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Anticoagulación en enfermedades valvulares ¿está todo definido?

Luciano N Fallabrino, Darío B Igolnikof, Ricardo M Iglesias

Revista del Consejo Argentino de Residentes de Cardiología ;():0196-0204 


Durante décadas, la prevención de eventos tromboembólicos en los diversos escenarios clínicos se realizó con los antagonistas de la vitamina K. En los últimos años se evidenció un aumento notable en la indicación de anticoagulantes orales directos, debido a las numerosas ventajas farmacocinéticas, acompañadas de un mejor perfil de seguridad y eficacia. El uso de estos en enfermedades valvulares cardíacas se encuentra menos respaldado por la evidencia y se basa en el análisis de subgrupos de grandes ensayos aleatorizados o pequeños ensayos no aleatorizados. Ante este panorama, analizamos las recomendaciones actuales del uso de los anticoagulantes orales directos y su proyección a futuro como estrategias de anticoagulación en contexto de enfermedades valvulares cardíacas.


Palabras clave: anticoagulantes, válvulas cardíacas, vitamina K, coagulación sanguínea,

For decades, the prevention of thromboembolic events in various clinical scenarios has been performed with vitamin K antagonists. There has been a notable increase in the indication of direct oral anticoagulants in recent years due to their numerous pharmacokinetic advantages, accompanied by a better safety and efficacy profile. The use of these in cardiac valve diseases is less supported by evidence and is based on the analysis of subgroups of large randomized or small non-randomized trials. In this scenario, we analyze the current recommendations of the use of direct oral anticoagulants and their future projection as anticoagulation strategies in the context of cardiac valvular diseases.


Keywords: anticoagulants, heart valves, vitamin K, blood coagulation,


Los autores declaran poseer conflictos de intereses. Ricardo Iglesias y Luciano Fallabrino son autores del libro “Fibrilación Auricular: respuesta a interrogantes actuales”. 1ra ed. Ciudad Autónoma de Buenos Aires. Edimed-Ediciones Médicas SRL; Olivos, 2015.

Fuente de información Consejo Argentino de Residentes de Cardiología. Para solicitudes de reimpresión a Revista del CONAREC hacer click aquí.

Recibido 2017-01-03 | Aceptado 2017-05-15 | Publicado 2017-12-29

Tabla 1. Enfermedades valvulares cardíacas en pacientes con FA incluidos en los estudios con antic...

Tabla 2. Eficacia y seguridad de anticoagulantes orales directos frente a warfarina en pacientes co...

Tabla 3. Eficacia y seguridad del dabigatran frente a warfarina en pacientes con válvulas protési...

Tabla 4. Recomendación de estrategias antitrombóticas en pacientes con válvulas protésicas mec...

Tabla 5. Recomendación de estrategias antitrombóticas en pacientes con válvulas protésicas biol...

Tabla 6. Recomendación de estrategias antitrombóticas en pacientes post reemplazo valvular aórt...

Figura 1. Definición de fibrilación auricular valvular en los principales estudios de anticoagula...

Figura 2. Eventos cerebrovasculares en los primeros 30 días posteriores a la colocación de una TA...

Figura 3. Riesgo de eventos cerebrovasculares acorde al tiempo trascurrido del implante del reemplaz...

  1. Boudoulas K, Ravi Y, Garcia D, Saini U, Sofowora G, Gumina RJ et al. Type of Valvular Heart Disease Requiring Surgery in the 21st Century: Mortality and Length-of-Stay Related to Surgery. Open Cardiovasc Med J. 2013;7:104-9.

  2. Boudoulas H. Etiology of valvular heart disease. Expert Rev Cardiovasc Ther. 2003;1(4):523-32.

  3. Selzer A, Kohn KE. Natural history of mitral stenosis: a review. Circulation. 1972;45(4):878-90.

  4. Carabello BA. The changing unnatural history of valvular regurgitation. Ann Thorac Surg. 1992;53(2):191-9.

  5. Boudoulas H, Sparks EE, Wooley CF. Mitral valvular regurgitation: etiology, pathophysiologic mechanisms, clinical manifestations. Herz. 2006;31(1):6-13.

  6. Carabello BA, Paulus WJ. Aortic stenosis. Lancet. 2009;373(9667):956-66.

  7. Brennan JM, Edwards FH, Zhao Y, O’Brien S, Booth ME, Dokholyan RS, et al. Long-term safety and effectiveness of mechanical versus biologic aortic valve prostheses in older patients: Results from the society of thoracic surgeons adult cardiac surgery national database. Circulation. 2013;127(16):1647-55.

  8. Stassano P, Di Tommaso L, Monaco M, Iorio F, Pepino P, Spampinato N, et al. Aortic valve replacement: A prospective randomized evaluation of mechanical versus biological valves in patients ages 55 to 70 years. J Am Coll Cardiol. 2009;54(20):1862-8.

