Eficacia de un programa de autocontrol en el tratamiento con anticoagulantes orales antivitamina K. Estudio de factibilidad / Effectiveness of a self-management programme in the treatment of antivitamin K oral anticoagulants. A feasibility study

INTRODUCCIÓN Y OBJETIVO: Evaluar la eficacia de un programa de autocontrol en pacientes con tratamiento anticoagulante oral (TAO) en el mantenimiento del nivel ratio internacional normalizada (INR) en rango terapéutico vs. el método tradicional realizado antes de la intervención, así como las complicaciones, la calidad de vida y el tiempo invertido en los controles. PACIENTES Y MÉTODOS: Estudio piloto de factibilidad con medidas pre-post. Se incluyó a 15 pacientes mayores de 18 años que acudían al control desde hacía más de 6meses. En la fase pre, el paciente realizaba los controles y el seguimiento desde la consulta hospitalaria. Tras realizar una intervención educativa individual al paciente para capacitarlo en la punción, el uso del coagulómetro, el manejo de las tablas de dosificación y el posterior seguimiento desde la consulta virtual, se comparó el porcentaje de controles de INR en rango, las complicaciones, la calidad de vida, y el tiempo invertido para realizar los controles pre (tradicional) y postintervención (autocontrol). RESULTADOS: El porcentaje de controles de INR en rango terapéutico en la fase post fue significativamente mayor que en la pre (65,6% vs. 37,8% p < 0,001). Las complicaciones leves, como las complicaciones graves, disminuyeron en la fase post (20% vs. 0% y 6,7% vs. 0%). Mejoraron significativamente las 5dimensiones del cuestionario de calidad de vida y disminuyó el tiempo invertido. CONCLUSIONES: En nuestra experiencia el autocontrol del TAO sugiere una mejora significativa en el control de pacientes, una disminución de las complicaciones, una mejora en la calidad de vida y un ahorro de tiempo

BACKGROUND AND OBJECTIVES: To compare the efficacy of a self-monitoring programme vs. the conventional method used before the intervention in maintaining the international normalised ratio (INR) in the therapeutic range in patients receiving oral anticoagulants, as well as complications, quality of life and the time invested in the tests. PATIENTS AND METHODS: Pre-pospilot and feasibility study. The study included 15 patients over the age of 18 years who had been attending the monitoring programme for more than 6months. In the pre phase, patients performed the tests and follow-up in the outpatient clinic. After conducting an individual training session with each patient to teach them how to perform venipuncture, use the coagulometer, manage dosing tables and subsequent follow-up from the virtual clinic, we compared the percentage of in-range INR tests, complications, quality of life, and the time invested in performing the tests pre-(conventional) and post-intervention (intervention for self-monitoring). RESULTS: The percentage of INR tests in the therapeutic range was significantly higher in the post-phase than in the pre-phase (65.6% vs. 37.8%, p<.001). Likewise, the incidence of both minor and serious complications decreased in the post-phase (20% vs. 0%, and 6.7% vs. 0%, respectively). Finally, all 5dimensions of the quality of life questionnaire improved significantly, while the time invested decreased. CONCLUSIONS: In our experience, OAT self-monitoring is associated with a significant improvement in patient management, a reduction in the rate of complications, improved quality of life and timesaving

Effectiveness of a self-management programme in the treatment of antivitamin K oral anticoagulants. A feasibility study. / Eficacia de un programa de autocontrol en el tratamiento con anticoagulantes orales antivitamina K. Estudio de factibilidad.

BACKGROUND AND OBJECTIVES: To compare the efficacy of a self-monitoring programme vs. the conventional method used before the intervention in maintaining the international normalised ratio (INR) in the therapeutic range in patients receiving oral anticoagulants, as well as complications, quality of life and the time invested in the tests. PATIENTS AND METHODS: Pre-pospilot and feasibility study. The study included 15 patients over the age of 18 years who had been attending the monitoring programme for more than 6months. In the pre phase, patients performed the tests and follow-up in the outpatient clinic. After conducting an individual training session with each patient to teach them how to perform venipuncture, use the coagulometer, manage dosing tables and subsequent follow-up from the virtual clinic, we compared the percentage of in-range INR tests, complications, quality of life, and the time invested in performing the tests pre- (conventional) and post-intervention (intervention for self-monitoring). RESULTS: The percentage of INR tests in the therapeutic range was significantly higher in the post-phase than in the pre-phase (65.6% vs. 37.8%, p<.001). Likewise, the incidence of both minor and serious complications decreased in the post-phase (20% vs. 0%, and 6.7% vs. 0%, respectively). Finally, all 5dimensions of the quality of life questionnaire improved significantly, while the time invested decreased. CONCLUSIONS: In our experience, OAT self-monitoring is associated with a significant improvement in patient management, a reduction in the rate of complications, improved quality of life and timesaving.

[Role of hepcidin in the pathogenesis of hemochromatosis]. / Papel de la hepcidina en la patogenia de la hemocromatosis.

In the last few years, biochemical and molecular study of the various types of hemochromatosis have established that the hepcidin peptide is the central regulator of iron absorption. This peptide, which is synthesized in the liver, acts through ferroportin degradation. Ferroportin is an iron exporter situated in the intestinal epithelium and in the macrophage membrane whose function is to transport iron from the intestinal cell to plasma and from the macrophage to the erythron. In hemochromatosis, there is a physical or functional hepcidin deficit that increases ferroportin, thus producing excessive iron absorption. The opposite occurs in situations of inflammation: hepcidin synthesis is stimulated while iron entry into the organism and hemoglobin synthesis are blocked.

Papel de la hepcidina en la patogenia de la hemocromatosis / Role of hepcidin in the pathogenesis of hemochromatosis

En los últimos años, el estudio bioquímico y molecular de los diversos tipos de hemocromatosis ha llevado a la certeza de que el péptido hepcidina es el regulador central de la absorción de hierro. Este péptido que se sintetiza en el hígado ejerce su función a través de la degradación de la proteína ferroportina. La ferroportina es una bomba biológica de hierro situada en el epitelio intestinal y en la membrana de los macrófagos, su función es la de transportar hierro desde la célula intestinal al plasma y desde el macrófago al eritrón. En la hemocromatosis se produce un déficit físico o funcional de la hepcidina que conduce a un incremento de la ferroportina y, con esto, a una absorción de hierro excesiva. En situaciones de inflamación sucede lo contrario, se estimula la síntesis de hepcidina y se bloquea la entrada de hierro en el organismo y la síntesis de hemoglobina(AU)

In the last few years, biochemical and molecular study of the various types ofhemochromatosis have established that the hepcidin peptide is the central regulator of iron absorption. This peptide, which is synthesized in the liver, acts through ferro portin degradation. Ferroportin is an iron exporter situated in the intestinal epithelium and in the macrophage membrane whose function is to transport iron from the intestinal cell toplasma and from the macrophage to the erythron. In hemochromatosis, there is a physical or functional hepcidin deficit that in creases ferroportin, thus producing excessive iron absorption. The opposite occursin situation sof inflammation: hepcidin synthesisisstimulated while iron entry in to the organism and hemoglobin synthesis are blocked(AU)

La sobrecarga férrica en los síndromes mielodisplásicos. Papel de los quelantes del hierro / Iron overload in myelodysplastic syndromes. Role of iron chelators

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Sobrecarga férrica. Algo más que hemocromatosis hereditaria / Iron overload. More than hereditary hemochromatosis

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