Download PDF
CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2021; 56(06): 697-704
DOI: 10.1055/s-0040-1715512
Artigo de Atualização
Pé e Tornozelo

Profilaxia do tromboembolismo venoso nas cirurgias do tornozelo e do pé

Article in several languages: português | English
Roberto Zambelli 
1   Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
2   Serviço de Ortopedia, Rede Mater Dei de Saúde, Belo Horizonte, Minas Gerais, Brasil
,
Marcos de Bastos 
3   Assessoria de Políticas de Saúde e Informações (ASPASI), Hospital Governador Israel Pinheiro (HGIP), Instituto de Previdência dos Servidores do Estado de Minas Gerais (IPSEMG), Belo Horizonte, Minas Gerais, Brasil
4   Faculdade da Saúde e Ecologia Humana (FASEH), Vespasiano, Minas Gerais, Brasil
,
Suely Meireles Rezende 
5   Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Resumo

O tromboembolismo venoso (TEV) é uma das complicações mais temidas pelos ortopedistas, tanto pelo seu desfecho potencialmente letal quanto pelas incertezas relacionadas à sua prevenção. Apesar da vasta literatura existente sobre a prevenção de TEV nas grandes cirurgias ortopédicas, pouco se sabe sobre sua prevenção nas cirurgias do tornozelo e do pé. Uma adequada prescrição da tromboprofilaxia em ortopedia exige criteriosa avaliação dos riscos trombóticos e hemorrágicos com base no tipo de cirurgia a ser realizada, além do conhecimento sobre os anticoagulantes. Esta revisão tem como objetivos abordar a avaliação do risco de desenvolver TEV, as modalidades de tromboprofilaxia, e os fármacos utilizados, tendo como ênfase as cirurgias do pé e do tornozelo.

