Prevención de la enfermedad tromboembólica venosa en cirugía general
Juan Ignacio Arcelusa, Francisco S. Lozanob, José L. Ramosc, Rafael Alósd, Eloy Espíne, Pedro Ricof, Eduardo Rosg
a Servicio de Cirugía General, Hospital Universitario Virgen de las Nieves, Granada, España
b Servicio de Angiología y Cirugía Vascular, Hospital Universitario, Salamanca, España
c Servicio de Cirugía General, Hospital Universitario, Getafe, España
d Servicio de Cirugía General, Hospital Universitario de Sagunto, Valencia, España
f Servicio de Cirugía General C, Hospital Universitario Doce de Octubre, Madrid, España
g Servicio de Angiología y Cirugía Vascular, Hospital Universitario San Cecilio, Granada, España
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Lozano, Juan I. Arcelus, José L. Ramos, Rafael Alós, Eloy Espín, Pedro Rico, Eduardo Ros" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Francisco S." "apellidos" => "Lozano" ] 1 => array:2 [ "nombre" => "Juan I." "apellidos" => "Arcelus" ] 2 => array:2 [ "nombre" => "José L." 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Ramos, Rafael Alós, Eloy Espín, Pedro Rico, Eduardo Ros" "autores" => array:7 [ 0 => array:3 [ "nombre" => "Juan" "apellidos" => "Ignacio Arcelus" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "nombre" => "Francisco S." "apellidos" => "Lozano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 2 => array:3 [ "nombre" => "José L." 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Además del riesgo de embolismo pulmonar, fatal en muchos casos, los pacientes que sufren ETV están expuestos a desarrollar complicaciones a largo plazo, tales como síndrome postrombótico o hipertensión pulmonar crónica. Por otra parte, la ETV postoperatoria suele ser asintomática o producir manifestaciones clínicas que se atribuyen a otros procesos, por lo que muchas veces esta complicación pasa desapercibida para el cirujano que intervino al paciente. Así pues, la mejor estrategia consiste en una eficaz prevención de la ETV, utilizando para ello las medidas profilácticas adecuadas al nivel de riesgo tromboembólico del paciente. Existe suficiente evidencia de que la ETV se puede prevenir mediante métodos farmacológicos, entre los que destacan la heparina y sus derivados, y con métodos mecánicos como las medias elásticas o los sistemas de compresión neumática intermitente de los miembros inferiores.</p> <p class="elsevierStylePara">Con objeto de reducir en lo posible la incidencia de ETV postoperatoria, se han propuesto estrategias que incluyen la combinación de fármacos y métodos mecánicos, nuevos fármacos antitrombóticos, o prolongar la duración de la profilaxis en los casos de muy alto riesgo, como los operados por cáncer. Otro aspecto importante es el del momento óptimo de inicio de la profilaxis con los fármacos anticoagulantes, con objeto de conseguir un equilibrio adecuado entre la eficacia antitrombótica y el riesgo de presentación de complicaciones hemorrágicas. En este artículo revisamos la evidencia disponible para intentar optimizar en lo posible la prevención de la ETV en cirugía general y en algunos grupos especiales, como la cirugía laparoscópica, de corta estancia y de la obesidad.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:62 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Autopsy proven pulmonary embolism in hospital patients: Are we detecting enough deep vein thrombosis?" 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Octubre | 71 | 20 | 91 |
| 2024 Septiembre | 107 | 31 | 138 |
| 2024 Agosto | 64 | 23 | 87 |
| 2024 Julio | 87 | 25 | 112 |
| 2024 Junio | 96 | 21 | 117 |
| 2024 Mayo | 75 | 22 | 97 |
| 2024 Abril | 72 | 28 | 100 |
| 2024 Marzo | 77 | 24 | 101 |
| 2024 Febrero | 77 | 26 | 103 |
| 2024 Enero | 74 | 27 | 101 |
| 2023 Diciembre | 51 | 15 | 66 |
| 2023 Noviembre | 66 | 18 | 84 |
| 2023 Octubre | 106 | 5 | 111 |
| 2023 Septiembre | 63 | 11 | 74 |
| 2023 Agosto | 54 | 28 | 82 |
