Anticoagulação oral em portadores de próteses valvares cardíacas mecânicas: experiência de dez anos

Abstract

Background: Published data suggest that rates of thromboembolism and bleeding in patients with mechanical heart valve prostheses can be greatly reduced if anticoagulant therapy is optimized.Objectives: To evaluate the occurrence of complications in patients with mechanical prosthetic heart valves undergoing anticoagulant therapy optimized by means of specialized clinics.Methods: We studied the occurrence of complications during 10 years in 261 patients with mechanical heart valve prostheses with anticoagulation and followed up in specialized clinics. These patients were divided into two groups according to percentage of consultations with prothrombin time (INR) within the desired range: G1-0% to 50.00% and G2-50, 01% to 100% of the consultations. We evaluated the occurrence of thromboembolic complications and bleeding in their entirety or subdivided into major and minor, according to severity. The results are presented in an actuarial study and linearized frequency of occurrence of events.Results: The actuarial study showed that, over time, in G2 (with 50.01% to 100% of the consultations with INR in desired range) more patients were free of the occurrence of any event type, minor bleeding events or the accentuated increase of INR. The linearized frequency of occurrence in all event types was also lower in group G2.Conclusions: The length of stay within the desired range of anticoagulation is directly related to the occurrence of complications. However, even with optimized monitoring by specialized outpatient clinic, only about a third of patients had adequate anticoagulation level in more than half of the consultations.Keywords: Anticoagulants. Embolism and thrombosis. Hemorrhage. Heart valve prosthesis. 458CAMPOS, NLKL ET AL -Oral anticoagulation in carriers of mechanical heart valve prostheses. Experience of ten years Rev Bras Cir Cardiovasc 2010; 25(4): 457-465Resumo Introdução: Dados da literatura sugerem que as taxas de tromboembolismo e sangramento em pacientes com próteses valvares cardíacas mecânicas podem ser muito reduzidas se a terapia anticoagulante for otimizada.Objetivos: Avaliar a ocorrência de complicações em portadores de próteses valvares cardíacas mecânicas submetidos à terapêutica anticoagulante, otimizada por meio de ambulatório especializado.Métodos: Estudou-se a ocorrência de complicações ao longo de 10 anos em 261 pacientes com próteses valvares cardíacas mecânicas, anticoagulados e acompanhados em ambulatório especializado. Esses pacientes foram divididos em dois grupos conforme porcentual de consultas com tempo de protrombina (RNI) dentro do intervalo desejado: G1-0% a 50,00% e G2-50,01% a 100% das consultas. Foram avaliadas as ocorrências de complicações tromboembólicas e hemorrágicas na sua totalidade, ou subdivididas em maiores e menores, de acordo com a gravidade. Os resultados estão apresentados sob forma de estudo atuarial e de frequência linearizada de ocorrência de eventos.Resultados: O estudo atuarial mostrou que, ao longo do tempo, no grupo G2 (com 50,01% a 100% das co...

Knowledge patients receiving outpatient treatment on oral anticoagulation therapy

“…11-2 However , Dantas and colleagues identified the male as majority in a study on the evaluation of control of INR in patients monitored in specific outpatients. 3 Regarding to age, education and occupation, the results of this study are similar to national surveys performed [5][6] , with patients taking anticoagulants in specialized outpatient follow-up. However, the context of European countries in relation to age, some studies show that the average age of patients being treated with anticoagulants is greater than 70 years , which is due mainly to the higher life expectancy in developed countries.…”

“…6 In addition to genetic and environmental factors, cited above, it is also considered important in the difficulty of control and management of the treatment, educational and socioeconomic status of the population using oral anticoagulants, which influence mainly on knowledge, understanding and adherence to the proposed treatment. 3 In this perspective, from the clinical practice of monitoring by a multidisciplinary team, there has been a necessity to know the profile of the population treated in the health facility in order to identify their needs and possible interventions, with the main objective of ISSN 2175-5361 DOI: 10.9789/2175-5361.2016 Figueirêdo TR, Nascimento MO, Silveira MMBM et al Data were obtained by applying one sociodemographic and clinical questionnaire and a specific instrument for the assessment of knowledge of patients using oral anticoagulants.…”

Resultados de pacientes submetidos à cirurgia de substituição valvar aórtica usando próteses mecânicas ou biológicas

“…Moreover, although different thromboplastin reagents produce very similar results with normal blood, they can produce very different prothrombin times with anticoagulated blood [29]. According Campos et al [33], only about a third of patients have adequate anticoagulation level in more than half of the follow-up visits, and the residence time within the desired range of anticoagulation is directly related to the occurrence of complications.…”

“…This is because there is no ideal substitute to provide a long life, without the use of oral anticoagulants, with no increased risk of thromboembolism and operating mechanism similar to the native valve [8][9][10][11][12][13][14]. Still, the clinical decision becomes increasingly challenging with the increase in life expectancy and the presence of comorbidities such as advanced age, congestive heart failure, coronary artery disease, pulmonary disease and renal failure [6].…”

Concepção de bancada e montagem de experimento para a análise in vitro de próteses cardíacas mitrais

“…All prosthetic heart valves cause narrowing of the valve orifice, which arises from the thickness of its ring and, moreover, a certain transvalvular pressure gradient occurs in all valves and has an inverse relation to blood flow through the valve orifice, in addition to depending on size, type and model of the valve. Mechanical prostheses have on their biological valves the advantage of long life, but patients who use them are still subject to thrombosis and thromboembolism, even if they are properly treated with anticoagulants and antiplatelet agents [2][3][4]. The biological valves require the use of anticoagulants, but their durability is limited as a result of degeneration.…”