¿Existen factores de riesgo para desarrollar complicaciones con el uso de filtros de vena cava removibles en cirugías ortopédicas
DOI:
https://doi.org/10.31053/1853.0605.v75.n2.17746Palabras clave:
filtro de vena cava removible, enfermedad tromboembólica, cirugía ortopédica, trombosis venosa profunda, embolia pulmonar,Resumen
Introducción: En pacientes sometidos a cirugía ortopédica y con antecedente de Enfermedad tromboembolica, la profilaxis común suele ser insuficiente para prevenir eventos tromboembólicos. Los filtros de vena cava (FVC) removibles pueden considerarse una alternativa. Objetivos: Estimar la tasa de complicaciones hematológicas, mecánicas y muertes asociadas al uso de FVC removibles en cirugía ortopédica. Métodos: Se diseñó una cohorte retrospectiva de pacientes con historia previa de Enfermedad tromboembolica (ETE) sometidos a procedimientos ortopédicos que requirieron FVC removible, entre el 2006-2014 en el servicio de ortopedia del Hospital Italiano de Buenos Aires. Se definió complicación asociada al FVC a las complicaciones mecánicas, hematológicas (recurrencia de ETE, síndrome postrombotico y sangrado mayor) y muerte. Para estimar la asociación con factores de riesgo, subclasificamos a las cirugías en 5 grupos: 1, artroplastia/no artroplastia; 2, primaria/revisión; 3, electiva/urgente; 4, oncológica/no oncológica; 5, filtro pre/postoperatorio. Resultados: Se incluyeron 68 pacientes, de los cuales 31 presentaron algún tipo de complicación. Las complicaciones mecánicas ostentaron un 16%, precisando de una revisión del filtro. 64% de los filtros revisados fallaron mecánicamente y no pudieron ser extraídos. Las tasas de recurrencia de ETE, síndrome postrombotico y sangrado mayor fueron del 33%, 15% y 4.5%, respectivamente. Las cirugías espinales presentaron un mayor riesgo de recurrencia de ETE. La mortalidad global fue del 28% y 4% asociada a recurrencia de ETE. Conclusiones: Las cirugías ortopédicas exhibieron un riesgo elevado de complicaciones mecánicas y hematológicas luego de usar un FVC removible. Empero, la mortalidad debido a dichas complicaciones fue baja.
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Agnelli G, Verso M, Ageno W, Imberti D, Moia M, Palareti G, Rossi R, Pistelli R. The MASTER registry on venous thromboembolism: Description of the study cohort. Thromb. Res. 2008;121:605–610.
Albrecht RM, Garwe T, Carter SM, Maurer AJ. Retrievable inferior vena cava filters in trauma patients: Factors that influence removal rate and an argument for institutional protocols. Am. J. Surg. 2012;203:297–302. Available at: http://dx.doi.org/10.1016/j.amjsurg.2011.09.006.
Allen TL, Carter JL, Morris BJ, Harker CP, Stevens MH. Retrievable vena cava filters in trauma patients for high-risk prophylaxis and prevention of pulmonary embolism. Am. J. Surg. 2005;189:656–61. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15910715.
Angel LF, Tapson V, Galgon RE, Restrepo MI, Kaufman J. Systematic review of the use of retrievable inferior vena cava filters. J. Vasc. Interv. Radiol. 2011;22:1522–1530.e3. Available at: http://dx.doi.org/10.1016/j.jvir.2011.08.024.
Antevil JL, Sise MJ, Sack DI, Sasadeusz KJ, Swanson SM, Rivera L, Lome BR, Weingarten KE, Kaminski SS. Retrievable Vena Cava Filters for Preventing Pulmonary Embolism in Trauma Patients: A Cautionary Tale. J. Trauma Inj. Infect. Crit. Care. 2006;60:35–40. Available at: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00005373-200601000-00006.
Austin MS, Parvizi J, Grossman S, Restrepo C, Klein GR, Rothman RH. The inferior vena cava filter is effective in preventing fatal pulmonary embolus after hip and knee arthroplasties. J. Arthroplasty. 2007;22:3438. Available at: http://www.sciencedirect.com/science/article/pii/S0883540306007121.
