Ümran KÜÇÜKGÖZ GÜLEÇ, Ahmet Barış GÜZEL, Süleyman Cansun DEMİR, Mehmet Ali VARDAR, Aytekin ALTINTAŞ

121114

JİNEKOLOJİK VE JİNEKO-ONKOLOJİK CERRAHİDE VENÖZ TROMBOEMBOLİZM PROFİLAKSİSİ

Venöz tromboembolizm, jinekolojik ve jineko-onkolojik cerrahinin ciddi ancak önlenebilir bir komplikasyonudur. Bu önlenebilir komplikasyonun sıklığı risk faktör veya faktörlerinin varlığına, cerrahinin şekli, süresi, takip süresi, kullanılan araştırma ve tanı yöntemleri, profilaktik yöntemlerin uygulanmasına göre değişir. VTE için yüksek risk faktörleri arasında yaş, kanser varlığı, major cerrahi girişimler ve VTE öyküsü vardır. Jinekolojik cerrahiye gidecek tüm hastaların, kişisel VTE risk tayini açısından ve en uygun profilaktik yöntem açısından değerlendirilmeleri gerekmektedir. VTE açısından orta ve yüksek risk taşıyan hastalara düşük doz unfraksiyone heparin (UFH), düşük moleküler heparin (DMAH), aralıklı pnömatik bacak kompresyonu (APK) ve basınçlı kompresyon çoraplarının (BKÇ) profilaktik kullanımlarının faydası gösterilmiştir. Çok yüksek risk faktörlerinin varlığında, kombinasyon profilaksisi ve uzamış sürede (28 gün) tromboprofilaksi önerilebilir. Kanıta dayalı tıp açısından net önerilere rağ- men, jinekolojik ve jineko-onkolojik cerrahide tromboprofilaksi gerektiği düzeyde uygulanmamaktadır. Farmakolojik tromboprofilaksiye ne zaman başlanmalıdır? Ne kadar süre devam etmelidir? Hangi hastalar iki profilaktik yöntemin beraber kullanılmasından fayda görürler gibi tromboprofilaksi konusunda cevap bekleyen sorular vardır
Anahtar Kelimeler:

Jineko-onkolojik Cerrahi, Kombine Tromboprofilaksi, Risk Faktörleri, Tromboprofilaksi.

Venous thromboembolism (VTE) is a serious but preventable complication in gynecologic and gyneco-oncologic surgery. The incidence of this preventable complication is vary due to some factors such as presence of risk factor/factors, type of surgery, duration of surgery, follow-up period, use of investigation and diagnostic methods of VTE and using prophylactic methods. High risk factors of VTE are age, presence of malignancy, major surgery and history of VTE. All patients who had undergone gynecologic surgery should be evaluated individually pre-operative risk assesment for VTE and the most appropriate methods of prophylaxis. Low dose unfractionated heparin, low molecular weight heparin, intermittent pneumatic leg compression and graded compression stocking have demostrated benefit for prophylaxy of VTE in gynecologic patients with moderate and high risk. The presence of very high risk, a combination of two prophylactic methods and prolonged prophylaxis (for 28 days) may be advisible. Despite clear recommendations from evidence –based guidelines, thromboprophylaxis is underused in patients with undergoing gynecologic and gyneco-oncologic surgery. There remain many questions to answer in the area of thromboprophylaxis such as when should pharmacologic prophylaxis be initiated?, How long should prophylaxis continue? Which patients really benefit from a combination of two prophlactic methods?
Keywords:

