TRATAMENTO DA TROMBOSE VENOSA PROFUNDA AGUDA COM RIVAROXABANA
Palavras-chave:
Trombose venosa profunda. Rivaroxabana.Resumo
A rivaroxabana é um anticoagulante oral, utilizado em dose fixa diária, sem necessidade de monitorização laboratorial, que já se mostrou eficaz e seguro no tratamento do tromboembolismo venoso como monoterapia. O objetivo desse trabalho foi acompanhar a evolução e o possível surgimento de efeitos colaterais em pacientes com trombose venosa profunda aguda em uso da rivaroxabana como monoterapia. Os pacientes incluídos no estudo utilizaram rivaroxabana durante 6 meses, sendo acompanhados através de avaliação clínica, eco-Doppler, exames laboratoriais e raio X de tórax. A análise estatística foi realizada através do teste exato de Fisher. Entre junho de 2012 e maio de 2015, 23 pacientes foram incluídos neste estudo, sendo 60,86% do sexo feminino e 39,13% do sexo masculino. Cirurgia recente foi o principal fator predisponente observado, seguido de imobilização. Em 56,52% dos casos a TVP se localizava na veia poplítea e/ou nas veias da perna, denominado grupo 1, e em 39,13% no território ilíaco-femoral, denominado de grupo 2. Dois pacientes apresentaram eventos tromboembólicos durante o período de observação. Os pacientes do grupo 1 obtiveram recanalização completa do segmento venoso acometido em 100% dos casos comparado com 33,33% naqueles do grupo 2 (p<0,05). Nenhum paciente foi a óbito ou desenvolveu eventos hemorrágicos durante o seguimento. Dor abdominal e queda na taxa de filtração glomerular foram os efeitos colaterais encontrados. Nesse trabalho, a rivaroxabana se mostrou efetiva e segura no tratamento da TVP aguda, sendo a localização da trombose um importante preditor da evolução do trombo.Referências
Fauci AC, Braunwald E, Kasper DL, Hauser SL, Longo DL. Harrison Medicina Interna. 17a ed. Rio de Janeiro. McGraw-Hill, 2008.
Spencer FA, Emery C, Lessard D, et al. The Worcester Venous Thromboembolism study: a population-based study of the clinical epidemiology of venous throm boembolism. J Gen Intern Med 2006;21: 722-7.
VTE Impact Assessment Group in Europe (VITAE). Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost. 2007 Oct; 98(4):756-64.
Morbidity and Mortality: 1998 Chartbook on Cardiovascular, Lung and Blood Diseases. National Institutes of Health. National Heart, Lung, and Blood Institute October, 1998.
Maffei, FHA et al. Doenças Vasculares Periféricas. 3. ed. Rio de Janeiro: MEDSI, 2002
Martins HS, Brandão Neto RA, Scalabrini Neto A, Velasco IT. Emergências Clínicas: Abordagem Prática. 8a ed. Barueri, SP. Manole, 2013.
Deitelzweig SB, Johnson BH, Lin L, Schulman KL. Prevalence of clinical venous thromboembolism in the USA: current trends and future projections. Am J Hematol 2011; 86:217–20.
Goldhaber SZ, Elliott CG. Acute pulmonary embolism: part I: epidemiology, pathophysiology, and diagnosis. Circulation. 2003 Dec 2;108(22):2726-9.
Wilbur J, Shian B. Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism. Am Fam Physician. 2012;86(10):913-919.
Kahn SR, Comerota AJ, Cushman M, Evans NS, Ginsberg JS, Goldenberg NA, et al. The Postthrombotic Syndrome: Evidence-Based Prevention, Diagnosis, and Treatment Strategies. A Scientific Statement From the American Heart Association. Circulation. 2014;130:1636-1661.
Van Dongen CJJ, Prandoni P, Frulla M, Marchiori A, Prins MH, Hutten BA. Relation between quality of anticoagulant treatment and the development of the postthrombotic syndrome. J Thromb Haemost 2005; 3: 939–42.
Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, et al. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines 2012.
The EINSTEIN Investigators, Oral Rivaroxaban for Symptomatic Venous Thromboembolism. N Engl J Med 2010;363:2499-510.
