Procesos de decisión en la antiagregación (II): Prevención primaria
DOI:
https://doi.org/10.30445/rear.v3i7.456Keywords:
antiagregantes, formación, M. perioperatoria,, Preanestesia, Preoperatorio, TromboembolismoAbstract
En una entrada anterior, intentamos reflejar las controversias en torno al tratamiento preventivo de los fenómenos tromboembólicos en pacientes sin factores de riesgo.
En el proceso de decisión frente dicho manejo preoperatorio parece quedar claro que una profilaxis primaria para evitar accidentes cerebrovasculares no tiene tanta base científica como para evitar eventos cardiovasculares. Pero incluso en esta última situación el beneficio real frente a posibles complicaciones puede ser discutible. Nos encontramos con odds ratios bajos aunque significativos estadísticamente y ciertas matizaciones en las recomendaciones, no todas unánimes.
El escenario parecería cambiar si el paciente presenta una serie de patologías que le predispongan, en mayor o menor medida a un accidente trombovascular. A primera vista nos puede parecer que hay más evidencias en estos casos para administrar warfarínicos o antiagregantes de manera consensuada, con un riesgo incrementado si suspendemos dicha terapia, pero revisando la literatura al respecto comprobamos que no siempre es así, y que la unanimidad tampoco está presente en todos los casos.
A continuación, revisamos algunas de las patologías asociadas más relevantes y exponemos las evidencias científicas encontradas para prevenir dichos eventos tromboembólicos.
References
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Más bibliografía consultada
- PROTOCOLOS DE TRATAMIENTO ANTIAGREGANTES DE LA SEMI (Sociedad Española de Medicina interna), 2.004. Coordinador Demetrio Sánchez Fuentes. Autores José Manuel Barragán Casas, José Luis Hernández Hernández, José Antonio Riancho, Moral, Carmen Suárez Fernández.
- Manejo de Antiagregantes en Perioperatorio de Cirugía Programada No Cardiaca. Dra Durán Giménez- Rico. Dr F Duro Ventura. Dra A.M Muñoz de solano Palacios. Dr Borja San Pedro de Urquiza. Dr Siro Tato. Prof F. Lopez Timoneda. Servicio Anestesiologia Hospital Clínico San Carlos. Madrid. España.
- Valoración Preoperatorio del paciente Antiagregado, portador de Stents Coronario. Dra Angeles de Miguel Guijaro. Servicio Anestesiología, H. Gregorio Marañón. Madrid. España. Guía Clínica consensuada.
- Manejo Preoperatorio de la Antiagregación en pacientes portadores de Stent Coronario. P. Sierra. P. Tormas et al. Rev esp anest. 2008. 55 8 (Supl 1).
- James D; ACCP. The perioperative management of antithrombotic therapy. 8TH EDICITION CHEST 2008:133.
- Anticoagulación; Coordinado por Armando Gomez Ortiz MD. Sociedad Colombiana de Cardiología y Cirugía Cardiovascular 2005.
- Hall R, Mazer CD. Antiplatelet Drugs: A Review of Their Pharmacology and Management in the Perioperative Period. Anesth Analg. 2011 Feb;112(2):292-318. Epub 2011 Jan 6.
- Ezekowitz MD, Bridgers SL, James KE, Carliner NH, Colling CL, Gornick CC, et al.Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation.Veterans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillation Investigators. N Engl J Med 1992;327:1406-12.
- Hassouna A, Allam H, Awad A, Hasssaballah F. Standard versus low-level anticoagulation combined to low-dose dipyridamole after mitral valve replacement. Cardiovasc Surg 2000; 8 (6): 491-8.
- Mok CK, Boey J,Wang R, Chan TK, Cheung KL, Lee PK, et al. Warfarin versus dipyridamole-aspirin and pentoxifyline-aspirin for the prevention of prothestic heart valve thromoembolism: a prospective clinical trial. Circulation 1985;72:1059-63.
- Fang MC, Go AS, Chang Y, Borowsky L, Pomernacki NK, Singer DE. Comparison of risk stratification schemes to predict thromboembolism in people with nonvalvular atrial fibrillation. J Am Coll Cardiol. 2008; 51:810-5.
2.- Albers GW, Dalen JE, Laupacis A, Manning WJ, Petersen P, Singer DE. Antithrombotic therapy in atrial fibrillation. Chest 2001;119(Suppl 1):194S-206S.
3.- Gage BF,Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001;285:2864-70.
4.- Douketis JD, Berger PB, Dunn AS, Jaffer AK, Spyropoulos AC, Becker RC, Ansell J; American College of Chest Physicians. The perioperative management of antithrombotic therapy. 8THEDICITION Chest. 2008 Jun;133(6 Suppl):299S-339S.
5.- Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation: Stroke Prevention in Atrial Fibrillation II Study. Lancet 1994;343:687-91.
6.- Lip GY, Gibbs CR. Anticoagulation for heart faillure in sinus rhythm: A Cochrane systematic review. QJ Med 2002; 95: 451-459.
7.- Lip GYH, Gibbs CR. Antiplatelet agents versus control or anticoagulation for heart failure in sinus rhythm (Cochran Review). The Cochrane Library. Issue 1. Chichester, UK: John Wiley & Sons, Ltd, 2004.
8.- Teo KK, Yusuf S, Pfeffer M, Kober L, Hall A, Pogue J et al. Effects of long-term treatment with angiotensin-convertingenzyme inhibitors in the presence of absence of aspirin: a systematic review. Lancet 2002; 360: 1037-43.
