2013, Number 3
<< Back Next >>
Evid Med Invest Salud 2013; 6 (3)
Use of thromboprophylaxis in a gyneco-obstetric hospital
Ramírez-Montiel ML, Pichardo-Cuevas M, Suárez-Muñiz MPB, Núñez-Valenzuela D, Contreras-Carreto NA
Language: Spanish
References: 23
Page: 77-83
PDF size: 369.70 Kb.
ABSTRACT
Introduction: Venous thromboembolism (VTE) is 4-6 times more common in pregnancy and postpartum period. Thromboprophylaxis is a cost-effectiveness helpful in reducing the high morbidity and mortality.
Material and methods: A retrospective, descriptive and analytical study was conducted from 3rd to 31st December 2012 in patients hospitalized in Woman’s Hospital, Ministry of Health, Mexico City, during pregnancy, labor or puerperium period, with the objective of determine our practice in risk assessment for VTE and thromboprophylaxis measures.
Results: 182 patients were included. Age 26.20 ± 7.74 years. Classified by low thromboembolic risk Caprini predictive model: 1.64% high risk (n = 3), 24.72% high risk (n = 45), 63.73% moderate risk (n = 116), 9.89% low risk (n = 18). The 90.10% (n = 164) were indicated for pharmacologic thromboprophylaxis, only 14.02% (n = 23) received low molecular weight heparin (LMWH) or unfractionated heparin (UFH) as thromboprophylaxis. The 100% (n = 182) had non-pharmacological measures that included graduated compression stockings and lower limbs bandage.
Conclusion: ETV has a high morbidity and mortality during pregnancy and puerperium period. However, thromboembolic risk assessment is an infrequent practice and thromboprophylaxis is still focused on non-pharmacologic measures.
REFERENCES
O’Riordan MN, Higgins JR. Haemostasis in normal and abnormal pregnancy. Best Pract Res Clin Obstet Gynaecol. 2003; 17: 385-396.
Bremme KA. Haemostatic changes in pregnancy. Best Pract Res Clin Haematol. 2003; 6: 264-267.
James A, Abel D, Brancazio L. Anticoagulants in pregnancy. Obstet Gynecol Survey. 2005; 61: 59-69.
Hanania G. Management of anticoagulants during pregnancy. Heart. 2001; 86: 125-126.
Bates SM, Greer IA, Hirsh J et al. Use of antithrombotic agents during pregnancy: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004; 126: 627-644.
James A, Brancazio L, Ortel T. Thrombosis, thrombophilia and thromboprofilaxis in pregnancy. Clin Advan Hematol Oncol. 2005; 3: 187-197.
Ansell J, Hirsh J, Poller L et al. The pharmacology and management of vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004; 126: 204-333.
Martinelli I, De Stefano V, Taioli E, Paciaroni K, Rossi E, Mannucci PM. Inherited thrombophilia and first venous thromboembolism during pregnancy and puerperium. Thromb Haemost. 2002; 87: 791-795.
Gerhardt A, Scharf RE, Zotz RB. Effect of hemostatic risk factors on the individual probability of thrombosis during pregnancy and the puerperium. Thromb Haemost. 2003; 90: 77-85.
Vucić N, Frleta M, Petrović D, Ostojić V. Thrombophilia, preeclampsia and other pregnancy complications. Acta Med Croatica. 2009; 63: 297-305.
Grandone E, Tomaiuolo M, Colaizzo D, Ames PR, Margaglione M. Role of thrombophilia in adverse obstetric outcomes and their prevention using antithrombotic therapy. Semin Thromb Hemost. 2009; 35: 630-643.
James AH. Pregnancy-associated thrombosis. Hematology Am Soc Hematol Educ Program. 2009: 277-85. doi: 10.1182/asheducation-2009.1.277.
Chan CM, Shorr AF. Venous thromboembolic disease in the intensive care unit. Semin Respir Crit Care Med. 2010; 31: 39-46.
Lepic K, Crowther MA. A logical approach to surgical thromboprophylaxis. Curr Opin Hematol. 2009; 16: 397-401.
Rocha AT, Braga P, Ritt G, Lopes AA. Inadequacy of thromboprophylaxis in hospitalized medical patients. Rev Assoc Med Bras. 2006; 52: 441-446.
Rawat A, Huynh TT, Peden EK, Kougias P, Lin PH. Primary prophylaxis of venous thromboembolism in surgical patients. Vasc Endovascular Surg. 2008; 42: 205-216.
Conard J, Horellou MH, Samama MM; American College of Chest Physicians (ACCP). Pregnancy and venous thromboembolism. North-American and European guidelines. American College of Chest Physicians. J Mal Vasc. 2009; 34: 300-313.
Geerts WH, Pineo GF, Heitz JA et al. Prevention of venous thromboembolism. Chest. 2004; 338S-400S.
Tooher R, Middleton P, Pham C et al. A systematic review of strategies to improve prophylaxis for venous thromboembolism in hospitals. Ann Surg. 2005; 241: 397-415.
Gates S, Brocklehurst P, Davis LJ. Profilaxis para la enfermedad tromboembólica venosa en el embarazo y en el periodo postnatal temprano (Revisión Cochrane traducida). En: La Biblioteca Cochrane Plus, 2008 Número 4. Oxford: Update Software Ltd. Disponible en: http://www.update-software.com. (Traducida de The Cochrane Library, 2008 Issue 3. Chichester, UK: John Wiley & Sons, Ltd.)
Carrillo Esper R et al. Guía de práctica clínica para la tromboprofilaxis en la Unidad de Terapia Intensiva. Rev Asoc Mex Med Crit y Ter Int. 2011; 25 (4): 227-254.
Danilenko-Dixon DR, Heit JA, Silverstein MD, Yawn BP, Petterson TM, Lohse CM, Melton LJ 3rd. Risk factors for deep vein thrombosis and pulmonary embolism during pregnancy or postpartum: a population-based, case-control study. Am J Obstet Gynecol. 2001; 184: 104-110.
Pérez-Castro y Vázquez JA. Lista de cotejo de Caprini modificada como una estrategia para la aplicación de un programa de seguridad del paciente en la prevención de la enfermedad tromboembólica. Cirujano General. 2011; 33 (3): 151-155.