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Tromboprofilaxis con warfarina en pacientes con cáncer con catéteres venosos centrales (WARP): un ensayo aleatorizado
Annie M Young1, Lucinda J Billingham, Gulnaz Begum
1Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK. a.young@bham.ac.uk
Lancet (London, England)
|February 17, 2009
Resumen
La warfarina no previene la trombosis relacionada con el catéter en pacientes con cáncer que reciben quimioterapia. La warfarina ajustada a la dosis mostró un beneficio sobre la dosis fija, pero en general, se deben considerar tratamientos más nuevos para la tromboprofilaxis.
Área de la Ciencia:
- Oncología Oncología.
- Hematología Hematología.
- Farmacología Farmacología.
Sus antecedentes:
- Existe controversia con respecto al uso de anticoagulantes para la tromboprofilaxis en pacientes con cáncer con catéteres venosos centrales (CVC).
- Es crucial evaluar la eficacia de la warfarina y la dosificación óptima para prevenir la trombosis relacionada con el catéter.
Objetivo del estudio:
- Evaluar si la warfarina reduce la trombosis relacionada con el catéter en comparación con la ausencia de warfarina en pacientes con cáncer sometidos a quimioterapia.
- Para determinar si la dosis de warfarina influye en su efecto tromboprofilactico.
Principales métodos:
- Un ensayo controlado aleatorizado que involucró a 1590 pacientes con cáncer con CVC en 68 centros del Reino Unido.
- A los pacientes se les asignó la ausencia de warfarina, la dosis fija de warfarina (1 mg/día) o la dosis ajustada de warfarina (INR 1,5-2,0).
- El resultado primario fue radiológicamente comprobado, trombosis sintomática relacionada con el catéter; se utilizó el análisis de intención de tratar.
Principales resultados:
- La warfarina (en cualquier dosis) no redujo significativamente las trombosis relacionadas con el catéter en comparación con la ausencia de warfarina (6% frente a 6%; p=0,98).
- La warfarina ajustada a la dosis fue superior a la warfarina de dosis fija en la prevención de las trombosis (3% frente a 7%; p=0,002).
- Los eventos hemorrágicos mayores fueron raros, con un ligero exceso observado con warfarina; no se observó ninguna diferencia significativa en los puntos finales combinados de trombosis y sangrado o beneficio de supervivencia.
Conclusiones:
- La warfarina profiláctica, en comparación con la ausencia de warfarina, no disminuye las trombosis sintomáticas relacionadas con el catéter en pacientes con cáncer.
- La warfarina ajustada a la dosis demuestra un beneficio potencial sobre la dosis fija, pero la eficacia general es limitada.
- Se recomienda considerar tratamientos anticoagulantes más nuevos para la tromboprofilaxis en esta población de pacientes.
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