Preferences and Practices of Brazilian Orthopedists for Thromboprophylaxis Techniques in Total Knee Arthroplasty: Survey Among Members of the Brazilian Society of Knee Surgery (SBCJ) / Preferências e práticas de ortopedistas brasileiros por técnicas de tromboprofilaxia na artroplastia total do joelho: Levantamento entre membros da Sociedade Brasileira de Cirurgia do Joelho (SBCJ)

Abstract Objective The present study describes the preferences and current practices of a sample of knee surgeons in Brazil regarding thromboprophylaxis in total knee arthroplasty (TKA). Method In the present internet survey, surgeons from the Brazilian Knee Surgery Society (SBCJ, in the Portuguese acronym) voluntarily answered an anonymous questionnaire including time of personal surgical experience, perceptions about the best thromboprophylaxis options, and actual practices in their work environment. Results From December 2020 to January 2021, 243 participants answered the questionnaire. All, except for 3 (1.2%), reported using thromboprophylaxis, and most (76%) combined pharmacological and mechanical techniques. The most prescribed drug was enoxaparin (87%), which changed to rivaroxaban (65%) after discharge. The time of thromboprophylaxis initiation varied according to the length of training of the knee surgeon (p ≤ 0.03), and their preferences and practices differed according to the Brazilian region (p< 0.05) and the health system in which the surgeons work (public or private sector; p= 0.024). The option for mechanical thromboprophylaxis also depended on the training time of the surgeon. Conclusion Thromboprophylaxis preferences and practices in TKA are diverse across Brazilian regions and health systems (public or private sectors). Given the lack of a national clinical guideline, most orthopedists follow either their hospital guidelines or none. The mechanical prophylaxis method and the little use of aspirin are the points that most diverge from international guidelines and practices.

Resumo Objetivo Descrever as preferências e práticas atuais de uma amostra de cirurgiões de joelho do Brasil quanto à forma de tromboprofilaxia na artroplastia total do joelho (ATJ). Método presente pesquisa realizada pela internet, cirurgiões associados à Sociedade Brasileira de Cirurgia do Joelho (SBCJ) foram convidados a responder voluntariamente a um questionário anônimo incluindo o tempo de experiência cirúrgica pessoal, percepções sobre as melhores opções de tromboprofilaxia e as reais práticas no ambiente onde trabalham. Resultados Entre dezembro de 2020 e janeiro de 2021, 243 participantes responderam ao questionário completo. Exceto por 3 (1,2%) participantes, todos declararam praticar tromboprofilaxia, a maioria (76%) combinando as formas farmacológica e mecânica. A droga mais prescrita é a enoxaparina (87%), com modificação para rivaroxabana (65%) após a alta. O momento de início da tromboprofilaxia variou conforme o tempo de formação do cirurgião de joelho (p ≤ 0,03) e as preferências e práticas variaram conforme a região do país (p< 0,05) e o sistema de saúde no qual trabalham os cirurgiões (público ou privado; p= 0,024). A opção por tromboprofilaxia mecânica também dependeu do tempo de formação do cirurgião. Conclusão As preferências e práticas de tromboprofilaxia na ATJ são diversas nas regiões do Brasil e sistemas de saúde (público ou privado). Dada a inexistência de uma diretriz clínica nacional, a maior parte dos ortopedistas segue ou a diretriz de seu próprio hospital ou nenhuma. O método de profilaxia mecânica e a pouca utilização do ácido acetilsalicílico são os pontos que mais destoam das diretrizes e práticas internacionais.

Evidence summary of intermittent pneumatic compression devices in preventing venous thromboembolism for trauma patients / 中国实用护理杂志

Objective:To summarize the best evidence for intermittent pneumatic compression devices in preventing venous thromboembolism for trauma patients.Methods:According to "6S" evidence model, computer evidence retrieval was carried out. Guidelines, clinical decisions, evidence summaries, expert consensuses, and systematic reviews regarding intermittent pneumatic compression in preventing of venous thromboembolism for trauma patients were considered. The retrieval time limit was from the establishment of the database to October 31, 2021. Two researchers independently appraised articles, and extracted data for eligible studies.Results:A total of 21 articles were enrolled, including 13 guidelines, 1 clinical decision, 1 evidence summary, 2 expert consensuses, 4 systematic reviews. Totally 27 items of best evidence were summarized from four aspects: pretherapeutic evaluation, contraindications and applicable conditions, therapeutic strategies, training and education.Conclusions:This study summarized the best evidence of using intermittent pneumatic compression devices to prevent venous thromboembolism for trauma patients, which can provide evidence-based practice bases for nurses to implement scientific and effective standardized management of mechanical thromboprophylaxis. It is necessary to select evidence according to clinical practice and patients ′ wishes, so as to improve the effectiveness of using IPC in preventing thrombosis.