Palavras-chave

trombose - ortopedia - cirurgia - pé - tornozelo - profilaxia pré-exposição


Publication History

Received: 06 March 2020

Accepted: 01 June 2020

Article published online:
25 September 2020

© 2020. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • Referências

  • 1 Geerts WH, Bergqvist D, Pineo GF. et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 (6 Suppl): 381S-453S
    CrossrefPubMedGoogle Scholar
  • 2 Naess IA, Christiansen SC, Romundstad P, Cannegieter SC, Rosendaal FR, Hammerstrøm J. Incidence and mortality of venous thrombosis: a population-based study. J Thromb Haemost 2007; 5 (04) 692-699
    CrossrefPubMedGoogle Scholar
  • 3 Anderson Jr FA, Spencer FA. Risk factors for venous thromboembolism. Circulation 2003; 107 (23, Suppl 1): I9-I16
    PubMedGoogle Scholar
  • 4 Falck-Ytter Y, Francis CW, Johanson NA. et al. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2 Suppl): e278S-e325S
    CrossrefPubMedGoogle Scholar
  • 5 Dai WL, Lin ZM, Shi ZJ, Wang J. Venous Thromboembolic Events after Total Knee Arthroplasty: Which Patients Are at a High Risk?. J Knee Surg 2020; 33 (10) 947-957
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Senay A, Trottier M, Delisle J. et al. Incidence of symptomatic venous thromboembolism in 2372 knee and hip replacement patients after discharge: data from a thromboprophylaxis registry in Montreal, Canada. Vasc Health Risk Manag 2018; 14: 81-89
    CrossrefPubMedGoogle Scholar
  • 7 Anderson DR, Morgano GP, Bennett C. et al. American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients. Blood Adv 2019; 3 (23) 3898-3944
    CrossrefPubMedGoogle Scholar
  • 8 Jacobs JJ, Mont MA, Bozic KJ. et al. American Academy of Orthopaedic Surgeons clinical practice guideline on: preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty. J Bone Joint Surg Am 2012; 94 (08) 746-747
    CrossrefPubMedGoogle Scholar
  • 9 Calder JD, Freeman R, Domeij-Arverud E, van Dijk CN, Ackermann PW. Meta-analysis and suggested guidelines for prevention of venous thromboembolism (VTE) in foot and ankle surgery. Knee Surg Sports Traumatol Arthrosc 2016; 24 (04) 1409-1420
    CrossrefPubMedGoogle Scholar
  • 10 Richey JM, Ritterman Weintraub ML, Schuberth JM. Incidence and Risk Factors of Symptomatic Venous Thromboembolism Following Foot and Ankle Surgery. Foot Ankle Int 2019; 40 (01) 98-104
    CrossrefPubMedGoogle Scholar
  • 11 Pedersen MH, Wahlsten LR, Grønborg H, Gislason GH, Petersen MM, Bonde AN. Symptomatic Venous Thromboembolism After Achilles Tendon Rupture: A Nationwide Danish Cohort Study of 28,546 Patients With Achilles Tendon Rupture. Am J Sports Med 2019; 47 (13) 3229-3237
    CrossrefPubMedGoogle Scholar
  • 12 Blanco JA, Slater G, Mangwani J. A Prospective Cohort Study of Symptomatic Venous Thromboembolic Events in Foot and Ankle Trauma: The Need for Stratification in Thromboprophylaxis?. J Foot Ankle Surg 2018; 57 (03) 484-488
    CrossrefPubMedGoogle Scholar
  • 13 Sullivan M, Eusebio ID, Haigh K, Panti JP, Omari A, Hang JR. Prevalence of Deep Vein Thrombosis in Low-Risk Patients After Elective Foot and Ankle Surgery. Foot Ankle Int 2019; 40 (03) 330-335
    CrossrefPubMedGoogle Scholar
  • 14 Saragas NP, Ferrao PNF, Saragas E, Jacobson BF. The impact of risk assessment on the implementation of venous thromboembolism prophylaxis in foot and ankle surgery. Foot Ankle Surg 2014; 20 (02) 85-89
    CrossrefPubMedGoogle Scholar
  • 15 Parisi R, Visonà A, Camporese G. et al. Isolated distal deep vein thrombosis: efficacy and safety of a protocol of treatment. Treatment of Isolated Calf Thrombosis (TICT) Study. Int Angiol 2009; 28 (01) 68-72
    Google Scholar
  • 16 Chien BY, Dixon T, Guss D, DiGiovanni C. Venous Thromboembolism Disease Prophylaxis in Foot and Ankle Surgery. Orthop Clin North Am 2018; 49 (02) 265-276
    CrossrefPubMedGoogle Scholar
  • 17 Fleischer AE, Abicht BP, Baker JR, Boffeli TJ, Jupiter DC, Schade VL. American College of Foot and Ankle Surgeons' clinical consensus statement: risk, prevention, and diagnosis of venous thromboembolism disease in foot and ankle surgery and injuries requiring immobilization. J Foot Ankle Surg 2015; 54 (03) 497-507
    CrossrefPubMedGoogle Scholar
  • 18 Ahmad J, Lynch MK, Maltenfort M. Incidence and Risk Factors of Venous Thromboembolism After Orthopaedic Foot and Ankle Surgery. Foot Ankle Spec 2017; 10 (05) 449-454
    CrossrefPubMedGoogle Scholar
