La TVP y la TEP son entidades de muy alto riesgo en algunos procedimientos quirúrgicos. Los pacientes que viajan más de 6 horas en avión, en especial si tienen factores de riesgo, pueden ser candidatos para desarrollar esta temida complicación. Este creciente grupo de pacientes-viajeros requiere de una vigilancia especial antes, durante y después de cirugía.
Deep vein thrombosis and pulmonary embolism are high-risk conditions in some surgeries. People who travel by plane more than 6 hours, especially if they have risk factors, may be able to develop this feared complication. This growing group of patients-travelers requiring special vigilance before, during, and after surgery.
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| Trombosis relacionada a los viajes. ¿Es un problema? |
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| Meta-análisis: viajes y riesgo de tromboembolismo |
Meta-analysis: travel and risk for venous thromboembolism.
Chandra D, Parisini E, Mozaffarian D.
Harvard School of Public Health, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts 02115, USA.
Ann Intern Med. 2009 Aug 4;151(3):180-90. Epub 2009 Jul 6.
BACKGROUND:
Abstract. The potential risk for travel-related venous thromboembolism (VTE) has become an important public health concern because of rapid increases in long-distance travel; however, previous studies on this relationship are surprisingly contradictory. PURPOSE: To estimate the risk for VTE in travelers, determine whether a dose-response relationship exists, and identify reasons for the contradictory results of previous studies. DATA SOURCES: MEDLINE, EMBASE, BIOSIS, CINAHL, grey-literature sources, contact with investigators, and reference lists of studies, without language restrictions. STUDY SELECTION: Reports were selected if they investigated the association between travel and VTE for persons who used any mode of transportation and if nontraveling persons were included for comparison. DATA EXTRACTION: Data on study and patient characteristics, risk estimates, and quality were independently extracted by 2 investigators. Pooled effect estimates were obtained by using random-effect meta-analysis. DATA SYNTHESIS: Of 1560 identified abstracts, 14 studies (11 case-control, 2 cohort, and 1 case-crossover) met inclusion criteria, including 4055 cases of VTE. Compared with nontravelers, the overall pooled relative risk for VTE in travelers was 2.0 (95% CI, 1.5 to 2.7). Significant heterogeneity was present because of the method for selecting control participants (P = 0.008): whether the studies used control participants who had been referred for VTE evaluation or nonreferred control participants. When the studies that used referred control participants were excluded, the pooled relative risk for VTE in travelers was 2.8 (CI, 2.2 to 3.7), without significant heterogeneity. A dose-response relationship was identified, with an 18% higher risk for VTE for each 2-hour increase in duration of travel by any mode (P = 0.010) and a 26% higher risk for every 2 hours of air travel (P = 0.005). LIMITATION: All available studies were from Western countries; generalizability to non-Western populations is expected but needs confirmation. CONCLUSION: Travel is associated with a nearly 3-fold higher risk for VTE, with a dose-response relationship of 18% higher risk for each 2-hour increase in travel duration. Heterogeneity in results of previous studies was due to selection bias toward the null from use of referred control participants.
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| Viajes aéreos y tromboembolismo venoso: una revisión sistemática |
Air travel and venous thromboembolism: a systematic review.
Philbrick JT, Shumate R, Siadaty MS, Becker DM.
Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA.
J Gen Intern Med. 2007 Jan;22(1):107-14.
Abstract
CONTEXT: Despite multiple attempts to document and quantify the danger of venous thromboembolism (VTE) following prolonged travel, there is still uncertainty about the magnitude of risk and what can be done to lower it. OBJECTIVES: To review the methodologic strength of the literature, estimate the risk of travel-related VTE, evaluate the efficacy of preventive treatments, and develop evidence-based recommendations for practice. DATA SOURCES: Studies identified from MEDLINE from 1966 through December 2005, supplemented by a review of the Cochrane Central Registry of Controlled Trials, the Database of Abstracts of Reviews of Effects, and relevant bibliographies. STUDY SELECTION: We included all clinical studies that either reported primary data concerning travel as a risk factor for VTE or tested preventive measures for travel-related VTE. DATA EXTRACTION AND ANALYSIS: Two reviewers reviewed each study independently to assess inclusion criteria, classify research design, and rate methodologic features. The effect of methodologic differences, VTE risk, and travel duration on VTE rate was evaluated using a logistic regression model. DATA SYNTHESIS: Twenty-four published reports, totaling 25 studies, met inclusion criteria (6 case-control studies, 10 cohort studies, and 9 randomized controlled trials). Method of screening for VTE [screening ultrasound compared to usual clinical care, odds ratio (OR) 390], outcome measure [all VTE compared to pulmonary embolism (PE) only, OR 21], duration of travel (<6 hours compared to 6-8 hours, OR 0.011), and clinical risk ("higher" risk travelers compared to "lower," OR 3.6) were significantly related to VTE rate. Clinical VTE after prolonged travel is rare [27 PE per million flights diagnosed through usual clinical care, 0.05% symptomatic deep venous thrombosis (DVT) diagnosed through screening ultrasounds], but asymptomatic thrombi of uncertain clinical significance are more common. Graduated compression stockings prevented travel-related VTE (P < 0.05 in 4 of 6 studies), aspirin did not, and low-molecular-weight heparin (LMWH) showed a trend toward efficacy in one study. CONCLUSIONS: All travelers, regardless of VTE risk, should avoid dehydration and frequently exercise leg muscles. Travelers on a flight of less than 6 hours and those with no known risk factors for VTE, regardless of the duration of the flight, do not need DVT prophylaxis. Travelers with 1 or more risk factors for VTE should consider graduated compression stockings and/or LMWH for flights longer than 6 hours
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1824715/
pdf/11606_2006_Article_16.pdf
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