medigraphic.com

2023, Número 2

<< Anterior Siguiente >>

Rev Hematol Mex 2023; 24 (2)


Manejo del sangrado en pacientes con terapia anticoagulante

Ramírez AJM, Alonso GD, Coronado RAA, Norzagaray OF, Sánchez SA, Martínez VMI, Anaya CJ, Arguelles EMF, García MG, Ramírez ADP, Sosa QLS, Osuna DJA, Borjas GC

Idioma: Español
Referencias bibliográficas: 20
Paginas: 89-100
Archivo PDF: 348.46 Kb.


RESUMEN

La terapia anticoagulante, que incluye a los antagonistas de la vitamina K, inhibidores directos del factor X activado, así como a la heparina, se asocian con diferentes tasas de hemorragia mayor. El aumento en la prescripción de dichos fármacos implica la necesidad de conocimiento del manejo de la hemorragia asociada con la anticoagulación en distintos escenarios clínicos, así como el conocimiento de las indicaciones, contraindicaciones, puntos a revisar en el seguimiento, escalas y el manejo específico acorde con el tipo de anticoagulante administrado. El propósito de este artículo es revisar las escalas de riesgo hemorrágico, manejo de la hemorragia asociada con anticoagulación, seguimiento, transición de terapia anticoagulante y el momento ideal para el reinicio de la anticoagulación; se realiza una revisión del manejo de sangrado en pacientes anticoagulados.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Moia M, Squizzato A. Reversal agents for oral anticoagulant-associated major or life-threatening bleeding.Intern Emerg Med 2019; 14 (8): 1233-1239. doi: 10.1007/s11739-019-02177-2.

  2. Schulman S, Kearon C; Subcommittee on Control ofAnticoagulation of the Scientific and StandardizationCommittee of the International Society on Thrombosisand Haemostasis. Definition of major bleeding in clinicalinvestigations of antihemostatic medicinal products in nonsurgicalpatients. J Thromb Haemost 2005; 3 (4): 692-4. doi:10.1111/j.1538-7836.2005.01204.x.

  3. Milling T, Spyropoulos AC. Re-initiation of dabigatranand direct factor Xa antagonists after a major bleed.Am J Med 2016; 129: S54-S63. doi: 10.1016/j.amjmed.2016.06.006.

  4. Zhu W, He W, Guo L, Wang X, Hong K. The HAS-BLEDscore for predicting major bleeding risk in anticoagulatedpatients with atrial fibrillation: A systematic review andmeta-analysis. Clin Cardiol 2015; 38 (9): 555-61. doi:10.1002/clc.22435.

  5. Lip GYH, Banerjee A, Boriani G, Chiang CE, Fargo R, FreedmanB, Lane DA, Ruff CT, Turakhia M, Werring D, PatelS, Moores L. Antithrombotic therapy for atrial fibrillation:CHEST guideline and expert panel report. Chest 2018; 154(5): 1121-1201. doi: 10.1016/j.chest.2018.07.040.

  6. Lip GY, Frison L, Halperin JL, Lane DA. Comparative validationof a novel risk score for predicting bleeding risk in anticoagulatedpatients with atrial fibrillation: the HAS-BLED(Hypertension, Abnormal Renal/Liver Function, Stroke,Bleeding History or Predisposition, Labile INR, Elderly,Drugs/Alcohol Concomitantly) score. J Am Coll Cardiol2011; 57 (2): 173-80. doi: 10.1016/j.jacc.2010.09.024.

  7. January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE,Cleveland JC Jr, Ellinor PT, Ezekowitz MD, Field ME, FurieKL, Heidenreich PA, Murray KT, Shea JB, Tracy CM, YancyCW. 2019 AHA/ACC/HRS Focused Update of the 2014AHA/ACC/HRS Guideline for the Management of PatientsWith Atrial Fibrillation: A Report of the American Collegeof Cardiology/American Heart Association Task Force onClinical Practice Guidelines and the Heart Rhythm Society.J Am Coll Cardiol 2019; 74 (1): 104-132. doi: 10.1016/j.jacc.2019.01.011.

  8. Wigle P, Hein B, Bernheisel CR. Anticoagulation: Updatedguidelines for outpatient management. Am Fam Physician2019; 100 (7): 426-434.

