Abstract
There is scarce available information on the treatment or prophylaxis with anticoagulant drugs of outpatients with medical diseases and complex clinical conditions. There are no clinical practice guidelines and/or specific recommendations for this patient subgroup, which are frequently treated by internists. Complex clinical conditions are those in which, due to comorbidity, age, vital prognosis or multiple treatment with drugs, a clinical situation arises of disease-disease, disease-drug or drug-drug interactions that is not included within the scenarios that commonly generate the scientific evidence. The objective of this narrative review is collecting and adapting of the clinical guidelines recommendations and systematic reviews to complex clinical conditions, in which the direct application of recommendations based on studies that do not include patients with this complexity and comorbidity could be problematic.La información disponible sobre el tratamiento o profilaxis con fármacos anticoagulantes en pacientes ambulatorios con enfermedades médicas y situaciones clínicas complejas es escasa, y no existen guías de práctica clínica y/o recomendaciones específicas para este subgrupo de sujetos, quienes son frecuentemente atendidos por los internistas. Entendemos por situaciones clínicas complejas aquellas en que por la comorbilidad, edad, pronóstico vital o tratamiento múltiple con fármacos de los pacientes, se configura una situación clínica de interacciones enfermedad-enfermedad; enfermedad-fármaco o fármaco-fármaco que no se incluye dentro de los escenarios sobre los que habitualmente se generan las evidencias científicas. El objetivo de esta revisión narrativa es recopilar y adaptar las recomendaciones de guías clínicas y revisiones sistemáticas a situaciones clínicas complejas, donde puede ser conflictivo la aplicación directa de recomendaciones basadas en estudios que no incorporan a pacientes con dicha complejidad y comorbilidad.
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