Süleyman Savaş HACIEVLİYAGİL, Özkan KIZKIN, Hakan GÜNEN

Yatan hastalarda tromboemboli profilaksinin klinik önemi

Amaç: Derin ven trombozu (DVT) ve pulmoner emboli (PE) profilaksisinde tüm dünyada kabul gören ve rutin kullanıma girmiş yöntemler olmasına rağmen, klinik uygulamalarda mevcut proflaksi prensipleri ihmal edilebilmektedir. Bu çalışma; hastanede yatarken PE gelişerek servisimize devredilen ve venöz tromboemboli (VTE) için risk faktörü taşıyan yatan hastalarda, ihmal edilmiş profilaksiyi araştırmak için yapılmıştır. Materyal ve Metod: Başka nedenlerle yatırılan; takibi sırasında PE tanısı almış hastalar ve hastanemizde VTE için risk grubundaki hastalar çalışmaya dahil edildi. Dosyalarına ulaşılabilen PE tanılı 21 hastanın dosyası retrospektif; VTE için risk grubundaki 74 hastanın dosyası prospektif olarak incelendi. Bulgular: PE tanısı alan hastaların 16'sı kadın, 5'i erkekti ve yaş ortalaması 44,2±14,4 yıl bulundu. Tanı öncesinde ortalama 12,6±10,7 gündür hastanede yattıkları, PE için ortalama 2,3 (1-4) riske sahip oldukları, buna rağmen hiçbirisinin profilaksi almadığı tespit edildi. En sık görülen risk faktörleri sırasıyla; operasyon (%27,1), ileri yaş (%25) ve travmaydı (%10,4). VTE için bir veya daha fazla risk taşıyan 74 hastanın; 43'ü cerrahi, 7'si dahili kliniklerde ve 17'si yoğun bakım ünitesinde ortalama 15,2±8,9 gündür yatıyorlardı. Yaş ortalaması 48,7±18,1 yıl olup, ortalama 2,7 (1-6) riske sahip olmalarına rağmen, yalnızca 17 olgu (%23) VTE için profilaksi alıyordu. En sık profilaksi, risk faktörlerinin en fazla olduğu (ortalama 2,9) yoğun bakım ünitelerinde (%52,9), en az profilaksi ise kadın-doğum kliniğinde (% 7,1) kullanılmaktaydı. Sonuç: PE, hastane ölümlerinin önemli bir kısmını oluşturmasına rağmen hastanemizde VTE'nin profilaksisine gereken önem verilmemektedir. Özellikle risk grubundaki hastalara profilaksi uygulanması halinde, hastanede gelişen VTE insidansını ve buna bağlı morbidite ve mortalitenin azalacağını düşünüyoruz.

Clinical significance of prophylaxis for thromboemboli in hospitalized patients

Objective: Although, there are methods recommended with consensus all over the world for the prophylaxis of deep venous thrombosis (DVT) and pulmonary embolus (PE), these principles of prophylaxis may be neglected in clinical practice. Materials and Methods: This study was performed to investigate the neglected prophylaxis in patients who were transferred to our clinics after the development of PE at the hospital and in floor patients with risk factors. Patients, who were hospitalized for other reasons, developed PE, and were risky for VTE were included in the study. Charts of the patients with PE (n=21) were reviewed retrospectively, and those of the patients with risk factors for VTE (n=74) were reviewed prospectively. Results: Sixteen patients with PE were female and 5 were male. Their mean age was 44,2±14,4 years. Although they have been hospitalized for 12,6±10,7 days and their mean risk factor was 2,3 (1-4), none of them were on prophylaxis. Most frequent risk factors were operation (27,1%), elderliness (25%) and trauma (10,4%). Of the 74 patients with one or more risk factors for VTE, 43 were in surgery department, 7 were in internal medicine floor and 17 were in the intensive care unit. Their mean duration of hospitalization, mean age and mean risk factor number were 15,2±8,9 days, 48,7±18,1 years and 2,7 (1-6) risk factors respectively. Only 17 of them (23%) were on prophylaxis for VTE. Most common administration of prophylaxis was noted in intensive care clinics (52,9%) whose mean risk factor was highest (2,9%), and the least prophylaxis was noted in obstetric and gynecology clinics (7,1%). Conclusion: Although PE is an important reason for the in-hospital mortality, prophylaxis for VTE has not been administered sufficiently. We think that, in case of sufficient administration of prophylaxis especially for patients with risk factors, development of VTE and/or PE incidence and their attributable morbidity will decrease.

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