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Manejo perioperatorio de Dabigatran: un estudio prospectivo de cohorte

Sam Schulman¹, Marc Carrier², Agnes Y Y Lee²

¹From Department of Medicine, McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada (S. Schulman, F.A.S., J.D.D.); Department of Hematology, Karolinska Institutet, Stockholm, Sweden (S. Schulman); Department of Medicine, Ottawa Hospital Research Institute at the University of Ottawa, ON, Canada (M.C.); Division of Hematology, University of British Columbia and Vancouver Coastal Health, Canada (A.Y.Y.L.); Faculty of Medicine, Dalhousie University, Halifax, NS, Canada (S. Shivakumar); Division of Hematology, Department of Medicine, Jewish General Hospital (M.B.) and Department of Medicine (S. Solymoss), McGill University, Montreal, QC, Canada; and McMaster Transfusion Research Program, McMaster University, Hamilton, ON, Canada (R.B., G.W., N.H.). schulms@mcmaster.ca.

|May 14, 2015

Resumen

Este estudio encontró que un protocolo específico para administrar dabigatrán perioperatorio es seguro y efectivo. El protocolo guió el tiempo de cesación y reanudación de dabigatran, minimizando los eventos de sangrado en pacientes sometidos a procedimientos invasivos.

Área de la Ciencia:

Cardiología Cardiología.
Farmacología Farmacología.
La medicina clínica es la medicina clínica.

Sus antecedentes:

El manejo perioperatorio de dabigatrán varía significativamente en la práctica clínica.
Existe la necesidad de protocolos estandarizados para garantizar la seguridad del paciente.

Objetivo del estudio:

Evaluar la seguridad y viabilidad de un protocolo específico para el manejo perioperatorio del dabigatrán.
Para evaluar los eventos hemorrágicos y las complicaciones tromboembólicas en pacientes tratados con el protocolo.

Principales métodos:

Un estudio prospectivo incluyó a 541 pacientes en dabigatrán sometidos a procedimientos invasivos.
El tiempo de interrupción de Dabigatran se basó en el aclaramiento de la creatinina y el riesgo de sangrado; la reanudación fue impulsada por el protocolo.
Los pacientes fueron monitoreados durante 30 días por sangrado mayor, sangrado menor, tromboembolismo y muerte.

Principales resultados:

El sangrado mayor se produjo en el 1,8% de los pacientes; el sangrado menor en el 5,2%.
Sólo se observó un evento tromboembólico (ataque isquémico transitorio) (0,2%).
Se produjeron cuatro muertes, sin relación con el sangrado o la trombosis.

Conclusiones:

El protocolo desarrollado para el manejo perioperatorio de dabigatrán es efectivo.
El protocolo es factible para la implementación clínica, demostrando buenos resultados de seguridad.

Palabras clave:

El dabigatran es el dabigatran.La hemorragia es una hemorragia.Adherencia a los medicamentos Adherencia a la medicación cirugía cirugía cirugía cirugía cirugía cirugía

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