Propuesta de protocolo para el manejo perioperatorio de pacientes con anticoagulación o antiagregación plaquetaria, sometidos a cirugía no cardiovascular en el hospital Dr. Rafael Ángel Calderón Guardia
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Abstract
Por el progresivo envejecimiento de la población y los avances de la medicina en los últimos años, el número de pacientes que reciben anticoagulación o antiagregación oral ha aumentado, ya que estos fármacos son necesarios para la prevención de eventos tromboembólicos venosos y arteriales.1,2 Por lo tanto, realizar procedimientos quirúrgicos no cardiovasculares, sean electivos o de emergencias a estos pacientes, es un reto clínico, por la heterogeneidad de sus propias comorbilidades y las diferentes terapias antitrombóticas actuales; en consecuencia es necesario estandarizar el manejo perioperatorio de estos pacientes, para minimizar las posibles complicaciones perioperatorias.
En la actualidad, el Hospital Dr. Rafael ángel Calderón Guardia no cuenta con un protocolo que guie y homogenice las prácticas seguras perioperatorias del tratamiento antitrombótico entre los distintos especialistas, lo anterior, ha motivado este trabajo.
Metodología: revisión bibliográfica descriptiva con uso de metaanálisis, artículos de revistas médicas indexadas, guías de manejo internacionales y consensos de expertos que no tengan más de 10 años desde la fecha de su publicación (desde el 1 de enero del 2014 hasta el 1 de enero del 2024) en idioma inglés y español. Se utilizó bases de datos de información biomédica: PubMed, MEDLINE, Bot Plus, EMBASE y Cochrane library plus.
Conclusiones: 1) Debido al envejecimiento paulatino de la población, las situaciones en la que se requiere del manejo de fármacos antitrombóticos durante el periodo perioperatorio han venido en aumento. 2) Es necesario manejar a fondo la farmacoterapia y farmacodinamia de estos medicamentos, para tomar la decisión más segura en cuanto a su suspensión, reinicio o reversión; previo a una intervención quirúrgica electiva o de emergencia. 3) Se debe establecer siempre, de la forma más objetiva el riesgo/beneficio de realizar la intervención quirúrgica, considerando las posibles consecuencias de no realizar el procedimiento.
Due to the progressive aging of the population and the advances in medicine in the recent years, the number of patients receiving anticoagulation or oral antiplatelet therapy has increased, since these drugs are necessary for the prevention of venous and arterial thromboembolic events.1,2 Performing elective or emergency non-cardiovascular surgical procedures on these patients is a clinical challenge, the heterogeneity of their own comorbidities and the different current antithrombotic therapies imply the need to standardize the perioperative management of these patients, in order to minimize possible perioperative complications. At present, the Dr. Rafael Angel Calderón Guardia Hospital does not have a protocol that helps to guide and standardize safe perioperative practices for the use of antithrombotic agents among the different specialists, which has motivated this study. Methodology: descriptive literature review using meta-analysis, articles from indexed medical journals, international management guidelines and expert consensus that are no more than 10 years old from the date of publication (from January 1, 2014, to January 1, 2024) in English and Spanish. Biomedical information databases were used: PubMed, MEDLINE, Bot Plus, EMBASE and Cochrane library plus. Conclusions: 1) Due to the gradual aging of the population, the number of situations requiring the use of antithrombotic drugs during the perioperative period has been increasing. 2) It is necessary to thoroughly manage the pharmacotherapy and pharmacodynamics of these drugs, to make the safest decision regarding their suspension, reinitiating, or reversal, prior to elective or emergency surgery. 3) The risk/benefit of performing the surgical intervention should always be established in the most objective way, considering the possible consequences of not performing the procedure.
Due to the progressive aging of the population and the advances in medicine in the recent years, the number of patients receiving anticoagulation or oral antiplatelet therapy has increased, since these drugs are necessary for the prevention of venous and arterial thromboembolic events.1,2 Performing elective or emergency non-cardiovascular surgical procedures on these patients is a clinical challenge, the heterogeneity of their own comorbidities and the different current antithrombotic therapies imply the need to standardize the perioperative management of these patients, in order to minimize possible perioperative complications. At present, the Dr. Rafael Angel Calderón Guardia Hospital does not have a protocol that helps to guide and standardize safe perioperative practices for the use of antithrombotic agents among the different specialists, which has motivated this study. Methodology: descriptive literature review using meta-analysis, articles from indexed medical journals, international management guidelines and expert consensus that are no more than 10 years old from the date of publication (from January 1, 2014, to January 1, 2024) in English and Spanish. Biomedical information databases were used: PubMed, MEDLINE, Bot Plus, EMBASE and Cochrane library plus. Conclusions: 1) Due to the gradual aging of the population, the number of situations requiring the use of antithrombotic drugs during the perioperative period has been increasing. 2) It is necessary to thoroughly manage the pharmacotherapy and pharmacodynamics of these drugs, to make the safest decision regarding their suspension, reinitiating, or reversal, prior to elective or emergency surgery. 3) The risk/benefit of performing the surgical intervention should always be established in the most objective way, considering the possible consequences of not performing the procedure.
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Keywords
Anticoagulatentes, Antiagregantes plaquetarios, reversión terapia antitrombótica, suspensión anticoagulación