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Advisor(s)
Abstract(s)
O tromboembolismo venoso com as suas principais manifestações, a trombose venosa
profunda e o tromboembolismo pulmonar, constitui a terceira causa de morte por doenças
cardiovasculares, sendo uma das principais causas preveníveis de morbilidade e
mortalidade em todo o mundo.
Dada a importância de um diagnóstico atempado e um tratamento eficaz e precoce, a
presente dissertação tem como objetivo proceder a uma revisão da literatura sobre a
abordagem da trombose venosa profunda do membro inferior com foco na apresentação
clínica, abordagem diagnóstica e terapêutica. Para tal, foi conduzida uma pesquisa de
artigos científicos, publicados nos últimos dez anos, nas principais bases de dados de
medicina baseada na evidência.
Apesar de útil na suspeição clínica de uma trombose venosa profunda, a presença de edema
assimétrico e inexplicável, calor, eritema e dor local não é suficiente para a sua confirmação.
Para um diagnóstico preciso é fundamental a integração da informação clínica com escalas
de probabilidade clínica, como a escala de Wells modificada, e exames complementares de
diagnóstico, como a mensuração D-dímeros e a ultrassonografia venosa.
Por outro lado, a abordagem terapêutica da trombose venosa profunda foi reformulada pela
introdução dos anticoagulantes orais diretos reformulou. A clara superioridade desta classe
anticoagulante face aos antagonistas da vitamina K, demonstrada pela mais recente
evidência cientifica, tornaram o tratamento e prevenção da trombose venosa profunda mais
seguro e prático, sendo o esquema preferencial, na ausência de contraindicações claras.
Com esta revisão, foi criada uma proposta de algoritmo, baseada na evidência, para a
abordagem da trombose venosa profunda do membro inferior nos cuidados de saúde
primários.
The venous thromboembolism with its main manifestations, the deep vein thrombosis and pulmonary thromboembolism, is the third leading cause of death from cardiovascular diseases and one of the main worldwide preventable causes of morbidity and mortality. Given the importance of a timely diagnosis and an effective and early treatment, the present dissertation aims to review the literature on the management of deep vein thrombosis of the lower limb with a focus on clinical presentation, diagnostic and therapeutic approach. To this end, a search of scientific articles, published in the last ten years, was carried out in the main evidence-based medicine databases. Despite being useful in the clinical suspicion of deep vein thrombosis, the presence of asymmetric and unexplained edema, heat, erythema and local pain is not sufficient for its diagnosis. For an accurate diagnosis, it is essential the integration of the clinical information with clinical probability scales, such as a modified Wells scale, and complementary diagnostic tests, such as D-dimer and venous ultrasound. The introduction of direct oral anticoagulants has reformulated the therapeutic approach to deep vein thrombosis. The clear superiority of this anticoagulant class over vitamin K antagonists, demonstrated by the most recent scientific evidence, made the treatment and prevention of deep vein thrombosis safer and more practical, being the preferred regimen, in the absence of clear contraindications. With this review, an evidence-based algorithm proposal was created for the management of lower limb deep vein thrombosis in primary health care.
The venous thromboembolism with its main manifestations, the deep vein thrombosis and pulmonary thromboembolism, is the third leading cause of death from cardiovascular diseases and one of the main worldwide preventable causes of morbidity and mortality. Given the importance of a timely diagnosis and an effective and early treatment, the present dissertation aims to review the literature on the management of deep vein thrombosis of the lower limb with a focus on clinical presentation, diagnostic and therapeutic approach. To this end, a search of scientific articles, published in the last ten years, was carried out in the main evidence-based medicine databases. Despite being useful in the clinical suspicion of deep vein thrombosis, the presence of asymmetric and unexplained edema, heat, erythema and local pain is not sufficient for its diagnosis. For an accurate diagnosis, it is essential the integration of the clinical information with clinical probability scales, such as a modified Wells scale, and complementary diagnostic tests, such as D-dimer and venous ultrasound. The introduction of direct oral anticoagulants has reformulated the therapeutic approach to deep vein thrombosis. The clear superiority of this anticoagulant class over vitamin K antagonists, demonstrated by the most recent scientific evidence, made the treatment and prevention of deep vein thrombosis safer and more practical, being the preferred regimen, in the absence of clear contraindications. With this review, an evidence-based algorithm proposal was created for the management of lower limb deep vein thrombosis in primary health care.
Description
Keywords
Anticoagulantes Orais Diretos Cuidados Saúde Primários Trombose Venosa Profunda