Vascular/Cirurgia Vascular/Circulação - Impacto clínico de hemorragias em pacientes sob terapia anti-tromboembólica
Esta página já teve 117.118.954 acessos - desde 16 maio de 2003. Média de 27.648 acessos diários
home | entre em contato
 

Vascular/Cirurgia Vascular/Circulação

Impacto clínico de hemorragias em pacientes sob terapia anti-tromboembólica

04/12/2003
 

 

Metanálise envolvendo 4374 pacientes de 33 estudos disponíveis no MEDLINE mostrou a necessidade de se avalie as particularidades de cada paciente antes de se iniciar terapias a base de anticoagulantes no manejo da doença venosa tromboembólica. O impacto clínico do uso desse tipo medicamento foi considerável, com índices significativamente alterados após três meses de terapia.

Annals of Internal Medicine

Clinical Impact of Bleeding in Patients Taking Oral Anticoagulant Therapy for Venous Thromboembolism

A Meta-Analysis

Lori-Ann Linkins, MD, FRCP(C); Peter T. Choi, MD, MSc, FRCP(C); and James D. Douketis, MD, FRCP(C)

2 December 2003 | Volume 139 Issue 11 | Pages 893-900

Background: Clinicians should consider the clinical impact of anticoagulant-related bleeding when deciding on the duration of anticoagulant therapy in patients with venous thromboembolism.

Purpose: To provide reliable estimates of the clinical impact of anticoagulant-related bleeding, defined as the case-fatality rate of major bleeding and the risk for intracranial bleeding.

Data Sources: MEDLINE (January 1989 to May 2003), Cochrane Controlled Trial Registry, thromboembolism experts, and reference lists; English-language literature only.

Study Selection: Randomized, controlled trials and prospective cohort studies that investigated patients with venous thromboembolism who received oral anticoagulant therapy (target international normalized ratio, 2.0 to 3.0) for at least 3 months and that reported major bleeding and death as primary study outcomes.

Data Extraction: Two reviewers independently extracted data on the number of anticoagulant-related major and intracranial bleeding episodes and on whether these events were fatal or nonfatal.

Data Synthesis: The authors analyzed 33 studies involving 4374 patient-years of oral anticoagulant therapy. For all patients, the case-fatality rate of major bleeding was 13.4% (95% CI, 9.4% to 17.4%) and the rate of intracranial bleeding was 1.15 per 100 patient-years (CI, 1.14 to 1.16 per 100 patient-years). For patients who received anticoagulant therapy for more than 3 months, the case-fatality rate of major bleeding was 9.1% (CI, 2.5% to 21.7%), and the rate of intracranial bleeding was 0.65 per 100 patient-years (CI, 0.63 to 0.68 per 100 patient-years) after the initial 3 months of anticoagulation.

Conclusion: The clinical impact of anticoagulant-related major bleeding in patients with venous thromboembolism is considerable, and clinicians should take this into account when deciding whether to continue long-term oral anticoagulant therapy in an individual patient.



IMPORTANTE

  •  Procure o seu médico para diagnosticar doenças, indicar tratamentos e receitar remédios. 
  • As informações disponíveis no site da Dra. Shirley de Campos possuem apenas caráter educativo.
Publicado por: Dra. Shirley de Campos
versão para impressão

Desenvolvido por: Idelco Ltda.
© Copyright 2003 Dra. Shirley de Campos