Pautas de manejo de trombosis venosa en miembros inferiores según la sociedad europea de cirugía vascular 2021.
Palabras clave:
Trombosis venosa profunda, Tromboembolismo venoso, Embolismo pulmonar, Ecografía por compresión de dos o tres puntos, Ecografía de toda la pierna, Síndrome antifosfolípidico, Abuso de sustancias, Heparina no fraccionada, Antagonista de la vitamina k, Heparina bajo peso molecular, Anticoagulantes orales directosResumen
La trombosis venosa profunda (TVP), es provocada por un trombo de fibrina el cual reduce el aporte sanguíneo a los tejidos circundantes. Dentro de las complicaciones reportadas en la literatura encontramos eventos embólicos pulmonares (EP), los cuales, una vez generados, desarrollan grandes repercusiones en la sobrevida de quien las padece. El diagnóstico se realiza de manera multidisciplinaria, utilizando medidas como el puntaje de Wells, medición de dímero D, venografía computarizada entre otros. La Sociedad Europea de Cirugía vascular en su guía de práctica clínica 2021, nos menciona la manera adecuada de realizar el diagnóstico, teniendo en cuenta los factores de riesgo, la clasificación según el factor desencadenante y las imágenes actualmente disponibles. Así mismo nos indica el tratamiento que se debe ofrecer en base a la localización del trombo y que medidas farmacológicas y no farmacológicas se pueden optar en diferentes escenarios clínicos. En la siguiente revisión se destacan los aspectos claves y más relevantes a tener en cuenta para el manejo de los pacientes con esta entidad.
Descargas
Citas
Sandino VM, Vega EV. Abordaje de trombosis venosa profunda en miembros inferiores. Rev Medica Sinerg [Internet]. 2020;5(2):e360.
Spencer FA, Emery C, Joffe SW, Pacifico L, Lessard D, Reed G, et al. Incidence rates, clinical profile, and outcomes of patients with venous thromboembolism. The Worcester VTE study. J Thromb Thrombolysis. 2009;28(4):401-9. DOI: 10.1007/s11239-009-0378-3
Dentali F, Ageno W, Rancan E, Donati A V, Galli L, Squizzato A, et al. Seasonal and monthly variability in the incidence of venous thromboembolism. A systematic review and a meta-analysis of the literature. Thromb Haemost. 2011;106(3):439-47. DOI: 10.1160/TH11-02-0116
Khan F, Rahman A, Carrier M, Kearon C, Weitz JI, Schulman S, et al. Long term risk of symptomatic recurrent venous thromboembolism after discontinuation of anticoagulant treatment for first unprovoked venous thromboembolism event: systematic review and meta-analysis. BMJ. 2019;366:l4363. DOI: 10.1136/bmj.l4363
Braithwaite I, Healy B, Cameron L, Weatherall M, Beasley R. Venous thromboembolism risk associated with protracted work- and computer-related seated immobility: A case-control study. JRSM Open. 2016;7(8):205427041663267. DOI: 10.1177/2054270416632670
Franchini M, Mannucci PM. ABO blood group and thrombotic vascular disease. Thromb Haemost. 2014;112(6):1103-9. DOI: 10.1160/TH14-05-0457
Heit JA, Ashrani A, Crusan DJ, McBane RD, Petterson TM, Bailey KR. Reasons for the persistent incidence of venous thromboembolism. Thromb Haemost. 2017;117(2):390-400. DOI: 10.1160/TH16-07-0509
Lee BB, Nicolaides AN, Myers K, Meissner M, Kalodiki E, Allegra C, et al. Venous hemodynamic changes in lower limb venous disease: the UIP consensus according to scientific evidence. Int Angiol. 2016;35(3):236-352.
Kakkos SK, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black SA, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg. 2021;61(1):9-82. DOI: 10.1016/j.ejvs.2020.09.023
Partsch H. Therapy of deep vein thrombosis with low molecular weight heparin, leg compression and immediate ambulation. Vasa. 2001;30(3):195-204. DOI: 10.1024/0301-1526.30.3.195
De Maeseneer MGR, Bochanen N, van Rooijen G, Neglén P. Analysis of 1,338 Patients with Acute Lower Limb Deep Venous Thrombosis (DVT) Supports the Inadequacy of the Term “Proximal DVT”. Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg. 2016;51(3):415-20. DOI: 10.1016/j.ejvs.2015.11.001
Goodacre S, Sampson F, Stevenson M, Wailoo A, Sutton A, Thomas S, et al. Measurement of the clinical and cost-effectiveness of non-invasive diagnostic testing strategies for deep vein thrombosis. Health Technol Assess. 2006;10(15):1-168. DOI: 10.3310/hta10150
Wells PS, Owen C, Doucette S, Fergusson D, Tran H. Does this patient have deep vein thrombosis? JAMA. 2006;295(2):199-207.
