Contenuto dell'articolo principale
Abstract
INTRODUZIONE: La metà dei decessi registrati nei pazienti non chirurgici attribuibili a tromboembolismo venoso (TEV) colpisce quelli con stroke. L’incerto beneficio della terapia anticoagulante ha accresciuto l’interesse verso gli interventi non farmacologici per prevenire il TEV.
OBIETTIVO: Valutare l’efficacia e la sicurezza degli interventi non farmacologici per prevenire il TEV nei pazienti con stroke.
METODI: Overview di revisioni sistematiche con reperimento dei documenti nel rispetto del PICOS Framework e tramite strategia di ricerca implementata il 4 aprile 2019 su sei database biomedici e sul registro PROSPERO. Gli strumenti utilizzati per la valutazione della qualità metodologica e del rischio di bias sono stati rispettivamente la checklist AMSTAR e lo strumento ROBIS. I risultati sono stati sintetizzati con modalità narrativa.
RISULTATI: Sette revisioni sistematiche di differente qualità metodologica e rischio di bias hanno rispettato i criteri di inclusione. Gli interventi non farmacologici di profilassi utilizzati sono stati calze a compressione graduata (CCG) e dispositivi di compressione pneumatica intermittente (DCPI). Il primo non ha effetto sul TEV e comporta importanti effetti collaterali, il secondo è promettente nel ridurre la mortalità per tutte le cause e diminuisce l’incidenza di trombosi venosa profonda.
DISCUSSIONE: L’utilizzo di DCPI, nonostante l’efficacia osservata, andrebbe riservato, dopo una valutazione del rischio di TEV e un’analisi per sottogruppi, ai pazienti che possono trarre il massimo beneficio dall’intervento.
CONCLUSIONI: Nei pazienti con stroke l’utilizzo di CCG per prevenire il TEV è sconsigliato perché non è superiore alle cure standard e può arrecare danno. I DCPI come intervento di profilassi sembrano efficaci ma sono necessarie ulteriori conferme da studi futuri.
Parole chiave
Dettagli dell'articolo
Riferimenti
- Anderson, J. (2015) Venous thromboembolic event prevention in acute stroke: update on evidence and recommendations. Pract Neurol, 15 (3), 160-163.
- André, C., de Freitas, G.R., & Fukujima, M.M. (2007) Prevention of deep venous thrombosis and pulmonary embolism following stroke: a systematic review of published articles. Eur J Neurol, 14 (1), 21-32.
- Casaubon, L.K., Boulanger, J.M., Glasser, E., Blacquiere, D., Boucher, S., Brown, K., et al. (2016) Canadian stroke best practice recommendations: acute inpatient stroke care guidelines, Update 2015. Int J Stroke, 11 (2), 239-252.
- CLOTS Trials Collaboration, Dennis, M., Sandercock, P.A., Reid, J., Graham, C., Murray, G., et al. (2009) Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial. Lancet, 373 (9679), 1958-1965.
- CLOTS Trial Collaboration. (2010) Thigh-length versus below-knee stockings for deep venous thrombosis prophylaxis after stroke: a randomized trial. Ann Intern Med, 153 (9), 553-562.
- Cooper, H., & Koenka, A.C. (2012) The overview of reviews: unique challenges and opportunities when research syntheses are the principal elements of new integrative scholarship. Am Psychol, 67 (6), 446-462.
- Dai, J. (2015). Nursing of patients with deep venous thrombosis after cerebral hemorrhage treated by pneumatic pump limb circulatory drive instrument. Zhejiang J Traum Surg, 20, 834-835.
- Dennis, M., & CLOTS Trial Collaboration. (2013) Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): A multicentre randomized, controlled trial. Lancet, 382, 516–524.
- Dennis, M., Caso, V., Kappelle, L.J., Pavlovic, A., Sandercock, P., for the European Stroke Organisation. (2016) European Stroke Organisation (ESO) guidelines for prophylaxis for venous thromboembolism in immobile patients with acute ischaemic stroke. Eur Stroke J, 1 (1), 6-19.
