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1.
Bone Joint J ; 101-B(11): 1331-1347, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674244

RESUMO

AIMS: Antibiotic-loaded bone cements (ALBCs) may offer early protection against the formation of bacterial biofilm after joint arthroplasty. Use in hip arthroplasty is widely accepted, but there is a lack of evidence in total knee arthroplasty (TKA). The objective of this study was to evaluate the use of ALBC in a large population of TKA patients. MATERIALS AND METHODS: Data from the National Joint Registry (NJR) of England and Wales were obtained for all primary cemented TKAs between March 2003 and July 2016. Patient, implant, and surgical variables were analyzed. Cox proportional hazards models were used to assess the influence of ALBC on risk of revision. Body mass index (BMI) data were available in a subset of patients. RESULTS: Of 731 214 TKAs, 15 295 (2.1%) were implanted with plain cement and 715 919 (97.9%) with ALBC. There were 13 391 revisions; 2391 were performed for infection. After adjusting for other variables, ALBC had a significantly lower risk of revision for any cause (hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77 to 0.93; p < 0.001). ALBC was associated with a lower risk of revision for all aseptic causes (HR 0.85, 95% CI 0.77 to 0.95; p < 0.001) and revisions for infection (HR 0.84, 95% CI 0.67 to 1.01; p = 0.06). The results were similar when BMI was added into the model, and in a subanalysis where surgeons using only ALBC over the entire study period were excluded. Prosthesis survival at ten years for TKAs implanted with ALBC was 96.3% (95% CI 96.3 to 96.4) compared with 95.5% (95% CI 95.0 to 95.9) in those implanted with plain cement. On a population level, where 100 000 TKAs are performed annually, this difference represents 870 fewer revisions at ten years in the ALBC group. CONCLUSION: After adjusting for a range of variables, ALBC was associated with a significantly lower risk of revision in this registry-based study of an entire nation of primary cemented knee arthroplasties. Using ALBC does not appear to increase midterm implant failure rates. Cite this article: Bone Joint J 2019;101-B:1331-1347.


Assuntos
Antibacterianos/administração & dosagem , Artroplastia do Joelho/métodos , Cimentos para Ossos , Prótese do Joelho/efeitos adversos , Adulto , Idoso , Anticoagulantes/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Infecções Relacionadas à Prótese/prevenção & controle , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Tromboembolia/prevenção & controle , Resultado do Tratamento
2.
Wiad Lek ; 72(9 cz 2): 1829-1833, 2019.
Artigo em Polonês | MEDLINE | ID: mdl-31622274

RESUMO

Atrial fibrillation (AF) is the most common cardiac arrhythmia in the adult population. Thromboembolic events are one of the reson of increased mortality in this group of patients. Oral anticoagulation therapy significantly reduces the risk of complications, however every tenth patient has contraindications to this treatment. Percutaneous left atrial appendage occlusion (LAAO) is effective, non-pharmacological method of treatment through elimination the source of thromi. This procedure is dedicated to patients with high risk of thromboembolism events and contraindications to anticoagulation.


Assuntos
Apêndice Atrial/cirurgia , Fibrilação Atrial/terapia , Tromboembolia/prevenção & controle , Anticoagulantes , Fibrilação Atrial/complicações , Humanos , Terapia Trombolítica
3.
Ceska Gynekol ; 84(3): 229-232, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31324115

