Información del artículo
Objetivo
Cuantificar la profilaxis tromboembólica en la cirugía de cadera y determinar su calidad.
Diseño experimentalEstudio retrospectivo de utilización de medicamentos, del tipo indicación-prescripción. Las variables principales fueron: realización o no de tromboprofilaxis, tipo de la misma (fármaco, dosis y tiempo) y cualidad (correcta, incorrecta y dudosa).
ResultadosLa profilaxis tromboembólica se indicó en el 91,3% de los pacientes (p < 0,05). Los fármacos utilizados más frecuentemente fueron las heparinas de bajo peso molecular (p < 0,001). La calidad de la profilaxis fue incorrecta en el 63,3% (p < 0,001), dudosa en el 28,3% y correcta en el 8,4%.
ConclusionesLos cirujanos ortopédicos conocen la indicación de tromboprofilaxis en los pacientes operados de cadera y la prescriben, aunque no siguen unánimemente las recomendaciones aceptadas internacionalmente para su realización.
Palabras clave:
trombosis
venosa
profunda
heparina
tromboprofilaxis
cirugía
cadera
Objective
To quantify thromboembolic prophylaxis in hip surgery and evaluate its quality.
Experimental designRetrospective study of the indications and prescription of medication. The principal variables were use or non-use of thromboembolic prophylaxis, type of prophylaxis (drug, dose, and time), and quality (correct, incorrect, dubious).
ResultsThromboembolic prophylaxis was indicated in 91.3% of patients (p < 0.05). The drugs used most often were low-molecular-weight heparins (p < 0.001). The quality of prophylaxis was incorrect in 63.3% (p < 0.001), dubious in 28.3% and correct in 8.4%.
ConclusionsOrthopedic surgeons are aware of the indication for thromboprophylaxis in patients undergoing hip surgery and prescribe drugs for this purpose, but they do not all follow internationally accepted recommendations for the use of these medicinal products.
Key words:
thrombosis
venous
deep
heparin
thromboprophylaxis
surgery
hip
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Bibliografía
[1.]
J.A. Heit, M.D. Silverstein, D.N. Mohr, T.M. Petterson, C.M. Lohse, W.M. O'Fallon, et al.
The epidemiology of venous thromboembolism in the community.
Thromb Haemost, 86 (2001), pp. 452-463
[2.]
W.H. Geerts, J.A. Heit, G.P. Clagett, G.F. Pineo, C.W. Colwell, F.A. Anderson Jr., et al.
Prevention of venous thromboembolism.
Chest, 119 (2001), pp. 132S-75
[3.]
E.A. Salvati, V.D. Pellegrini Jr., N.E. Sharrock, P.A. Lotke, D.W. Murray, H. Potter, et al.
Recent advances in venous thromboembolic prophylaxis during and after total hip replacement.
J Bone Joint Surg Am, 82A (2000), pp. 252-270
[4.]
D. Bergqvist, G. Benoni, O. Bjorgell, H. Fredin, U. Hedlundh, S. Nicolas, et al.
Low-molecular-weight heparin (enoxaparin) as prophylaxis against venous thromboembolism after total hip replacement.
N Engl J Med, 335 (1996), pp. 696-700
[5.]
A. Planes, N. Vochelle, J.Y. Darmon, M. Fagola, M. Belland, Y. Huet.
Risk of deep venous thrombosis after hospital discharge in patients having undergone total hip replacement double-blind randomised comparison of enoxaparin versus placebo.
Lancet, 348 (1996), pp. 224-228
[6.]
O.E. Dahl, G. Andreassen, T. Aspelin, C. Muller, P. Mathiesen, S. Nyhus, et al.
Prolonged thromboprophylaxis following hip replacement surgery-results of a double-blind, prospective, randomised, placebo-controlled study with dalteparin (Fragmin).
Thromb Haemost, 77 (1997), pp. 26-31
[7.]
M.R. Lassen, L.C. Borris, B.S. Anderson, H.P. Jensen, H.P. Skejo Bro, G. Andersen, et al.
Efficacy and safety of prolonged thromboprophylaxis with a low molecular weight heparin (dalteparin) after total hip arthroplasty. The Danish Prolonged Prophylaxis (DaPP) study.
Thromb Res, 89 (1998), pp. 281-287
[9.]
A.N. Nicolaides, J. Arcelus, G. Belcaro, D. Bergqvist, L.C. Borris, H.R. Buller, et al.
Prevention of venous thromboembolism. European Consensus Statement.
Int Angiol, 11 (1992), pp. 151-159
[10.]
Comité de Redacción de Protocolos..
Protocolos de prevención y tratamiento de la enfermedad tromboembólica (I). Profilaxis y tratamiento de la trombosis venosa y del tromboembolismo pulmonar.
Med Clin (Barc), 103 (1994), pp. 222-228
[11.]
A.N. Nicolaides.
Prevention of venous thromboembolism. International Consensus Statement Guidelines compiled in accordance with scientific evidence.
Int Angiol, 20 (2001), pp. 1-37
[12.]
D.P. Thomas.
Thromboprophylaxis after replacement arthroplasty.
