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>Revistas >Gaceta Médica de México >Año 2012, No. 3


Barinagarrementeria AF
Actualidades en prevención secundaria de infarto cerebral por fibrilación auricular
Gac Med Mex 2012; 148 (3)

Idioma: Español
Referencias bibliográficas: 56
Paginas: 248-256
Archivo PDF: 93.91 Kb.


Texto completo




RESUMEN

La enfermedad vascular cerebral (EVC) es la segunda causa de muerte en el mundo y deja a un importante número de pacientes con secuelas neurológicas permanentes. La fibrilación auricular (FA) es el principal factor de riesgo para isquemia cerebral por mecanismo cardioembólico. En México se calcula que 850,000 personas sufren de FA. En un análisis combinado de tres registros mexicanos con un total de 3,194 pacientes, la frecuencia de FA en pacientes con infarto cerebral fue de 12.5 y 8.1% en pacientes con isquemia cerebral transitoria. El riesgo de embolismo cerebral asociado a FA de tipo no valvular es seis veces superior a la de sujetos sin esta arritmia.
Se han propuesto diferentes abordajes para la detección de la FA en pacientes con isquemia cerebral. Además del electrocardiograma (ECG) y el examen clínico basales, el monitoreo cardíaco no invasivo es útil para detectar la FA. Es importante detectar subgrupos de pacientes con mayores posibilidades de tener fibrilación auricular paroxística (FAP), incluyendo aquellos con infarto cerebral criptogénico, latidos prematuros atriales de alta frecuencia y patrones clínicos y de neuroimagen de infarto cerebral compatibles con mecanismo embólico (p. ej., infartos corticales). Es importante estratificar el riesgo de EVC en pacientes con FA. Se han descrito más de 12 esquemas de estratificación de riesgo para pacientes con FA, pero ninguno de ellos ha sido considerado como ideal. La escala CHADS2 ha sido una de las más utilizadas. Recientemente, se ha propuesto la escala CHA2DS2-VASc, con mayor sensibilidad para clasificar el riesgo de embolismo.
La warfarina ha demostrado ser altamente eficaz en la prevención primaria y secundaria de EVC en pacientes portadores de FA. La necesidad de monitoreo de tiempos de coagulación, restricciones dietéticas y farmacológicas, y el riesgo de sangrado limitan su uso en pacientes con riesgo alto de EVC asociada a FA. Desde hace poco están disponibles nuevos anticoagulantes orales con distintos mecanismos de acción y sin necesidad de monitoreo de coagulación, pocas interacciones farmacológicas y riesgos menores de hemorragia.


Palabras clave: Fibrilación auricular, Embolismo cerebral, Anticoagulantes orales, Factores de riesgo, Hemorragia cerebral.


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>Revistas >Gaceta Médica de México >Año2012, No. 3
 

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