Por que alguns pacientes com acidente vascular cerebral isquêmico agudo após terapia trombolítica endovenosa não melhoram? Um estudo caso-controle
DOI:
https://doi.org/10.36311/jhgd.v33.15284Palavras-chave:
NIHSS, derrame, trombólise, terapia trombolíticaResumo
Introdução: a terapia trombolítica é a principal medida salvadora adotada em vítimas de acidente vascular cerebral isquêmico (AVCI), adequada para a maioria delas. Entretanto, alguns pacientes não apresentam evolução clínica, piorando o prognóstico, o que constitui uma lacuna científica essencial.
Objetivo: analisar os determinantes da não melhora clínica em pacientes com AVC em uso de trombolíticos rt-PA.
Método: estudo observacional retrospectivo caso-controle, realizado de 2014 a 2017 por meio de busca ativa de prontuários de pacientes com AVC submetidos à terapia trombolítica em um hospital de referência no Ceará. A falência clínica foi caracterizada como ausência de redução no National Institutes of Health Stroke Scale-Score (NIHSS).
Resultados: um total de 139 pacientes incluídos no estudo em uma única unidade de AVC. A média de idade foi de 66,14 anos (variando de 34 a 95). O seguimento de 24 horas foi completado em 100% dos pacientes. Resultado favorável 24 horas pós-trombólise foi observado em 113 pacientes (81,29%), e não houve melhora clínica em 26 (18,7%). A transformação hemorrágica pós-trombólise foi um forte preditor de não melhora (p=0,004), e diabetes foi o principal fator de risco modificável encontrado (p=0,040).
Conclusão: diabetes e transformação hemorrágica após trombólise foram identificados como fatores de risco para não melhora clínica em pacientes com AVC agudo submetidos à terapia trombolítica.
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Copyright (c) 2023 Filho HLM, Figueiredo FWS, Costa AVF, Albuquerque CNB, Diógenes RC, Rafael GV, Correa JA
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