  9. Milling TJ Jr, Ziebell CM. A review of oral anticoagulants,old and new, in major bleeding and the need for urgentsurgery. Trends Cardiovasc Med 2020; 30 (2): 86-90. doi:

  10. 10.1016/j.tcm.2019.03.004.10. Schulman S, Angerås U, Bergqvist D, Eriksson B, Lassen MR,Fisher W; Subcommittee on Control of Anticoagulationof the Scientific and Standardization Committee of theInternational Society on Thrombosis and Haemostasis.Definition of major bleeding in clinical investigations ofantihemostatic medicinal products in surgical patients. JThromb Haemost 2010; 8 (1): 202-4. doi: 10.1111/j.1538-7836.2009.03678.x.

  11. Milling TJ, Refaai MA, Sengupta N. Anticoagulant reversalin gastrointestinal bleeding: review of treatment guidelines.Dig Dis Sci. 2021; 66 (11): 3698-3714. doi: 10.1007/s10620-020-06728-y.

  12. Rivosecchi RM, Garavaglia J, Kane-Gill SL. An evaluation ofintravenous vitamin k for warfarin reversal: are guidelinerecommendations being followed? Hosp Pharm 2015; 50(1): 18-24. doi: 10.1310/hpj5001-018.

  13. Sarode R, Milling TJ Jr, Refaai MA, Mangione A, SchneiderA, Durn BL, Goldstein JN. Efficacy and safety of a 4-factorprothrombin complex concentrate in patients on vitamin Kantagonists presenting with major bleeding: a randomized,plasma-controlled, phase IIIb study. Circulation 2013; 128(11): 1234-43. doi: 10.1161/CIRCULATIONAHA.113.002283.

  14. Pollack CV Jr, Reilly PA, van Ryn J, Eikelboom JW, GlundS, Bernstein RA, Dubiel R, Huisman MV, Hylek EM, KamCW, Kamphuisen PW, Kreuzer J, Levy JH, Royle G, SellkeFW, Stangier J, Steiner T, Verhamme P, Wang B, Young L,Weitz JI. Idarucizumab for dabigatran reversal - full cohortanalysis. N Engl J Med 2017; 377 (5): 431-441. doi: 10.1056/NEJMoa1707278.

  15. Sartori M, Cosmi B. Andexanet alfa to reverse the anticoagulantactivity of factor Xa inhibitors: a review of design,development and potential place in therapy. J ThrombThrombolysis 2018; 45 (3): 345-352. doi: 10.1007/s11239-018-1617-2.

  16. Siegal DM, Curnutte JT, Connolly SJ, Lu G, Conley PB, WiensBL, Mathur VS, Castillo J, Bronson MD, Leeds JM, Mar FA,Gold A, Crowther MA. Andexanet alfa for the reversal offactor Xa inhibitor activity. N Engl J Med 2015; 373 (25):2413-24. doi: 10.1056/NEJMoa1510991.

  17. Connolly SJ, Crowther M, Eikelboom JW, Gibson CM, CurnutteJT, Lawrence JH, Yue P, Bronson MD, Lu G, Conley PB,Verhamme P, Schmidt J, Middeldorp S, Cohen AT, Beyer-Westendorf J, Albaladejo P, Lopez-Sendon J, Demchuk AM,Pallin DJ, Concha M, Goodman S, Leeds J, Souza S, SiegalDM, Zotova E, Meeks B, Ahmad S, Nakamya J, Milling TJ Jr;ANNEXA-4 Investigators. Full Study Report of AndexanetAlfa for Bleeding Associated with Factor Xa Inhibitors.N Engl J Med 2019; 380 (14): 1326-1335. doi: 10.1056/NEJMoa1814051.

  18. https://reference.medscape.com/drug/protamine-343746#0.

  19. Chai-Adisaksopha C, Hillis C, Monreal M, Witt DM,Crowther M. Thromboembolic events, recurrent bleedingand mortality after resuming anticoagulant following gastrointestinalbleeding. A meta-analysis. Thromb Haemost 2015; 114 (4): 819-25. doi: 10.1160/TH15-01-0063.

  20. Duffett L, Castellucci LA, Forgie MA. Pulmonary embolism:update on management and controversies. BMJ 2020; 370:m2177. doi: 10.1136/bmj.m2177.




2020     |     www.medigraphic.com