Профилактика венозного тромбоэмболизма в практике колопроктолога: исторические аспекты и современная реальность
Профилактика венозного тромбоэмболизма в практике колопроктолога: исторические аспекты и современная реальность
Кудыкин М.Н. Профилактика венозного тромбоэмболизма в практике колопроктолога: исторические аспекты и современная реальность. Consilium Medicum. 2017; 19 (8): 41–47. DOI: 10.26442/2075-1753_19.8.41-47
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Kudykin M.N. Prevention of venous thromboembolism in practice of coloproctologist: historical aspects and modern reality. Consilium Medicum. 2017; 19 (8): 41–47. DOI: 10.26442/2075-1753_19.8.41-47
Профилактика венозного тромбоэмболизма в практике колопроктолога: исторические аспекты и современная реальность
Кудыкин М.Н. Профилактика венозного тромбоэмболизма в практике колопроктолога: исторические аспекты и современная реальность. Consilium Medicum. 2017; 19 (8): 41–47. DOI: 10.26442/2075-1753_19.8.41-47
________________________________________________
Kudykin M.N. Prevention of venous thromboembolism in practice of coloproctologist: historical aspects and modern reality. Consilium Medicum. 2017; 19 (8): 41–47. DOI: 10.26442/2075-1753_19.8.41-47
Венозные тромбоэмболические осложнения (ВТЭО) могут возникнуть после любого хирургического вмешательства и осложнять течение любой патологии. Тромбоэмболия легочной артерии (ТЭЛА) признана наиболее распространенной идентифицируемой причиной смерти у госпитализированных пациентов во всем мире. Риск тромбоза глубоких вен и ТЭЛА выше при проведении хирургических вмешательств в клинике колопроктологии по сравнению с общехирургическими операциями. Частота ТЭЛА в этой популяции составляет 0,2–0,3%. Способы профилактики ВТЭО включают в себя механические средства (градуированный компрессионный трикотаж, проведение аппаратного пневмомассажа нижних конечностей) и фармакологические средства. Наилучшие результаты дает сочетание механических и фармакологических методов. Пациенты, перенесшие хирургическое вмешательство, должны быть стратифицированы в соответствии с их риском ВТЭО на основе факторов риска для пациента, связанных с заболеванием и процедурой вмешательства. Тип профилактики должен быть соизмерим с риском ВТЭО на основе профиля риска пациента.
Venous thromboembolic complications (VTEC) may occur after any surgical treatment and may complicate any kind of pathology. Pulmonary artery thromboembolism (PATE) is known as the most common identifiable cause of death in hospitalized patients around the world. The risk for deep vein thrombosis and PATE is higher in colorectal surgical procedures compared with general surgical procedures. The incidence of PATE in this population is estimated to be 0.2 to 0.3%. The measures for prevention of VTEC include mechanical methods (graduated compression stocking, intermittent pneumatic compression devices on lower-extremity) and pharmacologic agents. A combination of mechanical and pharmacological methods shows the best results. Patients underwent surgery should be stratified according to their risk of VTEC based on patient risk factors, disease-related risk factors, and procedure-related risk factors. The type of prevention should be commensurate with the risk of VTEC based on the risk profile of patient.
1. McLeod RS, Geerts WH, Sniderman KW et al. Canadian Colorectal Surgery DVT Prophylaxis Trial investigators. Subcutaneous heparin versus low-molecular-weight heparin as thromboprophylaxis in patients undergoing colorectal surgery: results of the canadian colorectal DVT prophylaxis trial: a randomized, double-blind trial. Ann Surg 2001; 233 (3): 438–44.
2. Wiseman DN, Harrison J. A retrospective review of the use of thromboprophylaxis in patients who subsequently developed a venous thromboembolism after discharge from hospital. N Z Med J 2010; 123 (1309): 37–49.
3. Zaghiyan KN, Sax HC, Miraflor E et al. Cedars-Sinai DVT Study Group. Timing of Chemical Thromboprophylaxis and Deep Vein Thrombosis in Major Colorectal Surgery: A Randomized Clinical Trial. Ann Surg 2016; 264 (4): 632–9. DOI: 10.1097/SLA.0000000000001856
4. Yun JL, Li XY. Prevalence of pulmonary embolism at autopsy among elderly patients in a Chinese general hospital. J Geriatr Cardiol 2016; 13 (11): 894–8. DOI: 10.11909/j.issn.1671-5411.2016.11.003
5. Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979–1998: an analysis using multiple-cause mortality data. Arch Intern Med 2003; 163 (14): 1711–7.
