Anticoagulation in patients with cardiac manifestations of Chagas disease and cardioembolic ischemic stroke

Abstract

Objectives To describe anticoagulation characteristics in patients with cardiac complications from Chagas disease and compare participants with and without cardioembolic ischemic stroke (CIS). Methods A retrospective cohort of patients with Chagas disease, using anticoagulation, conducted from January 2011 to December 2014. Results Forty-two patients with Chagas disease who were using anticoagulation were studied (age 62.9±12.4 years), 59.5% female and 47.6% with previous CIS, 78.6% with non-valvular atrial fibrillation and 69.7% with dilated cardiomyopathy. Warfarin was used in 78.6% of patients and dabigatran (at different times) in 38%. In the warfarin group, those with CIS had more medical appointments per person-years of follow-up (11.7 vs 7.9), a higher proportion of international normalized ratios within the therapeutic range (57% vs 42% medical appointments, p = 0.025) and an eight times higher frequency of minor bleeding (0.64 vs 0.07 medical appointments). Conclusion Patients with Chagas disease and previous CIS had better control of INR with a higher frequency of minor bleeding.

Chagas Disease Cardiomyopathy

“…Anticoagulation should be utilized in patients with AF, previous thromboembolism, or presence of cardiac thrombus or apical aneurism 26 . Warfarin, a vitamin K antagonist, is the most widely used anticoagulant but requires frequent medical appointments for dosage changes and monitoring of therapeutic international normalized ratios and has a higher frequency of minor bleeding events 56 . In a case report, rivaroxaban, an Xa inhibitor, was effective in preventing thromboembolism and allowed for greater patient adherence without increasing the risk of bleeding 57 .…”

“…26 Warfarin, a vitamin K antagonist, is the most widely used anticoagulant but requires frequent medical appointments for dosage changes and monitoring of therapeutic international normalized ratios and has a higher frequency of minor bleeding events. 56 In a case report, rivaroxaban, an Xa inhibitor, was effective in preventing thromboembolism and allowed for greater patient adherence without increasing the risk of bleeding. 57 The newer class of novel anticoagulants may be used in place of warfarin, but there are limited data available supporting their use.…”

Prognosis of chronic Chagas heart disease and other pending clinical challenges

“…(106) To prevent cardioembolic events in CCC patients, a risk benefit should always be evaluated. (107,108)…”

Vector-borne protozoal infections of the CNS: cerebral malaria, sleeping sickness and Chagas disease

“…The association between ischaemic stroke and Chagas disease is now well established [23][24][25] . In endemic regions, Chagas disease is a significant risk factor for ischaemic stroke, and the underlying mechanism is mainly cardioembolic.…”

“…The mainstay of primary and secondary prevention of stroke associated with Chagas disease is anticoagulation. Conventional agents are widely used, and there is anecdotal evidence for the use of newer oral anticoagulants [32,33]. However, no Class I or Class II studies exist to support the administration of the newer agents.…”