Stevens SM, Ageno W. Review: the Wells rule is more useful than individual clinical features for predicting risk of deep venous thrombosis. Evid Based Med. 2006;11(2):56. DOI: 10.1136/ebm.11.2.56
Stein PD, Hull RD, Patel KC, Olson RE, Ghali WA, Brant R, et al. D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review. Ann Intern Med. 2004;140(8):589-602. DOI: 10.7326/0003-4819-140-8-200404200-00005
Bernardi E, Camporese G. Diagnosis of deep-vein thrombosis. Thromb Res. 2018;163:201-6. DOI: 10.1016/j.thromres.2017.10.006
Parry BA, Chang AM, Schellong SM, House SL, Fermann GJ, Deadmon EK, et al. International, multicenter evaluation of a new D-dimer assay for the exclusion of venous thromboembolism using standard and age-adjusted cut-offs. Thromb Res. 2018;166:63-70. DOI: 10.1016/j.thromres.2018.04.003
Needleman L, Cronan JJ, Lilly MP, Merli GJ, Adhikari S, Hertzberg BS, et al.Ultrasound for Lower Extremity Deep Venous Thrombosis: Multidisciplinary Recommendations From the Society of Radiologists in Ultrasound Consensus Conference. Circulation. 2018;137(14):1505-15. DOI: 10.1161/CIRCULATIONAHA.117.030687
Gibson NS, Schellong SM, Kheir DY El, Beyer-Westendorf J, Gallus AS, McRae S, et al. Safety and sensitivity of two ultrasound strategies in patients with clinically suspected deep venous thrombosis: a prospective management study. J Thromb Haemost. 2009;7(12):2035-41. DOI: 10.1111/j.1538-7836.2009.03635.x
Righini M, Paris S, Le Gal G, Laroche J-P, Perrier A, Bounameaux H. Clinical relevance of distal deep vein thrombosis. Review of literature data. Thromb Haemost. 2006;95(1):56-64.
Karande GY, Hedgire SS, Sanchez Y, Baliyan V, Mishra V, Ganguli S, et al. Advanced imaging in acute and chronic deep vein thrombosis. Cardiovasc Diagn Ther. 2016;6(6):493-507. DOI: 10.21037/cdt.2016.12.06
Sampson FC, Goodacre SW, Thomas SM, van Beek EJR. The accuracy of MRI in diagnosis of suspected deep vein thrombosis: systematic review and meta-analysis. Eur Radiol. 2007;17(1):175-81. DOI: 10.1007/s00330-006-0178-5
Mendichovszky IA, Priest AN, Bowden DJ, Hunter S, Joubert I, Hilborne S, et al. Combined MR direct thrombus imaging and non-contrast magnetic resonance venography reveal the evolution of deep vein thrombosis: a feasibility study. Eur Radiol. 2017;27(6):2326-32. DOI: 10.1007/s00330-016-4555-4
van Dam LF, Dronkers CEA, Gautam G, Eckerbom Å, Ghanima W, Gleditsch J, et al. Magnetic resonance imaging for diagnosis of recurrent ipsilateral deep vein thrombosis. Blood. 2020;135(16):1377-85. DOI: 10.1182/blood.2019004114
Jenkins JS. Endovascular therapies to treat iliofemoral deep venous thrombosis. Prog Cardiovasc Dis. 2011;54(1):70-6. DOI: 10.1016/j.pcad.2011.03.008
Avnery O, Martin M, Bura-Riviere A, Barillari G, Mazzolai L, Mahé I, et al. D-dimer levels and risk of recurrence following provoked venous thromboembolism: findings from the RIETE registry. J Intern Med. 2020;287(1):32-41. DOI: 10.1111/joim.12969
Stein PD, Matta F, Musani MH, Diaczok B. Silent pulmonary embolism in patients with deep venous thrombosis: a systematic review. Am J Med. 2010;123(5):426-31. DOI: 10.1016/j.amjmed.2009.09.037
García-Fuster MJ, Fabia MJ, Furió E, Pichler G, Redon J, Forner MJ, et al. Should we look for silent pulmonary embolism in patients with deep venous thrombosis? BMC Cardiovasc Disord. 2014;14:178. DOI: 10.1186/1471-2261-14-178
Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, et al. Antithrombotic therapy for VTE disease: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 SUPPL.):e419S-e496S. DOI: 10.1378/chest.11-2301
Heit JA, Armasu SM, McCauley BM, Kullo IJ, Sicotte H, Pathak J, et al Identification of unique venous thromboembolism-susceptibility variants in African-Americans. Thromb Haemost. 2017;117(4):758-68.
