Abstract
Background
Chagas disease is an important cause of heart failure (HF) and stroke, affecting over
6 million people. High-intensity transient signals (HITS) are detected on transcranial
Doppler (TCD) in patients with Chagas disease, but the effect of antithrombotic treatment
on HITS is unknown.
Objective
To evaluate whether acetylsalicylic acid (ASA) reduces the frequency and number of
HITS in patients with Chagasic HF.
Methods
Proof-of-principle pilot prospective, randomized, open, blinded endpoint (PROBE) clinical
trial, in which patients with both Chagas and HITS were randomized 2:1 to ASA 300 mg
for 7 days and standard HF treatment or standard HF treatment alone (control group).
The primary outcome was the proportion of HITS after one week, analyzed using the
Chi-squared test.
Results
A total of 373 patients with HF were evaluated, with HITS occurring in 22/190 (12%)
Chagasic patients and in 16/183 (8%) non-Chagasic patients (p = 0.531). Twelve of the 22 (54%) Chagasic patients were randomized to treatment with
(n = 8) or without ASA (n = 4). Two patients in the control group (50%) persisted
with HITS after 7 days of treatment, compared to none in the ASA group, p = 0.028. The median number of HITS decreased from 3.5 to 0 with ASA (p = 0.012) and 4.0 to 0.5 in the control group (p = 0.095), with no significant between-group difference (p = 0.262). No adverse events were reported.
Conclusion
In the present pilot clinical trial, ASA reduced the proportion of HITS in patients
with Chagas disease HF.
Keywords
Cardiomyopathies - Chagas Disease - Cerebrovascular Disorders
Bibliographical Record
Renan Carvalho Castello-Branco, Cárita Victoria Carvalho de Santana, Victor L. P.
P. Botelho, Paulo R. S. P. deSousa, Maria C.P. Nunes, Karen L. Furie, Jamary Oliveira-Filho.
Pilot randomized controlled trial of acetylsalicylic acid to reduce cerebral microembolism
in Chagas heart failure. Arq Neuropsiquiatr 2025; 83: s00451812028.
DOI: 10.1055/s-0045-1812028
