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TRATAMIENTO MEDICO DEL DOLOR VENOSO
SON TODAS LAS DROGAS VENOACTIVAS EQUIVALENTES?
Dr. HUGO NAVAS
INSTITUTO CLINICO LA FLORIDA
HOSPITAL DE CLINICAS CARACAS
SIMPOSIO DOLOR Y CALIDAD DE VIDA EN ENFERMEDAD VENOSA
www.clinicadvarices.com
IX CONGRESO NACIONAL DE FLEBOLOGIA Y LINFOLOGIA
DOLOR VENOSOMagnitud del Problema
DOLOR EN PACIENTES CON EVC
CIRCULO VICIOSO HIPERTENSION VENOSA /INFLAMACION
PAIN
LA ENFERMEDAD VENOSA CRONICA
PODEMOS AFIRMAR QUE TIENE EL RANGO DE
ENFERMEDAD INFLAMATORIA
Mecanismos Fisiopatológicos involucrados en el Dolor Venoso
EDEMAINTERACCION LEUCOCITOS ENDOTELIO
DISFUNCION VALVULARESTIMULACION DE NOCICEPTORES
EFECTOS IDEALES PARA UN MEDICAMENTO VENOACTIVO
ANTI-INFLAMATORIOANALGESICOANTI-EDEMATOSOTONIFICANTE DE LA PARED VENOSA
MEDICAMENTO VENOACTIVO IDEALELEMENTOS DIANA
PARED VENOSAVALVULAS VENOSASFILTRACION CAPILARRED LINFATICAPARAMETROS HEMORREOLOGICOS
OBJETIVOS FINALES DEL TRATAMIENTO VENOACTIVO
EVITAR, CONTROLAR O REVERTIR LA HIPOXIA
EVITAR, CONTROLAR O REVERTIR LA HIPERTENSION VENOSA
MEJORAR LOS INDICES DE CALIDAD DE VIDA
MEDICAMENTOS VENOACTIVOS
Nicolaides et al. Int Angiol.2008;27:1-59
Recomendación sobre Tratamiento Medico de la EVC de la Guía AVF/SVS 2011
J. Vasc. Surg 2011;53:2s-48s
RECOMENDACIÓN EVIDENCIA
MEDICAMENTOS VENOACTIVOS DOSIFICACION
Ramelet et al. Phlebology . 5th edition 2008
SON EQUIVALENTES TODOS LOS
MEDICAMENTOS VENOACTIVOS ?
MEDICAMENTOS VENOACTIVOS EVIDENCIA EN EVC Y RECOMENDACIONES
Nicolaides AN, Allegra C, Bergan J, et al. Management of chronic venous disorders of the lower limbs: Guidelines according to cientific evidence. Int Angiol 2008;27:1-59
SON EQUIVALENTES TODAS LAS DROGAS VENOACTIVAS?
METANÁLISIS:Impacto de los medicamentos venoactivos en el dolor venoso y el edema
39 TRABAJOS EVALUADOS ENTRE AÑOS 1975-2000
10 SOLAMENTE COMPLETARON LOS CRITERIOS DE SELECCIÓN
DVA EVALUADAS: MPFF, DIOSMINA, ESTRACTO RUSCUS Y HIDROXIETILRUTOSIDO
NO SE INCLUYÓ EL DOBESILATO DE CALCIO
SON EQUIVALENTES LAS DROGAS VENOACTIVAS ? RESULTADOS
COMPARACION DE LA EFICACIA ENTRE DROGAS VENOACTIVAS
COMPARACION RESULTADOS
DOLOR Y DROGAS VENOACTIVASEVIDENCIA Y RECOMENDACIONES
Nicolaides AN, Allegra C, Bergan J, et al. Management of chronic venous disorders of the lower limbs: Guidelines according to cientific evidence. Int Angiol 2008;27:1-59
RECOMENDACIONES DE DROGAS VENOACTIVAS EN BASE A LA EVIDENCIA
Perrin M, Ramelet AA, Pharmacological treatment of primary chronic venous disease: rationale, results and un answered questions. Eur J Vasc Endovascular Surg 2011;41:117-125
SULODEXIDEEn pacientes con úlcera venosa refractaria y pacientes con enfermedad
arterial asociada Am J Cardiovasc Drugs. 2012 Apr 1;12(2):73-81. doi: 10.2165/11599360-000000000-00000.
Sulodexide in the treatment of chronic venous disease .
Andreozzi GM. Source Angiology Care Unit, University Hospital, Padua, Italy. [email protected] Abstract Chronic venous disease encompasses a range of venous disorders, including those involving the lower limbs resulting from
venous hypertension. The spectrum of chronic venous disease signs and symptoms shows variable severity, ranging from mild (aching, pain, and varicose veins) to severe (venous ulcers). The pathophysiology of chronic venous disease is characterized by venous hypertension, which triggers endothelial dysfunction and inflammation leading to microcirculatory and tissue damage, and eventually to varicose veins and venous ulcers. Sulodexide is an orally active mixture of glycosaminoglycan (GAG) polysaccharides with established antithrombotic and profibrinolytic activity. The agent is used in the treatment of a number of vascular disorders with increased risk of thrombosis, including intermittent claudication, peripheral arterial occlusive disease and post-myocardial infarction. Sulodexide differs from heparin because it is orally bioavailable and has a longer half-life and a smaller effect on systemic clotting and bleeding. An increasing body of preclinical evidence shows that sulodexide also exerts anti-inflammatory, endothelial-protective, and pleiotropic effects, supporting its potential efficacy in the treatment of chronic venous disease. Clinical studies of sulodexide have shown that the agent is associated with significant improvements in the clinical signs and symptoms of venous ulcers, and is therefore a recommended therapy in combination with local wound care and bandages for patients with persistent venous leg ulcers. Preliminary evidence supports the use of sulodexide in the prevention of recurrent deep venous thrombosis. Sulodexide was generally safe and well tolerated in clinical trials, without hemorrhagic complications. Sulodexide therefore appears to be a favorable option for the treatment of all stages of chronic venous disease and for the prevention of disease progression
CONTROL DE SINTOMAS EN PACIENTES CON ULCERAS VENOSAS ESPECIALMENTE EN ULCERAS REFRACTARIAS
EN COMBINACIÓN CON TRATAMIENTO COMPRESIVO
PENTOXIFILINA
PARA AYUDAR A CICATRIZAR LA ULCERA VENOSA
J. Vasc. Surg 2011;53:2s-48s
ANTE LA EVIDENCIA CIENTIFICA DISPONIBLE EN LA ACTUALIDAD
EL TRATAMIENTO DE PRIMERA ELECCION PARA EL CONTROL DEL DOLOR VENOSO DEBE SER:
FRACCION FLAVONOIDE PURIFICADA MICRONIZADA 1000 MGS /DIA
GRACIAS POR SU ATENCION
CAYO DE AGUA, LOS ROQUES VENEZUELA
INSTITUTO DE CIRUGIA EXPERIMENTAL UNIVERSIDAD CENTRAL DE VENEZUELA
CURSOS DE MICROCIRUGIA
TELFS 0212-6053624 0212-6053625
Email: [email protected]