- Field, T.S., & Hill, M.D. (2012) Prevention of deep vein thrombosis and pulmonary embolism in patients with stroke. Clin Appl Thromb Hemost, 18 (1), 5-19.
- Hanison, E., & Corbett, K. (2016) Non-pharmacological interventions for the prevention of venous thromboembolism: a literature review. Nurs Stand, 31 (8), 48-57.
- Hartling, L., Vandermeer, B., & Fernandes, R.M. (2014) Systematic reviews, overviews of reviews and comparative effectiveness reviews: a discussion of approaches to knowledge synthesis. Evid Based Child Health, 9 (2), 486-494.
- Ho, K.M., & Tan, J.A. (2013) Stratified meta-analysis of intermittent pneumatic compression of the lower limbs to prevent venous thromboembolism in hospitalized patients. Circulation, 128 (9), 1003-1020.
- Kamran, S.I., Downey, D., & Ruff, R.L. (1998) Pneumatic sequential compression reduces the risk of deep vein thrombosis in stroke patients. Neurology, 50 (6), 1683-1688.
- Kappelle, L.J. (2011) Preventing deep vein thrombosis after stroke: strategies and recommendations. Curr Treat Options Neurol, 13 (6), 629-635.
- Lacut, K., Bressollette, L., Le Gal, G., Etienne, E., De Tinteniac, A., Renault, A., et al. (2005). Prevention of venous thrombosis in patients with acute intracerebral hemorrhage. Neurology, 65, 865-869.
- Le Jeune, S., Pistorius, M.A., Planchon, B., & Pottier, P. (2008a) Risk of venous thromboembolism in the course of acute medical illness. Part 1: basic research, clinical models, descriptive and analytic epidemiology. Rev Med Interne, 29 (6), 452-461.
- Le Jeune, S., Pistorius, M.A., Planchon, B., & Pottier, P. (2008b) Risk of venous thromboembolism in acute medical illnesses. Part 2: situations at risk in ambulatory, hospital and internal medicine settings. Rev Med Interne, 29 (6), 462-475.
- Masotti, L., Cappelli, R., Panigada, G., Landini, G., & Di Napoli, M. (2012) Mechanical prophylaxis of venous thromboembolism in ill hospitalized medical patients: evidence and guidelines. Rev Health Care, 3 (3), 193-207
- Mazzone, C., Chiodo Grandi, F., Sandercock, P., Miccio, M., & Salvi, R. (2002) Physical methods for preventing deep vein thrombosis in stroke. Cochrane Database Syst Rev, (1), CD001922.
- Mazzone, C., Chiodo Grandi, F., Sandercock, P., Miccio, M., & Salvi, R. (2004) Physical methods for preventing deep vein thrombosis in stroke. Cochrane Database Syst Rev, (4), CD001922.
- McCullough, M., Kholdani, C., & Zamanian, R.T. (2018) Prevention of deep vein thrombosis and pulmonary embolism in high-risk medical patients. Clin Chest Med, 39 (3), 483-492.
- Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., & PRISMA Group. (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg, 8, 336-341.
- Muir, K.W., Watt, A., Baxter, G., Grosset, D.G., & Lees, K.R. (2000) Randomized trial of graded compression stockings for prevention of deep-vein thrombosis after acute stroke. QJM, 93 (6), 359-364.
- Naccarato, M., Chiodo Grandi, F., Dennis, M., & Sandercock, P.A. (2010) Physical methods for preventing deep vein thrombosis in stroke. Cochrane Database Syst Rev, (8), CD001922.
