaxia e no tratamento do tromboembolismo venoso. SBACVSP, 2019.
5. CHOWDHURY S, ALRAWAJI F, LEENEN L. Incidence and Nature of Lower-Limb Deep Vein Thrombosis in Patients with Polytrauma on Thromboprophylaxis: A Prospective Cohort Study. Vascular Health and Risk Management, 2021; 17: 395-405.
6. CHU C, HAGA H. Venous thromboembolism associated with lower limb fractures after trauma: dilemma and management. Journal of Orthopaedic Science, 2015; 20(2): 364-372.
7. CRUSH J, et al. Sequential low molecular weight heparin and rivaroxaban for venous thromboprophylaxis in pelvic and acetabular trauma. Archives of Orthopaedic and Trauma Surgery, 2022; 142(11): 3271-3277.
8. DANCHEV D, PETROV N, ZIDAROVA D. The role of LMWH in prevention of deep veins thrombosis and pulmonary embolism in patients with severe multiple trauma. International Society on Thrombosis and Haemostasis, 2013; 11(3): 17.
9. DOUILLET D, et al. Prevention of venous thromboembolic events in patients with lower leg immobilization after trauma: Systematic review and network meta-analysis with meta-epsidemiological approach. PLOS Medicine, 2022; 19(7): e1004059.
10. DROEGE M, et al. Impact of antithrombin III and enoxaparin dosage adjustment on prophylactic anti-Xa concentrations in trauma patients at high risk for venous thromboembolism: a randomized pilot trial. Journal of Thrombosis and Thrombolysis, 2021; 52(4): 1117-1128.
11. ELSEBAIE M, et al. Direct oral anticoagulantes in patients with venous thromboembolism and thrombophilia: a systematic review and meta-analysis. Journal of thrombosis and hemostasis, 2019; 17(4): 645-656.
12. FLEVAS D, et al. Thromboembolism prophylaxis in orthopaedics: an update. EFORT open reviews, 2018; 3(4): 136-148.
13. FREDENBURGH J, WEITZ J. New anticoagulants: Moving beyond the direct oral anticoagulants. Journal Of Thrombosis and Haemostasis, 2021; 19(1): 20-29.
14. FU D, et al. Fondaparinux sodium and low molecular weight heparin for venous thromboembolism prophylaxis in Chinese patients with major orthopedic surgery or trauma: a real-world study. BMC Surgery, 2022; 22(1): 1-10.
15. GEERTS W, et al. A prospective study of venous thromboembolism after major trauma. The New England Journal of Medicine, 1994; 331(24): S1601-S1606, supl. 6.
16. GOH E, et al. Direct Oral Anticoagulants in the Prevention of Venous Thromboembolism Following Surgery for Hip Fracture in Older Adults: A Population-Based Cohort Study. Geriatric Orthopaedic Surgery & Rehabilitation, 2020; 11: 1-5.
17. GRITSIOUK Y, et al. A retrospective analysis of the effectiveness of low molecular weight heparin for venous thromboembolism prophylaxis in trauma patients. The American Journal of Surgery, 2014; 207(5): 648-651.
18. HAAC B, et al. Aspirin versus low-molecular-weight heparin for venous thromboembolism prophylaxis in orthopaedic trauma patients: A patient-centered randomized controlled trial. PLoS One, 2020; 15(8): 1-13.
19. HAMIDI M, et al. Operative spinal trauma: Thromboprophylaxis with low molecular weight heparin or a direct oral anticoagulant. Journal of Thrombosis and Haemostasis, 2019; 17(6): 925-933.
20. HAUT E, et al. Predictors of Posttraumatic Deep Vein Thrombosis (DVT): Hospital Practive Versus Patient Factors – An Analysis of the National Trauma Data Bank (NTDB). The Journal of Trauma: injuty, infection, and critical care, 2009; 66(4): 994-1001.
21. HAYKAL T, et al. Thromboprophylaxis for orthopedic surgery; An updated meta-analysis. Thrombosis Research, 2021; 199: 43-53.
22. HEIT J, SPENCER F, WHITE R. The epidemiology of venous thromboembolism. Journal of Thrombosis and Thrombolysis, 2016; 41: 3-14.
