Major abdominal kanser cerrahisi geçiren hastalarda uzamış tromboemboli profilaksisi
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Date
2015
Authors
Candan, Barış
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Venöz tromboembolizm (VTE) hastane ölümlerinin en sık nedenlerinden biridir. Cerrahi VTE riskini arttırmaktadır. Kanser, fizyopatolojik olarak tromboza eğilimi daha da arttırmaktadır. Düşük molekül ağırlıklı heparinler (DMAH) cerrahi profilakside rutin olarak hastanede yatan ve major abdominal kanser cerrahisi geçiren hastalara uygulanmaktadır. En son ilaç kullanım kılavuzları DMAH'lerin major abdominal kanser cerrahisi geçiren hastalara 28 gün rutin profilakside uygulanması gerektiğini belirtmektedir. Bizim çalışmamızda kliniğimizde 1 ocak-15 aralık tarihlerinde major abdominal kanser cerrahisi uygulanan 114 hasta retrospektif olarak incelenmiş, bu hastaların bir kısmına yatış süresince DMAH'la profilaksi uygulanmış ( A grubu ), bir kısmına da taburculuk sonrası DMAH'la ( B grubu ) profilaksiye devam edilmiştir. Her iki grup için demografik özellikleri, cerrahi işlem ve sonrasındaki durumları ve sağ kalımları incelenmiştir. Ayrıca 34 hastanın da 3 haftalık D-Dimer fibrinojen seviye değişimleri incelenmiştir. Ameliyat süresi uzadıkça, B grubuna dahil olan hasta oranı artmaktadır (p=0,036). Yoğun bakımda yatış süresi uzadıkça yine B grubuna dahiliyet artmaktadır (p=0,01). Postoperatif VTE ve kanama açısından her iki grupta anlamlı fark saptanmamıştır. B grubunda takipte sağ kalım oranı daha fazla bulunmuştur (p=0,06). D-Dimer ve fibrinojen seviyeleri 3 hafta sonunda her iki grupta da azalmakla birlikte yüksek seyretmiştir. Major abdominal kanser cerrahi uygulanan hastaların yalnızca yatış süresince değil taburculuk sonrası da profilaksiye devam ederek toplam 4 hafta DMAH ile profilaksi uygulanması gerektiği ve bunun kliniğimizde de standart bir uygulama haline getirilmesi gerektiğini düşünmekteyiz.
Venous thromboembolism (VTE) is one of the most common cause of death in the hospital. Surgery reduces VTE risk. Also cancer, physiopathogicaly induces thrombosis. Prophylaxis with low molecular weight heparins (LMWH) are routinely used to patients in the hospital and patients who underwent major abdominal surgery for cancer. Last guidelines for LMWH suggested that it should be use for 28 days, after major abdominal surgery for routine prophylaxis. In our study, 114 patients who underwent major abdominal surgery for cancer in 1 january – 15 december 2014, are retrospectively studied, one part of these patients ( group A ) received prophylaxis in hospital period and the other one ( group B ) received out-of-hospital period also. All patients studied for demographic characteristics, surgery , surgery follow-up and survivals. Also for 34 patient's d-dimer and fibrinogen levels observed in three weeks period after surgery. B group patient percentage is getting more with long duration of surgery ( p=0,036 ). Also with long staying in intensive care unit (ICU) is more in group B ( p=0,01) . There was no differences in VTE and bleeding events in both groups. In follow-up term, survival is more in B group ( p=0,06 ). Altough its decreasing levels, d-dimer and fibrinogen levels stay higher in three weeks period in both groups. We suggested that patients who undergoing major abdominal surgery for cancer, should recive not only hospital stay prophylaxis, they should receive prophylaxis with LMWH after discharge and totally at least 28 days after surgery. In our opinion this should be standart practice in our clinics too.
Venous thromboembolism (VTE) is one of the most common cause of death in the hospital. Surgery reduces VTE risk. Also cancer, physiopathogicaly induces thrombosis. Prophylaxis with low molecular weight heparins (LMWH) are routinely used to patients in the hospital and patients who underwent major abdominal surgery for cancer. Last guidelines for LMWH suggested that it should be use for 28 days, after major abdominal surgery for routine prophylaxis. In our study, 114 patients who underwent major abdominal surgery for cancer in 1 january – 15 december 2014, are retrospectively studied, one part of these patients ( group A ) received prophylaxis in hospital period and the other one ( group B ) received out-of-hospital period also. All patients studied for demographic characteristics, surgery , surgery follow-up and survivals. Also for 34 patient's d-dimer and fibrinogen levels observed in three weeks period after surgery. B group patient percentage is getting more with long duration of surgery ( p=0,036 ). Also with long staying in intensive care unit (ICU) is more in group B ( p=0,01) . There was no differences in VTE and bleeding events in both groups. In follow-up term, survival is more in B group ( p=0,06 ). Altough its decreasing levels, d-dimer and fibrinogen levels stay higher in three weeks period in both groups. We suggested that patients who undergoing major abdominal surgery for cancer, should recive not only hospital stay prophylaxis, they should receive prophylaxis with LMWH after discharge and totally at least 28 days after surgery. In our opinion this should be standart practice in our clinics too.
Description
Keywords
Venöz tromboemboli, Kanser, Profilaksi, Cerrahi, Düşük molekül ağırlıklı heparin, Venous thromboembolism, Cancer, Surgery, Prophylaxis, Low molecular weight heparin
Citation
Candan, B. (2015). Major abdominal kanser cerrahisi geçiren hastalarda uzamış tromboemboli profilaksisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.