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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2018; 76(01): 22-25
DOI: 10.1590/0004-282X20170180
ARTICLE

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

Anticoagulação nas manifestações cardíacas da doença de Chagas e acidente vascular cerebral isquêmico cardioembólico
Jean M.C. Monteiro
1   Universidade Federal da Bahia, Faculdade de Medicina, Salvador BA, Brasil;
,
Daniel L. San-Martin
1   Universidade Federal da Bahia, Faculdade de Medicina, Salvador BA, Brasil;
,
Beatriz C.G. Silva
1   Universidade Federal da Bahia, Faculdade de Medicina, Salvador BA, Brasil;
,
Pedro A.P. de Jesus
1   Universidade Federal da Bahia, Faculdade de Medicina, Salvador BA, Brasil;
2   Universidade Federal da Bahia, Complexo Hospitalar Professor Edgard Santos, Salvador BA, Brasil.
,
Jamary Oliveira Filho
1   Universidade Federal da Bahia, Faculdade de Medicina, Salvador BA, Brasil;
2   Universidade Federal da Bahia, Complexo Hospitalar Professor Edgard Santos, Salvador BA, Brasil.
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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.

RESUMO

Objetivos descrever as características da anticoagulação em pacientes com manifestações cardíacas da doença de Chagas (MCDC) e comparar os participantes com sem acidente vascular cerebral isquêmico cardioembólico (AVCIC).

Resultados 42 pacientes com MCDC em anticoagulação foram estudados (62,9 ± 12,4 anos), 59,5% do sexo feminino e 47,6% com AVCIC prévio, 78,6% portadores de fibrilação atrial não valvar e 69,7% com cardiomiopatia dilatada. Varfarina foi utilizada em 78,6% dos pacientes e dabigatrana em 38% (em momentos diferentes). No grupo da varfarina, aqueles com AVCIC tiveram mais consultas médicas por pessoas-ano de seguimento (11,7 vs 7,9), maior taxa de RNI na faixa terapêutica (57% vs 42% consultas médicas, p = 0,025) e uma frequência oito vezes maior de sangramento menor (0,64 vs. 0,07 consultas médicas).

Conclusão pacientes com MCDC e AVCIC prévio têm melhor controle de RNI com maior frequência de sangramento menor.

Chagas disease - warfarin - stroke - atrial fibrillation
doença de Chagas - varfarina - acidente vascular cerebral - fibrilação atrial

Support:

We thank the support of the Neurology Academic League of Federal University of Bahia (LAN – FMB).




Publication History

Received: 19 June 2017

Accepted: 23 October 2017

Article published online:
30 August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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