Publicado may 11, 2012



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Iván Mauricio Alvarado Arteaga

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Resumen

El manejo de la anticoagulación perioperatoria en pacientes tratados crónicamente con warfarina es un problema clínico frecuente y de difícil manejo. La suspensión de la anticoagulación durante un procedimiento podría poner en riesgo de eventos tromboembólicos y continuarla podría generar sangrado excesivo. La evidencia al respecto es limitada y las guías por consenso de expertos son inconsistentes. La ausencia de esquemas de manejo claros y el uso indiscriminado de reemplazo transitorio con heparina no fraccionada genera demoras, sobrecostos y días de hospitalización innecesarios. En el presente texto se discuten las posibles variables y riesgos a considerar en la toma de decisiones y se revisa la evidencia concerniente al uso de heparinas de bajo peso molecular para la sustitución transitoria y ambulatoria de la anticoagulación en el perioperatorio; además, se proponen una guía de recomendaciones y un algoritmo novedoso y sencillo, que facilite su implementación.

Keywords

periodo perioperatorio, anticoagulantes, warfarina, heparina de bajo-peso-molecular, Perioperative care, anticoagulants, warfarin, low-molecular-weight heparin,

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Cómo citar
Alvarado Arteaga, I. M. (2012). Manejo perioperatorio de la anticoagulación en pacientes tratados crónicamente con warfarina (con énfasis en la sustitución ambulatoria con heparinas de bajo peso molecular). Universitas Medica, 53(3), 272–292. https://doi.org/10.11144/Javeriana.umed53-3.mpap
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