Reversión de anticoagulantes orales directos: una perspectiva desde urgencias

El sangrado en contexto de anticoagulación es uno de los riesgos que tienen ciertos pacientes durante determinados tratamientos, y es potencialmente mortal. Es importante conocer la farmacocinética de estas moléculas para predecir cuál será su comportamiento. Además se requiere juicio clínico en tod...

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Autores:: Zuluaga Gómez, Mateo
Zuluaga Arbeláez, Nicolás
Berrouet Mejía, Marie Claire
Estrada Atehortúa, Andrés Felipe

Tipo de recurso:: Article of investigation

Fecha de publicación:: 2020

Institución:: Universidad Autónoma de Bucaramanga - UNAB

Repositorio:: Repositorio UNAB

Idioma:: spa

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dc.title.spa.fl_str_mv	Reversión de anticoagulantes orales directos: una perspectiva desde urgencias
dc.title.translated.eng.fl_str_mv	Reversion of direct oral anticoagulants: an outlook from the emergency ward
dc.title.translated.por.fl_str_mv	Reversão de anticoagulantes orais diretos: Uma perspectiva da emergência
title	Reversión de anticoagulantes orales directos: una perspectiva desde urgencias
spellingShingle	Reversión de anticoagulantes orales directos: una perspectiva desde urgencias Anticoagulantes directos Sangrado Idarucizumab Andexanet Medicamentos hemoderivados Medical sciences Life sciences Direct anticoagulants Bleeding Idarucizumab Andexanet Blood-derivative drugs Medical sciences Life sciences Health sciences Anticoagulantes diretos Sangramento Idarucizumabe Andexanet Ciências médicas Ciências da vida Ciências da saúde Ciencias médicas Ciencias de la vida Ciencias de la salud
title_short	Reversión de anticoagulantes orales directos: una perspectiva desde urgencias
title_full	Reversión de anticoagulantes orales directos: una perspectiva desde urgencias
title_fullStr	Reversión de anticoagulantes orales directos: una perspectiva desde urgencias
title_full_unstemmed	Reversión de anticoagulantes orales directos: una perspectiva desde urgencias
title_sort	Reversión de anticoagulantes orales directos: una perspectiva desde urgencias
dc.creator.fl_str_mv	Zuluaga Gómez, Mateo Zuluaga Arbeláez, Nicolás Berrouet Mejía, Marie Claire Estrada Atehortúa, Andrés Felipe
dc.contributor.author.none.fl_str_mv	Zuluaga Gómez, Mateo Zuluaga Arbeláez, Nicolás Berrouet Mejía, Marie Claire Estrada Atehortúa, Andrés Felipe
dc.subject.spa.fl_str_mv	Anticoagulantes directos Sangrado Idarucizumab Andexanet Medicamentos hemoderivados
topic	Anticoagulantes directos Sangrado Idarucizumab Andexanet Medicamentos hemoderivados Medical sciences Life sciences Direct anticoagulants Bleeding Idarucizumab Andexanet Blood-derivative drugs Medical sciences Life sciences Health sciences Anticoagulantes diretos Sangramento Idarucizumabe Andexanet Ciências médicas Ciências da vida Ciências da saúde Ciencias médicas Ciencias de la vida Ciencias de la salud
dc.subject.keywords.eng.fl_str_mv	Medical sciences Life sciences Direct anticoagulants Bleeding Idarucizumab Andexanet Blood-derivative drugs Medical sciences Life sciences Health sciences
dc.subject.keywords.por.fl_str_mv	Anticoagulantes diretos Sangramento Idarucizumabe Andexanet Ciências médicas Ciências da vida Ciências da saúde
dc.subject.lemb.spa.fl_str_mv	Ciencias médicas Ciencias de la vida
dc.subject.proposal.spa.fl_str_mv	Ciencias de la salud
description	El sangrado en contexto de anticoagulación es uno de los riesgos que tienen ciertos pacientes durante determinados tratamientos, y es potencialmente mortal. Es importante conocer la farmacocinética de estas moléculas para predecir cuál será su comportamiento. Además se requiere juicio clínico en todos los casos de sangrado para determinar el manejo de acuerdo a la severidad. El objetivo de esta revisión es presentar un enfoque del paciente anticoagulado con sangrado en el servicio de urgencias. Temas tratados. Farmacocinética y farmacodinámica, generalidades, sangrado mayor y no mayor, opciones de reversión y tratamiento. Conclusión. En presencia de anticoagulantes orales directos (DOACS) se debe evaluar la gravedad del sangrado y el grado de anticoagulación, pues las estrategias de manejo se orientan dependiendo de si se trata de un sangrado mayor o menor.
