Manejo perioperatório dos novos anticoagulantes orais / Perioperative management of new oral anticoagulants

Os novos anticoagulantes orais revolucionaram a terapia de anticoagulação ao propiciar maior comodidade posológica e utilizar doses fixas, sem necessidade de acompanhamento do efeito com séries de exames laboratoriais e com menor risco de interações medicamentosas e alimentares. Porém, por serem medicamentos relativamente novos na prática clínica e, até recentemente, não existirem antídotos específicos para a reversão do seu efeito, o manejo no contexto perioperatório sempre gerou certo receio e questionamentos. O manejo adequado dos novos anticoagulantes no perioperatório envolve a avaliação cuidadosa do risco de tromboembolismo a que o paciente está sujeito na eventualidade da suspensão desses agentes em comparação com o risco de sangramento associado à manutenção; essa avaliação precisa abordar a susceptibilidade tanto de fatores relacionados com o paciente quanto do próprio tipo da cirurgia. Publicações recentes conseguiram reunir as evidências mais atuais que norteiam as estratégias de manejo desses medicamentos na eventualidade de um procedimento cirúrgico

The new oral anticoagulants have revolutionized anticoagulant therapy by providing greater dosage convenience, using fixed doses, without the need to monitor the effect with series of laboratory tests, and with a lower risk of drug and food interactions. However, because they are relatively new medications in clinical practice, and because until recently they did not have specific antidotes to reverse their effect, their handling in the perioperative context has always generated a certain fear and questioning. The proper management of the new anticoagulants in the perioperative period involves a careful evaluation of the thromboembolic risk to which the patient is subject in the event of suspension of these agents, compared with the risk of bleeding associated with their maintenance; this evaluation must address the susceptibility of both patient-related factors and the type of surgery. Recent publications have been able to gather the most recent evidence, which guides the strategies for handling these drugs in the event of a surgical procedure

Prevenção cardiovascular - Infância e adolescência - Intervenção sobre o aspecto comportamental / Cardiovascular prevention - Childhood and adolescence - Intervention on the behavorial aspect

As doenças cardiovasculares (DCV) são a principal causa d morte no Brasil e no mundo, sendo que os fatores de risco que contribuem para o desenvolvimento da aterosclerose têm crescido em proporções epidêmicas nas últimas três décadas. A prevenção das DCV deve se iniciar na infância uma vez que a aterosclerose tem início durante a vida fetal, é extremamente prevalente e com evolução insidiosa, cuja primeira manifestação pode ser fatal. Os hábitos de vida e fatores de risco responsáveis pelo desenvolvimento das DCV encontram-se agregados e compartilhados por membros de uma mesma família. Vários estudos tiveram sucesso em implementar políticas de nutrição saudável e estímulo à atividade física dentro das escolas baseado na colaboração de professores e equipes multidisciplinares de saúde. Outros estudos focaram seus esforços na melhora de fatores de risco dos pais como forma de influenciar na melhora dos fatores de risco cardiovascular de seus filhos. Porém, o estudo Childrem First mostrou que um programa multidisciplinar nas escolas, dirigido para temas de prevenção cardiovascular, pode não só ter impacto nos hábitos e estilo de vida das crianças como ser transferido para o cerne cultural da família através da influência infantil e modificar hábitos e o próprio risco cardiovascular de seus pais.

Cardiovascular diseases (CVD) are the leading cause of death in Brazil and in the world, and the risk factors that contribute to the development of atherosclerosis have grown to epidemic proportions in the last three decades. The prevention of CVD should begin in childhood since atherosclerosis begins during fetal life, is extremely prevalente with insidious progression, and whose first manifestation can be fatal. Life habits and risk factors responsible for the development of CVD are aggregated and clustered in members of the same Family. Several studies have been successful in implementing policies encouraging healthy nutrition and physical activity within schools based on teacher collaboration and multidisciplinar health teams. Other studies have focused their efforts on improving risk factors of parentes as a way to influence the improvement of cardiovascular risk factors in children. However, the Childrem First study showed that amultidisciplinary program in schools, directed to issues of cardiovascular prevention, can not only impact the habits and lifestyle of children as being as being transferred to the cultural heart of the family through the children's influence and modify habits and cardiovascular risk of their own parentes.

