Libro "Manual de Crisis en Neuroanestesia"

Libro "Manual de Crisis en Neuroanestesia"

Cordial saludo, por gentileza de la Dra Angela Builes compartimos el link para descargar completamente gratis el libro:  " Manual de Crisis en Neuroanestesia". En nombre del comité de Neuroanestesia de la SCARE queremos agradecer el esfuerzo de compartir este material académico que esperamos sea de mucha utilidad para los anestesiólogos del país.

Darwin Cohen

Alfredo Caro

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Hemorragia intracerebral asociada al uso de anticoagulantes en la era de los agentes de reversión.

Hemorragia intracerebral asociada al uso de anticoagulantes en la era de los agentes de reversión. "Anticoagulant-associated intracranial hemorrhage in the era of reversal agents".

Autores: Steiner T, Weitz J, Veltcamp R.
Referencia: Stroke. 2017;48:00-00. DOI: 10.1161/STROKEAHA.116.013343

From the Department of Neurology, Klinikum Frankfurt Höchst, Germany (T.S.); Department of Neurology, Heidelberg University Hospital, Germany
(T.S., R.V.); Thrombosis and Atherosclerosis Research Institute and the Departments of Medicine and Biochemistry and Biomedical Sciences, McMaster
University, Hamilton, Ontario, Canada (J.I.W.); and Department of Stroke, Medicine, Imperial College, London, United Kingdom (R.V.).

In patients taking oral anticoagulants (OACs), the annual
rate of intracranial hemorrhage is 0.3% to 0.6%. Of these
bleeds, 46% to 86% are intracerebral; 13% to 45% are subdural,
and 1% to 8% are subarachnoidal.1,2 With 30- to 90-day
mortality rates of 40% to 65%, intracerebral hemorrhage
(ICH) has the worst prognosis.
When we published a review on OAC-associated ICH in
2006, vitamin K antagonists (VKAs), such as warfarin, were
the only available OAC.3 Since then, the options have expanded
to include 4 direct OACs (DOACs; Table I in the online-only
Data Supplement): dabigatran, which inhibits thrombin, and
rivaroxaban, apixaban, and edoxaban, which inhibit factor
Xa. For long-term use, the DOACs are licensed for stroke prevention
in nonvalvular atrial fibrillation and for treatment of
venous thromboembolism. Their approval was based on randomized
controlled trials that compared them with warfarin
for stroke prevention in >71 000 patients with nonvalvular AF4
and with VKAs in >27 000 patients with venous thromboembolism.
5–8 These trials revealed that the DOACs were at least
as effective as VKAs but were associated with less bleeding,
particularly less ICH.9 With similar efficacy, better safety,
and greater convenience compared with VKAs, most current
guidelines recommend DOACs over VKAs for stroke prevention
in atrial fibrillation and for treatment of venous thromboembolism.
It is not surprising, therefore, that prescriptions for
DOACs have overtaken those for VKAs in some countries.10
Despite the rapid uptake of the DOACs, however, at least 40%
of patients continue to receive VKAs.10
Focusing on ICH in patients receiving OAC, this article (1)
reviews the currently available evidence on reversal of DOACs
and VKAs, (2) provides recommendations about reversal, and
(3) identifies the remaining questions on ICH management.

Comentario: La hemorragia intracerebral es una frecuente complicación en pacientes que utilizan anticoagulantes orales en forma crónica. El riesgo anual en este grupo de pacientes es tán alto como el 0,3 al 0,6% y cuando esta se presenta se asocia a una mortalidad a los 30 a 90 días del 40 a 65%. Esto evidentemente sinifica un muy malpronóstico, por lo que tener claridad sobre el manejo apropiado del caso viene a ser muy importante para proveer un tratamiento anestésico apropiado.

Este artículo resume en forma práctica y clara los principios actuales del tratamiento de reversión de la terapia anticoagulante en pacientes con hemorragia intracerebral asociada a anticoagulantes orales, una complicación temible pero cada vez más frecuente.

Obtenga el articulo libre online en:

Información adicional se encuentra disponible en: Frontera JA, Lewin JJ 3rd, Rabinstein AA, Aisiku IP, Alexandrov AW, Cook AM, et al. Guideline for reversal of antithrombotics in intracranial hemorrhage: a statement for healthcare professionals from the neurocritical care society and society of critical care medicine. Neurocrit Care.

2016;24:6–46. doi: 10.1007/s12028-015-0222-x.

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