Fatores de risco para hemorragia precoce após trombólise intravenosa em pacientes com acidente vascular cerebral isquêmico (AVCI)
Tipo
TCC
Data de publicação
2025-06-05
Periódico
Citações (Scopus)
Autores
Aquim, João Pedro Cardoso
Oliveira, Pedro Luís Peniche de
Oliveira, Pedro Luís Peniche de
Orientador
Seefeld, Marcos
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INTRODUÇÃO: O acidente vascular cerebral isquêmico (AVCi) representa a forma mais comum de AVC e permanece como importante causa de morbimortalidade no Brasil. A trombólise intravenosa com alteplase é atualmente o tratamento mais eficaz quando administrada nas primeiras 4,5 horas após o início dos sintomas. No entanto, seu uso pode resultar em hemorragias precoces, especialmente intracranianas, que comprometem o desfecho clínico. A identificação de fatores preditivos de risco é essencial para a segurança terapêutica. OBJETIVO: Identificar fatores clínicos, laboratoriais e demográficos associados à ocorrência de hemorragia precoce após trombólise intravenosa em pacientes com AVCi. METODOLOGIA: Estudo retrospectivo, observacional e transversal, aprovado pelo CEP sob CAAE 83664324.6.0000.0103, baseado na análise de 100 prontuários de pacientes com AVCi que receberam trombólise intravenosa entre 2021 e 2024 em um hospital terciário. Foram avaliadas variáveis como idade, sexo, comorbidades, uso de medicações, parâmetros laboratoriais, pressão arterial, escalas clínicas (NIHSS e GCS), tempo até a trombólise e local da hemorragia. Os dados foram analisados com testes estatísticos apropriados, regressão logística e curvas ROC. RESULTADOS: A média de idade foi de 66,35 ± 13,67 anos, sendo 55 % masculinos e 45 % femininos. Hipertensão arterial foi a comorbidade mais prevalente (66%). Hemorragias precoces ocorreram em 20% dos pacientes, sendo 50% intracranianas sintomáticas. A pressão arterial diastólica foi significativamente maior no grupo com hemorragia (99,27 ± 25,43 mmHg) em comparação ao grupo sem hemorragia (85,55 ± 14,72 mmHg, p = 0,028). A média do escore NIHSS foi de 13,19 ± 5,05 no grupo com hemorragia e 10,59 ± 4,77 no grupo sem (p = 0,032). A glicemia e a ureia também apresentaram valores mais altos nos casos com hemorragia (p = 0,033 e p = 0,025, respectivamente). O INR foi mais elevado no grupo com hemorragia (p = 0,033). O uso de antiplaquetários também foi associado à ocorrência de hemorragia (p = 0,048). A regressão logística identificou como preditores independentes: pressão arterial diastólica (OR 1,08; IC 95%: 1,01–1,16), NIHSS (OR 1,47; IC 95%: 1,03–2,10) e histórico de AVC/AIT (OR 43,33; IC 95%: 1,12–1674). A variável com maior acurácia foi o histórico de AVC/AIT (0,78), seguido por uso de antiplaquetários (0,71), PAD (0,66) e NIHSS (0,63). CONCLUSÃO: Pressão arterial diastólica elevada, maior gravidade clínica e histórico prévio de AVC/AIT foram associados à hemorragia precoce. Esses achados podem contribuir para uma triagem mais segura de pacientes elegíveis à trombólise.