  • 19 Mangwani J, Sheikh N, Cichero M, Williamson D. What is the evidence for chemical thromboprophylaxis in foot and ankle surgery? Systematic review of the English literature. Foot 2015; 25 (03) 173-178
    CrossrefPubMedGoogle Scholar
  • 20 Rosendaal FR. Venous thrombosis: a multicausal disease. Lancet 1999; 353 (9159): 1167-1173
    CrossrefPubMedGoogle Scholar
  • 21 van Adrichem RA, Debeij J, Nelissen RG, Schipper IB, Rosendaal FR, Cannegieter SC. Below-knee cast immobilization and the risk of venous thrombosis: results from a large population-based case-control study. J Thromb Haemost 2014; 12 (09) 1461-1469
    CrossrefPubMedGoogle Scholar
  • 22 Healy B, Beasley R, Weatherall M. Venous thromboembolism following prolonged cast immobilisation for injury to the tendo Achillis. J Bone Joint Surg Br 2010; 92 (05) 646-650
    CrossrefPubMedGoogle Scholar
  • 23 Riou B, Rothmann C, Lecoules N. et al. Incidence and risk factors for venous thromboembolism in patients with nonsurgical isolated lower limb injuries. Am J Emerg Med 2007; 25 (05) 502-508
    CrossrefPubMedGoogle Scholar
  • 24 Nemeth B, Timp JF, van Hylckama Vlieg A, Rosendaal FR, Cannegieter SC. High risk of recurrent venous thrombosis in patients with lower-leg cast immobilization. J Thromb Haemost 2018; 16 (11) 2218-2222
    CrossrefPubMedGoogle Scholar
  • 25 Caprini JA. Risk assessment as a guide for the prevention of the many faces of venous thromboembolism. Am J Surg 2010; 199 (1, Suppl) S3-S10
    CrossrefPubMedGoogle Scholar
  • 26 Huntley SR, Abyar E, Lehtonen EJ, Patel HA, Naranje S, Shah A. Incidence of and Risk Factors for Venous Thromboembolism After Foot and Ankle Surgery. Foot Ankle Spec 2019; 12 (03) 218-227
    CrossrefPubMedGoogle Scholar
  • 27 van Adrichem RA, Nelissen RG, Schipper IB, Rosendaal FR, Cannegieter SC. Risk of venous thrombosis after arthroscopy of the knee: results from a large population-based case-control study. J Thromb Haemost 2015; 13 (08) 1441-1448
    CrossrefPubMedGoogle Scholar
  • 28 Zhou X, Qian W, Li J. et al. Who are at risk for thromboembolism after arthroplasty? A systematic review and meta-analysis. Thromb Res 2013; 132 (05) 531-536
    CrossrefPubMedGoogle Scholar
  • 29 Jameson SS, Augustine A, James P. et al. Venous thromboembolic events following foot and ankle surgery in the English National Health Service. J Bone Joint Surg Br 2011; 93 (04) 490-497
    CrossrefPubMedGoogle Scholar
  • 30 Radl R, Kastner N, Aigner C, Portugaller H, Schreyer H, Windhager R. Venous thrombosis after hallux valgus surgery. J Bone Joint Surg Am 2003; 85 (07) 1204-1208
    CrossrefPubMedGoogle Scholar
  • 31 Department of Health VTE risk assessment tool. National Institute of Health and Care Excellence (NICE), published date: 21 March 2018. Available from: https://www.nice.org.uk/guidance/ng89/chapter/Recommendations#risk-assessment
  • 32 Haque S, Bishnoi A, Khairandish H, Menon D. Thromboprophylaxis in Ambulatory Trauma Patients With Foot and Ankle Fractures: Prospective Study Using a Risk Scoring System. Foot Ankle Spec 2016; 9 (05) 388-393
    CrossrefPubMedGoogle Scholar
  • 33 Caprini JA. Thrombosis risk assessment as a guide to quality patient care. Dis Mon 2005; 51 (2-3): 70-78
    CrossrefPubMedGoogle Scholar
  • 34 Luksameearunothai K, Sa-Ngasoongsong P, Kulachote N. et al. Usefulness of clinical predictors for preoperative screening of deep vein thrombosis in hip fractures. BMC Musculoskelet Disord 2017; 18 (01) 208
    CrossrefPubMedGoogle Scholar
  • 35 Krauss ES, Segal A, Cronin M. et al. Implementation and Validation of the 2013 Caprini Score for Risk Stratification of Arthroplasty Patients in the Prevention of Venous Thrombosis. Clin Appl Thromb Hemost 2019; 25: 1076029619838066
    CrossrefPubMedGoogle Scholar
  • 36 Dashe J, Parisien RL, Pina M, De Giacomo AF, Tornetta 3rd P. Is the Caprini Score Predictive of Venothromboembolism Events in Orthopaedic Fracture Patients?. J Orthop Trauma 2019; 33 (06) 269-275
    CrossrefPubMedGoogle Scholar
  • 37 Pannucci CJ, Bailey SH, Dreszer G. et al. Validation of the Caprini risk assessment model in plastic and reconstructive surgery patients. J Am Coll Surg 2011; 212 (01) 105-112
    CrossrefPubMedGoogle Scholar
  • 38 Swanson E. Caprini Scores, Risk Stratification, and Rivaroxaban in Plastic Surgery: Time to Reconsider Our Strategy. Plast Reconstr Surg Glob Open 2016; 4 (06) e733
    CrossrefPubMedGoogle Scholar
