TRATAMIENTO DE TROMBOSIS VENOSA

1. ANTICOAGULACIÓN EN
TROMBOSIS VENOSA
Andrés Ricardo Tangua Arias
R1 Medicina Familiar – Universidad del Valle

2. TVP PROXIMAL: Iliaca, femoral,
poplítea
TVP DISTAL: Pantorrilla (Peronea, tibial
posterior, gastrocnemio, sóleo)
SUPERFICIAL

3. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

5. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

6. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.
¿CUÁNDO ESTUDIAR AL PACIENTE?
No tamizar para trombofilias al paciente en el periodo agudo y tampoco si está recibiendo
heparina, Warfarina o DOAC
Evaluar 2 semanas luego de suspender Warfarina o al menos 3 días sin recibir DOAC
Recuerde que la actividad de la proteína C, S y el anticoagulante lúpico son afectados por la
Warfarina y los DOAC

8. FASE INICIAL
Hasta 10 días
Alcanzar rápidamente la anticoagulación
Prevenir la propagación de la TVP y el
desarrollo de PE
FASE PRINCIPAL DE TRATAMIENTO
3 meses
Mantener niveles de anticoagulación
Prevenir recurrencias tempranas de TVP
FASE DE TRATAMIENTO EXTENDIDO
Luego de 3 meses
Para pacientes de alto riesgo pare
prevención de recurrencias
Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

9. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

10. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

11. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

12. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

13. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.
DABIGATRAN
• Dosis 150 mg b.d
• Iniciar luego de 5 días de anticoagulación
parenteral
Usar dosis 110 mg b.d en:
- Mayores de 80 años
- Uso de verapamil
- TFG 30-50 ml
- Riesgo incrementado de sangrado
Contraindicado en TFG menor a 30 ml/min

14. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

15. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.
APIXABAN
• No requiere tiempo de anticoagulación
parenteral previo
• Iniciar con 10 mg b.d. por 7 días seguido de
la dosis estándar de 5 mg b.d.
• No requiere ajuste en insuficiencia renal
• Pero usar con precaución en TFG entre 15-
30 ml/min
• Contraindicado en TFG menor a 15 ml/min
• Dosis de 2.5 b.d puede ser usado en terapia
extendida

16. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.
RIVAROXABAN
• No requiere tiempo de anticoagulación
parenteral
• Iniciar a dosis de 15 mg b.d por tres semanas
seguido de dosis 20 mg al dia
• No requiere ajuste para TFG 15-49 ml/min y se
puede usar dosis de 15 – 20 mg dependiendo de
la individualización del paciente y el riesgo de
sangrado o de tromboembolismo
• Tomar con las comidas mejora la disponibilidad
• Dosis 10 mg utilizada en terapia extendida

17. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.
ANDEXANET
Actualmente sólo disponible en USA y Europa
Estudio ANNEXA-4
Reversión de anticoagulantes con acción sobre Xa
En dosis luego de 8 horas o de 5 mg apixaban o
10 mg rivaroxabán: Usar infusión 400 mg a
30mg/min seguido de infusión 4 mg/min por 120
min
En dosis antes de 8 horas y dosis plena de 10 mg
apixaban o 20 mg rivaroxabán. Usar 800 mg a 30
mg/min seguido de infusión 8 mg/min por 120
min

18. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

22. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

23. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

25. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

26. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.
CATCH UP

30. MODELOS DE PREDICCION DEL RIESGO DE VTE
https://cemsiis.meduniwien.ac.at/en/kb/science-
research/software/webtools/recurrent-vte/#calc-
params
https://www.mdcalc.com/herdoo2-rule-discontinuing-
anticoagulation-unprovoked-vte#evidence

31. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

32. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

33. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.
MANEJO DE LAS RECURRENCIAS

34. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

35. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

36. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

37. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

38. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

39. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

40. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

41. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

42. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

43. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

44. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.
TROMBOSIS VENOSA PROFUNDA DISTAL (CALF DVT)
Afecta:
- Vena peronea
- Vena tibial posterior
- Vena gastrocnemia
- Vena solea
Mayor frecuencia de asociación con factores transitorios
como cirugía reciente, inmovilización por fractura de
extremidad, viaje

45. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

46. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

47. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

48. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

49. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.
TROMBOSIS VENOSA SUPERFICIAL
Resulta de un trauma afectando venas varicosas o también
de forma espontánea
El estasis venoso puede resultar en extensión de la trombosis
al sistema venosos profundo

50. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

64. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

65. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

66. Kakkos S, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black S et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on
the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.

67. GRACIAS