Aziz F, Comerota AJ. Inferior Vena Cava Filters. Ann. Vasc. Surg. 2010;24:966–979. Available at: http://linkinghub.elsevier.com/retrieve/pii/S0890509610001949.
Bagot CN, Arya R. Virchow and his triad: A question of attribution. Br. J. Haematol. 2008;143:180–190.
Bass AR, Mattern CJ, Voos JE, Peterson MGE, Trost DW. Inferior vena cava filter placement in orthopedic surgery. Am. J. Orthop. (Belle Mead. NJ). 2010;39:435–9. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21290021.
Benevenia J, Bibbo C, Patel D V, Grossman MG, Bahramipour PF, Pappas PJ. Inferior vena cava filters prevent pulmonary emboli in patients with metastatic pathologic fractures of the lower extremity. Clin Orthop Relat Res. 2004:87–91. Available at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15346056.
Cg L, Ia I, Sf S. Evaluation of the First-Generation AAOS Clinical Guidelines on the Prophylaxis of Venous Thromboembolic Events in Patients Undergoing Total Joint Arthroplasty. 2014:1327–1332.
Charen DA, Qian ET, Hutzler LH, Bosco JA. Risk Factors for Postoperative Venous Thromboembolism in Orthopaedic Spine Surgery, Hip Arthroplasty, and Knee Arthroplasty Patients. 2015;73:198–203.
Cherry R a, Nichols P a, Snavely TM, David MT, Lynch FC. Prophylactic inferior vena cava filters: do they make a difference in trauma patients? J. Trauma. 2008;65:544–548. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18784566.
Colwell CW, Froimson MI, Mont MA, Ritter MA, Trousdale RT, Buehler KC, Spitzer A, Donaldson TK, Padgett DE. Thrombosis prevention after total hip arthroplasty: a prospective, randomized trial comparing a mobile compression device with low-molecular-weight heparin. J. Bone Joint Surg. Am. 2010;92:527–35. Available at: http://jbjs.org/cgi/doi/10.2106/JBJS.I.00047.
Cracowski J, Bosson J, Baloul F, Moirant C, Hunt M, Merloz P, Carpentier P. Early development of deep-vein thrombosis following hip fracture surgery : the role of venous wall thickening detected by B-mode ultrasonography. 1998:269–274.
Decousus H. Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: The PREPIC (Prévention du Risque d’Embolie Pulmonaire par Interruption Cave) randomized study. Circulation. 2005;112:416–422.
Decousus H, Leizorovicz A, Parent F, Page Y, Tardy B, Girard P, Laporte S, Faivre R, Charbonnier B, Barral FG, Huet Y, Simonneau G. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risque d’Embolie Pulmonaire par Interruption Cave Study Group. N. Engl. J. Med. 1998;338:409–15. Available at: http://www.ncbi.nlm.nih.gov/pubmed/9459643.
Dorr LD. Multimodal Thromboprophylaxis for Total Hip and Knee Arthroplasty Based on Risk Assessment. J. Bone Jt. Surg. 2007;89:2648. Available at: http://jbjs.org/cgi/doi/10.2106/JBJS.F.00235.
Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, Ortel TL, Pauker SG, Colwell CW. Prevention of VTE in Orthopedic Surgery Patients. Chest. 2012;141:e278S–e325S. Available at: http://linkinghub.elsevier.com/retrieve/pii/S0012369212601263.
Ferreyro BL, Angriman F, Giunta D, Posadas-Martinez ML, Vazquez F, De Quiros FGB, Amaral ACKB, Scales DC. Predictive score for estimating cancer after venous thromboembolism: a cohort study. BMC Cancer. 2013;13:352. Available at: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=medl&NEWS=N&AN=23875619.
Fullen WD, Miller EH, Steele WF, McDonough JJ. Prophylactic vena caval interruption in hip fractures. J. Trauma. 1973;13:403–10. Available at: http://www.ncbi.nlm.nih.gov/pubmed/4540786.
Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest. 2008;133:381–453.
