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Treatment with anti-Inflammatory drugs in post-myocardial infarction pericarditis
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Contextualização e objetivos: A pericardite após enfarte do miocárdio (PAEM) tem uma incidência baixa e não parece apresentar impacto significativo na mortalidade. Contudo está associada a um aumento da morbilidade. A terapêutica para a PAEM mantém-se empírica devido à falta de ensaios clínicos randomizados e de revisões sistemáticas para avaliar qual o melhor regime terapêutico. Efetuámos uma revisão sistemática com meta-análise para avaliar o impacto dos anti-inflamatórios, nomeadamente a aspirina, anti-inflamatórios não esteroides (AINEs), colchicina ou corticosteroides, nos adultos que desenvolvem PAEM.
Métodos e resultados: Pesquisámos as plataformas MEDLINE através do OVID, CENTRAL, PsychInfo e EMBASE por ensaios clínicos aleatorizados (ECRs) e estudos observacionais relevantes, sem qualquer restrição de idioma. Os dados foram selecionados e extraídos por dois revisores independentes. O risco de viés foi avaliado com recurso à ferramenta ROBINS-I e RoB 2. Foram estabelecidos como outcomes a melhoria da dor em 24 horas, a persistência da dor após tratamento inicial e eventos hemorrágicos. Um estudo observacional e dois ECRs foram incluídos, num total de 76 participantes. A terapêutica com corticosteroides, aspirina e AINEs associaram-se a melhoria da dor em 24 horas (RR=5.00, 95% CI 0.69 to 36.37; RR=1.53, 95% CI 0.40 to 5.84; RR=1.93, 95% CI 0.54 to 6.86, respetivamente), mas sem significância estatística. Nos restantes outcomes as intervenções também não apresentaram diferenças estatisticamente significativas comparativamente ao placebo.
Conclusões: O tratamento com aspirina, AINEs e corticosteroides não demonstraram impacto estatisticamente significativo no controlo sintomático em doentes com PAEM. Mais estudos são necessários para validar estes resultados.
Background and objective: The post-myocardial infarction pericarditis (PMIP) incidence is low, and it does not seem to have significant impact in mortality. However, it is associated with increased morbidity. Therapy for PMIP remains largely empiric due to the lack of randomized control trials and systematic reviews to evaluate the best therapy regimen. Our aim is to conduct a systematic review and meta-analysis of the impact of anti-inflammatory drugs namely aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), colchicine and corticosteroids in adults that developed PMIP. Methods and Results: We searched MEDLINE via OVID, CENTRAL, PsychInfo, EMBASE for relevant randomized controlled trials (RCTs) and observational studies, without language restrictions. Data were screened and extracted by two independent reviewers. The risk of bias was evaluated by ROBINS-I and RoB 2 tool. The primary outcomes were improvement within 24 hours, pain persistence with initial therapy and bleeding events. One observational study and two RCTs were included with a total of 76 patients. Corticosteroids, aspirin and NSAIDs, were associated with higher pain improvement rate within the first 24 hours, but without statistical significance, with Relative Risk (RR) =5.00 (95% Confidence Interval (CI) 0.69 to 36.37), RR=1.53 (95% CI 0.40 to 5.84) and RR=1.93 (95% CI 0.54 to 6.86), respectively. In the remaining outcomes, interventions did not show statistically significant differences compared to placebo as well. Conclusions: Treatment of PMIP with NSAIDs, aspirin or corticosteroids was not associated with a better symptomatic control, since none of the results were statistically significant. Further studies are warranted to validate these results.
Background and objective: The post-myocardial infarction pericarditis (PMIP) incidence is low, and it does not seem to have significant impact in mortality. However, it is associated with increased morbidity. Therapy for PMIP remains largely empiric due to the lack of randomized control trials and systematic reviews to evaluate the best therapy regimen. Our aim is to conduct a systematic review and meta-analysis of the impact of anti-inflammatory drugs namely aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), colchicine and corticosteroids in adults that developed PMIP. Methods and Results: We searched MEDLINE via OVID, CENTRAL, PsychInfo, EMBASE for relevant randomized controlled trials (RCTs) and observational studies, without language restrictions. Data were screened and extracted by two independent reviewers. The risk of bias was evaluated by ROBINS-I and RoB 2 tool. The primary outcomes were improvement within 24 hours, pain persistence with initial therapy and bleeding events. One observational study and two RCTs were included with a total of 76 patients. Corticosteroids, aspirin and NSAIDs, were associated with higher pain improvement rate within the first 24 hours, but without statistical significance, with Relative Risk (RR) =5.00 (95% Confidence Interval (CI) 0.69 to 36.37), RR=1.53 (95% CI 0.40 to 5.84) and RR=1.93 (95% CI 0.54 to 6.86), respectively. In the remaining outcomes, interventions did not show statistically significant differences compared to placebo as well. Conclusions: Treatment of PMIP with NSAIDs, aspirin or corticosteroids was not associated with a better symptomatic control, since none of the results were statistically significant. Further studies are warranted to validate these results.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Pericardite após enfarte agudo do miocárdio Aspirina Corticosteroides Anti-inflamatórios não esteroides Cardiologia