Desafio do Tratamento da Ateromatose Complexa da Aorta em Contexto de Acidente Vascular Cerebral Isquémico: Uma Análise Retrospetiva
DOI:
https://doi.org/10.24950/rspmi.2426Palavras-chave:
Acidente Vascular Cerebral, Aorta Torácica, Aterosclerose, Fatores de Risco de Doenças Cardíacas, IsquemiaResumo
Introdução: A ateromatose complexa da aorta é uma
causa importante de acidente vascular cerebral (AVC). Contudo, a falta de evidência científica leva a que o seu tratamento seja bastante controverso, tornando imperativa a realização de mais estudos. Este estudo pretende avaliar a eficácia e a segurança das várias estratégias terapêuticas
utilizadas na ateromatose complexa da aorta.
Material e Métodos: Foi realizada uma análise retrospetiva
dos doentes internados por AVC isquémico com diagnóstico de ateromatose complexa da aorta por ecocardiograma transesofágico, entre 1 de janeiro de 2010 e 31 de dezembro de 2022.
Resultados: Dos 82 doentes incluídos, 23,2% apresentaram
recorrência de AVC isquémico, dos quais 47,4% estavam
medicados com clopidogrel em monoterapia. Os
doentes medicados com clopidogrel apresentaram maior
recorrência de AVC isquémico (p <0,001), enquanto doentes
medicados com dupla antiagregação apresentaram menor recorrência (p = 0,035). Doentes medicados com anticoagulantes orais diretos não apresentaram recorrência. Dos doentes medicados com varfarina, cinco tiveram recorrência com INR infra-terapêutico e dois apresentaram eventos hemorrágicos.
Conclusão: Na nossa população a utilização de dupla
antiagregação com ácido acetilsalicílico e clopidogrel durante 3 a 6 meses seguido de antiagregação simples com
ácido acetilsalicílico demonstrou ser a estratégia mais segura e eficaz no tratamento do AVC isquémico associado a ateromatose complexa da aorta, enquanto o uso de clopidogrel se associou a maior taxa de recorrência. Nos doentes com indicação para anticoagulação os anticoagulantes orais diretos pareceram ser eficazes e mais seguros do que a varfarina.
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Direitos de Autor (c) 2024 Medicina Interna
Este trabalho encontra-se publicado com a Licença Internacional Creative Commons Atribuição 4.0.
Direitos de Autor (c) 2023 Medicina Interna
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