A fibrilação atrial é uma das arritmias mais encontradas na prática clínica e sua incidência vem aumentando por diversos fatores. Consequentemente, um cenário cada vez mais comum será o de pacientes em uso dos novos anticoagulantes orais (Dabigatran, Rivaroxaban, Apixaban e Edoxaban) e com outas doenças crônicas.
O uso dos NOACS na doença renal apresenta algumas particularidades, necessitando em alguns casos de redução da dose da medicação e as vezes até suspensão, de acordo com o clearance de creatinina. E com relação ao paciente hepatopata? Devemos utilizar a mesma dose? Devemos suspender a medicação? Qual seria o critério?
Através da classificação de Child-Pugh podemos estratificar a gravidade da doença hepática. São avaliados alguns paramêtros como encefalopatia, ascite, bilirrubina, albumina e INR e dado uma pontuação. A partir daí, classificamos em Child-Pugh A(05 a 06 pontos), B (07 a 09 pontos) e C(10 a 15 pontos). De acordo com esse estadiamento em A,B ou C, saberemos de acordo com o NOAC que o paciente faz uso se podemos usar sem redução da dose, usar com cautela ou se a medicação é contra indicada. Veja a imagem acima com a classificação de Child-Pugh e com as recomendações do uso dos NOACs.
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Referência: Novel Oral Anticoagulants for atrial fibrillation – NOAC for AF practical guide. ESC 2018
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