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1.
Rev. argent. cardiol ; 80(2): 114-120, abr. 2012. ilus, graf, tab
Artigo em Espanhol | LILACS-Express | ID: lil-657549

RESUMO

Introducción El 30% de los pacientes presentan antiagregación plaquetaria inadecuada con 100 mg/día de aspirina (AAS) luego de la cirugía de revascularización miocárdica (CRM), que podría deberse a una acción inhibitoria menor de esta dosificación de AAS a la mayor activación plaquetaria y al aumento del recambio plaquetario que ocurren en el posoperatorio. Objetivos Evaluar la relación entre el recuento plaquetario y el menor efecto antiagregante y determinar si dosis fragmentadas de AAS mejoran la antiagregación. Material y métodos Luego de la CRM con bypass cardiopulmonar (2,95 puentes en promedio), se aleatorizaron prospectivamente 50 pacientes a tres grupos: 18 pacientes (G100) a 100 mg/día, 14 (G300) a 300 mg/día y 18 (G100×3) a 100 mg 3 veces por día de AAS. En el preoperatorio todos recibieron 100 mg/día. La reactividad plaquetaria se midió mediante agregación en sangre entera con ácido araquidónico antes de la cirugía (T0), al primero (T1), tercero (T2) y séptimo días (T3) y al mes (T4) pos-CRM. Resultados En el preoperatorio todos los pacientes tenían valores óptimos de antiagregación (0 W). En el posoperatorio, los pacientes del G100×3 tuvieron mejores niveles de antiagregación (p < 0,05). Ningún paciente del G100×3 tuvo valores ≥ 6 W, correspondientes a los de personas sanas sin AAS, a diferencia de 5 pacientes (28%) del G100 y 4 pacientes (29%) del G300. Se observó una asociación estadísticamente significativa entre la antiagregación plaquetaria y el recambio del número de plaquetas (R2 = 0,57; p = 0,001). Un recambio diario > 20% se relacionó con valores de agregación plaquetaria ≥ 6 W con un OR = 2,1 (IC 1,8-4,21; p = 0,0028). Conclusiones En los pacientes sometidos a CRM, la menor respuesta antiagregante a la AAS se correlacionó con el recambio aumentado de plaquetas. El tratamiento podría fragmentarse con dosis bajas de AAS para obtener mejor antiagregación.


Thirty percent of patients do not achieve an adequate antiplatelet effect despite therapy with aspirin (ASA) 100 mg/d after coronary artery bypass-graft surgery (CABGS), probably due to reduced inhibitory effect of ASA, increased platelet activation and increased platelet turnover secondary to the surgical procedure. Objectives To evaluate the relation between platelet count and lower antiplatelet effect and to determine if antiaggregation improves by dividing the dose of ASA. Material and Methods A total of 50 patients undergoing CABGS (with an average of 2.95 grafts per surgery) were randomly assigned to three groups depending on the dose of ASA indicated: G100 (100 mg/d, n=18 patients), G300 (300 mg/d, n=14) and G100×3 (100 mg TID, n=18). All the patients received 100 mg/d before surgery. Platelet reactivity was assessed by whole blood impedance using arachidonic acid before surgery (T0), 24 h (T1), 72 h (T2), 7 days (T3), and one month post-CABG (T4). Results Before surgery, all patients had optimal values of antiaggregation (0 W). During the postoperative period, antiaggregation values were better in patients from G100×3 (p <0.05). No patients in G100×3 had values ≥6 W, which correspond to those of healthy subjects who do not receive ASA. This value was observed in 5 patients (28%) from G100 and 4 patients (29%) from G300. The association between antiaggregation and platelet turnover was statistically significant (R2=0.57; p=0.001). A daily turnover >20% was related with values of platelet aggregation ≥6 W; OR=2.1 (CI 1.8-4.21; p=0.0028). Conclusions In patients undergoing CABGS, the lowest antiplatelet effect of ASA was associated with the highest platelet turnover. A better antiaggregation might be achieved by dividing therapy in low dose of ASA.

