Trombosis venosa profunda en pacientes hospitalizados: estrategias de prevención. Una revisión sistemática
DOI:
https://doi.org/10.26820/reciamuc/8.(4).dic.2024.124-136Palabras clave:
Trombosis venosa, Hospitalización, Prevención y control, Evaluación de riesgos, AnticoagulantesResumen
La trombosis venosa profunda (TVP) es una complicación frecuente y potencialmente mortal en pacientes hospitalizados, asociada con inmovilidad, intervenciones quirúrgicas y comorbilidades. Su prevención es una prioridad clínica para reducir la morbilidad, mortalidad y costos hospitalarios. Esta revisión sistemática tuvo como objetivo identificar y analizar las estrategias de prevención más efectivas para la TVP en pacientes hospitalizados, con base en la evidencia científica disponible. Se incluyeron estudios observacionales, ensayos clínicos controlados y revisiones sistemáticas publicados entre 2010 y 2025. Los criterios de inclusión consideraron investigaciones en adultos hospitalizados con evaluación de intervenciones preventivas para TVP. Se excluyeron estudios en población ambulatoria o con diagnóstico previo de TVP. Se consultaron las bases de datos PubMed, Scopus, Cochrane Library y ScienceDirect. En total, se seleccionaron 28 estudios tras un proceso de revisión por pares. La calidad metodológica fue evaluada mediante la herramienta MMAT (Mixed Methods Appraisal Tool). Las estrategias más efectivas incluyeron el uso de anticoagulantes profilácticos (heparina de bajo peso molecular), dispositivos de compresión neumática intermitente y programas de movilización temprana. La evidencia mostró una reducción significativa en la incidencia de TVP con la implementación combinada de medidas farmacológicas y mecánicas. Se identificaron patrones que favorecen la individualización del riesgo trombótico para optimizar las intervenciones. La prevención efectiva de la TVP en pacientes hospitalizados requiere un enfoque multifactorial basado en la estratificación del riesgo. Se recomienda integrar protocolos clínicos estandarizados y continuar la investigación sobre estrategias adaptadas a diferentes perfiles de pacientes.
Descargas
Citas
Amari, T., Matta, D., Makita, Y., Fukuda, K., Miyasaka, H., Kimura, M., Sakamoto, Y., Shimo, S., & Yamaguchi, K. (2023). Early ambulation shortened the length of hospital stay in ICU patients after abdominal surgery. Clinical Practice, 13(6), 1612. https://doi.org/10.3390/clinpract13060141
Amin, A. N., & Fihn, S. D. (2017). Prevention of venous thromboembolism in hospitalized medical patients. American Journal of Medicine, 130(9), 1017-1025.
Amin, A. N., Girard, F., & Samama, M. M. (2010). Does ambulation modify venous thromboembolism risk in acutely ill medical patients? Thrombosis and Haemostasis, 104(5), 955–961. https://doi.org/10.1160/TH10-04-0236
Aprisunadi, N., Nursalam, N., Mustikasari, M., Ifadah, E., & Hapsari, E. D. (2023). Effect of early mobilization on hip and lower extremity postoperative: A literature review. SAGE Open Nursing, 9. https://doi.org/10.1177/23779608231167825
Aufwerber, S., Heijne, A., Edman, G., Gravare Silbernagel, K., & Ackermann, P. W. (2020). Early mobilization does not reduce the risk of deep venous thrombosis after Achilles tendon rupture: A randomized controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy, 28, 312–319. https://doi.org/10.1007/s00167-019-05767-x
Aujesky, D., Roy, P. M., Verschuren, F., Righini, M., Osterwalder, J., Egloff, M., Renaud, B., Verhamme, P., Stone, R. A., Legall, C., Sanchez, O., Pugh, N. A., N’Gako, A., Cornuz, J., Hugli, O., Beer, H. J., Perrier, A., Fine, M. J., & Yealy, D. M. (2011). Outpatient versus inpatient treatment for patients with acute pulmonary embolism: An international, open-label, randomised, non-inferiority trial. The Lancet, 378(9785), 41–48. https://doi.org/10.1016/S0140-6736(11)60824-6
Barbar, S., Noventa, F., Rossetto, V., Ferrari, A., Brandolin, B., Perlati, M., ... & Imberti, D. (2010). A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. Journal of Thrombosis and Haemostasis, 8(11), 2450-2457.
