Ácido tranexámico y su aplicación en cirugía oral. Revisión sistemática
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jun 25, 2023
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Resumen
Antecedentes: El ácido tranexámico (ATX) es un análogo sintético de la lisina que inhibe la fibrinólisis al reducir la conversión de plasminógeno en plasmina, lo que favorece la preservación del coágulo formado en el área operada y reduce el riesgo de sangrado. Eventualmente se utiliza como complemento en cirugía oral. Objetivo: Analizar la evidencia sobre la efectividad en hemostasia, dosis adecuada, margen de seguridad, beneficios y evolución postoperatoria de los ATX utilizados en cirugía bucal. Métodos: La revisión sistemática se estructuró a partir de un árbol de búsqueda (PubMed, Google Académico, ProQuest y Scopus), con las palabras clave y conector booleano: Ácido Tranexámico Y Cirugía Oral. La búsqueda se limitó a los idiomas inglés, portugués y español; artículos de acceso abierto; revisiones sistemáticas, metanálisis, ensayos clínicos aleatorizados e informes de casos. Se estableció una selección secundaria a partir del título y resumen de los artículos según el propósito del estudio. Hallazgos: La literatura reporta una eficacia del 80 % del ATX para reducir el riesgo de sangrado durante y después de los procedimientos quirúrgicos, lo que optimiza los procedimientos. Conclusiones: El ATX tópico o intravenoso en dosis no superiores a 20 mg ha mostrado ser eficaz para reducir el riesgo de sangrado en cirugía oral.
Keywords
ácido tranexámico, antifibrinolítico, cirugía oral, complicaciones, discrasias sanguíneas, hemorragia, odontología, procedimientos quirúrgicos orales, terapéutica, terapia de drogasantifibrinolytic, blood dyscrasias, complications, dentistry, drug therapy, hemorrhage, oral surgery, oral surgical procedures, therapeutics, tranexamic acidácido tranexâmico, antifibrinolítico, cirurgia oral, complicações, discrasias sanguíneas, hemorragia, odontologia, procedimentos cirúrgicos bucais, terapêutica, terapia de drogas
References
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3. Wang F, Zhao KC, Zhao MM, Zhao DX. The efficacy of oral versus intravenous tranexamic acid in reducing blood loss after primary total knee and hip arthroplasty: A meta-analysis. Medicine (Baltimore). 2018 Sep; 97(36): e12270. https://doi.org/10.1097/MD.0000000000012270
4. Franco R, Miranda M, Di Renzo L, De Lorenzo A, Barlattani A, Bollero P. Glanzmann's thrombastenia: The Role of tranexamic acid in oral surgery. Case Rep Dent. 2018 Sep 5; 2018: 9370212. https://doi.org/10.1155/2018/9370212
5. Engelen ET, Schutgens RE, Mauser-Bunschoten EP, van Es RJ, van Galen KP. Antifibrinolytic therapy for preventing oral bleeding in people on anticoagulants undergoing minor oral surgery or dental extractions. Cochrane Database Syst Rev. 2018 Jul 2; 7(7): CD012293. https://doi.org/10.1002/14651858.CD012293
6. Johansson K, Götrick B, Holst J, Tranæus S, Naimi-Akbar A. Impact of direct oral anticoagulants on bleeding tendency and postoperative complications in oral surgery: a systematic review of controlled studies. Oral Surg Oral Med Oral Pathol Oral Radiol. 2022 Mar; 135(3): 333-346. https://doi.org/10.1016/j.oooo.2022.07.003
7. Van Galen KP, Engelen ET, Mauser-Bunschoten EP, van Es RJ, Schutgens RE. Antifibrinolytic therapy for preventing oral bleeding in patients with haemophilia or Von Willebrand disease undergoing minor oral surgery or dental extractions. Cochrane Database Syst Rev. 2019 Apr 19; 4(4): CD011385. https://doi.org/10.1002/14651858.CD011385.pub3
