Fibrilação Atrial e Acidente Vascular Cerebral
DOI:
https://doi.org/10.34024/rnc.2014.v22.8128Palavras-chave:
Acidente Vascular Cerebral, Fibrilação Atrial, Varfarina, AnticoagulantesResumo
Cerca de 20 a 30% dos acidentes vasculares cerebrais (AVC) são de origem cardioembólica, sendo a fibrilação atrial (FA) a principal causa cardiogênica. A FA é uma situação não rara na população e aumenta sua prevalência com a idade. Está relacionada a quadros de AVC mais graves, comparativamente às demais causas. A prevenção de AVC em pacientes com FA deve ser realizada com anticoagulação oral, sendo a varfarina a medicação mais utilizada; no entanto, esta medicação é de difícil controle, devido a múltiplas interações medicamentosas, interações alimentares, o que faz necessário manter monitorização laboratorial periódica. Metade dos pacientes que iniciam este tratamento o interrompe em meses e metade dos tratados não atinge o alvo terapêutico. Como evento adverso, existe o risco de hemorragias, incluindo hemorragia cerebral, e o benefício da medicação deve ser individualizado ao paciente. Nesta atualização são apresentadas considerações sobre a farmacologia dos anticoagulantes e resultados de recentes ensaios clínicos. Neste cenário, os novos anticoagulantes orais (como a dabigatrana, rivaroxabana, apixabana, edoxabana) têm surgido como opção à varfarina, por apresentarem-se com eficácia semelhante ou discretamente melhor do que a varfarina e com risco de hemorragia discretamente menor.
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Publicado: 2014-03-31
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