Prevención mecánica de tromboembolismo

Medias con compresión gradual para prevenir tromboembolismo en el hospital. Graduated compression stockings to prevent venous thromboembolism in hospital: evidence from patients with acute stroke. Kearon C, O'Donnell M. Department of Medicine, McMaster University, Ontario, Canada.kearonc@mcmaster.ca Pol Arch Med Wewn. 2011 Jan-Feb;121(1-2):40-3. Abstract Pulmonary embolism is the most common preventable cause of death in hospital patients and prevention of venous thromboembolism (VTE) is cost-saving in high-risk patients. Low-dose anticoagulation is very effective at preventing VTE but increases bleeding. Graduated compression stockings and intermittent pneumatic compression devices are also used to prevent VTE and do not increase bleeding, which makes their use appealing in patients who cannot tolerate bleeding, such as patients with acute stroke. Studies that evaluated mechanical methods of preventing VTE were small and mainly used asymptomatic deep vein thrombosis (DVT), detected using screening tests, as the study outcome. The recently published CLOTS Trial 1 (Clots in Legs Or sTockings after Stroke) compared thigh-level compression stockings with no stockings in about 2500 patients with stroke and immobility, and found that thigh-level stockings were not effective. Indirectly, the findings of this study question the ability of stockings to prevent VTE in other patient groups, including those after surgery. CLOTS 1 compared thigh-level and below-knee stockings in about 3000 patients with acute stroke. Given that thigh-level stockings were ineffective in CLOTS 1, it is surprising that they were more effective than below-knee stockings in CLOTS Trial 2. A possible explanation is that below-knee stockings increase DVT, although this seems unlikely. CLOTS 1 and CLOTS 2 question whether graduated compression stockings prevent VTE and suggest the need for further trials evaluating their efficacy in medical and surgical patients. http://tip.org.pl/pamw/issue/article/516.html    Trombopropilaxis en prostatectomía radical retropúbica: eficacia y conformidad de los pacientes con una modalidad dual. Thromboprophylaxis in radical retropubic prostatectomy: efficacy and patient compliance of a dual modality. Cindolo L, Salzano L, Mirone V, Imbimbo C, Longo N, Kakkos SK, Reddy DJ. Urology Unit, G Rummo Hospital, Benevento, Italy. lucacindolo@virgilio.it Urol Int. 2009;83(1):12-8. Epub 2009 Jul 27. Abstract OBJECTIVES: The risk of developing venous thromboembolism (VTE) in urologic patients undergoing major surgery without thromboprophylaxis is high (up to 40%). The aims were to study the acceptability rate of and overall patient satisfaction with an automatic sequential leg compression system and the short-term effectiveness of a combined VTE prevention modality. METHODS: One-hundred and eighty-four consecutive patients undergoing radical retropubic prostatectomy were postoperatively treated with enoxaparine and intermittent pneumatic compression of the thigh. By completing a questionnaire, the patients were prospectively studied to evaluate the comfort and tolerability of a compression device (SCD Response Compression System; Covidien, Gosport, UK). The patients were monitored for complications and development of VTE for up to 4 weeks postoperatively. The device used ensures customized and effective compression therapy matching the patient's individual vascular refill by sequential, gradient, circumferential microprocessor-controlled compression cycles. RESULTS: No clinically evident VTE, critical bleeding or postoperative death occurred during the study period. Drain output was associated with transfusion requirement (p < 0.001), obesity (p < 0.02) and longer operation duration (p < 0.001). The sequential compression devices were well tolerated by 63% of the patients, in that the sleeves were judged as being pleasant (72%) and nonoppressive (79%). Patients reported bothersome insomnia (23%) and noise (44%), and early removal was required in 3%. CONCLUSIONS: Combined mechanical and pharmacological thromboprophylaxis was highly effective, well tolerated, and safe. The device tested showed a high comfort and tolerability profile. The use of combined modalities for VTE prophylaxis is justified in patients at very high risk of VTE, such as those undergoing radical retropubic prostatectomy. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2790802/pdf/uin0083-0012.pdf

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