English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

espanolLos especialistas en dolor cronico nos enfrentamos habitualmente a situaciones en las que los pacientes que van a ser sometidos a procedimientos intervencionistas estan bajo tratamiento antiagregante o anticoagulante. Las complicaciones hemorragicas pueden ser catastroficas cuando se trata de bloqueos profundos y tecnicas dentro del canal espinal. Sin embargo, el riesgo de eventos tromboembolicos aumenta con la suspension inadecuada de los farmacos antiagregantes y anticoagulantes en estos pacientes. A dia de hoy no existen unos algoritmos o recomendaciones actualizadas para el manejo de estos pacientes en el area de dolor cronico. El objetivo de este documento es ofrecer unas recomendaciones de seguridad sobre el manejo de estos farmacos segun el tipo de intervencion y el tipo de paciente, con el objetivo de minimizar el riesgo de complicaciones hemorragicas sin aumentar el riesgo de eventos tromboembolicos. Para ello, se han revisado las ultimas publicaciones sobre el manejo farmacos que alteran la hemostasia en anestesia regional y otras tecnicas de dolor cronico, incluyendo diferentes guias de manejo perioperatorio (ASRA, ESA, SEDAR...). Existe buena evidencia en el incremento del riesgo de eventos tromboembolicos en pacientes que suspenden la terapia antiagregante, y que este riesgo es mayor que el de la incidencia de hematomas epidurales en pacientes que continuan con el tratamiento, si bien ambos riesgos son significativos. Asi mismo, existe buena evidencia de la incidencia de hematomas epidurales espontaneos asociados o no a puncion traumatica, en pacientes con o sin terapia antitrombotica. Estos hematomas epidurales espontaneos estan asociados a factores favorecedores como la manipulacion excesiva, el uso de agujas de mayor calibre, el uso de cateteres, los procedimientos sobre el canal cervical, la edad avanzada, y las anormalidades vasculares y anatomicas del paciente. Hay una tendencia menos conservadora hacia los intervalos de interrupcion de los farmacos antiagregantes en pacientes de alto riesgo (Aspirina® 3 dias, clopidogrel 5 dias), si bien el manejo de heparinas y anticoagulantes orales clasicos practicamente no ha cambiado. Recientemente han surgido nuevos anticoagulantes orales no contemplados en muchas de estas guias (dabigatran, rivaroxaban, apixaban) con mayor perfil de seguridad que el Sintrom®, habitualmente sin necesidad de terapia puente con heparinas tras la suspension del farmaco. El inconveniente es que existe escasa documentacion en la literatura sobre su manejo perioperatorio, por lo que su suspension se basa actualmente en sus caracteristicas farmacocineticas y farmacodinamicas estrictas (2 dias, siendo mayor si existe insuficiencia renal). EnglishInterventional pain physicians usually face situations were, the patients that are going to be under an interventional procedure, are undergoing an antiplatelet or anticoagulant therapy. Bleeding complications can be catastrophic when we talk about deep blocks and interventions into the spinal canal. However, the risk of thromboembolic events increases with the improper discontinuation of antiplatelet and anticoagulant drugs in those patients. Nowadays, there are no algorithms or updated recommendations on the handling of those patients in the chronic pain area. The goal of this article is to offer some recommendations on how to use, in a safety way, those drugs depending on the type of intervention and patient, with the objective of minimizing the risk of bleeding complications without increasing the risk of thromboembolic events. To do this, the latest news on the use of drugs which alters the hemostasis in regional anesthesia and other chronic pain technics had been reviewed, including different guides on the perioperative management (ASRA, ESA, SEDAR, etc.). There is fair evidence that the risk of thromboembolic phenomenon increases on those patients whom discontinues their antiplatelet therapy, and that this risk is even higher than the risk of epidural hematomas on those patients whom continues with their treatment, even though both risks are significant. There is also good evidence of the incidence of spontaneous epidural hematomas, associated or not to a traumatic puncture, in patients with or without an antithrombotic therapy. Those spontaneous epidural hematomas are more likely associated to favorable factors such as: Excessive manipulation, the use of larger gauge needles, the use of catheters, procedures into the cervical spinal canal, elderly patients, and vascular and anatomical abnormalities of the patient. There is a less conservative tendency about intervals of discontinuation of antiplatelet drugs in high risk patients (3 days for Aspirin®, 5 days for clopidogrel), while the use of heparin and classic oral anticoagulants practically has not changed. Recently, new oral anticoagulants, not included in most of these guides, have appeared (dabigatran, rivaroxaban and apixaban) with a higher security profile than Sintrom®, usually without the need of heparin bridging therapy after discontinuation of the drug. The inconvenience is that there is limited evidence about its perioperative use. That is why it's suspension is actually based on its strict pharmacokinetic and pharmacodynamics characteristics (2 days, being higher if there exists a decline in renal function).

Manejo de antiagregantes y anticoagulantes en procedimientos intervencionistas de dolor crónico