Anticoagulación en escenarios clínicos inusuales: revisión narrativa de la literatura

Alejandro Arango Martínez; Rafael Ignacio Herrera Ramos

doi:10.17533/udea.iatreia.250

Autores/as

Alejandro Arango-Martínez Universidad Pontificia Bolivariana https://orcid.org/0000-0002-3242-0590
Rafael Ignacio Herrera-Ramos Hospital Alma Máter de Antioquia https://orcid.org/0000-0003-1061-0526

DOI:

https://doi.org/10.17533/udea.iatreia.250

Palabras clave:

Anticoagulantes, Cardiopatías Congénitas, Embolia y Trombosis, Isquemia, Síndrome Nefrótico

Resumen

Introducción: en la práctica clínica es frecuente el uso de anticoagulantes en escenarios específicos, como enfermedad tromboembólica venosa o fibrilación auricular, para los cuales existen pautas de manejo claramente establecidas. Sin embargo, hasta la fecha, no hay guías clínicas unificadas para el manejo de trombosis en escenarios inusuales, por lo que significan un verdadero reto terapéutico.
Objetivo: revisar las indicaciones de anticoagulación y sus esquemas en situaciones clínicas inusuales con base en la evidencia disponible.
Métodos: se realizó una revisión de la literatura desde el año 1997 al 2022, en la que fueron considerados los términos MeSH correspondientes para anticoagulación, anticoagulantes orales, embolia y trombosis. Se extrajo y sintetizó la información de manera estructurada.
Resultados: en síndrome nefrótico se recomienda el uso de warfarina, aun cuando existen alternativas como las heparinas de bajo peso molecular, aspirinas o los anticoagulantes orales directos. Para trombo intracavitario, el medicamento de elección es la warfarina y se ha demostrado una eficacia equivalente para los anticoagulantes orales directos. Para la enfermedad arterial periférica según el perfil individual, se demostró el beneficio del rivaroxabán a dosis de protección vascular + aspirina en desenlaces cardiovasculares adversos mayores.
Conclusiones: la atención de estos escenarios requiere una adecuada valoración clínica y elección del tipo de anticoagulante asegurando al máximo la reducción de trombosis y de sangrado.

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Biografía del autor/a

Alejandro Arango-Martínez, Universidad Pontificia Bolivariana

Estudiante de Medicina. Grupo de investigación Unidad de Inmunología Clínica y Reumatología (UNIR), Universidad Pontificia Bolivariana, Medellín, Colombia.

Rafael Ignacio Herrera-Ramos, Hospital Alma Máter de Antioquia

Médico internista, Especialista en Medicina Vascular. Hospital Alma Máter, Universidad de Antioquia. Profesor titular Medicina Interna, Universidad Pontificia Bolivariana, Medellín, Colombia.

Citas

DeWald TA, Washam JB, Becker RC. Anticoagulants: Pharmacokinetics, Mechanisms of Action, and Indications. Neurosurg Clin N Am [Internet]. 2018;29(4):503-515. https://doi.org/10.1016/j.nec.2018.06.003

Altiok E, Marx N. Oral Anticoagulation. Dtsch Arztebl Int [Internet]. 2018;115(46):776-783. https://doi.org/10.3238/arztebl.2018.0776

Schulman S. Optimal duration of anticoagulant therapy. Semin Thromb Hemost [Internet]. 2013;39(2):141-6. https://doi.org/10.1055/s-0032-1333542

Weitz JI. Anticoagulation therapy in 2015: where we are and where we are going. J Thromb Thrombolysis [Internet]. 2015;39(3):264-72. https://doi.org/10.1007/s11239-015-1194-6

Willner NA, Ehrenberg S, Musallam A, Roguin A. Coronary artery ectasia: prevalence, angiographic characteristics and clinical outcome. Open Heart [Internet]. 2020;7(1):e001096. https://doi.org/10.1136/openhrt-2019-001096

Vrachatis DA, Papathanasiou KA, Kazantzis D, Sanz-Sánchez J, Giotaki SG, Raisakis K, et al. Inflammatory Biomarkers in Coronary Artery Ectasia: A Systematic Review and Meta-Analysis. Diagnostics (Basel) [Internet]. 2022;12(5):1026. https://doi.org/10.3390/diagnostics12051026

Eitan A, Roguin A. Coronary artery ectasia: new insights into pathophysiology, diagnosis, and treatment. Coron Artery Dis [Internet]. 2016;27(5):420-8. https://doi.org/10.1097/MCA.0000000000000379

Aboeata AS, Sontineni SP, Alla VM, Esterbrooks DJ. Coronary artery ectasia: current concepts and interventions. Front Biosci (Elite Ed) [Internet]. 2012;4(1):300-310. https://doi.org/10.2741/377