RESUMO

OBJECTIVE: Summary of available literature concerning recommendation of antithrombotic prophylaxis in the infertility treatment by in vitro fertilization (IVF) and in pregnancies after IVF. DESIGN: Review article. SETTINGS: Department of Obstetrics and Gynecology, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký University Olomouc; Institute of Medical Genetics, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký University Olomouc. METHODS: Analysis of literary sources and databases Medline, Web of Science, Scholar Google, 2010-2018. CONCLUSION: The incidence of thromboembolism in the first trimester of pregnancy after IVF is 0.2% e. g. 10-times higher compared to normal pregnant population. Pregnancies after IVF are complicated in 6-7% by ovarian hyperstimulation syndrome (OHSS), they then have the risk of venous thromboembolism (VTE) 1.7% in the first trimester, what is 100-times higher as compared to the general population. Women after IVF without OHSS have a 5-times higher risk of VTE compared to the general population. To lower the risk of thromboembolism during treatment, use of low dose gonadotrophin (mild) stimulation protocols, prioritization of antagonistic stimulation protocols, avoidance of OHSS using GnRH agonists instead of hCG, cryo embryotransfer in natural cycles, reduction of incidence of multiple pregnancy by single embryo transfer, use of prophylactic and therapeutic low molecular weight heparin (LMWH) is recommended. These strategies can reduce the risk of thromboembolism. The LMWH application is suitable in pregnant women in the first trimester of pregnancy after IVF where OHSS was present.


Assuntos
Fertilização In Vitro/efeitos adversos , Fibrinolíticos/administração & dosagem , Heparina de Baixo Peso Molecular/administração & dosagem , Síndrome de Hiperestimulação Ovariana/complicações , Complicações Hematológicas na Gravidez/etiologia , Tromboembolia/prevenção & controle , Transferência Embrionária , Feminino , Humanos , Indução da Ovulação , Gravidez , Complicações Hematológicas na Gravidez/tratamento farmacológico , Taxa de Gravidez , Tromboembolia/tratamento farmacológico , Tromboembolia/etiologia
4.
Medicine (Baltimore) ; 98(30): e16586, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348297

RESUMO

RATIONALE: Acute myeloid leukemia (AML), in patients with coronary heart disease (CHD) and treated percutaneous coronary intervention (PCI), is rarely seen in clinic. There are few similar cases reported, and there are no evidence-based medicine guidelines for the treatment. PATIENT CONCERNS: A 52-year-old man was diagnosed with coronary atherosclerotic heart disease in November 2011, and received a stent placement in the left anterior descending coronary artery 1 year later. One day after the surgery, his laboratory tests showed pancytopenia. DIAGNOSES: Based on precise diagnosis of leukemia, namely cell morphology, immunology, cytogenetics, and molecular biological typing, the patient was diagnosed with AML-M2. INTERVENTIONS: The patient received idarubicin with cytarabine in 1st cycles, and single cytarabine regimen was used in 2nd and 3rd cycles for the accumulative toxicity of idarubicin in postinduction chemotherapy. Meanwhile, staged-treatment strategy was implemented by using antiplatelet drugs during different chemotherapy phases, and personalized pharmaceutical care on the basis of the recognition of potential adverse effects of chemotherapy regimen. OUTCOMES: Until now, the disease-free survival in the patient has been over 6 years, and he is still followed up in clinic. LESSONS: Although leukemia accompanied with coronary heart disease, even after receiving the coronary stenting therapy is rarely seen in clinic, the treatment with antiplatelet drugs for post chemotherapy patients with coronary disease is necessary. Clinical pharmacists are supposed to be more proficient in developing personalized drug treatment strategies, especially maintaining the balance between the effect and the risk in difficult and complex cases.


Assuntos
Doença das Coronárias/complicações , Doença das Coronárias/cirurgia , Leucemia Mieloide Aguda/complicações , Intervenção Coronária Percutânea/métodos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Humanos , Leucemia Mieloide Aguda/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/administração & dosagem , Tromboembolia/prevenção & controle
5.
Khirurgiia (Mosk) ; (7): 52-57, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31355815

