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Tromboembolismo venoso: avances en el diagnóstico y el tratamiento
Tobias Tritschler1, Noémie Kraaijpoel2, Grégoire Le Gal3,4
1Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
JAMA
|October 17, 2018
Resumen
Los avances en el diagnóstico y tratamiento del tromboembolismo venoso (TEV) simplifican la atención. Las nuevas estrategias permiten un tratamiento personalizado para la trombosis venosa profunda (TVP) y la embolia pulmonar (EP) con una seguridad y resultados mejorados.
Área de la Ciencia:
- Medicina cardiovascular
- Hematología
- Diagnóstico médico
Sus antecedentes:
- El tromboembolismo venoso (TEV), que abarca la trombosis venosa profunda (TVP) y la embolia pulmonar (EP), representa una carga significativa para la salud mundial.
- La gestión eficaz de la TEV es crucial debido a su potencial de morbilidad y mortalidad.
Objetivo del estudio:
- Proporcionar un resumen exhaustivo de los avances recientes en el diagnóstico y tratamiento de la TEV en los últimos cinco años.
- Resaltar los cambios clave en la práctica clínica y los enfoques terapéuticos para el tratamiento de la TEV.
Principales métodos:
- Se realizó una búsqueda sistemática de la literatura en las principales bases de datos biomédicas (EMBASE, MEDLINE) para los estudios publicados entre enero de 2013 y julio de 2018.
- Se incluyeron revisiones sistemáticas, metanálisis, ensayos controlados aleatorizados y estudios de cohorte prospectivos, complementados por la evaluación de las directrices clínicas.
Principales resultados:
- Los umbrales de D-dimero ajustados por edad y los criterios de exclusión de la embolia pulmonar mejoran la precisión del diagnóstico de la EP, reduciendo la necesidad de imágenes.
- Los anticoagulantes orales directos (DOAC) ofrecen un tratamiento simplificado de la TEV con un menor riesgo de hemorragia, facilitando la prevención secundaria prolongada.
- La trombólisis está reservada para la EP masiva o la TVP que amenaza a las extremidades; los filtros de vena cava inferior están indicados solo cuando la anticoagulación está contraindicada. Las medias de compresión graduada no se recomiendan para el tratamiento de la TVP, pero pueden aliviar los síntomas.
Conclusiones:
- Se han logrado avances significativos en el tratamiento de la TEV, lo que permite estrategias diagnósticas y terapéuticas adaptadas.
- Los enfoques actuales permiten la atención individualizada del paciente, teniendo en cuenta las características personales, las preferencias y los valores en el manejo de la TEV.
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