Kataoka Y, Doi T. Coronary artery ectasia: Importance of its risk stratification and management. Int J Cardiol [Internet]. 2021;322:43-44. https://doi.org/10.1016/j.ijcard.2020.08.061

Yasar AS, Erbay AR, Ayaz S, Turhan H, Metin F, Ilkay Et aI. Increased platelet activity in patients with isolated coronary artery ectasia. Coron Artery Dis [Internet]. 2007;18(6):451-4. https://doi.org/10.1097/MCA.0b013e3282a30665

Moghadam RH, Shahmohammadi A, Asgari N, Azizi K, Mansour SM, Roozbahani M. Comparison of mean platelet volume levels in coronary artery ectasia and healthy people: systematic review and meta-analysis. Blood Res [Internet]. 2018;53(4):269-275. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6300668/

Dahhan A. Coronary artery ectasia in atherosclerotic coronary artery disease, inflammatory disorders, and sickle cell disease. Cardiovasc Ther [Internet]. 2015;33(2):79-88. https://doi.org/10.1111/1755-5922.12106

Pranata R, Yonas E, Chintya V, Alkatiri AA. Is Anticoagulant Necessary in Patients with Coronary Artery Ectasia Presenting with Acute Coronary Syndrome? A Systematic Review of Case Reports. Int J Angiol [Internet]. 2019;28(4):231-236. https://doi.org/10.1055/s-0039-1692706

Almazán A, Nandayapa O, Rangel A, Badui E, Albarrán H, Lepe L. Asymptomatic ischemia in coronary arterial ectasia. Effects of anticoagulation. Arch Inst Cardiol Mex [Internet]. 1997;67(3):195-200. Disponible en: https://pubmed.ncbi.nlm.nih.gov/9412431/

Doi T, Kataoka Y, Noguchi T, Shibata T, Nakashima T, Kawakami S, et al. Coronary Artery Ectasia Predicts Future Cardiac Events in Patients With Acute Myocardial Infarction. Arterioscler Thromb Vasc Biol [Internet]. 2017;37(12):2350-2355. https://doi.org/10.1161/ATVBAHA.117.309683

Sorrell VL, Davis MJ, Bove AA. Current knowledge and significance of coronary artery ectasia: a chronologic review of the literature, recommendations for treatment, possible etiologies, and future considerations. Clin Cardiol [Internet]. 1998;21(3):157-60. https://doi.org/10.1002/clc.4960210304

Grigorov V. Invasive and anticoagulant treatment for coronary ectasia: a single operator's experience in a tertiary hospital in South Africa. Cardiovasc J Afr [Internet]. 2009;20(4):229-32. Disponible en: https://pubmed.ncbi.nlm.nih.gov/19701533/

Kerlin BA, Ayoob R, Smoyer WE. Epidemiology and pathophysiology of nephrotic syndrome-associated thromboembolic disease. Clin J Am Soc Nephrol [Internet]. 2012;7(3):513-20. https://doi.org/10.2215/CJN.10131011

Lionaki S, Derebail VK, Hogan SL, Barbour S, Lee T, Hladunewich M, et al. Venous thromboembolism in patients with membranous nephropathy. Clin J Am Soc Nephrol [Internet]. 2012;7(1):43-51. https://doi.org/10.2215/CJN.04250511

Welander F, Holmberg H, Dimény E, Jansson U, Själander A. Prophylactic anticoagulants to prevent venous thromboembolism in patients with nephrotic syndrome-A retrospective observational study. PLoS One [Internet]. 2021;16(7):e0255009. https://doi.org/10.1371/journal.pone.0255009

Beck L, Bomback AS, Choi MJ, Holzman LB, Langford C, Mariani LH, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis. Am J Kidney Dis [Internet]. 2013;62(3):403-41. https://doi.org/10.1053/j.ajkd.2013.06.002

Hofstra JM, Wetzels JFM. Should aspirin be used for primary prevention of thrombotic events in patients with membranous nephropathy? Kidney Int [Internet]. 2016;89(5):981-983. https://doi.org/10.1016/j.kint.2016.01.019

Zou H, Li Y, Xu G. Management of anticoagulation and antiplatelet therapy in patients with primary membranous nephropathy. BMC Nephrol [Internet]. 2019;20(1):442. https://doi.org/10.1186/s12882-019-1637-y

Lin R, McDonald G, Jolly T, Batten A, Chacko B. A Systematic Review of Prophylactic Anticoagulation in Nephrotic Syndrome. Kidney Int Rep [Internet]. 2019;5(4):435-447. https://doi.org/10.1016/j.ekir.2019.12.001

