¿hay lugar para la warfarina en el manejo clínico? Revisión narrativo de la literatura
DOI:
https://doi.org/10.29327/2393773.18.2-20Palabras clave:
warfarina; anticoagulantes; anticoagulantes orales de acción directa.Resumen
Introducción: La anticoagulación es esencial para la prevención de eventos tromboembólicos. La warfarina, aunque ampliamente utilizada y eficaz, requiere monitorización frecuente y presenta diversas interacciones que dificultan su manejo. Los anticoagulantes orales directos (ACOD) han surgido como alternativas más simples en varios escenarios, a pesar de su mayor costo. Este trabajo compara la warfarina y los ACOD en cuanto a indicaciones, eficacia, seguridad e impacto en la calidad de vida. Objetivo: Los trastornos tromboembólicos requieren una anticoagulación eficaz para prevenir complicaciones graves, siendo la warfarina y los ACOD las principales opciones terapéuticas. Este estudio tiene como objetivo revisar la literatura médica sobre las indicaciones de uso de la warfarina en comparación con los anticoagulantes orales directos (ACOD). Método: Revisión narrativa de la literatura, con búsqueda en la base PubMed utilizando los descriptores “warfarin”, “anticoagulants” y “direct oral anticoagulants”, aplicando filtros para ensayos clínicos de 2016 a 2024. Se incluyeron 23 artículos que comparaban clínicamente warfarina y ACOD. Resultados: La mayoría de los estudios indicó eficacia similar entre la warfarina y los ACOD en condiciones como trombosis venosa, fibrilación auricular y trombo ventricular izquierdo. Los ACOD mostraron menor riesgo de sangrado, especialmente intracraneal, y mayor practicidad al no requerir monitorización del INR. Discusión: Aunque los ACOD ofrecen ventajas, la warfarina sigue siendo preferida en poblaciones específicas, como pacientes con válvulas mecánicas y síndrome antifosfolípido. Se necesitan nuevos estudios para una mejor definición de su uso.
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