8. Sharma S, Chak RK, Khanna R. Management of haemostasis during dental extraction in a Bernard-Soulier syndrome child. BMJ Case Rep. 2019 Jul 8; 12(7): e229082. https://doi.org/10.1136/bcr-2018-229082
9. Ullah K, Mukhtar H, Khalid U, Sarfraz Z, Sarfraz A. Is antifibrinolytic therapy effective for preventing hemorrhage in patients with hemophilia undergoing dental extractions? A systematic review and meta-analysis. Clin Appl Thromb Hemost. 2022 Jan-Dec; 28: 10760296221114862. https://doi.org/10.1177/10760296221114862
10. Kurasawa Y, Sato H, Katada R, Inada T, Shirota T, Shimane T. Delayed epistaxis which was developed after orthognathic surgery with Le Fort I osteotomy and managed by endoscopic cauterization. Case Rep Dent. 2022 Feb 22; 2022: 3057472. https://doi.org/10.1155/2022/3057472
11. Dunphy L, Williams R. Immune thrombocytopenic purpura presenting with spontaneous gingival haemorrhage in pregnancy. BMJ Case Rep. 2019 Jan 17; 12(1): e228309. https://doi.org/10.1136/bcr-2018-228309
12. Zhao H, Liu S, Wu Z, Zhao H, Ma C. Comprehensive assessment of tranexamic acid during orthognathic surgery: A systematic review and meta-analysis of randomized, controlled trials. J Craniomaxillofac Surg. 2019 Apr; 47(4): 592-601. https://doi.org/10.1016/j.jcms.2019.01.021
13. Mei A, Qiu L. The efficacy of tranexamic acid for orthognathic surgery: a meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg. 2019 Oct; 48(10): 1323-1328. https://doi.org/10.1016/j.ijom.2018.07.027
14. de Vasconcellos SJ, Santos T, Reinheimer DM, Faria-e-Silva AL, de Melo MF, Martins-Filho PR. Topical application of tranexamic acid in anticoagulated patients undergoing minor oral surgery: A systematic review and meta-analysis of randomized clinical trials. J Craniomaxillofac Surg. 2017 Jan; 45(1): 20-26. https://doi.org/10.1016/j.jcms.2016.10.001
15. Montroy J, Hutton B, Moodley P, Fergusson NA, Cheng W, Tinmouth A, Lavallée LT, Fergusson DA, Breau RH. The efficacy and safety of topical tranexamic acid: A systematic review and meta-analysis. Transfus Med Rev. 2018 Feb 19: S0887-7963(17): 30151-7. https://doi.org/10.1016/j.tmrv.2018.02.003
16. Owattanapanich D, Ungprasert P, Owattanapanich W. Efficacy of local tranexamic acid treatment for prevention of bleeding after dental procedures: A systematic review and meta-analysis. J Dent Sci. 2019 Mar; 14(1): 21-26. https://doi.org/10.1016/j.jds.2018.10.001
17. Bensi C, Belli S, Paradiso D, Lomurno G. Postoperative bleeding risk of direct oral anticoagulants after oral surgery procedures: a systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2018 Jul; 47(7): 923-932. https://doi.org/10.1016/j.ijom.2018.03.016
18. Yates J, Perelman I, Khair S, Taylor J, Lampron J, Tinmouth A, Saidenberg E. Exclusion criteria and adverse events in perioperative trials of tranexamic acid: a systematic review and meta-analysis. Transfusion. 2019 Feb; 59(2): 806-824. https://doi.org/10.1111/trf.15030
19. Bajkin BV, Wahl MJ, Miller CS. Dental implant surgery and risk of bleeding in patients on antithrombotic medications: A review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol. 2020 Nov; 130(5): 522-532. https://doi.org/10.1016/j.oooo.2020.07.012
20. Murdaca G, Greco M, Vassallo C, Gangemi S. Tranexamic acid adverse reactions: a brief summary for internists and emergency doctors. Clin Mol Allergy. 2020 Sep 3; 18: 16. https://doi.org/10.1186/s12948-020-00131-8
21. Stelea CG, Dîmbu E, Sorin A, Oana E, Stelea AL, Bologa C. Assessing the bleeding risk in patients using direct oral anticoagulants submitted to dental surgery procedures. A systematic review. Rom J Oral Rehabil. 2020; 10(3).