Bettiol, A., Alibaz-Oner, F., Direskeneli, H., Hatemi, G., Saadoun, D., Seyahi, E., Prisco, D., & Emmi, G. (2023). Vascular Behçet syndrome: from pathogenesis to treatment. Nature reviews. Rheumatology, 19(2), 111–126. https://doi.org/10.1038/s41584-022-00880-7
Borges, L. F., Fraga Righetti, R., de Souza Francisco, D., Pereira Yamaguti, W., & Barros, C. F. de. (2022). Hemodynamic impact of early mobilization in critical patients receiving vasoactive drugs: A prospective cohort study. PLOS ONE, 17(12), e0279269. https://doi.org/10.1371/journal.pone.0279269
Broderick, C., Watson, L., & Armon, M. P. (2021). Thrombolytic strategies versus standard anticoagulation for acute deep vein thrombosis of the lower limb. The Cochrane database of systematic reviews, 1(1), CD002783. https://doi.org/10.1002/14651858.CD002783.pub5
Bryan Ivan, C. C., & Verónica Sofia, Q. A. (2025). Profilaxis del tromboembolismo venoso en la unidad de cuidados intensivos - Estrategias actuales y perspectivas futuras: Revisión Sistemática. Ibero-American Journal of Health Science Research, 5(1), 272–281. https://doi.org/10.56183/iberojhr.v5i1.741
Burk, C., Perry, J., Lis, S., Dischiavi, S., & Bleakley, C. (2020). Can myofascial interventions have a remote effect on ROM? A systematic review and meta-analysis. Journal of Sport Rehabilitation, 29(5), 650–656. https://doi.org/10.1123/jsr.2019-0074
Castelino, T., Fiore, J. F., Niculiseanu, P., Landry, T., Augustin, B., & Feldman, L. S. (2016). The effect of early mobilization protocols on postoperative outcomes following abdominal and thoracic surgery: A systematic review. Surgery, 159(4), 991–1003. https://doi.org/10.1016/j.surg.2015.11.029ayley W. E., Jr (2007). Preventing deep vein thrombosis in hospital inpatients. BMJ (Clinical research ed.), 335(7611), 147–151. https://doi.org/10.1136/bmj.39247.542477.AE
Chen, Y., Lin, S.-Y., Fu, Q., Xing, K., Wang, C., & Wang, H. (2020). Effect of FTS-based perioperative nursing on postoperative rehabilitation of tibia-fibula fracture. International Journal of Clinical and Experimental Medicine, 13, 4121–4128.
Clapham R, Marrinan, E & Roberts, L.(2023). VTE prevention in medical inpatients - Current approach and controversies, Thrombosis Update, 13, https://doi.org/10.1016/j.tru.2023.100151. (https://www.sciencedirect.com/science/article/pii/S2666572723000226)
Cook, D., Attia, J., Weaver, B., McDonald, E., Meade, M., & Crowther, M. (2000). Venous thromboembolic disease: An observational study in medical-surgical intensive care unit patients. Journal of Critical Care, 15(3), 127–132. https://doi.org/10.1053/jcrc.2000.19224
Cosmi B. (2015). Management of superficial vein thrombosis. Journal of thrombosis and haemostasis : JTH, 13(7), 1175–1183. https://doi.org/10.1111/jth.12986
Dentali, F., Douketis, J. D., Gianni, M., Lim, W., & Crowther, M. A. (2012). Meta-analysis: anticoagulation with low-molecular-weight heparin or unfractionated heparin in hospitalized patients with cancer. Annals of Internal Medicine, 156(2), 114-124.
Ding, R., & Zhang, H. (2021). Efficacy of very early mobilization in patients with acute stroke: A systematic review and meta-analysis. Annals of Palliative Medicine, 10, 11776–11784. https://doi.org/10.21037/apm-21-2997
Downs, S. H., & Black, N. (1998). The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Journal of Epidemiology & Community Health, 52(6), 377–384.
Duro-Ocana, P., Zambolin, F., Jones, A. W., Bryan, A., Moore, J., Quraishi-Akhtar, T., McPhee, J., Degens, H., & Bagley, L. (2023). Efficacy of supervised exercise prehabilitation programs to improve major abdominal surgery outcomes: A systematic review and meta-analysis. Journal of Clinical Anesthesia, 86, 111053. https://doi.org/10.1016/j.jclinane.2023.111053
Fitzmaurice, D., Murray, E., Nichols, L., et al. (2020). ExACT: Extended anticoagulation treatment for venous thromboembolism: A randomised trial. NIHR Journals Library, Programme Grants for Applied Research; 8(5). Este estudio encontró que la anticoagulación prolongada (hasta 2?años) es clínica y económicamente eficaz para prevenir recurrencias de tromboembolismo venoso y destacó barreras para su implementación
Geerts, W. H., Pineo, G. F., Heit, J. A., Bergqvist, D., Lassen, M. R., Colwell, C. W., & Ray, J. G. (2004). Prevention of venous thromboembolism: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest, 126(3), 338S–400S.