Golueke PJ, Garrett W V, Thompson JE, Smith BL, Talkington CM. Interruption of the vena cava by means of the Greenfield filter: expanding the indications. Surgery. 1988;103:111–7. Available at: http://www.ncbi.nlm.nih.gov/pubmed/3336860.
Horlander KT, Mannino DM, Leeper K V. Pulmonary embolism mortality in the United States, 1979-1998: an analysis using multiple-cause mortality data. Arch. Intern. Med. 2003;163:1711–7. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12885687.
Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, Jenkins JS, Kline JA, Michaels AD, Thistlethwaite P, Vedantham S, White RJ, Zierler BK, American Heart Association Council on Cardiopulmonary, Critical Care P and R, American Heart Association Council on Peripheral Vascular Disease, American Heart Association Council on Arteriosclerosis T and VB. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011;123:1788–830. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2884887&tool=pmcentrez&rendertype=abstract.
Johnson ON, Gillespie DL, Aidinian G, White PW, Adams E, Fox CJ. The use of retrievable inferior vena cava filters in severely injured military trauma patients. J. Vasc. Surg. 2009;49:410–416. Available at: http://dx.doi.org/10.1016/j.jvs.2008.09.004.
Kahn SR, Partsch H, Vedantham S, Prandoni P, Kearon C. Definition of post-thrombotic syndrome of the leg for use in clinical investigations: A recommendation for standardization. J. Thromb. Haemost. 2009;7:879–883.
Karmy-Jones R, Jurkovich GJ, Velmahos GC, Burdick T, Spaniolas K, Todd SR, McNally M, Jacoby RC, Link D, Janczyk RJ, Ivascu F a, McCann M, Obeid F, Hoff WS, McQuay N, Tieu BH, Schreiber M a, Nirula R, Brasel K, Dunn J a, Gambrell D, Huckfeldt R, Harper J, Schaffer KB, Tominaga GT, Vinces FY, Sperling D, Hoyt D, Coimbra R, Rosengart MR, Forsythe R, Cothren C, Moore EE, Haut ER, Hayanga AJ, Hird L, White C, Grossman J, Nagy K, Livaudais W, Wood R, Zengerink I, Kortbeek JB. Practice patterns and outcomes of retrievable vena cava filters in trauma patients: an AAST multicenter study. J. Trauma. 2007;62:17-24–5. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17215729.
Kaufman JA, Kinney TB, Streiff MB, Sing RF, Proctor MC, Becker D, Cipolle M, Comerota AJ, Millward SF, Rogers FB, Sacks D, Venbrux AC. Guidelines for the use of retrievable and convertible vena cava filters: report from the Society of Interventional Radiology multidisciplinary consensus conference. J. Vasc. Interv. Radiol. 2006;17:449–59. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16567669.
Lapidus LJ, Ponzer S, Pettersson H, Bri E De. Symptomatic venous thromboembolism and mortality in orthopaedic surgery – an observational study of 45 968 consecutive procedures. BMC Musculoskelet. Disord. 2013;14:1. Available at: BMC Musculoskeletal Disorders.
Lapner ST, Kearon C. Diagnosis and management of pulmonary embolism. BMJ. 2013;346:f757. Available at: http://www.healio.com/doiresolver?doi=10.3928/01477447-20160119-02.
Lieberman JR, Geerts WH. Prevention of venous thromboembolism after total hip and knee arthroplasty. J. Bone Joint Surg. Am. 1994;76:1239–50. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8056805.
Liebs TR, Splietker F. Is a Revision a Revision ? An Analysis of National Arthroplasty Registries ’ Definitions of Revision. Clin. Orthop. Relat. Res. 2015:3421–3430. Available at: http://dx.doi.org/10.1007/s11999-015-4255-4.
Masuda K, Chikuda H, Yasunaga H, Hara N, Horiguchi H, Matsuda S, Takeshita K, Kawaguchi H, Nakamura K. Factors affecting the occurrence of pulmonary embolism after spinal surgery: data from the national administrative database in Japan. Spine J. 2012;12:1029–34. Available at: http://joi.jlc.jst.go.jp/JST.Journalarchive/jscpt1970/7.375?from=CrossRef.