  9. Le Tourneau T, Lim V, Inamo J, Miller FA, Mahoney DW, Schaff HV, et al. Achieved anticoagulation vs. prosthesis selection for mitral mechanical valve replacement: A population-based outcome study. Chest. 2009;136(6):1503-1513.

  10. Heras M, Chesebro JH, Fuster V, Penny WJ, Grill DE, Bailey KR, et al. High risk of thromboemboli early after bioprosthetic cardiac valve replacement. J Am Coll Cardiol. 1995;25(5):1111-9.

  11. Hart R, Pearce LA, Aguilar MI. Meta-analysis: Antithrombotic Therapy to Prevent Stroke in Patients Who Have Nonvalvular Atrial Fibrillation. Ann Intern Med. 2007;146(12):857-67.

  12. Di Biase L. Use of Direct Oral Anticoagulants in Patients With Atrial Fibrillation and Valvular Heart Lesions. J Am Heart Assoc. 2016;5(2). pii: e002776.

  13. Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011;365(21):2002-12.

  14. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139-51

  15. Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, et al. ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883-91.

  16. Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, et al. ARISTOTLE Committees and Investigators. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981-92.

  17. Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, Halperin JL, et al. ENGAGE AF-TIMI 48 Investigators. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013;369(22):2093-104.

  18. Schulman S, Kearon C, Kakkar A, Schellong S, Eriksson H, Baanstra D et al. Extended Use of Dabigatran, Warfarin, or Placebo in Venous Thromboembolism. N Engl J Med. 2013;368(8):709-18.

  19. Schulman S, Kearon C, Kakkar A, Mismetti P, Schellong P, Eriksson H et al. Dabigatran versus Warfarin in the Treatment of Acute Venous Thromboembolism. N Engl J Med. 2009;361(24):2342-52.

  20. EINSTEIN Investigators, Bauersachs R, Berkowitz SD, Brenner B, Buller HR, Decousus H et al. Oral Rivaroxaban for Symptomatic Venous Thromboembolism. N Engl J Med. 2010;363(26):2499-510.

  21. EINSTEIN–PE Investigators, Büller HR, Prins MH, Lensin AW, Decousus H, Jacobson BF et al. Oral Rivaroxaban for the Treatment of Symptomatic Pulmonary Embolism. N Engl J Med. 2012;366(14):1287-97.

  22. Agnelli G, Buller HR, Cohen A, Curto M, Gallus AS, Johnson M et al. Oral Apixaban for the Treatment of Acute Venous Thromboembolism. N Engl J Med. 2013;369(9):799-808.

  23. Agnelli G, Buller HR, Cohen A, Curto M, Gallus AS, Johnson M et al. Apixaban for Extended Treatment of Venous Thromboembolism. N Engl J Med. 2013;368(8):699-708.

  24. Hokusai-VTE Investigators, Büller HR, Décousus H, Grosso MA, Mercuri M, Middeldorp S et al. Edoxaban versus Warfarin for the Treatment of Symptomatic Venous Thromboembolism. N Engl J Med. 2013;369(15):1406-15.

  25. Alexander JH, Lopes RD, James S, Kilaru R, He Y, Mohan P et al. Apixaban with Antiplatelet Therapy after Acute Coronary Syndrome. N Engl J Med. 2011;365(8):699-708.

  26. Mega JL, Braunwald E, Wiviott SD, Bassand JP, Bhatt DL, Bode C et al. Rivaroxaban in Patients with a Recent Acute Coronary Syndrome. N Engl J Med. 2012;366(1):9-19.

  27. Lip GY, Laroche C, Dan GA, Santini M, Kalarus Z, Rasmussen LH et al. A prospective survey in European Society of Cardiology member countries of atrial fibrillation management: baseline results of EurObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot General Registry. Europace. 2014;16(3):308-19.

  28. Nieuwlaat R, Capucci A, Camm AJ, Olsson SB, Andresen D, Davies DW et al. Atrial fibrillation management: a prospective survey in ESC Member Countries. Eur Heart J. 2005;26(22):2422-34.

  29. Molteni M, Polo Friz H, Primitz L, Marano G, Boracchi P, Cimminiello C. The definition of valvular and non-valvular atrial fibrillation: results of a physicians’ survey. Europace. 2014;16(12):1720-5.

  30. Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH et al. ESC Committee for Practice Guidelines-CPG; Document Reviewers. 2012 Focused update of the ESC guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fibrillation—developed with the special contribution of the European Heart Rhythm Association. Europace. 2012;14(10):1385-413.

  31. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64(21):e1-76.

  32. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893-2962.

  33. Iglesias R, Pozzer D, Vita N. Fibrilación auricular: Respuestas a interrogantes actuales. 2015, 1ra ed. Ciudad Autónoma de Buenos Aires: Edimed-Ediciones Médicas SRL.

