Nuevos antitrombóticos. ¿Qué debe conocer el cirujano cardiovascular?

La trombosis es una de las causas de muerte más importante en los países industrializados. La trombosis arterial es responsable del infarto de miocardio y de los accidentes cerebrovasculares y se genera en zonas de daño arterial. Los antiplaquetarios y anticoagulantes desempeñan un papel fundamental en la prevención y tratamiento. La enfermedad tromboembólica venosa, a través de la trombosis venosa profunda y la embolia pulmonar, es la tercera causa de muerte después de los eventos arteriales. Ésta suele tratarse con anticoagulantes. En este trabajo se revisan los nuevos fármacos antiplaquetarios y anticoagulantes y su impacto en la cirugía cardiovascular.Thrombosis is the main cause of mortality in the industrialized countries. Arterial thrombosis, responsible of acute myocardial infarction and cerebrovascular accidents are characterized by the presence of rich clots in platelets and with scanty fibrin (called “white thrombus”) that are generated in places of vascular injury. Under these circumstances antiplatelet agents are required for prevention and treatment. Nevertheless, as thrombin is the main enzyme of the coagulation system and is also a powerful platelet activator, anticoagulants are used to prevent arterial thrombosis. Venous tromboembolism, which includes deep venous thrombosis (DVT) and pulmonary embolism (PE), constitutes the third reason of cardiovascular mortality after myocardial infarction and stroke. Venous thrombi result from an activation of the coagulation and are constituted principally by fibrin, in which the red blood cells remain trapped together with scanty platelets (called “red thrombus”); they are generally treated with anticoagulant agents. In this paper we will discuss the new antiplatelet and anticoagulant agents and their impact in cardiovascular surgery