Fibrilação atrial e tratamento antitrombótico em pacientes atendidos em hospital especializado em cardiologia no Brasil / Atrial fibrilation and antithrombotic treatment in patients treated in a Brazilian University Heart Hospital

Objetivo: Avaliar o uso de antitrombóticos em pacientes com fibrilação atrial (FA) em hospital cardiológico no Brasil (InCOR). Métodos e resultados: Um estudo observacional transversal analisou os prontuários de todos os pacientes atendidos no InCor em cada um de 5 dias separados no ano de 2002 (Fase 1), sendo prospectivamente reanalisados após 1 ano (Fase 2). A prevalência da FA nos 3764 prontuários analisados foi de 8 por cento. Antiplaquetários foram prescritos para 21,26 por cento e 19,93 por cento, anticoagulantes para 46,51 por cento e 57,81 por cento, e 32,23 por cento e 22,26 por cento não usavam nenhum antitrombótico nas Fases 1 e 2, respectivamente. Somente 15,60 por cento e 23,25 por cento apresentavam níveis de RNI terapêuticos. Conclusão: A anticoagulação é subutilizada nos pacientes com FA apesar do fato de serem tratados por cardiologistas em um hospital universitário / Objective: To assess antithrombotic therapy among atrial fibrillation (AF) patients in a Brazilian University Heart Hospital (InCor).Methods and results: A cross sectional study analyzed the charts of all patients treated at InCor in 5 separate days of 2002 (Phase 1), and prospectively reviewed them after one year (Phase 2). The prevalence of AF in the 3,764 assessed charts was of 8.0 per cent. Antiplatelets were prescribed to 21.26 per cent and 19.93 per cent, anticoagulants to 46.51 per cent and 57.81 per cent, and 32.23...

Secular trends in a population with ischemic heart disease admitted to the Instituto do Coração in São Paulo.

OBJECTIVE: To assess the clinical and demographic characteristics of a population with ischemic heart disease admitted in the final decades of the 20th century. METHODS: This study retrospectively assessed patients hospitalized with ischemic heart disease divided into the following 2 groups: acute group - 11.181 patients with acute myocardial infarction admitted from 1/1/82 to 12/31/94; and chronic group - 4.166 patients undergoing coronary artery bypass graft surgery from 1/1/84 to 12/31/94. RESULTS: In the acute group, an increase in the percentage of females (from 22.7% to 27.7%, P<0.001) and diabetic individuals (from 12.4% to 17.5%, P<0.001) was observed, as was an increase in age (from 57.4 +/- 11.5 to 59.9 +/- 12.1 years, P<0.05). In-hospital mortality was greater among females (27.8% and 15.7%, P=0.001), among diabetic individuals (24.2% and 17.8%, P=0.001), and among the elderly (60.9 +/- 15.2 and 57.7 +/- 11.8 years, P=0.0001). In the chronic group, an increase in the percentage of females (from 17.5% to 27.2%, P=0.001) was observed, as was an increase in age (from 56.3 +/- 8.6 to 60.5 +/- 9.6 years, P=0.0001). In-hospital mortality was greater among females (8.3% and 5.8%, P<0.05) and among the elderly (58.1 +/- 9.1 and 62.1 +/- 7.9 years, P=0.0001). CONCLUSION: The characteristics of the population studied with ischemic heart disease point towards a worse prognosis, due to the greater percentages of females, older patients, and diabetic patients, groups known to have greater in-hospital mortality.

Demographic characteristics of the population undergoing cine coronary angiography at the Instituto do Coração of the Medical School of USP from 1986 to 1995.

OBJECTIVE: To obtain information about the profile and behavior of a population with ischemic heart disease undergoing cine coronary angiography and to determine disease severity. METHODS: Retrospective study assessing patients hospitalized at InCor from 1986 to 1995, in which the variables age, sex, and number of major coronary arteries with obstruction degree > or =40% were analyzed. RESULTS: We studied 18,221 patients and observed a significant increase in the number of females (22.8% to 25.2%, P=0.001) and an increase in age (57.1 +/- 29.3 to 60.4 +/- 10.7 years, P=0.0001). A significant increase in the incidence of multivessel disease was observed, which was more frequent among males (69.2% and 64.5%) and among the older patients (59.8 +/- 9.8 and 56.8 +/- 10.7 years, P=0.0001). A reduction in the incidence of single-vessel disease was also observed (66.2% vs 69.2% and 33.8% vs 30.5%, respectively, P<0.0001). CONCLUSION: A change in the profile of the population studied was observed as follows: patients undergoing cine coronary angiography at InCor were older, had a greater number of impaired major coronary arteries, and the number of females affected increased, leading to indices suggestive of a poorer prognosis.

