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La asociación entre la hemorragia perioperatoria mayor y el accidente cerebrovascular o el infarto de miocardio de
Hooman Kamel1, S Claiborne Johnston, John C Kirkham
1Department of Neurology and Neuroscience, Weill Cornell Medical College, New York, NY 10065, USA. hok9010@med.cornell.edu
Circulation
|June 9, 2012
Resumen
El sangrado mayor durante la cirugía aumenta significativamente el riesgo de accidente cerebrovascular y ataque cardíaco en los pacientes. Este hallazgo pone de relieve la necesidad de realizar más investigaciones sobre el manejo del sangrado y los eventos vasculares en entornos quirúrgicos.
Área de la Ciencia:
- La Medicina Perioperatoria es una medicina perioperatoria.
- Cirugía vascular Cirugía vascular.
- Medicina de cuidados críticos Medicina de cuidados críticos.
Sus antecedentes:
- La hemorragia es un factor de riesgo conocido para complicaciones isquémicas en pacientes cardíacos.
- La relación entre la hemorragia perioperatoria y los eventos isquémicos en pacientes quirúrgicos generales sigue sin estar clara.
Objetivo del estudio:
- Investigar la asociación entre la hemorragia perioperatoria mayor y la incidencia de accidente cerebrovascular o infarto de miocardio en pacientes quirúrgicos adultos.
- Para determinar si hay sangrado mayor durante una cirugía no cardíaca, no neurológica, la cirugía predice independientemente eventos vasculares subsiguientes.
Principales métodos:
- Análisis de los datos del Programa Nacional de Mejora de la Calidad Quirúrgica (2005-2009).
- Inclusión de pacientes adultos sometidos a cirugía no emergente, no traumática, no transplante, no cardíaca y no neurológica.
- Definición de hemorragia mayor como >4 unidades de glóbulos rojos empaquetados o transfusión de sangre completa; accidente cerebrovascular como causa vascular que dura ≥24 horas; infarto de miocardio como nuevas ondas Q del ECG.
- Modelos de peligros proporcionales de Cox utilizados para controlar las covariables y evaluar asociaciones independientes.
Principales resultados:
- De 651.775 pacientes, el 0,80% experimentó una hemorragia mayor, el 0,24% tuvo un infarto de miocardio de onda Q y el 0,20% sufrió un accidente cerebrovascular.
- La hemorragia perioperatoria mayor se asoció de forma independiente con un aumento de 2,5 veces el riesgo de accidente cerebrovascular (HR 2.5, IC del 95% 1.9-3.3).
- La hemorragia perioperatoria mayor se asoció de forma independiente con un aumento de 2,7 veces el riesgo de infarto de miocardio por onda Q (HR 2.7, IC del 95% 2.1-3.4).
Conclusiones:
- La hemorragia perioperatoria mayor es un predictor independiente significativo del accidente cerebrovascular posterior y el infarto de miocardio en pacientes sometidos a cirugía no cardíaca, no neurológica.
- Los hallazgos sugieren una posible necesidad de ensayos aleatorizados para evaluar estrategias perioperatorias, como el uso de medicamentos antiplaquetarios, para mitigar los riesgos de hemorragias y eventos vasculares.
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