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Advisor(s)
Abstract(s)
O paciente portador de patologia com elevado risco tromboembólico, em particular cardioembólico, tem muitas vezes indicação para anticoagulação.
A utilização de fármacos anticoagulantes implica risco hemorrágico e a hemorragia intracraniana é mais temida complicação da terapêutica anticoagulante, sendo frequentemente fatal ou resultando em grande morbilidade entre os sobreviventes. A controvérsia surge quando a comunidade médica tenta definir a melhor estratégia para o paciente que, na necessidade de manter anticoagulação, sofreu hemorragia intracraniana (HIC). Com esta monografia pretendeu-se fazer uma revisão baseada na evidência sobre as diferentes abordagens a este problema e daqui reunir dados que possam ajudar o clínico na decisão terapêutica de reintroduzir ou não anticoagulação no paciente em risco.
Não foi encontrada evidência consensual sobre o timing ótimo para reiniciação de fármacos anticoagulantes após HIC. Os estudos analisados basearam-se em diferentes metodologias, diferentes populações, sendo a comparação entre si difícil de conseguir sem vieses. Ao mesmo tempo, muitas questões permanecem sobre a superioridade dos novos agentes. Uma conclusão praticamente transversal aponta para a necessidade do médico assistente avaliar de forma individualizada cada caso de HIC em pacientes anticoagulados e, pesando os diferentes fatores, decidir sobre a necessidade e, portanto, o benefício de anticoagulação para prevenção de tromboembolismo face ao risco de eventos hemorrágicos.
The patient with high thromboembolic risk disease, especially if cardioembolic, often has indication for anticoagulation. The use of anticoagulant drugs implies hemorrhagic risk and intracranial hemorrhage is the most feared complication of anticoagulant therapy, being frequently fatal or leading to great morbidity among the survivors. The controversy arises when the medical community tries to define the best strategy for the management of the patient that, in the need of anticoagulant treatment, has suffered intracranial hemorrhage. With this monography it was intended to make a review based on the evidence on the different approaches to this problem and thus gather data to help the physician in the therapeutic decision of reinitiating or not anticoagulation in the patient at risk. No consensual evidence was found on the optimal timing for reinitiating anticoagulant drugs after intracranial hemorrhage. The analyzed studies were based on different designs, different populations, making its comparison difficult to attain without bias. At the same time, many questions prevail about the superiority of the new drugs. A common conclusion to practically all present studies points out the need for an individualized evaluation from the assistant physician in each case of intracranial hemorrhage in anticoagulated patients. The different features should be considered to decide on the need and benefit of the anticoagulation for thromboembolism prevention against the risk of hemorrhagic events.
The patient with high thromboembolic risk disease, especially if cardioembolic, often has indication for anticoagulation. The use of anticoagulant drugs implies hemorrhagic risk and intracranial hemorrhage is the most feared complication of anticoagulant therapy, being frequently fatal or leading to great morbidity among the survivors. The controversy arises when the medical community tries to define the best strategy for the management of the patient that, in the need of anticoagulant treatment, has suffered intracranial hemorrhage. With this monography it was intended to make a review based on the evidence on the different approaches to this problem and thus gather data to help the physician in the therapeutic decision of reinitiating or not anticoagulation in the patient at risk. No consensual evidence was found on the optimal timing for reinitiating anticoagulant drugs after intracranial hemorrhage. The analyzed studies were based on different designs, different populations, making its comparison difficult to attain without bias. At the same time, many questions prevail about the superiority of the new drugs. A common conclusion to practically all present studies points out the need for an individualized evaluation from the assistant physician in each case of intracranial hemorrhage in anticoagulated patients. The different features should be considered to decide on the need and benefit of the anticoagulation for thromboembolism prevention against the risk of hemorrhagic events.
Description
Keywords
Anticoagulação Avc Complicações Hemorrágicas Fibrilhação Auricular Hemorragia Intracraniana