Buscar en
Neurología
Toda la web
Inicio Neurología Limitaciones del tratamiento anticoagulante
Información de la revista
Vol. 27. Núm. S1.
Aplicaciones de dabigatrán en neurología
Páginas 27-32 (Marzo 2012)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 27. Núm. S1.
Aplicaciones de dabigatrán en neurología
Páginas 27-32 (Marzo 2012)
Aplicaciones de dabigatrán en neurología
Acceso a texto completo
Limitaciones del tratamiento anticoagulante
Limitations of anticoagulant therapy
Visitas
3747
J. Martí-Fàbregasa,
Autor para correspondencia
jmarti@santpau.cat

Autor para correspondencia.
, R. Delgado-Mederosa, J. Mateob
a Unidad de Enfermedades Vasculares Cerebrales, Servicio de Hematología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
b Unidad de Trombosis y Hemostasia, Servicio de Hematología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
Este artículo ha recibido
Información del artículo
Resumen
Bibliografía
Descargar PDF
Estadísticas
Resumen

Los antagonistas de la vitamina K han demostrado su eficacia en la prevención primaria y secundaria del embolismo sistémico y embolismo cerebral en pacientes con fuentes cardíacas de émbolos, especialmente la fibrilación auricular. La reducción del riesgo de ictus es más notable en prevención secundaria, aunque se acompaña de un riesgo inherente de complicaciones hemorrágicas, entre las que es especialmente grave la hemorragia cerebral. Su ventana terapéutica es limitada y el mejor perfil de beneficio/riesgo se obtiene con un cociente internacional normalizado entre 2 y 3. El efecto anticoagulante obtenido muestra una marcada variabilidad, lo que obliga a la monitorización clínica, y también analítica, frecuente del tratamiento. Se precisa la introducción de anticoagulantes orales que faciliten su administración con igual o mejor eficacia y menor riesgo.

Palabras clave:
Infarto cerebral
Hemorragia cerebral
Anticoagulantes orales
Prevención
Warfarina
Acenocumarol
Abstract

Vitamin K antagonists have been shown to be effective in the primary and secondary prevention of systemic and cerebral emboli in patients with cardiac causes of embolism, especially atrial fibrillation. The reduced risk of stroke is greater in secondary prevention, although this reduction is accompanied by an inherent risk of hemorrhagic complications, among which cerebral hemorrhage is especially serious. The therapeutic window of these agents is limited and the best benefit/risk profile is obtained with an INR of between 2 and 3. The anticoagulant effect obtained shows marked variability, requiring frequent clinical and laboratory monitoring of the treatment. The introduction of oral anticoagulants that would aid the administration of these agents with equal or greater efficacy and lower risk is required.

