Nova comparação entre Varfarina e NOACs. 
Autor: Platiny Mascarenhas | Publicado: 2017-06-04T12:46:00-07:00
















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N Engl J Med 2017; 376:1627-1636April 27, 2017DOI: 10.1056/NEJMoa1701005



Os NOACs já tiveram seu poder anticoagulante demostrado em diversos
trials. De acordo com o princípio da complacência, podemos utilizá-los com segurança
em vários cenários. Porém a comparação entre no NOACs e Varfarina ainda é explorada &nbsp;em vários pontos.





O RE-CIRCUIT, trial publicado na
New England Journal of Medicine em 19 de março de 2017, tem como objetivo comparar
a anticoagulação continua com Varfarina X Dabigratana durante a ablação de FA. O
desfecho primário foi a incidência de hemorragia importante. O desenho do
estudo foi um ensaio clínico, randomizado, aberto, foi um estudo exploratório
usando a prerrogativa que necessitaria de um N &gt;2000 em cada grupo para
atingir um poder com intervalo de confiança de 95 % para não inferioridade. 



Na análise dos dados do CIRCUIT
trial observamos uma redução de eventos hemorrágicos maiores no grupo Dabigratan X Varfarina, quando olhamos a curva de desfecho abaixo, com uma
diferença importante entres os grupos.



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Quando analisamos esses resultados
temos que ter o cuidado, pois estamos diante de um estudo exploratório, logo
não possui poder para demostrar superioridade nem inferioridade, limitando-se
apenas na geração de hipóteses, sendo necessário a realização um estudo com
poder suficiente para aceitar ou rejeitar um possível benefício.


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Ao nos depararmos com qualquer
estudo devemos sempre prestar muita atenção na sua análise estatística, pois
embora possam estar publicados em revistas médicas de alto impacto, como New
England, não necessariamente tem poder para afirmar ou negar uma hipótese, o
RE-CIRCUIT trial contextualiza bem esse cenário.