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Resultados de la terapia antitrombótica en pacientes sometidos a cirugía gastrointestinal: un metanálisis
Faryal Tariq1, Hasnain Ali2, Abdul Moeed Baig3
1General Medicine, East Kent Hospitals University NHS Foundation Trust, Margate, GBR.
Cureus
|August 25, 2025
Resumen
La terapia antitrombótica perioperatoria en cirugía gastrointestinal mostró una tendencia hacia un aumento de la hemorragia y una necesidad de transfusión significativamente mayor. El manejo cuidadoso es crucial, pero se necesitan más ensayos para obtener directrices claras.
Área de la Ciencia:
- Gastroenterología y Cirugía
- Cardiología y trombosis
- Resultados clínicos de la investigación
Sus antecedentes:
- La terapia antitrombótica es vital para la enfermedad tromboembólica, pero complica la cirugía gastrointestinal (GI) debido a los riesgos de hemorragia y trombosis.
- La administración de agentes antitrombóticos durante el período perioperatorio de la cirugía gastrointestinal requiere equilibrar los riesgos de sangrado y coagulación.
Objetivo del estudio:
- Evaluar los resultados clínicos de la terapia antitrombótica perioperatoria en pacientes sometidos a cirugía gastrointestinal.
- Evaluar los riesgos de hemorragia postoperatoria, eventos tromboembólicos y las necesidades de transfusión.
Principales métodos:
- Búsqueda sistemática de la literatura en las principales bases de datos (PubMed, CENTRAL, Scopus, etc.) el cumplimiento de las directrices PRISMA.
- Metaanálisis de 9 estudios en los que participaron 13.107 pacientes utilizando un modelo de efectos aleatorios de DerSimonian y Laird.
- Resultados primarios: sangrado postoperatorio, eventos tromboembólicos y necesidad de transfusión de sangre.
Principales resultados:
- Una tendencia no significativa hacia el aumento del sangrado postoperatorio (OR: 1,64, p=0,061).
- No hay diferencias significativas en los eventos tromboembólicos (OR: 0,91, p=0,82) con baja heterogeneidad.
- Necesidades de transfusión significativamente más altas en el grupo antitrombótico (OR: 2,87, p=0,019).
Conclusiones:
- La terapia antitrombótica perioperatoria en cirugía gastrointestinal está asociada con un aumento de las necesidades de transfusión.
- La monoterapia con aspirina puede ser segura en casos electivos, pero el tratamiento antiplaquetario dual y los DOAC aumentan los riesgos de sangrado.
- La evaluación de riesgos individualizada y la planificación cuidadosa son fundamentales; se necesitan más ECA para las directrices definitivas.
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