Berliner Shlomo, Shapira Itzhak
Harefuah. 2008 Oct;147(10):779-80, 838.
Recent studies have documented the utility of using heparin, and especially low molecular heparin, for the prevention of venous thromboembolism (VTE) in surgical patients. However, this approach might not be essential in individuals at low VTE risk and following minor surgical interventions. Arthroscopic surgery might be considered minor surgery but at times is performed in individuals with established risk factors for VTE. Furthermore, some arthroscopic procedures include tissue damage that is not necessarily trivial, and in addition, documented cases of VTE events, some of them even fatal, appeared in the literature. By now, most researchers agree that it is essential to adopt an individualized risk stratification to single out individuals who might benefit from a prophylactic approach that might include early mobilization, and mechanical devices, as well as heparins. Thus, despite the clearly low prevalence of documented VTE following arthroscopic surgery, one might not accept potential life threatening events following these relatively low risk procedures. Therefore, patients might benefit from a personalized risk-benefit equation before each particular intervention.
最近的研究已经证明,使用肝素,尤其是低分子肝素,对于预防外科手术患者的静脉血栓栓塞症(VTE)是有用的。然而,对于VTE风险较低以及接受小型手术干预的个体而言,这种方法可能并非必不可少。关节镜手术可能被视为小型手术,但有时是在具有VTE既定风险因素的个体中进行的。此外,一些关节镜手术会造成并非微不足道的组织损伤,而且,文献中出现了VTE事件的记录案例,其中一些甚至是致命的。到目前为止,大多数研究人员一致认为,采用个体化风险分层以挑选出可能从包括早期活动、机械装置以及肝素在内的预防性方法中获益的个体至关重要。因此,尽管关节镜手术后记录在案的VTE发生率明显较低,但人们可能无法接受这些相对低风险手术之后出现的潜在危及生命的事件。所以,在每次特定干预之前,患者可能会从个性化的风险效益权衡中受益。