Revisão sistemática da profilaxia para tromboembolismo venoso após artroplastia do joelho: enoxaparina versus rivaroxabana / Systematic review of prophylaxis for venous thromboembolism after knee arthroplasty: enoxaparin versus rivaroxaban

RESUMO A artroplastia total do joelho é um procedimento eletivo, realizado em indivíduos relativamente saudáveis. Porém, devido ao risco inerente de tromboembolismo venoso, são utilizados fármacos para sua profilaxia. O objetivo do presente trabalho foi conduzir uma revisão sistemática da literatura para comparar a eficácia da enoxaparina e da rivaroxabana na prevenção desta complicação e no risco de sangramento intraoperatório. Foi feita uma revisão no site SciELO, Pubmed e Cochrane através dos descritores, artroplastia de joelho, rivaroxabana e enoxaparina através da estratégia de busca PICO. Os critérios de inclusão foram os artigos no período estudado, que comparavam ambas as drogas em cirurgias de artroplastia do joelho. Os critérios de relevância para tornar o estudo elegível foram definidos como: somente artigos publicados a partir 2010 e com casuística com mais de 20 pacientes foram considerados; somente estudos obtidos em sua íntegra foram analisados; somente estudos com seguimento maior do que 12 meses foram considerados relevantes. As variáveis utilizadas para a comparação dos artigos foram as complicações mais comuns no pós-operatório de artroplastias do joelho: tromboembolismo venoso e sangramento. Foi utilizado o Review Man 5.3 para estruturação da revisão. Os autores observaram que nos estudos analisados, considerando tromboembolismo venoso sintomático, a rivaroxabana resultou em maiores benefícios quando comparada com a enoxaparina.

ABSTRACT Total knee arthroplasty is an elective procedure performed on relatively healthy individuals. However, due to the inherent risk of venous thromboembolism, drugs are used for its prophylaxis. The objective of the present study was to conduct a systematic review of the literature to compare the efficacy of enoxaparin and rivaroxaban in preventing this complication and the risk of intraoperative bleeding. We reviewed the SciELO, Pubmed and Cochrane databases with the descriptors knee arthroplasty, rivaroxaban and enoxaparin through the PICO search strategy. Inclusion criteria were the articles during the study period comparing both drugs in knee arthroplasty. Relevant criteria to study eligibility were articles published since 2010 and with a sample of more than 20 patients; studies obtained in their entirety; and studies with follow-up of more than 12 months. The variables used to compare the articles were the most common postoperative complications of knee arthroplasties: venous thromboembolism and bleeding. We used the Review Man software, version 5.3, for structuring the review. In the studies analyzed, considering symptomatic venous thromboembolism, rivaroxaban resulted in higher benefits when compared to enoxaparin.

Evidence-based for venous thromboembolism prevention to Perioperative patients in Orthopedic / 中国实用护理杂志

Objective To integrate the best evidence of venous thromboembolism (VTE) prevention into practice, improve nurses′compliance, and reduce the incidence of VTE in orthopaedic department. Methods Guided by the standard procedure in the JBI-Paces program, collected the best evidence from online databases and set the standards. Collected data through field observation, interviews and review of nursing records. A total of 167 patients and 36 nurses we recruited in the study and audited twice. We judged the result by the knowledge level of nurses and patients, nurses′ compliance with the evidence and the incidence rate of VTE. Results In baseline review, three criteria of poor compliance,"the correct situation of daily inspection of VTE risk assessment", "Wear gradient pressure stockings correctly for VTE high-risk patients " , "Intermittent pneumatic compression device (IPCD) used twice a day for 30 minutes each time ", were significantly improved after the application of evidence , increased from 47.22%(17/36),36.11%(13/36),36.11%(13/36)to 86.11%(31/36), 86.11%(31/36), 91.67(33/36) respectively (χ2=12.25, 18.94, 24.08, all P<0.05);The incidence of VTE decreased from 2.7% to 0 (P=0.195);the correct rate of VTE risk assessment, awareness rate of health education among patients, implementation rate of physical preventive measures and qualified rate of VTE-related knowledge and skills among nurses increased from 82.43%(61/74),74.32%(55/74),83.78%(62/74),77.03%(57/74)to 97.85%(91/93),91.40%(85/93), 97.85%(91/93),96.77%(90/93)respectively (χ2=8.86-15.24, all P<0.01). Conclusion The integration of best evidence standardize nurses′behaviors, reduce the incidence rate of VTE, improve the quality of clinical care and promote the satisfaction of patients continuously.