Andras A, Sala Tenna A, Stewart M. Vitamin K antagonists versus low-molecular-weight heparin for the long term treatment of symptomatic venous thromboembolism. Cochrane database Syst Rev. 2017;7(7):CD002001. DOI: 10.1002/14651858.CD002001.pub3
Kakkos SK, Kirkilesis GI, Tsolakis IA. Editor’s Choice - efficacy and safety of the new oral anticoagulants dabigatran, rivaroxaban, apixaban, and edoxaban in the treatment and secondary prevention of venous thromboembolism: a systematic review and meta-analysis of phase III trials. Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg. 2014;48(5):565-75. DOI: 10.1016/j.ejvs.2014.05.001
Cohen AT, Hamilton M, Mitchell SA, Phatak H, Liu X, Bird A, et al. Comparison of the Novel Oral Anticoagulants Apixaban, Dabigatran, Edoxaban, and Rivaroxaban in the Initial and Long-Term Treatment and Prevention of Venous Thromboembolism: Systematic Review and Network Meta-Analysis. PLoS One. 2015;10(12):e0144856. DOI: 10.1371/journal.pone.0144856
Partsch H, Blättler W. Compression and walking versus bed rest in the treatment of proximal deep venous thrombosis with low molecular weight heparin. J Vasc Surg. 2000;32(5):861-9. DOI: 10.1067/mva.2000.110352
Amin EE, Bistervels IM, Meijer K, Tick LW, Middeldorp S, Mostard G, et al. Reduced incidence of vein occlusion and postthrombotic syndrome after immediate compression for deep vein thrombosis. Blood. 2018;132(21):2298-304. DOI: 10.1182/blood-2018-03-836783
Kearon C, Ginsberg JS, Anderson DR, Kovacs MJ, Wells P, Julian JA, et al. Comparison of 1 month with 3 months of anticoagulation for a first episode of venous thromboembolism associated with a transient risk factor. J Thromb Haemost. 2004;2(5):743-9. DOI: 10.1046/j.1538-7836.2004.00698.x
Levine MN, Hirsh J, Gent M, Turpie AG, Weitz J, Ginsberg J, et al. Optimal duration of oral anticoagulant therapy: a randomized trial comparing four weeks with three months of warfarin in patients with proximal deep vein thrombosis. Thromb Haemost. 1995;74(2):606-11.
Pinede L, Ninet J, Duhaut P, Chabaud S, Demolombe-Rague S, Durieu I, et al. Comparison of 3 and 6 months of oral anticoagulant therapy after a first episode of proximal deep vein thrombosis or pulmonary embolism and comparison of 6 and 12 weeks of therapy after isolated calf deep vein thrombosis. Circulation. 2001;103(20):2453-60. DOI: 10.1177/1358836x0100600413
Bauersachs R, Berkowitz SD, Brenner B, Buller HR, Decousus H, Gallus AS, et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010 Dec;363(26):2499-510. DOI: 10.1056/NEJMoa1007903
Turner TE, Saeed MJ, Novak E, Brown DL. Association of Inferior Vena Cava Filter Placement for Venous Thromboembolic Disease and a Contraindication to Anticoagulation With 30-Day Mortality. JAMA Netw open. 2018;1(3):e180452. DOI: 10.1001/jamanetworkopen.2018.0452
Lijfering WM, Timp JF, Cannegieter SC. Predicting the risk of recurrent venous thrombosis: What the future might bring. J Thromb Haemost. 2019;17(9):1522-6. DOI: 10.1111/jth.14534
Siragusa S, Malato A, Anastasio R, Cigna V, Milio G, Amato C, et al. Residual vein thrombosis to establish duration of anticoagulation after a first episode of deep vein thrombosis: the Duration of Anticoagulation based on Compression UltraSonography (DACUS) study. Blood. 2008;112(3):511-5. DOI: 10.1182/blood-2008-01-131656
Palareti G, Cosmi B, Legnani C, Tosetto A, Brusi C, Iorio A, et al. D-dimer testing to determine the duration of anticoagulation therapy. N Engl J Med. 2006;355(17):1780-9. DOI: 10.1056/NEJMoa054444
Weitz JI, Bauersachs R, Beyer-Westendorf J, Bounameaux H, Brighton TA, Cohen AT, et al. Two doses of rivaroxaban versus aspirin for prevention of recurrent venous thromboembolism. Rationale for and design of the EINSTEIN CHOICE study. Thromb Haemost. 2015;114(3):645-50. DOI: 10.1160/TH15-02-0131
Prins MH, Lensing AWA, Prandoni P, Wells PS, Verhamme P, Beyer-Westendorf J, et al. Risk of recurrent venous thromboembolism according to baseline risk factor profiles. Blood Adv. 2018;2(7):788-96. DOI: 10.1182/bloodadvances.2018017160
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2023 Salutem Scientia Spiritus
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
La Revista Salutem Scientia Spiritus usa la licencia Creative Commons de Atribución – No comercial – Sin derivar: Los textos de la revista son posibles de ser descargados en versión PDF siempre que sea reconocida la autoría y el texto no tenga modificaciones de ningún tipo.
