Pronóstico de la enfermedad tromboembólica venosa en cirugía ortopédica o pacientes traumatológicos y uso de tromboprofilaxis / Prognosis of venous thromboembolism in orthopaedic surgery or trauma patients and use of thromboprophylaxis

Antecedentes: Hay escasa evidencia sobre el pronóstico de la tromboembolia venosa en pacientes sometidos a cirugía ortopédica y en pacientes que sufren un trauma no quirúrgico. Métodos: Utilizamos la base de datos RIETE (Registro Informatizado de pacientes con Enfermedad TromboEmbólica) para comparar el pronóstico del tromboembolismo venoso y el uso de tromboprofilaxis en pacientes sometidos a diferentes procedimientos ortopédicos y en pacientes con traumatismo que no requiere cirugía. Resultados: Desde marzo de 2001 a marzo de 2015, se inscribieron un total de 61.789 pacientes en RIETE. De estos, 943 (1.52%) desarrollaron tromboembolismo venoso después de artroplastia electiva, 445 (0.72%) después de fractura de cadera, 1.045 (1.69%) después de cirugía ortopédica no mayor y 2,136 (3.46%) después de trauma no quirúrgico. En general, 2.283 pacientes (50%) presentaron inicialmente embolia pulmonar. En los primeros 90 días de tratamiento, 30 pacientes (0.66%, IC 95% 0.45-0.93) murieron por embolia pulmonar. La tasa de embolia pulmonar fatal fue significativamente mayor después de cirugía de fractura de cadera (n = 9 [2.02%]) que después de la artroplastia electiva (n = 5 [0.53%]), cirugía ortopédica no mayor (n = 5 [0.48%]) o traumatismo no quirúrgico (n = 11 [0,48%]). La tromboprofilaxis se utilizó con mayor frecuencia para la fractura de cadera (93%) o la artroplastia electiva (94%) que para la cirugía ortopédica no mayor (71%) o traumatismo no quirúrgico (32%). La hemorragia mayor fue significativamente mayor después de la cirugía de fractura de cadera (4%) que después de artroplastia electiva (1,6%), cirugía ortopédica no mayor (1,5%) o traumatismo no quirúrgico (1,4%). Conclusiones: La tromboprofilaxis se utilizó con menos frecuencia en los procedimientos de menor riesgo a pesar del número absoluto de embolia pulmonar fatal después de cirugía ortopédica no mayor o traumatismo no quirúrgico, excedieron los observados después de procedimientos de alto riesgo

Background: There is scarce evidence about the prognosis of venous thromboembolism in patients undergoing orthopedic surgery and in patients suffering non-surgical trauma. Methods: We used the RIETE database (Registro Informatizado de pacientes con Enfermedad Trombo Embólica) to compare the prognosis of venous thromboembolism and the use of thromboprophylaxis in patients undergoing different orthopedic procedures and in trauma patients not requiring surgery. Results: From March 2001 to March 2015, a total of 61,789 patients were enrolled in RIETE database. Of these, 943 (1.52%) developed venous thromboembolism after elective arthroplasty, 445 (0.72%) after hip fracture, 1,045 (1.69%) after non-major orthopedic surgery and 2,136 (3.46%) after non-surgical trauma. Overall, 2,283 patients (50%) initially presented with pulmonary embolism. Within the first 90 days of therapy, 30 patients (0.66%; 95% CI 0.45-0.93) died from pulmonary embolism. The rate of fatal pulmonary embolism was significantly higher after hip fracture surgery (n = 9 [2.02%]) than after elective arthroplasty (n = 5 [0.53%]), non-major orthopedic surgery (n = 5 [0.48%]) or non surgical trauma (n = 11 [0.48%]). Thromboprophylaxis was more commonly used for hip fracture (93%) or elective arthroplasty (94%) than for non-major orthopedic surgery (71%) or non-surgical trauma (32%). Major bleeding was significantly higher after hip fracture surgery (4%) than that observed after elective arthroplasty (1.6%), non-major orthopedic surgery (1.5%) or non-surgical trauma (1.4%). Conclusions: Thromboprophylaxis was less frequently used in lower risk procedures despite the absolute number of fatal pulmonary embolism after non-major orthopedic surgery or non-surgical trauma, exceeded that observed after high risk procedures

Prognosis of venous thromboembolism in orthopaedic surgery or trauma patients and use of thromboprophylaxis. / Pronóstico de la enfermedad tromboembólica venosa en cirugía ortopédica o pacientes traumatológicos y uso de tromboprofilaxis.

BACKGROUND: There is scarce evidence about the prognosis of venous thromboembolism in patients undergoing orthopedic surgery and in patients suffering non-surgical trauma. METHODS: We used the RIETE database (Registro Informatizado de pacientes con Enfermedad Trombo Embólica) to compare the prognosis of venous thromboembolism and the use of thromboprophylaxis in patients undergoing different orthopedic procedures and in trauma patients not requiring surgery. RESULTS: From March 2001 to March 2015, a total of 61,789 patients were enrolled in RIETE database. Of these, 943 (1.52%) developed venous thromboembolism after elective arthroplasty, 445 (0.72%) after hip fracture, 1,045 (1.69%) after non-major orthopedic surgery and 2,136 (3.46%) after non-surgical trauma. Overall, 2,283 patients (50%) initially presented with pulmonary embolism. Within the first 90 days of therapy, 30 patients (0.66%; 95% CI 0.45-0.93) died from pulmonary embolism. The rate of fatal pulmonary embolism was significantly higher after hip fracture surgery (n = 9 [2.02%]) than after elective arthroplasty (n = 5 [0.53%]), non-major orthopedic surgery (n = 5 [0.48%]) or non surgical trauma (n = 11 [0.48%]). Thromboprophylaxis was more commonly used for hip fracture (93%) or elective arthroplasty (94%) than for non-major orthopedic surgery (71%) or non-surgical trauma (32%). Major bleeding was significantly higher after hip fracture surgery (4%) than that observed after elective arthroplasty (1.6%), non-major orthopedic surgery (1.5%) or non-surgical trauma (1.4%). CONCLUSIONS: Thromboprophylaxis was less frequently used in lower risk procedures despite the absolute number of fatal pulmonary embolism after non-major orthopedic surgery or non-surgical trauma, exceeded that observed after high risk procedures.