Arcelus Juan Ignacio, Monreal Manuel, Caprini Joseph A, Guisado Javier Gutiérrez, Soto Maria José, Núñez Manuel Jesús, Alvárez Juan Carlos
Departamento de Cirugía de la Universidad de Granada y Hospital Virgen de las Nieves, Granada, Spain.
Thromb Haemost. 2008 Mar;99(3):546-51. doi: 10.1160/TH07-10-0611.
There is little literature about the clinical presentation and time-course of postoperative venous thromboembolism (VTE) in different surgical procedures. RIETE is an ongoing, prospective registry of consecutive patients with objectively confirmed, symptomatic acute VTE. In this analysis, we analysed the baseline characteristics, thromboprophylaxis and therapeutic patterns, time-course, and three-month outcome of all patients with postoperative VTE. As of January 2006, there were 1,602 patients with postoperative VTE in RIETE: 393 (25%) after major orthopaedic surgery (145 elective hip arthroplasty, 126 knee arthroplasty, 122 hip fracture); 207 (13%) after cancer surgery; 1,002 (63%) after other procedures. The percentage of patients presenting with clinically overt pulmonary embolism (PE) (48%, 48%, and 50% respectively), the average time elapsed from surgery to VTE (22 +/- 16, 24 +/- 16, and 21 +/- 15 days, respectively), and the three-month incidence of fatal PE (1.3%, 1.4%, and 0.8%, respectively), fatal bleeding (0.8%, 1.0%, and 0.2%, respectively), or major bleeding (2.3%, 2.9%, and 2.8%, respectively) were similar in the three groups. However, the percentage of patients who had received thromboprophylaxis (96%, 76% and 52%, respectively), the duration of prophylaxis (17 +/- 9.6, 13 +/- 8.9, and 12 +/- 11 days, respectively) and the mean daily doses of low-molecular-weight heparin (4,252 +/- 1,016, 3,260 +/- 1,141, and 3,769 +/- 1,650 IU, respectively), were significantly lower in those undergoing cancer surgery or other procedures. In conclusion, the clinical presentation, time-course, and three-month outcome of VTE was similar among the different subgroups of patients, but the use of prophylaxis in patients undergoing cancer surgery or other procedures was suboptimal.
关于不同外科手术中术后静脉血栓栓塞症（VTE）的临床表现和病程的文献较少。RIETE是一项正在进行的、对有客观确诊的症状性急性VTE的连续患者进行前瞻性登记的研究。在本分析中，我们分析了所有术后VTE患者的基线特征、血栓预防和治疗模式、病程以及三个月的结局。截至2006年1月，RIETE中有1602例术后VTE患者：393例（25%）在大型骨科手术后（145例择期髋关节置换术、126例膝关节置换术、122例髋部骨折）；207例（13%）在癌症手术后；1002例（63%）在其他手术后。三组中出现临床明显肺栓塞（PE）的患者百分比（分别为48%、48%和50%）、从手术到VTE的平均时间（分别为22±16、24±16和21±15天）以及三个月致命PE的发生率（分别为1.3%、1.4%和0.8%）、致命出血（分别为0.8%、1.0%和0.2%）或大出血（分别为2.3%、2.9%和2.8%）相似。然而，接受血栓预防的患者百分比（分别为96%、76%和52%）、预防持续时间（分别为17±9.6、13±8.9和12±11天）以及低分子量肝素的平均每日剂量（分别为4252±1016、3260±1141和3769±1650 IU）在癌症手术或其他手术患者中显著较低。总之，VTE的临床表现、病程和三个月结局在不同亚组患者中相似，但癌症手术或其他手术患者的预防措施使用并不理想。
