Manual práctico de Trombosis y Hemostasia de la SETH

I I I . H E M O ST A S I A E N L A P R Á C T I C A C L Í N I C A — 2 8 2 — condicionan un incremento del riesgo de TEV, el tratamien- to con HBPM o HNF, bien sea a dosis de profilaxis de ele- vado riesgo de TEV o superiores, está plenamente indicado durante la supresión de los AVK. Reinicio de la anticoagulación Las HBPM a dosis de profilaxis pueden ser administradas a partir de las 6 horas del cierre de la herida quirúrgica y en au- sencia de sangrado, siempre que la dosis previa no se hubiese dado < 24 horas antes. Después de procedimientos de moderado o elevado ries- go hemorrágico no se puede administrar una anticoagulación rápidamente efectiva (HBPM, ACOD) a dosis terapéuticas en menos de 24 horas. Ante cirugías de elevado riesgo hemorrágico se recomien- da reiniciar HBPM o ACOD a dosis terapéuticas a los 2-3 días, siempre que se no exista evidencia de sangrado. Los AVK pueden ser administrados desde el primer día puesto que el paciente tardará días en llegar a INR eficaces. 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