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Isr Med Assoc J ; 23(9): 595-600, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34472236


BACKGROUND: Limited data exist regarding the safety of ultrasound-guided femoral nerve blockade (US-FNB) in patients with hip fractures treated with anti-Xa direct oral anticoagulants (DOAC). OBJECTIVES: To compare the safety outcomes of US-FNB to conventional analgesia in patients with hip fractures treated with anti-Xa DOAC. METHODS: This observational exploratory prospective study included 69 patients who presented to our emergency department (ED) in 3 years with hip fracture and who were treated with apixaban or rivaroxaban. Patients received either a US-FNB (n=19) or conventional analgesics (n=50) based on their preference and, and the presence of a trained ED physician qualified in performing US-FNB. Patients were observed for major bleeding events during and 30 days after hospitalization. The degree of preoperative pain and opioid use were also observed. RESULTS: We found no significant difference in the number of major bleeding events between groups (47.4% vs. 54.0%, P = 0.84). Degree of pain measured 3 and 12 hours after presentation was found to be lower in the US-FNB group (median visual analog scale of pain improvement from baseline of -5 vs. -3 (P = 0.002) and -5 vs.-4 (P = 0.023), respectively. Opioid administration pre-surgery was found to be more than three times more common in the conventional analgesia group (26.3% vs.80%, P < 0.0001). CONCLUSIONS: Regarding patients treated with Anti-Xa DOAC, US-FNB was not associated with an increase in major bleeding events compared to conventional analgesia, although it was an effective means of pain alleviation. Larger scale randomized controlled trials are required to determine long-term safety and efficacy.

Inibidores do Fator Xa/administração & dosagem , Fraturas do Quadril/cirurgia , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Analgésicos/administração & dosagem , Analgésicos Opioides/administração & dosagem , Estudos de Coortes , Serviço Hospitalar de Emergência , Inibidores do Fator Xa/efeitos adversos , Feminino , Nervo Femoral/diagnóstico por imagem , Hemorragia/epidemiologia , Hemorragia/etiologia , Humanos , Masculino , Bloqueio Nervoso/efeitos adversos , Medição da Dor , Projetos Piloto , Estudos Prospectivos , Pirazóis/administração & dosagem , Pirazóis/efeitos adversos , Piridonas/administração & dosagem , Piridonas/efeitos adversos , Rivaroxabana/administração & dosagem , Rivaroxabana/efeitos adversos , Ultrassonografia de Intervenção
Int J Cardiol ; 96(2): 151-5, 2004 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15262028


BACKGROUND: Enoxaparin has gained wide acceptance in patients with acute coronary syndromes. However, there is uncertainty regarding management of patients who require coronary intervention while on enoxaparin. Some physicians withhold the morning dose of enoxaparin prior to coronary intervention while others switch patients to unfractionated heparin. Both methods do not provide optimal anticoagulation in the hours preceding intervention. There are no published controlled data to assess the safety of coronary intervention using enoxaparin alone in patients with acute coronary syndromes. METHODS: We prospectively compared enoxaparin to unfractionated heparin during coronary angiography and intervention. Sixty four patients admitted to the coronary care unit (CCU) were given enoxaparin twice daily, including on the morning of procedure. Coronary angiography and intervention were performed without additional unfractionated heparin. The control group comprised of 52 patients admitted to Internal Medicine for an acute coronary syndrome. These were also given enoxaparin but the morning dose was withheld and unfractionated heparin was used during procedure. RESULTS: Patients in both groups had similar baseline characteristics. No significant differences were observed between the two groups in procedural success rate, complications or bleeding. One year follow up showed similar rates of hospitalization and mortality. CONCLUSION: Enoxaparin seems to offer safe and effective procedural anticoagulation in patients undergoing percutaneous intervention for acute coronary syndromes. Patients given enoxaparin can probably have coronary intervention without interruption of enoxaparin treatment and without additional procedural anticoagulation. These findings require confirmation in larger, randomized trials.

Angioplastia Coronária com Balão/métodos , Angiografia Coronária/métodos , Enoxaparina/uso terapêutico , Heparina/uso terapêutico , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Idoso , Anticoagulantes/uso terapêutico , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Seguimentos , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Probabilidade , Estudos Prospectivos , Medição de Risco , Tromboembolia/prevenção & controle , Resultado do Tratamento