Morbi-mortalidad de la enfermedad tromboembólica venosa en el Hospital Universitario "Arnaldo Milián Castro" / Morbi-mortality of venous thromboembolic disease at "Arnaldo Milián Castro" University Hospital

Introducción: La enfermedad tromboembólica venosa es un proceso grave y mortal, considerado un problema de salud a escala mundial. Objetivo: Caracterizar la morbi-mortalidad por enfermedad tromboembólica venosa en el Hospital Universitario "Arnaldo Milián Castro". Métodos: Se realizó un estudio descriptivo retrospectivo de corte transversal a una muestra de 290 casos atendidos en el Hospital Universitario "Arnaldo Milián Castro" de Villa Clara, entre febrero de 2014 y febrero de 2016. Las variables fueron: edad, sexo, factores de riesgo, forma de presentación de la enfermedad y tipo de diagnóstico. Resultados: Se observó un predominio del sexo femenino y de los pacientes mayores de 70 años, independientemente del sexo y la inmovilidad como factor de riesgo. La trombosis venosa profunda del sector íleo-femoral fue la forma de presentación más común. El diagnóstico clínico primó, aunque el tromboembolismo pulmonar, como la complicación principal, se diagnosticó por necropsia. La mayor cantidad de trombosis venosa profunda se registró en el Servicio de Angiología, mientras que las muertes por embolia pulmonar predominaron en el Servicio de Terapia Intensiva. El tratamiento médico más utilizado fue la heparina sódica más warfarina; el profiláctico se realizó solo en el 24,7 por ciento de los casos. La heparina sódica se utilizó más en los servicios de Terapia Intensiva. Conclusiones: La enfermedad tromboembólica venosa fue la principal causa de muerte prevenible en el hospital, lo que sugiere que la profilaxis antitrombótica debe resultar una práctica esencial en los pacientes hospitalizados(AU)

Introduction: Venous thromboembolic disease is a serious and fatal process considered a health problem on a global scale. Objective: Characterize morbidity and mortality due to venous thromboembolic disease at "Arnaldo Milián Castro" University Hospital. Methods: A retrospective descriptive cross-sectional study was conducted on a sample of 290 cases treated at "Arnaldo Milián Castro" University Hospital in Villa Clara between February 2014 and February 2016. The variables were: age, sex, risk factors, form of presentation of the disease and type of diagnosis. Results: A predominance of the female sex and patients over 70 years of age was observed, regardless of sex and immobility as risk factors. Deep vein thrombosis of the ileus-femoral sector was the most common form of presentation. Clinical diagnosis prevailed, although pulmonary thromboembolism, as the main complication, was diagnosed by necropsy. The highest amount of deep vein thrombosis was recorded in the Angiology Service, while deaths from pulmonary embolism predominated in the Intensive Care Service. The most commonly used medical treatment was sodium heparin plus warfarin; prophylaxis was performed only in 24.7 percent of cases. Sodium heparin was more used in Intensive Care services. Conclusions: Venous thromboembolic disease was the leading cause of preventable death in the hospital, suggesting that antithrombotic prophylaxis should be an essential practice in hospitalized patients.

Fatores de risco para embolia pulmonar em pacientes com COVID-19 anticoagulados na unidade de terapia intensiva submetidos à angiografia por tomografia computadorizada / Pulmonary embolism risk factors for intensive care unit anticoagulated COVID-19 patients undergoing computed tomography angiography

