29/04/2016 (SAF, anticoagulación, warfarina, embolismo pulmonar, embolismo arterial, trombosis venosa profunda

En los pacientes con SAF tratados con warfarina que presentan recurrencia de eventos trombóticos ¿que estrategia terapéutica es recomendable?

Contexto

Situación no tan frecuente pero de gran reto ante pacientes que vienen adecuadamente anticoagulados con warfarina y a pesar de ello presentan eventos embólicos.

Pregunta PICO

  • P: Pacientes con SAF anticoagulados con warfarina que tienen eventos embólicos recurrentes
  • I: Anticoagulación
  • C: -
  • O: recurrencia de eventos tromboticos

Búsqueda

definidad individualmente segun pico

Búsqueda

definida individualmente segun pico

Artículos Propuestos

Proponente Referencia Ver/Descargar
Eybar Alfonso Díaz Finazzi G, Marchioli R, Brancaccio V, et al. A randomized clinical trial of high-intensity warfarin vs. conventional antithrombotic therapy for the prevention of recurrent thrombosis in patients with the antiphospholipid syndrome (WAPS). J Thromb Haemost. 2005;3(5):848-853.

Jorge Abella Vargas-Hitos J, Ateka-Barrutia O, Sangle S, Khamashta M. Efficacy and safety of long-term low molecular weight heparin in patients with antiphospholipid syndrome. Ann Rheum Dis, 2011; 70: 1652-1654.
Renan Morales Schmidt-Tanguy A, Voswinkel J, Henrion D, Subra JF, Loufrani L, Rohmer V, Ifrah N, Belizna C.Antithrombotic effects of hydroxychloroquine in primary antiphospholipid syndrome patients. J Thromb Haemost 2013; 11: 1927–9
Javier Cajas Ruiz-Irastorza G, Hunt BJ, Khamashta MA. A systematic review of secondary thromboprophylaxis in patients with antiphospholipid antibodies. Arthritis and rheumatism. 2007;57(8):1487-95.

Ver DARE

Javier Cajas Sciascia S, Hunt B. Rivaroxaban Use in Patients with Antiphospholipid Syndrome Patients and Previous Poor Anticoagulation Control with Vitamin K Antagonists. 2014 ACR/ARHP Annual Meeting. ABSTRACT NUMBER: 14. Available from: http://goo.gl/xWtdSr
Alex Casallas Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic therapy for vte disease: Chest guideline and expert panel report. Chest. 2016;149(2):315-52. ----Recomendaciones 29 y 30-----
Andres Fernando Gómez Crowther M, Ginsberg J, Julian J et al.A Comparison of Two Intensities of Warfarin for the Prevention of Recurrent Thrombosis in Patients with the Antiphospholipid Antibody Syndrome.N Engl J Med 2003;349:1133-8.
Yimy Medina Noel N, Dutasta F, Costedoat-Chalumeau N, Bienvenu B, Mariette X, Geffray L, et al. Safety and efficacy of oral direct inhibitors of thrombin and factor Xa in antiphospholipid syndrome. Autoimmunity reviews. 2015;14(8):680-5.
Edwin Tellez Kampylafka E.I., Kosmidis M.L, Panagiotakos D.B., et al. Prevention of thrombosis relapse in antiphospholipid syndrome patients refractory to conventional therapy using intravenous immunoglobulin. Clin Exp Rheumatol. 2012 May-Jun;30(3):409-13.
David Enrique Perafan Gaona Cuadrado MJ, Bertolaccini ML, Seed PT, Tektonidou MG, Aguirre A, Mico L, et al. Low-dose aspirin vs low-dose aspirin plus low-intensity warfarin in thromboprophylaxis: a prospective, multicentre, randomized, open, controlled trial in patients positive for antiphospholipid antibodies (ALIWAPAS). Rheumatology (Oxford, England). 2014;53(2):275-84.
Angelita J. Diaz M Nalli C, Andreoli L, Casu C, Tincani A. Management of recurrent thrombosis in antiphospholipid syndrome. Current rheumatology reports. 2014;16(3):405.
Angelita J. Diaz M Legault KJ, Ugarte A, Crowther MA, Ruiz-Irastorza G. Prevention of Recurrent Thrombosis in Antiphospholipid Syndrome: Different from the General Population? Current rheumatology reports. 2016;18(5):26.
Jefferson A. Pérez JF Betancur JF, Bonilla-Abadıa F, et al. Direct oral anticoagulants in antiphospholipid syndrome: a real life case series. Lupus (2016) 0, 1–5
Rubén Guillermo Jaramillo Salamanca Okuma H, Kitagawa Y, Yasuda T, Tokuoka K, Takagi S. Comparison between single antiplatelet therapy and combination of antiplatelet and anticoagulation therapy for secondary prevention in ischemic stroke patients with antiphospholipid syndrome. Int J Med Sci. 2009;7(1):15–8.

Puntos clave/Conclusiones

La bacteiruria asintomática no debe ser tratada excepto en contadas excepciones como son: Paciente embarazada, paciente que va a ser llevado a procedimientos urológicos y esperemos las otras conclusiones.