JİNEKOLOJİK VE JİNEKO-ONKOLOJİK CERRAHİDE VENÖZ TROMBOEMBOLİZM PROFİLAKSİSİ

Abstract

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

Keywords

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

Abstract

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.

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