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Predicción del riesgo de tromboembolismo venoso en pacientes hospitalizados con insuficiencia cardíaca

Alexandre Mebazaa¹, Theodore E Spiro², Harry R Büller²

¹From Université Paris Diderot, PRES Sorbonne Paris Cité and Department of Anesthesiology and Critical Care Medicine, Saint Louis Lariboisière University Hospitals, U942 Inserm, Paris, France (A.M.); Bayer HealthCare Pharmaceuticals Inc, Montville, NJ (T.E.S., Y.D.S.); Academic Medical Center, Amsterdam, The Netherlands (H.R.B.); Janssen Research & Development LLC, Raritan, NJ (L.H.); People's Hospital of Peking University, Beijing, China (D.H.); Foothills Hospital, Calgary, Alberta, Canada (R.H.); Thomas Jefferson Medical Center, Philadelphia, PA (G.M.); Dresden-Friedrichstadt Hospital, Dresden, Germany (S.W.S.); Hofstra North Shore-LIJ School of Medicine, Manhasset, NY (A.C.S.); Duke University Medical Center, Durham, NC (V.F.T.); and King's College Hospital, London, UK (A.T.C.). alexandre.mebazaa@lrb.aphp.fr.

|June 28, 2014

Resumen

Los pacientes con insuficiencia cardíaca grave (IC) se enfrentan a un mayor riesgo de tromboembolismo venoso (TEV). El aumento de NT-proBNP indica un riesgo a corto plazo de TEV, mientras que el D-dimero sugiere un riesgo a medio plazo en estos pacientes.

Área de la Ciencia:

Cardiología Cardiología.
La medicina vascular es una medicina vascular.
Los ensayos clínicos son ensayos clínicos.

Sus antecedentes:

La relación entre la insuficiencia cardíaca (IC) y el riesgo de tromboembolismo venoso (TEV) no se entiende completamente.
El ensayo MAGELLAN investigó la prevención de TEV en pacientes hospitalizados con enfermedades agudas, comparando rivaroxaban con enoxaparin.
Este análisis examinó específicamente el impacto de la gravedad de la IH en el riesgo de TEV dentro de la población del ensayo MAGELLAN.

Objetivo del estudio:

Evaluar la asociación entre la gravedad de la insuficiencia cardíaca y el riesgo de tromboembolismo venoso (TEV).
Determinar la utilidad de biomarcadores como el NT-proBNP y el D-dimero en la predicción del riesgo de TEV en pacientes con HF.

Principales métodos:

Análisis de datos de 2593 pacientes hospitalizados con insuficiencia cardíaca de clase III o IV de la Asociación del Corazón de Nueva York del ensayo MAGELLAN.
La gravedad de la HF se estratificó utilizando las concentraciones plasmáticas de péptido natriurético en el probrain N-terminal (NT-proBNP) y D-dimero.
La incidencia de TEV se comparó entre los subgrupos de gravedad de la IH hasta el día 10 y el día 35.

Principales resultados:

Los pacientes con HF más grave (mayor NT-proBNP) mostraron una incidencia significativamente mayor de TEV en comparación con aquellos con HF menos grave (7,2% frente a 4,1% en el día 35).
El análisis multivariable confirmó la asociación de NT-proBNP con el riesgo de TEV hasta el día 10 (P=0,017) y el D-dimer hasta el día 35 (P=0,005).
El mayor riesgo de TEV asociado con la gravedad de la fibrilación alta no se observó en el grupo de rivaroxaban de duración prolongada.

Conclusiones:

La insuficiencia cardíaca más grave, indicada por el aumento de NT-proBNP, está relacionada con un mayor riesgo de TEV.
NT-proBNP puede identificar a los pacientes con alto riesgo a corto plazo de TEV, mientras que el D-dimero puede sugerir un mayor riesgo a medio plazo.
La estratificación del riesgo guiada por biomarcadores podría ayudar en las estrategias de prevención de TEV para pacientes hospitalizados con IC.

Palabras clave:

La insuficiencia cardíaca es insuficiencia cardíaca.Los péptidos natriuréticos también se usan.La trombosis es una trombosis.

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