Dual Prophylaxis, Gyneco-oncologic Surgery, Risk Factors, Thromboprophylaxis.,

PDF

___

  • 1. Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126:338S–400S.
  • 2. Clarke-Pearson DL, Synan IS, Coleman RE, Hinshaw W, Creasman WT. The natural history of postoperative venous thromboemboli in gynecologic oncology: a prospective study of 382 patients. Am J Obstet Gynecol 1984;148:1051–4.
  • 3. Salman MC, Durukan B, Deren Ö, Durukan T. Jinekolojide tromboz profilaksisi. Turk Jinekol Obstet Der 2005;2(5):31-36.
  • 4. Davis JD. Prevention, diagnosis, and treatment of venous thromboembolic complications of gynecologic surgery. Am J Obstet Gynecol 2001;184:759-775.
  • 5. Prevention of fatal postoperative pulmonary embolism by low doses of heparin. An international multicentre trial. Lancet 1975;2:45–51.
  • 6. Rahn DD, Mamik MM, Sanses TV, Matteson KA, Aschkenazi SO, Washington BB, Steinberg AC, Harvie HS, Lukban JC, Uhlig K, Balk EM, Sung VW; Society of Gynecologic Surgeons Systematic Review Group Venous thromboembolism prophylaxis in gynecologic surgery: a systematic review. Obstet Gynecol. 2011;118(5):1111-25.
  • 7. Nick AM, Schmeler KM, Frumovitz MM, Soliman PT, Spannuth WA, Burzawa JK, Coleman RL, Wei C, dos Reis R, Ramirez PT. Risk of thromboembolic disease in patients undergoing laparoscopic gynecologic surgery. Obstet Gynecol. 2010;116(4):956-61.
  • 8. Ageno W, Manfredi E, Denatli F, Silingardi M, Ghezzi F, Camporese G, et al. The incidence of venous thromboembolism following gynecologic laparoscopy: a multicenter, prospective cohort study. J Thromb Haemost 2007;5:503–6.
  • 9. Backes FJ, Brudie LA, Farrell MR, Ahmad S, Finkler NJ, Bigsby GE, O’Malley D, Cohn DE, Holloway RW, Fowler JM. Short- and long-term morbidity and outcomes after robotic surgery for comprehensive endometrial cancer staging.Gynecol Oncol. 2012 ;125(3):546-51.
  • 10. Agnelli G, Bolis G, Capussotti L, Scarpa RM, Tonelli F, Bonizzoni E, et al. A clinical outcome-based prospective study on venous thromboembolism after cancer surgery: the @RISTOS project. Ann Surg 2006;243:89–95.
  • 11. Martino MA, Borges E, Williamson E, Siegfried S, Cantor AB, Lancaster J, et al. Pulmonary embolism after major abdominal surgery in gynecologic oncology. Obstet Gynecol 2006;107: 666–71.
  • 12. Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol 2009;27:5331–6.
  • 13. Ulusal Tromboembolizm Profilaksi ve Tedavi Klavuzu -2010.
  • 14. Lyman GH, Khorana AA, Falanga A, Clarke-Pearson D, Flowers C, Jahanzeb M, et al. American Society of Clinical Oncology guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer. J Clin Oncol 2007;25:5490–505.
  • 15. Ritch JMB, Kim JH, Lewin SN, Burke WM, Sun X, Herzog TJ, et al. Venous thromboembolism and use of prophylaxis among women undergoing laparoscopic hysterectomy. Obstet Gynecol 2011;117:1367–74.
  • 16. Piccioli A, Prandoni P, Ewenstein BM, Goldhaber SZ. Cancer and venous thromboembolism. Am Heart J 1996;132:850–5.
  • 17. Clarke-Pearson DL, Abaid LN. Prevention of venous thromboembolic events after gynecologic surgery. Obstet Gynecol. 2012;119(1):155-67.
  • 18. Clarke-Pearson DL, DeLong ER, Synan IS, Coleman RE, Creasman WT. Variables associated with postoperative deep venous thrombosis: a prospective study of 411 gynecology patients and creation of a prognostic model. Obstet Gynecol 1987;69:146–50.
  • 19. Duggan C, Marriott K, Edwards R, Cuzick J. Inherited and acquired risk factors for venous thromboembolic disease among women taking tamoxifen to prevent breast cancer. J Clin Oncol 2003;21:3588–93.
  • 20. Robinson GE, Burren T, Mackie IJ, Bounds W, Walshe K, Faint R, et al. Changes in haemostasis after stopping the combined contraceptive pill: implications for major surgery. BMJ 1991;302:269–71.
  • 21. Raymond EG, Burke AE, Espey E. Combined hormonal contraceptives and venous thromboembolism: putting the risks into perspective. Obstet Gynecol. 2012;119(5):1039-44.
