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Aplicabilidad en el mundo real del Voyager-Pad según la puntuación de Oac3pad
Luís Fernandes1, Diogo Silveira1, João Peixoto1
1Angiology and Vascular Surgery Department, Vila Nova de Gaia/Espinho Hospital, Portugal.
Portuguese journal of cardiac thoracic and vascular surgery
|August 31, 2025
Resumen
La inhibición de la vía dual (IPD) con rivaroxabán y aspirina puede aumentar el riesgo de hemorragia en pacientes con enfermedad arterial periférica (EAP), especialmente en aquellos con isquemia crónica que amenaza a las extremidades (ITC). La evaluación cuidadosa del riesgo utilizando la puntuación OAC3PAD es crucial para optimizar el tratamiento antitrombótico.
Área de la Ciencia:
- Cirugía vascular
- Cardiología
- Farmacología
Sus antecedentes:
- La enfermedad arterial periférica (EAP) conlleva un alto riesgo de complicaciones cardiovasculares y de las extremidades.
- Las estrategias antitrombóticas influyen significativamente en los resultados a largo plazo después de la revascularización.
- El ensayo VOYAGER PAD demostró los beneficios de rivaroxaban más aspirina, pero persisten las preocupaciones de seguridad, especialmente en poblaciones reales como los pacientes con isquemia crónica que amenaza las extremidades.
Objetivo del estudio:
- Evaluar la elegibilidad para la inhibición de la vía dual (IPD) en pacientes con EAP sometidos a revascularización.
- Para evaluar la distribución del riesgo de hemorragia utilizando la puntuación OAC3PAD en esta cohorte de pacientes.
- Determinar la proporción de pacientes adecuados para el DPI basándose en los criterios del ensayo VOYAGER PAD.
Principales métodos:
- Estudio retrospectivo en un solo centro de 652 pacientes sometidos a revascularización de las extremidades inferiores (2020-2023).
- Pacientes clasificados por la puntuación OAC3PAD para estratificar el riesgo de hemorragia.
- Análisis de la elegibilidad para el DPI (rivaroxaban más aspirina) de acuerdo con los criterios de VOYAGER PAD.
Principales resultados:
- El 67,6% de los pacientes (441/ 652) eran candidatos potenciales para el tratamiento con dosis bajas de rivaroxaban.
- Distribución del riesgo de hemorragia: 12% alto, 23% medio alto, 46% bajo moderado, 19% bajo.
- La elegibilidad de DPI varió significativamente entre las categorías de riesgo de OAC3PAD (p< 0,001), siendo más alta en pacientes de bajo riesgo intermedio y más baja en pacientes de alto riesgo.
Conclusiones:
- Los pacientes con EAP en el mundo real, especialmente aquellos con ICL, pueden tener un mayor riesgo de hemorragia que el reconocido anteriormente.
- La inhibición de la vía dual (IPD) con rivaroxaban y aspirina requiere precaución en casi el 50% de los pacientes con ITLC debido al riesgo de hemorragia.
- Las herramientas de estratificación de riesgo como OAC3PAD son esenciales para equilibrar los beneficios y riesgos de la terapia antitrombótica en poblaciones frágiles de PAD.
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