Tromboprofilaxis en cirugía ginecológica laparoscópica

Gilzan Javier Narvaez Ortega

Resumen


Dentro de los eventos tromboembólicos considerados están: la trombosis venosa profunda y el embolismo pulmonar, principales complicaciones que se pueden presentar durante y después de una cirugía ginecológica, por vía abierta o laparoscópica. Existe incertidumbre sobre el riesgo atribuido de tromboembolismo venoso después de procedimientos laparoscópicos, siendo controvertida la recomendación de tromboprofilaxis en este campo. El American College of Chest Physicians y el American Congress of Obstetricians and Gynecologist sugieren la clasificación de riesgo en 4 categorías: bajo, medio, alto y muy alto de las pacientes programadas para cirugía ginecológica. El riesgo de evento tromboembólico va a depender del tipo de procedimiento, tiempo quirúrgico, edad y la presencia de otros factores de riesgo. Hasta tener mayor evidencia, las pacientes llevadas a cirugía laparoscópica deberán ser estratificadas por categoría de riesgo y proveer profilaxis similar a pacientes llevadas a laparotomía. En mujeres de alto riesgo (mayores de 60 años, historia de trombosis venosa profunda, embolismo pulmonar o cáncer) se pueden beneficiar de la profilaxis dual y de prolongar su profilaxis hasta por 28 días.

Palabras clave


Embolismo pulmonar, Laparoscopia, Tromboprofilaxis, Trombosis venosa profunda

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Referencias


Clarke-Pearson DL, Abaid LN. Prevention of venous thromboembolic events after gynecologic surgery. Obstet Gynecol. 2012; 119 (1): 155–67. URL disponible en: http://www.ncbi.nlm.nih.gov/pubmed/22183223 DOI: 10.1097/AOG.0b013e31823d389e

Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CH, Lassen MR, 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. URL disponible en: http://journal.publications.chestnet.org/article.aspx?articleid=1085923 DOI:10.1378/chest.08-0656

Suzuki N, Yoshioka N, Ohara T, Yokomichi N, Nako T, Yahagi N, et al. Risk factors for perioperative venous thromboembolism: A retrospective study in Japanese women with gynecologic diseases. Thromb J. 2010; 8: 17. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/21054901 DOI: 10.1186/1477-9560-8-17

Nick AM, Schmeler KM, Frumovitz MM, Soliman PT, Spannuth WA, Burzawa JK, et al. Risk of thromboembolic disease in patients undergoing laparoscopic gynecologic surgery. Gynecol Oncol. 2010116 (4): 956-61. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/20859161 DOI: 10.1097/AOG.0b013e3181f240f7

Solomon ER, Frick AC, Paraiso MF, Barber MD. Risk of deep venous thrombosis and pulmonary embolism in urogynecologic surgical patients. Am J Obstet Gynecol. 2010; 203 (5): 510.e1-4. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/20800214 DOI: 10.1016/j.ajog.2010.07.021

Peedicayil A, Weaver A, Li X, Carey E, Cliby W, Mariani A. Incidence and timing of venous thromboembolism after surgery for gynecological cancer. Gynecol Oncol. 2011; 121 (1): 64-9. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/21183211 DOI: 10.1016/j.ygyno.2010.11.038

Zhang L, Liu X, Xue Y. Analysis of deep venous thrombosis after gynecological surgery: A clinical study of 498 cases. Pak J Med Sci. 2015; 31 (2): 453-6. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/26101510 DOI: 10.12669/pjms.312.6608

Oger E. Incidence of venous thromboembolism: a communitybased study in Western France. EPI-GETBP Study Group. Groupe d’Etude de la Thrombose de Bretagne Occidentale. Thromb Haemost. 2000; 83 (5): 657-60. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/10823257

Hussain YR, Tsai J, Atrash HK, Boulet S,Grosse SC. Venous thromboembolism in adult hospitalizations-United States, 2007-2009. MMWR. 2012; 61 (22): 401-4. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6122a1.htm

Cushman M, Tsai AW, White RH, Heckbert SR, Rosamond WD, Enright P, et al. Deep vein thrombosis and pulmonary embolism in two cohorts: The longitudinal investigation of thromboembolism etiology. Am J Med. 2004; 117 (1): 19-25. URL disponible en: https://experts.umn.edu/en/publications/deep-vein-thrombosis-and-pulmonary-embolism-in-two-cohorts-the-lo DOI: 10.1016/j.amjmed.2004.01.018

Anderson FA Jr, Wheeler HB, Goldberg RJ, Hosmer DW, Patwardhan NA, Jovanovic B, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med. 1991; 151 (5): 933-8. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/2025141

Qu H, Li Z, Zhai Z, Liu C, Wang S, Guo S, et al. Predicting of venous thromboembolism for patients undergoing gynecological surgery. Medicine (Baltimore). 2015; 94 (39): e1653. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/26426660 DOI: 10.1097/MD.0000000000001653

Caprini JA. Thrombosis risk assessment as a guide to quality patient care. Dis Mon. 2005; 51 (2-3): 70-8. https://www.ncbi.nlm.nih.gov/pubmed/15900257 DOI: 10.1016/j.disamonth.2005.02.003

Brennand JE, Greer IA. Thromboembolism in gynaecological surgery. Curr Obst Gynaecol. 1998; 8 (1): 44-8. URL disponible en: https://www.researchgate.net/publication/223286768_Thromboembolism_in_gynaecological_surgery doi: 10.1016/ S0957–5847(98)80010–3.

