Anticoagulation in patients with cardiac manifestations of Chagas disease and cardioembolic ischemic stroke
ABSTRACT Objectives To describe anticoagulation characteristics in patients with cardiac complications from Chagas disease and compare participants with and without cardioembolic ischemic stroke (CIS). Methods A retrospective cohort of patients with Chagas disease, using anticoagulation, conducted f...
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| Published in: | Arquivos de neuro-psiquiatria Vol. 76; no. 1; pp. 22 - 25 |
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| Format: | Journal Article |
| Language: | English |
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Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
Thieme Revinter Publicações Ltda
01-01-2018
Academia Brasileira de Neurologia - ABNEURO Academia Brasileira de Neurologia (ABNEURO) |
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| Abstract | ABSTRACT
Objectives
To describe anticoagulation characteristics in patients with cardiac complications from Chagas disease and compare participants with and without cardioembolic ischemic stroke (CIS).
Methods
A retrospective cohort of patients with Chagas disease, using anticoagulation, conducted from January 2011 to December 2014.
Results
Forty-two patients with Chagas disease who were using anticoagulation were studied (age 62.9±12.4 years), 59.5% female and 47.6% with previous CIS, 78.6% with non-valvular atrial fibrillation and 69.7% with dilated cardiomyopathy. Warfarin was used in 78.6% of patients and dabigatran (at different times) in 38%. In the warfarin group, those with CIS had more medical appointments per person-years of follow-up (11.7 vs 7.9), a higher proportion of international normalized ratios within the therapeutic range (57% vs 42% medical appointments, p = 0.025) and an eight times higher frequency of minor bleeding (0.64 vs 0.07 medical appointments).
Conclusion
Patients with Chagas disease and previous CIS had better control of INR with a higher frequency of minor bleeding. |
|---|---|
| AbstractList | ABSTRACT Objectives To describe anticoagulation characteristics in patients with cardiac complications from Chagas disease and compare participants with and without cardioembolic ischemic stroke (CIS). Methods A retrospective cohort of patients with Chagas disease, using anticoagulation, conducted from January 2011 to December 2014. Results Forty-two patients with Chagas disease who were using anticoagulation were studied (age 62.9±12.4 years), 59.5% female and 47.6% with previous CIS, 78.6% with non-valvular atrial fibrillation and 69.7% with dilated cardiomyopathy. Warfarin was used in 78.6% of patients and dabigatran (at different times) in 38%. In the warfarin group, those with CIS had more medical appointments per person-years of follow-up (11.7 vs 7.9), a higher proportion of international normalized ratios within the therapeutic range (57% vs 42% medical appointments, p = 0.025) and an eight times higher frequency of minor bleeding (0.64 vs 0.07 medical appointments). Conclusion Patients with Chagas disease and previous CIS had better control of INR with a higher frequency of minor bleeding.
RESUMO Objetivos descrever as características da anticoagulação em pacientes com manifestações cardíacas da doença de Chagas (MCDC) e comparar os participantes com sem acidente vascular cerebral isquêmico cardioembólico (AVCIC). Resultados 42 pacientes com MCDC em anticoagulação foram estudados (62,9 ± 12,4 anos), 59,5% do sexo feminino e 47,6% com AVCIC prévio, 78,6% portadores de fibrilação atrial não valvar e 69,7% com cardiomiopatia dilatada. Varfarina foi utilizada em 78,6% dos pacientes e dabigatrana em 38% (em momentos diferentes). No grupo da varfarina, aqueles com AVCIC tiveram mais consultas médicas por pessoas-ano de seguimento (11,7 vs 7,9), maior taxa de RNI na faixa terapêutica (57% vs 42% consultas médicas, p = 0,025) e uma frequência oito vezes maior de sangramento menor (0,64 vs. 0,07 consultas médicas). Conclusão pacientes com MCDC e AVCIC prévio têm melhor controle de RNI com maior frequência de sangramento