Oral anticoagulation in the prevention of secondary cerebral vascular disease. a long-term follow-up of 169 patients
Introduction. Although the indications for oral anticoagulation (AO) in the treatment of cerebral vascular disease (CVD) are well established, their potential side effects continue to give cause for worry. Objectives. To describe the complications and ischemic relapses in patients treated with AO for secondary prevention of CVD of cardiac embolic origin. Patients and methods. We included 169 patients with embologenic cardiopathy who, following an CVD, were treated with AO and followedup at our medical centre for at least three months. We recorded their past clinical history and risk factors, occurrence of vascular relapses (VR), complications involving hemorrhage (CH), and data regarding course and follow-up. Results. During an average follow-up of 50.3 months of a total of 707.9 patient/years, 20 VR (2.8% per year) were recorded; 15 of these were cerebro-vascular and mainly mild. We recorded 59 CH in 41 patients (8.3% per year) of which 6 were considered to be major. There was a 30% drop-out rate from follow-up at our centre, mainly due to death from other causes or to change of referral centre. Conclusions. There is a low incidence of relapse and of complications (usually mild) following AO for the secondary prevention of CVD of cardio-embolic origin. Efficacy and security are maintained in the long term
Objetivos Describir las complicaciones y las recidivas isquémicas en los pacientes tratados con AO para la prevención secundaria de la EVC de origen embólico cardíaco.
Pacientes y métodos Se incluyen 169 pacientes con cardiopatía embolígena que, tras sufrir una EVC, fueron tratados con AO y seguidos en nuestro centro durante un mínimo de tres meses. Se recogieron sus antecedentes y factores de riesgo, la aparición de recidivas vasculares (RV) y de complicaciones hemorrágicas (CH) y los datos de evolución y seguimiento.
Resultados Durante un seguimiento medio de 50,3 meses, para un total de 707,8 pacientes/años, se recogieron 20 RV (2,8% anual), 15 de ellas vasculocerebrales y mayoritariamente leves. Se recogieron 59 CH en 41 pacientes (8,3% anual), de las que 6 fueron consideradas mayores. Un 30% de los pacientes abandonaron el seguimiento en nuestro centro, principalmente por éxitus debido a otras causas o por haber cambiado de centro de referencia.
Conclusiones La AO para la prevención secundaria de la EVC de origen cardioembólico obtiene una baja incidencia de recidivas y complicaciones, que generalmente son de carácter leve. La eficacia y seguridad se mantienen a largo plazo