2.
Rev. argent. cardiol ; 80(2): 114-120, abr. 2012. ilus, graf, tab
Artigo em Espanhol | BINACIS | ID: bin-129289

RESUMO

Introducción El 30% de los pacientes presentan antiagregación plaquetaria inadecuada con 100 mg/día de aspirina (AAS) luego de la cirugía de revascularización miocárdica (CRM), que podría deberse a una acción inhibitoria menor de esta dosificación de AAS a la mayor activación plaquetaria y al aumento del recambio plaquetario que ocurren en el posoperatorio. Objetivos Evaluar la relación entre el recuento plaquetario y el menor efecto antiagregante y determinar si dosis fragmentadas de AAS mejoran la antiagregación. Material y métodos Luego de la CRM con bypass cardiopulmonar (2,95 puentes en promedio), se aleatorizaron prospectivamente 50 pacientes a tres grupos: 18 pacientes (G100) a 100 mg/día, 14 (G300) a 300 mg/día y 18 (G100Î3) a 100 mg 3 veces por día de AAS. En el preoperatorio todos recibieron 100 mg/día. La reactividad plaquetaria se midió mediante agregación en sangre entera con ácido araquidónico antes de la cirugía (T0), al primero (T1), tercero (T2) y séptimo días (T3) y al mes (T4) pos-CRM. Resultados En el preoperatorio todos los pacientes tenían valores óptimos de antiagregación (0 W). En el posoperatorio, los pacientes del G100Î3 tuvieron mejores niveles de antiagregación (p < 0,05). Ningún paciente del G100Î3 tuvo valores ≥ 6 W, correspondientes a los de personas sanas sin AAS, a diferencia de 5 pacientes (28%) del G100 y 4 pacientes (29%) del G300. Se observó una asociación estadísticamente significativa entre la antiagregación plaquetaria y el recambio del número de plaquetas (R2 = 0,57; p = 0,001). Un recambio diario > 20% se relacionó con valores de agregación plaquetaria ≥ 6 W con un OR = 2,1 (IC 1,8-4,21; p = 0,0028). Conclusiones En los pacientes sometidos a CRM, la menor respuesta antiagregante a la AAS se correlacionó con el recambio aumentado de plaquetas. El tratamiento podría fragmentarse con dosis bajas de AAS para obtener mejor antiagregación.(AU)


Thirty percent of patients do not achieve an adequate antiplatelet effect despite therapy with aspirin (ASA) 100 mg/d after coronary artery bypass-graft surgery (CABGS), probably due to reduced inhibitory effect of ASA, increased platelet activation and increased platelet turnover secondary to the surgical procedure. Objectives To evaluate the relation between platelet count and lower antiplatelet effect and to determine if antiaggregation improves by dividing the dose of ASA. Material and Methods A total of 50 patients undergoing CABGS (with an average of 2.95 grafts per surgery) were randomly assigned to three groups depending on the dose of ASA indicated: G100 (100 mg/d, n=18 patients), G300 (300 mg/d, n=14) and G100Î3 (100 mg TID, n=18). All the patients received 100 mg/d before surgery. Platelet reactivity was assessed by whole blood impedance using arachidonic acid before surgery (T0), 24 h (T1), 72 h (T2), 7 days (T3), and one month post-CABG (T4). Results Before surgery, all patients had optimal values of antiaggregation (0 W). During the postoperative period, antiaggregation values were better in patients from G100Î3 (p <0.05). No patients in G100Î3 had values ≥6 W, which correspond to those of healthy subjects who do not receive ASA. This value was observed in 5 patients (28%) from G100 and 4 patients (29%) from G300. The association between antiaggregation and platelet turnover was statistically significant (R2=0.57; p=0.001). A daily turnover >20% was related with values of platelet aggregation ≥6 W; OR=2.1 (CI 1.8-4.21; p=0.0028). Conclusions In patients undergoing CABGS, the lowest antiplatelet effect of ASA was associated with the highest platelet turnover. A better antiaggregation might be achieved by dividing therapy in low dose of ASA.(AU)

