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Diario Oficial de la Sociedad Mexicana de Cirugía Cardiaca, A.C., y del Colegio Mexicano de Cirugía Cardiovascular y Torácica, A.C.

2019, Número 2

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Cir Card Mex 2019; 4 (2)


Safety of anticoagulant therapy for patients with atrial fibrillation: a systematic review and meta-analysis

Dong L, Hu A, Wang J, Liu T, Zou C, Wang X

Idioma: Ingles.
Referencias bibliográficas: 38
Paginas: 35-47
Archivo PDF: 717.20 Kb.


RESUMEN

Antecedentes. Los anticoagulantes se recomiendan en pacientes con fibrilación auricular. Sin embargo, muchos pacientes prefieren perapia antiplaquetaria o ninguna debido al riesfo de sangrado mayor. Los eventos de sangrado mayor (SM) pueden ser el origen de un mal pronóstico. Objetivos. Buscamos explorar la seguridad de los anticoagulantes analizando las diferencias en la incidencia de SM y eventos vasculares mortales (EVM) en pacientes con FA. Métodos. Tres bases de datos fueron investigadas desde el inicio hasta Noviembre 30, 2017. Quince estudios controlados randomizados se incluyerin en este estudio. Resultados. Comparada con placebo, (risk ratio [RR] 1.95, 95% intervalo de confianza [IC] 0.87-4.38, p = 0.11), aunque la warfarina incrementó el riesgo de sangrado (warfarin vs aspirin: RR 1.86, 95% CI 1.30-2.65, p = 0.0006), el riesgo no aumentó con el aumento en la intensidad del tratamiento. Además, la warfarina no incrementó el riesgo de SM (warfarin vs aspirin: RR 1.08, 95% IC 0.71-1.64, p = 0.72; warfarin vs placebo RR 2.27, 95% IC 0.84-6.15, p = 0.11). Además, una importante reducción en el riesgo de EVM fue observado grupo de warfarina a altas dosis ((warfarin vs aspirin: RR 0.44, 95% IC 0.25-0.76, p = 0.004; warfarin vs placebo: RR 0.30, 95% IC 0.13-0.71, p = 0.005). Solamente un estudio demostró que comparado con aspirina, el apixabán no aumentó la incidencia de SM (p = 0.57), y tuvo una tendencia hacia una menor mortalidad. (p = 0.07). Conclusiones. El uso de anticoagulantes orales es seguro en pacientes con FA. Además, la dosis de warfarina no debería ser tan conservadora.


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