RESUMO Objetivo: Avaliar a incidência de embolia pulmonar, seu relacionamento com os níveis de dímero D e outros possíveis fatores associados, além dos efeitos adversos da anticoagulação e meios de contraste. Métodos: Conduziu-se um estudo de coorte retrospectiva em um hospital público chileno. Foram incluídos os pacientes com idade acima de 18 anos com COVID-19, mecanicamente ventilados na unidade de terapia intensiva, admitidos entre março e junho de 2020. Todos os pacientes receberam tromboprofilaxia com heparina, que foi aumentada até uma dose de anticoagulação com níveis de dímero D acima de 3µg/mL. Resultados: Foram acompanhados 127 pacientes, dos quais 73 foram submetidos à angiografia por tomografia computadorizada (média de idade de 54 ± 12 anos; 49 homens). Sessenta e dois dos 73 pacientes (84,9%) receberam anticoagulação total antes da angiografia por tomografia computadorizada. Além disso, 18 dos 73 pacientes tiveram embolia pulmonar (24,7%). Na comparação entre pacientes com e sem embolia pulmonar, não se observaram diferenças significantes em termos de idade, sexo, obesidade, tabagismo, escores de Wells e Genebra revisado, dímero D ou mortalidade. O uso de anticoagulantes foi similar em ambos os grupos. O número de dias desde o início da anticoagulação até a angiografia por tomografia computadorizada foi significantemente menor no grupo com embolia pulmonar (p = 0,002). Três pacientes tiveram lesão renal aguda após o contraste (4,1%), e um paciente teve sangramento importante. Conclusão: Apesar da anticoagulação, um em cada quatro pacientes com COVID-19 submetidos à ventilação mecânica e avaliados com angiografia por tomografia computadorizada apresentou embolia pulmonar. Com uma maior demora para realização da angiografia por tomografia computadorizada após início de anticoagulação empírica, identificou-se um número significantemente menor de embolias

Abstract Objective: To assess pulmonary embolism incidence, its relationship with D-dimer levels and other possible associated factors in addition to anticoagulation and contrast medium adverse effects. Methods: A retrospective observational cohort study at a Chilean public hospital was performed. Intensive care unit mechanically ventilated COVID-19 patients older than 18 years old between March and June 2020 were included. All patients received heparin thromboprophylaxis, which was increased to the anticoagulation dose with D-dimer greater than 3µg/mL. Results: A total of 127 patients were followed up, of whom 73 underwent pulmonary computed tomography angiography (mean age, 54 ± 12 years; 49 men). Sixty-two of the 73 patients (84.9%) received full anticoagulation before computed tomography angiography. In addition, 18 of the 73 patients had pulmonary embolism (24.7%). When comparing patients with and without pulmonary embolism, no significant differences were observed in age, sex, obesity, smoking, Wells and revised Geneva scores, D-dimer or mortality. Anticoagulant use was similar in both groups. Days from the start of anticoagulation until computed tomography angiography were significantly lower in the pulmonary embolism group (p = 0.002). Three patients presented post contrast-acute kidney injury (4.1%), and one patient had major bleeding. Conclusion: Despite anticoagulation, one in four COVID-19 patients connected to mechanical ventilation and evaluated with pulmonary computed tomography angiography had pulmonary embolism. With a longer the delay in performing computed tomography angiography once empirical anticoagulation was started, significantly less pulmonary embolism was identified.

Monoclonal gammopathy of undetermined significance clinic during the coronavirus disease-19 pandemic: caring for the vulnerable in an academic medical center

Background: Patients with monoclonal gammopathy of undetermined significance (MGUS) have clinical features including older age, presence of medical comorbidities, susceptibility to infections, and thrombotic tendencies which are relevant when assessing their risk during the coronavirus disease (COVID-19) pandemic. Objective: To study the vulnerability of patients with MGUS during the COVID-19 pandemic, we assessed the local management of MGUS patients and their clinical outcomes. Methods: Retrospective chart reviews were performed for all patients with MGUS seen at a university medical center clinic (2014-2020). Results: A total of 228 MGUS patients were included; 211 patients are alive, 7 patients died before the pandemic, and 10 patients died since the pandemic declaration. The mean age and the overall survival (OS) of the patients who died before versus during the pandemic were 83.0 versus 75.2 years, p = 0.4, and OS 40.6 versus 53.2 months, p = 0.3, respectively. One patient died of COVID-19. Nine patients had venous thromboembolisms (VTE), all of which occurred before the pandemic onset. Conclusions: There were no significant differences found in the mean age or OS of the MGUS patients who died before versus after the pandemic onset. An increase in VTE rates was not seen. Study results are limited by small patient numbers.