- National Institute for health and Care Excellence (NICE). Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. Data accesso 3 dicembre 2019, dahttps://www.nice.org.uk /guidance/ng89/resources/venous-thromboembolism-in-over-16s-reducing-the-risk-of-hospitalacquired-deep-vein-thrombosis-or-pulmonary-embolism-pdf-1837703092165
- Olaf, M., & Cooney, R. (2017) Deep venous thrombosis. EmergMed Clin North Am, 35 (4), 743-770.
- Pambianco, G., Orchard, T., & Landau, P. (1995). Deep vein thrombosis: prevention in stroke patients during rehabilitation. Arch Phys Med Rehabil, 76, 324-330.
- Pavon, J.M., Williams, J.W. Jr., Adam, S.S., Razouki, Z.A., McDuffie, J.R., Lachiewicz, P.F., et al. (2015) Effectiveness of intermittent pneumatic compression devices for venous thromboembolism prophylaxis in high-risk surgical and medical patients. VA Evidence-based Synthesis Program Reports. Washington (DC): Department of Veterans Affairs (US), 1-63.
- Prasad, B., Banerjee, A., & Howard, H. (1982). Incidence of deep vein thrombosis and the effect of pneumatic compression of the calf in elderly hemiplegics. Age Ageing, 11, 42-44
- Robinson, K.A., Saldanha, I.J., & Mckoy, N.A. (2011) Development of a framework to identify research gaps from systematic reviews. J Clin Epidemiol, 64 (12), 1325-1330.
- Royal College of Physicians (RCP). (2016) National clinical guideline for stroke. Fifth edition 2016. Data accesso 3 dicembre 2019, da
- https://www.strokeaudit.org/SupportFiles/Documents/Guidelines/2016-National-Clinical-Guideline-for-Stroke-5t-(1).aspx
- Ryan, R., Santesso, N., Lowe, D., Hill, S., Grimshaw, J., Prictor, M., et al. (2014) Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews. Cochrane Database Syst Rev, 4, CD007768.
- Schünemann, H.J., Cushman, M., Burnett, A.E., Kahn, S.R., Beyer-Westendorf, J., Spencer, F.A., et al. (2018) American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients. Blood Adv, 2 (22), 3198-3225.
- Shea, B.J., Grimshaw, J.M., Wells, G.A., Boers, M., Andersson, N., Hamel, C., et al. (2007) Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 7 (10), 1-7.
- Wan, F., Huang, M., Lv, W., Tian, Y., & Wang, C. (2013). Preventive effect of intermittent pneumatic compression on deep venous thrombosis after acute cerebral infarction. Chi J Rehabil, 28, 446-448.
- Wang, Y. (2017). Clinical study of early rehabilitation intervention and IPC combined with low molecular weight heparin for preventing cerebral hemorrhage DVT formation. Chi J Prim Med Pharm, 24, 1308-1311.
- Whiting, P., Savović, J., Higgins, J.P., Caldwell, D.M., Reeves, B.C., Shea, B.J., et al. (2016) ROBIS: A new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol, 69, 225-234.
- Zhang, D., Li, F., Li, X., & Du, G. (2018) Effect of intermittent pneumatic compression on preventing deep vein thrombosis among stroke patients: a systematic review and meta-analysis. Worldviews Evid Based Nurs, 15 (3), 189-196.
Riferimenti
Anderson, J. (2015) Venous thromboembolic event prevention in acute stroke: update on evidence and recommendations. Pract Neurol, 15 (3), 160-163.
André, C., de Freitas, G.R., & Fukujima, M.M. (2007) Prevention of deep venous thrombosis and pulmonary embolism following stroke: a systematic review of published articles. Eur J Neurol, 14 (1), 21-32.
Casaubon, L.K., Boulanger, J.M., Glasser, E., Blacquiere, D., Boucher, S., Brown, K., et al. (2016) Canadian stroke best practice recommendations: acute inpatient stroke care guidelines, Update 2015. Int J Stroke, 11 (2), 239-252.
CLOTS Trials Collaboration, Dennis, M., Sandercock, P.A., Reid, J., Graham, C., Murray, G., et al. (2009) Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial. Lancet, 373 (9679), 1958-1965.
