ABSTRACT
Objetivo: El protocolo de medicación antiplaquetaria óptimo para prevenir las complicaciones trombóticas después de embolización de aneurismas cerebrales no es claro. Nuestro objetivo es describir las características de los pacientes que presentan complicaciones trombóticas o hemorrágicas secundarias al tratamiento endovascular. Métodos: Se realizó un estudio descriptivo de corte transversal. Se incluyó a todos los pacientes que requirieron manejo endovascular de aneurismas cerebrales en el Hospital Universitario San Ignacio desde noviembre del 2007 hasta enero del 2016. Se evaluaron las complicaciones trombóticas o hemorrágicas durante 6 meses de seguimiento, teniendo en cuenta el esquema de premedicación con antiagregantes plaquetarios, localización, tamaño del aneurisma y técnica de embolización utilizada. Resultados: Se evaluó a 122 pacientes en los cuales se realizaron 130 procedimientos para tratamiento endovascular de aneurismas cerebrales. Las complicaciones trombóticas fueron más frecuentes en pacientes que no recibieron premedicación (25%) comparados con aquellos que recibieron algún esquema de antiagregación (estándar 3,87% o carga 8,70%); esta diferencia fue estadísticamente significativa (p=0,043). Conclusiones: Los eventos tromboembólicos son la complicación más frecuente de la embolización de aneurismas cerebrales. Nuestro trabajo, al igual que la literatura revisada, sustenta el uso de terapia antiplaquetaria dual con ácido acetilsalicílico y clopidogrel para disminuir la tasa de complicaciones tromboembólicas sintomáticas independientemente del protocolo de administración
Objective: The protocol for optimal antiplatelet therapy to prevent thrombotic complications following brain aneurysm embolisation is not clear. Our objective is to describe the characteristics of patients presenting with thrombotic or haemorrhagic complications secondary to endovascular treatment. Methods: A cross sectional descriptive study was performed, which included all patients that required endovascular treatment for brain aneurysm at San Ignacio University Hospital from November 2007 to January 2016. Thrombotic and haemorrhagic complications over six months of follow-up were assessed, considering the premedication regimen with antiplatelet agents, location, size of the aneurysm and embolisation technique performed. Results: 122 patients were evaluated, on whom 130 procedures were performed for endovascular treatment of brain aneurysms. Thrombotic complications were more frequent in patients who did not receive premedication (25%) compared to those who did receive an antiplatelet treatment regimen (standard dose 3.87% or loading dose 8.70%), and this difference was statistically significant (P=.043). Conclusions Thromboembolic events are the most common complication of brain aneurysm embolisation. Both our study and the literature suggest that the use of dual antiplatelet therapy with aspirin and clopidogrel lowers the rate of symptomatic thromboembolic complications, regardless of the administration protocol
Subject(s)
Humans , Male , Female , Child , Adolescent , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Intracranial Aneurysm/complications , Intracranial Aneurysm/drug therapy , Platelet Aggregation Inhibitors/therapeutic use , Cerebral Hemorrhage/complications , Cerebral Infarction/complications , Sinus Thrombosis, Intracranial/complications , Clinical Protocols , Endovascular Procedures/methods , Cerebral Hemorrhage/therapy , Sinus Thrombosis, Intracranial/prevention & control , Cross-Sectional Studies/methods , Logistic Models , Multivariate AnalysisABSTRACT
OBJECTIVE: The protocol for optimal antiplatelet therapy to prevent thrombotic complications following brain aneurysm embolisation is not clear. Our objective is to describe the characteristics of patients presenting with thrombotic or haemorrhagic complications secondary to endovascular treatment. METHODS: A cross sectional descriptive study was performed, which included all patients that required endovascular treatment for brain aneurysm at San Ignacio University Hospital from November 2007 to January 2016. Thrombotic and haemorrhagic complications over six months of follow-up were assessed, considering the premedication regimen with antiplatelet agents, location, size of the aneurysm and embolisation technique performed. RESULTS: 122 patients were evaluated, on whom 130 procedures were performed for endovascular treatment of brain aneurysms. Thrombotic complications were more frequent in patients who did not receive premedication (25%) compared to those who did receive an antiplatelet treatment regimen (standard dose 3.87% or loading dose 8.70%), and this difference was statistically significant (P=.043). CONCLUSIONS: Thromboembolic events are the most common complication of brain aneurysm embolisation. Both our study and the literature suggest that the use of dual antiplatelet therapy with aspirin and clopidogrel lowers the rate of symptomatic thromboembolic complications, regardless of the administration protocol.