Implementação de protocolo para profilaxia de tromboembolismo venoso: um estudo antes e depois em pacientes clínicos e cirúrgicos / Protocol implementation for venous thromboembolism prophylaxis: a before-and-after study in medical and surgical patients

RESUMO Objetivo Este estudo visou avaliar a adequação da prescrição de profilaxia de tromboembolismo venoso (TEV) após a implementação do protocolo. Métodos Trata-se de um estudo antes e depois realizado em um hospital de cuidados terciários no Rio Grande do Sul, Brasil. Pacientes clínicos e cirúrgicos internados, com 18 anos ou mais, foram avaliados para o risco de TEV e, posteriormente, para adequação da tromboprofilaxia, de acordo com o risco. As avaliações ocorreram antes e depois de uma estratégia de implementação de protocolo, que consistiu em uma plataforma on-line para acessar o protocolo, uma postagem pública do diagrama do protocolo, alertas clínicos na sala de convívio médico, alertas de e-mail e alertas pop-up no sistema informatizado de prescrição médica. O Desfecho principal foi a adequação da prescrição de profilaxia do TEV de acordo com o protocolo. Resultados Foram avaliados 429 pacientes para adequação da tromboprofilaxia (213 antes e 216 depois). A prevalência de adequação aumentou de 54% para 63% (pré e pós-intervenção, respectivamente) e após o ajuste por tipo de paciente e fase do estudo, a razão de prevalência atingiu (RP) = 1,20, intervalo de confiança de 95% (IC) 1,02-1,42. Conclusões os resultados mostraram que a adequação geral da prescrição de tromboprofilaxia foi discretamente melhorada. Apesar desses resultados, este estudo fornece evidências, até o momento, de uma série de estratégias para implementar o protocolo em instituições privadas em países de renda média com uma equipe médica aberta, pois há poucas pesquisas investigando esse tipo de intervenção simples e pragmática.

ABSTRACT Objective This study aimed to assess the adequacy of venous thromboembolism (VTE) prophylaxis prescription after a protocol implementation. Methods This was a before-and-after study conducted in a tertiary care hospital in Rio Grande do Sul, Southern Brazil. Medical and surgical inpatients aged 18 years or older were assessed for VTE risk and subsequently for thromboprophylaxis adequacy, according to their risk. The evaluations occurred before and after the protocol strategy implementation; it consisted of an online platform to access the protocol, a public posting of the protocol diagram, clinical alerts on the medical staff TV, e-mail alerts, and pop-up alerts on the computerized physician order entry system. The main outcome measure was the adequacy of VTE prophylaxis prescription according to the protocol. Results A total of 429 patients were evaluated for thromboprophylaxis adequacy (213 before and 216 after). The prevalence of adequacy increased from 54% to 63% (pre and post-intervention, respectively), and after adjustment for patient type and phase of the study, the prevalence ratio reached (PR)=1.20, 95% confidence interval (CI) 1.02-1.42. Conclusion The results showed that the overall appropriateness of thromboprophylaxis prescription was weakly improved. Despite these results, this study provides evidence to date a bunch of strategies for protocol implementations in private institutions in middle-income countries with an open medical staff, as there are few studies investigating these simple and pragmatic interventions.

Venous thromboembolism and route of delivery - review of the literature / Tromboembolismo venoso e via de parto - revisão da literatura

Abstract Venous thromboembolism events are important causes of maternal death during pregnancyandthepostpartumperiodworldwide.Are view of the literature with the objective of evaluating venous thromboembolism events in the puerperium according to the route of delivery was performed through a bibliographic survey in the Medline, LILACS and Scielo databases. We observed that patients submitted to cesarean sections present a significantlyhigher riskofdeveloping venousthromboembolismwhencomparedwiththose who undergo spontaneous vaginal delivery. The pathophysiological bases for this difference were explored and described in this review, as well as the indications of prophylaxis and treatment. Doctors and health professionals must be continuously vigilant regarding this condition, since it is associated with high morbidity and mortality.

Resumo Os eventos de tromboembolismo venoso são causas importantes de morte materna durante a gravidez e o período do pós-parto em todo o mundo. Foi realizada uma revisão da literatura com o objetivo de avaliar os eventos de tromboembolismo venoso no puerpério de acordo com a via de parto utilizada, por meio de uma pesquisa bibliográfica nas bases de dados Medline, LILACS e Scielo. Observou-se que as pacientes submetidas a cesariana apresentam um risco significativamente maior de desenvolver tromboembolismo venoso do que aquelas que se submetem a parto vaginal espontâneo. As bases fisiopatológicas desta diferença foram exploradas e descritas nesta revisão, bem como as indicações de profilaxia e tratamento. O alerta contínuo dos médicos e profissionais de saúde é necessário, uma vez que se trata de uma condição comum associada a alta morbidade e mortalidade.