  34. Keenan NG, Cueff C, Cimadevilla C, Brochet E, Lepage L, Detaint D et al. Usefulness of left atrial volume versus diameter to assess thromboembolic risk in mitral stenosis. Am J Cardiol. 2010;106(8):1152-6.

  35. Eikelboom JW, Connolly SJ, Brueckmann M, Granger CB, Kappetein AP, Mack MJ et al. Dabigatran versus warfarin in patients with mechanical heart valves. N Engl J Med. 2013;369(13):1206-14.

  36. Hylek E. Dabigatran and Mechanical Heart Valves — Not as Easy as We Hoped. N Engl J Med. 2013;369(13):1264-6.

  37. Comparison of Antithrombotic Treatments After Aortic Valve Replacement. Rivaroxaban: A New Antithrombotic Treatment for Patients With Mechanical Prosthetic Aortic Heart Valve. https://clinicaltrials.gov/ct2/show/NCT02128841

  38. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(22):e57-185.

  39. Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Baron-Esquivias G, Baumgartner H et al. Guías de práctica clínica sobre el tratamiento de las valvulopatías (versión 2012). Grupo de trabajo conjunto de la Sociedad Europea de Cardiología (ESC) y de la Asociación Europea de Cirugía Cardiotorácica (EACTS). Rev Esp Cardiol. 2013;66(2):131.e1-e42.

  40. Whitlock RP, Sun JC, Fremes SE, Rubens FD, Teoh KH. Antithrombotic and Thrombolytic Therapy for Valvular Disease. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians. Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e576S-e600S.

  41. Heras M, Chesebro JH, Fuster V, Penny WJ, Grill DE, Bailey KR et al. High risk of thromboembolia early after bioprosthetic cardiac valve replacement. J Am Coll Cardiol. 1995;25(5):1111-9.

  42. Russo A, Grigioni F, Avierinos JF, Freeman WK, Suri R, Michelena H et al. Thromboembolic complications after surgical correction of mitral regurgitation incidence, predictors, and clinical implications. J Am Coll Cardiol. 2008;51(12):1203-11.

  43. Brennan JM, Edwards FH, Zhao Y, O’Brien S, Booth ME, Dokholyan RS et al. Long-term safety and effectiveness of mechanical versus biologic aortic valve prostheses in older patients: Results from the society of thoracic surgeons adult cardiac surgery national database. Circulation. 2013;127(16):1647-55.

  44. Cohn LH, Mudge GH, Pratter F, Collins JJ Jr. Five to eight-year follow-up of patients undergoing porcine heart-valve replacement. N Engl J Med. 1981;304(5):258-62.

  45. Roudaut R, Serri K, Lafitte S. Thrombosis of prosthetic heart valves: Diagnosis and therapeutic considerations. Heart. 2007;93(1):137-42.

  46. Sundt TM, Zehr KJ, Dearani JA, Daly RC, Mullany CJ, McGregor CG et al. Is early anticoagulation with warfarin necessary after bioprosthetic aortic valve replacement? J Thorac Cardiovasc Surg. 2005;129(5):1024-31.

  47. Mérie C, Køber L, Skov Olsen P, Andersson C, Gislason G, Skov Jensen J et al. Association of warfarin therapy duration after bioprosthetic aortic valve replacement with risk of mortality, thromboembolic complications, and bleeding. JAMA. 2012;308(20):2118-25.

  48. Colli A, Verhoye JP, Heijmen R, Strauch JT, Hyde JA, Pagano D et al. Antithrombotic therapy after bioprosthetic aortic valve replacement: ACTION registry survey results. Eur J Cardiothorac Surg. 2008;33(4):531-6.

  49. Hynes GB, Rode´s-Cabau J. Transcatheter aortic valve implantation and cerebrovascular events: the current state of the art. Ann N Y Acad Sci. 2012;1254:151-63.

  50. Eggebrecht H, Schmermund A, Voigtländer T, Kahlert P, Erbel R, Mehta RH. Risk of stroke after transcatheter aortic valve implantation (TAVI): a meta-analysis of 10,037 published patients. EuroIntervention. 2012;8(1):129-38.

  51. Nombela-Franco L, Webb JG, de Jaegere PP, Toggweiler S, Nuis RJ, Dager AE et al. Timing, Predictive Factors, and Prognostic Value of Cerebrovascular Events in a Large Cohort of Patients Undergoing Transcatheter Aortic Valve Implantation. Circulation. 2012;126(25):3041-53.

  52. Amat-Santos IJ, Rodés-Cabau J, Urena M, DeLarochellière R, Doyle D, Bagur R et al. Incidence, Predictive Factors, and Prognostic Value of New-Onset Atrial Fibrillation Following Transcatheter Aortic Valve Implantation. J Am Coll Cardiol. 2012;59(2):178-88.

  53. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG et al, for the PARTNER Trial Investigators. Transcatheter versus Surgical Aortic-Valve Replacement in High-Risk Patients. N Engl J Med. 2011;364(23):2187-98.

  54. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG et al, for the PARTNER Trial Investigators. Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery. N Engl J Med. 2010;363(17):1597-607.

  55. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK et al, for the PARTNER 2 Investigators. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2016;374(17):1609-20.

  56. Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM et al, for the U.S. CoreValve Clinical Investigators. Transcatheter Aortic-Valve Replacement with a Self-Expanding Prosthesis. N Engl J Med. 2014;370(19):1790-8.

  57. Makkar RR, Fontana G, Jilaihawi H, Chakravarty T, Kofoed KF, de Backer O et al. Possible ubclinical Leaflet Thrombosis in Bioprosthetic Aortic Valves. N Engl J Med. 2015;373(21):2015-24.

  58. Tay EL, Gurvitch R, Wijesinghe N, Nietlispach F, Wood D, Cheung A et al. A High-Risk Period for Cerebrovascular Events Exists After Transcatheter Aortic Valve Implantation. JACC Cardiovasc Interv. 2011;4(12):1290-7.

  59. Anti-Thrombotic Strategy After Trans-Aortic Valve Implantation for Aortic Stenosis. https://clinicaltrials.gov/ct2/show/NCT02664649.

  60. Global Study Comparing a rivAroxaban-based Antithrombotic Strategy to an antipLatelet-based Strategy After Transcatheter aortIc vaLve rEplacement to Optimize Clinical Outcomes. https://clinicaltrials.gov/ct2/show/NCT02556203.

  61. Bauer KA. Targeted Anti-Anticoagulants. N Engl J Med. 2015;373(6):569-71.

  62. Pollack CV Jr, Reilly PA, Eikelboom J, Glund S, Verhamme P, Bernstein RA et al. Idarucizumab for Dabigatran Reversal. N Engl J Med. 2015;373(6):511-20.

  63. Boehringer Ingelheim Pharmaceuticals, Inc. PRAXBIND (idarucizumab) prescribing information. Disponible en : http://us.boehringer-ingelheim.com/content/dam/internet/opu/us_EN/documents/Media_Press_Releases/2015/Praxbind.pdf. Accessed November 11, 2015.

  64. Siegal DM, Curnutte JT, Connolly SJ, Lu G, Conley PB, Wiens BL et al. Andexanet Alfa for the Reversal of Factor Xa Inhibitor Activity. N Engl J Med. 2015;373(25):2413-24.

  65. Connors JM. Antidote for Factor Xa Anticoagulants. N Engl J Med. 2015;373(25):2471-2.

  66. Connolly SJ, Milling TJ Jr, Eikelboom JW, Gibson CM, Curnutte JT, Gold A et al, for the ANNEXA-4 Investigators. Andexanet Alfa for Acute Major Bleeding Associated with Factor Xa Inhibitors. N Engl J Med. 2016;375(12):1131-41.

  67. Roel V, Moukarzel J, Zaidel E, Galli M, Da Rosa W, Leiva R et al, en nombre del Consejo Argentino de Residentes de Cardiología. Estrategias antitrombóticas en fibrilación auricular. Registro CONAREC XIX. Rev Argent Cardiol 2015;83:208-214.

  68. Chai-Adisaksopha C, Crowther M, Isayama T, Lim W. The impact of bleeding complications in patients receiving target specific oral anticoagulants: a systematic review and meta-analysis. Blood. 2014;124(15):2450-8

Autores

Luciano N Fallabrino
Instructor de Residentes del Servicio de Cardiología del Sanatorio Trinidad Mitre. Presidente del CONAREC 2015..
Darío B Igolnikof
Staff del Servicio de Cardiología del Hospital Universitario Austral. Presidente del CONAREC 2016..
Ricardo M Iglesias
Presidente del CONAREC 1983 Miembro Titular de la Sociedad Argentina de Cardiología. Fellow del American College of Cardiology. Presidente de la Sociedad Argentina de Cardiología 2009. Presidente de la Fundación Cardiológica Argentina 2010-2011..

Autor correspondencia

Luciano N Fallabrino
Instructor de Residentes del Servicio de Cardiología del Sanatorio Trinidad Mitre. Presidente del CONAREC 2015..

Correo electrónico: fallabrinoluciano@gmail.com

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Titulo
Anticoagulación en enfermedades valvulares ¿está todo definido?

Autores
Luciano N Fallabrino, Darío B Igolnikof, Ricardo M Iglesias

Publicación
Revista del CONAREC

Editor
Consejo Argentino de Residentes de Cardiología

Fecha de publicación
2017-12-29

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© Consejo Argentino de Residentes de Cardiología

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