Virchow R. Die Cellularpathologie in ihrer Begrindung auf physiologische and pathologische Gewebslehre. Berlin;: 1858. URL disponible en: http://www.deutschestextarchiv.de/book/show/virchow_cellularpathologie_1858

Goldman L, Schafer AI (eds.). Pulmonary embolism. In: Goldman’s Cecil Medicine. 24th ed. Philadelphia: Elsevier Saunders; 2012; pp. 596-602.

Mann DL, Zipes DP, Libby P, Bonow RO. eds. Pulmonary embolism. In: Braunwald’s heart disease: a textbook of cardiovascular medicine. 10th ed. Philadelphia: Elsevier Saunders; 2015. pp. 1664-81.

Pérez-Gómez F, Bover R. La nueva cascada de la coagulación y su posible influencia en el difícil equilibrio entre trombosis y hemorragia. Rev Esp Cardiol. 2007; 60 (12): 1217-9. URL disponible: http://www.revespcardiol.org/es/la-nueva-cascada-coagulacion-su/articulo/13113924/

Clark C, Cotton LT. Blood flow in deep veins of legs: recording technique and evaluation of methods to increase flow during operation. Br J Surg. 1968; 55: 211-4.

Elisha S, Heiner J, Nagelhout J, Gabot M. Venous thromboembolism: New concepts in perioperative management. AANA J. 2015; 83 (3): 211-21. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/26137764

Egan EL, Bowie EJ, Kazmier FJ, Gilchrist GS, Woods JW, Owen CA Jr. Effect of surgical operations on certain tests used to diagnose intravascular coagulation and fibrinolysis. Mayo Clin Proc. 1974; 49: 658-64. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/4413095

Piccioli A, Prandoni P, Ewenstein BM. Cancer and venous thromboembolism. Am Hear J. 1996; 132: 850-5.

Goad KE, Gralnick HR. Coagulation disorders in cancer. Hematol Oncol Clin North Am. 1996; 10 (2): 457-84. URL disponible: https://www.ncbi.nlm.nih.gov/pubmed/8707764

Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, et al.. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol. 2009; 27 (32): 5331-6. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/19805679 DOI: 10.1200/JCO.2009.22.3248

Zhang H, Cui J, Jia L, Hong S, Kong B, Dadong L. Comparison of laparoscopy and laparotomy for endometrial cancer. Int J Gynaecol Obstetr. 2012; 116 (3): 185-91.

Nguyen NT, Hinojosa MW, Fayad C, Varela E, Konyalian V, Stamos MJ, et al. Laparoscopic surgery is associated with a lower incidence of venous thromboembolism compared with open surgery. Ann Surg. 2007; 246 (6): 1021-7. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/18043105 DOI: 10.1097/SLA.0b013e31815792d8

Feng L, Song J, Wong F, Xia E. Incidence of deep venous thrombosis after gynaecological laparoscopy. Chin Med J (Engl). 2001; 114 (6): 632-5. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/11780442

Clarke-Pearson DL, Synan IS, CreasmanWT. Significant venous thromboembolism caused by pelvic lymphocysts: diagnosis and management. Gynecol Oncol. 1982; 13 (1): 136-43. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/7060988

Goldhaber SZ, Fanikos J. Prevention of deep vein thrombosis and pulmonary embolism. Am Coll Obstet Gynecol Obs Gynecol. 2007; 110: 429-40.

Clarke-Pearson DL, Dodge RK, Synan I MR, GL. M. Venous thromboembolism prophylaxis: patients at high risk to fail intermittent pneumatic compression. Obstet Gynecol. 2003; 101 (1):157-63. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/12517661

Ageno W, Manfredi E, Dentali F, Silingardi M, Ghezzi F, Camporese G, et al. The incidence of venous thromboembolism following gynecologic laparoscopy: a multicenter, prospective cohort study. J Thromb Haemost. 2007; 5 (3): 503-6.