Incidencia de tromboembolismo venoso en cirugía ortognática / Incidence of venous thromboembolism in orthognathic surgery

Introducción: El tromboembolismo venoso (TEV) es una causa importante de morbimortalidad en la población hospitalaria y quirúrgica. Esta entidad tiene mecanismos fisiopatológicos bien definidos y descritos, además, de factores de riesgo que permiten una clasificación de los pacientes según diversos modelos de valoración, los cuales permiten adoptar medidas profilácticas. En el ámbito de la cirugía maxilofacial se han descrito bajos niveles de incidencia. Sin embargo, hay evidencia bastante limitada y representa un problema de salud al cual se le ha prestado poca atención en la literatura. Objetivo: El presente estudio tiene como objetivo conocer la incidencia de tromboembolismo venoso en pacientes sometidos a cirugía ortognática. Material y Método: Se evaluaron en forma retrospectiva fichas clínicas de 86 pacientes operados de cirugía ortognática entre octubre de 2006 y enero de 2016 en el Hospital Clínico de la Pontificia Universidad Católica de Chile. Se identificaron 2 casos de tromboembolismo pulmonar, lo cual corresponde a una incidencia de 2,6%. Sin embargo, no se obtuvo un espacio muestral suficiente para lograr identificar factores de riesgo específicos en esta población. Conclusiones: A pesar de la baja incidencia de TEV en pacientes sometidos a cirugía maxilofacial, es fundamental considerar el riesgo individual del paciente y el riesgo que implica la cirugía. La prolongación del tiempo quirúrgico, la estadía hospitalaria y la inmovilización prolongada pueden determinar un riesgo mayor de desarrollar este tipo de complicación, por lo tanto, es necesario considerarla y saber prevenirla de manera adecuada.

Introduction: Venous thromboembolism (VTE) is an important cause of morbidity and mortality in surgical patients. This entity has well defined and described pathophysiological mechanisms, in addition to risk factors that allow a classification of patients according to different assessment models, which allow to adopt prophylactic measures. In maxillofacial surgery, low levels of incidence have been described. However, there is quite limited evidence and represents a health problem that has received little attention in the literature. Objective: To determine the incidence of venous thromboembolism in patients undergoing orthognathic surgery. Material and Method: Retrospectively, 86 patients who underwent orthognathic surgery was evaluated between October 2006 and January 2016 at the Hospital Clínico de la Pontificia Universidad Católica de Chile. Two cases of pulmonary thromboembolism were identified, which corresponds to an incidence of 2.6%. Despite the low incidence of VTE in patients undergoing maxillofacial surgery, it is essential to consider the individual risk of the patient and the risk involved in surgery. The prolongation of surgical time, the hospital stay and prolonged immobilization can determine a greater risk of developing this type of complication, therefore it is necessary to consider it and know how to prevent it in an adequate way.

Prévention de la maladie thrombo-embolique et veineuse. Connaissances et attitudes pratiques du personnel soignant des services de gynécologie-obstétrique des centres hospitaliers universitaires de Côte d'Ivoire

Introduction : L'étude épidémiologique transversale ENDORSE montrait une forte prévalence 52% des patients hospitalisés présentant un risque de MTEV dans le monde dont 64% de patients en chirurgie. Ce risque est encore plus élevé pendant la période obstétricale. Objectif : Evaluer les connaissances et attitudes pratiques sur la prévention de la maladie thrombo-embolique du personnel des services de gynécologie-obstétriques de Côte d'Ivoire. Méthodes : Etude multicentrique, mixte, transversale descriptive avec 198 questionnaires anonymes correctement remplis retenus soit 61,9% et un taux de non-réponses élevé de 19% dans les CHU de Côte d'Ivoire destinés au Personnel soignant des structures concernées ayant donné leur consentement libre et éclairé sur une période de 4 mois allant du 1er avril au 31 juillet 2016. La collecte et le traitement des données a été réalisée grâce aux logiciels Epidata et Epi Info 7.Résultats : L'âge moyen était de 39,3 ans avec des extrêmes de 27 et 60 ans et 58,6% du personnel avait moins de 5 années d'activités dans le service. Il s'agissait en majorité des sages-femmes (60,1%) suivi du personnel médical (39,9%). Soixante et onze virgule quatre pour cent (71,4%) jugeaient leur niveau de connaissances suffisant. Les facteurs de risques les plus cités par le personnel médical et paramédical étaient l'immobilisation prolongée (92,4% et 82,4%) suivie de la chirurgie pelvienne (89,9% et 64,7%) et de la contraception orale (86,1% et 51,3%). Trente-huit pour cent des médecins instauraient une héparinothérapie après un accouchement par voie basse contre 95% pour un accouchement par césarienne. Quatre-vingt-six virgule sept pour cent (86,7%) des médecins débutaient l'héparinothérapie préventive entre 12 et 24 heures du post-partum quel que soit le mode d'accouchement, pendant au moins 3 semaines pour 78% d'entre eux.Conclusion : Cette étude montre une connaissance et des attitudes pratiques approximatives d'où la nécessité d'une formation continue du personnel et l'éducation des patients afin d'assurer l'amélioration continue de la qualité des soins

A incidência regional do tromboembolismo venoso no Brasil / Regional incidence of venous thromboembolism in Brazil

Contexto: Vários estudos realizados em climas temperados sugerem que há uma variação na incidência de tromboembolismo venoso (TEV) de acordo com as estações climáticas. Entretanto, nenhum estudo foi feito comparando áreas de clima semiárido com áreas de clima temperado. Objetivos: Analisar se existe correlação entre a incidência do TEV em áreas de clima semiárido e de clima temperado no Brasil. Métodos: Foi feito um levantamento de dados retrospectivos de pacientes com diagnóstico de TEV no Sistema Único de Saúde de janeiro de 2011 a dezembro de 2014 provenientes dos seguintes estados com clima semiáridos: Alagoas, Ceará, Maranhão, Paraíba, Pernambuco, Piauí e Rio Grande do Norte, localizados na Região Nordeste do Brasil; e dos seguintes estados com clima temperado: Paraná, Santa Catarina e Rio Grande do Sul, localizados na Região Sul do Brasil. Os dados de variação climática foram obtidos do Instituto Nacional de Meteorologia e os dados populacionais do Instituto Brasileiro de Geografia e Estatística. Resultados: Houve correlação significativa na incidência de casos de TEV em regiões de temperaturas mais baixas (p < 0,001). A Região Sul apresentou temperaturas significativamente menores que as da Região Nordeste (p < 0,001) e apresentou número significativamente maior de casos de TEV do que a Região Nordeste (p < 0,001). Conclusão: Há mais casos de TEV em regiões de clima temperado, onde as temperaturas são mais baixas. No entanto, pouco ainda é conhecido na literatura sobre a flutuação sazonal e a incidência de TEV. Sendo assim, mais estudos são necessários nessa área

Background: Several studies conducted in areas with temperate climates have suggested that the incidence of venous thromboembolism (VTE) varies depending on seasonal climatic fluctuations. However, no studies have been conducted comparing areas with semi-arid climate with areas with temperate climates. Objectives: To analyze whether there is a correlation between the incidence of VTE in areas with semi-arid climates and areas with temperate climates in Brazil. Methods: Retrospective data were acquired for patients diagnosed with VTE from January 2011 to December 2014 from the Brazilian National Health Service for the following Brazilian states that have semi-arid climates: Alagoas, Ceará, Maranhão, Paraíba, Pernambuco, Piauí, and Rio Grande do Norte (all located in the Northeast Region of Brazil); and the following states with temperate climates: Paraná, Santa Catarina, and Rio Grande do Sul (all located in the South Region of Brazil). Data on climatic variation were obtained from the National Meteorological Institute and population data were obtained from the Brazilian Institute of Geography and Statistics. Results: There was a significant correlation in the incidence of VTE cases in areas with lower temperatures (p < 0.001). The South Region exhibited significantly lower temperatures than the Northeast Region (p < 0.001) and had a significantly higher number of cases of VTE than the Northeast Region (p < 0.001). Conclusions: There are more cases of VTE in areas with temperate climates, where temperatures are lower. However, there is still little information in the literature on seasonal fluctuations and incidence of VTE. More studies of this subject are needed

