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Terapia Trombolítica em Octogenários com Embolia Pulmonar Aguda / Thrombolytic Therapy in Octogenarians with Acute Pulmonary Embolism
Zengin, Ahmet; Karatas, Mehmet Baran; Çanga, Yigit; Güzelburç, Özge; Yelgeç, Nizamettin Selçuk; Emre, Ayse.
  • Zengin, Ahmet; University of Health Sciences. Dr. Siyami Ersek Training and Research Hospital. Department of Cardiology. Istambul. TR
  • Karatas, Mehmet Baran; University of Health Sciences. Dr. Siyami Ersek Training and Research Hospital. Department of Cardiology. Istambul. TR
  • Çanga, Yigit; University of Health Sciences. Dr. Siyami Ersek Training and Research Hospital. Department of Cardiology. Istambul. TR
  • Güzelburç, Özge; University of Health Sciences. Dr. Siyami Ersek Training and Research Hospital. Department of Cardiology. Istambul. TR
  • Yelgeç, Nizamettin Selçuk; University of Health Sciences. Dr. Siyami Ersek Training and Research Hospital. Department of Cardiology. Istambul. TR
  • Emre, Ayse; University of Health Sciences. Dr. Siyami Ersek Training and Research Hospital. Department of Cardiology. Istambul. TR
Arq. bras. cardiol ; 118(1): 68-74, jan. 2022. tab
Article in English, Portuguese | LILACS | ID: biblio-1360106
Responsible library: BR1.1
RESUMO
Resumo Fundamento Apesar da grande proporção de octogenários com embolia pulmonar aguda, há pouca informação indicando a estratégia de manejo ideal, especialmente medidas terapêuticas, como a terapia lítica. Objetivos O número de pacientes idosos diagnosticados com embolia pulmonar aguda aumenta constantemente. Porém, o papel do tratamento trombolítico não está claramente definido entre os octogenários. Nosso objetivo é avaliar a efetividade da terapia lítica em pacientes octogenários diagnosticados com embolia pulmonar. Métodos Cento e quarenta e oito indivíduos (70,3% de mulheres, n=104) com mais de 80 anos foram incluídos no estudo. Os pacientes foram divididos em dois grupos tratamento trombolítico versus não-trombolítico. As taxas de mortalidade hospitalar e episódios de sangramento foram definidos como desfechos do estudo. Valor de p <0,05 foi considerado como estatisticamente significativo. Resultados A mortalidade hospitalar reduziu significativamente no grupo trombolítico em comparação ao não-trombolítico (10,5% vs. 24,2%; p=0,03). Episódios de sangramento menores foram mais comuns no braço que recebeu o tratamento trombolítico, mas grandes hemorragias não diferiram entre os grupos (35,1% vs. 13,2%, p<0,01; 7% vs. 5,5% p=0,71, respectivamente). O escore de PESI alto (OR 1,03 IC95%; 1,01-1,04 p<0,01), a terapia trombolítica (OR 0,15 IC95%; 0,01-0,25, p< 0,01) e níveis altos de troponina (OR 1,20 IC95%; 1,01-1,43, p=0,03) estiveram independentemente associados a taxas de mortalidade hospitalar na análise de regressão multivariada. Conclusão A terapia trombolítica esteve associada à mortalidade hospitalar reduzida em detrimento do aumento geral das complicações de sangramento em octogenários.
ABSTRACT
Abstract Background Despite the high proportion of octogenarians with acute pulmonary embolism, there is little information indicating the optimal management strategy, mainly therapeutic measures, such as lytic therapy. Objectives The number of elderly patients diagnosed with acute pulmonary embolism increases constantly. However, the role of thrombolytic treatment is not clearly defined among octogenarians. Our objective is to evaluate the effectiveness of lytic therapy in octogenarian patients diagnosed with pulmonary embolism. Methods One hundred and forty eight subjects (70.3% women, n=104) aged more than eighty years were included in the study. The patients were divided in two groups thrombolytic versus non-thrombolytic treatment. In-hospital mortality rates and bleeding events were defined as study outcomes. P-value <0.05 was considered as statistical significance. Results In-hospital mortality decreased significantly in the thrombolytic group compared to the non-thrombolytic group (10.5% vs. 24.2% p=0.03). Minor bleeding events were more common in the arm that received thrombolytic treatment, but major hemorrhage did not differ between the groups (35.1% vs. 13.2%, p<0.01; 7% vs. 5.5% p=0.71, respectively). High PESI score (OR 1.03 95%CI; 1.01-1.04 p<0.01), thrombolytic therapy (OR 0.15 95%CI; 0.01-0.25, p< 0.01) and high troponin levels (OR 1.20 95%CI; 1.01-1.43, p=0.03) were independently associated with in-hospital mortality rates in the multivariate regression analysis. Conclusion Thrombolytic therapy was associated with reduced in-hospital mortality at the expense of increased overall bleeding complications in octogenarians.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Cardiovascular Diseases / Metabolic Syndrome / Pediatric Obesity Type of study: Prognostic study / Risk factors Limits: Adolescent / Child / Humans Language: English / Portuguese Journal: Arq. bras. cardiol Journal subject: Cardiology Year: 2022 Type: Article Affiliation country: Turkey Institution/Affiliation country: University of Health Sciences/TR

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Full text: Available Index: LILACS (Americas) Main subject: Cardiovascular Diseases / Metabolic Syndrome / Pediatric Obesity Type of study: Prognostic study / Risk factors Limits: Adolescent / Child / Humans Language: English / Portuguese Journal: Arq. bras. cardiol Journal subject: Cardiology Year: 2022 Type: Article Affiliation country: Turkey Institution/Affiliation country: University of Health Sciences/TR