CLOTS Trial Collaboration. (2010) Thigh-length versus below-knee stockings for deep venous thrombosis prophylaxis after stroke: a randomized trial. Ann Intern Med, 153 (9), 553-562.
Cooper, H., & Koenka, A.C. (2012) The overview of reviews: unique challenges and opportunities when research syntheses are the principal elements of new integrative scholarship. Am Psychol, 67 (6), 446-462.
Dai, J. (2015). Nursing of patients with deep venous thrombosis after cerebral hemorrhage treated by pneumatic pump limb circulatory drive instrument. Zhejiang J Traum Surg, 20, 834-835.
Dennis, M., & CLOTS Trial Collaboration. (2013) Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): A multicentre randomized, controlled trial. Lancet, 382, 516–524.
Dennis, M., Caso, V., Kappelle, L.J., Pavlovic, A., Sandercock, P., for the European Stroke Organisation. (2016) European Stroke Organisation (ESO) guidelines for prophylaxis for venous thromboembolism in immobile patients with acute ischaemic stroke. Eur Stroke J, 1 (1), 6-19.
Field, T.S., & Hill, M.D. (2012) Prevention of deep vein thrombosis and pulmonary embolism in patients with stroke. Clin Appl Thromb Hemost, 18 (1), 5-19.
Hanison, E., & Corbett, K. (2016) Non-pharmacological interventions for the prevention of venous thromboembolism: a literature review. Nurs Stand, 31 (8), 48-57.
Hartling, L., Vandermeer, B., & Fernandes, R.M. (2014) Systematic reviews, overviews of reviews and comparative effectiveness reviews: a discussion of approaches to knowledge synthesis. Evid Based Child Health, 9 (2), 486-494.
Ho, K.M., & Tan, J.A. (2013) Stratified meta-analysis of intermittent pneumatic compression of the lower limbs to prevent venous thromboembolism in hospitalized patients. Circulation, 128 (9), 1003-1020.
Kamran, S.I., Downey, D., & Ruff, R.L. (1998) Pneumatic sequential compression reduces the risk of deep vein thrombosis in stroke patients. Neurology, 50 (6), 1683-1688.
Kappelle, L.J. (2011) Preventing deep vein thrombosis after stroke: strategies and recommendations. Curr Treat Options Neurol, 13 (6), 629-635.
Lacut, K., Bressollette, L., Le Gal, G., Etienne, E., De Tinteniac, A., Renault, A., et al. (2005). Prevention of venous thrombosis in patients with acute intracerebral hemorrhage. Neurology, 65, 865-869.
Le Jeune, S., Pistorius, M.A., Planchon, B., & Pottier, P. (2008a) Risk of venous thromboembolism in the course of acute medical illness. Part 1: basic research, clinical models, descriptive and analytic epidemiology. Rev Med Interne, 29 (6), 452-461.
Le Jeune, S., Pistorius, M.A., Planchon, B., & Pottier, P. (2008b) Risk of venous thromboembolism in acute medical illnesses. Part 2: situations at risk in ambulatory, hospital and internal medicine settings. Rev Med Interne, 29 (6), 462-475.
Masotti, L., Cappelli, R., Panigada, G., Landini, G., & Di Napoli, M. (2012) Mechanical prophylaxis of venous thromboembolism in ill hospitalized medical patients: evidence and guidelines. Rev Health Care, 3 (3), 193-207
Mazzone, C., Chiodo Grandi, F., Sandercock, P., Miccio, M., & Salvi, R. (2002) Physical methods for preventing deep vein thrombosis in stroke. Cochrane Database Syst Rev, (1), CD001922.
Mazzone, C., Chiodo Grandi, F., Sandercock, P., Miccio, M., & Salvi, R. (2004) Physical methods for preventing deep vein thrombosis in stroke. Cochrane Database Syst Rev, (4), CD001922.
