Prevention of Deep Venous Thromboembolism in Foot and Ankle Surgery

Profilaxia do tromboembolismo venoso nas cirurgias do tornozelo e do pé

“…16 In orthopedic surgeries, mechanical thromboprophylaxis can be performed using intermittent pneumatic compression devices (IPCDs) and elastic compression stockings. 41 In a recent meta-analysis 42 with 16,164 patients, IPCDs were effective in reducing VTE in hospitalized subjects when compared to placebo, with a relative risk (RR) of developing DVT of 0.43 (95%CI: 0.36 to 0.52) and an RR of developing PTE of 0.48 (95%CI: 0.33 to 0.69). 42 As advantages, these devices do not have the adverse effects presented by anticoagulant drugs, such as bleeding, nor do they require laboratory monitoring.…”

“…Unfractionated heparin acts indirectly, binding to antithrombin (a natural anticoagulant) and bolstering its inhibitory action on various coagulation proteases, including thrombin (factor IIa) and factor Xa. 41 Low-molecular-weight heparin results from the partial digestion of UFH, and it presents a reduced ability to bind to other plasma proteins and a greater specificity against factor Xa. Both forms are effective, safe, and administered by subcutaneous route.…”

“…51 Warfarin is a vitamin K antagonist that inhibits the synthesis of calcium-dependent coagulation factors (factors II, VII, IX and X), as well as proteins C, S and Z. 41 The recommended dose varies, mostly ranging from 5 mg to 10 mg a day during the postoperative period. 41 Although cheap and widely available, warfarin should only be used as a thromboprophylactic agent in orthopedic surgeries when heparins or DAOAs are not available.…”

“…41 The recommended dose varies, mostly ranging from 5 mg to 10 mg a day during the postoperative period. 41 Although cheap and widely available, warfarin should only be used as a thromboprophylactic agent in orthopedic surgeries when heparins or DAOAs are not available. Warfarin requires continuous monitoring of prothrombin time and its derivative, the international normalized ratio (INR), which should have a target value between 2 and 3 in order to be considered adequate for VTE prevention.…”

“…16 A tromboprofilaxia mecânica nas cirurgias ortopédicas pode ser realizada utilizando dispositivos de compressão pneumática intermitente (DCPI) e meias de compressão elásticas. 41 Em recente meta-análise 42 com 16.164 pacientes, o uso de DCPI se mostrou eficaz na redução de TEV em pacientes internados quando comparado ao uso de placebo, sendo o risco relativo (RR) para TVP de 0,43 (IC95%: 0,36-0,52), e, para TEP, de 0,48 (IC95%: 0,33-0,69). 42 Como vantagens, esses dispositivos não têm os efeitos adversos apresentados pelas drogas anticoagulantes, tais como sangramento, e tampouco requerem monitoramento laboratorial.…”