  • 22. Geerts WH, Bergqvist D, Pineo GR, Heit JA, Samama CM, Lassen MR, et al. Prevention of venous thromboembolism. American College of Chest Physicians evidence-based clinical practice guidelines (8th Edition). Chest 2008;133(suppl):381S–453S
  • 23. Prevention of deep vein thrombosis and pulmonary embolism. ACOG Practice Bulletin No. 84. American College of Obstetricians and Gynecologists. Obstet Gynecol 2007;110:429–40.
  • 24. Amaragiri SV, Lees TA. Elastic compression stockings for prevention of deep vein thrombosis. The Cochrane Database of Systematic Reviews 2000, Issue 3. Art. No.: CD001484. DOI: 10.1002/14651858.CD001484.
  • 25. Turner GM, Cole SE, Brooks JH. The efficacy of graduated compression stockings in the prevention of deep vein thrombosis after major gynaecological surgery. Br J Obstet Gynaecol 1984;91:588–91
  • 26. Clarke-Pearson DL, Synan IS, Hinshaw WM, Coleman RE, Creasman WT. Prevention of postoperative venous thromboembolism by external pneumatic calf compression in patients with gynecologic malignancy. Obstet Gynecol 1984;63:92–8.
  • 27. Clarke-Pearson DL, Creasman WT, Coleman RE, Synan IS, Hinshaw WM. Perioperative external pneumatic calf compression as thromboembolism prophylaxis in gynecology: report of a randomized controlled trial. Gynecol Oncol 1984;18: 226–32.
  • 28. Maxwell GL, Synan I, Dodge R, Carroll B, Clarke-Pearson DL. Pneumatic compression versus low molecular weight heparin in gynecologic oncology surgery: a randomized trial. Obstet Gynecol 2001;98:989–95.
  • 29. Clarke-Pearson DL, Synan IS, Dodge R, Soper JT, Berchuck A, Coleman RE. A randomized trial of low-dose heparin and intermittent pneumatic calf compression for the prevention of deep venous thrombosis after gynecologic oncology surgery. Am J Obstet Gynecol 1993;168:1146–53.
  • 30. Collins R, Scrimgeour A, Yusuf S, Peto R. Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. Overview of results of randomized trials in general, orthopedic, and urologic surgery. N Engl J Med 1988;318:1162–73.
  • 31. Clarke-Pearson DL, Coleman RE, Synan IS, Hinshaw W, Creasman WT. Venous thromboembolism prophylaxis in gynecologic oncology: a prospective, controlled trial of low dose heparin. Am J Obstet Gynecol 1983;145:606–13.
  • 32. Clark-Pearson DL, DeLong E, Synan IS, Soper JT, Creasman WT, Coleman RE. A controlled trial of two lowdose heparin regimens for the prevention of postoperative deep vein thrombosis. Obstet Gynecol 1990;75:684–9.
  • 33. Oates-Whitehead RM, D’Angelo A, Mol B. Anticoagulant and aspirin prophylaxis for preventing thromboembolism after major gynaecological surgery. The Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD003679. DOI: 10.1002/14651858. CD003679.pub2.
  • 34. Einstein MH, Pritts EA, Hartenbach EM. Venous thromboembolism prevention in gynecologic cancer surgery: a systematic review. Gynecol Oncol 2007;105:813–9.
  • 35. Martino MA, George JG, Chen CC, Galic V, Kapoor R, Murray KC, Shubella J Bs, Riker E, Lancaster JM, Hoffman MS. Preoperative Enoxaparin Is Safe to Use in Major Gynecologic Surgery for Prophylaxis of Venous Thromboembolism: A Retrospective Cohort Study. Int J Gynecol Cancer. 2012 May;22(4):681-685.
  • 36. Hull RD, Pineo GF, Stein PD, Mah AF, MacIsaac SM, et al. Timing of initial administration of low-molecularweight heparin prophylaxis against deep vein thrombosis in patients following elective hip arthroplasty: a systematic review. Arch Intern Med 2001;161:1952–60.
  • 37. Hansen CT, Kehlet H, Moller C, Morch L, Utzon J, Ottesen B. Timing of heparin prophylaxis and bleeding complications in hysterectomy a nationwide prospective cohort study of 9,949 Danish women. Acta Obstet Gynecol Scand 2008;87:1039–47.
  • 38. Whitworth JM, Schneider KE, Frederick PJ, Finan MA, Reed E, Fauci JM, Straughn JM Jr, Rocconi RP. Double prophylaxis for deep venous thrombosis in patients with gynecologic oncology who are undergoing laparotomy: does preoperative anticoagulation matter? Int J Gynecol Cancer. 2011;21(6):1131-4.
