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2008, Número 1

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Rev Mex Anest 2008; 31 (1)


Factor VII recombinante activado en cirugía cardíaca, reporte de un caso y revisión de la evidencia científica

Carrillo-Esper R, Díaz-Medina MI, Carrillo-Córdova JR, Carrillo-Córdova LD

Idioma: Español
Referencias bibliográficas: 57
Paginas: 45-54
Archivo PDF: 128.39 Kb.


RESUMEN

Introducción: La hemorragia es una complicación frecuente en el postoperatorio de procedimientos quirúrgicos cardiovasculares que requieren derivación cardiopulmonar. El manejo habitual es con productos sanguíneos, antifibrinolíticos y reexploración quirúrgica, esta última asociada a una elevada morbi-mortalidad y costos. Objetivo: Reportar un caso de hemorragia en el postoperatorio de revascularización coronaria refractaria al manejo habitual que respondió al Factor VII recombinante activado (FVIIra) y revisar la evidencia científica sobre el uso y seguridad del FVIIra en cirugía cardíaca. Caso clínico: Paciente de 56 años que presentó en el postoperatorio de revascularización coronaria hemorragia microvascular refractaria al manejo con plasma fresco, crioprecipitados, aprotinina, reversión de heparina y recalentamiento que respondió de manera satisfactoria a dos dosis de FVIIra de 90 µg/kg cada una. No se presentaron complicaciones tromboembólicas. Discusión: Varios estudios han demostrado que el uso de FVIIra en la hemorragia grave asociada a cirugía cardíaca controla y reduce la hemorragia, los requerimientos de productos sanguíneos y la necesidad de reintervención. La dosis varía de 30-60 µg/kg en niños a 90-100 µg/kg en adultos en una o dos aplicaciones. Su margen de seguridad es satisfactorio, con una baja incidencia de complicaciones tromboembólicas. Conclusión: La terapia con Factor VII recombinante activado (FVIIra) se ha posicionado como una alternativa terapéutica efectiva para los pacientes adultos y pediátricos que presentan hemorragia refractaria al manejo habitual en el postoperatorio de cirugía cardíaca.


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