Ciencias de la Salud

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    TRATAMIENTO ANTICOAGULANTE EN PACIENTES CON FIBRILACIÓN AURICULAR Y ENFERMEDAD RENAL CRÓNICA
    (2025-06-16) Oñate Gutiérrez, Alan Daniel; Sánchez Salazar, Nelly Alexandra; Universidad Técnica de Ambato / Facultad de Ciencias de Salud / Carrera de Medicina
    Introduction. Atrial fibrillation is the most common arrhythmia characterized by premature atrial beats, causing ineffective atrial contraction and promoting thrombus formation. It is associated with chronic kidney disease, where a prothrombotic and prohemorrhagic state coexists, further increasing thromboembolic risk. Treatment with oral anticoagulants is key to preventing thromboembolic events. Objective. To analyze the clinical benefit of oral anticoagulant therapy in patients with non-valvular AF and advanced CKD. Methodology. A bibliographic review was conducted in the MEDLINE/PubMed, Scopus, and ScienceDirect databases. The review included articles published in the last 5 years, open access, and in English or Spanish. Results. The reviewed studies indicate the need to properly stratify thromboembolic and hemorrhagic risk. DOACs are the anticoagulant therapy of choice over warfarin, except in moderate to severe mitral stenoses and in patients with mechanical prosthetic valves. The recommendations and evidence for advanced CKD and dialysis are unclear, especially when CrCl <15 ml/min. Furthermore, factors that could influence therapy, such as the presence of polypharmacy and the assessment of renal function, should be considered. Conclusion. The evidence does not suggest a benefit of oral anticoagulant therapy in preventing thromboembolism in patients with advanced CKD, and alternative non-pharmacological therapies could be chosen.
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    Tromboembolia Pulmonar
    (Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Bayas Azogue, Carolina Estefanía; Córdova Peñaloza, Opilio Dr. ESP.
    Pulmonary embolism (PE) is a condition that could become a cardiovascular emergency, clinical presentation has a broad spectrum, from being asymptomatic to cardiogenic shock or sudden death due to acute right ventricular failure continues. Its diagnosis is based on a set of clinical symptoms and signs within a framework of a series of complementary studies. As pulmonary arterial angiography the gold standar and pulmonary CT angiography a much easier test that surpasses 90% sensitivity and specificity (failure when Microthromb into thin arteries and distal). We report the case of a patient of 68 years, subject to change knee four months ago. Debuts sudden onset epigastric pain accompanied by vomiting brown, diaphoresis, dyspnea on moderate efforts. Physical examination crackles in the lung bases. CXR effacement costodiaphragmatic right angle evidence. EKG narrow QRS complex, turn right, Q with pathological progression with a D Dimer 1780. It was studied and ruled out heart and TEP injury.