Yeh CH, Hogg K, Weitz JI. Overview of the new oral anticoagulants: opportunities and challenges. Arterioscler Thromb Vasc Biol. 2015 May;35(5):1056-65.
Harder S. Pharmacokinetic and pharmacodynamic evaluation of rivaroxaban: considerations for the treatment of venous thromboembolism. Harder Thrombosis Journal 2014, 12:22
Merli GJ, Hollander JE, Lefebvre P, Laliberte F, Raut MK, Olson WH, Pollack Jr CV. Rates of hospitalization among patients with deep vein thrombosis before and after the introduction of rivaroxaban. Hospital Practice, 2015; 43(2): 85–93.
Bostom AG, Kronenberg F, Ritz E. Predictive Performance of Renal Function Equations for Patients with Chronic Kidney Disease and Normal Serum Creatinine Levels. J Am Soc Nephol 2002;13: 2140-2144.
Meissner MH, Manzo RA, Bergelin RO, Markel A, Strandness DE. Deep venous insufficiency: the relationship between lysis and subsequent reflux. J Vasc Surg 1993; 18: 596605; discussion 606608.
Siragusa S, Malato A, Anastasio R, Cigna V, Milio G, Amato C, Bellisi M, Attanzio MT, Cormaci O, Pellegrino M, Dolce A, Casuccio A, Bajardi G, Mariani G. Residual vein thrombosis to establish duration of anticoagulation after a first episode of deep vein thrombosis: the Duration of Anticoagulation based on Compression UltraSonography (DACUS) study. Blood 2008; 112: 511515.
White RH. The Epidemiology of Venous Thromboembolism. Circulation. 2003;107:I-4–I-8.
Elsharawy M, Elzayat E. Early results of thrombolysis vs anticoagulation in iliofemoral venous thrombosis. A ran- domised clinical trial. Eur J Vasc Endovasc Surg. 2002;24(3): 209-214.
Enden T, Kløw NE, Sandvik L, et al; CaVenT study group. Catheter-directed thrombolysis vs. anticoagulant therapy alone in deep vein thrombosis: results of an open randomized, controlled trial reporting on short-term patency. J Thromb Haemost. 2009;7(8):1268-1275.
Enden T, Sandvik L, Kløw NE, et al. Catheter-directed venous thrombolysis in acute iliofemoral vein thrombosis— the CaVenT study: rationale and design of a multicenter, randomized, controlled, clinical trial. Am Heart J. 2007;154(5):808-814.
Jenkins JS, Michael P. Deep Venous Thrombosis: An Interventionalist’s Approach. The Ochsner Journal 14:633–640, 2014.
Watson LI, Armon MP. Thrombolysis for acute deep vein thrombosis. Cochrane Database Syst Rev. 2004;(4): CD002783.
Van der Hulle T, Kooiman J, Den Exter PL, Dekkers OM, Klok FA, Huisman MV Effectiveness and safety of novel oral anticoagulants as compared with vitamin K antagonists in the treatment of acute symptomatic venous thromboembolism: a systematic review and meta-analysis. Journal of Thrombosis and Haemostasis, 12: 320–328.
FDA [homepage na internet]. Acesso em: 11 de outubro de 2013. Disponível em: http://www.fda.gov/.
Samama MM, Gerotziafas GT. Newer anticoagulants in 2009. J Thromb Thrombolysis. 2010;29:92-104.
Hutten BA, Prins MH. Duration of treatment with vitamin K antagonists in symptomatic venous thromboembolism. Cochrane Database Syst Rev 2006.
Bayer Health Care Pharmaceuticals [home page na Internet]. Acesso em: 01 de abril de 2014. Disponível em: http://m.bayerpharma.com.br/html/bulas/publico_geral/Xarelto.pdf.
Michiels JJ, Michiels JM, Moossdorff W, Lao M, Maasland H, Palareti G. Diagnosis of deep vein thrombosis, and prevention of deep vein thrombosis recurrence and the post-thrombotic syndrome in the primary care medicine. World J Crit Care Med 2015 February 4; 4(1): 29-39
Masuda EM, Kessler DM, Kistner RL, Eklof B, Sato DT. The natural history of calf vein thrombosis: lysis of thrombi and development of reflux. J Vasc Surg. 1998 Jul;28(1):67-73; discussion 73-4.
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Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
