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Siglas y abreviaturas: AASLD — American Association for the Study of Liver Diseases, ACG — American College of Gastroenterology, ACOD — anticoagulantes orales directos, AFP — α-fetoproteína, APTT (activated partial thromboplastin time) — tiempo de tromboplastina parcial activado, AVK — antagonista de la vitamina K, HBPM — heparina de bajo peso molecular, HNF — heparina no fraccionada, RMN — resonancia magnética nuclear, SBC — síndrome de Budd-Chiari, TC — tomografía computarizada, TIPS (transjugular intrahepatic portosystemic shunt) — derivación portosistémica intrahepática transyugular
Introducción
Las enfermedades de la vena porta y las venas hepáticas tienen una importancia clínica considerable, puesto que pueden desembocar en insuficiencia hepática aguda, enfermedad hepática crónica e hipertensión portal, con las complicaciones que esta conlleva. Desgraciadamente, la literatura disponible sobre el manejo de las enfermedades vasculares hepáticas es bastante limitada. En los últimos 2 años, el American College of Gastroenterology (ACG)1 y la American Association for the Study of Liver Diseases (AASLD)2 han publicado documentos sobre las enfermedades vasculares hepáticas y los trastornos de la coagulación en las enfermedades hepáticas. El ACG1 ha elaborado unas guías mediante la metodología GRADE. Las recomendaciones se han clasificado como fuertes [F] o débiles [D], mientras que la calidad de los datos en los que se han basado se ha clasificado en alta [A], moderada [M], baja [B] o muy baja [MB]. Desgraciadamente, la mayoría de las recomendaciones son débiles, con una calidad de datos baja o muy baja. Los expertos de la AASLD han publicado indicaciones de manejo, ya que han considerado que el número de ensayos clínicos aleatorizados (ECA) es insuficiente para elaborar unas guías. En este artículo, redactado a partir de los documentos mencionados del ACG y la AASLD, se presentan las recomendaciones e indicaciones sobre la trombosis de la vena porta y las venas hepáticas (fig. 1).
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