  • 39. Peedicayil A, Weaver A, Li X, Carey E, Cliby W, Mariani A. Incidence and timing of venous thromboembolism after surgery for gynecological cancer. Gynecol Oncol 2011;121:64–9.
  • 40. Bergqvist D, Agnelli G, Cohen AT, Eldor A, Nilsson PE, Le Moigne-Amrani A, et al. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med 2002;346:975–80.
  • 41. Rasmussen MS, Jorgensen LN, Wille-Jørgensen P, Nielsen JD, Horn A, Mohn AC, et al. Prolonged prophylaxis with dalteparin to prevent late thromboembolic complications in patients undergoing major abdominal surgery: a multicenter randomized open-label study. J Thromb Haemost 2006;4: 2384–90.
  • 42. Huo MH, Muntz J. Extended thromboprophylaxis with low molecular- weight heparins after hospital discharge in high-risk surgical and medical patients: a review. Clin Ther 2009;31:1129–41.
  • 43. Rasmussen MS, Jorgensen LN, Wille-Jorgensen P. Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery. Cochrane Database Syst Rev 2009:CD004318.
  • 44. Teoh D, Berchuck A, Alvarez Secord A, Lee PS, Lowery WJ, Sfakianos GP, Valea FA, Myers ER, Havrilesky LJ. Cost comparison of strategies for the management of venous thromboembolic event risk following laparotomy for ovarian cancer. Gynecol Oncol. 2011;122(3): 467-72.
  • 45. Wille-Jorgensen P, Rasmussen MS, Andersen BR, Borly L. Heparins and mechanical methods for thromboprophylaxis in colorectal surgery. The Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD001217. DOI: 10.1002/ 14651858.CD001217.
  • 46. Kakkos SK, Caprini JA, Geroulakos G, Nicolaides AN, Stansby GP, Reddy DJ. Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism in high-risk patients. The Cochrane Database of Systematic Review 2008, Issue 4. Art. No.: CD005258. DOI: 10.1002/1451858.CD005258.Pub 2.
  • 47. Schulz SL, Stechemesser B, Seeberger U, Meyer D, KesselringMC. Graduated compression stockings for the prevention of venous thromboembolism in surgical patients in the age of low molecular weight heparin. J Thromb Haemost 2005;3: 2363–5.
  • 48. Dainty L, Maxwell GL, Clarke-Pearson DL, Myers ER. Cost-effectiveness of combination thromboembolism prophylaxis in gynecologic oncology surgery. Gynecol Oncol 2004;93:366 –73.
  • 49. Krivak TC, Zorn KK. Venous thromboembolism in obstetrics and gynecology. Obstet Gynecol. 2007 Mar;109(3):761-77.
  • 50. Dewdney SB, Benn T, Rimel BJ, Gao F, Saad N, Vedantham S, Mutch DG, Zighelboim I. Inferior vena cava filter placement in the gynecologic oncology patient: A 15-year institutional experience. Gynecol Oncol. 2011;121(2):344-6.
  • 51. Wright JD. Lewin SN, Shah M, Burke WM, Lee SM, Sun X, Herzog TJ. Quality of Venous Thromboembolism Prophylaxis in Patients Undergoing Oncologic Surgery. Ann Surg 2011;253:1140–1146.
  • 52. Wright JD, Hershman DL, Shah M, Burke W, Sun X, Neugut AI, et al. Quality of perioperative venous thromboembolism prophylaxis in gynecologic surgery. Obstet Gynecol 2011;118: 978–86.
  • 53. Cohen AT, Tapson DF, Bergmann J-F, Goldhaber SZ, Kakkar AK, Deslandes B, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 2008;371:387-394.
  • 54. Ongen G, Yilmaz A, Cirak AK, Ersoy CY, Erden F, Altintas F, et al. Venous thromboembolism risk and thromboprophylaxis among hospitalized patients: data from the Turkish arm of the ENDORSE study. Clin Appl Thromb/Hemost 2011;17(5):539-45.
  • 55. Kurtoglu M. An observational study for VTE risk assessment among hospitalized patients in general surgery clinics across Turkey. Phylebotology. 2011;26(8):344-52.
  • 55. Clarke-Pearson DL, Abaid LN. Prevention of venous thromboembolic events after gynecologic surgery. Obstet Gynecol. 2012;119(1):155-67.
Türk Jinekolojik Onkoloji Dergisi-Cover
  • ISSN: 2148-5372
  • Başlangıç: 2014
  • Yayıncı: Türk Jinekolojik Onkoloji Derneği
Arşiv
Sayıdaki Diğer Makaleler

