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Un nuevo sistema de puntuación para determinar el riesgo tromboembólico después del reemplazo de válvula cardíaca

Eric G Butchart¹, Adrian Ionescu, Nicola Payne

¹Department of Cardiothoracic Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. egbutchart@aol.com.

|September 13, 2003

Resumen

Los marcadores inflamatorios y hematológicos, junto con los factores clínicos, pueden predecir el riesgo de tromboembolismo (TE) en pacientes con reemplazo de válvula (VR). Un sistema de puntuación que utilice estos predictores puede guiar las decisiones de tratamiento.

Área de la Ciencia:

Medicina Cardiovascular La medicina cardiovascular es una especialidad de la salud.
Hematología Hematología.
Enfermedad Infecciosa Enfermedad Infecciosa.

Sus antecedentes:

El tromboembolismo (TE) es un riesgo significativo después del reemplazo de válvula (VR).
Una estratificación precisa del riesgo preoperatorio es crucial para el manejo del paciente.
Se necesita identificar predictores confiables más allá de los factores clínicos tradicionales.

Objetivo del estudio:

Identificar los principales predictores inflamatorios y hematológicos de TE en pacientes con RV.
Desarrollar un sistema de puntuación para el perfil de riesgo preoperatorio de TE.
Para informar la elección de prótesis y las estrategias de manejo antitrombótico.

Principales métodos:

Examen prospectivo de los parámetros clínicos, ecocardiográficos, hematológicos y microbiológicos en 370 pacientes con RV.
Análisis multivariado para identificar predictores de eventos de TE durante un seguimiento promedio de 4.4 años.
Desarrollo de un sistema de puntuación aditivo basado en factores de riesgo identificados.

Principales resultados:

Los predictores de TE después del reemplazo de la válvula aórtica (AVR) incluyeron infección por Chlamydia pneumoniae (CP), TE anterior, eosinófilos elevados, antecedentes de cáncer, infección postoperatoria, hipertensión, CABG y diabetes.
Los predictores de TE después del reemplazo de la válvula mitral (MVR) / DVR incluyeron el volumen promedio elevado de plaquetas, el aumento del factor VII, la infección de CP, la valvotomía mitral previa, el fibrinógeno elevado y los reticulocitos elevados.
Un sistema de puntuación aditivo predijo con precisión el riesgo de TE basado en el número de factores de riesgo presentes.

Conclusiones:

Los análisis de sangre seleccionados y los factores clínicos predicen eficazmente el riesgo de TE en pacientes con RV.
Un sistema de puntuación desarrollado puede ayudar en la evaluación del riesgo preoperatorio.
Los hallazgos pueden guiar la selección de prótesis y la terapia antitrombótica.

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