Trombosis venosa profunda en cirugías de tobillo y pie. Algoritmo de profilaxis [A prophylaxis algorithm for deep vein thrombosis in ankle and foot surgery]

Héctor Masaragian, Fernando Perin, Hernán Coria, Luciano Mizdraji, Nicolás Ameriso, Leonel Rega

Resumen


Introducción: La enfermedad tromboembólica es una de las complicaciones serias en la cirugía ortopédica. La tromboprofilaxis para las cirugías de tobillo y pie no está estandarizada, porque la incidencia es baja, según la bibliografía. El objetivo de este estudio es aportar un algoritmo de prevención para la trombosis venosa profunda y una revisión de la bibliografía.

Materiales y Métodos: Se llevó a cabo una revisión de las historias clínicas de los pacientes operados entre 2011 y 2017. La muestra estaba integrada por 696 hombres (28,98%) y 1706 mujeres (71,02%), con un promedio de edad de 51 años (rango 20-82). Se realizaron 2402 procedimientos, 575 (23,94%) fueron por patologías traumáticas y 1827 (76,06%), por patologías ortopédicas.

Resultados: Nueve pacientes (0,37%) presentaron trombosis venosa profunda y solo dos, tromboembolismo pulmonar (0,08%). Los procedimientos en los que ocurrieron fueron: artroscopia, reparación aguda del tendón de Aquiles, hallux valgus y fractura del 5.° metatarsiano.

Conclusiones: Se recomienda un enfoque multimodal para la profilaxis de la trombosis venosa profunda. Esto incluye abordar los factores de riesgo modificables, mediante la profilaxis mecánica, la movilización temprana y la profilaxis química. La heparina de bajo peso molecular es eficaz para reducir la tasa de trombosis venosa profunda y tromboembolismo pulmonar.

 

Abstract


Introduction: Deep vein thrombosis (DVT) is a major complication in orthopedic surgery. According to the literature, thromboprophylaxis in foot and ankle surgery is not a standardized practice due to the low incidence of DVT.

Materials and Methods: We reviewed the medical records of surgical patients. Between 2011 and 2017, 1591 surgeries were performed, 6 of them due to symptomatic DVT.

Results: The incidence of DVT in major orthopedic surgeries, such as knee and hip, is well documented, but there are only a few reports about its incidence in foot and ankle surgery. It is considered a relatively rare complication in many published studies; thus, preventive drug therapy is not routine practice.

Conclusions: A multimodal approach to DVT prophylaxis for high-risk patients is recommended. All risk factors should be addressed, such as mechanical prophylaxis, early mobilization, and the use of chemoprophylaxis. Low molecular weight heparin is effective in reducing the rate of clinically significant DVT and is also likely to reduce the rate of pulmonary embolism.


Palabras clave


Trombosis venosa profunda; cirugía; tobillo; pie; complicaciones; profilaxis. Deep vein thrombosis; surgery; ankle; foot; complications; prophylaxis

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Referencias


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DOI: http://dx.doi.org/10.15417/issn.1852-7434.2019.84.3.783

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Registro de la Propiedad Intelectual Nº 22171081 (en línea).

ISSN 1852-7434 (en línea).

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