RESUMEN
La transfusión de sangre alogénica (TSA) no es inocua, y como consecuencia han surgido múltiples alternativas a la misma (ATSA). Existe variabilidad respecto a las indicaciones y buen uso de las ATSA. Dependiendo de la especialidad de los médicos que tratan a los pacientes, el grado de anemia, la política transfusional, la disponibilidad de las ATSA y el criterio personal, estas se usan de forma variable. Puesto que las ATSA tampoco son inocuas y pueden no cumplir criterios de coste-efectividad, la variabilidad en su uso es inaceptable. Las sociedades españolas de Anestesiología y Reanimación (SEDAR), Hematología y Hemoterapia(SEHH), Farmacia Hospitalaria (SEFH), Medicina Intensiva y Unidades Coronarias(SEMICYUC), Trombosis y Hemostasia (SETH) y Transfusiones Sanguíneas (SETS) han elaborado un documento de consenso para el buen uso de la ATSA. Un panel de expertos de las 6sociedades ha llevado a cabo una revisión sistemática de la literatura médica y elaborado el 2013. Documento Sevilla de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica. Solo se contempla las ATSA dirigidas a disminuir la transfusión de concentrado de hematíes. Se definen las ATSA como toda medida farmacológica y no farmacológica encaminada a disminuir la transfusión de concentrado de hematíes, preservando siempre la seguridad del paciente. La cuestión principal que se plantea en cada ítem se formula, en forma positiva o negativa, como: La ATSA en cuestión reduce/no reduce la tasa transfusional». Para formular el grado de recomendación se ha usado la metodología Grades of Recommendation Assessment, Development and Evaluation (GRADE) (AU)
Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH)and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: Does this particular AABT reduce the transfusion rate or not? All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation(GRADE) methodology (AU)
Asunto(s)
Humanos , Transfusión de Sangre Autóloga , Transfusión Sanguínea/métodos , Sustitutos Sanguíneos/uso terapéutico , Anemia/terapia , Hemoglobina Glucada/uso terapéutico , Fibrinógeno/uso terapéutico , Pautas de la Práctica en MedicinaRESUMEN
La transfusión de sangre alogénica (TSA) no es inocua, y como consecuencia han surgido múltiples alternativas a la misma (ATSA). Existe variabilidad respecto a las indicaciones y buen uso de las ATSA. Dependiendo de la especialidad de los médicos que tratan a los pacientes, el grado de anemia, la política transfusional, la disponibilidad de las ATSA y el criterio personal, estas se usan de forma variable. Puesto que las ATSA tampoco son inocuas y pueden no cumplir criterios de coste-efectividad, la variabilidad en su uso es inaceptable. Las sociedades españolas de Anestesiología y Reanimación (SEDAR), Hematología y Hemoterapia (SEHH), Farmacia Hospitalaria (SEFH), Medicina Intensiva y Unidades Coronarias (SEMICYUC), Trombosis y Hemostasia (SETH) y Transfusiones Sanguíneas (SETS) han elaborado un documento de consenso para el buen uso de la ATSA. Un panel de expertos de las 6 sociedades ha llevado a cabo una revisión sistemática de la literatura médica y elaborado el 2013. Documento Sevilla de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica. Solo se contempla las ATSA dirigidas a disminuir la transfusión de concentrado de hematíes. Se definen las ATSA como toda medida farmacológica y no farmacológica encaminada a disminuir la transfusión de concentrado de hematíes, preservando siempre la seguridad del paciente. La cuestión principal que se plantea en cada ítem se formula, en forma positiva o negativa, como: «La ATSA en cuestión reduce/no reduce la tasa transfusional». Para formular el grado de recomendación se ha usado la metodología Grades of Recommendation Assessment, Development and Evaluation (GRADE) (AU)
Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: "Does this particular AABT reduce the transfusion rate or not?" All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) methodology (AU)
Asunto(s)
Humanos , Masculino , Femenino , Trasplante Homólogo/instrumentación , Trasplante Homólogo/métodos , Trasplante Homólogo , Análisis Costo-Beneficio/organización & administración , Análisis Costo-Beneficio/normas , Análisis Costo-Beneficio , Evaluación de Eficacia-Efectividad de Intervenciones , Anestesiología/métodos , Trasplante Homólogo/normas , Trasplante Homólogo/tendencias , 50303 , Anestesiología/organización & administración , Anestesiología/normas , Transfusión de Eritrocitos/tendencias , Transfusión de EritrocitosRESUMEN
Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: « Does this particular AABT reduce the transfusion rate or not?¼ All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) methodology.
Asunto(s)
Transfusión Sanguínea/normas , Terapias Complementarias , Humanos , Seguridad del Paciente , Procedimientos Quirúrgicos OperativosRESUMEN
Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: "Does this particular AABT reduce the transfusion rate or not?" All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) methodology.