6. Lindblad B, Eriksson A, Bergqvist D. Autopsy-verified pulmonary embolism in a surgical department: analysis of the period from 1951 to 1988. Br J Surg 1991; 78 (7): 849–52.
7. Stein P D, Henry J W. Prevalence of acute pulmonary embolism among patients in a general hospital and at autopsy. Chest 1995; 108 (4): 978–81.
8. White RH, Zhou H, Romano PS. Incidence of symptomatic venous thromboembolism after different elective or urgent surgical procedures. Thromb Haemost 2003; 90 (3): 446–55.
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12. Heit JA, Silverstein MD, Mohr DN et al. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 2000; 160 (6): 809–15.
13. Fleming FJ, Kim MJ, Salloum RM et al. How much do we need to worry about venous thromboembolism after hospital discharge? A study of colorectal surgery patients using the National Surgical Quality Improvement Program database. Dis Colon Rectum 2010; 53 (10): 1355–60.
14. Geerts WH, Heit JA, Clagett GP et al. Prevention of venous thromboembolism. Chest 2001; 119 (Suppl. 1): 132S–175S.
15. Bustos Merlo AB, Arcelus Martínez JI, Turiño Luque JD et al.; miembros del grupo RIETE. Form of presentation, natural history and course of postoperative venous thromboembolism in patients operated on for pelvic and abdominal cancer. Analysis of the RIETE registry. Cir Esp 2017; 95 (6): 328–34. DOI: 10.1016/j.ciresp.2017.05.006
16. Moghadamyeghaneh Z, Hanna MH, Carmichael JC et al. A nationwide analysis of postoperative deep vein thrombosis and pulmonary embolism in colon and rectal surgery. J Gastrointest Surg 2014; 18 (12): 2169–77. DOI: 10.1007/s11605-014-2647-5
17. Stratton MA, Anderson FA, Bussey HI et al. Prevention of venous thromboembolism: adherence to the 1995 American College of Chest Physicians consensus guidelines for surgical patients. Arch Intern Med 2000; 160 (3): 334–40.
18. Litter J. Thromboembolism; its prophylaxis and medical treatment; recent advances. Med Clin North Am 1952; 36 (5): 1309–21.
19. Lewis CE Jr, Antoine J, Mueller C et al. Elastic compression in the prevention of venous stasis. A critical reevaluation. Am J Surg 1976; 132 (6): 739–43.
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21. Agu O, Hamilton G, Baker D. Graduated compression stockings in the prevention of venous thromboembolism. Br J Surg 1999; 86 (8): 992–1004.
22. Allan A, Williams JT, Bolton JP, Le Quesne LP. The use of graduated compression stockings in the prevention of postoperative deep vein thrombosis. Br J Surg 1983; 70 (3): 172–4.
23. Kakkos SK, Daskalopoulou SS, Daskalopoulos ME et al. Review on the value of graduated elastic compression stockings after deep vein thrombosis. Thromb Haemost 2006; 96 (4): 441–5.
24. Amaragiri SV, Lees TA. Elastic compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev 2000; (3): CD001484.
25. Allwood MJ. The effect of an increased local pressure gradient on blood flow in the foot. Clin Sci (Lond) 1957; 16 (2): 231–9.
26. Chen AH, Frangos SG, Kilaru S, Sumpio BE. Intermittent pneumatic compression devices–physiological mechanisms of action. Eur J Vasc Endovasc Surg 2001; 21 (5): 383–92.
27. Comerota AJ Chouhan V Harada RN et al. The fibrinolytic effects of intermittent pneumatic compression: mechanism of enhanced fibrinolysis Ann Surg 1997; 226 (3): 306–13.
28. Morris RJ, Woodcock JP. Evidence-based compression: prevention of stasis and deep vein thrombosis. Ann Surg 2004; 239 (2): 162–71.
29. Salzman EW, McManama GP, Shapiro AH et al. Effect of optimization of hemodynamics on fibrinolytic activity and antithrombotic efficacy of external pneumatic calf compression. Ann Surg 1987; 206 (5): 636–41.
