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Anticorpos antifosfolípidos y sucesos trombooclusivos subsiguientes en pacientes con ictus isquémico
Steven R Levine1, Robin L Brey, Barbara C Tilley
1Department of Neurology, Mt Sinai School of Medicine, New York, NY 10029-6574, USA. steven.levine@mssm.edu
JAMA
|February 6, 2004
Resumen
Los anticuerpos antifosfolípidos (aPL) no predicen eventos vasculares recurrentes en pacientes con accidente cerebrovascular isquémico. No se recomienda la detección de aPL, ya que no altera la respuesta al tratamiento con aspirina o warfarina.
Área de la Ciencia:
- Neurología Neurología.
- Inmunología Inmunología.
- Medicina Cardiovascular La medicina cardiovascular es una especialidad de la salud.
Sus antecedentes:
- Los anticuerpos antifosfolípidos (aPL) están relacionados con los eventos de oclusión vascular.
- El papel predictivo de aPL en eventos isquémicos, especialmente en accidentes cerebrovasculares recurrentes, sigue siendo objeto de debate.
Objetivo del estudio:
- Para evaluar si la positividad aPL basal predice futuros eventos trombo-oclusivos.
- Para determinar si el estado de aPL influye en la respuesta al tratamiento con warfarina versus aspirina en pacientes con accidente cerebrovascular.
Principales métodos:
- Estudio de cohorte prospectivo (APASS) dentro de un ensayo aleatorizado (WARSS) de 1770 pacientes con accidente cerebrovascular isquémico.
- El estado basal de la aPL (anticuerpos anticardiolipina [aCL], anticuerpos anticoagulantes del lupus [LA]) analizado dentro de los 90 días del accidente cerebrovascular índice.
- Seguimiento de dos años para el criterio de valoración compuesto que incluye la muerte, accidente cerebrovascular isquémico y otros eventos trombo-oclusivos.
Principales resultados:
- No se encontró un mayor riesgo de eventos trombo-oclusivos en pacientes aPL-positivos en warfarina (RR 0.99) o aspirina (RR 0.94).
- Las tasas generales de eventos fueron similares entre los pacientes aPL-positivos (22,2%) y aPL-negativos (21,8%).
- No se observó ninguna interacción significativa del tratamiento con el estado de aPL.
Conclusiones:
- La positividad aPL basal no predice eventos vasculares posteriores en pacientes con accidente cerebrovascular isquémico.
- El estado de aPL no indica una respuesta diferencial al tratamiento con aspirina o warfarina.
- El cribado de rutina para aPL en pacientes con accidente cerebrovascular isquémico no está clínicamente justificado.
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