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2011, Número 1

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Rev Mex Anest 2011; 34 (1)


Rol del factor recombinante VII activado en sangrado posterior a cirugía cardíaca. Su aplicación en anestesiología cardiovascular

Gómez-Ríos N, Rodríguez-Ortega MF, Tejero-Langarica A, Hernández-Mercado MA, Palma-Mercado J, Juárez-Lemus ÁM, Molina-Méndez FJ

Idioma: Español
Referencias bibliográficas: 111
Paginas: 15-24
Archivo PDF: 433.15 Kb.


RESUMEN

Objetivo: Reportar la experiencia del anestesiólogo cardiovascular en el tratamiento del sangrado no quirúrgico con el uso de factor recombinante VII activado (FrVIIa). Sede: Centro Médico del Instituto de Seguridad Social del Estado de México y Municipios (ISSEMyM). Diseño: Estudio observacional, descriptivo, retrospectivo, retrolectivo de una serie de casos. Análisis estadístico: Porcentaje como medida de resumen para variables cualitativas. Material y métodos: Entre junio de 2005 a junio de 2009, se revisaron expedientes clínicos analizando las siguientes variables: edad y género, tipo de cirugía cardíaca, protocolo anestésico transquirúrgico, sangrado y complicaciones postquirúrgicas, uso de hemoderivados, dosis de FrVIIa, morbimortalidad. Resultados: Se estudiaron 20 pacientes en un período de 4 años, género masculino 16, edad promedio de 59.4 años, peso promedio 63.8 kg. Cirugías realizadas: revascularización coronaria (4 casos), sustitución mitro-aórtica (4), revascularización más sustitución mitral (3), sustitución mitral más plastia tricuspídea (3), Bentall-Bono (3) y sustitución aórtica (3). Tiempo de derivación cardiopulmonar promedio de 83.4 min. Utilizando recuperador celular en todos los casos y un volumen promedio de 357.7 mL. La dosis utilizada de FrVIIa fue 90 µg/kg. Promedio de requerimiento de transfusión: paquetes globulares (4.0 U), plasma fresco congelado (6.2 U), crioprecipitados (2.3 U), aféresis plaquetaria (2.2 U), gasto por drenaje torácico antes de FrVIIa 1,425 mL y posterior de 319.5 mL. Se reintervinieron tres pacientes a los cuales se les aplicó una segunda dosis de 45 µg/kg, presentando 2 complicaciones postquirúrgicas secundarias a procedimiento anestésico. Adecuada evolución de 10 a 22 meses de egreso hospitalario. Conclusión: Nuestros resultados suponen, que la utilización de FrVIIa como terapia de rescate para sangrado por coagulopatía después de cirugía cardiovascular es beneficioso dado que disminuye el consumo de productos hemáticos y el número de reintervenciones.


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