| 2023 Julio | 89 | 22 | 111 |
| 2023 Junio | 89 | 20 | 109 |
| 2023 Mayo | 95 | 14 | 109 |
| 2023 Abril | 46 | 12 | 58 |
| 2023 Marzo | 55 | 16 | 71 |
| 2023 Febrero | 31 | 27 | 58 |
| 2023 Enero | 25 | 21 | 46 |
| 2022 Diciembre | 25 | 7 | 32 |
| 2022 Noviembre | 29 | 21 | 50 |
| 2022 Octubre | 29 | 18 | 47 |
| 2022 Septiembre | 65 | 31 | 96 |
| 2022 Agosto | 47 | 14 | 61 |
| 2022 Julio | 35 | 10 | 45 |
| 2022 Junio | 74 | 20 | 94 |
| 2022 Mayo | 15 | 9 | 24 |
| 2022 Abril | 35 | 14 | 49 |
| 2022 Marzo | 38 | 9 | 47 |
| 2022 Febrero | 16 | 10 | 26 |
| 2022 Enero | 32 | 14 | 46 |
| 2021 Diciembre | 44 | 23 | 67 |
| 2021 Noviembre | 22 | 15 | 37 |
| 2021 Octubre | 76 | 21 | 97 |
| 2021 Septiembre | 36 | 19 | 55 |
| 2021 Agosto | 27 | 7 | 34 |
| 2021 Julio | 19 | 27 | 46 |
| 2021 Junio | 12 | 11 | 23 |
| 2021 Mayo | 20 | 2 | 22 |
| 2021 Abril | 79 | 21 | 100 |
| 2021 Marzo | 53 | 21 | 74 |
| 2021 Febrero | 39 | 20 | 59 |
| 2021 Enero | 54 | 17 | 71 |
| 2020 Diciembre | 52 | 18 | 70 |
| 2020 Noviembre | 25 | 21 | 46 |
| 2020 Octubre | 22 | 20 | 42 |
| 2020 Septiembre | 23 | 17 | 40 |
| 2020 Agosto | 25 | 18 | 43 |
| 2020 Julio | 17 | 9 | 26 |
| 2020 Junio | 31 | 17 | 48 |
| 2020 Mayo | 64 | 23 | 87 |
| 2020 Abril | 18 | 19 | 37 |
| 2020 Marzo | 13 | 17 | 30 |
| 2020 Febrero | 37 | 19 | 56 |
| 2020 Enero | 21 | 20 | 41 |
| 2019 Diciembre | 20 | 36 | 56 |
| 2019 Noviembre | 14 | 11 | 25 |
| 2019 Octubre | 38 | 21 | 59 |
| 2019 Septiembre | 24 | 40 | 64 |
| 2019 Agosto | 33 | 37 | 70 |
| 2019 Julio | 35 | 33 | 68 |
| 2019 Junio | 69 | 67 | 136 |
| 2019 Mayo | 192 | 138 | 330 |
| 2019 Abril | 68 | 86 | 154 |
| 2019 Marzo | 23 | 90 | 113 |
| 2019 Febrero | 17 | 78 | 95 |
| 2019 Enero | 21 | 90 | 111 |
| 2018 Diciembre | 19 | 74 | 93 |
| 2018 Noviembre | 37 | 96 | 133 |
| 2018 Octubre | 32 | 16 | 48 |
| 2018 Septiembre | 31 | 105 | 136 |
| 2018 Agosto | 4 | 234 | 238 |
| 2018 Julio | 6 | 190 | 196 |
| 2018 Junio | 13 | 173 | 186 |
| 2018 Mayo | 5 | 177 | 182 |
| 2018 Abril | 12 | 146 | 158 |
| 2018 Marzo | 7 | 81 | 88 |
| 2018 Febrero | 6 | 69 | 75 |
| 2018 Enero | 5 | 54 | 59 |
| 2017 Diciembre | 10 | 42 | 52 |
| 2017 Noviembre | 8 | 92 | 100 |
| 2017 Octubre | 7 | 72 | 79 |
| 2017 Septiembre | 6 | 68 | 74 |
| 2017 Agosto | 6 | 44 | 50 |
| 2017 Julio | 3 | 54 | 57 |
| 2017 Junio | 16 | 86 | 102 |
| 2017 Mayo | 23 | 68 | 91 |
| 2017 Abril | 19 | 83 | 102 |
| 2017 Marzo | 10 | 103 | 113 |
| 2017 Febrero | 12 | 81 | 93 |
| 2017 Enero | 24 | 54 | 78 |
| 2016 Diciembre | 25 | 47 | 72 |
| 2016 Noviembre | 28 | 57 | 85 |
| 2016 Octubre | 30 | 68 | 98 |
| 2016 Septiembre | 28 | 52 | 80 |
| 2016 Agosto | 36 | 40 | 76 |
| 2016 Julio | 68 | 6 | 74 |
| 2016 Junio | 167 | 754 | 921 |
| 2016 Mayo | 188 | 794 | 982 |
| 2016 Abril | 165 | 636 | 801 |
| 2016 Marzo | 148 | 489 | 637 |
| 2016 Febrero | 144 | 466 | 610 |
| 2016 Enero | 129 | 353 | 482 |
| 2015 Diciembre | 138 | 258 | 396 |
| 2015 Noviembre | 165 | 362 | 527 |
| 2015 Octubre | 236 | 325 | 561 |
| 2015 Septiembre | 166 | 271 | 437 |
| 2015 Agosto | 119 | 187 | 306 |
| 2015 Julio | 100 | 178 | 278 |
| 2015 Junio | 73 | 158 | 231 |
| 2015 Mayo | 110 | 176 | 286 |
| 2015 Abril | 96 | 177 | 273 |
| 2015 Marzo | 90 | 128 | 218 |
| 2015 Febrero | 65 | 59 | 124 |
| 2015 Enero | 99 | 40 | 139 |
| 2014 Diciembre | 156 | 53 | 209 |
| 2014 Noviembre | 56 | 43 | 99 |
| 2014 Octubre | 50 | 57 | 107 |
| 2014 Septiembre | 63 | 41 | 104 |
| 2014 Agosto | 41 | 42 | 83 |
| 2014 Julio | 100 | 53 | 153 |
| 2014 Junio | 54 | 27 | 81 |
| 2014 Mayo | 60 | 39 | 99 |
| 2014 Abril | 56 | 67 | 123 |
| 2014 Marzo | 38 | 71 | 109 |
| 2014 Febrero | 58 | 49 | 107 |
| 2014 Enero | 35 | 53 | 88 |
| 2013 Diciembre | 39 | 53 | 92 |
| 2013 Noviembre | 81 | 106 | 187 |
| 2013 Octubre | 85 | 94 | 179 |
| 2013 Septiembre | 58 | 68 | 126 |
| 2013 Agosto | 38 | 65 | 103 |
| 2013 Julio | 0 | 17 | 17 |
| 2009 Julio | 8890 | 0 | 8890 |
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