9.- Salem DN, Daudelin DH, Pauker SG, Levine HJ, Eckman MH. Antithrombotic therapy in valvular heart disease. Chest 2001; 119: 207S-219S.
10.- Turpie AG, Gent M, Laupacis A, Latour Y, Gunstensen J, Basile F, et al. Aspirin and warfarin after heart-valve replacement: a comparison of aspirin with placebo in patients treated with warfarin after heart-valve replacement. N Engl J Med 1993;329:524-9.
11.- Hirsh J, Dalen JE, Guyatt G. The sixth (2000) ACCP guidelines for antithrombotic therapy for prevention and treatment of thrombosis. Platelet active drugs. The relationships among dose, effectiveness, and side effects. Chest 2001;119:39S-63S.
12.- Little SH, Massel DR. Antiplatelet and anticoagulation for patients with prosthetic heart valves (Cochrane Review). The Cochrane Library. Issue 2. Chichester, UK: John Wiley & Sons, Ltd, 2004.
13.- Bonow et al. ACC/AHA guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association. Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). J Am Coll Cardiol. 1998 Nov;32(5):1486-588.
14.- Antiplatelet Therapy in Peripheral Arterial Disease. Consensus Statement Peripheral Arterial Diseases Antiplatelet Consensus Group Department of Vascular Surgery, Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, U.K. Eur J Vasc Endovasc Surg 2003;26:1-16. doi: 10.1053/ejvs.2002.1927.
14b.- Hart RG, Halperin JL, McBride R, Benavente O, Man-Son-Hing M, Kronmal RA. Aspirin for the primary prevention of stroke and other major vascular events: meta-analysis and hypotheses. Arch Neurol 2000;57: 326-32.
15.- Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, Zinman B; American Diabetes Association; European Association for Study of Diabetes. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2009 Jan;32(1):193-203. Epub 2008 Oct 22.
16.- Sacco M, Pellegrini F, Roncaglioni MC, Avanzini F, Tognoni G, Nicolucci A; PPP Collaborative Group. Primary prevention of cardiovascular events with low-dose aspirin and vitamin E in type 2 diabetic patients: results of the Primary Prevention Project (PPP) trial. Diabetes Care 2003;26:3264-72.
17.- HOT Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 1998; 351:1755-62.
Más bibliografía consultada
- PROTOCOLOS DE TRATAMIENTO ANTIAGREGANTES DE LA SEMI (Sociedad Española de Medicina interna), 2.004. Coordinador Demetrio Sánchez Fuentes. Autores José Manuel Barragán Casas, José Luis Hernández Hernández, José Antonio Riancho, Moral, Carmen Suárez Fernández.
- Manejo de Antiagregantes en Perioperatorio de Cirugía Programada No Cardiaca. Dra Durán Giménez- Rico. Dr F Duro Ventura. Dra A.M Muñoz de solano Palacios. Dr Borja San Pedro de Urquiza. Dr Siro Tato. Prof F. Lopez Timoneda. Servicio Anestesiologia Hospital Clínico San Carlos. Madrid. España.
- Valoración Preoperatorio del paciente Antiagregado, portador de Stents Coronario. Dra Angeles de Miguel Guijaro. Servicio Anestesiología, H. Gregorio Marañón. Madrid. España. Guía Clínica consensuada.
- Manejo Preoperatorio de la Antiagregación en pacientes portadores de Stent Coronario. P. Sierra. P. Tormas et al. Rev esp anest. 2008. 55 8 (Supl 1).
- James D; ACCP. The perioperative management of antithrombotic therapy. 8TH EDICITION CHEST 2008:133.
- Anticoagulación; Coordinado por Armando Gomez Ortiz MD. Sociedad Colombiana de Cardiología y Cirugía Cardiovascular 2005.
- Hall R, Mazer CD. Antiplatelet Drugs: A Review of Their Pharmacology and Management in the Perioperative Period. Anesth Analg. 2011 Feb;112(2):292-318. Epub 2011 Jan 6.
- Ezekowitz MD, Bridgers SL, James KE, Carliner NH, Colling CL, Gornick CC, et al.Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation.Veterans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillation Investigators. N Engl J Med 1992;327:1406-12.
- Hassouna A, Allam H, Awad A, Hasssaballah F. Standard versus low-level anticoagulation combined to low-dose dipyridamole after mitral valve replacement. Cardiovasc Surg 2000; 8 (6): 491-8.
- Mok CK, Boey J,Wang R, Chan TK, Cheung KL, Lee PK, et al. Warfarin versus dipyridamole-aspirin and pentoxifyline-aspirin for the prevention of prothestic heart valve thromoembolism: a prospective clinical trial. Circulation 1985;72:1059-63.
- Fang MC, Go AS, Chang Y, Borowsky L, Pomernacki NK, Singer DE. Comparison of risk stratification schemes to predict thromboembolism in people with nonvalvular atrial fibrillation. J Am Coll Cardiol. 2008; 51:810-5.
Published
2011-07-31
How to Cite
Gironés Muriel, A., San Pedro, B., Domenech de Frutos, S., & Lage Piñeiro, S. (2011). Procesos de decisión en la antiagregación (II): Prevención primaria. Revista Electrónica AnestesiaR, 3(7), 2. https://doi.org/10.30445/rear.v3i7.456
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Review articles
Revista Electrónica AnestesiaR by 