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El tratamiento de la hemofilia A y B atraviesa un cambio de paradigma, evolucionando desde la terapia de reemplazo tradicional hacia estrategias de no reemplazo. Los anticuerpos anti-TFPI (inhibidor de la vía del factor tisular) son una alternativa terapéutica dentro de estas estrategias. El TFPI es el principal regulador de la fase de iniciación de la coagulación. Su inhibición permite la generación sostenida de trombina de manera independiente de los factores VIII o IX. Este artículo analiza en profundidad dos anticuerpos monoclonales anti-TFPI: concizumab y marstacimab. Ambas terapias ofrecen ventajas críticas: administración subcutánea, farmacocinética estable sin picos ni valles, y universalidad para HA y HB con o sin inhibidores. No obstante, presentan desafíos terapéuticos, incluyendo el riesgo intrínseco de trombosis derivado de interacciones con agentes “bypass” o factores de riesgo basales del paciente. Además, su monitoreo es complejo, ya que el efecto hemostático no se refleja en las pruebas de coagulación de rutina. En conclusión, los agentes anti-TFPI representan una innovación disruptiva que busca normalizar la hemostasia y mejorar la calidad de vida, aunque requieren una vigilancia clínica estrecha y un manejo especializado de eventos intercurrentes.
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Derechos de autor 2026 Daniela Neme