3.
Medicina (B Aires) ; 71(5): 441-8, 2011.
Artigo em Espanhol | MEDLINE | ID: mdl-22057170

RESUMO

Contrast induced nephropathy (CIN) is one of the most frequent causes of acute renal failure in hospitalized patients. It is associated with an increase in morbidity and mortality in patients hospitalized for acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Risk factors and prevention strategies are not well defined. The aim of this study was to assess the incidence and clinical risk factors associated to the development of contrast induced nephropathy in patients hospitalized for ACS. In a retrospective cohort we analyzed consecutive patients hospitalized for ACS undergoing urgent PCI within 72 hours from the admission. CIN was defined as a 25% increase of creatinine levels from baseline at 48 hours from the PCI. The inclusion period was from January 1, 2004 to June 30, 2010. A total of 125 patients were analyzed, and CIN occurred in 13 (10.4%) patients. An independent association was found between age (OR 1.05; 95% CI 1.004 to 1.11; p = 0.034), multiple vessel angioplasty (OR 2.2; 95% IC 1.07 to 4.8; p = 0.03) and the volume of contrast infused (OR 1.007; 95% CI 1.001 to 1.01; p = 0.014) with the development of CIN.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Lesão Renal Aguda/induzido quimicamente , Angioplastia , Meios de Contraste/efeitos adversos , Síndrome Coronariana Aguda/terapia , Fatores Etários , Argentina/epidemiologia , Creatinina/sangue , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
4.
Medicina (B.Aires) ; 71(5): 441-448, oct. 2011. tab
Artigo em Espanhol | LILACS | ID: lil-633894

RESUMO

La nefropatía inducida por contraste (NIC) es una de las causas más frecuentes de insuficiencia renal en pacientes internados. En el síndrome coronario agudo (SCA), la presencia de NIC aumenta la morbimortalidad. Las medidas de profilaxis y los factores de riesgo intervinientes de NIC en SCA no han sido determinados con exactitud. El objetivo de este estudio fue evaluar la incidencia de NIC y los factores asociados a su desarrollo en pacientes ingresados en unidad coronaria con requerimiento de cinecoronariografía (CCG). Se realizó un estudio de cohorte retrospectivo. Se incluyeron pacientes consecutivos cursando SCA estudiados con CCG dentro de las 72 horas de su admisión. Se definió NIC al aumento del 25% del valor de creatinina a las 48 h sobre el nivel basal de ingreso. El período de inclusión fue entre el 1° de enero de 2004 hasta el 30 de junio de 2010. Se analizaron 125 casos. La incidencia de NIC fue del 10.4% (n = 13). En el análisis multivariado, los factores asociados independientemente a su desarrollo fueron la edad [OR 1.05 (IC 95% 1.004 - 1.11) p = 0.034], la angioplastia a múltiple vaso [OR 2.2 (IC 95% 1.07 - 4.8), p = 0.03] y el volumen de contraste utilizado [OR 1.007 (IC 95% 1.001 - 1.01), p = 0.014].


Contrast induced nephropathy (CIN) is one of the most frequent causes of acute renal failure in hospitalized patients. It is associated with an increase in morbidity and mortality in patients hospitalized for acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Risk factors and prevention strategies are not well defined. The aim of this study was to assess the incidence and clinical risk factors associated to the development of contrast induced nephropathy in patients hospitalized for ACS. In a retrospective cohort we analyzed consecutive patients hospitalized for ACS undergoing urgent PCI within 72 hours from the admission. CIN was defined as a 25% increase of creatinine levels from baseline at 48 hours from the PCI. The inclusion period was from January 1°, 2004 to June 30, 2010. A total of 125 patients were analyzed, and CIN occurred in 13 (10.4%) patients. An independent association was found between age (OR 1.05; 95% CI 1.004 to 1.11; p = 0.034), multiple vessel angioplasty (OR 2.2; 95% IC 1.07 to 4.8; p = 0.03) and the volume of contrast infused (OR 1.007; 95% CI 1.001 to 1.01; p = 0.014) with the development of CIN.


Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Angioplastia , Síndrome Coronariana Aguda/diagnóstico , Lesão Renal Aguda/induzido quimicamente , Meios de Contraste/efeitos adversos , Fatores Etários , Síndrome Coronariana Aguda/terapia , Argentina/epidemiologia , Creatinina/sangue , Hospitalização/estatística & dados numéricos , Tempo de Internação , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
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