Tendências seculares da populaçäo com doença isquêmia do coraçäo internada do Instituto do Coraçäo - Säo Paulo / Secular trends in a population with ischemic heart disease admitted to the Instituto do Coraçäo in Säo Paulo

OBJECTIVE: To assess the clinical and demographic characteristics of a population with ischemic heart disease admitted in the final decades of the 20th century. METHODS: This study retrospectively assessed patients hospitalized with ischemic heart disease divided into the following 2 groups: acute group - 11.181 patients with acute myocardial infarction admitted from 1/1/82 to 12/31/94; and chronic group - 4.166 patients undergoing coronary artery bypass graft surgery from 1/1/84 to 12/31/94. RESULTS: In the acute group, an increase in the percentage of females (from 22.7 percent to 27.7 percent, P<0.001) and diabetic individuals (from 12.4 percent to 17.5 percent, P<0.001) was observed, as was an increase in age (from 57.4±11.5 to 59.9±12.1 years, P<0.05). In-hospital mortality was greater among females (27.8 percent and 15.7 percent, P=0.001), among diabetic individuals (24.2 percent and 17.8 percent, P=0.001), and among the elderly (60.9±15.2 and 57.7±11.8 years, P=0.0001). In the chronic group, an increase in the percentage of females (from 17.5 percent to 27.2 percent, P=0.001) was observed, as was an increase in age (from 56.3±8.6 to 60.5±9.6 years, P=0.0001). In-hospital mortality was greater among females (8.3 percent and 5.8 percent, P<0.05) and among the elderly (58.1±9.1 and 62.1±7.9 years, P=0.0001). CONCLUSION: The characteristics of the population studied with ischemic heart disease point towards a worse prognosis, due to the greater percentages of females, older patients, and diabetic patients, groups known to have greater in-hospital mortality

Características demográficas da populaçäo submetida à cinecoronariografia no Instituto do Coraçäo da Faculdade de Medicina da USP de 1986 a 1995 / Demographic characteristics of the population undergoing cine coronary angiography at the Instituto do Coraçäo of the Medical School of USP from 1986 to 1995

OBJECTIVE: To obtain information about the profile and behavior of a population with ischemic heart disease undergoing cine coronary angiography and to determine disease severity. METHODS: Retrospective study assessing patients hospitalized at InCor from 1986 to 1995, in which the variables age, sex, and number of major coronary arteries with obstruction degree > 40 percent were analyzed. RESULTS: We studied 18,221 patients and observed a significant increase in the number of females (22.8 percent to 25.2 percent, P=0.001) and an increase in age (57.1±29.3 to 60.4±10.7 years, P=0.0001). A significant increase in the incidence of multivessel disease was observed, which was more frequent among males (69.2 percent and 64.5 percent) and among the older patients (59.8±9.8 and 56.8±10.7 years, P=0.0001). A reduction in the incidence of single-vessel disease was also observed (66.2 percent vs 69.2 percent and 33.8 percent vs 30.5 percent, respectively, P<0.0001). CONCLUSION: A change in the profile of the population studied was observed as follows: patients undergoing cine coronary angiography at InCor were older, had a greater number of impaired major coronary arteries, and the number of females affected increased, leading to indices suggestive of a poorer prognosis

O uso de betabloqueadores na terapêutica da insuficiência cardíaca / Use of the beta-blockers in the heart failure treatment

Considerando o crescente interesse e o constante aporte de novas informaçoes sobre o uso de betabloqueadores no tratamento da insuficiência cardíaca, os autores fazem uma ampla revisao do assunto. Nessa abordagem, sao focalizados os dados mais recentes de interesse prático, aspectos controversos e detalhes conclusivos