Marcos de Bastos

Tromboprofilaxia: recomendações médicas e programas hospitalares

Venous thromboembolism (VTE) is the most preventable cause of death in hospitalized patients. Hospital-related VTE is associated with more than half of the VTE burden in a community, either in-hospital or after discharge. Selective thromboprophylaxis is recommended for patients at risk. Patient selection for thromboprophylaxis requires proper VTE risk stratification. VTE stratification may be achieved by either risk assessment models (RAM) or by models based on patients illness and associated risk factors. Whatever the model, a thromboprophylatic recommendation should be formulated for each VTE risk category. VTE thromboprophylaxis may include general measures, mechanic compression procedures, pharmacological intervention or a combined approach. After many decades of consensus statements, a large proportion of at risk patients (20% to 75%) still does not receive proper thromboprophylaxis. This study aims to alert to the relevance of thromboprophylaxis and to suggest hospital thromboprophylatic strategies in a Brazilian setting.

Managing suspected venous thromboembolism in a mixed primary and secondary care setting using standard clinical assessment and D-dimer in a noninvasive diagnostic strategy.

Venous thromboembolism is a potentially lethal disease if not properly treated. Noninvasive strategies have become an attractive clinical option for effective diagnosis. There has been controversy, however, regarding the use of standard clinical rules in a primary care setting. The objective of the present study was to validate a noninvasive diagnostic strategy in an emergency unit giving assistance to patients with primary and secondary care needs. A total of 291 outpatients (primary and secondary care needs) with suspected venous thromboembolism attending the emergency unit of a general hospital from August 2002 to 2004 were retrospectively evaluated. The diagnostic strategy included assessment of risk for venous thromboembolism and a rapid quantitative enzyme-linked immunosorbent assay D-dimer test. Venous thromboembolism was ruled out in patients with a low-probability or intermediate-probability risk (or an unlikely diagnosis) and a negative D-dimer. The prevalence of venous thromboembolism was 8.2%. Patients with an unlikely diagnosis comprised 93.8% of the evaluations for deep venous thrombosis, and those with a low probability for pulmonary embolism comprised 81.4%. Proportions of patients with venous thromboembolic events observed were 7.2% in patients with an unlikely diagnosis of deep venous thrombosis and 3.0% in those with low probability for pulmonary embolism. The percentage of patients with a thrombotic event excluded using this strategy was 37% (positive predictive value 13%, negative predictive value 100%). In conclusion, this noninvasive clinical strategy is safe for ruling out venous thromboembolism, and excludes the need for imaging tests in about one-third of the patients in the population studied.

Thromboprophylaxis: medical recommendations and hospital programs

Venous thromboembolism (VTE) is the most preventable cause of death in hospitalized patients. Hospital-related VTE is associated with more than half of the VTE burden in a community, either in-hospital or after discharge. Selective thromboprophylaxis is recommended for patients at risk. Patient selection for thromboprophylaxis requires proper VTE risk stratification. VTE stratification may be achieved by either risk assessment models (RAM) or by models based on patients illness and associated risk factors. Whatever the model, a thromboprophylatic recommendation should be formulated for each VTE risk category. VTE thromboprophylaxis may include general measures, mechanic compression procedures, pharmacological intervention or a combined approach. After many decades of consensus statements, a large proportion of at risk patients (20% to 75%) still does not receive proper thromboprophylaxis. This study aims to alert to the relevance of thromboprophylaxis and to suggest hospital thromboprophylatic strategies in a Brazilian setting.

Impact of Hormone Therapy Linked to Wells Prediction Score in the Diagnosis of Deep Vein Thrombosis in Women Submitted to Vascular Ultrasound

Impact of Hormone Therapy Linked to Wells Prediction Score in the Diagnosis of Deep Vein Thrombosis in Women Submitted to Vascular Ultrasound Marcio Vinicius Lins Barros1,2, Ana Elisa Loyola Arancibia1, Ana Paula Costa1, Fernando Brito Bueno1 , Marcela Aparecida Correa Martins1 , Maria Claudia Magalhaes1 , Jose Luiz Padilha Silva3, Marcos de Bastos 1 Faculdade de Saude e Ecologia Humana1, Vespasiano; Rede Mater Dei de Saude2; Faculdade de Medicina – UFMG3, Belo Horizonte, MG – Brazil

Non-pharmacological thromboprophylaxis efficacy in hospitalized patients: a nested case-control study

Introduction: Hospital-acquired venous thrombosis (VT) is a potentially fatal but preventable complication. Thromboprophylaxis may include pharmacological or non-pharmacological strategies (NPTP). NPTP may include early patient ambulation, graduated elastic compressive stockings or compressive pneumatic compression of lower limbs. Our objective was to measure NPTP efficacy in a brazilian public hospital. Material and Method: This is a case-control study nested in a cohort comprising patients admitted to Hospital Naval Marcílio Dias from 1995 to 2001 who participated in the hospital TP program; Participants were over 18 years of age, without anticoagulation or suspected VT at admission. Cases were participants who developed VT during hospital stay. Five controls were matched by age, gender and date of VT to each index case. Outcome was evaluated by OR for VT comparing participants submitted to NPTB to no TP. Results: There were 76 cases matched to 379 controls out of 21,067 participants. Unadjusted OR for VT was 0.41 (95% CI 0.22-0.77) and the Non-pharmacological thromboprophylaxis efficacy in hospitalized patients: a nested case-control study Marcos de Bastos1, Luciana Mendes Oliveira2, Clarissa Santos Lages2, Fernanda Martins Cunha de Carvalho2, Maria Carolina Luiza Gonçalves2, Rafael de Souza Menezes2, Rosângela Carrusca Alvim3, Jackson Silveira Caiafa4, Sandhi Maria Barreto5, Suely Meireles Rezende 6 Eficácia da tromboprofilaxia não farmacológica em pacientes hospitalizados: estudo caso-controle aninhado DOI: 10.5935/2238-3182.20140085

Unexpected finding in computed tomographic pulmonary angiography

1 Hospital Mater Dei; Department of Internal Medicine, Grupo de Estudo da Hemostasia e Trombose (GETHe), Faculty of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil 2 Instituto de Previdência do Estado de Minas Gerais, Department of Internal Medicine, GETHe, Faculty of Medicine, UFMG, Belo Horizonte, MG, Brazil 3 Hospital Mater Dei, Belo Horizonte, MG, Brazil 4 Department of Internal Medicine, GETHe, Faculty of Medicine, UFMG, Belo Horizonte, MG, Brazil