Las guías de práctica clínica del síndrome coronario agudo sin elevación del segmento ST recomiendan la utilización de aspirina, heparina, clopidogrel e inhibidores de la glucoproteína IIb/IIIa asociados con una estrategia invasiva precoz en los pacientes de alto riesgo. Sin embargo, no hay evidencias directas que demuestren la eficacia, la seguridad y la relación coste-efectividad de esta actitud. En pacientes con alto riesgo de desarrollar eventos coronarios y bajo riesgo de sangrado, ésta es una actitud razonable. Sin embargo, una proporción importante de estos pacientes no cumple estos criterios. En estos casos, parece sensato restringir el tratamiento antitrombótico. Para ello, se revisan los aspectos que pueden ayudar a tomar este tipo de decisiones. Éstos pueden ser clínicos, como la edad, el sexo y los antecedentes de insuficiencia renal y diabetes, o logísticos, como la factibilidad de realizar una coronariografía en 48 h o una revascularización quirúrgica en menos de 5 días, al margen de las situaciones urgentes.
Palabras clave
Síndrome coronario agudo sin elevación del segmento ST
Alto riesgo
Fármacos antitrombóticos
Clopidogrel
Inhibidores de la glucoproteína IIb/IIIa
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