SERVİKAL YÜKSEK DERECELİ SKUAMOZ İNTRAEPİTELYAL LEZYON İÇİN DE⁄ERLENDİRME SIRASINDA İNSİDENTAL OLARAK SAPTANAN İLERİ EVRE UTERİN LEİOMYOSARKOM: OLGU SUNUMU

Bülent ÖZDAL, Sevgi AYHAN, Eralp BAŞER, Oğuz Devrim YARDIMCI, Levent ŞİRVAN, Tayfun GÜNGÖR

JİNEKOLOJİK VE JİNEKO-ONKOLOJİK CERRAHİDE VENÖZ TROMBOEMBOLİZM PROFİLAKSİSİ

Ümran KÜÇÜKGÖZ GÜLEÇ, Ahmet Barış GÜZEL, Süleyman Cansun DEMİR, Mehmet Ali VARDAR, Aytekin ALTINTAŞ

Dimitrov GO, Dimitrov GL, Dzikova E, Panov S, Ceselkovska M, Babusku GJ

SERVİKS KARSİNOMU VE YÜKSEK DERECELİ SKUAMOZİNTRAEPİTELYAL LEZYONLARDA SERUM FOLAT, VİTAMİN B12,HOMOSİSTEİN VE ESER ELEMENT DÜZEYLERİ

Müjdegül ZAYIFOĞLU KARACA, Cihan TOĞRUL, Eralp BAŞER, Bülent ÖZDAL, Tayfun GÜNGÖR

ROBOTİK RADİKAL PARAMETREKTOMİ, PELVİKLENFADENEKTOMİ, VAJEN 1/3 ÜST KISMININ ÇIKARILMASI:OLGU SUNUMU

Fatih GÜÇER, Koray ÖZBAY, Nuri CEYDELİ

KOLPOSKOPİ UYGULANAN OLGULARIN SOSYODEMOGRAFİK ÖZELLİKLERİNİN SERVİKAL BİYOPSİ SONUÇLARIYLA KORELASYONU

Mete ÇAĞLAR, Aysel U. DERBENT, Mine KANAT PEKTAŞ, Onur EROL, Mustafa ÖZAT, Selahattin KUMRU