RESUMO

OBJECTIVE: To compare incidence of thromboembolic and hemorrhagic complications in patients with atrial fibrillation (AF) undergoing elective surgery on different schemes of perioperative anticoagulant therapy (ACT). MATERIAL AND METHODS: There were 86 patients (56 (65.1%) men and 30 (34.9%) women, mean age was 69 (64; 78) years) with non-valvular AF who underwent elective interventions. Forty (46.5%) patients underwent abdominal surgery, 34 (39.5%) - cardiovascular procedures, 12 (14.0%) patients underwent surgery for malignant diseases. We have analyzed incidence of thromboembolic and hemorrhagic events and compliance of perioperative ACT modes with current international guidelines. RESULTS: Thromboembolic and hemorrhagic events developed in 14 (16.3%) patients. Thromboembolic complications were noted in 6 (7.0%) patients, hemorrhagic events - in 8 (9.3%) cases. Maximum complication rate was observed in case of bridge-therapy (n=12, 20.0%). Cancellation of ACT was followed by 2 (9.5%) complications, bridge-therapy - by 4 (6.7%) thromboembolic complications. Hemorrhagic events were 2 times more common in case of this therapy (n=8, 13.3%). It was found that ESC guidelines for perioperative ACT were applied in less than half of patients (41, 47.7% patients with AF undergoing elective surgery). Half of complications (8 out of 16) occurred if unapproved modes of ACT were used (including 7 cases of bridge-therapy was not necessary). The causes of these complications were inadequate assessment of perioperative risk of thromboembolic and hemorrhagic events; unreasonable administration of bridge therapy. CONCLUSION: An unambiguous clinical effect of bridge therapy has not been confirmed in patients with high risk of thromboembolic complications. Cancer patients have higher risk of complications compared with others. These events occur mainly due to non-compliance with clinical guidelines and insufficient prevention of thromboembolic events.


Assuntos
Anticoagulantes/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Hemorragia/prevenção & controle , Tromboembolia/prevenção & controle , Idoso , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Feminino , Fidelidade a Diretrizes , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tromboembolia/etiologia
6.
Orthopade ; 48(7): 629-642, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31250079

RESUMO

BACKGROUND: Thromboembolism is one of the most significant complications in many orthopaedic treatments and illnesses. Therefore, prevention is of vital importance. CURRENT STATUS: The existing S3 guideline, revised in 2015, investigates the various symptoms and treatments in great detail, and thus provides very good recommendations. The difficulties of thrombosis prophylaxis in orthopaedics were ever-present in 2018, which is shown by the large number of publications on the topic. These new findings can be incorporated into further versions of the guideline, thereby adapting them to the current status. Finally, the fact that is especially important for everyday practice should be mentioned, that is, in particular when patients are transferred or discharged, information about the necessary prophylaxis is communicated to the colleagues who will be carrying out further treatment to guarantee uninterrupted prophylaxis.


Assuntos
Procedimentos Ortopédicos , Ortopedia , Tromboembolia , Anticoagulantes , Humanos , Tromboembolia/prevenção & controle
9.
Int J STD AIDS ; 30(7): 718-722, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30975070

RESUMO

The potential for drug-drug interactions (DDIs) between direct oral anticoagulants and antiretroviral therapy (ART) is vast. Ritonavir and cobicistat are used as pharmacokinetic enhancers with either concurrent protease inhibitors or the integrase strand transfer inhibitor, elvitegravir, to optimize therapeutic concentrations by cytochrome P450 (CYP) inhibition. To date, only rivaroxaban and dabigatran have reported cases of use with ritonavir-boosted ART. Apixaban is metabolized similarly to rivaroxaban, but offers a dose reduction in the case of major DDIs. We report the successful use of reduced-dose apixaban to treat and prevent thromboembolic complications in six persons living with human immunodeficiency virus (HIV) on ritonavir- or cobicistat-boosted ART. This case series and available literature support the use of apixaban or dabigatran, depending on the boosted ART regimen.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Cobicistat/uso terapêutico , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Ritonavir/uso terapêutico , Tromboembolia/tratamento farmacológico , Idoso , Interações de Medicamentos , Inibidores do Fator Xa , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Tromboembolia/prevenção & controle , Resultado do Tratamento
10.
Medicine (Baltimore) ; 98(11): e14833, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30882670

