[Oral anticoagulant treatment]. / EL tratamiento anticoagulante oral.

Oral anticoagulant treatment is a preventive measure against thromboembolic disease; while this measure has very beneficial aspects, it is not exempt from risks since it has a few peculiar characteristics such as possible hemorrhages. The increasing number of patients who require anticoagulant medicine means that nurses may have to treat these patients in any forum where nurses work and therefore nurses need to know the traits this treatment measure entails. This article reviews the general characteristics of anticoagulant treatment and nurses' role in controlling this treatment.

El tratamiento anticoagulante oral / Oral anticoagulant treatment

La anticoagulación oral supone un tratamiento preventivo contra la enfermedad tromboembólica, muy beneficioso pero no exento de cierto riesgo ya que tiene unas características peculiares, como la posibilidad de originar hemorragias. El creciente número de pacientes anticoagulados hace que Enfermería pueda tener que prestarles cuidados en cualquiera de sus ámbitos de actuación y necesite conocer las particularidades de este tratamiento. Este artículo realiza un repaso por las generalidades del tratamiento anticoagulante oral y la función de enfermería en su control(AU)

Oral anticoagulant treatment is a preventive measure against thrombo-embolic disease; while this measure has very beneficial aspects, it is not exempt from risks since it has a few peculiar characteristics such as possible hemorrhages. The increasing number of patients who require anticoagulant medicine means that nurses may have to treat these patients in any forum where nurses work and therefore nurses need to know the traits this treatment measure entails. This article reviews the general characteristics of anticoagulant treatment and nurses’ role in controlling this treatment(AU)

Control de anti coagulación oral en una planta de cirugía cardiaca / Oral Anticoagulation Control in a cardiac surgery ward

En pacientes sometidos a cirugía cardiaca, especialmente valvular, es preciso realizar frecuentes controles de anticoagulación durante su hospitalización. Se plantea si es fiable hacerlo con un coagulómetro portátil que, a priori, puede suponer ventajas en la atención. Para determinarlo, se evalúa la concordancia entre las mediciones obtenidas con este dispositivo y las de laboratorio. Se comparan los INR (Tiempo de protrombina, Ratio Internacional Normalizada) de 106 pares de muestras sanguíneas simultáneas, venosa y capilar, obtenidas de 60 pacientes anticoagulados, ingresados en la unidad de cirugía cardiaca del hospital La Fe, tras ser intervenidos. Las muestras venosas se procesaron en el laboratorio de hemostasia y las capilares con un coagulómetro portátil CoaguChek(r) S de Roche. Los análisis estadísticos aplicados fueron el coeficiente de Pearson, el coeficiente de correlación intraclase (CCI) y el método de la media de las diferencias (MMD). Se tienen en cuenta las cifras de hematocrito y la terapia combinada con heparina. Los resultados muestran, para el conjunto de los datos, un grado de acuerdo muy bueno, CCI=0,939 (intervalo de confianza [IC] del 95%=0,902-0,961) y unas cifras MMD <10%. Para hematocritos <32, la concordancia disminuye, CCI=0,876 (IC 95%=0,787-0,930). Se concluye que nuestro coagulómetro es fiable, por lo que su uso permitiría mejorar la atención del paciente anticoagulado durante su estancia en la planta (obtener resultados inmediatos, menor traumatismo en la extracción, etc.). Sin embargo, en los casos de hematocritos bajos es más prudente el empleo de resultados de laboratorio(AU)

In patients who undergo cardiac surgery, particularly valvular surgery, it is essential to carry out frequent anticoagulation controls during their hospital stay. The author questions if it is viable to carry out these controls by means of a portable coagulation meter which, in principle, can provide advantages in patient care. To determine this viability, the author evaluates the concordance between the measurements obtained with this device and measurements taken in a laboratory. The author compared the INR (prothrombin time, Normalized International Ratio) in 106 pairs of simultaneous blood samples, from both veins and capillaries, taken from 60 patients receiving anticoagulation medicine hospitalized in the cardiac surgery ward at the La Fe Hospital after each underwent surgery. The samples taken from veins were processed in a hemostasia laboratory, while the capillary samples were processed with a portable coagulation meter, a Roche CoaguChek(r) S. The statistical analyses applied were Pearson coefficient, intraclass correlation coefficient (CCI) and the method for mean differences (MMD). Numbers for hemocytes and therapy combined with heparine were taken into account. The results showed, in the overall analysis of data, a very good degree of concordance, CCI=0,939 (confidence interval, IC=95%, 0.902-0.961) and MMD numbers <10%. For hemocytes <32, the concordance decreases, CCI=0.876 (IC 95%=0.787-0.930). The author concludes that this coagulation meter is trustworthy, therefore using it would improve care for a patient needing anti-coagulation treatment during his/her stay in the ward since using this meter helps to obtain immediate results and reduces the trauma when extracting blood samples, etc. Nonetheless, when dealing with patients having a low hemocyte level, it is more prudent to make use of laboratory results(AU)