Randomized Trial of Deep Vein Thrombosis Chemoprophylaxis with Bemiparin and Enoxaparin in Patients with Moderate to High Thrombogenic Risk Undergoing Plastic and Reconstructive Surgery Procedures.

BACKGROUND: Deep vein thrombosis (DVT) is a common complication during postoperative convalescence characterized by hypercoagulability, vascular endothelium damage and blood stasis. It increases noticeably in peri/postoperative phases of surgery procedures. Pulmonary embolism secondary to iliofemoral DVT is a frequent cause of death. METHODS: Adult patients scheduled for plastic and reconstructive surgery (PRSx) with moderate to high thrombogenic risk were selected. We evaluated the efficacy and safety of bemiparin compared to enoxaparin as chemoprophylaxis for DVT. Following balanced general anesthesia techniques, patients were randomly assigned for subcutaneous enoxaparin 40 IU (Group-E) or bemiparin 3500 IU (Group-B) q24h starting 6 h after procedure conclusion for at least 10 days. All patients were evaluated for DVT through Doppler ultrasound mapping of the lower limbs. RESULTS: Seventy-eight patients were evaluated, mostly women (83%), physical status ASA II (59%), ASA III (10%); Caprini's thrombogenic risk score 3-4 (moderate) 58%, 5-6 (high) 29%, > 6 (too high) 13%; demographics, clinical variables and scores were similar between groups. Median drainage time in breast surgery was 4 days in both groups (p = 0.238). In the case of abdominal surgery, median was 14 days in Group-E versus 13 days in Group-B (p = 0.059). No DVT was detected in either group. CONCLUSIONS: DVT was prevented with bemiparin, without significant bleeding increase nor adverse events; moreover, the cost of bemiparin is lower than enoxaparin. Bemiparin can be considered as alternative drug for DVT chemoprophylaxis in PRSx procedures. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Angioplastia percutánea de aorta infrarrenal. Experiencia en The American British Cowdray Medical Center IAP / Percutaneous transluminal angioplasty of infrarenal aorta. Experience at the American British Cowdray Medical Center IAP

La angioplastia percutánea se desarrolló hace alrededor de 40 años y actualmente es uno de los tratamientos establecidos para restaurar el flujo sanguíneo en extremidades con isquemia crónica. Objetivo: Presentamos la experiencia en el Hospital ABC sobre el tratamiento con angioplastia percutánea de lesiones estenóticas de la aorta abdominal, así como un caso y la revisión de los criterios para efectuar estos procedimientos. Material y método: Estudio retrospectivo de los registros clínicos de los procedimientos realizados en el hospital, presentación de un caso y revisión de la literatura. Conclusiones: La angioplastia percutánea de lesiones estenóticas de aorta abdominal es un procedimiento mínimamente invasivo, seguro y con la misma efectividad que los procedimientos quirúrgicos, por lo que se considera el tratamiento de elección. Debe ser realizada en pacientes seleccionados y por un equipo de cirujanos vasculares y radiólogos para obtener los mejores resultados.