title: [Venous thromboembolic prophylaxis. Guidelines for adults in Argentina].
abstract: The venous thromboembolic disease (VTD) in adults has a high morbidity and mortality. It can be also associated to disabling chronic conditions. In spite of this, prophylaxis in healthcare assistance is still underused. In this article, the available evidence in thromboprophylaxis was analyzed to offer recommendations (1) or suggestions (2) classified according to different levels of evidence (A, B or C). Different medical scenarios and types of thromboprophylaxis were analyzed. In major orthopedic surgeries low molecular weight heparins, LMWH, inhibitors of the Xa and IIa factors are recommended (1B) to be started during hospitalization and continued for 35 days in hip replacement surgery and for 10 days in total knee replacement surgery. Knee arthroscopy and spine surgery do not require pharmacologic treatment (2B) unless the patient has other risks factors for thrombosis. In such cases, LMWH are recommended. Non-surgical patients who have at least one risk factor should receive LMWH, NFH or fondaparinux (1B) if they are to be bedridden or unable to walk for three or more days. Patients undergoing neurosurgery or with intracranial hemorrhage should receive mechanic prophylaxis (2C), and accordingly they should start LMWH or NFH 24 to 72 hours afterwards (2C). The latter two drugs are recommended for critically ill patients. Patients with low risk for VTD undergoing other type of surgeries should be prescribed with mechanical prophylaxis (2C) and encouraged to walk promptly (2C), while those with high risk should be prescribed with LMWH or NFH (1B or 2C according to bleeding risk factors).
authors.affiliation: Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Argentina. E-mail: fernando.vazquez@hospitalitaliano.org.ar.
authors.forename: Fernando Javier
authors.initials: FJ
authors.lastname: Vázquez
authors.forename: Esteban
authors.initials: E
authors.lastname: Lifschitz
authors.forename: Ricardo
authors.initials: R
authors.lastname: Watman
authors.forename: Alicia B
authors.initials: AB
authors.lastname: Vilaseca
authors.forename: Viviana E
authors.initials: VE
authors.lastname: Rodríguez
authors.forename: Adrián J
authors.initials: AJ
authors.lastname: Cruciani
authors.forename: Jorge D
authors.initials: JD
authors.lastname: Korin
authors.forename: Aldo H
authors.initials: AH
authors.lastname: Tabares
authors.forename: José M
authors.initials: JM
authors.lastname: Ceresetto
authors.forename: Marcel M
authors.initials: MM
authors.lastname: Clavier Lietti
authors.forename: Claudia A
authors.initials: CA
authors.lastname: Stinga
authors.forename: Pablo
authors.initials: P
authors.lastname: Bongiorno
authors.forename: Magdalena A
authors.initials: MA
authors.lastname: Princz
authors.forename: Natalia
authors.initials: N
authors.lastname: Schutz
authors.forename: Claudia E
authors.initials: CE
authors.lastname: Barada Palmero
authors.forename: Ricardo
authors.initials: R
authors.lastname: Salvador
authors.forename: Amanda
authors.initials: A
authors.lastname: Canaveri
authors.forename: Jorge
authors.initials: J
authors.lastname: Morón
authors.forename: Carlos
authors.initials: C
authors.lastname: Pale
authors.forename: Javier
authors.initials: J
authors.lastname: Saimovici
authors.forename: Federico J
authors.initials: FJ
authors.lastname: Capparelli
authors.forename: Néstor A
authors.initials: NA
authors.lastname: Wainsztein
authors.forename: Enrique M
authors.initials: EM
authors.lastname: Baldessari
authors.forename: María E
authors.initials: ME
authors.lastname: Ariscancela
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D001118:Argentina; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D019983:Guideline Adherence; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D019637:Orthopedic Procedures / Q000009:adverse effects; D011183:Postoperative Complications / Q000517:prevention & control; D012307:Risk Factors; D020246:Venous Thrombosis / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight
keywords: deep vein thrombosis; prophylaxis; pulmonary embolism; thrombosis; venous thromboembolic disease