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1.
Interv Cardiol Clin ; 9(1): 107-115, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31733737

RESUMEN

This review summarizes the impact of transradial access for cardiac catheterization and percutaneous coronary intervention related to patient satisfaction, patient safety, and health care costs. In studies comparing transradial versus transfemoral approach, transradial access causes less bleeding and less vascular access site complications and provides a mortality benefit in patients with acute coronary syndromes. Transradial access improves patient satisfaction related to site tolerability by reducing pain and discomfort, and facilitating early ambulation with reduced length of stay. Taken in total, the existing randomized and observational data strongly support radial access for improved safety, patient satisfaction, and significant cost savings.


Asunto(s)
Cateterismo Cardíaco/economía , Cateterismo Cardíaco/métodos , Satisfacción del Paciente , Intervención Coronaria Percutánea/economía , Intervención Coronaria Percutánea/métodos , Arteria Radial , Cateterismo Cardíaco/efectos adversos , Hemorragia/epidemiología , Hemorragia/etiología , Humanos , Intervención Coronaria Percutánea/efectos adversos , Medición de Riesgo
3.
Circulation ; 134(1): 37-47, 2016 Jul 05.
Artículo en Inglés | MEDLINE | ID: mdl-27358435

RESUMEN

BACKGROUND: Despite rapid clinical adoption of novel anticoagulants, it is unknown whether outcomes differ among patients with worsening renal function (WRF) taking these new drugs compared with warfarin. We aimed to determine whether the primary efficacy (stroke or systemic embolism) and safety (major bleeding and nonmajor clinically relevant bleeding) end points from the ROCKET AF trial (Rivaroxaban Once-Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation trial) differed among participants with WRF taking rivaroxaban and those taking warfarin. METHODS: After excluding patients without at least 1 follow-up creatinine measurement (n=1624), we included all remaining patients (n=12 612) randomly assigned to either rivaroxaban or dose-adjusted warfarin. On-treatment WRF (a decrease of >20% from screening creatinine clearance measurement at any time point during the study) was evaluated as a time-dependent covariate in Cox proportional hazards models. RESULTS: Baseline characteristics were generally similar between patients with stable renal function (n=9292) and WRF (n=3320). Rates of stroke or systemic embolism, myocardial infarction, and bleeding were also similar, but WRF patients experienced a higher incidence of vascular death versus stable renal function (2.21 versus 1.41 events per 100 patient-years; P=0.026). WRF patients who were randomized to receive rivaroxaban had a reduction in stroke or systemic embolism compared with those taking warfarin (1.54 versus 3.25 events per 100 patient-years) that was not seen in patients with stable renal function who were randomized to receive rivaroxaban (P=0.050 for interaction). There was no difference in major or nonmajor clinically relevant bleeding among WRF patients randomized to warfarin versus rivaroxaban. CONCLUSIONS: Among patients with on-treatment WRF, rivaroxaban was associated with lower rates of stroke and systemic embolism compared with warfarin, without an increase in the composite bleeding end point. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00403767.


Asunto(s)
Inhibidores del Factor Xa/uso terapéutico , Riñón/fisiopatología , Rivaroxabán/uso terapéutico , Warfarina/uso terapéutico , Anciano , Fibrilación Atrial/complicaciones , Creatinina/sangre , Método Doble Ciego , Embolia/prevención & control , Inhibidores del Factor Xa/efectos adversos , Inhibidores del Factor Xa/farmacocinética , Femenino , Hemorragia/inducido químicamente , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Rivaroxabán/efectos adversos , Rivaroxabán/farmacocinética , Accidente Cerebrovascular/prevención & control , Trombofilia/tratamiento farmacológico , Trombofilia/etiología , Warfarina/efectos adversos , Warfarina/farmacocinética
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