tromboprofilaxis en pacientes médicos

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Tromboprofilaxis

Tromboprofilaxis en pacientes no-quirrgicosNicols OrdazInternado Docente Medicina InternaHospital Base de Curic Universidad de Talca

Magnitud del problema

Twenty-six percent of patients with undiagnosed and untreated PE will have a subsequent fatal embolic event, whereas another 26% will have a nonfatal recurrent embolic event2

Magnitud del problema

3

FisiopatologaTriada de Virchow

4

Factores de riesgo en pacientes hospitalizados

Recomendaciones

8

Riesgo de enfermedad tromboemblica

(hazard ratio [HR], 32.0; 95% CI, 4.1-251.09

Escala de prediccin de PaduaJ Thromb Haemost. 2010; 8 (11): 2450-2457

Escala de prediccin de Padua

MEDICINA (Buenos Aires) 2013; 73 (Supl. II): 1-26

Riesgo de hemorragiaCHEST. 2011; 139 (1): 69-79

Factores de riesgo independientes de hemorragia segn estudio IMPROVEFactor de riesgoOR (IC 95%)Ulcera gastroduodenal activa4,15 (2,21-7,77)Hemorragia 3 meses previo a ingreso3,64 (2,21-5,99)Recuento de plaquetas 85 aos2,96 (1,43-6,15)Insuficiencia heptica (INR >1,5)2,18 (1,10-4,33)Insuficiencia renal severa (TFG 85% after s.c. injection; in contrast, s.c. administered UFH has low bioavailability of only 1540% with wide interindividual variability [15]. Furthermore, LMWH have a linear elimination pharmacokinetics [15] which renders their pharmacodynamic effect highly predictable and therefore safe in most situations, without the need for coagulation tests to monitor efficacy or safety19

Heparina no-fraccionada

Fondaparinux

21

N Engl J Med 2007;356:1438-44.

Medias de compresin graduada

Compresin neumtica intermitente

Esquema tromboprofilaxis HBC

Esquema tromboprofilaxis HBC

Esquema tromboprofilaxis HBC

Objective: Despite extensive use of oral anticoagulation (OAC) in patients with atrial fi brillation (AF) and the increased bleeding risk associated with such OAC use, no handy quantifi cation tool for assessing this risk exists. We aimed to develop a practical risk score to estimate the 1-year risk for major bleeding (intracranial, hospitalization, hemoglobin decrease . 2 g/L, and/or transfusion) in a cohort of real-world patients with AF. Methods: Based on 3,978 patients in the Euro Heart Survey on AF with complete follow-up, all univariate bleeding risk factors in this cohort were used in a multivariate analysis along with historical bleeding risk factors. A new bleeding risk score termed HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly ( . 65 years), Drugs/alcohol concomitantly) was calculated, incorporating risk factors from the derivation cohort. Results: Fifty-three (1.5%) major bleeds occurred during 1-year follow-up. The annual bleeding rate increased with increasing risk factors. The predictive accuracy in the overall population using signifi cant risk factors in the derivation cohort (C statistic 0.72) was consistent when applied in several subgroups. Application of the new bleeding risk score (HAS-BLED) gave similar C statistics except where patients were receiving antiplatelet agents alone or no antithrombotic therapy, with C statistics of 0.91 and 0.85, respectively. Conclusion: This simple, novel bleeding risk score (HAS-BLED) provides a practical tool to assess the individual bleeding risk of real-world patients with AF, potentially supporting clinical decision making regarding antithrombotic therapy in patients with AF28

Algoritmo guas brasileas para tromboprofilaxis

Clinics. 2013;68(11):1416-1420

Conclusiones

Bibliografa principalKahn SR et al. Prevention of VTE in Nonsurgical Patients. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST 2012; 141(2)(Suppl):e195Se226SQaseem A et al. Venous Thromboembolism Prophylaxis in Hospitalized Patients: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2011;155:625-632.Francis CW. Prophylaxis for Thromboembolism in Hospitalized Medical Patients. N Engl J Med 2007;356:1438-44.

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