Br Med J, 322 (2001), pp. 686-687
[13.]
J.A. Vallés, A. Vallano, F. Torres, J.M. Arnau, J.R. Laporte.
Multicentre hospital drug utilization study on the prophylaxis of venous thromboembolism. The Venous Thromboembolism Study Group of the Spanish Society of Clinical Pharmacology.
Br J Clin Pharmacol, 37 (1994), pp. 255-259
[14.]
M. Gross, D.R. Anderson, S. Nagpal, B. O'Brien.
Venous thromboembolism prophylaxis after total hip or knee arthroplasty: a survey of Canadian orthopedic surgeons.
Can J Surg, 42 (1999), pp. 457-461
[15.]
G. Wright, K. Elliott, C. Wilkie, R.J. Cuschieri, B. Bittiner, K.B. Hughes.
A prospective audit of hospital-acquired deep vein thrombosis and pulmonary embolism.
Int J Clin Pract, 53 (1999), pp. 497-504
[16.]
R. Collins, A. Scrimgeour, S. Yusuf, R. Peto.
Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. Overview of results of randomized trials in general, orthopedics and urologic surgery.
N Engl J Med, 318 (1988), pp. 1162-1173
[17.]
P.F. Leyvraz, F. Bachmann, Hoek, H.R. Buller, M. Postel, M.J. Samama, et al.
Prevention of deep vein thrombosis after hip replacement: randomised comparison between unfractioned heparin and low molecular weight heparin.
Br Med J, 303 (1991), pp. 543-548
[18.]
C.W. Colwell, T.E. Spiro, A.A. Trowbridge, B.A. Morris, H.C. Kwaan, J.D. Blaha, et al.
Use of enoxaparin, a low-molecular-weight heparin, and unfractionated heparin for the prevention of deep venous thrombosis after elective hip replacement. A clinical trial comparing efficacy and safety. Enoxaparin Clinical Trial Group.
J Bone Joint Surg Am, 76A (1994), pp. 3-14
[19.]
M. Drummond, M. Aristides, L. David, C. Forbes.
Economic evaluation of standard heparin and enoxaparin for prophylaxis against deep vein thrombosis in elective hip surgery.
Br J Surg, 81 (1994), pp. 1742-1746
[20.]
D. Warwick, J. Harrison, D. Glew, A. Mitchelmore, T.J. Peters, J. Donovan.
Comparison of the use of a foot pump with the use of low-molecular-weight heparin for the prevention of deep-vein thrombosis after total hip replacement: a prospective, randomized trial.
J Bone Joint Surg Am, 80A (1998), pp. 1158-1166
[21.]
J. Blanchard, J.Y. Meuwly, P.F. Leyvraz, M.J. Miron, H. Bounameaux, P. Hoffmeyer, et al.
Prevention of deep-vein thrombosis after total knee replacement. Randomized comparison between low-molecular-weight heparin (nadroparin) and mechanical prophylaxis with a food-pump system.
J Bone Joint Surg Br, 81B (1999), pp. 654-659
[22.]
M.M. Samama, A.T. Cohen, J.Y. Darmon, L. Desjardins, A. Eldor, C. Janbon, et al.
A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in Medical Patients with Enoxaparin Study Group.
N Engl J Med, 341 (1999), pp. 793-800
[23.]
The TIFDED Study Group.
Thromboprophylaxis in hip fracture surgery: a pilot study comparing danaparoid, enoxaparin and dalteparin.
Haemostasis, 29 (1999), pp. 310-317
[24.]
Pulmonary Embolism prevention (PEP) trial..
Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin.
Lancet, 355 (2000), pp. 1295-1302
[25.]
R.D. Hull, G.F. Pineo, C. Francis, D. Bergqvist, C. Fellenius, K. Soderberg, et al.
Low-molecular-weight heparin prophylaxis using dalteparin extended out-of-hospital vs in-hospital warfarin/out-of-hospital placebo in hip arthroplasty patients: a double-blind, randomized comparison. North American Fragmin Trial Investigators.
Arch Intern Med, 160 (2000), pp. 2208-2215
[26.]
Comité de Expertos de la OMS. Serie de Informes Té cnicos n.o 615 OMS.
Ginebra, (1977),
[27.]
C.M. Jiménez, J.A. Durán, J.A. Abadín, J.M. Cruz, A. Sánchez.
Profilaxis tromboembólica en infarto agudo de miocardio.
Rev Clin Esp, 201 (2001), pp. 61-64
[28.]
G.N. Fox, M.A. Lysney.
Use of deep venous thrombosis prophylaxis by family physicians.
J Am Board Fam Pract, 5 (1992), pp. 369-373
[29.]
D.P. Thomas.
Thromboprophylaxis-which treatment for which patient?.
J Bone Joint Surg Br, 82B (2000), pp. 1083-1084
[30.]
A.L. Greer.
Scientific knowledge and social consensus.
Controlled Clin Trial, 15 (1994), pp. 431-436
[31.]
E. Gil Garay.
Profilaxis de la enfermedad tromboembólica en la cirugía de cadera y rodilla.
Rev Ortop Traumatol, 2 (2001), pp. 137-143
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