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Diario Oficial de la Sociedad Mexicana de Cirugía Cardiaca, A.C., y del Colegio Mexicano de Cirugía Cardiovascular y Torácica, A.C.

2017, Número 2

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Cir Card Mex 2017; 2 (2)


Warfarina y hemorragia cerebral

García-Villarreal OA

Idioma: Español
Referencias bibliográficas: 19
Paginas: 60-62
Archivo PDF: 191.74 Kb.


RESUMEN

La posiblidad de stroke en pacientes con fibrilación auricular no-valvular es de 5 veces mayor, y hasta 17 veces mayor con fibrilación auricular valvular comparados con la población en general. El uso de anticoagulación oral con warfarina reduce hasta 6 veces la posibilidad de stroke. Las niveles recomendados de INR para un manejo adecuado en la fibrilación auricular son de 2.0 a 3.9. La posibilidad de stroke con INR ‹ 2.0 es de 18% anual (OR = 1.9). La posibilidad de hemorragia intracraneal con INR › 4.5 es de 9.4% anual. La hemorragia intracraneal es más frecuente bajo la forma de hemorragia intracerebral (70%), y el resto son hemorragias subdurales principalmente. La hemorragia intracerebral tiene una mortalidad temprana absoulta de 60%, mientras que para la hemorragia subdural es de 15-20%. Esta última es más susceptible de tratamiento quirúrgico y reversión de la anticoagulación. La terapia con antiagregantes plaquetarios reduce sólo en un 20% la posibilidad de stroke en la fibrilación auricular no valvular.


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