RESUMO

Although the new oral P2Y12 inhibitors, prasugrel/ticagrelor have shown greater efficacy than clopidogrel in patients with the acute coronary syndrome, but they have not shown better efficacy in Korean patients. So we evaluated the efficacy of the prasugrel/ticagrelor in patients with myocardial infarction (MI) and diabetes, a more high-risk patients group.From the Korea Acute Myocardial Infarction Registry-National Institute of Health, 3985 patients with MI and diabetes who underwent PCI were enrolled between November 2011 and December 2015. The patients were divided into 2 groups: clopidogrel (n = 2985) and prasugrel/ticagrelor (n = 1000).After propensity score matching, prasugrel/ticagrelor group showed a no significant difference in risk of the composite of cardiac death (CD), recurrent MI or stroke (hazard ratio [HR], 0.705; 95% confidence interval [CI], 0.474-1.048; P = .084). However, the risk of major bleeding was significantly higher in the prasugrel/ticagrelor group. (HR; 2.114, 95% CI; [1.027-4.353], P = .042). In subgroup analysis, major bleeding was significantly increased in the subgroup of creatinine clearance <60 ml/min/1.73 m, hypertension, underwent a trans-femoral approach and diagnosed as NSTEMI among the prasugrel/ticagrelor group.The use of prasugrel/ticagrelor did not improve the composite of CD, recurrent MI or stroke, however, significantly increased major bleeding events in Korean patients with MI and diabetes undergoing PCI.


Assuntos
Clopidogrel , Diabetes Mellitus , Infarto do Miocárdio , Intervenção Coronária Percutânea , Complicações Pós-Operatórias/prevenção & controle , Cloridrato de Prasugrel , Tromboembolia , Ticagrelor , Idoso , Clopidogrel/administração & dosagem , Clopidogrel/efeitos adversos , Estudos de Coortes , Comorbidade , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Avaliação de Processos e Resultados (Cuidados de Saúde) , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Inibidores da Agregação de Plaquetas/administração & dosagem , Inibidores da Agregação de Plaquetas/efeitos adversos , Período Pós-Operatório , Cloridrato de Prasugrel/administração & dosagem , Cloridrato de Prasugrel/efeitos adversos , República da Coreia/epidemiologia , Tromboembolia/etiologia , Tromboembolia/prevenção & controle , Ticagrelor/administração & dosagem , Ticagrelor/efeitos adversos
11.
Expert Opin Emerg Drugs ; 24(1): 55-61, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30845846

RESUMO

INTRODUCTION: Thromboembolic diseases are leading cause of mortality accounting for an estimated 1 in 4 deaths all over the world. Anticoagulation remains the mainstay of prevention and treatment of venous thromboembolic disorders. Conventional anticoagulants have been efficiently used over the last decades, but their clinical use encounters safety and convenience issues. To overcome these limitations, research have focused on development of new targets for anticoagulation leading to a relatively new class of drugs, non-vitamin K antagonist oral anticoagulants, specifically targeting activated factor X and thrombin. However, the search for more potent anticoagulant agents with reduced bleeding risk is still continuing. Areas covered: In this review, we provide an overview on emerging investigational anticoagulant drugs targeting factor XI in the coagulation cascade. We review data about the role of intrinsic pathway in thrombosis and haemostasis and the rationale of different pharmacodynamic approaches targeting factor XI. Expert opinion: Recent evidence suggests that the contact pathway plays a significant role in thrombosis by thrombus stabilization and growth without perturbing haemostasis. Factor XI might be a promising drug target to develop highly effective antithrombotic therapy with safety bleeding profile. Most of these investigational agents are in early development phases, only few have reached early phase clinical trials.