publishDate	2020
dc.date.issued.none.fl_str_mv	2020-07-08
dc.date.accessioned.none.fl_str_mv	2024-07-23T20:30:40Z
dc.date.available.none.fl_str_mv	2024-07-23T20:30:40Z
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dc.relation.references.none.fl_str_mv	Chen A, Stecker E, A Warden B. Direct Oral Anticoagulant Use: A Practical Guide to Common Clinical Challenges. JAm Heart Assoc [Internet]. 2020 Jun 15 [citado 2020 Jun 27];e017559. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/32538234 Ho KH, Van Hove M, Leng G. Trends in anticoagulant prescribing: A review of local policies in English primary care [Internet]. Vol. 20, BMC Health Services Research. BioMed Central Ltd.; 2020 [citado 2020 Jun 27]. p. 279. https://doi.org/10.1186/s12913-020- 5058-1 Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: A meta-analysis of randomised trials. Lancet [Internet]. 2014 [citado 2020 Jun 27];383(9921):955-62. https:// doi.org/10.1016/S0140-6736(13)62343-0 Providência R, Grove EL, Husted S, Barra S, Boveda S, Morais J. A meta-analysis of phase III randomized controlled trials with novel oral anticoagulants in atrial fibrillation: Comparisons between direct thrombin inhibitors vs. factor Xa inhibitors and different dosing regimens. Thromb Res [Internet]. 2014 Dec 1 [citado 2020 Jun 28];134(6):1253-64. https://doi. org/10.1016/j.thromres.2014.10.002 Blech S, Ebner T, Ludwig-Schwellinger E, Stangier J, Roth W. The metabolism and disposition of the oral direct thrombin inhibitor, dabigatran, in humans. Drug Metab Dispos [Internet]. 2008 Feb [citado 2020 Jun 28];36(2):386-99. https://doi.org/10.1124/ dmd.107.019083 Stangier J. Clinical pharmacokinetics and pharmacodynamics of the oral direct thrombin inhibitor dabigatran etexilate [Internet]. Vol. 47, Clinical Pharmacokinetics. Clin Pharmacokinet; 2008 [citado 2020 Jun 28]. p. 285-95. https://doi. org/10.2165/00003088-200847050-00001 Eriksson BI, Quinlan DJ, Weitz JI. Comparative pharmacodynamics and pharmacokinetics of oral direct thrombin and factor Xa inhibitors in development [Internet]. Vol. 48, Clinical Pharmacokinetics. Clin Pharmacokinet; 2009 [citado 2020 Jun 28]. p. 1-22. https://doi.org/10.2165/0003088-200948010-00001 Cui Y, Song Y, Wang J, Yu Z, Schuster A, Barrett YC, et al. Single- and multiple-dose pharmacokinetics, pharmacodynamics, and safety of apixaban in healthy Chinese subjects. Clin Pharmacol Adv Appl [Internet]. 2013 Dec 6 [citado 2020 Jun 28];5:177-84. Disponible en: /pmc/articles/PMC3861362/?report=abstract He K, Luettgen JM, Zhang D, He B, Grace JE, Xin B, et al. Preclinical pharmacokinetics and pharmacodynamics of apixaban, a potent and selective factor Xa inhibitor. Eur J Drug Metab Pharmacokinet [Internet]. 2011 Sep [citado 2020 Jun 28];36(3):129- 39. https://doi.org/10.1007/s13318-011-0037-x Tamargo J. Edoxabán. Propiedades farmacocinéticas y farmacodinámicas. Rev Esp Cardiol Supl [Internet]. 2016 Jan 1 [citado 2020 Jun 26];16:60-6. https://doi. org/10.1016/S1131-3587(16)30017-6 Tomaselli GF, Mahaffey KW, Cuker A, Dobesh PP, Doherty JU, Eikelboom JW, et al. 2017 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol [Internet]. 2017 Dec 19 [citado 2020 Jun 28];70(24):3042-67. https://doi.org/10.1016/j. jacc.2017.09.1085 Schulman S, Kearon C. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients [Internet]. Vol. 3, Journal of Thrombosis and Haemostasis. J Thromb Haemost; 2005 [citado 2020 Jun 27]. p. 692-4. https:// doi.org/10.1111/j.1538-7836.2005.01204.x Samuelson BT, Cuker A, Siegal DM, Crowther M, Garcia DA. Laboratory Assessment of the Anticoagulant Activity of Direct Oral Anticoagulants: A Systematic Review. Chest [Internet]. 