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Selección de pacientes con fibrilación auricular para anticoagulación: estratificación del riesgo de accidente

Brian F Gage¹, Carl van Walraven, Lesly Pearce

¹Division of General Medical Sciences, Washington University School of Medicine Campus Box 8005, 660 S Euclid Ave, St. Louis, MO 63110, USA. bgage@im.wustl.edu

|October 13, 2004

Resumen

La identificación del riesgo de accidente cerebrovascular en pacientes con fibrilación auricular (FA) que reciben aspirina es crucial. La puntuación CHADS (2) identifica efectivamente a las personas de alto riesgo, lo que permite la selección de la profilaxis antitrombótica personalizada.

Área de la Ciencia:

Cardiología Cardiología.
Neurología Neurología.
Farmacología Farmacología.

Sus antecedentes:

El riesgo de accidente cerebrovascular en la fibrilación auricular (FA) está influenciado por las comorbilidades y la terapia antitrombótica.
La dosis ajustada de warfarina reduce el ictus más que la aspirina en la FA, pero la reducción del riesgo absoluto varía.
Este estudio evaluó 5 esquemas de estratificación del riesgo de accidente cerebrovascular para pacientes con AF que recibían aspirina.

Objetivo del estudio:

Para probar la precisión predictiva de 5 esquemas de estratificación del riesgo de accidente cerebrovascular en pacientes con FA no valvular que reciben aspirina.
Para determinar si estos esquemas pueden identificar de manera confiable a los pacientes con altas y bajas tasas de ictus.
Apoyar la selección de la profilaxis antitrombótica individualizada basada en el riesgo de accidente cerebrovascular.

Principales métodos:

Se agruparon datos individuales de 2580 participantes con FA no valvular de 5 ensayos multicéntricos.
Análisis de eventos de accidente cerebrovascular isquémico durante la terapia con aspirina (4887 pacientes-años).
Comparación de la precisión predictiva de 5 diferentes esquemas de estratificación del riesgo de accidente cerebrovascular.

Principales resultados:

Los 5 esquemas predijeron el accidente cerebrovascular mejor que el azar, pero la categorización del riesgo varió.
Los pacientes con isquemia cerebral previa tenían un alto riesgo en todos los esquemas (10,8 accidentes cerebrovasculares/100 pacientes-año).
El esquema CHADS2 identificó pacientes de prevención primaria de alto riesgo (5,3 accidentes cerebrovasculares/100 pacientes-años), que superaron a otros.

Conclusiones:

La identificación confiable de pacientes con alto y bajo riesgo de accidente cerebrovascular con AF en aspirina es factible.
La selección de la profilaxis antitrombótica individualizada puede guiarse por una estratificación del riesgo validada.
El esquema CHADS (2) demuestra su utilidad en la identificación de pacientes con FA de alto riesgo para una intervención específica.

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