Assuntos
Anticoagulantes/farmacologia , Fator XI/antagonistas & inibidores , Tromboembolia/prevenção & controle , Animais , Anticoagulantes/efeitos adversos , Desenho de Drogas , Desenvolvimento de Medicamentos/métodos , Drogas em Investigação/efeitos adversos , Drogas em Investigação/farmacologia , Hemorragia/induzido quimicamente , Humanos , Terapia de Alvo Molecular , Trombose/prevenção & controle
12.
Expert Rev Cardiovasc Ther ; 17(4): 319-330, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30897988

RESUMO

INTRODUCTION: Edoxaban is the last direct oral anticoagulant marketed for the prevention of stroke among patients with nonvalvular atrial fibrillation (AF). Areas covered: ENGAGE AF-TIMI 48 was the pivotal clinical trial that led to the approval of edoxaban 60 mg once daily. After the publication of this study, a great number of substudies and post hoc analyses have been published, together with some observational studies. The aim of this review was to update the current evidence about the use of edoxaban in AF patients. Expert opinion: In the ENGAGE AF-TIMI 48 trial, edoxaban 60 mg was noninferior to warfarin for the prevention of stroke or systemic embolism, but significantly reduced the risk of bleeding, major adverse cardiac events and death from cardiovascular causes. The relative efficacy and safety of edoxaban 60 mg compared with warfarin were independent of different clinical conditions, such as prior stroke, age, risk of falls, renal function, hepatic disease, ischemic heart disease, heart failure, valvular heart disease, or cancer. Data about the effectiveness and safety of edoxaban in real-life patients are scarce, but consistent with those of the pivotal clinical trial. Edoxaban seems a cost-effective alternative to warfarin among AF patients with moderate to high thromboembolic risk.


Assuntos
Fibrilação Atrial/complicações , Inibidores do Fator Xa/uso terapêutico , Piridinas/uso terapêutico , Acidente Vascular Cerebral/prevenção & controle , Tiazóis/uso terapêutico , Tromboembolia/prevenção & controle , Anticoagulantes/uso terapêutico , Ensaios Clínicos como Assunto , Análise Custo-Benefício , Inibidores do Fator Xa/farmacocinética , Hemorragia/induzido quimicamente , Humanos , Piridinas/farmacocinética , Acidente Vascular Cerebral/etiologia , Tiazóis/farmacocinética , Tromboembolia/etiologia , Varfarina/uso terapêutico
14.
Thromb Haemost ; 119(4): 618-632, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30791055

RESUMO

Unfractionated heparin (UFH) and their low-molecular-weight derivatives are sourced almost exclusively from porcine mucosa (HPI); however, a worldwide introduction of UFH from bovine mucosa (HBI) has been recommended to reinforce the currently unsteady supply chain of heparin products. Although HBI has different chemical composition and about half of the anticoagulant potency of HPI (∼100 and ∼180 international unit [IU]/mg, respectively), they have been employed as interchangeable UFHs in some countries since the 1990s. However, their use as a single drug provoked several bleeding incidents in Brazil, which precipitated the publication of the first monographs exclusive for HBI and HPI by the Brazilian Pharmacopoeia. Nevertheless, we succeed in producing with high-resolution anion-exchange chromatography a novel HBI derivative with anticoagulant potency (200 IU/mg), disaccharide composition (enriched in N,6-disulfated α-glucosamine) and safety profile (bleeding and heparin-induced thrombocytopaenia potentials and protamine neutralization) similar to those seen in the gold standard HPI. Therefore, we show that it is possible to equalize the composition and pharmacological characteristics of these distinct UFHs by employing an easily implementable improvement in the HBI manufacturing.