menor. ABSTRACT Objectives To describe anticoagulation characteristics in patients with cardiac complications from Chagas disease and compare participants with and without cardioembolic ischemic stroke (CIS). Methods A retrospective cohort of patients with Chagas disease, using anticoagulation, conducted from January 2011 to December 2014. Results Forty-two patients with Chagas disease who were using anticoagulation were studied (age 62.9±12.4 years), 59.5% female and 47.6% with previous CIS, 78.6% with non-valvular atrial fibrillation and 69.7% with dilated cardiomyopathy. Warfarin was used in 78.6% of patients and dabigatran (at different times) in 38%. In the warfarin group, those with CIS had more medical appointments per person-years of follow-up (11.7 vs 7.9), a higher proportion of international normalized ratios within the therapeutic range (57% vs 42% medical appointments, p = 0.025) and an eight times higher frequency of minor bleeding (0.64 vs 0.07 medical appointments). Conclusion Patients with Chagas disease and previous CIS had better control of INR with a higher frequency of minor bleeding. To describe anticoagulation characteristics in patients with cardiac complications from Chagas disease and compare participants with and without cardioembolic ischemic stroke (CIS). A retrospective cohort of patients with Chagas disease, using anticoagulation, conducted from January 2011 to December 2014. Forty-two patients with Chagas disease who were using anticoagulation were studied (age 62.9±12.4 years), 59.5% female and 47.6% with previous CIS, 78.6% with non-valvular atrial fibrillation and 69.7% with dilated cardiomyopathy. Warfarin was used in 78.6% of patients and dabigatran (at different times) in 38%. In the warfarin group, those with CIS had more medical appointments per person-years of follow-up (11.7 vs 7.9), a higher proportion of international normalized ratios within the therapeutic range (57% vs 42% medical appointments, p = 0.025) and an eight times higher frequency of minor bleeding (0.64 vs 0.07 medical appointments). Patients with Chagas disease and previous CIS had better control of INR with a higher frequency of minor bleeding. ABSTRACT Objectives To describe anticoagulation characteristics in patients with cardiac complications from Chagas disease and compare participants with and without cardioembolic ischemic stroke (CIS). Methods A retrospective cohort of patients with Chagas disease, using anticoagulation, conducted from January 2011 to December 2014. Results Forty-two patients with Chagas disease who were using anticoagulation were studied (age 62.9±12.4 years), 59.5% female and 47.6% with previous CIS, 78.6% with non-valvular atrial fibrillation and 69.7% with dilated cardiomyopathy. Warfarin was used in 78.6% of patients and dabigatran (at different times) in 38%. In the warfarin group, those with CIS had more medical appointments per person-years of follow-up (11.7 vs 7.9), a higher proportion of international normalized ratios within the therapeutic range (57% vs 42% medical appointments, p = 0.025) and an eight times higher frequency of minor bleeding (0.64 vs 0.07 medical appointments). Conclusion Patients with Chagas disease and previous CIS had better control of INR with a higher frequency of minor bleeding. |
| Abstract_FL | RESUMO
Objetivos
descrever as características da anticoagulação em pacientes com manifestações cardíacas da doença de Chagas (MCDC) e comparar os participantes com sem acidente vascular cerebral isquêmico cardioembólico (AVC
IC
).
Resultados
42 pacientes com MCDC em anticoagulação foram estudados (62,9 ± 12,4 anos), 59,5% do sexo feminino e 47,6% com AVC
IC
prévio, 78,6% portadores de fibrilação atrial não valvar e 69,7% com cardiomiopatia dilatada. Varfarina foi utilizada em 78,6% dos pacientes e dabigatrana em 38% (em momentos diferentes). No grupo da varfarina, aqueles com AVC
IC
tiveram mais consultas médicas por pessoas-ano de seguimento (11,7 vs 7,9), maior taxa de RNI na faixa terapêutica (57% vs 42% consultas médicas, p = 0,025) e uma frequência oito vezes maior de sangramento menor (0,64 vs. 0,07 consultas médicas).