McCullough, M., Kholdani, C., & Zamanian, R.T. (2018) Prevention of deep vein thrombosis and pulmonary embolism in high-risk medical patients. Clin Chest Med, 39 (3), 483-492.
Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., & PRISMA Group. (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg, 8, 336-341.
Muir, K.W., Watt, A., Baxter, G., Grosset, D.G., & Lees, K.R. (2000) Randomized trial of graded compression stockings for prevention of deep-vein thrombosis after acute stroke. QJM, 93 (6), 359-364.
Naccarato, M., Chiodo Grandi, F., Dennis, M., & Sandercock, P.A. (2010) Physical methods for preventing deep vein thrombosis in stroke. Cochrane Database Syst Rev, (8), CD001922.
National Institute for health and Care Excellence (NICE). Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. Data accesso 3 dicembre 2019, dahttps://www.nice.org.uk /guidance/ng89/resources/venous-thromboembolism-in-over-16s-reducing-the-risk-of-hospitalacquired-deep-vein-thrombosis-or-pulmonary-embolism-pdf-1837703092165
Olaf, M., & Cooney, R. (2017) Deep venous thrombosis. EmergMed Clin North Am, 35 (4), 743-770.
Pambianco, G., Orchard, T., & Landau, P. (1995). Deep vein thrombosis: prevention in stroke patients during rehabilitation. Arch Phys Med Rehabil, 76, 324-330.
Pavon, J.M., Williams, J.W. Jr., Adam, S.S., Razouki, Z.A., McDuffie, J.R., Lachiewicz, P.F., et al. (2015) Effectiveness of intermittent pneumatic compression devices for venous thromboembolism prophylaxis in high-risk surgical and medical patients. VA Evidence-based Synthesis Program Reports. Washington (DC): Department of Veterans Affairs (US), 1-63.
Prasad, B., Banerjee, A., & Howard, H. (1982). Incidence of deep vein thrombosis and the effect of pneumatic compression of the calf in elderly hemiplegics. Age Ageing, 11, 42-44
Robinson, K.A., Saldanha, I.J., & Mckoy, N.A. (2011) Development of a framework to identify research gaps from systematic reviews. J Clin Epidemiol, 64 (12), 1325-1330.
Royal College of Physicians (RCP). (2016) National clinical guideline for stroke. Fifth edition 2016. Data accesso 3 dicembre 2019, da
Ryan, R., Santesso, N., Lowe, D., Hill, S., Grimshaw, J., Prictor, M., et al. (2014) Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews. Cochrane Database Syst Rev, 4, CD007768.
Schünemann, H.J., Cushman, M., Burnett, A.E., Kahn, S.R., Beyer-Westendorf, J., Spencer, F.A., et al. (2018) American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients. Blood Adv, 2 (22), 3198-3225.
Shea, B.J., Grimshaw, J.M., Wells, G.A., Boers, M., Andersson, N., Hamel, C., et al. (2007) Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 7 (10), 1-7.
Wan, F., Huang, M., Lv, W., Tian, Y., & Wang, C. (2013). Preventive effect of intermittent pneumatic compression on deep venous thrombosis after acute cerebral infarction. Chi J Rehabil, 28, 446-448.
Wang, Y. (2017). Clinical study of early rehabilitation intervention and IPC combined with low molecular weight heparin for preventing cerebral hemorrhage DVT formation. Chi J Prim Med Pharm, 24, 1308-1311.
Whiting, P., Savović, J., Higgins, J.P., Caldwell, D.M., Reeves, B.C., Shea, B.J., et al. (2016) ROBIS: A new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol, 69, 225-234.
Zhang, D., Li, F., Li, X., & Du, G. (2018) Effect of intermittent pneumatic compression on preventing deep vein thrombosis among stroke patients: a systematic review and meta-analysis. Worldviews Evid Based Nurs, 15 (3), 189-196.