Evidence-based for venous thromboembolism prevention to Perioperative patients in Orthopedic / 中国实用护理杂志

Objective@#To integrate the best evidence of venous thromboembolism (VTE) prevention into practice, improve nurses′ compliance, and reduce the incidence of VTE in orthopaedic department.@*Methods@#Guided by the standard procedure in the JBI-Paces program, collected the best evidence from online databases and set the standards. Collected data through field observation, interviews and review of nursing records. A total of 167 patients and 36 nurses we recruited in the study and audited twice. We judged the result by the knowledge level of nurses and patients, nurses′ compliance with the evidence and the incidence rate of VTE.@*Results@#In baseline review, three criteria of poor compliance, "the correct situation of daily inspection of VTE risk assessment", "Wear gradient pressure stockings correctly for VTE high-risk patients", "Intermittent pneumatic compression device (IPCD) used twice a day for 30 minutes each time", were significantly improved after the application of evidence, increased from 47.22% (17/36) ,36.11% (13/36) ,36.11% (13/36) to 86.11% (31/36) , 86.11% (31/36) , 91.67 (33/36) respectively (χ2=12.25, 18.94, 24.08, all P < 0.05); The incidence of VTE decreased from 2.7% to 0 (P=0.195); the correct rate of VTE risk assessment, awareness rate of health education among patients, implementation rate of physical preventive measures and qualified rate of VTE-related knowledge and skills among nurses increased from 82.43% (61/74) ,74.32% (55/74) ,83.78% (62/74) ,77.03% (57/74) to 97.85% (91/93) ,91.40% (85/93) ,97.85% (91/93) ,96.77% (90/93) respectively (χ2= 8.86-15.24, all P < 0.01) .@*Conclusion@#The integration of best evidence standardize nurses′ behaviors, reduce the incidence rate of VTE, improve the quality of clinical care and promote the satisfaction of patients continuously.

New anticoagulants for the treatment of venous thromboembolism / Os novos anticoagulantes no tratamento do tromboembolismo venoso

Worldwide, venous thromboembolism (VTE) is among the leading causes of death from cardiovascular disease, surpassed only by acute myocardial infarction and stroke. The spectrum of VTE presentations ranges, by degree of severity, from deep vein thrombosis to acute pulmonary thromboembolism. Treatment is based on full anticoagulation of the patients. For many decades, it has been known that anticoagulation directly affects the mortality associated with VTE. Until the beginning of this century, anticoagulant therapy was based on the use of unfractionated or low-molecular-weight heparin and vitamin K antagonists, warfarin in particular. Over the past decades, new classes of anticoagulants have been developed, such as factor Xa inhibitors and direct thrombin inhibitors, which significantly changed the therapeutic arsenal against VTE, due to their efficacy and safety when compared with the conventional treatment. The focus of this review was on evaluating the role of these new anticoagulants in this clinical context.

O tromboembolismo venoso (TEV) está entre as principais causas de morte por doenças cardiovasculares no mundo, atrás apenas do infarto agudo do miocárdio e do acidente vascular cerebral. O TEV possui espectro de apresentação que vai desde a trombose venosa profunda até o tromboembolismo pulmonar agudo, de acordo com gravidade crescente de acometimento, sendo seu tratamento baseado na anticoagulação plena dos pacientes. Há muitas décadas, sabe-se que a anticoagulação interfere diretamente na mortalidade associada ao TEV. Até o início deste século a terapia anticoagulante se baseava no uso de heparina, em suas formas não fracionada ou de baixo peso molecular, e de antagonistas da vitamina K, principalmente a varfarina. Ao longo das últimas décadas, foram desenvolvidos novas classes de medicamentos anticoagulantes, inibidores do fator Xa e inibidores diretos da trombina, que mudaram significativamente o arsenal terapêutico do TEV, em função de suas características de eficácia e segurança em relação ao tratamento convencional, sendo o foco principal de esta revisão avaliar seu papel neste contexto clínico.