Eficacia de heparina intravenosa vs. heparina subcutánea en la prevención de la formación de trombos ventriculares izquierdos en infarto agudo del miocardio de pared anterior
Keywords:
Heparina intravenosa, heparina subcutánea, trombos ventriculares izquierdos, infarto agudo (es)Downloads
La trombosis en ventrículo izquierdo (TVI) es una complicación frecuente en el infarto agudo de miocardio (lAM) de pared anterior (40-60%) y se asocia con un riesgo incrementado de embolismo sistémico (3-15%). La anticoagulación con heparina intravenosa (IV) en las primeras 24 horas del lAM, reduce la formación de trombo ventricular izquierdo en 34-48%. El objetivo del estudio fue demostrar que heparina subcutánea (SC) es tan eficaz como la heparina intravenosa (IV), luego de un lAM de pared anterior en fase aguda y comparar las complicaciones intrahospitalarias en cuanto a fen6menos trombohemorrágicos entre los dos esquemas de manejo. El estudio es de tipo analítico, prospectivo, comparativo, experimental y aleatorio en 33 pacientes que ingresaron al Servicio de Urgencias del Hospital San Juan de Dios entre febrero de 1993 y diciembre de 1995, con diagnóstico de lAM de pared anterior en sus 24 primeras horas de evolución. Aleatoriamente se asignaron 19 pacientes al grupo que recibió el esquema de heparina IV (Grupo I) a dosis plena anticoagulante y 14 pacientes al grupo con el esquema de heparina SC a dosis de 12500 U cada 12 horas (Grupo II). En ambos grupos el nivel de anticoagulación se ajustó para mantener el TPT entre 1.5 y 2 veces el control normal. Se determine la presencia de TVI mediante ecocardiografía, al final de la primera semana y se registraron las complicaciones trombohemorrágicas a lo largo de tres meses de seguimiento. Se encontró que la incidencia de TVI en ambos grupos fue baja (5.26% en el esquema heparina IV vs. 7.1% en el esquema heparina SC), sin diferencia estadísticamente significamente en cuanto a complicaciones trombohemorrágicas o morbimortalidad. Los resultados del estudio sugieren que la eficacia de ambos esquemas en la prevención de la formación de TVI después de un lAM de pared anterior, es similar siempre y cuando se asegure una nivel óptimo de anticoagulación.
Left ventricular thrombosis (LVT) is a frequent complication in Acute Anterior Myocardial Infarction (Anterior AMI) (40-60%) associated with an increased risk of systemic embolism (3-15%). IV heparin anticoagulat therapy in the first 24h of AMI, reduces thrombi formation in 34-48%. The objective of this study was to demostrate that subcutaneous (SC) heparin in high doses is as effective as intravenous (IV) heparin in preventing thrombi formation after an anterior AMI and to compare the rate of thrombohemorraghic events in the two schemes of treatment. This is an analytic, prospective, comparative, experimental and study in 33 patients, who were hospitalized randomized with acute anterior myocardial infarction, in first 24 hours, in the Emergency Room of Hospital San Juan de Dios (Bogota) between february 1993 and december 1995. Nineteen patients were randomly assigned to receive IV heparin and 14 patients to receive SC heparin at doses of 12.500 UI b.Ld. The level of anticoagulation was regulated tritated to maintain the JYIT 1.5 to 2 times the control. Each patient had echocardiographic examination at the end of the first week, to determine the presence of left ventricular thrombosis (LVT). The patients were followed during three months looking for complications related to anticoagulant therapy. It was found that the incidence of LVT in both groups was low (5.26% IV heparin scheme vs 7.1% SC heparin scheme), without statistically significant differences in complication rate and mortality. This study suggests that the effectiveness in preventing LVT in the post AMI period is similar in IV and SC heparin schemes, if a good anticoagulation level is warranted.
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