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2007, Número S4

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Arch Cardiol Mex 2007; 77 (S4)


Terapia anticoagulante en la circulación extracorpórea

Lespron RMC, Molina MFJ

Idioma: Español
Referencias bibliográficas: 31
Paginas: 185-193
Archivo PDF: 166.93 Kb.


RESUMEN

La cirugía cardíaca es un área en la que la monitorización de la coagulación es de gran importancia. Los procedimientos bajo Circulación Extracorpórea (CEC), no pueden ser llevados a cabo sin un método efectivo para evitar la coagulación del circuito extracorpóreo. A principios del siglo XX, se descubrieron las propiedades anticoagulantes de la heparina; hoy sigue siendo el anticoagulante más usado durante CEC. Los efectos de la heparina se revierten con protamina; sin embargo existen varios agentes farmacológicos anticoagulantes y también técnicas para revertirlos. La CEC Induce a una “respuesta inflamatoria” durante el contacto de la sangre y elementos celulares con el circuito extracorpóreo. Esta interacción de sistemas lleva a una coagulopatía caracterizada por coagulación microvascular, disfunción plaquetaria y fibrinólisis. La necesidad de monitorear la Anticoagulación durante y después de la cirugía es la razón por la cual la cirugía cardíaca ha tenido un buen desarrollo en la evaluación y utilización de métodos para poder saber cómo está la hemostasis. La trombocitopenia inducida por heparina (TIH) es una complicación seria, mediada por el sistema inmune, inducida por el uso de heparina y que frecuentemente termina con eventos tromboembólicos devastadores. Otras alternativas de Anticoagulación deberán iniciarse inmediatamente (argatroban, lepirudina y danaparoide). La lepirudina y bivalirudina han sido utilizadas en cirugía cardíaca con CEC.


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