Adaptation and Effects of the Evidence-based IPC Nursing Protocol on Prevention of Postoperative Venous Thromboembolism / 간호행정학회지

PURPOSE: This study was conducted to adapt the standardized evidence-based nursing protocol using the IPC (intermittent pneumatic compression) intervention to prevent venous thromboembolism in surgical patients. Further, an investigation was done to measure knowledge on prevention of venous thromboembolism, surrogate incidence of venous thromboembolism and to assess IPC compliance in the study patients compared with those in surgical patients who underwent IPC intervention due to previous clinical experience. METHODS: An analysis was done of the nine modules suggested by National Evidence-based Healthcare Collaborating Agency (NECA) in the adaptation manual of the clinical practice guideline for protocol adaptation. A nonequivalent control group post test design as a quasi-experiment was used to verify the effect of the IPC protocol. RESULTS: There was a significant difference in knowledge of prevention of venous thromboembolism, IPC application time after intervention and the number of IPC applications between the experimental group (n=50) using the IPC nursing protocol and the control group (n=49). However, the symptoms of deep vein thrombosis and pulmonary thromboembolism were not observed in either the experimental group or the control group after the intervention. CONCLUSION: Results confirm that the standardized IPC nursing protocol provides effective intervention to prevent venous thromboembolism in surgical patients.

Avaliação linfocintilográfica qualitativa de pacientes com linfedema de membros inferiores tratados com compressão pneumática intermitente por quatro semanas / Qualitative lymphoscintigraphic evaluation of patients with lower limb lymphedema, treated with sequential intermittent pneumatic compression for four weeks

Introdução: O tratamento conservador do linfedema periférico consta de drenagem linfática manual, exercícios terapêuticos, contenção elástica e inelástica e também a compressão pneumática intermitente sequencial. Objetivo: Avaliar o efeito da compressão pneumática intermitente sequencial associada ao uso de contenção inelástica e elástica e exercícios miolinfocinéticos, durante quatro semanas, em pacientes com linfedema das extremidades inferiores, utilizando a análise qualitativa da linfocintilografia e a perimetria. Material e métodos: Dez pacientes portadores de linfedema das extremidades inferiores selecionados por conveniência, totalizando 14 membros acometidos, foram submetidos a quatro semanas de tratamento com compressão pneumática intermitente sequencial, contenção inelástica e elástica e exercícios miolinfocinéticos. Para a avaliação dos membros realizou-se a análise qualitativa da linfocintilografia e também a perimetria dos membros antes e após o tratamento proposto. Resultados: Não foi encontrada diferença estatisticamente significativa nos achados linfocintilográficos pré e pós-tratamento. Contudo, encontrou-se redução significativa da perimetria dos membros (p < 0,01) cuja redução máxima encontrada foi de 5,9% na perimetria do tornozelo e a mínima de 1,8% na perimetria da coxa. Conclusão: O tratamento realizado foi eficaz na redução da perimetria do membro tratado, porém não foi observada alteração significativa nos padrões linfocintilográficos qualitativos para estes pacientes. (AU)

Introduction: Conservative treatment of peripheral lymphedema consists of manual lymphatic drainage, therapeutic exercises, elastic and inelastic compression and sequential intermittent pneumatic compression. Objective: The objective of this study was to evaluate the effect of four weeks of sequential intermittent pneumatic compression combined with elastic and inelastic compression and lymphokinetic exercises on patients with lymphedema of the lower extremities by means of qualitative analysis with lymphoscintigraphy and circumference measurements. Methods: Ten people with lymphedema of the lower limbs, totaling 14 limbs treated, selected by convenience, underwent lymphoscintigraphy before and after four weeks of treatment with sequential intermittent pneumatic compression, elastic and inelastic sleeves and lymphokinetic exercises. For evaluating limbs, were carried out qualitative analysis of lymphoscintigraphy and also circumference measurements before and after the proposed treatment. Results: No statistically significant differences were detected in lymphoscintigraphic findings before and after treatment. However, there was a significant reduction in the circumference measurements (p <0.01) of the limbs. The maximum reduction was found 5.9% in the ankle circumference and the minimum was 1.8% thigh circumference. Conclusion: The treatment was effective at reducing limb circumference, however, no significant changes were observed on the qualitative lymphoscintigraphic analysis for these patients. (AU)

