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A asma e o risco de tromboembolismo pulmonar
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Introdução: A relação entre as doenças inflamatórias crónicas e o tromboembolismo pulmonar (TEP) tem vindo a ser investigada nos últimos anos. Os mediadores inflamatórios interferem na homeostasia da coagulação, aumentando o risco para eventos trombóticos.
Objectivo: Avaliar o papel da asma, enquanto doença inflamatória crónica, no risco de desenvolvimento de TEP.
Materiais e métodos: Estudo retrospectivo dos doentes internados com os diagnósticos de asma e TEP na enfermaria do Serviço de Pneumologia do Hospital de Santa Maria, entre 2010 e 2014. Determinação das causas de TEP agudo e respectivas frequências. Caracterização do grupo de doentes asmáticos com TEP: dados demográficos; tratamento e controlo da asma em ambulatório; diagnóstico, tratamento e evolução do TEP durante o internamento; estudo da coagulação e factores protrombóticos; controlo da asma após anticoagulação.
Resultados: Doze por cento dos internamentos por TEP agudo ocorreram em doentes asmáticos, manifestando-se como agudização da doença obstrutiva em 92% dos casos. Os doentes asmáticos apresentaram um risco 2,16 vezes superior de desenvolverem TEP do que os doentes sem asma (p-valor=0,004). Dois terços dos doentes asmáticos apresentavam outro factor de risco vascular para TEP. A anticoagulação teve uma influência positiva no controlo da asma, permitindo o controlo da doença em 69% dos casos.
Discussão e conclusões: Deve considerar-se a hipótese de TEP em doentes asmáticos mal controlados, mesmo quando clínica seja frustre ou atípica. De futuro, poderá ponderar-se a instituição de tromboprofilaxia em alguns grupos de doentes asmáticos com maior risco tromboembólico.
Introduction: The association between chronic inflammatory diseases and pulmonary embolism has been investigated for the last few years. The inflammatory mediators impair the homeostasis of coagulation, increasing the risk of thrombotic events. Objective: To evaluate the role of asthma, as a chronic inflammatory disease, in the risk of developing pulmonary embolism. Material and methods: Retrospective study of the patients admitted to the ward of the Pulmonology Department of Hospital de Santa Maria, in Lisbon, with the diagnosis of asthma and acute pulmonary embolism, between 2010 and 2014. Determination of the causes for acute pulmonary embolism and respective frequencies. Characterization of the group of asthmatic patients with pulmonary embolism: demographics; ambulatory asthma treatment and disease control prior to admission; diagnostic, treatment and evolution of the pulmonary embolism during admission; evaluation of the coagulation and prothrombotic factors; asthma control after anticoagulation. Results: Twelve percent of the admissions for acute pulmonary embolism occurred in asthmatic patients, expressing itself as an exacerbation of the obstructive disease in 92% of the cases. Asthmatic patients presented a 2,16 times higher odd of developing pulmonary embolism than non-asthmatic patients (p-value=0,004). Two thirds of the asthmatic patients presented an additional vascular risk factor for pulmonary embolism. Anticoagulation had a positive influence in asthma management, allowing the disease control in 69% of the cases. Discussion and conclusions: The diagnosis of pulmonary embolism should be considered in asthmatic patients with poor disease control, even when presenting with atypical clinical features. In the future, thromboprophylaxis may be considered in subgroups of asthmatic patients with increased thromboembolic risk.
Introduction: The association between chronic inflammatory diseases and pulmonary embolism has been investigated for the last few years. The inflammatory mediators impair the homeostasis of coagulation, increasing the risk of thrombotic events. Objective: To evaluate the role of asthma, as a chronic inflammatory disease, in the risk of developing pulmonary embolism. Material and methods: Retrospective study of the patients admitted to the ward of the Pulmonology Department of Hospital de Santa Maria, in Lisbon, with the diagnosis of asthma and acute pulmonary embolism, between 2010 and 2014. Determination of the causes for acute pulmonary embolism and respective frequencies. Characterization of the group of asthmatic patients with pulmonary embolism: demographics; ambulatory asthma treatment and disease control prior to admission; diagnostic, treatment and evolution of the pulmonary embolism during admission; evaluation of the coagulation and prothrombotic factors; asthma control after anticoagulation. Results: Twelve percent of the admissions for acute pulmonary embolism occurred in asthmatic patients, expressing itself as an exacerbation of the obstructive disease in 92% of the cases. Asthmatic patients presented a 2,16 times higher odd of developing pulmonary embolism than non-asthmatic patients (p-value=0,004). Two thirds of the asthmatic patients presented an additional vascular risk factor for pulmonary embolism. Anticoagulation had a positive influence in asthma management, allowing the disease control in 69% of the cases. Discussion and conclusions: The diagnosis of pulmonary embolism should be considered in asthmatic patients with poor disease control, even when presenting with atypical clinical features. In the future, thromboprophylaxis may be considered in subgroups of asthmatic patients with increased thromboembolic risk.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Asma Tromboembolismo pulmonar Tromboembolismo venoso Trombose venosa profunda