Atualização em tromboprofilaxia em cirurgias eletivas da coluna
                  vertebral. Revisão sistemática

Oliveira, Leonardo; Marchi, Luis; Pimenta, Luiz

doi:10.1590/S1808-18512014130200413

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Systematic Review • Coluna/Columna 13 (02) • 2014 • https://doi.org/10.1590/S1808-18512014130200413 copiar

Atualização em tromboprofilaxia em cirurgias eletivas da coluna vertebral. Revisão sistemática

Autoria SCIMAGO INSTITUTIONS RANKINGS

O tromboembolismo venoso (TEV) e a tromboembolia pulmonar (TEP) apresentam elevada incidência no pós-operatório, sendo de alto risco na prática cirúrgica. Embora já exista consenso sobre tromboprofilaxia em cirurgias ortopédicas, na cirurgia de coluna, a conduta ainda é controversa. Neste artigo, analisamos e discutimos as diferentes tromboprofilaxias publicadas na literatura, a fim de desenvolver orientações sobre medidas profiláticas em cirurgia da coluna, melhorando os resultados do paciente e reduzindo os problemas médico-legais que possam surgir a partir de uma complicação trombótica.

Tromboembolia venosa; Embolia pulmonar; Coluna vertebral/cirurgia; Complicações pós-operatórias

		Study design	Type of surgical procedure	Number of patients	Prophylaxis	Incidence of VTE	Incidence of symptomatic PTE	Diagnostic method
1	Yoshioka et al¹⁰	Comparativeprospective	Lumbar or lower thoracic decompression with or without instrumentation Cervical decompression with or without instrumentation Spinal tumors	340	Mechanical (compression stockings and intermittent pneumatic compression devices)	13.5%	2.9%	Duplex US
2	Oglesby et al¹¹	Retrospectivedatabase analysis	Posterior and anterior cervical fusion Posterior cervicaldecompression	273,396	Not available	0.38%	0.15%	Not available
3	Fineberg et al¹²	Retrospectivedatabase analysis	Lumbar fusion or decompression	578,457	Not available	0.34%	0.18%	Not available
4	Al-Dujaili et al¹³	Single centerprospective	Spinal sugery (excluding facetary inflitration, vertebroplasty, epidural injection, and thermocoagulation of the medial branch)	158	Mechanical(compression stockings) Chemical (low molecular weight heparin)	0.63%	Zero	Clinical and Doppler US
5	Gephart et al¹⁴	Retrospective database analysis	Spinal fusion	430,081	Not available	0.4%	not available	Not available
6	Kim et al¹⁵	Retrospective database analysis	Spinal fusion	3331	Not available	0.24%	1%	Spiral CT
7	Takahashi et al¹⁶	Retrospective database analysis	Lumbar fusion ordecompression	1975	Without prophylaxis Intermittent pneumatic compression devices and compression stockings	19%	0.56%	D-Dimer
8	Cunninghamet al¹⁷	Retrospective database analysis	Spinal surgery	3870	Without prophylaxisChemoprophylaxis	0.28%	0.31%	Not available
9	Yoshiiwa et al¹⁸	Retrospective database analysis	Spinal surgery	88	Mechanical (compression stockings and intermittent pneumatic compression devices)	5.68%	2.27%	D-DImer
10	Smith et al¹⁹	Retrospective analysis of prospectively collected data	Lumbar microdiscectomy Anterior cervical fusion Lumbar decompression	108,419	Not available	0.12%	0.14%	Not available
11	Schizas et al²⁰	Single centerprospective	Lumbar fusion ordecompression	270	Compression stockings and low molecular weight heparin	not available	2.22%	Spiral CT
12	Piasecki et al²¹	Single center prospective	Anterior posterior reconstruction of spinal deformity	66	Mechanical (compression stockings and intermittent pneumatic compression devices)	9.1%	7.6%	Magnetic resonance venography, Doppler US, and Spiral CT
13	Epstein²²	Single center prospective	Posterior fusion with instrumentation and laminectomy	139	Compression stockings	2.8%	0.7%	Doppler US
14	Oskouian and Johnson²³	Retrospective database analysis	Anterior thoracic and lumbar spinal reconstruction	207	Not available	2.42%	0.48%	Not available
15	Oda et al²⁴	Single center prospective	Posterior spinal surgery	110	Without prophylaxis	15.5%	0%	Bilateral ascending venography
16	Lee et al²⁵	Single center prospective	Major spinal surgery	313	Without prophylaxis	1.3%	0%	Duplex US
17	Dearborn et al²⁶	Retrospective database analysis	Major spinal surgery	116	Mechanical (compression stockings and intermittent pneumatic compression devices)	0.86%	2.2%	Duplex US
18	Rajaramanet al²⁷	Single center prospective	Anterior spinal surgery	50	Not available	1.67%	0%	Doppler US
19	Wood et al²⁸	Prospective, comparative, and randomized	Major spinal surgery	136	Pneumatic compression stockings or pneumatic thigh compression bandages	1.47%	0.74%	Duplex US
20	Rokito et al²⁹	Single center prospective	Major spinal surgery	329	Compression stockings of the thigh, calf, or a low dose of coumadin	0.3%	0%	Doppler US
21	Nelson et al³⁰	Single center prospective	Posterior spinal fusion	117	Compression stockings and intermittent pneumatic compression pumps	0%	0%	Duplex US
22	Smith et al³¹	Single center prospective	Spinal reconstruction	317	Compression stockings and intermittent pneumatic compression devices	0.95%	0.32%	Duplex US
23	Ferree³²	Single center prospective	Lumbar laminectomy	60	Compression stockings	5%	0%	Not available
24	Ferree andWright³³	Single center prospective	Posterior spinal surgery	185	Elastic compression stockings or intermittent pneumatic compression devices	2.16%	not available	Duplex US
25	Ferree et al³⁴	Single center prospective	Spinal surgery	86	Not available	6%	not available	Not available
26	West andAnderson³⁵	Single center prospective	Posterior spinal surgery	41	Not available	14%	not available	Duplex Doppler US

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[1] Correspondence: Rua Vergueiro, 1421, Sala 305 - 04101-000 São Paulo, SP, Brazil. Leonardo@patologiadacoluna.com.br