Ulus Travma Acil Cerrahi Derg. 2010; 16(2): 130-134

Travma ve acil cerrahi yoðun bakým hastalarýnda venöz tromboemboli profilaksisi: Düþük molekül aðýrlýklý heparin ile elastik çorap + aralýklý pnömotik kompresyonun karþýlaþtýrýlmasý

Kürþat Serin¹, Hakan Yanar¹, Yaþar Özdenkaya¹, Simru Tuðrul², Mehmet Kurtoðlu^1
1Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi Genel Cerrahi Ana Bilim Dalý
²Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi Anesteziyoloji Ve Reanimasyon Ana Bilim Dalý

AMAÇ
Travma ve acil cerrahi yoðun bakým hastalarýnda venöz tromboembolide (VTE) düþük molekül aðýrlýklý heparin (DMAH) ile elastik çorap ve aralýklý pnömatik kompresyon (EÇ+APK) profilaksi yöntemlerinin VTE riski açýsýndan etkinliði ve güvenirliliði araþtýrýldý.
GEREÇ VE YÖNTEM
Haziran 2005 ile Haziran 2007 tarihleri arasýnda 7 günden uzun süre mekanik ventilatöre baðýmlý olarak yoðun bakýmda yatan 259 hasta prospektif olarak yatýþlarýnýn 3. ve 7. gününde alt ekstremite venöz Doppler ultrasonografi ile deðerlendirildi. Hastalarýn 152’sinde (%59) DMAH, 94 hastada (%36) EÇ ve APK kullanýldý.

BULGULAR
DMAH grubunda üç hastada (%2) derin ven trombozu (DVT) saptanýrken, EÇ ve APK grubunda bir hastada (%1) DVT saptandý. Kanama 15 hastada (%11) görüldü. VTE sýklýðý %1,5 (4/259) olarak saptandý. PE geliþen dört hastadan ikisinde ölümcül pulmoner emboli geliþti (%0,7).
SONUÇ
Ýstanbul Týp Fakültesi Acil Cerrahi biriminde, yüksek mortalite ve morbiditenin olduðu yoðun bakým hastalarýnda uygulanan VTE profilaksi protokolünü yeterli ve güvenli olduðuna inanýyoruz.

Anahtar Kelimeler: Travma ve acil cerrahi, venöz tromboemboli; yoðun bakým.

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Venous thromboembolism prophylaxis methods in trauma and emergency surgery intensive care unit patients: low molecular weight heparin versus elastic stockings + intermittent pneumatic compression

Kürþat Serin¹, Hakan Yanar¹, Yaþar Özdenkaya¹, Simru Tuðrul², Mehmet Kurtoðlu^1
1Department Of General Surgery, Ýstanbul Medical Faculty, Ýstanbul University
²Department Of Anesthesiology And Intensive Care, Istanbul Medical Faculty, Istanbul University

BACKGROUND
We aimed to evaluate the efficacy and safety of low molecular weight heparin (LMWH) compared to elastic stockings in combination with intermittent pneumatic compression (ES+IPC) in venous thromboembolism (VTE) prophylaxis in the intensive care unit (ICU) of trauma and emergency surgery.
METHODS
From June 2005 to June 2007, 259 patients who were on mechanic ventilation in the ICU were assigned to two groups as either LMWH (152 patients) or ES+IPC (94 patients). Color flow Doppler sonography was performed on the 3rd and 7th days.
RESULTS
Deep venous thrombosis was determined in 3 (2%) of the LMWH group and in 1 (1%) in the ES+IPC group. Minor bleeding was seen in 15 patients. The frequency of VTE was 1.5%. Two patients suffered from fatal pulmonary embolism (PE) among a total of 4 patients with PE.

CONCLUSION
We believe that the protocol applied for VTE prophylaxis in the Emergency Surgery Department of Istanbul Medical Faculty is effective and safe in this group with such high mortality and morbidity.

Keywords: Trauma and emergency surgery, venous thromboembolism; intensive care unit.

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ATIF KOPYALA