Cirurgia da mão ou do punho na vigência de antitrombóticos orais: Revisão sistemática e metanálise
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Data
2018-07-19
Autores
Deienno, Francisco Simões
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: O risco de sangramento em cirurgias realizadas na vigência de antitrombóticos preocupa o cirurgião, em contrapartida, a suspensão do agente antitrombótico aumenta o risco de trombose. Esse dilema levou a realização desta revisão. Objetivo: avaliar, por meio de revisão sistemática e metanálise, se há ou não necessidade de suspender medicamentos antitrombóticos orais (varfarina, fluindiona, acenocumarol, AAS e clopidogrel) para a realização de procedimentos eletivos de cirurgia do punho e da mão. Métodos: revisão sistemática de estudos experimentais ou observacionais que tenham avaliado cirurgias de mão e punho na vigência do agente antitrombótico. Foram pesquisadas as bases de dados LILACS, Pubmed, Embase, Cochrane e Scopus, sendo selecionados series com cinco ou mais cirurgias . Os desfechos avaliados foram: complicações graves (necessidade de tratamento cirúrgico) e leves (sem necessidade de tratamento cirúrgico). Resultados : foram selecionados 10 estudos observacionais para análise qualitativa envolvendo 2971 cirurgias. Seis desses estudos foram selecionados para análise quantitativa, envolvendo 319 cirurgias do punho e da mão realizadas na vigência de varfarina, fluindiona, acenocumarol, AAS e clopidogrel e 629 cirurgias realizadas em pacientes sem uso dos antitrombóticos. O risco de complicações leves foi maior nos pacientes que estavam recebendo antitrombóticos ( RR 1,55, IC 95% 1,02 a 2,35; I 2 = 23%, 948 cirurgias), e o risco de complicações graves foi semelhante nos dois grupos (RR 1,83, IC 95% 0,32 a 10,29; I 2 = 0%, 948 cirurgias). Conclusões: Pacientes em uso de anticoagulantes orais ou antiplaquetários orais tem um risco maior de desenvolver complicações leves, isto é aquelas que não necessitam de reintervenção cirúrgica , quando submetidos a cirurgias do punho e da mão na vigência de tratamento antitrombótico.
Introduction : The risks of bleeding in surgeries performed during the antithrombotic period are of concern to the surgeon, and on the other hand, the suspension of the antithrombotic agent increases the risk of thrombosis. This dilemma led to this review. Objective: to evaluate, through a systematic review, whether or not there is a need to suspend antithrombotic drugs (warfarin, fluindione, acenocumarol, ASA and clopidogrel) to perform elective procedures for wrist and hand surgery. Methods: systematic review of experimental or observational studies that have evaluated hand and wrist surgeries during the antithrombotic agent. The databases LILACS, Pubmed, Embase, Cochrane and Scopus were searched, being selected series with five or more surgeries. The outcomes evaluated were: severe complications (need for surgical treatment) and mild complications (no need for surgical treatment). Results: 10 observational studies were selected for qualitative analysis involving 2971 surgeries. Six of these studies were selected for quantitative analysis, involving 319 wrist and hand surgeries performed during warfarin, fluindione, acenocumarol, ASA and clopidogrel and 629 surgeries performed in patients without antithrombotic drugs. The risk of mild complications was greater in patients receiving antithrombotic drugs (RR 1.55, 95% CI 1.02 to 2.35, I 2 = 23%, 948 surgeries), and the risk of severe complications was similar in both groups (RR 1.83, 95% CI 0.32 to 10.29, I 2 = 0%, 948 surgeries). Conclusions: Patients taking oral anticoagulants or oral antiplatelet agents may be at increased risk of developing mild complications , that is, those that do not require surgical reintervention, when undergoing hand and wrist surgeries during antithrombotic treatment
Introduction : The risks of bleeding in surgeries performed during the antithrombotic period are of concern to the surgeon, and on the other hand, the suspension of the antithrombotic agent increases the risk of thrombosis. This dilemma led to this review. Objective: to evaluate, through a systematic review, whether or not there is a need to suspend antithrombotic drugs (warfarin, fluindione, acenocumarol, ASA and clopidogrel) to perform elective procedures for wrist and hand surgery. Methods: systematic review of experimental or observational studies that have evaluated hand and wrist surgeries during the antithrombotic agent. The databases LILACS, Pubmed, Embase, Cochrane and Scopus were searched, being selected series with five or more surgeries. The outcomes evaluated were: severe complications (need for surgical treatment) and mild complications (no need for surgical treatment). Results: 10 observational studies were selected for qualitative analysis involving 2971 surgeries. Six of these studies were selected for quantitative analysis, involving 319 wrist and hand surgeries performed during warfarin, fluindione, acenocumarol, ASA and clopidogrel and 629 surgeries performed in patients without antithrombotic drugs. The risk of mild complications was greater in patients receiving antithrombotic drugs (RR 1.55, 95% CI 1.02 to 2.35, I 2 = 23%, 948 surgeries), and the risk of severe complications was similar in both groups (RR 1.83, 95% CI 0.32 to 10.29, I 2 = 0%, 948 surgeries). Conclusions: Patients taking oral anticoagulants or oral antiplatelet agents may be at increased risk of developing mild complications , that is, those that do not require surgical reintervention, when undergoing hand and wrist surgeries during antithrombotic treatment
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cirurgia da mão, anticoagulante,, varfarina, fluindiona, acenocumarol, AAS, clopidogrel, hand surgery, anticoagulant, warfarin, fluindione, ASA