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Recorrência de tromboembolismo pulmonar varfarina versus rivaroxabano : estudo retrospetivo
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Introdução: Este trabalho teve como objetivo comparar as recorrências de TEP nos doentes com o diagnóstico de TEP medicados inicialmente com varfarina ou rivaroxabano. Assim, pretendeu-se testar a afirmação que, de acordo com os estudos realizados, os anticoagulantes orais diretos são não-inferiores à varfarina.
Materiais e métodos: Foram analisados 108 doentes da base de dados da consulta de Tromboembolismo Venoso/ Medicina Interna do HGO. As recorrências de TEP foram analisadas e os doentes caracterizados com base em características demográficas, antecedentes, fatores de risco e características da doença. A análise estatística foi efetuada com recurso ao software IBM®SPSS® versão 22.
Resultados: Apenas foram registadas duas recorrências até aos três meses, o que não permitiu comparar a eficácia dos dois fármacos. Até aos seis meses 12% dos doentes recorreram: do grupo medicado inicialmente com varfarina verificaram-se 8,2% de recorrências, contra 15,3% do grupo inicialmente medicado com rivaroxabano. A varfarina obteve melhores resultados em todas as análises subsequentes, à exceção de: género masculino, doentes sem trombofilia, doentes com dislipidémia e doentes sem TVP anterior. De realçar o género feminino onde não existiram recorrências no grupo da varfarina, contra 21,1% no grupo do rivaroxabano. Os doentes que realizaram switch de varfarina para rivaroxabano apresentaram maus resultados em variados grupos.
Discussão: O grupo de doentes que realiza switch é o que apresenta mais recorrências, sendo recomendável um estudo dirigido a este grupo. Entre os dois fármacos, a varfarina revelou-se, de um modo geral, superior ao rivaroxabano, contrariando a bibliografia que aponta este fármaco como sendo não inferior à terapêutica clássica.
Introduction: The aim of this work was to compare pulmonary thromboembolism recurrences in patients to whom was prescribed warfarin and rivaroxaban. According to different studies, the direct oral anticoagulants are non-inferior to warfarin. Materials and methods: 108 patients from Garcia de Orta Hospital database were analyzed. The recurrences of pulmonary thromboembolism were noted and the patients characterized according to personal, demographic and disease related data. IBM®SPSS® 22 software was used to do the statistical analysis. Results: There were only two recurrences until three months after the index event which unable the comparison between therapies. Until six months after the index event, 12% of the patients fell back on. From those using warfarin, 8,2% had a new event against 15,3%, using rivaroxaban. Warfarin achieved better results in all groups except in males, patients without thrombophilia, patients with dyslipidemia and patients without prior deep venous thrombosis. In the female group, there weren’t any recurrences using warfarin despite 21,1% with rivaroxaban. Patients who switched from warfarin to rivaroxaban presented worse outcomes in several groups. Discussion: Patients who switched therapies are the group with higher recurrences and, for that reason, a more directed study is recommended. Between both drugs, warfarin revealed itself superior to rivaroxaban, contradicting the bibliography that stands rivaroxaban to be non-inferior to the classic therapy.
Introduction: The aim of this work was to compare pulmonary thromboembolism recurrences in patients to whom was prescribed warfarin and rivaroxaban. According to different studies, the direct oral anticoagulants are non-inferior to warfarin. Materials and methods: 108 patients from Garcia de Orta Hospital database were analyzed. The recurrences of pulmonary thromboembolism were noted and the patients characterized according to personal, demographic and disease related data. IBM®SPSS® 22 software was used to do the statistical analysis. Results: There were only two recurrences until three months after the index event which unable the comparison between therapies. Until six months after the index event, 12% of the patients fell back on. From those using warfarin, 8,2% had a new event against 15,3%, using rivaroxaban. Warfarin achieved better results in all groups except in males, patients without thrombophilia, patients with dyslipidemia and patients without prior deep venous thrombosis. In the female group, there weren’t any recurrences using warfarin despite 21,1% with rivaroxaban. Patients who switched from warfarin to rivaroxaban presented worse outcomes in several groups. Discussion: Patients who switched therapies are the group with higher recurrences and, for that reason, a more directed study is recommended. Between both drugs, warfarin revealed itself superior to rivaroxaban, contradicting the bibliography that stands rivaroxaban to be non-inferior to the classic therapy.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017
Palavras-chave
Tromboembolismo pulmonar Rivaroxabano Varfarina Terapêutica