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Influência da fibrilhação auricular na transformação hemorrágica do AVC isquémico tratado com alteplase intravenosa
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Abstract(s)
Objetivos: A fibrilhação auricular (FA) é responsável por ¼ dos acidentes vasculares cerebrais (AVCs) isquémicos. A alteplase iv é a única terapêutica de reperfusão aprovada para o tratamento do AVC isquémico, sendo a sua complicação mais temida a hemorragia intracraniana (HIC). Realizámos este estudo retrospetivo com o objetivo de avaliar o possível papel da FA como preditor de HIC nos doentes com AVC isquémico tratados com alteplase iv.
Métodos: Neste estudo observacional retrospetivo, foram incluídos doentes consecutivos com AVC isquémico agudo tratados com alteplase iv. Foi realizada tomografia axial computorizada (TAC) e avaliado o NIHSS, antes do tratamento. Os pacientes foram divididos em 2 grupos (grupo “FA” e o grupo “Sem FA”). HIC foi definida como qualquer hemorragia dentro do parênquima cerebral, após terapêutica com alteplase iv.
Resultados: 403 doentes (246 (61%) do sexo masculino; média de idade 68.4 ± 9.3 anos) foram incluídos neste estudo. O grupo “FA” tinha 176 doentes , e o “Sem FA” tinha 227 doentes. Os doentes do grupo “FA” eram mais velhos (71 ± 6.9 anos, P <0.001), apresentaram mais vezes sinal da corda na TAC CE (31% vs 19.4%, P 0.006) e mais hemorragia nos dois subgrupos, total (36.9% vs 21.6%, P 0.001) e sintomática (8% vs 3.2%, P 0.029) . Depois de ajustados idade, sexo, glicémia pré-tratamento, TAC CE com sinal da corda e intervalo injeção/tratamento, a pontuação NIHSS pré-tratamento e a FA mostraram-se significativamente associados à ocorrência de HIC.
Conclusão: Este estudo concluiu que a FA influencia a ocorrência de hemorragia intracraniana na generalidade, ainda que não tenha o mesmo significado quando se trata de hemorragia intracraniana sintomática.
Objective: Atrial fribrillation (AF) is responsible for about ¼ of all ischemic strokes. The intravenous tissue plasminogen activator (tPA iv) is the only therapeutic approved for reperfusion treatment in acute ischemic stroke, and its most feared complication is intracranial hemorrhage (ICH). We conducted this retrospective study to evaluate the possible role of FA as a predictor of ICH in patients with ischemic stroke treated with tPA iv. Methods: In this retrospective observational study were included consecutive ischemic stroke patients treated with tPA iv. It was performed computed tomography and the NIHSS evaluated before treatment. Patients were divided into 2 groups (AF group and the group No AF). HIC was defined as any bleeding within the brain parenchyma after therapy with tPA iv. Results: 403 patients (246 (61%) male; mean age 68.4 ± 9.3 years) were enrolled in this study. The AF group had 176 patients, and no AF had 227 patient. Patients in the AF group are older (71 ± 6.9 years, P <0.001), had more often CE TC with artery occlusion (31% vs 19.4%, P 0.006) and presented more often bleeding in both subgroups, total (36.9% vs 21.6%, P 0.001) and symptomatic (8% vs 3.2%, P 0.029). After adjusting age, sex, blood glucose pretreatment, CE TC with artery occlusion and range injection / treatment, NIHSS score pretreatment and the FA were significantly associated with the occurrence of ICH. Conclusion: This study concluded that AF influences the occurrence of ICH in general, though not have the same significance when it comes to symptomatic ICH.
Objective: Atrial fribrillation (AF) is responsible for about ¼ of all ischemic strokes. The intravenous tissue plasminogen activator (tPA iv) is the only therapeutic approved for reperfusion treatment in acute ischemic stroke, and its most feared complication is intracranial hemorrhage (ICH). We conducted this retrospective study to evaluate the possible role of FA as a predictor of ICH in patients with ischemic stroke treated with tPA iv. Methods: In this retrospective observational study were included consecutive ischemic stroke patients treated with tPA iv. It was performed computed tomography and the NIHSS evaluated before treatment. Patients were divided into 2 groups (AF group and the group No AF). HIC was defined as any bleeding within the brain parenchyma after therapy with tPA iv. Results: 403 patients (246 (61%) male; mean age 68.4 ± 9.3 years) were enrolled in this study. The AF group had 176 patients, and no AF had 227 patient. Patients in the AF group are older (71 ± 6.9 years, P <0.001), had more often CE TC with artery occlusion (31% vs 19.4%, P 0.006) and presented more often bleeding in both subgroups, total (36.9% vs 21.6%, P 0.001) and symptomatic (8% vs 3.2%, P 0.029). After adjusting age, sex, blood glucose pretreatment, CE TC with artery occlusion and range injection / treatment, NIHSS score pretreatment and the FA were significantly associated with the occurrence of ICH. Conclusion: This study concluded that AF influences the occurrence of ICH in general, though not have the same significance when it comes to symptomatic ICH.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Keywords
AVC isquémico Fibrilhação auricular Hemorragia intracraniana