Anticoagulación en escenarios clínicos inusuales: revisión narrativa de la literatura
DOI:
https://doi.org/10.17533/udea.iatreia.250Palabras clave:
Anticoagulantes, Cardiopatías Congénitas, Embolia y Trombosis, Isquemia, Síndrome NefróticoResumen
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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