  • 39 Shuman AG, Hu HM, Pannucci CJ, Jackson CR, Bradford CR, Bahl V. Stratifying the risk of venous thromboembolism in otolaryngology. Otolaryngol Head Neck Surg 2012; 146 (05) 719-724
    CrossrefPubMedGoogle Scholar
  • 40 Stroud W, Whitworth JM, Miklic M. et al. Validation of a venous thromboembolism risk assessment model in gynecologic oncology. Gynecol Oncol 2014; 134 (01) 160-163
    CrossrefPubMedGoogle Scholar
  • 41 Carr P, Ehredt Jr DJ, Dawoodian A. Prevention of Deep Venous Thromboembolism in Foot and Ankle Surgery. Clin Podiatr Med Surg 2019; 36 (01) 21-35
    CrossrefPubMedGoogle Scholar
  • 42 Ho KM, Tan JA. Stratified meta-analysis of intermittent pneumatic compression of the lower limbs to prevent venous thromboembolism in hospitalized patients. Circulation 2013; 128 (09) 1003-1020
    CrossrefPubMedGoogle Scholar
  • 43 Leme LE, Sguizzatto GT. Prophylaxis of venous thromboembolism in orthopaedic surgery. Rev Bras Ortop 2015; 47 (06) 685-693
    Google Scholar
  • 44 Anderson DR, Dunbar M, Murnaghan J. et al. Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty. N Engl J Med 2018; 378 (08) 699-707
    CrossrefPubMedGoogle Scholar
  • 45 Chu JN, Maselli J, Auerbach AD, Fang MC. The risk of venous thromboembolism with aspirin compared to anticoagulants after hip and knee arthroplasty. Thromb Res 2017; 155: 65-71
    CrossrefPubMedGoogle Scholar
  • 46 Deirmengian GK, Heller S, Smith EB, Maltenfort M, Chen AF, Parvizi J. Aspirin Can Be Used as Prophylaxis for Prevention of Venous Thromboembolism After Revision Hip and Knee Arthroplasty. J Arthroplasty 2016; 31 (10) 2237-2240
    CrossrefPubMedGoogle Scholar
  • 47 Flevas DA, Megaloikonomos PD, Dimopoulos L, Mitsiokapa E, Koulouvaris P, Mavrogenis AF. Thromboembolism prophylaxis in orthopaedics: an update. EFORT Open Rev 2018; 3 (04) 136-148
    CrossrefPubMedGoogle Scholar
  • 48 Eriksson BI, Borris LC, Friedman RJ. et al. RECORD1 Study Group. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med 2008; 358 (26) 2765-2775
    CrossrefPubMedGoogle Scholar
  • 49 Lassen MR, Ageno W, Borris LC. et al. RECORD3 Investigators. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med 2008; 358 (26) 2776-2786
    CrossrefPubMedGoogle Scholar
  • 50 Raskob GE, Gallus AS, Pineo GF. et al. Apixaban versus enoxaparin for thromboprophylaxis after hip or knee replacement: pooled analysis of major venous thromboembolism and bleeding in 8464 patients from the ADVANCE-2 and ADVANCE-3 trials. J Bone Joint Surg Br 2012; 94 (02) 257-264
    CrossrefPubMedGoogle Scholar
  • 51 Samama CM, Laporte S, Rosencher N. et al. PRONOMOS Investigators. Rivaroxaban or Enoxaparin in Nonmajor Orthopedic Surgery. N Engl J Med 2020; 382 (20) 1916-1925
    CrossrefPubMedGoogle Scholar
  • 52 Ageno W, Gallus AS, Wittkowsky A, Crowther M, Hylek EM, Palareti G. Oral anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2 Suppl): e44S-e88S
    CrossrefPubMedGoogle Scholar
  • 53 Strebel N, Prins M, Agnelli G, Büller HR. Preoperative or postoperative start of prophylaxis for venous thromboembolism with low-molecular-weight heparin in elective hip surgery?. Arch Intern Med 2002; 162 (13) 1451-1456
    CrossrefPubMedGoogle Scholar
  • 54 Testroote M, Stigter W, de Visser DC, Janzing H. Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-leg immobilization. Cochrane Database Syst Rev 2008; (04) CD006681
    PubMedGoogle Scholar
  • 55 Hanslow SS, Grujic L, Slater HK, Chen D. Thromboembolic disease after foot and ankle surgery. Foot Ankle Int 2006; 27 (09) 693-695
    CrossrefPubMedGoogle Scholar
  • 56 Mayle Jr RE, DiGiovanni CW, Lin SS, Tabrizi P, Chou LB. Current concepts review: venous thromboembolic disease in foot and ankle surgery. Foot Ankle Int 2007; 28 (11) 1207-1216
    CrossrefPubMedGoogle Scholar
  • 57 Francis CW. Prevention of VTE in patients having major orthopedic surgery. J Thromb Thrombolysis 2013; 35 (03) 359-367
    CrossrefPubMedGoogle Scholar
  • 58 Bloemen A, Testroote MJ, Janssen-Heijnen ML, Janzing HM. Incidence and diagnosis of heparin-induced thrombocytopenia (HIT) in patients with traumatic injuries treated with unfractioned or low-molecular-weight heparin: a literature review. Injury 2012; 43 (05) 548-552
    CrossrefPubMedGoogle Scholar
  • 59 Martel N, Lee J, Wells PS. Risk for heparin-induced thrombocytopenia with unfractionated and low-molecular-weight heparin thromboprophylaxis: a meta-analysis. Blood 2005; 106 (08) 2710-2715
    CrossrefPubMedGoogle Scholar