Randomized Trial of Deep Vein Thrombosis Chemoprophylaxis with Bemiparin and Enoxaparin in Patients with Moderate to High Thrombogenic Risk Undergoing Plastic and Reconstructive Surgery Procedures.

BACKGROUND: Deep vein thrombosis (DVT) is a common complication during postoperative convalescence characterized by hypercoagulability, vascular endothelium damage and blood stasis. It increases noticeably in peri/postoperative phases of surgery procedures. Pulmonary embolism secondary to iliofemoral DVT is a frequent cause of death. METHODS: Adult patients scheduled for plastic and reconstructive surgery (PRSx) with moderate to high thrombogenic risk were selected. We evaluated the efficacy and safety of bemiparin compared to enoxaparin as chemoprophylaxis for DVT. Following balanced general anesthesia techniques, patients were randomly assigned for subcutaneous enoxaparin 40 IU (Group-E) or bemiparin 3500 IU (Group-B) q24h starting 6 h after procedure conclusion for at least 10 days. All patients were evaluated for DVT through Doppler ultrasound mapping of the lower limbs. RESULTS: Seventy-eight patients were evaluated, mostly women (83%), physical status ASA II (59%), ASA III (10%); Caprini's thrombogenic risk score 3-4 (moderate) 58%, 5-6 (high) 29%, > 6 (too high) 13%; demographics, clinical variables and scores were similar between groups. Median drainage time in breast surgery was 4 days in both groups (p = 0.238). In the case of abdominal surgery, median was 14 days in Group-E versus 13 days in Group-B (p = 0.059). No DVT was detected in either group. CONCLUSIONS: DVT was prevented with bemiparin, without significant bleeding increase nor adverse events; moreover, the cost of bemiparin is lower than enoxaparin. Bemiparin can be considered as alternative drug for DVT chemoprophylaxis in PRSx procedures. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

"Propranolol versus nifedipina para el control transanéstesico del paciente hipertenso": estudio comparativo / \"Propranolol versus nifedipine for the intranesthetic control of the hypertensive patient\": comparative study

Se llevó a cabo un estudio comparativo entre propranolol y nifedipina en un grupo de 60 pacientes con historia de hipertensión arterial esencial moderada programados para cirugía electiva. La edad estuvo entre 47 y 68 años, clasificación de ASAII-III y el peso estuvo entre 51 a 87 Kg. Se consideraron estudios previos como espinometría, electrocardiograma, biometría hemática, gases en sangre arterial, química sanguínea, examen general de orina pruebas de coagulación, presión arterial y patología agregada. Un grupo recibió un beta bloqueador: Propanolol 40 mg. por vía oral y el otro grupo recibió bloqueadores de canales de calcio: nifedipina 10 mg por vía sublingual, antes de la inducción anestésica. La cirugía se llevó a cabo con anestesia analgésica balanceada. Se registraron frecuencia cardiaca, presión arterial media y tensión arterial sistólica y diastólica. Tanto propanolol como nifedipina no mostraron cambios significativos en la frecuencia cardiaca (p>0.05). Ambos fármacos produjeron cambios significativos en la presión arterial durante el periodo trananestésico o (p<0.05), sin embargo en el periodo postanestésico se observó un efecto hipotensor sostenido de nifedipina (p<0.05). Se concluye que la nifedipina mantuvo estabilización en el descenso tensional durante los diferentes periodos de la anestesia mayor que el propanolol