Asunto(s)
Procedimientos Médicos y Quirúrgicos sin Sangre/normas , Humanos , Guías de Práctica Clínica como AsuntoRESUMEN
OBJECTIVE: To determine the frequency and causes for discontinuing treatment with tenofovir and analyse possible predictive factors for changing this therapy in pretreated HIV patients. METHOD: A multi-centre, observational and retrospective study of all HIV patients undergoing treatment with tenofovir between July 2002 and December 2005. Data were obtained from databases for outpatients attending the three pharmacy departments participating in the study, and by reviewing clinical histories. The main sociodemographic, clinical and analytical variables at the start of treatment with tenofovir were collected. The causes for discontinuing treatment were classified as follows: adverse effects, virological failure, death and "other causes". A survival analysis was performed using the Kaplan-Meier method to analyse the possible predictive factors for discontinuing treatment. RESULTS: A total of 733 patients were included in the study and the median treatment period was 34.7 months. A total of 23.8% of patients discontinued treatment for the following reasons: adverse effects (43.2%), death (17.7%), virological failure (14.8%) and "other causes" (24.4%). There were 99 cases of lost to follow-up. In the survival analysis an association was found between normal serum creatinine values (p = 0.0042) at the start of treatment and the statistically significant probability of discontinuing treatment. CONCLUSIONS: Almost a quarter of the patients discontinued treatment with tenofovir during the study. The main cause for this was adverse effects. No association was found between any abnormal basal analytical parameter and a greater probability of discontinuing treatment.
Asunto(s)
Adenina/análogos & derivados , Fármacos Anti-VIH/administración & dosificación , Infecciones por VIH/tratamiento farmacológico , Organofosfonatos/administración & dosificación , Adenina/administración & dosificación , Adenina/efectos adversos , Adulto , Fármacos Anti-VIH/efectos adversos , Femenino , Predicción , Humanos , Masculino , Persona de Mediana Edad , Organofosfonatos/efectos adversos , Estudios Retrospectivos , Tenofovir , Negativa del Paciente al Tratamiento/estadística & datos numéricosRESUMEN
Objetivo: Determinar la frecuencia y las causas de discontinuacióndel tratamiento con tenofovir y analizar los posibles factorespredictores de cambio de esta terapia en pacientes VIHpretratados.Método: Estudio multicéntrico, observacional y retrospectivode todos los pacientes VIH en tratamiento con tenofovir entrejulio-2002 y diciembre-2005. Los datos fueron obtenidos a travésde las bases de datos de pacientes externos de los tres servicios defarmacia participantes y de la revisión de las historias clínicas. Serecogieron las principales variables sociodemográficas, clínicas yanalíticas al inicio del tratamiento con tenofovir. Las causas de discontinuaciónse clasificaron en: efectos adversos, fracaso virológico,exitus y otras causas. Se realizó un análisis de supervivenciade Kaplan-Meier para analizar los posibles factores predictores dediscontinuación.Resultados: Un total de 733 pacientes se incluyeron en elestudio. La mediana de tiempo en tratamiento fue de 34,7meses. El 23,8% de los sujetos discontinuó el tratamiento. Lascausas fueron: efectos adversos: 43,2%, exitus: 17,7%, fracasovirológico: 14,8% y otros motivos: 24,4%. Hubo 99 casos deperdida de seguimiento. En el análisis de supervivencia, se asociótener niveles normales de creatinina sérica (p = 0,0042) alinicio del tratamiento con probabilidad estadisticamente significativade discontinuación.Conclusiones: Durante el estudio, casi una cuarta parte delos pacientes discontinuó el tratamiento con tenofovir. La principalcausa de discontinuación fueron los efectos adversos. No seasoció ningún parametro analítico basal anormal a mayor probabilidadde discontinuación de tratamiento
Objective: To determine the frequency and causes for discontinuingtreatment with tenofovir and analyse possible predictivefactors for changing this therapy in pretreated HIV patients.Method: A multi-centre, observational and retrospectivestudy of all HIV patients undergoing treatment with tenofovirbetween July 2002 and December 2005. Data were obtainedfrom databases for outpatients attending the three pharmacydepartments participating in the study, and by reviewing clinicalhistories. The main sociodemographic, clinical and analyticalvariables at the start of treatment with tenofovir were collected.The causes for discontinuing treatment were classified as follows:adverse effects, virological failure, death and other causes.A survival analysis was performed using the Kaplan-Meiermethod to analyse the possible predictive factors for discontinuingtreatment.Results: A total of 733 patients were included in the studyand the median treatment period was 34.7 months. A total of23.8% of patients discontinued treatment for the following reasons:adverse effects (43.2%), death (17.7%), virological failure(14.8%) and other causes (24.4%). There were 99 cases of lostto follow-up. In the survival analysis an association was foundbetween normal serum creatinine values (p = 0.0042) at the startof treatment and the statistically significant probability of discontinuingtreatment.Conclusions: Almost a quarter of the patients discontinuedtreatment with tenofovir during the study. The main cause for thiswas adverse effects. No association was found between anyabnormal basal analytical parameter and a greater probability ofdiscontinuing treatment
