Preferências e práticas de ortopedistas brasileiros por técnicas de tromboprofilaxia na artroplastia total do joelho: Levantamento entre membros da Sociedade Brasileira de Cirurgia do Joelho (SBCJ)

Resumo

Objetivo Descrever as preferências e práticas atuais de uma amostra de cirurgiões de joelho do Brasil quanto à forma de tromboprofilaxia na artroplastia total do joelho (ATJ).

Método Na presente pesquisa realizada pela internet, cirurgiões associados à Sociedade Brasileira de Cirurgia do Joelho (SBCJ) foram convidados a responder voluntariamente a um questionário anônimo incluindo o tempo de experiência cirúrgica pessoal, percepções sobre as melhores opções de tromboprofilaxia e as reais práticas no ambiente onde trabalham.

Resultados Entre dezembro de 2020 e janeiro de 2021, 243 participantes responderam ao questionário completo. Exceto por 3 (1,2%) participantes, todos declararam praticar tromboprofilaxia, a maioria (76%) combinando as formas farmacológica e mecânica. A droga mais prescrita é a enoxaparina (87%), com modificação para rivaroxabana (65%) após a alta. O momento de início da tromboprofilaxia variou conforme o tempo de formação do cirurgião de joelho (p ≤ 0,03) e as preferências e práticas variaram conforme a região do país (p < 0,05) e o sistema de saúde no qual trabalham os cirurgiões (público ou privado; p = 0,024). A opção por tromboprofilaxia mecânica também dependeu do tempo de formação do cirurgião.

Conclusão As preferências e práticas de tromboprofilaxia na ATJ são diversas nas regiões do Brasil e sistemas de saúde (público ou privado). Dada a inexistência de uma diretriz clínica nacional, a maior parte dos ortopedistas segue ou a diretriz de seu próprio hospital ou nenhuma. O método de profilaxia mecânica e a pouca utilização do ácido acetilsalicílico são os pontos que mais destoam das diretrizes e práticas internacionais.

Palavras-chave

trombose - tromboembolia - embolia e trombose - heparina de baixo peso molecular - enoxaparina - dispositivos de compressão pneumática intermitente

Suporte Financeiro

O presente estudo não recebeu nenhum suporte financeiro de fontes públicas, comerciais ou sem fins lucrativos.

^* Trabalho desenvolvido na Faculdade de Medicina da Universidade Federal do Pará, Campus Belém.