Subject(s)
Embolization, Therapeutic , Hemorrhage/etiology , Intracranial Aneurysm/therapy , Platelet Aggregation Inhibitors/therapeutic use , Premedication , Thrombosis/etiology , Adolescent , Adult , Aged , Aged, 80 and over , Aneurysm, Ruptured/complications , Aneurysm, Ruptured/therapy , Child , Cross-Sectional Studies , Embolization, Therapeutic/instrumentation , Female , Hemorrhage/chemically induced , Humans , Intracranial Aneurysm/complications , Male , Middle Aged , Platelet Aggregation Inhibitors/administration & dosage , Platelet Aggregation Inhibitors/adverse effects , Thrombophilia/drug therapy , Thrombophilia/etiology , Thrombosis/prevention & control , Young AdultABSTRACT
Objetivo: analizar el manejo de protocolos y normas técnicas, así como la percepción de los usuarios sobre la educación recibida en tres programas de detección temprana en Colombia, entre los años 2002 y 2007. Metodología: se realizó un estudio descriptivo retrospectivo de corte trasversal, según registros de la Encuesta Nacional de Demografía y Salud-2007 (ENDS). Hallazgos: el 57% del personal estaba en instituciones públicas, predominio del sexo femenino (67%), del rango de edad de 21 a 30 años (44%) y flexibilización laboral (56%). El cumplimiento en protocolos, tenencia (85 %), conocimiento (96%), utilización (98%) y disponibilidad (74%), y en normas técnicas, tenencia (93%) y disponibilidad (68%). El 79,2% de las maternas percibieron educación para consultar nuevamente, y en otros programas el 90%. Conclusión: no se cumplió en el 100% lo establecido en protocolos y normas técnicas, en lo que pudo haber influido la flexibilización laboral y el desestímulo de programas de salud pública, en respuesta al sistema neoliberal y en detrimento de la calidad.
Objective: to analyze management protocols and standards, and the perception of users about the education received in three early detection programs in Colombia. 2002-07. Methodology: a retrospective descriptive study of transversal cut was made, according to records from the National Demographic and Health Survey 2007 (ENDS). Findings: 57% of the workforce was in public institutions, the female predominance (67%), the 21-30 years (44%), and labor flexibility (56%). Compliance Protocols, holding (85%) knowledge (96%), using (98%) and availability (74%) and technical standards, holding (93%) and availability (68%). 79.2% of maternal education perceived to check again, and other programs, 90%. Conclusion: was not met in 100 % established protocols and standards, in what may have influenced labor flexibility and the discouragement of public health programs, in response to the neoliberal system and to the detriment of quality.
Objetivo: analisar o maneio de protocolos e normas técnicas, assim como a percepção dos usuários sobre o ensino recebido em três programas de detecção precoce na Colômbia, entre os anos 2002 e 2007. Metodologia: realizou-se estudo descritivo retrospectivo de corte transversal, segundo registros do Inquérito Nacional de Demografia e Saúde-2007 (ENDS). Achados: o 57% do pessoal foi em instituições públicas, predomínio do sexo feminino (67%), na faixa etária de 21 para 30 anos (44%) e flexibilização laboral (56%). O cumprimento em protocolos, existência (85%), conhecimento (96 %), utilização (98 %) e disponibilidade (74 %), e em normas técnicas, existência (93%) e disponibilidade (68 %). O 79,2 % das maternas receberam instrução para consultar de novo, e em outros programas o 90%. Conclusão: não foi cumprido o 100% do estabelecido em protocolos e normas técnicas, e nisso pode ter influenciado a flexibilização laboral e o desestímulo de programas de saúde pública, em resposta ao sistema neoliberal e em detrimento da qualidade.