Venous thromboembolism in Latin America: a review and guide to diagnosis and treatment for primary care

There are various region-specific challenges to the diagnosis and effective treatment of venous thromboembolism in Latin America. Clear guidance for physicians and patient education could improve adherence to existing guidelines. This review examines available information on the burden of pulmonary embolism and deep vein thrombosis in Latin America and the regional issues surrounding the diagnosis and treatment of pulmonary embolism and deep vein thrombosis. Potential barriers to appropriate care, as well as treatment options and limitations on their use, are discussed. Finally, an algorithmic approach to the diagnosis and treatment of venous thromboembolism in ambulatory patients is proposed and care pathways for patients with pulmonary embolism and deep vein thrombosis are outlined for primary care providers in Latin America.

Tromboprofilaxis farmacológica en pacientes oncológicos quirúrgicos en el Hospital Clínico de la Universidad de Chile / Pharmacological thromboprophylaxis in surgical oncology patients in Hospital Clínico Universidad de Chile

The aim of this study is to evaluate the use of thromboprophylaxis in surgical oncology patients in HCUCH in 2011. Method: Retrospective analysis of patients with cancer undergoing surgery in 2011. Was defined as adequate pharmacological thromboprophylaxis the correct dose, mechanical prophylaxis in case of drug contraindications and beginning on day 0 or 1. Results: 131 medical records were reviewed. Main neoplasms were colorectal (21.3 percent), prostate (12.9 percent), gallbladder (8.3 percent) and stomach (6.9 percent). Of the patients requiring pharmacologic thromboprophylaxis (n = 110) were rated as adequate 52 patients (47 percent), 47 inadequate (43 percent) and 11 absent (10 percent). The causes of inappropriate use of pharmacological thromboprophylaxis included 27 late onset (58 percent), 10 lower doses (21 percent), 3 late onset associated with lower dose (6 percent), 6 incomplete thromboprophylaxis (13 percent) and 1 dose increased (2 percent). Factors significantly associated with pharmacological thromboprophylaxis absent were: <40 years of age (p = 0.002), head and neck cancer (p < 0.001), and hospital stay <7 days (p < 0.001). Conclusions: The absence of pharmacological thromboprophylaxis is associated with lower absolute risk factors for VTE: Age less than 40 years old, head and neck cancer, hospital stay less than 7 days...

Non-pharmacological Prophylaxis of Venous Thromboembolism in Acutely Ill Medical Patients.

Venous thromboembolism (VTE) represents one of the leading causes of mortality and morbidity in acutely ill medical patients. VTE prophylaxis can be assured by pharmacological strategies and, when contraindicated, by non pharmacological measures, such as early mobilization, graduated compression stockings (GCS), intermittent pneumatic compression (IPC) or inferior vena caval filters. Literature evidence on non pharmacological VTE prophylaxis lacks and guidelines are not standardized for hospitalized ill medical patients. Much recently randomized clinical trials in patients with stroke and other medical diseases, seem to increase doubts and reduce certainties in this context. In this review we provide information about non pharmacological thromboprophylaxis in acutely hospitalized ill medical patients.

Does thromboprophylaxis prevent venous thromboembolism after major orthopedic surgery? / A tromboprofilaxia evita o tromboembolismo venoso após cirurgia ortopédica de grande porte?

