Tromboembolia Venosa (TEV) | Boehringer Ingelheim

O tromboembolismo venoso (TEV) se caracteriza pela formação de trombos nas veias profundas, com obstrução parcial ou total, sendo mais frequente o acometimento dos membros inferiores, ao redor de 80% a 95% dos casos.¹ Constitui uma complicação grave em pacientes hospitalizados e a causa mais frequente de morte evitável nesses pacientes, além de ser a terceira causa de morte de origem cardiovascular, após a doença arterial coronariana e o acidente vascular cerebral.² Numerosas situações clínicas ou cirúrgicas aumentam o risco de TEV. A imobilização dos membros inferiores por mais de três dias aumenta o risco em até 10 vezes;³ 10% a 30% dos pacientes internados por doenças clínicas agudas podem apresentar TEV;⁴ a insuficiência cardíaca e a insuficiência respiratória aumentam o risco trombótico em até 10 vezes.⁵ Esses dados reforçam a importância da tromboprofilaxia, tanto para pacientes clínicos como cirúrgicos.
Imobilidade

Cirurgia (particularmente ortopédica)

A artroplastia total do joelho (ATJ) e a de quadril (ATQ) são procedimentos cirúrgicos para aliviar a dor e melhorar a função prejudicada das articulações. Apesar de esses procedimentos serem seguros, a trombose venosa profunda (TVP) e a tromboembolia pulmonar (TEP) são potenciais complicações. Estudo observacional prospectivo usando venografia de membro inferior bilateral na primeira semana de pósoperatório encontrou uma elevada incidência de TVP sintomática (4,6%) e TVP assintomática (18,3%) em pacientes submetidos a artroplastia de joelho.⁹ Caprini e cols.¹⁰ Encontraram, por meio de Doppler de membros inferiores realizado uma e quatro semanas após cirurgia de ATQ, uma taxa elevada de TVP (15,2%), apesar do uso meias elásticas, heparina e varfarina após alta hospitalar, dos quais 64% eram assintomáticos, sendo 31,6% detectados na primeira semana e 68%, um mês após a cirurgia.

Câncer

Uso de estrogênio

Gravidez e puerpério

Idade avançada (>65 anos)

Obesidade

Distúrbios hereditários/idiopáticos pró-trombóticos da coagulação – resistência à proteína C ativada (principalmente fator V de Leiden); mutação do gene da protrombina G20210A; deficiência de antitrombina; deficiência de proteína C; deficiência de proteína S; hiper-homocisteinemia; aumento do fator VIII; aumento do fibrinogênio
Insuficiência venosa crônica/síndrome pós-trombótica (edema e/ou dor em membros inferiores, mudança na pigmentação e ulcerações na pele).

TEP com elevado risco de morte. Aproximadamente 5% a 15% de indivíduos não tratados da TVP podem morrer de embolia pulmonar.²

Referências

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21.
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Tromboembolismo Venoso

Referências