McClendon J, Oʼshaughnessy B a, Smith TR, Sugrue P a, Halpin RJ, Morasch M, Koski T, Ondra SL. Comprehensive assessment of prophylactic preoperative inferior vena cava filters for major spinal reconstruction in adults. Spine (Phila. Pa. 1976). 2012;37:1122–9. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22281478.
Mikhail S, Hannan L, Pishvaian MJ, Kessler C. Retrievable inferior vena cava filters in patients with cancer are safe but are they beneficial? Med. Oncol. 2015;32:175. Available at: http://link.springer.com/10.1007/s12032-015-0622-y.
Mobin-Uddin K, McLean R, Bolooki H, Jude JR. Caval interruption for prevention of pulmonary embolism. Long-term results of a new method. Arch. Surg. 1969;99:711–5. Available at: http://www.ncbi.nlm.nih.gov/pubmed/5370194.
Mont M a, Jacobs JJ, Boggio LN, Bozic KJ, Della Valle CJ, Goodman SB, Lewis CG, Yates AJ, Watters WC, Turkelson CM, Wies JL, Donnelly P, Patel N, Sluka P. Preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty. J. Am. Acad. Orthop. Surg. 2011;19:768–76. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22134209.
Myojo M, Takahashi M, Tanaka T, Higashikuni Y, Kiyosue A, Ando J, Fujita H, Komuro I, Hirata Y. Midterm Follow-up After Retrievable Inferior Vena Cava Filter Placement in Venous Thromboembolism Patients With or Without Malignancy. Clin. Cardiol. 2015;38:216–221. Available at: http://doi.wiley.com/10.1002/clc.22377.
Ozturk C, Ganiyusufoglu K, Alanay A, Aydogan M, Onat L, Hamzaoglu A. Efficacy of prophylactic placement of inferior vena cava filter in patients undergoing spinal surgery. Spine (Phila. Pa. 1976). 2010;35:1893–6. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20802386.
Rogers FB, Strindberg G, Shackford SR, Osler TM, Morris CS, Ricci M a, Najarian KE, D’Agostino R, Pilcher DB. Five-year follow-up of prophylactic vena cava filters in high-risk trauma patients. Arch. Surg. 1998;133:406–11; discussion 412. Available at: http://www.ncbi.nlm.nih.gov/pubmed/9565121.
Rosenthal D, Wellons ED, Lai KM, Bikk A, Henderson VJ. Retrievable inferior vena cava filters: initial clinical results. Ann. Vasc. Surg. 2006;20:157–65. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16378141.
Rosner MK, Kuklo TR, Tawk R, Moquin R, Ondra SL. Prophylactic placement of an inferior vena cava filter in high-risk patients undergoing spinal reconstruction. Neurosurg. Focus. 2004;17:E6. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15633992.
Schulman S, Anger SU, Bergqvist D, Eriksson B, Lassen MR, Fisher W. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients. J. Thromb. Haemost. 2010;8:202–204.
Sharrock NE, Go G, Harpel PC, Ranawat CS, Sculco TP, Salvati EA. The John Charnley Award. Thrombogenesis during total hip arthroplasty. Clin. Orthop. Relat. Res. 1995:16–27. Available at: http://www.ncbi.nlm.nih.gov/pubmed/7554626.
Strauss EJ, Egol KA, Alaia M, Hansen D, Bashar M, Steiger D. The use of retrievable inferior vena cava filters in orthopaedic patients. J. Bone Joint Surg. Br. 2008;90:662–7. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18450637.
Tagalakis V, Patenaude V, Kahn SR, Suissa S. Incidence of and mortality from venous thromboembolism in a real-world population: the Q-VTE Study Cohort. Am. J. Med. 2013;126:832.e13-21. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23830539.
Takai N, Takasugi Y, Kajikawa R, Takase T, Yamamoto Y, Nakao S. Fatal pulmonary embolism following spinal surgery in a patient with permanent inferior vena cava filter placement. J. Anesth. 2014;28:606–609.
Young T, Tang H, Aukes J, Hughes R. Vena caval filters for the prevention of pulmonary embolism. Cochrane Database Syst. Rev. 2007.
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