OBJECTIVE: Pulmonary embolism (PE) is an important complication of major orthopedic surgery. The aim of this study was to evaluate the incidence of venous thromboembolism (VTE) and factors influencing the development of VTE in patients undergoing major orthopedic surgery in a university hospital. METHODS: Patients who underwent major orthopedic surgery (hip arthroplasty, knee arthroplasty, or femur fracture repair) between February of 2006 and June of 2012 were retrospectively included in the study. The incidences of PE and deep vein thrombosis (DVT) were evaluated, as were the factors influencing their development, such as type of operation, age, and comorbidities. RESULTS: We reviewed the medical records of 1,306 patients. The proportions of knee arthroplasty, hip arthroplasty, and femur fracture repair were 63.4%, 29.9%, and 6.7%, respectively. The cumulative incidence of PE and DVT in patients undergoing major orthopedic surgery was 1.99% and 2.22%, respectively. Most of the patients presented with PE and DVT (61.5% and 72.4%, respectively) within the first 72 h after surgery. Patients undergoing femur fracture repair, those aged ≥ 65 years, and bedridden patients were at a higher risk for developing VTE. CONCLUSIONS: Our results show that VTE was a significant complication of major orthopedic surgery, despite the use of thromboprophylaxis. Clinicians should be aware of VTE, especially during the perioperative period and in bedridden, elderly patients (≥ 65 years of age). .

OBJETIVO: A embolia pulmonar (EP) é uma complicação importante de cirurgia ortopédica de grande porte. Este estudo visou avaliar a incidência de tromboembolismo venoso (TEV) e os fatores que influenciam o desenvolvimento de TEV em pacientes submetidos a cirurgia ortopédica de grande porte em um hospital universitário. MÉTODOS: Pacientes submetidos a cirurgia ortopédica de grande porte (artroplastia de quadril, artroplastia do joelho ou reparação de fratura de fêmur) entre fevereiro de 2006 e junho de 2012 foram incluídos retrospectivamente no estudo. As incidências de EP e de trombose venosa profunda (TVP) foram avaliadas, assim como os fatores que influenciaram sua ocorrência, tais como o tipo de cirurgia, idade e comorbidades. RESULTADOS: Foram revisados os prontuários médicos de 1.306 pacientes. As proporções de artroplastia do joelho, artroplastia de quadril e reparação de fratura de fêmur foram, respectivamente, de 63,4%, 29,9% e 6,7%. A incidência cumulativa de EP e TVP nos pacientes submetidos a cirurgia ortopédica de grande porte foi, respectivamente, de 1,99% e 2,22%. A maioria dos pacientes apresentou EP e TVP (61,5% e 72,4 %, respectivamente) nas primeiras 72 h após a cirurgia. Pacientes submetidos à reparação de fratura de fêmur, aqueles com idade ≥ 65 anos, e pacientes acamados tinham um risco maior de desenvolver TVP. CONCLUSÕES: Nossos resultados demonstram que o TEV foi uma complicação importante de cirurgia ortopédica de grande porte, apesar da utilização de tromboprofilaxia. Os médicos clínicos devem estar alerta para a ocorrência ...

Prevalence of venous thrombo-embolism in acute exacerbations of chronic obstructive pulmonary disease

Objectives: To determine the prevalence of venous thrombo-embolism in patients with acute exacerbations of COPD

Subjects and methods: This was a cross-sectional study involving 105 patients hospitalized with exacerbations of COPD. Clinical and hematological parameters on admission were collected. Multislice computed tomographic pulmonary angiography [CTPA] and ultrasonographic examination of lower limbs, for pulmonary embolism and deep vein thrombosis respectively were done. Wells and Geneva scores were calculated

Results: This study was conducted on 105 COPD patients with acute exacerbations. All of them were males with mean age 49.3 + 8.43. Pulmonary embolism was found in 28.6% of COPD patients who were definitely diagnosed by CTPA while DVT was found in 26.7% of positive cases of pulmonary embolism detected by venous duplex. Wells and Geneva scores were calculated, high probability Wells score was found in 83.3% while Geneva score was likely in 90% of COPD patients proved to have pulmonary embolism. D-dimer and CBC were done; D-dimer was found negative in 90.0% in patients proven not to have pulmonary embolism while was positive in 100% of the diagnosed patients. Regarding CBC; polcythemia was found in 73.3% of diagnosed cases

Conclusion: VTE appeared to be a common problem in COPD patients with exacerbations. The role of CTPA is the cornerstone in the diagnosis of pulmonary embolism. DVT of lower limbs was not essential in all cases of proven pulmonary embolism. Serum D-dimer, Wells criteria and Geneva score are useful bedside criteria that may help to assess the occurrence of VTE in such patients