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Riesgo de hemorragia con la combinación de antiplaquetarios y anticoagulantes para la prevención secundaria del
Salia Farrokh1,2, Krishna Nalleballe3, Sanjeeva Onteddu3
1Division of Neurosciences Critical Care, Department of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery Johns Hopkins University School of Medicine Baltimore MD USA.
Journal of the American Heart Association
|August 20, 2025
Resumen
La combinación de antiplaquetas con anticoagulantes en pacientes con accidente cerebrovascular aumenta el riesgo de hemorragia a largo plazo, en particular de hemorragia intracerebral después de 12 meses. El riesgo de hemorragia gastrointestinal es elevado a largo plazo con estas terapias combinadas.
Área de la Ciencia:
- Cardiología
- Neurología
- Farmacología
Sus antecedentes:
- Existen datos limitados sobre la seguridad de la combinación de terapias antiplaquetarias y anticoagulantes para la prevención secundaria del accidente cerebrovascular en el accidente cerebrovascular isquémico agudo (AIS).
- El riesgo de hemorragia asociado con estas combinaciones en pacientes con fibrilación auricular y infarto agudo de miocardio concomitantes no está bien establecido.
Objetivo del estudio:
- Para examinar el riesgo de hemorragia asociado con la combinación de terapia antiplaquetaria simple (SAPT) o doble (DAPT) con anticoagulantes.
- Para comparar este riesgo en pacientes con AIS, fibrilación auricular y infarto agudo de miocardio.
Principales métodos:
- Estudio retrospectivo de cohorte transversal utilizando datos de TriNetX de 76 hospitales estadounidenses.
- Análisis de propensión por puntuación que compara el anticoagulante solo, el anticoagulante más SAPT y las subcohortas de anticoagulante más DAPT.
- Evaluación del riesgo de hemorragia intracerebral espontánea aguda y sangrado gastrointestinal a los 3 meses, 12 meses y durante todo el seguimiento.
Principales resultados:
- Entre 144.434 pacientes, 8772 recibieron anticoagulantes solos, 88.430 recibieron anticoagulantes más SAPT y 47.232 recibieron anticoagulantes más DAPT.
- No hay aumento significativo en el riesgo de hemorragia intracerebral a los 3 y 12 meses con terapias combinadas en comparación con el anticoagulante solo.
- Aumento del riesgo de hemorragia intracerebral a largo plazo (OR 1,26 para SAPT, 1,34 para DAPT) y aumento del riesgo de hemorragia gastrointestinal en todos los momentos.
Conclusiones:
- La combinación de antiplaquetarios con anticoagulantes después de la AIS puede aumentar el riesgo de hemorragia intracerebral a largo plazo, especialmente después de 12 meses.
- Las terapias combinadas se asocian con un mayor riesgo de sangrado gastrointestinal agudo y a largo plazo.
- Se necesitan estudios prospectivos más amplios para confirmar estos hallazgos.
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