Conclusão
pacientes com MCDC e AVC
IC
prévio têm melhor controle de RNI com maior frequência de sangramento menor. |
| Author | Oliveira, Jamary Monteiro, Jean M.C. Silva, Beatriz C.G. Jesus, Pedro A.P. de San-Martin, Daniel L. |
| AuthorAffiliation | Universidade Federal da Bahia |
| AuthorAffiliation_xml | – name: Universidade Federal da Bahia |
| Author_xml | – sequence: 1 givenname: Jean M.C. surname: Monteiro fullname: Monteiro, Jean M.C. organization: Universidade Federal da Bahia, Faculdade de Medicina, Salvador BA, Brasil – sequence: 2 givenname: Daniel L. surname: San-Martin fullname: San-Martin, Daniel L. organization: Universidade Federal da Bahia, Faculdade de Medicina, Salvador BA, Brasil – sequence: 3 givenname: Beatriz C.G. surname: Silva fullname: Silva, Beatriz C.G. organization: Universidade Federal da Bahia, Faculdade de Medicina, Salvador BA, Brasil – sequence: 4 givenname: Pedro A.P. de surname: Jesus fullname: Jesus, Pedro A.P. de organization: Universidade Federal da Bahia, Complexo Hospitalar Professor Edgard Santos, Salvador BA, Brasil – sequence: 5 givenname: Jamary surname: Oliveira fullname: Oliveira, Jamary organization: Universidade Federal da Bahia, Complexo Hospitalar Professor Edgard Santos, Salvador BA, Brasil |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29364390$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1056/NEJMoa1300615 10.1007/s00228-012-1411-6 10.1161/01.STR.0000163104.92943.50 10.1161/STROKEAHA.109.560854 10.1136/jnnp.74.4.516 10.1161/01.STR.0000208294.46968.a4 10.1161/01.STR.0000177866.13451.e4 10.1159/000069893 10.1056/NEJMra1410150 10.1056/NEJMoa0905561 10.1161/CIRCULATIONAHA.106.653048 10.1016/j.jns.2008.12.015 10.1161/STROKEAHA.113.000990 |
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| Keywords | acidente vascular cerebral atrial fibrillation varfarina Chagas disease doença de Chagas fibrilação atrial stroke warfarin |
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| References | Paixão LC (ref7) 2009; 40 Mansur AP (ref2) 2003; 22 Oliveira Filho J (ref5) 2005; 36 Eikelboom JW (ref14) 2013; 369 Sousa AS (ref9) 2008; 91 Hori M (ref13) 2013; 44 Connolly SJ (ref12) 2009; 361 Carod-Artal FJ (ref4) 2003; 74 Nunes MCP (ref8) 2009; 278 Martins MA (ref15) 2013; 69 Carod-Artal FJ (ref6) 2005; 36 Birman-Deych E (ref10) 2006; 37 Hylek EM (ref11) 2007; 115 (ref1) 2002; 905 Longo DL (ref3) 2015; 373 Nunes, MCP; Barbosa, MM; Ribeiro, ALP; Barbosa, FB; Rocha, MO 2009; 278 Martins, MA; Ribeiro, DD; Nobre, VA; Pereira, FR; César, CC; Rocha, MO 2013; 69 Paixão, LC; Ribeiro, AL; Valacio, RA; Teixeira, AL 2009; 40 Birman-Deych, E; Radford, MJ; Nilasena, DS; Gage, BF 2006; 37 Longo, DL 2015; 373 Hylek, EM; Evans-Molina, C; Shea, C; Henault, LE; Regan, S 2007; 115 Sousa, AS; Xavier, SS; Freitas, GR; Hasslocher-Moreno, A 2008; 91 Eikelboom, JW; Connolly, SJ; Brueckmann, M; Granger, CB; Kappetein, AP; Mack, MJ 2013; 369 Mansur, AP; Souza, MFM; Favarato, D; Avakian, SD; César, LAM; Aldiqui, JM; Ramirs, JAF 2003; 22 Connolly, SJ; Ezekowitz, MD; Yusuf, S; Eikelboom, J; Oldgren, J; Parekh, A 2009; 361 Carod-Artal, FJ; Vargas, AP; Melo, M; Horan, TA 2003; 74 Carod-Artal, FJ; Vargas, AP; Horan, TA; Nunes, LGN 2005; 36 Hori, M; Connolly, SJ; Zhu, J; Liu, LS; Lau, CP; Pais, P 2013; 44 Oliveira Filho, J; Viana, LC; Vieira-de-Melo, R; Faiçal, F; Torreão, JA; Villar, FA 2005; 36 2002; 905 |
| References_xml | – volume: 91 start-page: 306 issue: 5 year: 2008 ident: ref9 article-title: Prevention strategies of cardioembolic ischemic stroke in Chagas’ disease publication-title: Arq Bras Cardiol contributor: fullname: Sousa AS – volume: 369 start-page: 1206 issue: 13 year: 2013 ident: ref14 article-title: Dabigatran versus Warfarin in patients with mechanical heart valves publication-title: N Engl J Med doi: 10.1056/NEJMoa1300615 contributor: fullname: Eikelboom JW – volume: 69 start-page: 919 issue: 4 year: 2013 ident: ref15 article-title: Agreement among four drug information sources for the occurrence of warfarin drug interactions in Brazilian heart disease