Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492007000100007
Jornal Vascular Brasileiro
Original Article

O uso da estreptoquinase no tratamento da oclusão arterial aguda pós-cateterização da artéria femoral em crianças com menos de 10 kg

The use of streptokinase in the treatment of acute arterial occlusion after catheterization of the femoral artery in children weighing less than 10 kg

Nilo César Barbosa Mandelli; Cláudio Nhuch; Paulo Roberto Fontes; Haroldo Diez Paiva; Raul Rossi; Mario Frederico Chagas Pereira; Silvio Perini

http://dx.doi.org/10.1590/S1677-54492007000100007 J Vasc Bras, vol.6, n1, p.42-49, 2007
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Resumo

CONTEXTO: O tratamento da oclusão arterial aguda em menores de 5 kg tem constituído tema de discussão. OBJETIVOS: Avaliar o tratamento do quadro da oclusão arterial aguda pós-cateterismo da artéria femoral em crianças com menos de 10 kg com o uso de heparina isolada e também associada com estreptoquinase, e comparar os resultados do exame físico (como diagnóstico), da reversão da oclusão arterial, de complicações e de exames laboratoriais nos dois métodos MÉTODOS: Trinta casos de oclusão da artéria femoral foram identificados em 1.583 cateterismos em crianças no Instituto de Cardiologia de Porto Alegre, entre 1992 e 2000. Os pacientes foram divididos em dois grupos: um usou apenas heparina (14 casos), e o outro usou heparina associada com estreptoquinase (16 casos). Os exames laboratoriais (tempo de protrombina, tempo de tromboplastina parcial ativado e fibrinogênio) coletados antes e durante a infusão intravenosa foram avaliados estatisticamente, assim como o tempo de uso da medicação, as complicações e os resultados. RESULTADOS: O exame físico mostrou-se método fidedigno para avaliar a oclusão; no grupo que utilizou a associação de heparina e estreptoquinase, houve a resolução de 87% dos casos de oclusão arterial, e a principal complicação foi sangramento no sítio de punção em 56,3% dos pacientes. Os resultados apresentaram p < 0,05. Os exames laboratoriais não tiveram significado estatístico. CONCLUSÃO: A estreptoquinase associada com a heparina é mais efetiva do que a heparina isolada no tratamento da oclusão arterial aguda da artéria femoral pós-cateterismo, tanto que sua associação apresenta uma redução do risco relativo de 88% em relação à heparina isolada.

Palavras-chave

Estreptoquinase, criança, cateterismo, oclusão arterial

Abstract

BACKGROUND: The treatment of acute arterial occlusion in children weighing less than 5 kg has been widely discussed. OBJECTIVES: To evaluate the treatment of acute arterial occlusion after catheterization of the femoral artery in children weighing less than 10 kg using heparin alone and associated with streptokinase, and to compare the results of physical examination (such as diagnosis), reversal of the arterial occlusion, complications and laboratory tests between both methods. METHODS: Thirty cases of femoral artery occlusion were identified among 1,583 catheterizations in children at Instituto de Cardiologia de Porto Alegre between 1992 and 2000. The patients were divided into two groups: one used heparin alone (14 cases) and the other used heparin associated with streptokinase (16 cases). The laboratory tests (prothrombin time, activated partial thromboplastin time and fibrinogen) performed before and during the intravenous infusion were statistically analyzed, as well as period of drug administration, complications and results. RESULTS: Physical examination proved to be reliable to evaluate occlusion; in the group using heparin associated with streptokinase, there was resolution of the arterial occlusion in 87% of cases, and the main complication was bleeding at the puncture site, which was present in 56.3% of the patients. These results showed p < 0.05. Laboratory tests were not statistically significant. CONCLUSION: Streptokinase associated with heparin is more effective on acute artery occlusions following femoral catheterization than heparin alone. Its association presents an 88% rate of relative risk reduction in relation to heparin alone.

Keywords

Streptokinase, child, catheterization, arterial occlusion

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