30. Proctor MC, Greenfield LJ, Wakefield TW, Zajkowski PJ. A clinical comparison of pneumatic compression devices: the basis for selection J Vasc Surg 2001; 34(3): 459–63.
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1. McLeod RS, Geerts WH, Sniderman KW et al. Canadian Colorectal Surgery DVT Prophylaxis Trial investigators. Subcutaneous heparin versus low-molecular-weight heparin as thromboprophylaxis in patients undergoing colorectal surgery: results of the canadian colorectal DVT prophylaxis trial: a randomized, double-blind trial. Ann Surg 2001; 233 (3): 438–44.
2. Wiseman DN, Harrison J. A retrospective review of the use of thromboprophylaxis in patients who subsequently developed a venous thromboembolism after discharge from hospital. N Z Med J 2010; 123 (1309): 37–49.
3. Zaghiyan KN, Sax HC, Miraflor E et al. Cedars-Sinai DVT Study Group. Timing of Chemical Thromboprophylaxis and Deep Vein Thrombosis in Major Colorectal Surgery: A Randomized Clinical Trial. Ann Surg 2016; 264 (4): 632–9. DOI: 10.1097/SLA.0000000000001856
4. Yun JL, Li XY. Prevalence of pulmonary embolism at autopsy among elderly patients in a Chinese general hospital. J Geriatr Cardiol 2016; 13 (11): 894–8. DOI: 10.11909/j.issn.1671-5411.2016.11.003
5. Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979–1998: an analysis using multiple-cause mortality data. Arch Intern Med 2003; 163 (14): 1711–7.
6. Lindblad B, Eriksson A, Bergqvist D. Autopsy-verified pulmonary embolism in a surgical department: analysis of the period from 1951 to 1988. Br J Surg 1991; 78 (7): 849–52.
7. Stein P D, Henry J W. Prevalence of acute pulmonary embolism among patients in a general hospital and at autopsy. Chest 1995; 108 (4): 978–81.
8. White RH, Zhou H, Romano PS. Incidence of symptomatic venous thromboembolism after different elective or urgent surgical procedures. Thromb Haemost 2003; 90 (3): 446–55.
9. Sandler DA, Martin JF. Autopsy proven pulmonary embolism in hospital patients: are we detecting enough deep vein thrombosis? J R Soc Med 1989; 82 (4): 203–5.
10. Dismuke SE, Wagner EH. Pulmonary embolism as a cause of death. The changing mortality in hospitalized patients. JAMA 1986; 255 (15): 2039–42.
11. Khorana AA, Francis CW, Culakova E et al. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost 2007; 5 (3): 632–4.
12. Heit JA, Silverstein MD, Mohr DN et al. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 2000; 160 (6): 809–15.
13. Fleming FJ, Kim MJ, Salloum RM et al. How much do we need to worry about venous thromboembolism after hospital discharge? A study of colorectal surgery patients using the National Surgical Quality Improvement Program database. Dis Colon Rectum 2010; 53 (10): 1355–60.
14. Geerts WH, Heit JA, Clagett GP et al. Prevention of venous thromboembolism. Chest 2001; 119 (Suppl. 1): 132S–175S.
15. Bustos Merlo AB, Arcelus Martínez JI, Turiño Luque JD et al.; miembros del grupo RIETE. Form of presentation, natural history and course of postoperative venous thromboembolism in patients operated on for pelvic and abdominal cancer. Analysis of the RIETE registry. Cir Esp 2017; 95 (6): 328–34. DOI: 10.1016/j.ciresp.2017.05.006
16. Moghadamyeghaneh Z, Hanna MH, Carmichael JC et al. A nationwide analysis of postoperative deep vein thrombosis and pulmonary embolism in colon and rectal surgery. J Gastrointest Surg 2014; 18 (12): 2169–77. DOI: 10.1007/s11605-014-2647-5
17. Stratton MA, Anderson FA, Bussey HI et al. Prevention of venous thromboembolism: adherence to the 1995 American College of Chest Physicians consensus guidelines for surgical patients. Arch Intern Med 2000; 160 (3): 334–40.
18. Litter J. Thromboembolism; its prophylaxis and medical treatment; recent advances. Med Clin North Am 1952; 36 (5): 1309–21.