2017 Jan 1 [citado 2020 Jun 27];151(1):127-38. https://doi. org/10.1016/j.chest.2016.08.1462 Shih AW, Crowther MA. Reversal of direct oral anticoagulants: A practical approach. Hematology [Internet]. 2016 [citado 2020 Jun 28];2016(1):612-9. https://doi.org/10.1182/asheducation-2016.1.612 Syed YY. Idarucizumab: A review as a reversal agent for dabigatran [Internet]. Vol. 16, American Journal of Cardiovascular Drugs. Springer International Publishing; 2016 [citado 2020 Jun 28]. p. 297-304. https://doi.org/10.1007/s40256-016-0181-4 Pollack C V., Reilly PA, Eikelboom J, Glund S, Verhamme P, Bernstein RA, et al. Idarucizumab for Dabigatran Reversal. N Engl J Med [Internet]. 2015 Aug 6 [citado 2020 Jun 28];373(6):511-20. https://doi. org/10.1056/NEJMoa1502000 Khadzhynov D, Wagner F, Formella S, Wiegert E, Moschetti V, Slowinski T, et al. Effective elimination of dabigatran by haemodialysis: A phase I single- centre study in patients with end-stage renal disease. Thromb Haemost [Internet]. 2013 Feb 7 [citado 2020 Jun 28];109(4):596-605. https://doi.org/10.1160/ TH12-08-0573 Siegal DM. Managing target-specific oral anticoagulant associated bleeding including an update on pharmacological reversal agents. J Thromb Thrombolysis [Internet]. 2015 [citado 2020 Jun 28];39(3):395-402. https://doi.org/10.1007/s11239- 015-1167-9 Crowther M, Crowther MA. Antidotes for novel oral anticoagulants: Current status and future potential. Arterioscler Thromb Vasc Biol [Internet]. 2015 agosto 25 [citado 2020 Jun 28];35(8):1736-45. https://doi. org/10.1161/ATVBAHA.114.303402 Eerenberg ES, Kamphuisen PW, Sijpkens MK, Meijers JC, Buller HR, Levi M. Reversal of rivaroxaban and dabigatran by prothrombin complex concentrate: A randomized, placebo-controlled, crossover study in healthy subjects. Circulation [Internet]. 2011 Oct 4 [citado 2020 Jun 28];124(14):1573-9. https://doi. org/10.1161/CIRCULATIONAHA.111.029017 M L, KT M, CF C, D K, SD B, SZ G, et al. Comparison of Three-Factor and Four-Factor Prothrombin Complex Concentrates Regarding Reversal of the Anticoagulant Effects of Rivaroxaban in Healthy Volunteers. J Thromb Haemost [Internet]. 2014 [citado 2020 Jun 28];12(9). https://doi.org/10.1111/jth.12599 Zahir H, Brown KS, Vandell AG, Desai M, Maa JF, Dishy V, et al. Edoxaban effects on bleeding following punch biopsy and reversal by a 4-factor prothrombin complex concentrate. Circulation [Internet]. 2015 [citado 2020 Jun 28];131(1):82-90. https://doi. org/10.1161/CIRCULATIONAHA.114.013445
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dc.source.spa.fl_str_mv	Vol. 23 Núm. 3 (2020): diciembre 2020 - marzo 2021: Depresión, Infecciones Urinarias, Agotamiento Profesional; 483-490
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spelling	Zuluaga Gómez, Mateocad6d9dc-ce73-49fb-9dad-b14ba33f79f0Zuluaga Arbeláez, Nicolás21bcc417-fc51-429d-828d-296ff741ea14Berrouet Mejía, Marie Clairea267971f-6c0d-41a2-b24d-d152c4723cf6Estrada Atehortúa, Andrés Felipe7868fd5e-0a43-4235-b567-77f6cbe7327e2024-07-23T20:30:40Z2024-07-23T20:30:40Z2020-07-08i-ISSN 0123-7047e-ISSN 2382-4603http://hdl.handle.net/20.500.12749/25681instname:Universidad Autónoma de Bucaramanga UNABreponame:Repositorio Institucional UNABrepourl:https://repository.unab.edu.cohttps://doi.org/10.29375/01237047.3841El sangrado en contexto de anticoagulación es uno de los riesgos que tienen ciertos pacientes durante determinados tratamientos, y es potencialmente mortal. Es importante conocer la