Kelddal S, Hvas AM, Grove EL, Birn H. Safety and effectiveness of direct oral anticoagulants in patients with nephrotic syndrome: a report of 21 cases. BMC Nephrol [Internet]. 2022;23(1):305. https://doi.org/10.1186/s12882-022-02929-x

McNally MM, Univers J. Acute Limb Ischemia. Surg Clin North Am [Internet]. 2018;98(5):1081-1096. https://doi.org/10.1016/j.suc.2018.05.002

Suggested standards for reports dealing with lower extremity ischemia. Prepared by the Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery/North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg [Internet]. 1986;4(1):80-94. Disponible en: https://pubmed.ncbi.nlm.nih.gov/3723692/

Björck M, Earnshaw JJ, Acosta S, Bastos Gonçalves F, Cochennec F, Debus ES eta al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia. Eur J Vasc Endovasc Surg [Internet]. 2020;59(2):173-218. https://doi.org/10.1016/j.ejvs.2019.09.006

Akdemir R, Vatan MB. Updates in 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases. Turk Kardiyol Dern Ars [Internet]. 2017;45(8):681-686. https://doi.org/10.5543/tkda.2017.78578

Debus ES, Nehler MR, Govsyeyev N, Bauersachs RM, Anand SS, Patel MR, et al. Effect of Rivaroxaban and Aspirin in Patients With Peripheral Artery Disease Undergoing Surgical Revascularization: Insights From the VOYAGER PAD Trial. Circulation [Internet]. 2021;144(14):1104-1116. https://doi.org/10.1161/CIRCULATIONAHA.121.054835

Mumoll N, Invernizzi C, Luschi R, Carmignani G, Camaiti A, Cel M. Phlegmasia cerulea dolens. Circulation [Internet]. 2012;125(8):1056-7. https://doi.org/10.1161/CIRCULATIONAHA.111.051912

Guzkurt L, Ozkan U, Demirturk OS, Gur S. Endovascular treatment of phlegmasia cerulea dolens with impending venous gangrene: manual aspiration thrombectomy as the first-line thrombus removal method. Cardiovasc Intervent Radiol [Internet]. 2011;34(6):1214-21. https://doi.org/10.1007/s00270-010-0042-5

Ichida F, Hamamichi Y, Miyawaki T, Ono Y, Kamiya T, Akagi T, et al. Clinical features of isolated noncompaction of the ventricular myocardium: long-term clinical course, hemodynamic properties, and genetic background. J Am Coll Cardiol [Internet]. 1999;34(1):233-40. https://doi.org/10.1016/s0735-1097(99)00170-9

Stöllberger C, Blazek G, Dobias C, Hanafin A, Wegner C, Finsterer J. Frequency of stroke and embolism in left ventricular hypertrabeculation/noncompaction. Am J Cardiol [Internet]. 2011;108(7):1021-3. https://doi.org/10.1016/j.amjcard.2011.05.039

Chimenti C, Lavalle C, Magnocavallo M, Alfarano M, Mariani MV, Bernardini F, et al. A proposed strategy for anticoagulation therapy in noncompaction cardiomyopathy. ESC Heart Fail [Internet]. 2022;9(1):241-250. https://doi.org/10.1002/ehf2.13694

Pöyhönen P, Kuusisto J, Järvinen V, Pirinen J, Räty H, Lehmonen L, et al. Left ventricular non-compaction as a potential source for cryptogenic ischemic stroke in the young: A case-control study. PLoS One [Internet]. 2020;15(8):e0237228. https://doi.org/10.1371/journal.pone.0237228

Fazio G, Corrado G, Zachara E, Rapezzi C, Sulafa AK, Sutera L, et al. Anticoagulant drugs in noncompaction: a mandatory therapy? J Cardiovasc Med (Hagerstown) [Internet]. 2008 Nov;9(11):1095-7. https://doi.org/10.2459/JCM.0b013e328308da04

Kido K, Guglin M. Anticoagulation Therapy in Specific Cardiomyopathies: Isolated Left Ventricular Noncompaction and Peripartum Cardiomyopathy. J Cardiovasc Pharmacol Ther [Internet]. 2019;24(1):31-36. https://doi.org/10.1177/1074248418783745

Abdelnaby M, Almaghraby A, Abdelkarim O, Saleh Y, Hammad B, Badran H. The role of rivaroxaban in left ventricular thrombi. Anatol J Cardiol [Internet]. 2019;21(1):47-50. https://doi.org/10.14744/AnatolJCardiol.2018.48313

Habash F, Vallurupalli S. Challenges in management of left ventricular thrombus. Ther Adv Cardiovasc Dis [Internet]. 2017;11(8):203-213. https://doi.org/10.1177/1753944717711139

