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Riesgo de accidente cerebrovascular en adultos con enfermedad cardíaca congénita cianótica
J K Perloff1, A J Marelli, P D Miner
1Department of Medicine, University of California Los Angeles.
Circulation
|June 1, 1993
Resumen
La flebotomía no se recomienda para adultos con enfermedad cardíaca congénita cianotica únicamente para prevenir el accidente cerebrovascular. Este estudio no encontró evidencia de riesgo de accidente cerebrovascular asociado con niveles elevados de hematocrito en estos pacientes.
Área de la Ciencia:
- Cardiología Cardiología.
- Neurología Neurología.
- Hematología Hematología.
Sus antecedentes:
- Los adultos con enfermedad cardíaca congénita cianótica a menudo se someten a flebotomía debido a los altos niveles de hematocrito, basados en un supuesto riesgo de accidente cerebrovascular.
- La relación entre el hematocrito, la eritrocitosis sintomática (hiperviscosidad) y el accidente cerebrovascular en esta población requiere más investigación.
Objetivo del estudio:
- Determinar si los niveles elevados de hematocrito y la eritrocitosis sintomática en adultos con enfermedad cardíaca congénita cianótica se correlacionan con un mayor riesgo de ictus trombótico arterial cerebral.
- Evaluar la necesidad de la flebotomía para la prevención del ictus en este grupo de pacientes.
Principales métodos:
- Un estudio retrospectivo de 112 adultos con enfermedad cardíaca congénita cianótica, observado durante 1-12 años.
- Los pacientes se clasificaron en grupos de eritrocitosis compensada y descompensada en función de los niveles de hematocrito, el estado del hierro y los síntomas de hiperviscosidad.
- Los criterios de exclusión incluyeron factores de riesgo independientes para accidente cerebrovascular embolico o vasospático.
Principales resultados:
- Ningún paciente, independientemente del nivel de hematocrito, reservas de hierro o síntomas de hiperviscosidad, desarrolló un accidente cerebrovascular completo (trombosis arterial cerebral con infarto cerebral).
- Tanto los grupos de eritrocitosis compensados (hematócrito 46.0-72.7%) como los descompensados (hematócrito 61.5-75.0%) no mostraron progresión hacia el accidente cerebrovascular.
- La deficiencia de hierro inducida por flebotomía puede tener consecuencias negativas para la salud.
Conclusiones:
- La flebotomía no está justificada para mitigar un supuesto riesgo de accidente cerebrovascular en pacientes con enfermedad cardíaca congénita cianótica, ya que este riesgo no se demostró.
- Se puede considerar la flebotomía para el alivio temporal de los síntomas severos de hiperviscosidad, pero no para el control del hematocrito solo.
- Los efectos circulatorios transitorios de la flebotomía y los riesgos de deficiencia de hierro no apoyan su uso rutinario para la prevención del accidente cerebrovascular en esta población.
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