Guyatt, G. H., Akl, E. A., Hirsh, J., Kearon, C., Guyatt, G., Bodnar, M. E., ... & Bates, S. M. (2012). Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 141(2 Suppl), 7S-47S.
Jaramillo Bajaña, C. J., & Toaza Carpio, M. R. (2025). Factores de riesgos y su relación en la trombosis venosa profunda en pacientes hospitalizados del IEES Babahoyo, octubre 2024-mayo 2025 (Tesis de pregrado). Universidad Técnica de Babahoyo – Facultad de Ciencias de la Salud.
Kaiser, R., Dewender, R., Mulkers, M., Stermann, J., Rossaro, D., Di Fina, L., Li, L., Gold, C., Schmid, M., Kääb, L., Eivers, L., Akgöl, S., Yue, K., Kammerer, L., Loew, Q., Anjum, A., Escaig, R., Akhalkatsi, A., Laun, L., Kranich, J., … Nicolai, L. (2024). Procoagulant platelet activation promotes venous thrombosis. Blood, 144(24), 2546–2553. https://doi.org/10.1182/blood.2024025476
Kearon, C., Et al. (2016). Antithrombotic therapy for VTE disease: CHEST Guideline and Expert Panel Report. Chest, 149(2), 315-352.
Khan, F., Tritschler, T., Kahn, S. R., & Rodger, M. A. (2021). Venous thromboembolism. Lancet (London, England), 398(10294), 64–77. https://doi.org/10.1016/S0140-6736(20)32658-1
Linnemann, B., Beyer-Westendorf, J., Espinola-Klein, C., Mühlberg, K. S., Müller, O. J., & Klamroth, R. (2024). Management of Deep Vein Thrombosis: An Update Based on the Revised AWMF S2k Guideline. Hamostaseologie, 44(2), 97–110. https://doi.org/10.1055/a-2178-6574
Monagle, P., Chan, A. K. C., Goldenberg, N. A., Ichord, R. N., Journeycake, J. M., Nowak-Göttl, U., & Vesely, S. K. (2012). Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 141(2 Suppl), e737S–e801S. https://doi.org/10.1378/chest.11-2308
Onwuzo, C., Olukorode, J., Sange, W., Tanna, S. J., Osaghae, O. W., Hassan, A., Kristilere, H., Orimoloye, D. A., Omokore, O., Ganiyu, B., Fayemi, T., & Addeh, E. (2023). A Review of the Preventive Strategies for Venous Thromboembolism in Hospitalized Patients. Cureus, 15(11), e48421. https://doi.org/10.7759/cureus.48421
Paydar, S., Sabetian, G., Khalili, H., Fallahi, J., Tahami, M., Ziaian, B., Abbasi, H. R., Bolandparvaz, S., Ghaffarpasand, F., & Ghahramani, Z. (2016). Management of Deep Vein Thrombosis (DVT) Prophylaxis in Trauma Patients. Bulletin of emergency and trauma, 4(1), 1–7.
Stansby, G., & Donald, I. (2019). Reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism in medical inpatients. Clin Med (Lond), 19(2), 100–103. https://doi.org/10.7861/clinmedicine.19-2-100
Thiyagarajan, M., & P., J. (2022). Deep vein thrombosis – a systematic review. GLOBAL JOURNAL for research analysis, 4–8. https://doi.org/10.36106/gjra/4700229
Tritschler, T., Kraaijpoel, N., Le Gal, G., & Wells, P. S. (2018). Venous Thromboembolism: Advances in Diagnosis and Treatment. JAMA, 320(15), 1583–1594. https://doi.org/10.1001/jama.2018.14346
Vosicka, K., Qureshi, M. I., Shapiro, S. E., Lim, C. S., & Davies, A. H. (2018). Post thrombotic syndrome following deep vein thrombosis in paediatric patients. Phlebology, 33(3), 185–194. https://doi.org/10.1177/0268355516686597
Vosicka, K., Qureshi, M. I., Shapiro, S. E., Lim, C. S., & Davies, A. H. (2018). Post thrombotic syndrome following deep vein thrombosis in paediatric patients. Phlebology, 33(3), 185–194. https://doi.org/10.1177/0268355516686597
Yap, F. S. D., Ng, Z. Y., Wong, C. Y., & Yang, L. B. (2019). Appropriateness of deep vein thrombosis (DVT) prophylaxis use among medical inpatients: A DVT Risk Alert Tool (DRAT) study. Med J Malaysia, 74(1), 45–50. https://doi.org/10. betrouwbare (PMID: 30846662
Publicado
Cómo citar
Número
Sección
Derechos de autor 2025 Emilio José Martínez Benítez

Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.