McCarthy CP, Vaduganathan M, McCarthy KJ, Januzzi JL Jr, Bhatt DL, McEvoy JW. Left Ventricular Thrombus After Acute Myocardial Infarction: Screening, Prevention, and Treatment. JAMA Cardiol [Internet]. 2018;3(7):642-649. https://doi.org/10.1001/jamacardio.2018.1086

Massussi M, Scotti A, Lip GYH, Proietti R. Left ventricular thrombosis: new perspectives on an old problem. Eur Heart J Cardiovasc Pharmacother [Internet]. 2021;7(2):158-167. https://doi.org/10.1093/ehjcvp/pvaa066

Hansen ML, Sørensen R, Clausen MT, Fog-Petersen ML, Raunsø J, Gadsbøll N, et al. Risk of bleeding with single, dual, or triple therapy with warfarin, aspirin, and clopidogrel in patients with atrial fibrillation. Arch Intern Med [Internet]. 2010;170(16):1433-41. https://doi.org/10.1001/archinternmed.2010.271

Dans AL, Connolly SJ, Wallentin L, Yang S, Nakamya J, Brueckmann M, et al. Concomitant use of antiplatelet therapy with dabigatran or warfarin in the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial. Circulation [Internet]. 2013;127(5):634-40. https://doi.org/10.1161/CIRCULATIONAHA.112.115386

O'Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol [Internet]. 2013;61(4):e78-e140. https://doi.org/10.1016/j.jacc.2012.11.019

Kouvaras G, Chronopoulos G, Soufras G, Sofronas G, Solomos D, Bakirtzis A, et al. The effects of long-term antithrombotic treatment on left ventricular thrombi in patients after an acute myocardial infarction. Am Heart J [Internet]. 1990;119(1):73-8. https://doi.org/10.1016/s0002-8703(05)80084-5

Maniwa N, Fujino M, Nakai M, Nishimura K, Miyamoto Y, Kataoka Y, et al. Anticoagulation combined with antiplatelet therapy in patients with left ventricular thrombus after first acute myocardial infarction. Eur Heart J [Internet]. 2018;39(3):201-208. https://doi.org/10.1093/eurheartj/ehx551

Jones DA, Wright P, Alizadeh MA, Fhadil S, Rathod KS, Guttmann O, et al. The use of novel oral anticoagulants compared to vitamin K antagonists (warfarin) in patients with left ventricular thrombus after acute myocardial infarction. Eur Heart J Cardiovasc Pharmacother [Internet]. 2021;7(5):398-404. https://doi.org/10.1093/ehjcvp/pvaa096

Alcalai R, Butnaru A, Moravsky G, Yagel O, Rashad R, Ibrahimli M et al. Apixaban vs. warfarin in patients with left ventricular thrombus: a prospective multicentre randomized clinical trial‡. Eur Heart J Cardiovasc Pharmacother [Internet]. 2022;8(7):660-667. https://doi.org/10.1093/ehjcvp/pvab057

Kido K, Ghaffar YA, Lee JC, Bianco C, Shimizu M, Shiga T, et al. Meta-analysis comparing direct oral anticoagulants versus vitamin K antagonists in patients with left ventricular thrombus. PLoS One [Internet]. 2021;16(6):e0252549. https://doi.org/10.1371/journal.pone.0252549

Michael F, Natt N, Shurrab M. Direct Oral Anticoagulants vs Vitamin K Antagonists in Left Ventricular Thrombi: A Systematic Review and Meta-analysis. CJC Open [Internet]. 2021;3(9):1169-1181. https://doi.org/10.1016/j.cjco.2021.04.007

Levine GN, McEvoy JW, Fang JC, Ibeh C, McCarthy CP, Misra A, et al. Management of Patients at Risk for and With Left Ventricular Thrombus: A Scientific Statement From the American Heart Association. Circulation [Internet]. 2022;146(15):e205-e223. https://doi.org/10.1161/CIR.0000000000001092

Lattuca B, Bouziri N, Kerneis M, Portal JJ, Zhou J, Hauguel-Moreau M, et al. Antithrombotic Therapy for Patients With Left Ventricular Mural Thrombus. J Am Coll Cardiol [Internet]. 2020;75(14):1676-1685. https://doi.org/10.1016/j.jacc.2020.01.057

Ding KJ, Cammann VL, Szawan KA, Stähli BE, Wischnewsky M, Di Vece D, et al. Intraventricular Thrombus Formation and Embolism in Takotsubo Syndrome: Insights From the International Takotsubo Registry. Arterioscler Thromb Vasc Biol [Internet]. 2020;40(1):279-287. https://doi.org/10.1161/ATVBAHA.119.313491

Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J [Internet]. 2018;39(2):119-177. https://doi.org/10.1093/eurheartj/ehx393