Efeitos do uso de anticoncepcionais hormonais combinados sobre o acidente vascular cerebral

Abstract

The relationship between the use of combined hormonal contraceptives(HCA) (oral and injectable) and the clinical repercussion of stroke were analyzed. Ambispective cohort study performed in three public hospitals in the city of Fortaleza, Ceará, Brazil. A total of 105 women of fertile age were hospitalized with diagnosis of stroke, of whom 37 were Contraceptive Use Group 1(G1U) and 68 of Non-users Group 2(G2U). Data collection took place from October 2015 to October 2016, in two stages: 1. Initial evaluation; 2. Evaluation after three months. During the hospitalization, identification data, sociodemographic data, family and personal background histories, gynecological and obstetric histories, previous use of AHC and presence of other risk factors for stroke were collected. Neurological impairment, stroke severity, functionality, and degree of dependence were assessed using the National Institute of Health Stroke Scale(NIH) and Modified Rankin and Modified Barthel Index Scales, respectively. In the G1U, the type of AHC, hormone composition, duration of use, who indicated and safe use. After three months, the women were contacted by telephone, using the Rankin and Barthel scales. The data were analyzed by the Software Statistical Package for Social Science(SPSS), version 21.0. Pearson's Chi-square test, Fisher-Freeman-Halton test and Fisher's exact test were used.. The project was approved by the Research Ethics Committee involving human beings from the Federal University of Ceará (opinion No.1282922) and the General Hospital of Fortaleza (opinion No.1327321) and followed Resolution n. 466/12. The AHC (G1U) users were younger (p=0.001) and had a higher prevalence of occupancy outside the home (p=0.011) and Central Venous Thrombosis (p<0.001), being more independent (p=0.036) of G2U. There was an improvement in stroke severity and functional evaluation after three months in both groups (p<0.001). Of the AHC users, 74% used unsafe use (p=0.003), cases of hemorrhagic stroke were more expressive (p=0.017), and the results of the NIH and Rankin scales showed a trend towards greater severity of stroke (p=0.848 and p=0.520, respectively) than among women in safe use. The severity of stroke was also higher in the group whose indication of use was given by "others" (p=0.010). The thesis was confirmed that the use of AHC contributes to the affection of stroke at an earlier age and greater severity of the event and functional impairment of the victims when there was unsafe use of the method and indication by untrained persons. Hormone dosage and duration of use showed no greater neurological impairment or severity stroke.