farmacocinética de estas moléculas para predecir cuál será su comportamiento. Además se requiere juicio clínico en todos los casos de sangrado para determinar el manejo de acuerdo a la severidad. El objetivo de esta revisión es presentar un enfoque del paciente anticoagulado con sangrado en el servicio de urgencias. Temas tratados. Farmacocinética y farmacodinámica, generalidades, sangrado mayor y no mayor, opciones de reversión y tratamiento. Conclusión. En presencia de anticoagulantes orales directos (DOACS) se debe evaluar la gravedad del sangrado y el grado de anticoagulación, pues las estrategias de manejo se orientan dependiendo de si se trata de un sangrado mayor o menor.Bleeding in the context of anticoagulation is one of the risks faced by some patients during certain treatments, and is potentially deadly. It is important to be aware of the pharmacokinetics of these molecules in order to predict their behavior. Clinical judgment is also required in all cases of bleeding, because management will depend on its severity. The purpose of this review is to present an approach to an anticoagulated patient with bleeding in the emergency ward. Topics Discussed. Pharmacokinetics and pharmacodynamics, generalities, major and non- major bleeding, reversal options and treatment. Conclusion. If direct oral anticoagulants (DOACS) are present, it is necessary to assess the severity of bleeding and the degree of anticoagulation, because the management treatment depends on whether bleeding is major or minor.O sangramento no contexto da anticoagulação é um dos riscos que alguns pacientes apresentam durante certos tratamentos e é potencialmente fatal. É importante conhecer a farmacocinética dessas moléculas para prever qual será o seu comportamento. Além disso, o julgamento clínico é necessário em todos os casos de sangramento para determinar o manejo de acordo com a gravidade. O objetivo desta revisão é apresentar uma abordagem do paciente anticoagulado com sangramento no departamento de emergência. Tópicos abordados. Farmacocinética e farmacodinâmica, visão geral, sangramento maior e não maior, opções de reversão e tratamento. Conclusão. Na presença de anticoagulantes orais diretos (DOACS), a gravidade do sangramento e o grau de anticoagulação devem ser avaliados, uma vez que são orientadas as estratégias de manejo de acordo com o sangramento, se for maior ou menorapplication/pdfspahttps://revistas.unab.edu.co/index.php/medunab/article/view/3841/3358https://revistas.unab.edu.co/index.php/medunab/issue/view/264Chen A, Stecker E, A Warden B. Direct Oral Anticoagulant Use: A Practical Guide to Common Clinical Challenges. JAm Heart Assoc [Internet]. 2020 Jun 15 [citado 2020 Jun 27];e017559. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/32538234Ho KH, Van Hove M, Leng G. Trends in anticoagulant prescribing: A review of local policies in English primary care [Internet]. Vol. 20, BMC Health Services Research. BioMed Central Ltd.; 2020 [citado 2020 Jun 27]. p. 279. https://doi.org/10.1186/s12913-020- 5058-1Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: A meta-analysis of randomised trials. Lancet [Internet]. 2014 [citado 2020 Jun 27];383(9921):955-62. https:// doi.org/10.1016/S0140-6736(13)62343-0Providência R, Grove EL, Husted S, Barra S, Boveda S, Morais J. A meta-analysis of phase III randomized controlled trials with novel oral anticoagulants in atrial fibrillation: Comparisons between direct thrombin inhibitors vs. factor Xa inhibitors and different dosing regimens. Thromb Res [Internet]. 