Journal of Literature Pharmacy Sciences

Palyatif Bakım Hastalarında Tromboprofilaksi Tedavisinin Kılavuzlar Eşliğinde Değerlendirilmesi: Geleneksel Derleme
Evaluation of Thromboprophylaxis Treatment in Palliative Care Patients with Guidelines: Traditional Review
Özgenur GERİDÖNMEZa , Kamer TECEN YÜCELa , Uygar OLGENb
aAnadolu Üniversitesi Eczacılık Fakültesi, Klinik Eczacılık ABD, Eskişehir, Türkiye
bEskişehir Yunus Emre Devlet Hastanesi, Genel Cerrahi Kliniği, Eskişehir, Türkiye
J Lit Pharm Sci. 2023;12(3):256-67
doi: 10.5336/pharmsci.2023-98032
Article Language: TR
Full Text
ÖZET
 Palyatif bakım, yaşamı tehdit eden fiziksel, psikolojik, sosyal ya da ruhsal hastalıklarla ilgili zorluklarla karşılaşan hastaların ve ailelerinin yaşam kalitesini artırmayı hedeflemektedir. Palyatif bakım hastaları ileri yaş, hareket kabiliyetinde azalma ve malign hastalık dâhil eş zamanlı kronik hastalık varlığına sahip hasta popülasyonundan oluştuğu için venöz tromboembolizm riski yönünden takip edilmelidir. Venöz tromboembolizm riskini azaltmak amacı ile tromboprofilaksi tedavisi uygulanmaktadır. Ancak tromboprofilaksi alacak hastaların belirlenmesi, venöz tromboembolizmin teşhisi, tedavisi ve tedavi süresi palyatif bakım hastalarında venöz tromboembolizm yönetiminin zorluklarını oluşturmaktadır. Venöz tromboembolizm yönetimine ait kılavuzlar daha çok onkoloji hastalarına yönelik olup, palyatif bakım hastalarında venöz tromboembolizmin yönetimine yer veren kılavuzlar oldukça sınırlıdır. Bu çalışmanın amacı, güncel kılavuzlar incelenerek, palyatif bakım servisinde yatma potansiyeli olan hastalarda tromboprofilaksi tedavisinin gerekliliğini ve hangi ajanların kullanımının uygun olduğunu özetlemektir. Kılavuzlar incelendiğinde ise venöz tromboembolizm oluşum riskinin ölümcül kanama riskine üstünlüğünün hastaya spesifik belirlenmesi gerektiği vurgulanmaktadır. Prognostik venöz tromboembolizm ile ilişkili faktörler venöz tromboembolizm oluşum riskini belirlemede ve tromboprofilaksi tedavisine başlamada yardımcı olmaktadır. Venöz tromboembolizm oluşum riski yüksek ve kanama riski düşük olan palyatif bakım hastalarına farmakolojik tromboprofilaksi tedavisi önerilmektedir. Düşük molekül ağırlıklı heparin başta olmak üzere hastadaki risk faktörleri değerlendirilerek standart heparin, fondaparinuks, varfarin, aspirin ve yeni nesil oral antikoagülanlar tromboprofilaksi tedavisi olarak tercih edilmektedir.

Anahtar Kelimeler: Palyatif bakım; venöz tromboembolizm; kaynak kılavuzu
ABSTRACT
 Palliative care aims to improve the quality of life of patients and their families facing difficulties related to life-threatening physical, psychological, social or mental illnesses. Palliative care patients should be tracked to identify the risk of venous thromboembolism (VTE) as they consist of a patient population with advanced age, decreased mobility and comorbidities, including cancer. Thromboprophylaxis is used to reduce the risk of VTE. However, identifying patients who should receive thromboprophylaxis and determining diagnosis, treatment processes and duration of VTE treatment involve certain challenges regarding managing VTE for palliative care patients. The currently available guidelines for managing VTE are primarily for oncology patients and there are, unfortunately, a limited number of guidelines for palliative care patients. This study aims to emphasize the necessity of thromboprophylaxis treatment and determine the agents that should be used for patients with a potential to be hospitalized in palliative care centers by reviewing the existing guidelines. When the guidelines are examined, it is emphasized that the superiority of the risk of formation of VTE over the risk of fatal bleeding should be determined specifically for the patient. Factors associated with prognostic VTE are helpful in determining the risk of VTE and initiating thromboprophylaxis treatment. Pharmacological thromboprophylaxis treatment is recommended for palliative care patients with a high risk of VTE and a low risk of bleeding. By evaluating the risk factors in the patient, especially low molecular weight heparin, standard heparin, fondaparinux, warfarin, aspirin and new generation oral anticoagulants are preferred as thromboprophylaxis treatment.

Keywords: Palliative care; venous thromboembolism; resource guide
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