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Profilaxia Farmacológica da Trombose Venosa Profunda: Quais as implicações e condutas? Ricardo Lopes da Silva TSA-SBA

Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90

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Page 1: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90

Profilaxia Farmacológica da Trombose Venosa Profunda:Quais as implicações e condutas?

Ricardo Lopes da Silva

TSA-SBA

Page 2: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90

SANGRAMENTO

TVP

Page 3: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90

Trombose Venosa Profunda

Definição

Incidência

Page 4: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90

Grupos de Riscos

Idade > 60 anos

História de TVP

Anestesia > 2 horas

Repouso > 4 dias

Longa Hospitalização

Sexo Masculino

Sepsi

Gestação

Pós parto

Câncer

Page 5: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90

Grupos de Riscos

Page 6: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90

Risco de Sangramento

Page 7: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90

Risco de Sangramento

Page 8: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90

Risco de Sangramento

Page 9: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90
Page 10: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90

AnticoagulantesAntagonistas da Vitamina k

Inibidores direto do Fator Xa

Inibidor indireto do Fator Xa

Inibidores indiretos da Trombina

Inibidores direto da Trombina

Antiagregante Plaquetário

Rivroxabam

ApixabamFondaparinuxIdraparinux

HEPARINAS

Aspirina

DabigatranArgatroban

Page 11: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90

N Engl J Med 1996; 335: 701-7

Page 12: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90

N Engl J Med 1996; 335: 701-7

Page 13: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90

N Engl J Med 1996; 335: 701-7

Page 14: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90
Page 15: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90
Page 16: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90
Page 17: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90
Page 18: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90
Page 19: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90
Page 20: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90
Page 21: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90
Page 22: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90
Page 23: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90
Page 24: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90

GUIDELINECIRURGIA Caprini Recomendação Evidência

Abdominal 3-4 HBPM 2B

Oncológica Independe HBPM 1B

Cardíaca Independe HBPM 2C

Torácica 3-4 HBPM 2B

Torácica >5 HBPM 1B

Neurocirurgia >5 HBPM* 2C

Trauma Independe HBPM 2C

Ortopédicas Independente HBPM 1B

Page 25: Profilaxia Farmacológica da Trombose Venosa Profunda€¦ · Craniotomy Spinal surgery Spinal trauma Reconstructive procedures involving free flap Cardiac surgery Use of aspirin90