2014 Dec 1 [citado 2020 Jun 28];134(6):1253-64. https://doi. org/10.1016/j.thromres.2014.10.002Blech S, Ebner T, Ludwig-Schwellinger E, Stangier J, Roth W. The metabolism and disposition of the oral direct thrombin inhibitor, dabigatran, in humans. Drug Metab Dispos [Internet]. 2008 Feb [citado 2020 Jun 28];36(2):386-99. https://doi.org/10.1124/ dmd.107.019083Stangier J. Clinical pharmacokinetics and pharmacodynamics of the oral direct thrombin inhibitor dabigatran etexilate [Internet]. Vol. 47, Clinical Pharmacokinetics. Clin Pharmacokinet; 2008 [citado 2020 Jun 28]. p. 285-95. https://doi. org/10.2165/00003088-200847050-00001Eriksson BI, Quinlan DJ, Weitz JI. Comparative pharmacodynamics and pharmacokinetics of oral direct thrombin and factor Xa inhibitors in development [Internet]. Vol. 48, Clinical Pharmacokinetics. Clin Pharmacokinet; 2009 [citado 2020 Jun 28]. p. 1-22. https://doi.org/10.2165/0003088-200948010-00001Cui Y, Song Y, Wang J, Yu Z, Schuster A, Barrett YC, et al. Single- and multiple-dose pharmacokinetics, pharmacodynamics, and safety of apixaban in healthy Chinese subjects. Clin Pharmacol Adv Appl [Internet]. 2013 Dec 6 [citado 2020 Jun 28];5:177-84. Disponible en: /pmc/articles/PMC3861362/?report=abstractHe K, Luettgen JM, Zhang D, He B, Grace JE, Xin B, et al. Preclinical pharmacokinetics and pharmacodynamics of apixaban, a potent and selective factor Xa inhibitor. Eur J Drug Metab Pharmacokinet [Internet]. 2011 Sep [citado 2020 Jun 28];36(3):129- 39. https://doi.org/10.1007/s13318-011-0037-xTamargo J. Edoxabán. Propiedades farmacocinéticas y farmacodinámicas. Rev Esp Cardiol Supl [Internet]. 2016 Jan 1 [citado 2020 Jun 26];16:60-6. https://doi. org/10.1016/S1131-3587(16)30017-6Tomaselli GF, Mahaffey KW, Cuker A, Dobesh PP, Doherty JU, Eikelboom JW, et al. 2017 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol [Internet]. 2017 Dec 19 [citado 2020 Jun 28];70(24):3042-67. https://doi.org/10.1016/j. jacc.2017.09.1085Schulman S, Kearon C. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients [Internet]. Vol. 3, Journal of Thrombosis and Haemostasis. J Thromb Haemost; 2005 [citado 2020 Jun 27]. p. 692-4. https:// doi.org/10.1111/j.1538-7836.2005.01204.xSamuelson BT, Cuker A, Siegal DM, Crowther M, Garcia DA. Laboratory Assessment of the Anticoagulant Activity of Direct Oral Anticoagulants: A Systematic Review. Chest [Internet]. 2017 Jan 1 [citado 2020 Jun 27];151(1):127-38. https://doi. org/10.1016/j.chest.2016.08.1462Shih AW, Crowther MA. Reversal of direct oral anticoagulants: A practical approach. Hematology [Internet]. 2016 [citado 2020 Jun 28];2016(1):612-9. https://doi.org/10.1182/asheducation-2016.1.612Syed YY. Idarucizumab: A review as a reversal agent for dabigatran [Internet]. Vol. 16, American Journal of Cardiovascular Drugs. Springer International Publishing; 2016 [citado 2020 Jun 28]. p. 297-304. https://doi.org/10.1007/s40256-016-0181-4Pollack C V., Reilly PA, Eikelboom J, Glund S, Verhamme P, Bernstein RA, et al. Idarucizumab for Dabigatran Reversal. N Engl J Med [Internet]. 2015 Aug 6 [citado 2020 Jun 28];373(6):511-20. https://doi. org/10.1056/NEJMoa1502000Khadzhynov D, Wagner F, Formella S, Wiegert E, Moschetti V, Slowinski T, et al. Effective elimination of dabigatran by haemodialysis: A phase I single- centre study in patients with end-stage renal disease. Thromb Haemost [Internet]. 2013 Feb 7 [citado 2020 Jun 28];109(4):596-605. https://doi.org/10.1160/ TH12-08-0573Siegal DM. Managing target-specific oral anticoagulant associated bleeding including an update on pharmacological reversal agents. J Thromb Thrombolysis [Internet]. 