22. Franchini M, Mannucci PM. The never-ending success story of tranexamic acid in acquired bleeding. Haematologica. 2020 May; 105(5): 1201-1205. https://doi.org/10.3324/haematol.2020.250720
23. Cervino G, Fiorillo L, Monte IP, De Stefano R, Laino L, Crimi S, Bianchi A, Herford AS, Biondi A, Cicciù M. Advances in antiplatelet therapy for dentofacial surgery patients: focus on past and present strategies. Materials (Basel). 2019 May 9; 12(9): 1524. https://doi.org/10.3390/ma1209152
24. Karasneh J, Christoforou J, Walker JS, Dios PD, Lockhart PB, Patton LL. World Workshop on Oral Medicine VII: Bleeding control interventions for invasive dental procedures in patients with inherited functional platelet disorders: A systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2022 Apr; 133(4): 412-431. https://doi.org/10.1016/j.oooo.2021.08.003
25. Picetti R, Shakur-Still H, Medcalf RL, Standing JF, Roberts I. What concentration of tranexamic acid is needed to inhibit fibrinolysis? A systematic review of pharmacodynamics studies. Blood Coagul Fibrinolysis. 2019 Jan; 30(1): 1-10. https://doi.org/10.1097/MBC.0000000000000789
26. Barrett CD, Kong YW, Yaffe MB. Influence of tranexamic acid on inflammatory signaling in trauma. Semin Thromb Hemost. 2020 Mar; 46(2): 183-188. https://doi.org/10.1055/s-0040-1702169
27. Chen LF, Wang TC, Lin TY, Pao PJ, Chu KC, Yang CH, Chang JH, Hsu CW, Bai CH, Hsu YP. Does tranexamic acid reduce the risk of mortality on patients with hemoptysis? A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2021 May 21; 100(20): e25898. https://doi.org/10.1097/MD.0000000000025898
28. Pirlog CD, Pirlog AM, Maghiar T. A systematic review of the hemorrhage risk for patients on antithrombotic medication after dental procedures. World J Dent 2018; 9(1): 59-67. https://doi.org/10.5005/jp-journals-10015-1508
29. Monteilh C, Rabon L, Mayer-Hirshfeld I, McGreevy J. Nebulized tranexamic acid for pediatric post-tonsillectomy hemorrhage: a report of two cases. Clin Pract Cases Emerg Med. 2021 May; 5(2): 148-151. https://doi.org/10.5811/cpcem.2021.2.50799
30. Dermendjieva M, Gopalsami A, Glennon N, Torbati S. Nebulized tranexamic acid in secondary post-tonsillectomy hemorrhage: case series and review of the literature. Clin Pract Cases Emerg Med. 2021 Aug; 5(3): 1-7. https://doi.org/10.5811/cpcem.2021.5.52549
31. Boccio E, Hultz K, Wong AH. Topical tranexamic acid for hemostasis of an oral bleed in a patient on a direct oral anticoagulant. Clin Pract Cases Emerg Med. 2020 Mar 27; 4(2): 146-149. https://doi.org/10.5811/cpcem.2020.1.45326
32. Poppe M, Grimaldo F. A case report of nebulized tranexamic acid for post-tonsillectomy hemorrhage in an adult. Clin Pract Cases Emerg Med. 2020 Aug; 4(3): 443-445. https://doi.org/10.5811/cpcem.2020.6.47676
33. Shadamarshan R A, Sharma R, Pradhan I, Kumar P. Post-dental extraction bleeding: Emphasis on the diagnosis of rare coagulation disorders. Clin Case Rep. 2021 Aug 30; 9(9): e04746. https://doi.org/10.1002/ccr3.4746
34. Ehrhard S, Burkhard JP, Exadaktylos AK, Sauter TC. Severe enoral bleeding with a direct oral anticoagulant after tooth extraction and heparin bridging treatment. Case Rep Emerg Med. 2019 Oct 29; 2019: 6208604. https://doi.org/10.1155/2019/6208604
35. O'Connor MK, Emanuelli E, Garg RK. Le Fort I maxillary osteotomy in a Jehovah's Witness patient: strategies for minimizing blood loss and maximizing safety. Maxillofac Plast Reconstr Surg. 2022 Mar 2; 44(1): 10. https://doi.org/10.1186/s40902-022-00338-6
36. Gkiatas I, Kontokostopoulos AP, Tsirigkakis SE, Kostas-Agnantis I, Gelalis I, Korompilias A, Pakos E. Topical use of tranexamic acid: Are there concerns for cytotoxicity? World J Orthop. 2022 Jun 18; 13(6): 555-563. https://doi.org/10.5312/wjo.v13.i6.555
37. Modir H, Moshiri E, Naseri N, Faraji F, Almasi-Hashiani A. A randomized parallel design trial of the efficacy and safety of tranexamic acid, dexmedetomidine and nitroglycerin in controlling intraoperative bleeding and improving surgical field quality during septorhinoplasty under general anesthesia. Med Gas Res. 2021 Oct-Dec; 11(4): 131-137. https://doi.org/10.4103/2045-9912.318857
2. Ambrogio RI, Levine MH. Tranexamic acid as a hemostatic adjunct in dentistry. Compend Contin Educ Dent. 2018 Jun; 39(6): 392-401.