INTRODUCTION: Ischemic stroke (IS) is the most common type of stroke and remains a significant cause of morbidity and mortality in Brazil. Intravenous thrombolysis with alteplase is currently the most effective treatment when administered within the first 4.5 hours after symptom onset. However, its use may result in early hemorrhagic events, especially intracranial hemorrhages, which negatively affect clinical outcomes. Identifying predictive risk factors is essential for therapeutic safety. OBJECTIVE: To identify clinical, laboratory, and demographic factors associated with the occurrence of early hemorrhage following intravenous thrombolysis in patients with AIS. METHODS: This was a retrospective, observational, and cross-sectional study, approved by the Research Ethics Committee under CAAE 83664324.6.0000.0103. It was based on the analysis of 100 medical records of patients with ischemic stroke who received intravenous thrombolysis between 2021 and 2024 at a tertiary hospital. Variables evaluated included age, sex, comorbidities, medication use, laboratory parameters, blood pressure, clinical scales (NIHSS and GCS), time to thrombolysis, and hemorrhage location. Data were analyzed using appropriate statistical tests, logistic regression, and ROC curves. RESULTS: The mean age was 66.35 ± 13.67 years, with 55% male and 45% female patients. Hypertension was the most prevalent comorbidity (66%). Early hemorrhages occurred in 20% of patients, with 50% being symptomatic intracranial hemorrhages. Diastolic blood pressure was significantly higher in the hemorrhage group (99.27 ± 25.43 mmHg) compared to the non-hemorrhage group (85.55 ± 14.72 mmHg, p = 0.028). The mean NIHSS score was 13.19 ± 5.05 in the hemorrhage group and 10.59 ± 4.77 in the non-hemorrhage group (p = 0.032). Glucose and urea levels were also higher in patients with hemorrhage (p = 0.033 and p = 0.025, respectively). INR was elevated in the hemorrhage group (p = 0.033). The use of antiplatelet agents was also associated with hemorrhage occurrence (p = 0.048). Logistic regression identified the following independent predictors: diastolic blood pressure (OR 1.08; 95% CI: 1.01–1.16), NIHSS (OR 1.47; 95% CI: 1.03–2.10), and prior history of stroke/TIA (OR 43.33; 95% CI: 1.12–1674). The variable with the highest accuracy was prior history of stroke/TIA (0.78), followed by use of antiplatelets (0.71), diastolic blood pressure (0.66), and NIHSS (0.63). CONCLUSION:Elevated diastolic blood pressure, higher clinical severity, and a previous history of stroke/TIA were associated with early hemorrhage. These findings may contribute to safer screening of patients eligible for thrombolysis.
INTRODUCTION: Ischemic stroke (IS) is the most common type of stroke and remains a significant cause of morbidity and mortality in Brazil. Intravenous thrombolysis with alteplase is currently the most effective treatment when administered within the first 4.5 hours after symptom onset. However, its use may result in early hemorrhagic events, especially intracranial hemorrhages, which negatively affect clinical outcomes. Identifying predictive risk factors is essential for therapeutic safety. OBJECTIVE: To identify clinical, laboratory, and demographic factors associated with the occurrence of early hemorrhage following intravenous thrombolysis in patients with AIS. METHODS: This was a retrospective, observational, and cross-sectional study, approved by the Research Ethics Committee under CAAE 83664324.6.0000.0103. It was based on the analysis of 100 medical records of patients with ischemic stroke who received intravenous thrombolysis between 2021 and 2024 at a tertiary hospital. Variables evaluated included age, sex, comorbidities, medication use, laboratory parameters, blood pressure, clinical scales (NIHSS and GCS), time to thrombolysis, and hemorrhage location. Data were analyzed using appropriate statistical tests, logistic regression, and ROC curves. RESULTS: The mean age was 66.35 ± 13.67 years, with 55% male and 45% female patients. Hypertension was the most prevalent comorbidity (66%). Early hemorrhages occurred in 20% of patients, with 50% being symptomatic intracranial hemorrhages. Diastolic blood pressure was significantly higher in the hemorrhage group (99.27 ± 25.43 mmHg) compared to the non-hemorrhage group (85.55 ± 14.72 mmHg, p = 0.028). The mean NIHSS score was 13.19 ± 5.05 in the hemorrhage group and 10.59 ± 4.77 in the non-hemorrhage group (p = 0.032). Glucose and urea levels were also higher in patients with hemorrhage (p = 0.033 and p = 0.025, respectively). INR was elevated in the hemorrhage group (p = 0.033). The use of antiplatelet agents was also associated with hemorrhage occurrence (p = 0.048). Logistic regression identified the following independent predictors: diastolic blood pressure (OR 1.08; 95% CI: 1.01–1.16), NIHSS (OR 1.47; 95% CI: 1.03–2.10), and prior history of stroke/TIA (OR 43.33; 95% CI: 1.12–1674). The variable with the highest accuracy was prior history of stroke/TIA (0.78), followed by use of antiplatelets (0.71), diastolic blood pressure (0.66), and NIHSS (0.63). CONCLUSION:Elevated diastolic blood pressure, higher clinical severity, and a previous history of stroke/TIA were associated with early hemorrhage. These findings may contribute to safer screening of patients eligible for thrombolysis.
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Palavras-chave
AVC isquêmico , terapia trombolítica , hemorragia , ischemic stroke , thrombolytic therapy , hemorrhage