Anticoagulantes orais diretos versus varfarina na prevenção de acidente vascular cerebral em pacientes idosos com fibrilação atrial: uma revisão sistemática

Paulo Ricardo Sousa Ramalho; Ester da Silva  Correia; Isabella Ferreira Brandão  da Silva; Isadora Torres  Moreira; Julia Barbosa  Machado; Juliana Marini  dos Santos; Laura Sayuri Takemoto; Maria Eduarda Lopes  Ladislau; Érica Eugênio Lourenço  Gontijo

doi:10.61411/rsc2026138619

Autores

Paulo Ricardo Sousa Ramalho Autor
Ester da Silva Correia Universidade de Gurupi - UNIRG Autor
Isabella Ferreira Brandão da Silva Universidade de Gurupi - UNIRG Autor
Isadora Torres Moreira Autor
Julia Barbosa Machado Autor
Juliana Marini dos Santos Autor
Laura Sayuri Takemoto Autor
Maria Eduarda Lopes Ladislau Autor
Érica Eugênio Lourenço Gontijo Autor

DOI:

https://doi.org/10.61411/rsc2026138619

Resumo

A Fibrilação atrial não valvar (FANV) representa a arritmia cardíaca sustentada mais prevalente na população idosa e está associada ao aumento significativo do risco de AVC, embolia sistêmica, mortalidade e complicações hemorrágicas. O envelhecimento populacional, associado à fragilidade, multimorbidade, polifarmácia e alterações fisiológicas relacionadas à idade, torna o manejo anticoagulante um importante desafio clínico. Nesse contexto, os Anticoagulantes Orais Diretos (AODs) surgiram como alternativa à varfarina, apresentando maior previsibilidade farmacológica, menor necessidade de monitorização Laboratorial e melhor perfil de segurança. Este estudo teve como objetivo sintetizar as evidências atuais sobre eficácia, segurança, limitações e implicações clínicas do uso de anticoagulantes em idosos com FANV, com ênfase na comparação entre AODs e varfarina. Foram analisados desfechos relacionados à prevenção de AVC e embolia sistêmica, risco hemorrágico, hemorragia intracraniana, mortalidade, adesão terapêutica, fragilidade, multimorbidade, função renal e impacto da polifarmácia. Os estudos demonstraram que os AODs apresentam eficácia semelhante ou superior à varfarina na prevenção de eventos tromboembólicos, além de menor incidência de sangramento maior e hemorragia intracraniana, especialmente em idosos frágeis. A apixabana destacou-se por apresentar melhor equilíbrio entre eficácia e segurança clínica em comparação aos demais anticoagulantes. Em contrapartida, a varfarina apresentou limitações importantes relacionadas à necessidade de monitorização frequente do INR, maior variabilidade terapêutica, múltiplas interações medicamentosas e alimentares e menor adesão terapêutica. Os estudos mostraram que os AODs são a terapia preferencial para pacientes com FANV, mantendo a varfarina indicada em situações específicas, como próteses valvares mecânicas, estenose mitral moderada a grave e insuficiência renal avançada. Contudo, fatores econômicos, alto custo e limitações de acesso ainda representam barreiras significativas para o uso generalizado de AODs em alguns sistemas de saúde. Ainda assim, a escolha do tratamento deve permanecer dividualizada, considerando o risco tromboembólico, o risco hemorrágico, a função renal, as condições clínicas, a adesão terapêutica e a necessidade de acompanhamento multidisciplinar contínuo.

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