TY - JOUR AU - Cadena Sanabria, Miguel Oswaldo AU - Pinto, Oscar Mariano AU - Contreras, Juan Fernando AU - Ortega Ramirez, Gustavo Eduardo AU - Bautista Mier, Heider PY - 2017/08/03 Y2 - 2024/03/28 TI - Anticoagulación oral en el adulto mayor frágil con fibrilación auricular JF - MedUNAB JA - MedUNAB VL - 19 IS - 3 SE - Revisión de Tema DO - UR - https://revistas.unab.edu.co/index.php/medunab/article/view/2273 SP - 221-229 AB - <!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Revision>0</o:Revision> <o:TotalTime>0</o:TotalTime> <o:Pages>1</o:Pages> <o:Words>196</o:Words> <o:Characters>1082</o:Characters> <o:Company>VitalGer IPS</o:Company> <o:Lines>9</o:Lines> <o:Paragraphs>2</o:Paragraphs> <o:CharactersWithSpaces>1276</o:CharactersWithSpaces> <o:Version>14.0</o:Version> </o:DocumentProperties> <o:OfficeDocumentSettings> <o:AllowPNG /> </o:OfficeDocumentSettings> </xml><![endif]--> <!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves /> 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mso-para-margin-left:0cm; line-height:107%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-fareast-language:EN-US;} --> <!--[endif] --> <!--StartFragment--><p class="MsoNormal" style="text-align: justify;"><strong>Introducción: </strong>El envejecimiento incrementa el riesgo de trombosis y fenómenos embólicos, trae cambios fisiológicos y comorbilidades como la fibrilación auricular que hacen complejo el inicio y la seguridad de la anticoagulación. A pesar de la mayor disponibilidad de clínicas de anticoagulación y nuevos anticoagulantes orales, es bajo el porcentaje de adultos mayores que están anticoagulados aunque tengan indicación plena y ausencia de contraindicaciones.  <strong>Objetivo: </strong>Revisar las principales estrategias para predecir y disminuir el riesgo de sangrado con el empleo de anticoagulantes orales en pacientes adultos mayores frágiles. <strong>Metodología: </strong>Se realizó una búsqueda sistemática sobre estudios que evaluaran la seguridad y eficacia de anticoagulantes orales en pacientes con fibrilación auricular en adultos mayores de 65 años, y una búsqueda de estudios sobre el síndrome de fragilidad y su impacto en el adulto mayor anticoagulado. <strong>Resultados y Discusión:</strong> Se ha denominado fragilidad al porcentaje de adultos mayores que presentan un mayor deterioro de sus sistemas biológico, físico y cognitivo, conduciendo a una mayor probabilidad de desenlaces adversos en salud, discapacidad y muerte. Se han estudiado características clínicas que permiten identificar pacientes como frágiles; el fenotipo de fragilidad de Linda Fried evalúa esas características; además, existen estrategias de monitoreo de los anticoagulantes orales que deben ser conocidos para minimizar el riesgo de eventos adversos. <strong>Conclusiones: </strong>el anciano frágil presenta factores de riesgo que probablemente afectan la eficacia y seguridad de la terapia con anticoagulantes orales. Las guías clínicas existentes no proveen la suficiente evidencia y no consideran de manera multidimensional al paciente geriátrico. </p><!--EndFragment--> ER -