Recomendações para a Abordagem do Tromboembolismo Venoso no Doente Oncológico em Fim de Vida: Consenso Nacional
DOI:
https://doi.org/10.20344/amp.24007Palavras-chave:
Anticoagulantes, Cuidados Paliativos, Cuidados Terminais, Neoplasias, Tromboembolismo VenosoResumo
O tromboembolismo venoso é uma complicação frequente em doentes oncológicos, sobretudo em fases avançadas, nas quais a presença de doença metastática pode aumentar o risco de trombose em cerca de 20 vezes relativamente aos estádios iniciais, sendo esse risco ainda mais acentuado nos doentes em fim de vida. Apesar da elevada prevalência, persistem lacunas significativas na evidência que orienta a sua gestão nesta fase da doença. A abordagem do tromboembolismo venoso nesta população representa um desafio terapêutico, dada a elevada taxa de recorrência trombótica e de complicações hemorrágicas. Adicionalmente, o diagnóstico é dificultado tanto pela inespecificidade dos sintomas como pela necessidade de evitar exames invasivos ou onerosos, que possam comprometer o conforto do doente. Este manuscrito, desenvolvido em colaboração entre o Grupo de Estudos de Cancro e Trombose e a Associação Portuguesa de Cuidados Paliativos, revê os principais desafios clínicos e éticos associados ao diagnóstico, tratamento e profilaxia do tromboembolismo venoso nesta população, com o intuito de apoiar a prática médica em decisões muitas vezes complexas. As recomendações aqui propostas baseiam-se na melhor evidência disponível, complementada pela experiência clínica dos autores e por uma reflexão ética centrada no doente. São apresentados critérios para orientar i) a decisão de iniciar, manter ou suspender anticoagulação; ii) o papel da imagiologia neste contexto; iii) as indicações para a tromboprofilaxia. Com esta síntese, pretende-se contribuir para uma prática mais informada e consistente, com foco na qualidade de vida e dignidade do doente, reforçando a qualidade dos cuidados prestados e promovendo a sua aplicação transversal nos diferentes contextos assistenciais.
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