Randomized Trial of Deep Vein Thrombosis Chemoprophylaxis with Bemiparin and Enoxaparin in Patients with Moderate to High Thrombogenic Risk Undergoing Plastic and Reconstructive Surgery Procedures
Por:
Revilla-Penaloza, Francisco, Jay Olsoff-Pagovich, Paul, Ramon Ochoa-Gomez, Jose, Castaneda-Gaxiola, Roberto, Ivan Rubio-Gayosso, Angel, Ceballos, Guillermo, Arcadio Molina-Guarneros, Juan
Publicada:
1 jun 2020
Categoría:
Surgery
Resumen:
Background Deep vein thrombosis (DVT) is a common complication during
postoperative convalescence characterized by hypercoagulability,
vascular endothelium damage and blood stasis. It increases noticeably in
peri/postoperative phases of surgery procedures. Pulmonary embolism
secondary to iliofemoral DVT is a frequent cause of death. Methods Adult
patients scheduled for plastic and reconstructive surgery (PRSx) with
moderate to high thrombogenic risk were selected. We evaluated the
efficacy and safety of bemiparin compared to enoxaparin as
chemoprophylaxis for DVT. Following balanced general anesthesia
techniques, patients were randomly assigned for subcutaneous enoxaparin
40 IU (Group-E) or bemiparin 3500 IU (Group-B) q24h starting 6 h after
procedure conclusion for at least 10 days. All patients were evaluated
for DVT through Doppler ultrasound mapping of the lower limbs. Results
Seventy-eight patients were evaluated, mostly women (83%), physical
status ASA II (59%), ASA III (10%); Caprini's thrombogenic risk score
3-4 (moderate) 58%, 5-6 (high) 29%, > 6 (too high) 13%; demographics,
clinical variables and scores were similar between groups. Median
drainage time in breast surgery was 4 days in both groups (p = 0.238).
In the case of abdominal surgery, median was 14 days in Group-E versus
13 days in Group-B (p = 0.059). No DVT was detected in either group.
Conclusions DVT was prevented with bemiparin, without significant
bleeding increase nor adverse events; moreover, the cost of bemiparin is
lower than enoxaparin. Bemiparin can be considered as alternative drug
for DVT chemoprophylaxis in PRSx procedures.
Filiaciones:
Revilla-Penaloza, Francisco:
Amer British Cowdray Santa Fe Med Ctr, Anesthesiol Serv, 154 Carlos Graef Fernandez Av, Mexico City 053333, DF, Mexico
Inst Politecn Nacl, Escuela Super Med, Secc Estudios Posgrad, Mexico City 11340, DF, Mexico
Jay Olsoff-Pagovich, Paul:
ABC Santa Fe Med Ctr, Plast & Reconstruct Surg, 154 Carlos Graef Fernandez Av, Mexico City 053333, DF, Mexico
Ramon Ochoa-Gomez, Jose:
ABC Santa Fe Med Ctr, Plast & Reconstruct Surg, 154 Carlos Graef Fernandez Av, Mexico City 053333, DF, Mexico
Castaneda-Gaxiola, Roberto:
ABC Santa Fe Med Ctr, Angiol & Vasc Surg, 154 Carlos Graef Fernandez Av, Mexico City 053333, DF, Mexico
Ivan Rubio-Gayosso, Angel:
Inst Politecn Nacl, Escuela Super Med, Secc Estudios Posgrad, Mexico City 11340, DF, Mexico
Ceballos, Guillermo:
Inst Politecn Nacl, Escuela Super Med, Secc Estudios Posgrad, Mexico City 11340, DF, Mexico
Arcadio Molina-Guarneros, Juan:
Univ Nacl Autonoma Mexico, Fac Med, Pharmacol Dept, Av Univ 3000, Mexico City 04510, DF, Mexico
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