patients with a high prevalence of Trypanosomacruzi infection publication-title: Eur J Clin Pharmacol doi: 10.1007/s00228-012-1411-6 contributor: fullname: Martins MA – volume: 36 start-page: 965 issue: 5 year: 2005 ident: ref6 article-title: Chagasic cardiomyopathy is independently associated with ischemic stroke in Chagas disease publication-title: Stroke doi: 10.1161/01.STR.0000163104.92943.50 contributor: fullname: Carod-Artal FJ – volume: 905 start-page: 1 year: 2002 ident: ref1 article-title: Control of Chagas’ disease: report of a WHO Expert Committee publication-title: World Health Organ Tech Rep Ser – volume: 40 start-page: 3691 issue: 12 year: 2009 ident: ref7 article-title: Chagas disease: independent risk factor for stroke publication-title: Stroke doi: 10.1161/STROKEAHA.109.560854 contributor: fullname: Paixão LC – volume: 74 start-page: 516 issue: 4 year: 2003 ident: ref4 article-title: American trypanosomiasis (Chagas’ disease): an unrecognised cause of stroke publication-title: J Neurol Neurosurg Psychiatry doi: 10.1136/jnnp.74.4.516 contributor: fullname: Carod-Artal FJ – volume: 37 start-page: 1070 issue: 4 year: 2006 ident: ref10 article-title: Use and effectiveness of warfarin in Medicare beneficiaries with atrial fibrillation publication-title: Stroke doi: 10.1161/01.STR.0000208294.46968.a4 contributor: fullname: Birman-Deych E – volume: 36 start-page: 2015 issue: 9 year: 2005 ident: ref5 article-title: Chagas disease Is an independent risk factor for stroke baseline characteristics of a Chagas disease cohort publication-title: Stroke doi: 10.1161/01.STR.0000177866.13451.e4 contributor: fullname: Oliveira Filho J – volume: 22 start-page: 179 issue: 3 year: 2003 ident: ref2 article-title: Stroke and ischemic heart disease mortality trends in Brazil from 1979 to 1996 publication-title: Neuroepidemiology doi: 10.1159/000069893 contributor: fullname: Mansur AP – volume: 373 start-page: 456 issue: 5 year: 2015 ident: ref3 article-title: Chagas’ fisease publication-title: N Engl J Med doi: 10.1056/NEJMra1410150 contributor: fullname: Longo DL – volume: 361 start-page: 1139 issue: 12 year: 2009 ident: ref12 article-title: Dabigatran versus Warfarin in Patients with Atrial Fibrillation publication-title: N Engl J Med doi: 10.1056/NEJMoa0905561 contributor: fullname: Connolly SJ – volume: 115 start-page: 2689 issue: 21 year: 2007 ident: ref11 article-title: Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation publication-title: Circulation doi: 10.1161/CIRCULATIONAHA.106.653048 contributor: fullname: Hylek EM – volume: 278 start-page: 96 issue: 1-2 year: 2009 ident: ref8 article-title: Ischemic cerebrovascular events in patients with Chagas cardiomyopathy: a prospective follow-up study publication-title: Journal of the Neurological Sciences doi: 10.1016/j.jns.2008.12.015 contributor: fullname: Nunes MCP – volume: 44 start-page: 1891 issue: 7 year: 2013 ident: ref13 article-title: Dabigatran versus Warfarin: effects on ischemic and hemorrhagic strokes and bleeding in Asians and Non-Asians with atrial fibrillation publication-title: Stroke doi: 10.1161/STROKEAHA.113.000990 contributor: fullname: Hori M – volume: 36 start-page: 2015 issue: 9 year: 2005 end-page: 2017 article-title: Chagas disease Is an independent risk factor for stroke baseline characteristics of a Chagas disease cohort publication-title: Stroke contributor: fullname: Oliveira Filho, J; Viana, LC; Vieira-de-Melo, R; Faiçal, F; Torreão, JA; Villar, FA – volume: 91 start-page: 306 issue: 5 year: 2008 end-page: 310 article-title: Prevention strategies of cardioembolic ischemic stroke in Chagas’ disease publication-title: Arq Bras Cardiol contributor: fullname: Sousa, AS; Xavier, SS; Freitas, GR; Hasslocher-Moreno, A – volume: 37 start-page: 1070 issue: 4 year: 2006 end-page: 1074 article-title: Use and effectiveness of warfarin in Medicare beneficiaries with atrial fibrillation publication-title: Stroke contributor: fullname: Birman-Deych, E; Radford, MJ; Nilasena, DS; Gage, BF – volume: 373 start-page: 456 issue: 5 