Complicações da terapia anticoagulante com warfarina em pacientes com doença vascular periférica: estudo coorte prospectivo

Abstract

194 ResumoObjetivo: Estudar prospectivamente a freqüência de complicações em pacientes tratados com warfarina e acompanhados no Ambulatório de Anticoagulação da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista.Métodos: Pacientes sorteados entre os agendados para consulta de junho de 2002 a fevereiro de 2004. Na primeira consulta, foi preenchida ficha com dados de identificação e clínicos. A cada retorno, ou quando o paciente procurou o hospital por intercorrência, foi preenchida ficha com a razão normatizada internacional, existência e tipo de intercorrência e condições de uso dos antagonistas da vitamina K.Resultados: Foram acompanhados 136 pacientes (61 homens e 75 mulheres), 99 com tromboembolismo venoso e 37 com doença arterial; 59 pacientes eram de Botucatu, e 77, de outros municípios. Foram registradas 30 intercorrências: nove não relacionadas ao uso da warfarina e 21 complicações hemorrágicas (38,8 por 100 pacientes/ ano). Uma hematêmese foi considerada grave (1,9 por 100 pacientes/ ano). As demais foram consideradas moderadas ou leves. Não houve óbitos, hemorragia intracraniana ou necrose cutânea. A única associação significante foi da freqüência de hemorragia com nível médio de razão normatizada internacional.Conclusão: Nossos resultados mostram a viabilidade desse tratamento em pacientes vasculares em nosso meio, mesmo em população de baixo nível socioeconômico, quando tratados em ambulatório especializado.Palavras-chave: Anticoagulantes, warfarina, efeitos adversos, doenças vasculares, trombose venosa, embolia pulmonar. AbstractObjective: To prospectively study the frequency of complications in patients treated with warfarin followed at Botucatu Medical School.Methods: Patients randomly selected among those with appointments scheduled from June 2002 to February 2004. At the first appointment, a protocol was filled with identification and clinical data. At every return or when the patient went to the hospital due to clinical events, another form was filled with the international normalized ratio, existence and type of clinical event and the conditions of use of vitamin K antagonists.Results: A total of 136 patients (61 men and 75 women), were followed; 99 patients with venous thromboembolism and 37 with arterial disease; 59 were from Botucatu and 77 were from other municipalities. Thirty clinical events were registered: nine of them were not related to the use of warfarin and 21 were hemorrhagic complications (38.8 per 100 patients-year). One hematemesis was considered severe (1.9 per 100 patients-year). The others were considered moderate or mild. There were no deaths, intracranial hemorrhage or cutaneous necrosis. The only significant association was frequency of hemorrhage and average international normalized ratio level.Conclusion: Our results demonstrate the feasibility of this treatment in vascular patients in our country, even in socially and economically poor populations, when treated in specialized clinics.

Health related quality of life of patients undergoing oral anticoagulation therapy

“…The group was composed of subjects of various ages, with 40% over 60 years of age. Similar results were found in other studies (16,(19)(20)(21)(22) . It should be noted that the site in which the study was conducted is a tertiary level public hospital, characterized by its care, teaching and research activities.…”

Comparison of initial loading doses of 5 mg and 10 mg for warfarin therapy

“…There were no episodes of major or minor bleeding while in hospital, possibly because of the rigid schedule of daily laboratory tests, conducted in order to avoid large variations in aPTT or INR levels. The overall rate of severe hemorrhagic complications (hematuria and hematemesis ) in patients on warfarin at this service is 2.2% 21 .…”

Trombocitopenia induzida por heparina e necrose cutânea por varfarina: relato de caso

“…The lesions are well-defined, painful, initially erythematous or hemorrhagic, and include the formation of hemorrhagic blisters, skin necrosis and pressure ulcers. 5,6 The use of lower doses of warfarin is believed to reduce the risk of the patient developing a state of hypercoagulability caused by the fall in protein C levels in the first 36 hours of anticoagulant therapy. 7 Therapeutic regimens are suggested to maintain protein C levels stable during the critical period following initiation of warfarin use, with a low initial dose (1-2 mg/day) and daily increases of 1-2 mg/day until reaching the desired international normalized ratio (INR) in around 10 days.…”