Healey MG, Maher PJ, Hill DJ, Meagher SE, Tregaskis-Lye LE. The risk of venous thrombosis following gynaecological laparoscopic surgery. Med J Aust. 1998; 168 (10): 524. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/9631681

Lyman GH, Khorana AA, Kuderer NM, Lee AY, Arcelus JI, Balaban EP, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2013; 31 (17): 2189-204. URL disponible en: http://ascopubs.org/doi/full/10.1200/jco.2013.49.1118 DOI: 10.1200/JCO.2013.49.1118

Clarke-Pearson DL, Synan IS, Colemen RE, Hinshaw W, Creasman WT. The natural history of postoperative venous thromboemboli in gynecologic oncology: a prospective study of 382 patients. Am J Obstet Gynecol. 1984; 148 (8): 1051-4. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/6711637

Kakkar VV, Howe CT, Flanc C, Clarke MB. Natural history of postoperative deep-vein thrombosis. Lancet. 1969; 2 (7614): 230-2. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/4184105

Ramírez PT, Nick AM, Frumovitz M, Schmeler KM. Venous thromboembolic events in minimally invasive gynecologic surgery. J Minim Invasive Gynecol. 2013; 20 (6): 766-9. URL disponible en: http://www.ncbi.nlm.nih.gov/pubmed/23850360 DOI: 10.1016/j.jmig.2013.06.001

Hansen CT, Kehlet H, Moller C, Morch L, Utzon J, Ottesen B. Timing of heparin prophylaxis and bleeding complications in hysterectomy: a nationwide prospective cohort study of 9,949 Danish women. Acta Obstet Gynecol Scand. 2008; 87 (10): 1039-47. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/18792841 DOI: 10.1080/00016340802419384

Raskob GE, Hirsh J. Controversies in timing of the first dose of anticoagulant prophylaxis against venous thromboembolism after major orthopedic surgery. Chest. 2003; 124 (6): 379S-85S. URL disponible en: http://www.sciencedirect.com/science/article/pii/S0012369215317402 http://dx.doi.org/10.1378/chest.124.6_suppl.379S

Agnelli G, Bolis G, Capussotti L, Scarpa RM, Tonelli F, Bonizzoni E, et al. A clinical outcome-based prospective study on venous thromboembolism after cancer surgery. The @RISTOS Project. Ann Surg. 2006; 243 (1): 89-95.

Heit JA, Silverstein MD, Mohr DN, Pettterson TM, O´Fallon WM, Melton LJ. Predictors of survival after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med. 1999; 159 (5): 445-53.

Bergqvist D, Agnelli G, Cohen AT, Eldor A, Nilsson PE, Moigne-Amrani AL, et al. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med. 2002; 346 (13): 975-80. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/11919306 DOI: 10.1056/NEJMoa012385

Rasmussen MS, Jorgensen LN, Wille-Jørgensen P, Nielsen JD, Horn A, Mohn AC, et al. Prolonged prophylaxis with dalteparin to prevent late thromboembolic complications in patients undergoing major abdominal surgery: a multicenter randomized open-label study. J Thromb Haemost. 2006; 4 (11): 2384-90. URL disponibe en: https://www.ncbi.nlm.nih.gov/pubmed/16881934 DOI: 10.1111/j.1538-7836.2006.02153.x

Rasmussen MS, Jorgensen LN W-JP. Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvis surgery. Cochrane Database Syst Rev. 2009; 21 (1): CD004318. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/19160234 DOI: 10.1002/14651858.CD004318.pub2

Del Priore G, Hamed AH. Incidence of venous thromboembolism after minimally invasive surgery in patients with newly diagnosed endometrial cancer. Obstet Gynecol. 2013; 121 (4): 876-7. URL disponible en: http://www.ncbi.nlm.nih.gov/pubmed/23635694 DOI: 10.1097/AOG.0b013e31828a70b1

Gien LT, Kupets R, Covens A. Feasibility of same-day discharge after laparoscopic surgery in gynecologic oncology. Gynecol Oncol. 2011; 121 (2): 339-43. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/21292313 DOI: 10.1016/j.ygyno.2010.12.344

Wille-Jorgensen P, Rasmussen MS, Andersen BR, Borly L. Heparins and mechanical methods for thromboprophylaxis in colorectal surgery. Cochrane DatabaseSyst Rev. 2003; 4. CD001217. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/14583929 DOI: 10.1002/ 14651858.CD001217.

Kakkos SK, Caprini JA, Geroulakos G, Nicolaides AN, Stansby GP, Reddy DJ. Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism in high-risk patients. Cochrane Database Syst Rev. 2008; 4: CD005258. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/18843686 DOI: 101002/1451858CD005258

Dainty L, Maxwell GL, Clarke-Pearson DL. Myers ER. Cost-effectiveness of combination thromboembolism prophylaxis in gynecologic oncology surgery. Gynecol Oncol. 2004; 93 (2): 366-73. URL disponible en: https://www.ncbi.nlm.nih.gov/pubmed/15099947 DOI: 10.1016/j.ygyno.2004.02.004




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