Keywords:
Cerebral infarct
Cerebral hemorrhage
Oral anticoagulants
Prevention
Warfarin
Acenocoumarol
El Texto completo está disponible en PDF
Bibliografía
[1.]
E.M. Hylek, A.S. Go, Y. Chang, N.G. Jensvold, L.E. Henault, J.V. Selby, et al.
Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation.
N Engl J Med, 349 (2003), pp. 1019-1026
[2.]
A.J. Grau, C. Weimar, F. Buggle, A. Heinrich, M. Goertler, S. Neumaier, et al.
Risk factors, outcome, and treatment in subtypes of ischemic stroke: the german stroke data bank.
Stroke, 32 (2001), pp. 2559-2566
[3.]
B. Fuentes, E. Díez Tejedor, A. Gil-Núñez, A. Gil-Peralta, J. Matías- Guiu, por el Comité ad hoc del Grupo de Estudio de Enfermedades Cerebrovasculares de la Sociedad Española de Neurología.
Guía para el tratamiento preventivo de la isquemia cerebral.
Guía para el diagnóstico y tratamiento del ictus, pp. 133-183
[4.]
R.G. Hart, L.A. Pearce, M.I. Aguilar.
Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation.
Ann Intern Med, 146 (2007), pp. 857-867
[5.]
A.S. Go, E.M. Hylek, Y. Chang, K.A. Phillips, L.E. Henault, A.M. Capra, et al.
Anticoagulation therapy for stroke prevention in atrial fibrillation: How well do randomized trials translate into clinical practice?.
JAMA, 290 (2003), pp. 2685-2692
[6.]
J. Mant, F.D. Hobbs, K. Fletcher, A. Roalfe, D. Fitzmaurice, G.Y. Lip, et al.
Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the birmingham atrial fibrillation treatment of the aged study, bafta): A randomised controlled trial.
[7.]
Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor, stroke. EAFT (European Atrial Fibrillation Trial) Study Group.
Lancet, 342 (1993), pp. 1255-1262
[8.]
D.A. Fitzmaurice, A.D. Blann, G.Y. Lip.
Bleeding risks of antithrombotic therapy.
BMJ, 325 (2002), pp. 828-831
[9.]
C. Van Walraven, R.G. Hart, D.E. Singer, A. Laupacis, S. Connolly, P. Petersen, et al.
Oral anticoagulants vs aspirin in nonvalvular atrial fibrillation: An individual patient meta-analysis.
JAMA, 288 (2002), pp. 2441-2448
[10.]
T. Steiner, J. Rosand, M. Diringer.
Intracerebral hemorrhage associated with oral anticoagulant therapy: current practices and unresolved questions.
[11.]
M.C. Fang, Y. Chang, E.M. Hylek, J. Rosand, S.M. Greenberg, A.S. Go, et al.
Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation.
Ann Intern Med, 141 (2004), pp. 745-752
[12.]
R.G. Hart, S.B. Tonarelli, L.A. Pearce.
Avoiding central nervous system bleeding during antithrombotic therapy: recent data and ideas.
[13.]
E.M. Hylek, C. Evans-Molina, C. Shea, L.E. Henault, S. Regan.
Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation.
Circulation, 115 (2007), pp. 2689-2696
[14.]
H. Arima, R.G. Hart, S. Colman, J. Chalmers, C. Anderson, A. Rodgers, et al.
Perindopril-based blood pressure-lowering reduces major vascular events in patients with atrial fibrillation and prior stroke or transient ischemic attack.
[15.]
S.D. Fihn, C.M. Callahan, D.C. Martin, M.B. McDonell, J.G. Henikoff, R.H. White.
The risk for and severity of bleeding complications in elderly patients treated with warfarin. The national consortium of anticoagulation clinics.
Ann Intern Med, 124 (1996), pp. 970-979
[16.]
J. Rosand, E.M. Hylek, H.C. O’Donnell, S.M. Greenberg.
Warfarin-associated hemorrhage and cerebral amyloid angiopathy: a genetic and pathologic study.
Neurology, 55 (2000), pp. 947-951
[17.]
E.E. Smith, J. Rosand, K.A. Knudsen, E.M. Hylek, S.M. Greenberg.
Leukoaraiosis is associated with warfarin-related hemorrhage following ischemic stroke.
Neurology, 59 (2002), pp. 193-197
[18.]
C. Heneghan, P. Alonso-Coello, J.M. García-Alamino, R. Perera, E. Meats, P. Glasziou.
Self-monitoring of oral anticoagulation: A systematic review and meta-analysis.
[19.]
B. Menéndez-Jándula, J.C. Souto, A. Oliver, I. Montserrat, M. Quintana, I. Gich, et al.
Comparing self-management of oral anticoagulant therapy with clinic management: a randomized trial.
Ann Intern Med, 142 (2005), pp. 1-10
[20.]
M. Sudlow, R. Thomson, B. Thwaites, H. Rodgers, R.A. Kenny.
Prevalence of atrial fibrillation and eligibility for anticoagulants in the community.
Lancet, 352 (1998), pp. 1167-1171
[21.]
A.L. Waldo, R.C. Becker, V.F. Tapson, K.J. Colgan.
Hospitalized patients with atrial fibrillation and a high risk of stroke are not being provided with adequate anticoagulation.
J Am Coll Cardiol, 46 (2005), pp. 1729-1736
[22.]
R. Nieuwlaat, A. Capucci, G.Y. Lip, S.B. Olsson, M.H. Prins, F.H. Nieman, et al.
Antithrombotic treatment in real-life atrial fibrillation patients: a report from the Euro Heart Survey on Atrial Fibrillation.
Eur Heart J, 27 (2006), pp. 3018-3026
Copyright © 2012. Sociedad Española de Neurología
Opciones de artículo
Herramientas
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos