Antiagregación y anticoagulación en el paciente con disfunción renal
pacientes hemodializados
pacientes hemodializados con mayor riesgo de sangrado, pacientes críticos o trombocitopenia inducida por heparina, deben reemplazar el uso de HnF o HF en el dializado por anticoagulación regional con citrato (19, 20). Fondaparinux, a pesar de ser eliminación renal preponderante, presenta menor riesgo de sangrado intracraneal en SCA, con eficacia equivalente, cuando se lo comparó con enoxaparina (21) en este estudio multicéntrico (OASIS V) la diferencia a favor de fondaparinux se acentuaba con filtrado glomerular estimado (FGe) o
farmacología cardiovascular 30 | Mayode2015 lar, principalmente hemorrágico, siendo de mejor pronóstico el uso de aspirina o clopidogrel, en un estudio observacional de 48.000 pacientes hemodializados, el 4,5 % tenían FA (1671 pacientes) de ellos un 28 % no tenían ningún tratamiento anticoagulante o antiagregante y tenían mejor pronóstico de evento final, como así los pacientes con RIN 65 años se encontró mayor riesgo de sangrado con el empeoramiento de la función renal, este riesgo es más pronunciado en los primeros treinta días de tratamiento (34) ocasionado mayoritariamente por sangrado gastrointestinal (3.5 en FGe < 15 ml/min/1.73m2 comparado con ≥ 90 ml/min/ 1.73m2) En pacientes añosos con Fa de reciente comienzo y hemodiálisis, el uso de warfarina fue asociada a mayor sangrado intracraneal sin disminución de eventos isquémicos cerebrales. Un trabajo más reciente llega a la misma conclusión, con un aumento de sangrado de 44 % en quienes usaron warfarina. 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