Prevention of venous thromboembolism after primary intracerebral hemorrhage / 国际脑血管病杂志

Venous thromboembolism includes deep venous thrombosis and pulmonary embolism. It is a more common and preventable complication in neurology. The prevention of venous thromboembolism is an important component in the treatment of the patients with cerebral hemorrhage. The measures include mechanical prevention and drug prevention. The mechanical prevention measures include intermittent pneumatic compression devices and pressure gradient elastic stockings. Studies have suggested that anticoagulants also plays an important role in the prevention of venous thromboembolism. The comprehensive and systematic understanding of the prevention of venous thromboembolism wil help to guide the clinical therapy and improve the outcomes of patients after primary intracerebral hemorrhage.

Terapias compressivas no tratamento de úlcera venosa: estudo bibliométrico / Terapias compresivas en el tratamiento de úlcera venosa: estudio bibliométrico / Compressive Therapy in the Treatment of Venous Ulcers: Bibliometric Study

Introdução: Úlceras de origem venosas são lesóes cutâneas que geralmente acometem o terço inferior das pernas. O tratamento dessas feridas é dinâmico e depende da evolução das fases da reparação tecidual. Esse tratamento inclui métodos clínicos e cirúrgicos, sendo a terapia compressiva o método não cirúrgico mais frequentemente utilizado. Dentre as terapias compressivas, destacam-se as bandagens inelásticas e elásticas, meias elásticas e pressão pneumática intermitente. Objetivo: O presente estudo pretendeu identificar o perfil da produção científica nacional e internacional que descrevesse terapia compressiva e úlcera venosa classificando-o de acordo com: cronologia de publicação, procedência, periódicos em que estão publicadas, avaliação do "Qualis" - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes), distribuição da abordagem metodológica, análise do conteúdo das publicaçóes e comparar, quando possível, os dados apresentados nessa revisão. Método: Estudo bibliométrico realizado nas bases de dados Medline, Lilacs e CINAHL no qual se utilizaram os descritores "Varicose Ulcer/therapy", "Compression Bandages", "Wound Healing" e o operador booleano AND entre os anos de 2009 a 2013. Resultados: Foram selecionados 47 artigos; a maioria publicada em 2012 (n = 12; 25,53%), nos Estados Unidos (n = 14; 29,78%) e Reino Unido (n = 14; 29,78%), em revistas de especialidade vascular (n = 19; 40,42%), com avaliaçóes A2 (n = 13; 27,65%) e B1 (n = 13; 27,65%). A maior parte da metodologia utilizada nos estudos selecionados era tipo "estudos clínicos" (n = 30; 63,82%). Dentre os estudos clínicos e metanálises, apenas 30% (n= 14) apresentavam como objetivo principal avaliação da terapia compressiva e pretenderam estudar comparativamente eficácia de bandagens elásticas, inelásticas, meias elásticas, pressão pneumática intermitente e ausência de terapia compressiva no tratamento de úlceras venosas. Conclusão: Há preocupação da comunidade científica com a busca do tratamento eficaz para as úlceras venosas, porém a distribuição mundial de publicaçóes é desigual. Evidenciou-se que a terapia compressiva não é o objeto principal na maioria dos trabalhos selecionados, o que leva ao interesse em terapias adjuvantes ou complementares a essa. Ficou evidente a necessidade da terapia compressiva, porém não há consenso sobre qual pressão deva ser utilizada para se obter melhores resultados na cicatrização; portanto, são necessários mais estudos que avaliem as interferências das diversas pressóes sobre o processo de reparo tecidual. Também há carência de estudos que comprovem a ação da pressão pneumática intermitente com associaçóes ou não de bandagens elásticas.

