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ANTICOAGULACION EN PACIENTES CON INSUFICIENCIA CARDIACA
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ANTICOAGULACION EN PACIENTES CON INSUFICIENCIA CARDIACA

(especial para SIIC © Derechos reservados)
Datos recientes indican de manera decisiva la reducción en la mortalidad y en la morbilidad cardiovascular con el empleo de anticoagulantes en pacientes con insuficiencia cardíaca y fibrilación auricular. En presencia de ritmo sinusal, los datos disponibles no avalan el empleo rutinario de esta terapéutica.
delorenzoferruccio9.jpg Autor:
Ferruccio De Lorenzo
Columnista Experto de SIIC

Institución:
Thrombosis Research Institute


Artículos publicados por Ferruccio De Lorenzo
Coautor
Olena Dotsenko* 
MD, Thrombosis Research Insitute*
Recepción del artículo
22 de Junio, 2005
Aprobación
23 de Junio, 2005
Primera edición
27 de Febrero, 2006
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
La insuficiencia cardíaca representa uno de los trastornos cardiovasculares mórbidos más prevalentes en el mundo. Se piensa que la insuficiencia cardíaca crónica está asociada con el aumento en la incidencia de complicaciones tromboembólicas como el accidente cerebrovascular y los embolismos pulmonares, coronarios y periféricos. Sin embargo, los datos epidemiológicos sobre este tema son muy limitados. El síndrome de insuficiencia cardíaca comprende importantes características fisiopatológicas como el estado procoagulante crónico, la inflamación de bajo grado, la estructura de la pared vascular y anormalidades en el funcionamiento. Todos estos cambios predisponen al tromboembolismo. Aún no se establecióel lugar que ocupa la anticoagulación en el tratamiento de la insuficiencia cardíaca, a pesar de los debates y las discusiones prolongadas. De hecho, hasta la fecha se carece de pruebas ue sugieran que la anticoagulación oral sea beneficiosa para los pacientes con insuficiencia cardíaca, a menos que presenten fibrilación auricular o múltiples factores de riesgo de tromboembolismo, como el antecedente de un episodio trombótico. Sin embargo, se dispone de nuevos datos acerca de enfoques alternativos a la anticoagulación oral, como los que incluyen los inhibidores directos de la trombina y del factor Xa, heparinas de bajo peso molecular y agentes antiplaquetarios, que abren nuevos caminos para la intervención farmacológica antiplaquetaria en la insuficiencia cardíaca e imponen la necesidad de probar estas hipótesis promisorias en ensayos clínicos prospectivos y aleatorizados. Este trabajo resume los datos publicados acerca de las bases teóricas, resultados actuales y la base biopatológica sobre la prevención y el tratamiento del tromboembolismo en el contexto de la insuficiencia cardíaca.

Palabras clave
Insuficiencia cardíaca, tromboembolismo, tratamiento antitrombótico


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Abstract
Heart failure represents one of the most prevalent and morbid cardiovascular condition thorough the world. It is thought, that chronic heart failure is associated with the increased incidence of thromboembolic complications, including stroke, pulmonary, coronary and peripheral embolism. However, epidemiological data on this subject is very limited. Important pathophysiological features of heart failure syndrome encompass chronic procoagulant blood state, low-grade inflammation, vessel wall structure and function abnormalities – all changes, predisposing to thromboembolism. The place of anticoagulant therapy in heart failure management, despite long-standing active discussions and debates, remains to be established. In fact, there is a lack of firm evidence to date, suggesting, that oral anticoagulation could be beneficent to heart failure patients, unless they have atrial fibrillation or multiple risk factors of thromboembolism, including previous thrombotic episode. However, emerging data on alternative to oral anticoagulants approaches, including direct thrombin and factor Xa inhibitors, low molecular weight heparins and antiplatelet agents opens new avenues for pharmacological antithrombotic interventions in heart failure and dictates the need to test these promising hypotheses in prospective randomised clinical trials. This paper summarises data on pathobiological background, rationale and existing evidence on thromboembolism treatment and prevention in the setting of heart failure.

Key words
Heart failure, thromboembolism, antithrombotic treatment


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Especialidades
Principal: Cardiología, Hematología
Relacionadas: Medicina Farmacéutica, Medicina Interna



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Patrocinio y reconocimiento:
Reconocimiento: Los resultados presentados en este trabajo han dado lugar a las tesis doctorales de los siguientes profesionales:
Dra. Clara Silva de Ruiz, Dra. Virginia Ocaña y Dra. Silvina Juárez Tomas.
Los proyectos de investigación cuyos resultados se vuelcan en el presente trabajo han sido financiados por subsidios de CONICET.
Las cepas probióticas seleccionadas se licenciaron a la empresa italiana Anidral, del grupo Molfin-Ace-Probiotical, para su obtención en gran escala y comercialización mundial.
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