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Abstract(s)
INTRODUÇÃO: A fibrilhação auricular é a arrítmica cardíaca mais frequentemente encontrada na prática clínica, conferindo um aumento do risco tromboembólico. A anticoagulação oral diminui o risco de acidentes vasculares nestes pacientes, no entanto está associada a um aumento do risco hemorrágico. O objectivo deste trabalho é quantificar o risco hemorrágico e a taxa de eventos hemorrágicos associados à anticoagulação oral na nossa população e validar na amostra duas escalas de previsão de risco hemorrágico.
METODOLOGIA: Através de uma metodologia epidemiológica analítica foi realizado um estudo retrospectivo, numa amostra de 101 pacientes seleccionados aleatoriamente, para obter a validação de dois modelos de previsão de risco hemorrágico. Foram incluídos pacientes com fibrilhação auricular a realizar tratamento com anticoagulantes orais. Os eventos primários foram os episódios hemorrágicos major, nos quais se incluem hemorragia intracraneana, hemorragia gastrointestinal e necessidade de transfusão de pelo menos duas unidades de concentrado eritrocitário, por hemorragia cuja relação se estabeleceu com a anticoagulação oral.
RESULTADOS: Foram observados 0.87 eventos hemorrágicos major por 100 pacientes-ano, dos quais 0.35 atribuíveis a HGI, 0.17 a transfusão sanguínea e 0.35 a AVC hemorrágico. O tempo médio para a sua ocorrência foi de 1345.8 dias. Utilizando os critérios dos modelos de Shireman e de Gage, observou-se não existir concordância entre as taxas de hemorragia previstas por estes modelos e as observadas neste estudo.
CONCLUSÕES: Um passo evolutivo com base na evidência necessita de ser dado, para que novos estudos acrescentem uma maior capacidade preditiva do risco hemorrágico.
BACKGROUND: Atrial fibrillation is the most common arrhythmia found in clinical practice and it increases the risk of thromboembolic events. Oral anticoagulation reduces the risk of stroke in this patients, yet associated with an increased risk in bleeding events. The purpose is to quantify the bleeding risk and hemorrhagic rates associated with oral anticoagulation and validate two bleeding risk models. METHODS: A retrospective statistical analysis was used in 101 patients randomly selected, in order to validate two bleeding risk scores in our population. Patients were elected if they had diagnosis of atrial fibrillation and were receiving oral anticoagulation. Primary outcomes were intracranial hemorrhage, gastrointestinal hemorrhage and any bleeding related to oral anticoagulation, requiring transfusion of at least two units of red blood cells. RESULTS: It was observed 0.87 primary outcomes per 100 patients-year, of which 0.35 due to gastrointestinal bleeding, 0.17 due to transfusion and 0.35 due to ischaemic stroke. The median time to occur major bleeding was 1345.8 days. According to Shireman’s and Gage criteria, there was no concordance between bleeding events predicted in this models and observed events in our population. CONCLUSIONS: The development of new bleeding risks, based on evidence, needs to be done in order increase the accuracy in predicting bleeding events.
BACKGROUND: Atrial fibrillation is the most common arrhythmia found in clinical practice and it increases the risk of thromboembolic events. Oral anticoagulation reduces the risk of stroke in this patients, yet associated with an increased risk in bleeding events. The purpose is to quantify the bleeding risk and hemorrhagic rates associated with oral anticoagulation and validate two bleeding risk models. METHODS: A retrospective statistical analysis was used in 101 patients randomly selected, in order to validate two bleeding risk scores in our population. Patients were elected if they had diagnosis of atrial fibrillation and were receiving oral anticoagulation. Primary outcomes were intracranial hemorrhage, gastrointestinal hemorrhage and any bleeding related to oral anticoagulation, requiring transfusion of at least two units of red blood cells. RESULTS: It was observed 0.87 primary outcomes per 100 patients-year, of which 0.35 due to gastrointestinal bleeding, 0.17 due to transfusion and 0.35 due to ischaemic stroke. The median time to occur major bleeding was 1345.8 days. According to Shireman’s and Gage criteria, there was no concordance between bleeding events predicted in this models and observed events in our population. CONCLUSIONS: The development of new bleeding risks, based on evidence, needs to be done in order increase the accuracy in predicting bleeding events.
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Keywords
Fibrilhação auricular Fibrilhação auricular - Anticoagulação oral - Risco hemorrágico Anticoagulação oral - Varfarina
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Publisher
Universidade da Beira Interior