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Sensibilidad a la Heparina, reversión y sangrado en revascularización miocárdica: estudio de cohorte, Fundación Cardioinfantil, 2019

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dc.contributor.advisorFranco Gruntorad, Germán Andrés
dc.contributor.advisorMartínez del Valle, Anacaona
dc.creatorCastro Perdomo, Leonardo
dc.creatorMesa Gómez, María Del Pilar
dc.creatorKling, Juan Carlos
dc.creator.degreeEspecialista en Anestesia Cardiotorácicaspa
dc.creator.degreetypeFull timespa
dc.date.accessioned2020-07-29T23:46:10Z
dc.date.available2020-07-29T23:46:10Z
dc.date.created2020-07-16
dc.descriptionIntroducción: La revascularización miocárdica es la cirugía cardíaca más frecuente, la sensibilidad a heparina y los efectos anticoagulantes de la protamina están relacionados con el sangrado peri-operatorio. Objetivo: Establecer la relación protamina-heparina y el sangrado postoperatorio según la sensibilidad a heparina de pacientes llevados a revascularización miocárdica bajo circulación extracorpórea (CEC) en la Fundación Cardioinfantil. Materiales y Métodos: Se analizaron los datos de una cohorte de pacientes llevados a revascularización miocárdica bajo CEC en la Fundación Cardioinfantil entre enero y julio 2019. Se clasificaron en grupos de acuerdo a la sensibilidad a heparina y se exploraron las variables de interés. Resultados: La cohorte está constituida por 82 pacientes, 34 pacientes se categorizaron en el grupo de sensibilidad reducida, 41 intermedia y 7 con hipersensibilidad a heparina; fueron similares en cuanto a edad, género, IMC, ASA, uso de técnicas de ahorro sanguíneo, tiempo de CEC y tiempo de clampeo aórtico. Se usó una dosis total de heparina mayor en el grupo sensibilidad reducida, con mayor requerimiento de transfusión durante cirugía. El 87,8% de los pacientes presentó una relación protamina: heparina menor a 1:1. Se evidenció un sangrado postoperatorio con requerimiento transfusional mayor en el grupo sensibilidad intermedia, probablemente asociado a un ACT final postprotamina más alto. Conclusión: Una relación protamina: heparina menor a 1:1 en esta cohorte podría explicar un menor sangrado en los grupos de sensibilidad reducida e hipersensibilidad, aunque impresiona ser insuficiente para el grupo de sensibilidad intermedia a la heparina.spa
dc.description.abstractIntroduction: Coronary bypass is the most frequent cardiac surgery; individual heparin sensitivity and the anticoagulant effects of Protamine and this impact on perioperative bleeding have been reported. Objective: To establish the relationship between heparin sensitivity, Protamine: Heparin ratio and postoperative blood loss in patients undergoing coronary bypass on pump at the Fundacion Cardioinfantil. Methods: We analyze data from a adults cohort taken to coronary bypass (BCP) at Fundación cardioinfantil between january an july 2019; were classified into heparin sensitivity groups and was explored the interest variables. Results: Eighty two patients taken a coronary bypass on BCP, thirty four patients had reduced sensitivity, forty one had intermediate sensitivity and seven had heparin hypersensitivity, they were similar in terms of age, sex, body mass index, ASA, blood saving techniques, BCP time and aortic clamping time. A higher total heparin dose was used in the reduced sensitivity group, with a higher transfusion requirement during surgery. 87.8% of the patients presented a protamine: heparin ratio de less than 1:1. Postoperative bleeding with a higher transfusion requirement was evident in the intermediate sensitivity group, probably associated with a higher post-protamin final ACT. Conclusion: the protamine: Heparin ratio less than 1:1 in this cohort could explain less bleeding in the groups with reduced sensitivity and hypersensitivity, although the impression is insufficient for the group with intermediate sensitivity to heparin.spa
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dc.identifier.doihttps://doi.org/10.48713/10336_25574
dc.identifier.urihttps://repository.urosario.edu.co/handle/10336/25574
dc.language.isospaspa
dc.publisherUniversidad del Rosariospa
dc.publisher.departmentFacultad de Medicinaspa
dc.publisher.programEspecialización en Anestesia Cardiotorácicaspa
dc.rightsAtribución-SinDerivadas 2.5 Colombiaspa
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.rights.accesoAbierto (Texto Completo)spa
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dc.source.instnameinstname:Universidad del Rosariospa
dc.source.reponamereponame:Repositorio Institucional EdocURspa
dc.subjectSensibilidad a la heparinaspa
dc.subjectProtaminaspa
dc.subjectSangradospa
dc.subjectRevascularización miocárdicaspa
dc.subject.ddcFarmacología & terapéuticaspa
dc.subject.keywordPharmacogenomic variantsspa
dc.subject.keywordHeparinspa
dc.subject.keywordProtaminespa
dc.subject.keywordPostoperative hemorrhagespa
dc.subject.keywordCoronary artery bypassspa
dc.titleSensibilidad a la Heparina, reversión y sangrado en revascularización miocárdica: estudio de cohorte, Fundación Cardioinfantil, 2019spa
dc.title.TranslatedTitleHeparin sensitivity, protamine management and postoperative hemorrhage in coronary bypass: cohort study, Fundación Cardioinfantil, 2019eng
dc.typemasterThesiseng
dc.type.documentDescriptivo observacional retrospectivospa
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
dc.type.spaTrabajo de gradospa
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