Introducción: úlceras de origen venosas son lesiones cutáneas que generalmente acometen el tercio inferior de las piernas. El tratamiento de estas heridas es dinámico y depende de la evolución de las fases de la reparación del tejido. Este tratamiento incluye métodos clínicos y quirúrgicos, y la terapia compresiva es el método no quirúrgico más utilizado. Entre las terapias compresivas, se destacan los vendajes inelásticos y elásticos, medias elásticas y presión neumática intermitente. Objetivo: este estudio buscó identificar el perfil de la producción científica nacional e internacional que describiera la terapia compresiva y la úlcera venosa para clasificarla de acuerdo con: cronología de publicación, procedencia, periódicos en que están publicadas, evaluación del "Qualis" - coordinación de perfeccionamiento de personal de nivel superior (Capes), distribución del abordaje metodológico, análisis del contenido de las publicaciones y comparar, cuando fuera posible, los datos presentados en esta revisión. Método: estudio bibliométrico realizado en las bases de datos Medline, Lilacs y CINAHL en el que se utilizaron los descriptores "Varicose Ulcer/therapy", "Compression Bandages", "Wound Healing" y el operador booleano AND entre los años de 2009 a 2013. Resultados: se seleccionaron 47 artículos; la mayoría de ellos publicados en 2012 (n = 12; 25,53%), en Estados Unidos (n = 14; 29,78%) y Reino Unido (n = 14; 29,78%), en revistas de especialidad vascular (n = 19; 40,42%), con evaluaciones A2 (n = 13; 27,65%) y B1 (n = 13; 27,65%). La parte más grande de la metodología utilizada en los estudios seleccionados fue tipo "estudios clínicos" (n= 30; 63,82%). Entre los estudios clínicos y metanálisis, apenas 30% (n= 14) presentaban como objetivo principal evaluación de la terapia compresiva y estudiaban comparativamente eficacia de vendajes elásticos, inelásticos, medias elásticas, presión neumática intermitente y ausencia de terapia compresiva en el tratamiento de úlceras venosas. Conclusión: hay preocupación de la comunidad científica sobre la búsqueda del tratamiento eficaz para las úlceras venosas; sin embargo, la distribución mundial de publicaciones es desigual. Se evidenció que la terapia compresiva no es el objeto principal en la mayoría de los trabajos seleccionados, lo que lleva al interés en terapias adyuvantes o complementarias a esta. Quedó evidente la necesidad de la terapia compresiva, pero no hay consenso sobre cuál presión deba ser utilizada para obtener mejores resultados en la cicatrización; por lo tanto, son necesarios más estudios que evalúen las interferencias de las diversas presiones sobre el proceso de reparación del tejido. También hay carencia de estudios que comprueben la acción de la presión neumática intermitente con asociaciones o no de vendajes elásticos.

Introduction: Venous ulcers are skin lesions, which usually affect the lower third of the legs. The treatment of these wounds is dynamic and depends on the tissue repair process. Clinical and surgical procedures are included among those therapies, and the therapeutic compressive most often used non-surgical method. Inelastic and elastic bandages, elastic stockings and intermittent pneumatic pressure are the most common compressive therapy used. Objective: This study aimed to identify the national and international scientific literature profile describing compression therapy and venous ulcers and classify that profile according to: chronology of publication, country, periodicals that are published review of 'Qualis' - CAPES, distribution of the methodological approach, analysis of the publications content and compare, where possible, the data presented. Method: bibliometric study conducted in the Medline, Lilacs and CINAHL databases using the keywords "Varicose Ulcer / therapy", "Compression Bandages", "Wound Healing" and boleyn word AND between the years 2009-2013. Results: 47 articles were selected, the major part was published in 2012 (n = 12, 25.53 %), the United States (n = 14, 29.78 %) and the United Kingdom (n = 14, 29.78%), in vascular surgery specialized magazines (n = 19, 40.42%), Qualis A2 (n = 13, 27.65 %) and B1 (n = 13, 27.65 %). Much of the methodology used in the selected studies was "clinical studies" type (n = 30, 63.82 %). Only 30 % ( n = 14 ) had as main objective assessment of compressive therapy and intended study compared the effectiveness of elastic bandages, inelastic, elastic stockings , intermittent pneumatic pressure and absence compression therapy for the treatment of venous ulcers. Conclusions: There is a concern, in the scientific community, about the research for effective treatment for venous ulcers. However, the worldwide distribution of publications is uneven. It was evident that compression therapy is ...

