Anticoagulacion en sindrome antifosfolipido, revision del manejo terapeutico de una patologia compleja, actualizacion para resultados mas adecuados en estos pacientes
Resumen
Los anticoagulantes orales directos (AOD) son alternativas terapéuticas a la warfarina y otros antagonistas de la vitamina K (AVK), y constituyen el estándar de atención para muchas indicaciones. Los AVK constituyen la terapia convencional para el tratamiento y la tromboprofilaxis secundaria del síndrome antifosfolípido trombótico (SAF), pero a menudo son problemáticos debido a la sensibilidad variable de las tromboplastinas al anticoagulante lúpico. Por lo tanto, es posible que la razón normalizada internacional no refleje con precisión la intensidad de la anticoagulación o que no sea clínicamente efectiva. La definición de la función actual de los AOD en el tratamiento del APS se basa en datos limitados de ensayos clínicos e información de otras fuentes, incluidos datos de fabricantes, series de casos o estudios de cohortes y consenso de expertos. El ensayo controlado aleatorizado (ECA) con Rivaroxabán en el síndrome antifosfolípido (RAPS), que tenía una medida de resultado primaria sustituta de laboratorio, sugiere que rivaroxabán tiene el potencial de ser una alternativa efectiva y conveniente a la warfarina en pacientes con SAF trombótico con un solo evento de tromboembolismo venoso que requiere anticoagulación de intensidad estándar. Sin embargo, se necesitan más estudios, en particular para proporcionar mejores datos de eficacia y seguridad a largo plazo, antes de que pueda recomendarse ampliamente. Los pacientes con SAF son clínicamente heterogéneos, con el riesgo de trombosis recurrente y la intensidad de la anticoagulación influenciada por su fenotipo clínico y perfil de riesgo. Los ensayos de AOD que involucran poblaciones homogéneas de SAF trombótico, con el estado de anticuerpos antifosfolípidos bien definido, ayudarán a optimizar el tratamiento adecuado en los subgrupos de pacientes con SAF. Los ECA de AOD en curso y emergentes deben proporcionar más información para guiar el uso de AOD en pacientes con SAF. La identificación óptima de los pacientes con APS es un paso clave para trabajar hacia mejores estrategias terapéuticas en estos individuos.
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Derechos de autor 2025 Andrea Liliana Navarro Quintero, Andrea Carolina Rincón Campillo, Karoll Juliet Fragozo Vergara, Natalia Ramírez Barbosa , Besneider Fabián Estupiñan Jacome , Isabella Betancourt Barón, Angie Steffany Duarte Duran
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
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