Publication History

Received: 14 October 2021

Accepted: 31 January 2022

Article published online:
01 August 2022

• Referências

• 1 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
• 2 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
• 3 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
• 4 Samama CM, Afshari A. AESA; VTE Guidelines Task Force. European guidelines on perioperative venous thromboembolism prophylaxis. Eur J Anaesthesiol 2018; 35 (02) 73-76
• 5 Eysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res 2004; 6 (03) e34
• 6 Almeida RF, Queiroz AA, Belloti JC, Castro Filho JM, Cohen M, Navarro RD. Approach towards total knee arthroplasty in Brazil: cross-sectional study. Sao Paulo Med J 2009; 127 (04) 190-197
• 7 Erduran M, Akseki D, Araç S. Surgical practices in total knee arthroplasty in Turkey. Acta Orthop Traumatol Turc 2012; 46 (04) 255-261
• 8 Mirkazemi C, Bereznicki LR, Peterson GM. Comparing Australian orthopaedic surgeons' reported use of thromboprophylaxis following arthroplasty in 2012 and 2017. BMC Musculoskelet Disord 2019; 20 (01) 57
• 9 Excellence NIfHaC. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. Updated August 2019. Accessed 2021 Aug 08, 2020 https:/www.nice.org.uk/guidance/ng89
• 10 Liu F, Chu X, Huang J, Tian K, Hua J, Tong P. Administration of enoxaparin 24 h after total knee arthroplasty: safer for bleeding and equally effective for deep venous thrombosis prevention. Arch Orthop Trauma Surg 2014; 134 (05) 679-683
• 11 Plante S, Belzile EL, Fréchette D, Lefebvre J. Analysis of contributing factors influencing thromboembolic events after total knee arthroplasty. Can J Surg 2017; 60 (01) 30-36
• 12 Runner RP, Gottschalk MB, Staley CA, Pour AE, Roberson JR. Utilization Patterns, Efficacy, and Complications of Venous Thromboembolism Prophylaxis Strategies in Primary Hip and Knee Arthroplasty as Reported by American Board of Orthopedic Surgery Part II Candidates. J Arthroplasty 2019; 34 (04) 729-734
• 13 Hunt LP, Ben-Shlomo Y, Whitehouse MR, Porter ML, Blom AW. The Main Cause of Death Following Primary Total Hip and Knee Replacement for Osteoarthritis: A Cohort Study of 26,766 Deaths Following 332,734 Hip Replacements and 29,802 Deaths Following 384,291 Knee Replacements. J Bone Joint Surg Am 2017; 99 (07) 565-575
• 14 Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial. Lancet 2000; 355 (9212): 1295-1302
• 15 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
• 16 Farey JE, An VVG, Sidhu V, Karunaratne S, Harris IA. Aspirin versus enoxaparin for the initial prevention of venous thromboembolism following elective arthroplasty of the hip or knee: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2021; 107 (01) 102606
• 17 Haykal T, Kheiri B, Zayed Y. et al. Aspirin for venous thromboembolism prophylaxis after hip or knee arthroplasty: An updated meta-analysis of randomized controlled trials. J Orthop 2019; 16 (04) 312-319
• 18 Matharu GS, Kunutsor SK, Judge A, Blom AW, Whitehouse MR. Clinical Effectiveness and Safety of Aspirin for Venous Thromboembolism Prophylaxis After Total Hip and Knee Replacement: A Systematic Review and Meta-analysis of Randomized Clinical Trials. JAMA Intern Med 2020; 180 (03) 376-384
• 19 Gali JC, Camargo DB. Thromboprophylaxis for Total Knee Arthroplasty. Rev Bras Ortop (Sao Paulo) 2019; 54 (01) 1-5
• 20 Chandrasekaran S, Ariaretnam SK, Tsung J, Dickison D. Early mobilization after total knee replacement reduces the incidence of deep venous thrombosis. ANZ J Surg 2009; 79 (7-8): 526-529
• 21 Pearse EO, Caldwell BF, Lockwood RJ, Hollard J. Early mobilisation after conventional knee replacement may reduce the risk of postoperative venous thromboembolism. J Bone Joint Surg Br 2007; 89 (03) 316-322
• 22 Elkassabany NM, Cai LF, Badiola I. et al. A prospective randomized open-label study of single injection versus continuous adductor canal block for postoperative analgesia after total knee arthroplasty. Bone Joint J 2019; 101-B [phone]
• 23 Li D, Tan Z, Kang P, Shen B, Pei F. Effects of multi-site infiltration analgesia on pain management and early rehabilitation compared with femoral nerve or adductor canal block for patients undergoing total knee arthroplasty: a prospective randomized controlled trial. Int Orthop 2017; 41 (01) 75-83
• 24 Shalhoub J, Lawton R, Hudson J. et al; GAPS trial investigators. Graduated compression stockings as adjuvant to pharmaco-thromboprophylaxis in elective surgical patients (GAPS study): randomised controlled trial. BMJ 2020; 369: m1309
• 25 Wang D, Bao F, Li Q, Teng Y, Li J. Semiautomatic intermittent pneumatic compression device applied to deep vein thrombosis in major orthopedic surgery. Biomed Eng Online 2018; 17 (01) 78
• 26 He ML, Xiao ZM, Lei M, Li TS, Wu H, Liao J. Continuous passive motion for preventing venous thromboembolism after total knee arthroplasty. Cochrane Database Syst Rev 2014; (07) CD008207
• 27 Kahn SR, Shivakumar S. What's new in VTE risk and prevention in orthopedic surgery. Res Pract Thromb Haemost 2020; 4 (03) 366-376
• 28 Parvizi J, Huang R, Rezapoor M, Bagheri B, Maltenfort MG. Individualized Risk Model for Venous Thromboembolism After Total Joint Arthroplasty. J Arthroplasty 2016; 31 (9, Suppl): 180-186
• 29 Viana LMAT, Nogueira IAL, Fontenele AMM, Oliveira LP. Thromboembolism in Arthroplasty: Compliance to Prophylaxis. Rev Bras Ortop (Sao Paulo) 2021; 56 (05) 647-655
• 30 Carvalho Júnior LH, Correa MA, Lima MR, Silvestre CB, Almeida VF, Temponi EF. Venous Thromboembolism Prevention Protocol: Experience of 2,000 Cases in Total Knee Arthroplasty. Rev Bras Ortop (Sao Paulo) 2020; 55 (04) 426-431