2011, Número 4
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Rev Med Inst Mex Seguro Soc 2011; 49 (4)
Cirugía y los nuevos anticoagulantes orales
García-Chávez J
Idioma: Español
Referencias bibliográficas: 52
Paginas: 393-399
Archivo PDF: 48.72 Kb.
RESUMEN
Actualmente en los pacientes sometidos a cirugía u hospitalizados
con afecciones médicas podemos medir la probabilidad para desarrollar
enfermedad tromboembólica venosa, y en función de tal
probabilidad indicar manejo tromboprofiláctico con anticoagulantes
o medidas antitrombóticas no medicamentosas. El uso de anticoagulantes
siempre conlleva el riesgo de provocar un sangrado
anormal potencialmente faltal. Últimamente este concepto ha sufrido
cambios favorables tanto para el paciente como para los médicos,
concretamente en el desarrollo de nuevos medicamentos
que conservan su actividad antitrombótica, pero disminuyen considerablemente
su efecto anticoagulante y con esto el riesgo de
hemorragia, además de otras ventajas como la vía de administración,
la biodisponibilidad predecible y la poca interacción con alimentos
y otras medicinas. Así, hacemos referencia a los inhibidores
directos del factor Xa de la coagulación como el rivaroxabán y el
apixabán, y también a los inhibidores del factor IIa como el dabigatrán,
agentes evaluados en el posoperatorio de los pacientes
sometidos a cirugía de reemplazo total de cadera o rodilla con
resultados mejores en términos de eficacia, y similares en términos
de seguridad a las heparinas de bajo peso molecular. Actualmente
están en curso los ensayos para evaluar su uso en otros
entornos quirúrgicos y en pacientes no quirúrgicos.
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