year: 2015 end-page: 466 article-title: Chagas’ fisease publication-title: N Engl J Med contributor: fullname: Longo, DL – volume: 361 start-page: 1139 issue: 12 year: 2009 end-page: 1151 article-title: Dabigatran versus Warfarin in Patients with Atrial Fibrillation publication-title: N Engl J Med contributor: fullname: Connolly, SJ; Ezekowitz, MD; Yusuf, S; Eikelboom, J; Oldgren, J; Parekh, A – volume: 115 start-page: 2689 issue: 21 year: 2007 end-page: 2696 article-title: Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation publication-title: Circulation contributor: fullname: Hylek, EM; Evans-Molina, C; Shea, C; Henault, LE; Regan, S – volume: 69 start-page: 919 issue: 4 year: 2013 end-page: 928 article-title: Agreement among four drug information sources for the occurrence of warfarin drug interactions in Brazilian heart disease patients with a high prevalence of Trypanosomacruzi infection publication-title: Eur J Clin Pharmacol contributor: fullname: Martins, MA; Ribeiro, DD; Nobre, VA; Pereira, FR; César, CC; Rocha, MO – volume: 905 start-page: 1 year: 2002 end-page: 92 article-title: Control of Chagas’ disease: report of a WHO Expert Committee publication-title: World Health Organ Tech Rep Ser – volume: 36 start-page: 965 issue: 5 year: 2005 end-page: 970 article-title: Chagasic cardiomyopathy is independently associated with ischemic stroke in Chagas disease publication-title: Stroke contributor: fullname: Carod-Artal, FJ; Vargas, AP; Horan, TA; Nunes, LGN – volume: 40 start-page: 3691 issue: 12 year: 2009 end-page: 3694 article-title: Chagas disease: independent risk factor for stroke publication-title: Stroke contributor: fullname: Paixão, LC; Ribeiro, AL; Valacio, RA; Teixeira, AL – volume: 278 start-page: 96 issue: 1-2 year: 2009 end-page: 101 article-title: Ischemic cerebrovascular events in patients with Chagas cardiomyopathy: a prospective follow-up study publication-title: Journal of the Neurological Sciences contributor: fullname: Nunes, MCP; Barbosa, MM; Ribeiro, ALP; Barbosa, FB; Rocha, MO – volume: 44 start-page: 1891 issue: 7 year: 2013 end-page: 1896 article-title: Dabigatran versus Warfarin: effects on ischemic and hemorrhagic strokes and bleeding in Asians and Non-Asians with atrial fibrillation publication-title: Stroke contributor: fullname: Hori, M; Connolly, SJ; Zhu, J; Liu, LS; Lau, CP; Pais, P – volume: 22 start-page: 179 issue: 3 year: 2003 end-page: 183 article-title: Stroke and ischemic heart disease mortality trends in Brazil from 1979 to 1996 publication-title: Neuroepidemiology contributor: fullname: Mansur, AP; Souza, MFM; Favarato, D; Avakian, SD; César, LAM; Aldiqui, JM; Ramirs, JAF – volume: 369 start-page: 1206 issue: 13 year: 2013 end-page: 1214 article-title: Dabigatran versus Warfarin in patients with mechanical heart valves publication-title: N Engl J Med contributor: fullname: Eikelboom, JW; Connolly, SJ; Brueckmann, M; Granger, CB; Kappetein, AP; Mack, MJ – volume: 74 start-page: 516 issue: 4 year: 2003 end-page: 518 article-title: American trypanosomiasis (Chagas’ disease): an unrecognised cause of stroke publication-title: J Neurol Neurosurg Psychiatry contributor: fullname: Carod-Artal, FJ; Vargas, AP; Melo, M; Horan, TA |
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To describe anticoagulation characteristics in patients with cardiac complications from Chagas disease and compare participants with and... To describe anticoagulation characteristics in patients with cardiac complications from Chagas disease and compare participants with and without cardioembolic... ABSTRACT Objectives To describe anticoagulation characteristics in patients with cardiac complications from Chagas disease and compare participants with and... |
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| SubjectTerms | atrial fibrillation Chagas disease NEUROSCIENCES PSYCHIATRY stroke warfarin |
| Title | Anticoagulation in patients with cardiac manifestations of Chagas disease and cardioembolic ischemic stroke |
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