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Authors
Advisor(s)
Abstract(s)
Introdução:
A terapia anticoagulante é usada na prevenção de eventos tromboembólicos em doentes sob risco. Esta mostrou-se efetiva na redução do risco de enfarte nestes pacientes. Contudo, é um fator de risco independente para a expansão e morte por hemorragia intracraniana. (1) (2)
O objetivo deste estudo é determinar a prevalência de hematomas cerebrais associados à anticoagulação oral e definir as características clínicas e imagiológicas dos mesmos.
Materiais e metodologia:
Estudo retrospetivo com duração de 5 anos (2008-2012). A amostra em estudo consiste nos doentes internados, por AVC hemorrágico, na unidade de AVC do Centro Hospitalar Cova da Beira durante este período. A análise estatística dos dados foi realizada com recurso ao software IBM SPSS Statistics versão 24.0.
Resultados:
Doentes anticoagulados apresentam uma média de idades estatisticamente superior em relação aos doentes que não faziam terapia anticoagulante/antiagregante. Encontramos maiores percentagens de doença cardiovascular em doentes antiagregados e nestes ocorre atingimento de zonas cerebrais profundas com mais frequência. Já no caso dos doentes anticoagulados, a zona cerebral que é afetada com mais frequência é o córtex. Os parâmetros bioquímicos analisados parecem não sofrer influência do estado de coagulação. O valor INR encontra-se estatisticamente mais elevado no grupo dos anticoagulados.
Verificou-se ainda que nos doentes hipertensos são atingidas zonas cerebrais mais profundas o que acarreta piores resultados funcionais, estando este parâmetro associado a maiores graus de dependência nas atividades de vida diária. Fatores como ressangramento e a presença de hidrocefalia parecem contribuir para maiores percentagens de mortalidade e estão também associados a maiores graus de dependência.
Conclusão:
A terapia anticoagulante pode contribuir para hemorragias cerebrais mais extensas e piores resultados funcionais. Contudo existem outros fatores a ter em linha de conta que podem ter forte influência no desfecho final como é o caso da existência de fatores de risco/ comorbilidades, território vascular afetado e zona cerebral atingida. Dada a importância e eficácia da terapia anticoagulante é importante reconhecermos estes fatores que são na sua maioria passíveis de controlo dado que, na maior parte dos casos, é extremamente difícil ou impossível abdicar desta terapia.
Background: Anticoagulant therapy is used to prevent thromboembolic events in patients at risk. This was shown to be effective in reducing the risk of infarction in these patients. However, it is an independent risk factor for the expansion and death from intracranial haemorrhage. (1) (2) The objective of this study is to determine the prevalence of cerebral hematomas associated with oral anticoagulation and to define their clinical and imaging characteristics. Method and methodology: Retrospective study lasting 5 years (2008-2012). The study sample consists of hospitalized patients, due to hemorrhagic stroke, in the Stroke Unit of Cova da Beira Hospital Center during this period. Statistical analysis of the data was performed using IBM SPSS Statistics software version 24.0. Results: Anticoagulated patients have a statistically higher mean age compared to patients who were not taking anticoagulant therapy. We found higher percentages of cardiovascular disease in antiaggregated patients, and in these cases, deep brain areas are more frequently reached. In anticoagulated patients, the cerebral zone that is most frequently affected is the cortex. The biochemical parameters analyzed do not appear to be influenced by the cogulation state. The INR value is statistically higher in the anticoagulant group. It was also observed that in hypertensive patients, deeper cerebral areas are reached, which leads to worse functional results, being this parameter associated to higher degrees of dependence in daily life activities. Factors such as rebleeding and the presence of hydrocephalus appear to contribute to higher percentages of mortality and are also associated with higher degrees of dependence. Conclusion: Anticoagulant therapy may contribute to more extensive brain hemorrhages and worse functional outcomes. However, there are other factors to take into account that may have a strong influence on the final outcome, such as risk factos/comorbidities, affected vascular territory and the brain area affected. Given the importance and efficacy of anticoagulant therapy, it is important to recognize these factors that are mostly controllable since, in most cases, it is extremely difficult or impossible to abdicate from this therapy.
Background: Anticoagulant therapy is used to prevent thromboembolic events in patients at risk. This was shown to be effective in reducing the risk of infarction in these patients. However, it is an independent risk factor for the expansion and death from intracranial haemorrhage. (1) (2) The objective of this study is to determine the prevalence of cerebral hematomas associated with oral anticoagulation and to define their clinical and imaging characteristics. Method and methodology: Retrospective study lasting 5 years (2008-2012). The study sample consists of hospitalized patients, due to hemorrhagic stroke, in the Stroke Unit of Cova da Beira Hospital Center during this period. Statistical analysis of the data was performed using IBM SPSS Statistics software version 24.0. Results: Anticoagulated patients have a statistically higher mean age compared to patients who were not taking anticoagulant therapy. We found higher percentages of cardiovascular disease in antiaggregated patients, and in these cases, deep brain areas are more frequently reached. In anticoagulated patients, the cerebral zone that is most frequently affected is the cortex. The biochemical parameters analyzed do not appear to be influenced by the cogulation state. The INR value is statistically higher in the anticoagulant group. It was also observed that in hypertensive patients, deeper cerebral areas are reached, which leads to worse functional results, being this parameter associated to higher degrees of dependence in daily life activities. Factors such as rebleeding and the presence of hydrocephalus appear to contribute to higher percentages of mortality and are also associated with higher degrees of dependence. Conclusion: Anticoagulant therapy may contribute to more extensive brain hemorrhages and worse functional outcomes. However, there are other factors to take into account that may have a strong influence on the final outcome, such as risk factos/comorbidities, affected vascular territory and the brain area affected. Given the importance and efficacy of anticoagulant therapy, it is important to recognize these factors that are mostly controllable since, in most cases, it is extremely difficult or impossible to abdicate from this therapy.
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Keywords
Acidente Vascular Cerebral Hemorrágico Anticoagulação Oral Características Clínicas Características Topográficas