2015 [citado 2020 Jun 28];39(3):395-402. https://doi.org/10.1007/s11239- 015-1167-9Crowther M, Crowther MA. Antidotes for novel oral anticoagulants: Current status and future potential. Arterioscler Thromb Vasc Biol [Internet]. 2015 agosto 25 [citado 2020 Jun 28];35(8):1736-45. https://doi. org/10.1161/ATVBAHA.114.303402Eerenberg ES, Kamphuisen PW, Sijpkens MK, Meijers JC, Buller HR, Levi M. Reversal of rivaroxaban and dabigatran by prothrombin complex concentrate: A randomized, placebo-controlled, crossover study in healthy subjects. Circulation [Internet]. 2011 Oct 4 [citado 2020 Jun 28];124(14):1573-9. https://doi. org/10.1161/CIRCULATIONAHA.111.029017M L, KT M, CF C, D K, SD B, SZ G, et al. Comparison of Three-Factor and Four-Factor Prothrombin Complex Concentrates Regarding Reversal of the Anticoagulant Effects of Rivaroxaban in Healthy Volunteers. J Thromb Haemost [Internet]. 2014 [citado 2020 Jun 28];12(9). https://doi.org/10.1111/jth.12599Zahir H, Brown KS, Vandell AG, Desai M, Maa JF, Dishy V, et al. Edoxaban effects on bleeding following punch biopsy and reversal by a 4-factor prothrombin complex concentrate. Circulation [Internet]. 2015 [citado 2020 Jun 28];131(1):82-90. https://doi. org/10.1161/CIRCULATIONAHA.114.013445http://creativecommons.org/licenses/by-nc-nd/2.5/co/Abierto (Texto Completo)Atribución-NoComercial-SinDerivadas 2.5 Colombiahttp://purl.org/coar/access_right/c_abf2Vol. 23 Núm. 3 (2020): diciembre 2020 - marzo 2021: Depresión, Infecciones Urinarias, Agotamiento Profesional; 483-490Anticoagulantes directosSangradoIdarucizumabAndexanetMedicamentos hemoderivadosMedical sciencesLife sciencesDirect anticoagulantsBleedingIdarucizumabAndexanetBlood-derivative drugsMedical sciencesLife sciencesHealth sciencesAnticoagulantes diretosSangramentoIdarucizumabeAndexanetCiências médicasCiências da vidaCiências da saúdeCiencias médicasCiencias de la vidaCiencias de la saludReversión de anticoagulantes orales directos: una perspectiva desde urgenciasReversion of direct oral anticoagulants: an outlook from the emergency wardReversão de anticoagulantes orais diretos: Uma perspectiva da emergênciaArticleinfo:eu-repo/semantics/articleArtículohttp://purl.org/coar/resource_type/c_2df8fbb1http://purl.org/coar/resource_type/c_6501http://purl.org/redcol/resource_type/ARThttp://purl.org/coar/version/c_970fb48d4fbd8a85Universidad Autónoma de Bucaramanga UNABFacultad Ciencias de la SaludORIGINALArtículo.pdfArtículo.pdfArtículoapplication/pdf616906https://repository.unab.edu.co/bitstream/20.500.12749/25681/1/Art%c3%adculo.pdfbcee7b0b311941209e359d34ca274e4dMD51open accessLICENSElicense.txtlicense.txttext/plain; charset=utf-8183https://repository.unab.edu.co/bitstream/20.500.12749/25681/2/license.txt737346e09d47a3db691f1370de49426aMD52open accessTHUMBNAILArtículo.pdf.jpgArtículo.pdf.jpgIM Thumbnailimage/jpeg11821https://repository.unab.edu.co/bitstream/20.500.12749/25681/3/Art%c3%adculo.pdf.jpg55a8d2b10a2cbd69a21fb65a3f68a9deMD53open access20.500.12749/25681oai:repository.unab.edu.co:20.500.12749/256812024-07-23 22:01:03.019open accessRepositorio Institucional \| Universidad Autónoma de Bucaramanga - UNABrepositorio@unab.edu.coTGFzIHB1YmxpY2FjaW9uZXMgZGUgbGEgcmV2aXN0YSBNZWRVTkFCIGVzdMOhbiBiYWpvIHVuYSBMaWNlbmNpYSBkZSBBdHJpYnVjacOzbiBkZSBCaWVuZXMgQ29tdW5lcyBDcmVhdGl2b3MgKENyZWF0aXZlIENvbW1vbnMsIENDKSB0aXBvIDQuMCwgY29uIGRlcmVjaG9zIGRlIGF0cmlidWNpw7NuIHkgbm8gY29tZXJjaWFs

Reversión de anticoagulantes orales directos: una perspectiva desde urgencias

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