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Apixaban y el riesgo recurrente de accidente cerebrovascular con disfunción ventricular izquierda: un análisis
Richa Sharma1, Dinesh Jillella2, Cenai Zhang3
1Department of Neurology, Yale School of Medicine, New Haven, CT (R.S.).
Stroke
|September 2, 2025
Resumen
Apixaban redujo significativamente el riesgo de recidiva de ictus en pacientes con disfunción sistólica del ventrículo izquierdo en comparación con la aspirina. Este hallazgo es crucial para las estrategias de prevención secundaria del ictus en este grupo de pacientes.
Área de la Ciencia:
- Cardiología
- Neurología
- Farmacología
Sus antecedentes:
- Existe incertidumbre con respecto al vínculo entre la disfunción sistólica ventricular izquierda (LV), el accidente cerebrovascular recurrente y el tratamiento antitrombótico óptimo para la prevención del accidente cerebrovascular secundario.
- La disfunción sistólica del ventrículo izquierdo es un factor de riesgo potencial para el accidente cerebrovascular, lo que requiere estrategias de prevención adaptadas.
Objetivo del estudio:
- Investigar la asociación entre la disfunción sistólica de LV y el riesgo recurrente de ictus isquémico.
- Comparar la eficacia de apixaban frente a la aspirina en la prevención del ictus isquémico recurrente en pacientes con y sin disfunción sistólica de LV.
Principales métodos:
- Análisis post hoc de los datos del ensayo aleatorizado ARCADIA.
- Definición de la disfunción sistólica de LV basada en parámetros ecocardiográficos (acortamiento fraccionario de LV < 25%, fracción de eyección de LV < 50% o anormalidad del movimiento de la pared de LV).
- Se utilizaron modelos de riesgo proporcional de Cox para evaluar el riesgo de accidente cerebrovascular y los efectos del tratamiento.
Principales resultados:
- El 17,1% de los pacientes (165/964) exhibió disfunción sistólica de LV.
- La disfunción sistólica LV no se asoció significativamente con el riesgo recurrente de accidente cerebrovascular después del ajuste covariado (HR, 1,3; IC 95%, 0,7-2,4).
- Apixaban redujo significativamente el riesgo de ictus isquémico recurrente en comparación con la aspirina en pacientes con disfunción sistólica LV (RH, 0, 24; IC del 95%, 0, 07- 0, 87; Pinteracción=0, 028).
Conclusiones:
- Apixaban demostró una eficacia superior a la aspirina en la prevención del ictus isquémico recurrente entre los pacientes con disfunción sistólica LV.
- Estos hallazgos sugieren un enfoque personalizado de la terapia antitrombótica basado en la función sistólica LV en pacientes con accidente cerebrovascular.
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