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Hemorragia intracraneal relacionada con inhibidores del factor Xa: resultados de una cohorte multicéntrica de
Nicholas G Panos1, Aaron M Cook2, Sayona John3
1Department of Pharmacy (N.G.P.), Rush University Medical Center, Chicago, IL.
Circulation
|April 9, 2020
Resumen
Los concentrados de complejo de protrombina (PCC) controlaron eficazmente la hemorragia intracraneal (HIC) en pacientes que tomaban inhibidores del factor Xa, mostrando altas tasas de hemostasis y un bajo riesgo de trombosis. Se recomiendan ensayos aleatorizados adicionales para el ICH relacionado con los inhibidores del factor Xa.
Área de la Ciencia:
- Neurología
- Hematología
- Farmacología
Sus antecedentes:
- Los inhibidores orales del factor Xa se usan ampliamente, lo que plantea preocupaciones sobre el manejo de la hemorragia intracraneal asociada (ICH).
- Las directrices actuales recomiendan los concentrados de complejo de protrombina (PCC) para el ICH relacionado con los inhibidores del factor Xa, pero la evidencia se basa en datos limitados de pacientes.
- Este estudio aborda la necesidad de datos de cohorte más amplios sobre los PCC en la ICH relacionada con los inhibidores del factor Xa.
Objetivo del estudio:
- Evaluar la seguridad y eficacia de los concentrados de complejo de protrombina (PCC) en pacientes con hemorragia intracraneal relacionada con inhibidores del factor Xa (ICH).
- Evaluar la eficacia hemostática y la aparición de eventos trombóticos después de la administración de PCC en esta población de pacientes.
Principales métodos:
- Un estudio de cohorte multicéntrico, retrospectivo y observacional incluyó pacientes con ICH relacionada con apixaban o rivaroxaban tratados con PCC.
- El análisis de seguridad se centró en los eventos trombóticos, mientras que la eficacia hemostática se evaluó utilizando criterios de Sarode modificados basados en imágenes de seguimiento.
- La mortalidad hospitalaria, la duración de la estancia y las reacciones a la perfusión fueron resultados secundarios.
Principales resultados:
- Se logró una hemostasis excelente o buena en el 81,8% de los 433 pacientes evaluados para la eficacia.
- Un total de 26 eventos trombóticos ocurrieron en el 3,8% de los pacientes, con la mayoría de los eventos ocurriendo dentro de los 14 días de la administración de PCC.
- La mortalidad hospitalaria fue del 19,0%, con estadías medianas en UCI y hospitalización de 2,0 y 6,0 días, respectivamente.
Conclusiones:
- Los concentrados de complejo de protrombina (PCC) muestran una alta eficacia hemostática (81,8%) y una baja tasa de trombosis (3,8%) en pacientes con ICH relacionada con inhibidores del factor Xa.
- Los hallazgos apoyan el uso de PCC en este entorno clínico, pero subrayan la necesidad de realizar más investigaciones.
- Los ensayos controlados aleatorizados son esenciales para establecer definitivamente la eficacia clínica de los PCC para el ICH relacionado con los inhibidores del factor Xa.
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