23. JACOBS B, et al. Unfractionated Heparin Versus Low Molecular Weight Heparin for Venous Thromboembolism Prophylaxis in Trauma. Journal of trauma and acute care surgery, 2017; 83(1).
24. JOHN M, et al. A Prospective Randomized Controlled Trial Comparing Enoxaparin & Rivaroxaban for Venous Thromboembolism Prophylaxis in Orthopaedic Trauma. Journal of Orthopaedic Trauma, 2022; 36(12): 615-622.
25. KAY A, et al. Weight-based enoxaparin dosing and deep vein thrombosis in hospitalized trauma patients: a double-blind, randomized, pilot study. Surgery, 2018; 164(1): 144-149.
26. KHURRUM M, et al. The survival benefit of low molecular weight heparin over unfractionated heparin in pediatric trauma patients. Journal of Pediatric Surgery, 2021; 56(3): 494-499.
27. KINGDOM L, MILLER E, SAVAGE S. The Utility of Rivaroxaban as Primary Venous Thromboprophylaxis in an Adult Trauma Population. Journal Of Surgical Research, 2019; 244: 509-515.
28. KRANTZ E, et al. Retrospective Evaluation of Venous Thromboembolism Prophylaxis in Elderly, High-Risk Trauma Patients. Journal of Surgical Research, 2020; 249: 225-231.
29. LONG A, et al. Efficacy and safety of rivaroxaban versus low-molecular-weight heparin therapy in patients with lower limb fractures. Journal of Thrombosis and Thrombolysis, 2014; 38(3): 299-305.
30. NEDERPELT C, et al. Direct Oral Anticoagulants Are a Potential Alternative to Low-Molecular-Weight Heparin for Thromboprophylaxis in Trauma Patients Sustaining Lower Extremity Fractures. Journal Of Surgical Research, 2021; 258: 324-331.
31. NEIFERT S, et al. Lower Mortality and Morbidity with Low-Molecular-Weight Heparin for Venous Thromboembolism Prophylaxis in Spine Trauma. Spine, 2020; 45(23): 1613-1618.
32. O’TOOLE R, et al. Prevention of Clots in Orthopaedic Trauma (PREVENT CLOT): a randomised pragmatic trial protocol comparing aspirin versus low-molecular-weight heparin for blood clot prevention in orthopaedic trauma patients. BMJ open, 2021; 11(3): 1-9.
33. OLSON EL, et al. Heparin versus enoxaparin for prevention of venous thromboembolism after trauma: A randomized noninferiority trial. Journal of Acute and Care Surgery, 2015; 79: 961-968.
34. ONISHI A, et al. Heparin and anticoagulation. Frontiers in Bioscience-Landmark, 2016; 21(7): 1372-1392.
35. PAGE M, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 2021; 372(71): 1-9.
36. PRESTI C, et al. Trombose venosa profunda diagnóstico e tratamento. Projeto diretriz SBACV, 2015; 1-35.
37. RUSKIN K. Deep vein thrombosis and venous thromboembolism in trauma. Current Opinion in Anaesthesiology, 2018; 31(2): 215-218.
38. SAMUEL S, et al. Enoxaparin may be associated with lower rates of mortality than unfractionated heparin in neurocritical and surgical patients. Journal of Thrombosis and Thrombolysis, 2023; 55(3): 439-448.
39. SHIQING W, et al. Efficacy of low molecular weight heparin in spinal trauma patients after part concentrated screw surgery and its influence on blood parameters and the incidence of deep venous thrombosis. Medical hypotheses, 2019; 132: 1-5.
40. SILVA L, et al. Análise retrospectiva da prevalência e do perfil epidemiológico dos pacientes vítimas de trauma em um hospital secundário. Revista de Medicina, 2017; 96(4): 246-254.
41. STEVENS SM, et al. Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report. CHEST, 2021; 160: 545-608.
42. TRAN A, et al. Efficacy and Safety of Low Molecular Weight Heparin Versus Unfractionated Heparin for Prevention of Venous Thromboembolism in Trauma Patients: A Systematic Review and Meta-analysis. Annals of Surgery, 2022; 275(1): 19-28.