3. Wang F, Zhao KC, Zhao MM, Zhao DX. The efficacy of oral versus intravenous tranexamic acid in reducing blood loss after primary total knee and hip arthroplasty: A meta-analysis. Medicine (Baltimore). 2018 Sep; 97(36): e12270. https://doi.org/10.1097/MD.0000000000012270
4. Franco R, Miranda M, Di Renzo L, De Lorenzo A, Barlattani A, Bollero P. Glanzmann's thrombastenia: The Role of tranexamic acid in oral surgery. Case Rep Dent. 2018 Sep 5; 2018: 9370212. https://doi.org/10.1155/2018/9370212
5. Engelen ET, Schutgens RE, Mauser-Bunschoten EP, van Es RJ, van Galen KP. Antifibrinolytic therapy for preventing oral bleeding in people on anticoagulants undergoing minor oral surgery or dental extractions. Cochrane Database Syst Rev. 2018 Jul 2; 7(7): CD012293. https://doi.org/10.1002/14651858.CD012293
6. Johansson K, Götrick B, Holst J, Tranæus S, Naimi-Akbar A. Impact of direct oral anticoagulants on bleeding tendency and postoperative complications in oral surgery: a systematic review of controlled studies. Oral Surg Oral Med Oral Pathol Oral Radiol. 2022 Mar; 135(3): 333-346. https://doi.org/10.1016/j.oooo.2022.07.003
7. Van Galen KP, Engelen ET, Mauser-Bunschoten EP, van Es RJ, Schutgens RE. Antifibrinolytic therapy for preventing oral bleeding in patients with haemophilia or Von Willebrand disease undergoing minor oral surgery or dental extractions. Cochrane Database Syst Rev. 2019 Apr 19; 4(4): CD011385. https://doi.org/10.1002/14651858.CD011385.pub3
8. Sharma S, Chak RK, Khanna R. Management of haemostasis during dental extraction in a Bernard-Soulier syndrome child. BMJ Case Rep. 2019 Jul 8; 12(7): e229082. https://doi.org/10.1136/bcr-2018-229082
9. Ullah K, Mukhtar H, Khalid U, Sarfraz Z, Sarfraz A. Is antifibrinolytic therapy effective for preventing hemorrhage in patients with hemophilia undergoing dental extractions? A systematic review and meta-analysis. Clin Appl Thromb Hemost. 2022 Jan-Dec; 28: 10760296221114862. https://doi.org/10.1177/10760296221114862
10. Kurasawa Y, Sato H, Katada R, Inada T, Shirota T, Shimane T. Delayed epistaxis which was developed after orthognathic surgery with Le Fort I osteotomy and managed by endoscopic cauterization. Case Rep Dent. 2022 Feb 22; 2022: 3057472. https://doi.org/10.1155/2022/3057472
11. Dunphy L, Williams R. Immune thrombocytopenic purpura presenting with spontaneous gingival haemorrhage in pregnancy. BMJ Case Rep. 2019 Jan 17; 12(1): e228309. https://doi.org/10.1136/bcr-2018-228309
12. Zhao H, Liu S, Wu Z, Zhao H, Ma C. Comprehensive assessment of tranexamic acid during orthognathic surgery: A systematic review and meta-analysis of randomized, controlled trials. J Craniomaxillofac Surg. 2019 Apr; 47(4): 592-601. https://doi.org/10.1016/j.jcms.2019.01.021
13. Mei A, Qiu L. The efficacy of tranexamic acid for orthognathic surgery: a meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg. 2019 Oct; 48(10): 1323-1328. https://doi.org/10.1016/j.ijom.2018.07.027
14. de Vasconcellos SJ, Santos T, Reinheimer DM, Faria-e-Silva AL, de Melo MF, Martins-Filho PR. Topical application of tranexamic acid in anticoagulated patients undergoing minor oral surgery: A systematic review and meta-analysis of randomized clinical trials. J Craniomaxillofac Surg. 2017 Jan; 45(1): 20-26. https://doi.org/10.1016/j.jcms.2016.10.001
