Utilidad de la midodrina para el control del síncope vasovagal: ¿la evidencia la recomienda?
Usefulness of midodrine for the control of recurrent vasovagal syncope: does the evidence recommend it?
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Introducción: El sincope vasovagal es la principal causa de perdida transitoria de la consciencia, siendo un motivo de consulta cada vez más frecuente en pediatría y medicina del adulto. Midodrina, es un agonista de los receptores alfa, de acción periférica, empleado principalmente en el manejo de la hipotensión ortostática. Sin embargo, ha sido evaluado también en sincope vasovagal, con resultados prometedores.
Objetivo: Analizar la evidencia más reciente sobre la utilidad de la midodrina para el control y prevención del sincope vasovagal.
Materiales y Métodos: Se realizó una búsqueda bibliográfica utilizando términos de búsqueda como “Vasovagal Syncope” y “Midodrine”, así como sinónimos, que se combinaron con operadores booleanos, en 5 bases de datos, hasta octubre del 2022. Se incluyeron estudios originales, revisiones sistemáticas y meta-análisis, publicados tanto en ingles como español.
Resultados: Ensayos controlados aleatorizados y revisiones sistemáticas y meta-análisis difieren ligeramente entre resultados, pero estos demuestran un efecto global protector. La evidencia más reciente y completa, demuestra que utilizar este agente, reduce significativamente la probabilidad de positividad al realizar la prueba de mesa inclinada y, previene la aparición de episodios sincopales.
Conclusiones: Aunque la evidencia actual sobre la eficacia de midodrina respecto a la prevención y control del síncope vasovagal es limitada, se observa un efecto protector significativo, reduciendo el riesgo de sufrir episodio sincopal aproximadamente hasta en un 50%.
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