Guía de práctica clínica para el diagnóstico y tratamiento de hemofilia en el Seguro Social de Salud del Perú (EsSalud)

Abstract

La hemofilia es un trastorno hemorrágico congénito poco común que requiere un manejo interdisciplinario, complejo, y frecuentemente costoso. La presente guía de práctica clínica provee recomendaciones clínicas basadas en evidencia para el diagnóstico y tratamiento de hemofilia en el Seguro Social de Salud del Perú (EsSalud). Se conformó un grupo elaborador local (GEG-Local) integrado por especialistas en hematología y metodólogos. El GEG-Local formuló ocho preguntas clínicas a ser respondidas por la presente guía. Se buscaron y seleccionaron guías de práctica clínica de hemofilia que respondieran a las preguntas planteadas y obtuvieran un puntaje mayor a 60% en los dominios uno y tres del instrumento Appraisal of Guidelines for Research and Evaluation II (AGREE-II). En base a las preguntas formuladas se desarrollaron 22 recomendaciones (tres recomendaciones fuertes y 19 recomendaciones condicionales) y cuatro flujogramas. Este artículo es el resumen de la guía de práctica clínica realizada, en la cual se valoró la evidencia científica disponible sobre diagnóstico y tratamiento de hemofilia.

Hemophilia is a rare congenital bleeding disorder; which requires interdisciplinary, complex, and often expensive management. The objective of this clinical practice guideline (CPG) is to provide evidence-based clinical recommendations for the evaluation and management of patients with hemophilia in the Peruvian Social Security (EsSalud). Methods. A local elaboration group (GEG-Local) was established, conformed by specialists in hematology and methodologists. The GEG-Local formulated 8 clinical questions to be answered by this CPG. We searched for and selected hemophilia CPGs that answered the questions posed and obtained a score higher than 60% in domains 1 and 3 of the Appraisal of Guidelines for Research and Evaluation II (AGREE-II). During 2016, bibliographic searches were conducted in Pubmed, EMBASE and the Cochrane library, to update 7 clinical questions of the preselected CPG, and to answer a question de novo. In regular work meetings, the GEG-Local reviewed the evidence and formulated the recommendations and flowcharts using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Finally, the CPG was approved with Resolution No. 32-IETSI-ESSALUD-2016. Results. This CPG addressed 8 clinical questions. Based on these questions, 22 recommendations were formulated (three strong recommendations and 19 weak recommendations) and four flowcharts. Conclusion. This article is the summary of the EsSalud CPG, in which the available scientific evidence on the diagnosis and treatment of hemophilia was assessed