15. Montroy J, Hutton B, Moodley P, Fergusson NA, Cheng W, Tinmouth A, Lavallée LT, Fergusson DA, Breau RH. The efficacy and safety of topical tranexamic acid: A systematic review and meta-analysis. Transfus Med Rev. 2018 Feb 19: S0887-7963(17): 30151-7. https://doi.org/10.1016/j.tmrv.2018.02.003
16. Owattanapanich D, Ungprasert P, Owattanapanich W. Efficacy of local tranexamic acid treatment for prevention of bleeding after dental procedures: A systematic review and meta-analysis. J Dent Sci. 2019 Mar; 14(1): 21-26. https://doi.org/10.1016/j.jds.2018.10.001
17. Bensi C, Belli S, Paradiso D, Lomurno G. Postoperative bleeding risk of direct oral anticoagulants after oral surgery procedures: a systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2018 Jul; 47(7): 923-932. https://doi.org/10.1016/j.ijom.2018.03.016
18. Yates J, Perelman I, Khair S, Taylor J, Lampron J, Tinmouth A, Saidenberg E. Exclusion criteria and adverse events in perioperative trials of tranexamic acid: a systematic review and meta-analysis. Transfusion. 2019 Feb; 59(2): 806-824. https://doi.org/10.1111/trf.15030
19. Bajkin BV, Wahl MJ, Miller CS. Dental implant surgery and risk of bleeding in patients on antithrombotic medications: A review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol. 2020 Nov; 130(5): 522-532. https://doi.org/10.1016/j.oooo.2020.07.012
20. Murdaca G, Greco M, Vassallo C, Gangemi S. Tranexamic acid adverse reactions: a brief summary for internists and emergency doctors. Clin Mol Allergy. 2020 Sep 3; 18: 16. https://doi.org/10.1186/s12948-020-00131-8
21. Stelea CG, Dîmbu E, Sorin A, Oana E, Stelea AL, Bologa C. Assessing the bleeding risk in patients using direct oral anticoagulants submitted to dental surgery procedures. A systematic review. Rom J Oral Rehabil. 2020; 10(3).
22. Franchini M, Mannucci PM. The never-ending success story of tranexamic acid in acquired bleeding. Haematologica. 2020 May; 105(5): 1201-1205. https://doi.org/10.3324/haematol.2020.250720
23. Cervino G, Fiorillo L, Monte IP, De Stefano R, Laino L, Crimi S, Bianchi A, Herford AS, Biondi A, Cicciù M. Advances in antiplatelet therapy for dentofacial surgery patients: focus on past and present strategies. Materials (Basel). 2019 May 9; 12(9): 1524. https://doi.org/10.3390/ma1209152
24. Karasneh J, Christoforou J, Walker JS, Dios PD, Lockhart PB, Patton LL. World Workshop on Oral Medicine VII: Bleeding control interventions for invasive dental procedures in patients with inherited functional platelet disorders: A systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2022 Apr; 133(4): 412-431. https://doi.org/10.1016/j.oooo.2021.08.003
25. Picetti R, Shakur-Still H, Medcalf RL, Standing JF, Roberts I. What concentration of tranexamic acid is needed to inhibit fibrinolysis? A systematic review of pharmacodynamics studies. Blood Coagul Fibrinolysis. 2019 Jan; 30(1): 1-10. https://doi.org/10.1097/MBC.0000000000000789
26. Barrett CD, Kong YW, Yaffe MB. Influence of tranexamic acid on inflammatory signaling in trauma. Semin Thromb Hemost. 2020 Mar; 46(2): 183-188. https://doi.org/10.1055/s-0040-1702169