19. Lewis CE Jr, Antoine J, Mueller C et al. Elastic compression in the prevention of venous stasis. A critical reevaluation. Am J Surg 1976; 132 (6): 739–43.
20. Arcelus JI, Caprini JA, Hoffman KN et al. Modifications of plasma levels of tissue factor pathway inhibitor and endothelin-1 induced by a reverse Trendelenburg position: influence of elastic compression-preliminary results. J Vasc Surg 1995; 22 (5): 568–72.
21. Agu O, Hamilton G, Baker D. Graduated compression stockings in the prevention of venous thromboembolism. Br J Surg 1999; 86 (8): 992–1004.
22. Allan A, Williams JT, Bolton JP, Le Quesne LP. The use of graduated compression stockings in the prevention of postoperative deep vein thrombosis. Br J Surg 1983; 70 (3): 172–4.
23. Kakkos SK, Daskalopoulou SS, Daskalopoulos ME et al. Review on the value of graduated elastic compression stockings after deep vein thrombosis. Thromb Haemost 2006; 96 (4): 441–5.
24. Amaragiri SV, Lees TA. Elastic compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev 2000; (3): CD001484.
25. Allwood MJ. The effect of an increased local pressure gradient on blood flow in the foot. Clin Sci (Lond) 1957; 16 (2): 231–9.
26. Chen AH, Frangos SG, Kilaru S, Sumpio BE. Intermittent pneumatic compression devices–physiological mechanisms of action. Eur J Vasc Endovasc Surg 2001; 21 (5): 383–92.
27. Comerota AJ Chouhan V Harada RN et al. The fibrinolytic effects of intermittent pneumatic compression: mechanism of enhanced fibrinolysis Ann Surg 1997; 226 (3): 306–13.
28. Morris RJ, Woodcock JP. Evidence-based compression: prevention of stasis and deep vein thrombosis. Ann Surg 2004; 239 (2): 162–71.
29. Salzman EW, McManama GP, Shapiro AH et al. Effect of optimization of hemodynamics on fibrinolytic activity and antithrombotic efficacy of external pneumatic calf compression. Ann Surg 1987; 206 (5): 636–41.
30. Proctor MC, Greenfield LJ, Wakefield TW, Zajkowski PJ. A clinical comparison of pneumatic compression devices: the basis for selection J Vasc Surg 2001; 34(3): 459–63.
31. Urbankova J, Quiroz R, Kucher N, Goldhaber SZ. Intermittent pneumatic compression and deep vein thrombosis prevention. A meta-analysis in postoperative patients. Thromb Haemost 2005; 94 (6): 1181–85.
32. Kakkos SK, Caprini JA, Geroulakos G et al. Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism in high-risk patients. Cochrane Database Syst Rev 2008; 4: CD005258.
33. Wille-Jørgensen P, Rasmussen MS, Andersen BR, Borly L. Heparins and mechanical methods for thromboprophylaxis in colorectal surgery. Cochrane Database Syst Rev 2004; 1: CD001217.
34. Weitz JI. Low-molecular-weight heparins. N Engl J Med 1997; 337 (10): 688–98.
35. White RH, Ginsberg JS. Low-molecular-weight heparins: are they all the same? Br J Haematol 2003; 121 (1): 12–20.
36. International Multicentre Trial. Prevention of fatal postoperative pulmonary embolism by low doses of heparin. An international multicentre trial. Lancet 1975; 2 (7924): 45–51.
37. Bergqvist D et al. ENOXACAN Study Group. Efficacy and safety of enoxaparin versus unfractionated heparin for prevention of deep vein thrombosis in elective cancer surgery: a double-blind randomized multicentre trial with venographic assessment. Br J Surg. 1997; 84 (8): 1099–103.
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Авторы
М.Н.Кудыкин
ФГБУ «Приволжский федеральный медицинский исследовательский центр» Минздрава России. 603155, Россия, Нижний Новгород, Верхне-Волжская наб., д. 18 mady5@yandex.ru
________________________________________________
M.N.Kudykin
Volga Region Federal Medical Research Center of the Ministry of Health of the Russian Federation. 603155, Russian Federation, Nizhny Novgorod, Verkhne-Volzhskaia nab., d. 18 mady5@yandex.ru