Fármacos da coagulação análise do uso como prevenção primária e secundária em quadros de acidente vascular cerebral

Abstract

Introduction: Stroke is a disease associated with significant morbidity and mortality. Objective: To analyze whether the prior use of coagulation-related drugs (anticoagulants and antiplatelet agents) is associated with better outcomes in the primary prevention of stroke. Methods: A retrospective cohort study conducted at a referral center in northern Rio Grande do Sul, Brazil, including individuals aged ≥18 years treated between 2017 and 2022 after a first ischemic or hemorrhagic stroke. Sociodemographic variables, comorbidities/risk factors, clinical parameters, and outcomes (sequelae at discharge, length of hospital stay, and death) were analyzed. Descriptive statistics were performed, outcome incidence was estimated with a 95% confidence interval (95% CI), and Poisson regression was used to identify risk factors, with adjusted Relative Risks (RR) and 95% CIs calculated in a multivariate analysis. Results: The sample (n=884) consisted mostly of men (50.8%), white individuals (91.3%), and those aged 60 years or older (68.4%). Among patients using antiplatelet agents, 47.6% had NIHSS scores between 6 and 14, 31.3% presented with 3 symptoms upon admission, and 59.9% had no complications during hospitalization; 70.1% were hospitalized for more than 5 days, 40.1% had no sequelae at discharge, and 12.9% died. Among those on anticoagulants, 47% had NIHSS scores between 0 and 5, 33.3% had 3 symptoms at admission, and 72.9% had no complications; 79.2% were hospitalized for more than 5 days, 45.8% had no sequelae, and 6.3% died. Among those not using these medications, 49% had NIHSS scores between 6 and 14, 31.6% had 2 symptoms at admission, and 65.7% had no complications; 68.3% stayed in the hospital for more than 5 days, 48.6% had no sequelae, and 17.3% died. The incidence of longer hospital stays (>5 days) was 69% (95% CI: 66–72), and the incidence of more sequelae at discharge was 53% (95% CI: 50–56), with a statistically significant association observed for a higher number of signs and symptoms at admission (RR=1.96; 95% CI: 1.40–2.75; p<0.001). The incidence of death was 17% (95% CI: 14–19), associated with higher NIHSS scores (RR=5.01; 95% CI: 1.64–15.3; p=0.001) and with the occurrence of at least one complication during hospitalization (RR=4.59; 95% CI: 1.07–19.8; p=0.041).Conclusion: The use of coagulation-related drugs for primary prevention does not appear to produce significant changes in outcomes during the acute phase of stroke.