27. Chen LF, Wang TC, Lin TY, Pao PJ, Chu KC, Yang CH, Chang JH, Hsu CW, Bai CH, Hsu YP. Does tranexamic acid reduce the risk of mortality on patients with hemoptysis? A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2021 May 21; 100(20): e25898. https://doi.org/10.1097/MD.0000000000025898
28. Pirlog CD, Pirlog AM, Maghiar T. A systematic review of the hemorrhage risk for patients on antithrombotic medication after dental procedures. World J Dent 2018; 9(1): 59-67. https://doi.org/10.5005/jp-journals-10015-1508
29. Monteilh C, Rabon L, Mayer-Hirshfeld I, McGreevy J. Nebulized tranexamic acid for pediatric post-tonsillectomy hemorrhage: a report of two cases. Clin Pract Cases Emerg Med. 2021 May; 5(2): 148-151. https://doi.org/10.5811/cpcem.2021.2.50799
30. Dermendjieva M, Gopalsami A, Glennon N, Torbati S. Nebulized tranexamic acid in secondary post-tonsillectomy hemorrhage: case series and review of the literature. Clin Pract Cases Emerg Med. 2021 Aug; 5(3): 1-7. https://doi.org/10.5811/cpcem.2021.5.52549
31. Boccio E, Hultz K, Wong AH. Topical tranexamic acid for hemostasis of an oral bleed in a patient on a direct oral anticoagulant. Clin Pract Cases Emerg Med. 2020 Mar 27; 4(2): 146-149. https://doi.org/10.5811/cpcem.2020.1.45326
32. Poppe M, Grimaldo F. A case report of nebulized tranexamic acid for post-tonsillectomy hemorrhage in an adult. Clin Pract Cases Emerg Med. 2020 Aug; 4(3): 443-445. https://doi.org/10.5811/cpcem.2020.6.47676
33. Shadamarshan R A, Sharma R, Pradhan I, Kumar P. Post-dental extraction bleeding: Emphasis on the diagnosis of rare coagulation disorders. Clin Case Rep. 2021 Aug 30; 9(9): e04746. https://doi.org/10.1002/ccr3.4746
34. Ehrhard S, Burkhard JP, Exadaktylos AK, Sauter TC. Severe enoral bleeding with a direct oral anticoagulant after tooth extraction and heparin bridging treatment. Case Rep Emerg Med. 2019 Oct 29; 2019: 6208604. https://doi.org/10.1155/2019/6208604
35. O'Connor MK, Emanuelli E, Garg RK. Le Fort I maxillary osteotomy in a Jehovah's Witness patient: strategies for minimizing blood loss and maximizing safety. Maxillofac Plast Reconstr Surg. 2022 Mar 2; 44(1): 10. https://doi.org/10.1186/s40902-022-00338-6
36. Gkiatas I, Kontokostopoulos AP, Tsirigkakis SE, Kostas-Agnantis I, Gelalis I, Korompilias A, Pakos E. Topical use of tranexamic acid: Are there concerns for cytotoxicity? World J Orthop. 2022 Jun 18; 13(6): 555-563. https://doi.org/10.5312/wjo.v13.i6.555
37. Modir H, Moshiri E, Naseri N, Faraji F, Almasi-Hashiani A. A randomized parallel design trial of the efficacy and safety of tranexamic acid, dexmedetomidine and nitroglycerin in controlling intraoperative bleeding and improving surgical field quality during septorhinoplasty under general anesthesia. Med Gas Res. 2021 Oct-Dec; 11(4): 131-137. https://doi.org/10.4103/2045-9912.318857
Cómo citar
Armijos Idrovo, S. G., Pacheco Carabajo, L. A., Lafebre Carrasco, M. F., & Pesantez Alvarado, J. M. (2023). Ácido tranexámico y su aplicación en cirugía oral. Revisión sistemática. Universitas Odontologica, 42. https://doi.org/10.11144/Javeriana.uo41.taao
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