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Acidente vascular cerebral: fisiopatologia, consequências e abordagem farmacoterapêutica
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Abstract(s)
O acidente vascular cerebral é a doença neurológica aguda de maior relevância, devido à sua incidência, ao largo espetro de idades em que ocorre e à incapacidade que provoca. É considerado um problema de saúde pública, visto ser uma das principais
causas de morbilidade e mortalidade no mundo, bem como a principal causa de morte e incapacidade em Portugal.
A fisiopatologia deste quadro clínico envolve uma complexa cascata de eventos que interrompe o fluxo sanguíneo para o cérebro, resultando em isquemia ou hemorragia cerebral. O entendimento desses mecanismos é fundamental para a implementação de
estratégias de prevenção, tratamento e reabilitação da doença. O sobrevivente de um acidente vascular cerebral pode apresentar distúrbios cognitivos e comportamentais que resultam, frequentemente, num prognóstico funcional desfavorável. Estima-se que um terço dos sobreviventes possa desenvolver como consequência a longo prazo, comprometimento cognitivo e demência, especialmente em casos de acidente vascular cerebral recorrente. O tratamento de primeira linha para o acidente vascular cerebral isquémico é a trombólise intravenosa com alteplase, mas se este quadro for causado por oclusão de grandes vasos, recorre-se à trombectomia mecânica. No acidente vascular cerebral hemorrágico, são adotadas medidas de controlo da pressão arterial e pressão intracraniana e técnica de ventriculostomia. Na prevenção de novos eventos isquémicos, é instituída a dupla antiagregação (ácido acetilsalicílico e clopidogrel) durante 21 dias, seguido de monoterapia. A utilização de anticoagulantes orais é feita em pacientes com condições específicas, fibrilhação auricular, enquanto na prevenção de eventos hemorrágicos a mesma deve ser interrompida devido ao risco de aumento de hemorragia. Para além disso, utilizam-se agentes de reversão da anticoagulação.
Para que tudo seja possível, é necessário haver uma monitorização da terapêutica por parte dos profissionais de saúde, nomeadamente o farmacêutico, que desempenha um papel integral no cuidado de pacientes com acidente vascular cerebral.
Stroke is the most important acute neurological disease, due to its incidence, the wide range of ages at which it occurs and the disability it causes. It is considered a public health problem, as it is one of the main causes of morbidity and mortality in the world, as well as the main cause of death and disability in Portugal. The physiopathology of this clinical condition involves a complex cascade of events that interrupts blood flow to the brain, resulting in cerebral ischemia or haemorrhage. Understanding these mechanisms is fundamental for implementing strategies to prevent, treat and rehabilitate the disease. The survivor of a stroke may have cognitive and behavioural disorders that often result in an unfavourable functional prognosis. It is estimated that one third of survivors may develop cognitive impairment and dementia as a long-term consequence, especially in cases of recurrent stroke. The first-line treatment for ischemic stroke is intravenous thrombolysis with alteplase, but if the condition is caused by occlusion of large vessels, mechanical thrombectomy is used. In haemorrhagic stroke, blood pressure and intracranial pressure control measures and ventriculostomy technique are adopted. To prevent further ischemic events, dual antiplatelet therapy (acetylsalicylic acid and clopidogrel) is instituted for 21 days, followed by monotherapy. Oral anticoagulants are used in patients with specific conditions, such as atrial fibrillation, while in the prevention of haemorrhagic events they should be discontinued due to the risk of increased bleeding. In addition, anticoagulation reversal agents are used. For all this to be possible, therapy should be monitored by healthcare professionals, particularly pharmacists, who play an integral role in the care of stroke patients.
Stroke is the most important acute neurological disease, due to its incidence, the wide range of ages at which it occurs and the disability it causes. It is considered a public health problem, as it is one of the main causes of morbidity and mortality in the world, as well as the main cause of death and disability in Portugal. The physiopathology of this clinical condition involves a complex cascade of events that interrupts blood flow to the brain, resulting in cerebral ischemia or haemorrhage. Understanding these mechanisms is fundamental for implementing strategies to prevent, treat and rehabilitate the disease. The survivor of a stroke may have cognitive and behavioural disorders that often result in an unfavourable functional prognosis. It is estimated that one third of survivors may develop cognitive impairment and dementia as a long-term consequence, especially in cases of recurrent stroke. The first-line treatment for ischemic stroke is intravenous thrombolysis with alteplase, but if the condition is caused by occlusion of large vessels, mechanical thrombectomy is used. In haemorrhagic stroke, blood pressure and intracranial pressure control measures and ventriculostomy technique are adopted. To prevent further ischemic events, dual antiplatelet therapy (acetylsalicylic acid and clopidogrel) is instituted for 21 days, followed by monotherapy. Oral anticoagulants are used in patients with specific conditions, such as atrial fibrillation, while in the prevention of haemorrhagic events they should be discontinued due to the risk of increased bleeding. In addition, anticoagulation reversal agents are used. For all this to be possible, therapy should be monitored by healthcare professionals, particularly pharmacists, who play an integral role in the care of stroke patients.
Description
Keywords
Acidente vascular cerebral Fisiopatologia Consequência Farmacoterapia Farmacêutico