Compressão pneumática intermitente na prevenção de trombose venosa profunda em pacientes cirúrgicos: revisão sistemática e metanálise
Arquivos
Data
2006-12-20
Autores
Campos, Maria Aparecida Zanutto 
Orientadores
Atallah, Álvaro Nagib
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: Trombose Venosa Profunda (TVP) é o resultado de inúmeros fatores,
incluindo estase venosa, injuria endotelial e hipercoagulação do sangue. O embolismo
pulmonar é a maior complicação da TVP e ocorre quando um trombo ou um coágulo
sangüíneo desloca-se em direção aos pulmões. O tromboembolismo é um sério problema de saúde e é responsável por um considerável número de mortes súbitas e por significantes custos de hospitalizações em todo o mundo. Entre os métodos profiláticos usados na prevenção da TVP, há os classificados como mecânicos e os farmacológicos. Ambos são efetivos e podem ser usados sempre que necessário, tendo sido recomendados por consenso internacional. Objetivos: Avaliar a incidência da TVP em pacientes cirúrgicos através da Compressão pneumática Intermitente CPI (coxa/perna ou perna/pé) contra nenhuma forma de profilaxia ou contra fármacos. Métodos: Revisão sistemática de ensaios clínicos randomizados, utilizando a metodologia Cochrane, através de buscas eletrônica e manual. Foram incluídos pacientes cirúrgicos, de ambos os sexos, cuja intervenção foi o uso de aparelhos de compressão pneumática intermitente. Resultados: 4269 pacientes cirúrgicos investigados por 31 ensaios submetidos a um
número de intervenções cirúrgicas, incluindo cirurgia ortopédica (joelho e quadris),
geral, ginecológica, urológica e neurológica. Dados combinados demonstraram efeitos
de tratamento virtualmente iguais entre CPI e abordagens farmacológicas [0.95 (95%CI
0.82, 1.10)], em relação à incidência de TVP. Entretanto, o risco de hemorragia foi
maior e estatisticamente significante em pacientes tratados com intervenções
farmacológicas [0.37(95%CI 0.20, 0.69)]. Conclusão: Comparações entre as
estratégias farmacológicas e mecânicas indicam que ambas são similares na
prevenção de trombose venosa profunda. Entretantio, a evidência atual suportaria a
escolha das abordagens mecâncias, uma vez que o risco de eventos hemorrágicos
favorece os métodos mecânicos.
Background: Deep vein thrombosis (DVT) is the result of a number of factors that include stasis of blood, endothelial injury and hypercoagulability of blood. Thromboembolism is a serious health problem, which is often misdiagnosed. It is responsible for a considerable number of sudden deaths and significant hospitalization costs worldwide. Amongst the procedures used in the prevention of DVT, there are some that are classified either as mechanical or pharmacological. The frequent use of physiotherapy and mechanical methods in patients with DVT has been recommended in an international consensus. Objetives: The aim of this research is to evaluate the incidence of DVT in surgical patients by intermittent pneumatic compression for prophylaxis of venous thrombous (IPC and A-V Impulse System) as compared to either no prophylaxis or pharmacological prophylaxis. Methods: Systematic review of randomized controlled trials. Search strategy was used through the following electronic databases: The Cochrane Library, PUBMED, EMBASE, LILACS and reference lists from relevant studies. Data analysis and extraction were carried out by three reviewers. Results were polled in a meta-analysis. Results: 4269 patients, who had suffered a number of surgical interventions, including general surgery, orthopedics surgery (Knee and hip), gynecological, urological and neurological surgery across 31 trials, were analyzed. However the risk of hemorrhage was higher and statistically significant in patients treated with the pharmacological interventions [0.37(95%CI 0.20, 0.69)], pooled data have shown a virtually equall treatment effects between IPC and pharmacologic approaches [0.95 (95%CI 0.82, 1.10)] regarding the incidence of DVT. Conclusion: Comparisons between the pharmacological and mechanical strategies indicate that both are similar in the prevention of deep venous thrombosis. However, the current evidence would support the choice of the mechanical approaches, since the risk of hemorrhagic events favours the mechanical method.
Background: Deep vein thrombosis (DVT) is the result of a number of factors that include stasis of blood, endothelial injury and hypercoagulability of blood. Thromboembolism is a serious health problem, which is often misdiagnosed. It is responsible for a considerable number of sudden deaths and significant hospitalization costs worldwide. Amongst the procedures used in the prevention of DVT, there are some that are classified either as mechanical or pharmacological. The frequent use of physiotherapy and mechanical methods in patients with DVT has been recommended in an international consensus. Objetives: The aim of this research is to evaluate the incidence of DVT in surgical patients by intermittent pneumatic compression for prophylaxis of venous thrombous (IPC and A-V Impulse System) as compared to either no prophylaxis or pharmacological prophylaxis. Methods: Systematic review of randomized controlled trials. Search strategy was used through the following electronic databases: The Cochrane Library, PUBMED, EMBASE, LILACS and reference lists from relevant studies. Data analysis and extraction were carried out by three reviewers. Results were polled in a meta-analysis. Results: 4269 patients, who had suffered a number of surgical interventions, including general surgery, orthopedics surgery (Knee and hip), gynecological, urological and neurological surgery across 31 trials, were analyzed. However the risk of hemorrhage was higher and statistically significant in patients treated with the pharmacological interventions [0.37(95%CI 0.20, 0.69)], pooled data have shown a virtually equall treatment effects between IPC and pharmacologic approaches [0.95 (95%CI 0.82, 1.10)] regarding the incidence of DVT. Conclusion: Comparisons between the pharmacological and mechanical strategies indicate that both are similar in the prevention of deep venous thrombosis. However, the current evidence would support the choice of the mechanical approaches, since the risk of hemorrhagic events favours the mechanical method.
Descrição
Citação
CAMPOS, Maria Aparecida Zanutto. Compressão pneumática intermitente na prevenção de trombose venosa profunda em pacientes cirúrgicos: revisão sistemática e metanálise. 2006. 241 f. Dissertação (Mestrado em Ciências) – Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2006.