IPC devices combined with anticoagulants for the prevention of deep vein thrombosis in TKA and THA patients: A prospective randomized control study / 中华骨科杂志

Objective To investigate the effectiveness of intermittent pneumatic compression (IPC) devices combined with anticoagulants for the prevention of deep vein thrombosis (DVT) after joint replacement surgery.Methods All of 400 patients were involved in this prospective randomized control study with 100 total knee arthroplasty (TKA) patients and 100 total hip arthroplasty (THA) patients in each group.All patients were operated under the general anesthesia.Patients in the control group received 10 mg of rivaroxaban per day beginning 6-8 hours after the surgery.Besides the prescription of rivaroxaban, IPC devices were used just after the anesthesia in the operating theater and lasted for 48 hours in the experimental group.The diagnosis of DVT in the lower extremities was made by color Duplex sonography on the second postoperative day.The incidence rate of DVT and symptomatic pulmonary embolism was recorded.The incidence rates of total DVT, proximal DVT (p-DVT, proximal to the trifurcation of the popliteal vein), distal DVT (d-DVT, in the anterior tibial vein, posterior tibial vein or peroneal vein) and intermuscular DVT were recorded.CT pulmonary angiography was used to confirm the pulmonary embolism if it was suspected.Results The incidence rates of overall, proximal, distal and intermuscular DVT were 9.5％, 0.5％, 0.5％, 8.5％ in the experimental group and 30％, 0.5％, 5.5％, 24％ in the control group respectively.The incidence rates of total DVT, distal DVT and intermuscular DVT were significantly lower in the experimental group.The incidence rate of DVT in TKA patients and THA patients were significantly lower in the experimental group than in the control group respectively.For patients with DVT, enoxaparin was used instead of rivaroxaban, and DVT was found disappeared by color Duplex sonography 10-12 days postoperatively.Conclusion Compared with the use of rivaroxaban alone, IPC devices combined with anticoagulants can significantly reduce the incidence rate of distal DVT and intermuscular DVT in the early postoperative period after joint replacement surgery.

Prevention Effects of Graduated Compression Stockings and Intermittent Pneumatic Compression on Deep Vein Thrombosis in SICU Patients: Pilot Study / 기본간호학회지

PURPOSE: The purpose of this pilot study was to investigate the effects of mechanical interventions for deep vein thrombosis (DVT) prophylaxis in surgical intensive care unit (SICU) patients. METHODS: The participants were assigned to the intermittent pneumatic compression (IPC) and graduated compression stocking (GCS) intervention. Patients who met the criteria were selected for comparison from our previous study. Data for 140 patients were included in the final analysis. RESULTS: The mean age was 57.5 (+/-15.7) and 61.4% were men. About forty-seven percent of the participants were 61 years or over. In the second duplex scan, 3, 2 and 1 critically ill patients developed deep vein thrombosis in the control, GCS, and IPC groups, respectively. Incidences of DVT were 6.0%, 5.0%, and 2.0% for the control, GCS, and IPC groups, respectively. This difference was not significant. Relative risks of no intervention were 3.0 and 1.2 compared with IPC and GCS application. There were no significantly different variables among the three groups before the intervention except for diagnosis on admission. CONCLUSION: Although it may difficult to conclude that mechanical prophylaxis effectively prevents DVT among SICU patients because there was no statistical significance in this study, but incidence rates among the three groups differed greatly. The findings reveal that further study should be conducted with larger samples and randomized controlled trial for SICU patients.

Common Peroneal Nerve Palsy by the Use of Intermittent Pneumatic Compression Device after Hartmann's Operation

Intermittent pneumatic compression device is a standard component for prevention of deep venous thrombosis in immobile patients. This method has been known to be safe with very low rate of complications compared to medical thromboprophylaxis. Therefore, this modality has been used widely in patients who underwent a general surgery. We report a patient who developed common peroneal nerve palsy during the use of intermittent pneumatic compression device after Hartmann's operation.

Effects of graduated compression stocking and intermittent pneumatic compression on the incidence of deep vein thrombosis after major surgery / 中华麻醉学杂志

60 yr, hypertension, diabetes mellitus, smoking, long term inactivity etc), and duration of operation. The incidence of DVT was 49.3% in control group, 30.0% in group CS alone, 15.0% in group CS + IPC1 and 23.3% in group CS + IPC2 (P