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Abstract(s)
tromboembolismo venoso e a fibrilação auricular, principal fator de risco do acidente vascular cerebral, são patologias frequentes nos idosos sendo o seu tratamento a anticoagulação oral. Até há poucos anos, a única terapêutica disponível eram os antagonistas da vitamina K, ferramenta pouco famosa principalmente para esta população pelo risco hemorrágico, múltiplas interações que apresenta e necessidade de controlos analíticos frequentes. Os novos anticoagulantes orais vieram proporcionar uma alternativa prometedora para estes doentes. Perceber melhor a realidade do seu uso na prática clínica poderá contribuir para um melhor conhecimento das suas consequências nos idosos.
Com este objetivo, procedeu-se a um estudo observacional descritivo com idosos internados nos Serviços de Medicina Interna I e II do Hospital Pêro da Covilhã no período de 2013 e 2014 fazendo um seguimento durante 27 meses.
Durante esses dois anos foram admitidos um total de 3008 idosos dos quais 427 fizeram terapêutica com anticoagulantes orais sendo usado na maioria (86, 42 %) antagonista da vitamina K. No grupo medicado com novos anticoagulantes orais, o mais prescrito (63,49% de doentes) foi o dabigatrano. Nos doentes que iniciaram anticoagulação oral pela primeira vez (14,9%), mais do 73% foi tratado com varfarina. O novo anticoagulante escolhido para os que iniciavam foi o rivaroxabano (70% dos doentes). Foi mais frequente o uso de anticoagulação nos doentes do género feminino. A média de idade foi elevada nos dois grupos (81,40 anos) sendo mais frequente o uso nos mais idosos (75 ou mais anos no grupo tratado com novos anticoagulantes e maiores de 85 anos nos doentes em uso de varfarina)
A patologia que com mais frequência motivou terapêutica anticoagulante foi a fibrilação auricular. Para início de anticoagulação em doentes com esta patologia preferiu-se os novos anticoagulantes enquanto que nos doentes com Tromboembolismo pulmonar o anticoagulante escolhido na maioria foi a varfarina.
Observaram-se complicações hemorrágicas nos dois grupos, sendo de origem gastrointestinal nos doentes com novos anticoagulantes, concretamente com dabigatrano. A adesão à consulta foi elevada nos dois grupos.
Venous thromboembolism and atrial fibrillation, major risk factors for acute cerebral stroke, are frequent diseases in the elderly, and its treatment is oral anticoagulation. Until recent years, the only available treatment was the vitamin k antagonists, a less good tool especially for this population by the hemorrhagic risk, multiple interactions and the need for frequent analytical control that it presents. The new oral anticoagulants provide a promising alternative for such patients. To understand the reality of its application in the clinical practice can contribute to a better knowledge of its consequences in the elderly. For this purpose we proceeded to a descriptive observational study in elderly who were hospitalized in the wards of internal medicine 1 and 2 of Hospital Pêro da Covilhã, in the period between 2013 and 2014, making a follow-up of 27 months. During those two years a total of 3008 elderly were admitted, of which 427 were treated with oral anticoagulants, and the vitamin k antagonists being most used (86, 42%). In the group treated with the new oral anticoagulants, the most prescribed (63, 49%) was dabigatran. In patients who started anticoagulation for the first time (14, 9%), more than 73% was treated with warfarin. The new oral anticoagulant more frequently used for the first time was rivaroxaban (70%). The use of anticoagulation was more frequent in female patients. The mean age was high at both groups (81, 40 years), being more frequent in the most elderly (75 or more years in the group treated with the new anticoagulants, and more than 85 years in the group treated with warfarin). The condition that more often motivated treatment with anticoagulants was atrial fibrillation, and the anticoagulant for beginning of its treatment were the new anticoagulants, while for patients with pulmonary thromboembolism the choice was warfarin. Hemorrhagic complications were observed in both groups, being from gastrointestinal origin in the group of new anticoagulants, particularly with dabigatran. The adhesion to the doctor´s visit was high in both groups.
Venous thromboembolism and atrial fibrillation, major risk factors for acute cerebral stroke, are frequent diseases in the elderly, and its treatment is oral anticoagulation. Until recent years, the only available treatment was the vitamin k antagonists, a less good tool especially for this population by the hemorrhagic risk, multiple interactions and the need for frequent analytical control that it presents. The new oral anticoagulants provide a promising alternative for such patients. To understand the reality of its application in the clinical practice can contribute to a better knowledge of its consequences in the elderly. For this purpose we proceeded to a descriptive observational study in elderly who were hospitalized in the wards of internal medicine 1 and 2 of Hospital Pêro da Covilhã, in the period between 2013 and 2014, making a follow-up of 27 months. During those two years a total of 3008 elderly were admitted, of which 427 were treated with oral anticoagulants, and the vitamin k antagonists being most used (86, 42%). In the group treated with the new oral anticoagulants, the most prescribed (63, 49%) was dabigatran. In patients who started anticoagulation for the first time (14, 9%), more than 73% was treated with warfarin. The new oral anticoagulant more frequently used for the first time was rivaroxaban (70%). The use of anticoagulation was more frequent in female patients. The mean age was high at both groups (81, 40 years), being more frequent in the most elderly (75 or more years in the group treated with the new anticoagulants, and more than 85 years in the group treated with warfarin). The condition that more often motivated treatment with anticoagulants was atrial fibrillation, and the anticoagulant for beginning of its treatment were the new anticoagulants, while for patients with pulmonary thromboembolism the choice was warfarin. Hemorrhagic complications were observed in both groups, being from gastrointestinal origin in the group of new anticoagulants, particularly with dabigatran. The adhesion to the doctor´s visit was high in both groups.
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Keywords
Anticoagulantes Orais Fibrilação Auricular Idosos Internamento Hospitalar Tromboembolismo