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TRATAMIENTO DE LA TROMBOSIS CON WARFARINA

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Ante el estrecho margen terapéutico que presenta el tratamiento anticoagulante con cumarínicos surgieron otras opciones. Se comparan en este artículo el clásico tratamiento con cumarínicos, la heparina endovenosa y el ximelagatran por vía oral.
pineo9.jpg Autor:
Pineo, graham f
Columnista Experto de SIIC

Institución:
Faculty of Medicine University of Calgary Alberta, Canada

Artículos publicados por Pineo, graham f
Coautor
Russell D. Hull, MBBS, MSc* 
Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada*
Recepción del artículo
22 de Junio, 2004 		Primera edición
6 de Abril, 2005 		Segunda edición, ampliada y corregida
7 de Junio, 2021

TRATAMIENTO DE LA TROMBOSIS CON WARFARINA

Resumen
La warfarina y sus derivados demostraron ser eficaces y seguros en una amplia variedad de trastornos clínicos trombóticos, como el tromboembolismo venoso, la prevención del accidente cerebrovascular (ACV) en la fibrilación auricular no valvular, la prevención del tromboembolismo sistémico en pacientes con infarto de miocardio o válvulas cardíacas protésicas. Al presentar estas drogas un estrecho margen terapéutico en lo que se refiere a la Razón Internacional Normalizada (RIN), el tratamiento insuficiente se asoció con aumento del riesgo trombótico, mientras que el exceso de anticoagulación se asoció con hemorragias. Por estas razones se hicieron varios intentos para hallar alternativas a la warfarina. La heparina de bajo peso molecular (HBPM) provee una alternativa para el tratamiento a largo plazo del tromboembolismo venoso, pero debe ser aplicada a través de una inyección. El ximelagatran, un inhibidor directo de la trombina de uso oral, demostró una eficacia equivalente y segura al compararse con la warfarina por tiempo prolongado en el tratamiento de varias enfermedades trombóticas. Cuando esta droga esté disponible simplificará el uso del tratamiento antitrombótico prolongado.

Palabras clave
Antagonistas de la vitamina K, warfarina, trombosis, hemorragia, ximelagatran


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ORAL ANTITHROMBOTIC THERAPY: VITAMIN K ANTAGONISTS AND RELATED PRODUCTS

Abstract
Warfarin and related compounds have been shown to be efficacious and safe in a wide variety of clinical thrombotic disorders including venous thromboembolism, stroke prevention in nonvalvular atrial fibrillation, prevention of systemic emboli in patients with myocardial infarction or prosthetic heart valves. With these drugs having a narrow therapeutic window with respect to INR, inadequate therapy is associated with an increased thrombotic risk whereas over anticoagulation is associated with bleeding. For these reasons attempts have been made to develop alternatives to warfarin. Low-molecular-weight heparin provides an alternative for the long term treatment of venous thromboembolism but it must given by injection. ximelagatran an oral direct thrombin inhibitor has been shown to be of equal efficacy and safety when compared with long-term warfarin for the treatment of number of different thrombotic disorders. When this drug becomes available it should simplify the use of long-term antithrombotic therapy.

Key words
Vitamin K antagonists, warfarin, thrombosis, bleeding, ximelagatran


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Especialidades
Principal: Cardiología, Farmacología, Hematología
Relacionadas: Bioquímica, Cardiología, Cuidados Intensivos, Diagnóstico por Laboratorio, Farmacología, Hematología, Medicina Farmacéutica, Medicina Interna



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