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Evitar la electrocauterización: Agentes hemostáticos para el sangrado perioperatorio en la cirugía micrográfica de
George M Jeha1,2, Hannah R Malinosky1, Jacob Beer3
1Louisiana State University Health Sciences Center, New Orleans, Louisiana.
Resumen
Los agentes hemostáticos tópicos reducen efectivamente el sangrado durante la cirugía de Mohs, especialmente para los pacientes que toman anticoagulantes. Estos agentes son prometedores para mejorar la hemostasis perioperatoria y merecen más estudios.
Área de la Ciencia:
- Cirugía dermatológica
- La hemostasis quirúrgica
- Farmacología
Sus antecedentes:
- El sangrado es una complicación común en la cirugía micrográfica de Mohs.
- El aumento del uso de anticoagulantes y antiplaquetarios eleva el riesgo de hemorragia.
- Necesidad de estrategias eficaces de hemostasis perioperatoria en la cirugía de Mohs.
Objetivo del estudio:
- Revisar sistemáticamente la literatura sobre agentes hemostáticos tópicos y locales para la cirugía de Mohs.
- Evaluar la eficacia y la seguridad de los métodos hemostáticos complementarios.
- Identificar los agentes que reducen el sangrado durante y después de los procedimientos de Mohs.
Principales métodos:
- Búsqueda sistemática de la literatura (PubMed, Scopus, Cochrane, EMBASE) hasta el mes de marzo de 2024.
- Incluir estudios originales sobre agentes hemostáticos inyectados tópicamente o localmente.
- Análisis de 7 estudios en los que participaron 458 pacientes.
Principales resultados:
- Los agentes evaluados incluyeron ácido tranexámico, gel de brimonidina, polvos hemostáticos y materiales de polisacáridos microporosos.
- Los agentes fueron generalmente bien tolerados por los pacientes.
- Se observaron reducciones tanto en el sangrado intraoperatorio como en el postoperatorio.
Conclusiones:
- Los agentes hemostáticos administrados localmente son un complemento prometedor para el control de la hemorragia en la cirugía de Mohs.
- Estos agentes pueden ser particularmente beneficiosos para los pacientes con hemorragias de alto riesgo.
- Se recomiendan otros estudios controlados a gran escala.
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