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2012, Número 1

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Med Sur 2012; 19 (1)


Trombocitopenia inducida por heparina

Carrillo-Esper R, Zárate-Vega V, Medrano-del-Ángel T, Andrade-Montes de Oca G

Idioma: Español
Referencias bibliográficas: 36
Paginas: 15-22
Archivo PDF: 249.19 Kb.


RESUMEN

La trombocitopenia inducida por la heparina (TIH) es un estado protrombótico mediado, inmunológicamente asociada a fenómenos tromboembólicos en la circulación arterial y venosa. La predisposición a la trombosis distingue a la TIH de otros tipos de trombocitopenia, como las inducidas por fármacos. El diagnóstico de TIH en pacientes hospitalizados con frecuencia es un reto debido al uso recurrente de heparina, presencia de trombocitopenia secundaria a otras causas y el desarrollo de anticuerpos heparina/PF4 asintomáticos en pacientes tratados con heparina. La determinación de anticuerpos heparina/PF4, anticuerpo polianion-PF4 y el examen de activación plaquetaria inducida por heparina son usados para el diagnóstico de la TIH. Para pacientes con alta sospecha o TIH confirmada, la heparina debe interrumpirse e iniciarse la anticoagulación con una alternativa, como la lepirudina o Danaparoide, en caso de no existir contraindicación. La warfarina no debe usarse hasta la recuperación de la cuenta plaquetaria. Cuando se decide por una anticoagulación combinada con warfarina debe de continuarse hasta que el cociente normalizado internacional (INR) se encuentre en rango terapéutico por dos días consecutivos. Las plaquetas no deben administrarse para profilaxis o tratamiento. La TIH es una enfermedad con elevada morbimortalidad, pero tratable y prevenible, por lo que se requiere de un elevado índice de sospecha, además de monitoreo y seguimiento estrecho de los enfermos tratados con heparina.


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