Assuntos
Anticoagulantes/química , Heparina/química , Mucosa Intestinal/metabolismo , Tromboembolia/tratamento farmacológico , Tromboembolia/prevenção & controle , Animais , Ânions , Anticoagulantes/uso terapêutico , Bovinos , Cromatografia por Troca Iônica , Composição de Medicamentos/métodos , Fator Xa/química , Heparina/uso terapêutico , Heparina de Baixo Peso Molecular/química , Humanos , Tempo de Tromboplastina Parcial , Ligação Proteica , Protrombina/química , Suínos , Equivalência Terapêutica
15.
Minerva Cardioangiol ; 67(2): 121-130, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30724269

RESUMO

Although atrial fibrillation (AF) is an arrhythmia with a variable clinical profile (symptomatic and asymptomatic episodes), the first symptomatic episode leads to its initial diagnosis in most cases. Nowadays, continuous and remote long-term cardiac rhythm monitoring is feasible by the use of implantable loop recorders. The data concerning the AF recurrences and progression after the first electrocardiographic-documented clinical AF episode demonstrates that a high percentage of patients may not suffer any other AF recurrence, or may present a low recurrence rate of the arrhythmia in the future. The AF burden may play a key role in the management of the arrhythmia as far as the decision-making for anticoagulation, rate and/or rhythm control therapy is concerned. There is evidence that a higher AF burden is associated with a higher risk of ischemic stroke. Non-vitamin K antagonists (NOACs) anticoagulants are increasingly used in the management of AF, providing a more predictable effect with rapid onset and offset of their action. The use of these agents in combination with devices that provide a continuous remote rhythm monitoring capability has encouraged anticoagulation strategies based on the AF burden. Data from tailored anticoagulation studies in AF are in favor of the long-term rhythm monitoring, ensuring a patient-centered approach with a better evaluation and more individualized management of AF, especially in patients with intermediate thromboembolic risk and high bleeding risk. Further large randomized trials are needed, not only to evaluate such strategies but also to elucidate the long-term cardiac rhythm monitoring in the AF management.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/diagnóstico , Eletrocardiografia Ambulatorial/métodos , Anticoagulantes/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/fisiopatologia , Desenho de Equipamento , Hemorragia/induzido quimicamente , Humanos , Recidiva , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Tromboembolia/etiologia , Tromboembolia/prevenção & controle
16.
Crit Care ; 23(1): 62, 2019 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-30795779

RESUMO

There is a high degree of uncertainty regarding optimum care of patients with potential or known intake of oral anticoagulants and traumatic brain injury (TBI). Anticoagulation therapy aggravates the risk of intracerebral hemorrhage but, on the other hand, patients take anticoagulants because of an underlying prothrombotic risk, and this could be increased following trauma. Treatment decisions must be taken with due consideration of both these risks. An interdisciplinary group of Austrian experts was convened to develop recommendations for best clinical practice. The aim was to provide pragmatic, clear, and easy-to-follow clinical guidance for coagulation management in adult patients with TBI and potential or known intake of platelet inhibitors, vitamin K antagonists, or non-vitamin K antagonist oral anticoagulants. Diagnosis, coagulation testing, and reversal of anticoagulation were considered as key steps upon presentation. Post-trauma management (prophylaxis for thromboembolism and resumption of long-term anticoagulation therapy) was also explored. The lack of robust evidence on which to base treatment recommendations highlights the need for randomized controlled trials in this setting.


Assuntos
Anticoagulantes/uso terapêutico , Lesões Encefálicas Traumáticas/tratamento farmacológico , Administração Oral , Anticoagulantes/efeitos adversos , Áustria , Lesões Encefálicas Traumáticas/fisiopatologia , Consenso , Dabigatrana/efeitos adversos , Dabigatrana/uso terapêutico , Desamino Arginina Vasopressina/farmacologia , Humanos , Comunicação Interdisciplinar , Tempo de Tromboplastina Parcial/métodos , Pirazóis/análise , Pirazóis/sangue , Pirazóis/uso terapêutico , Piridinas/análise , Piridinas/sangue , Piridinas/uso terapêutico , Piridonas/análise , Piridonas/sangue , Piridonas/uso terapêutico , Rivaroxabana/análise , Rivaroxabana/sangue , Rivaroxabana/uso terapêutico , Tiazóis/análise , Tiazóis/sangue , Tiazóis/uso terapêutico , Tromboembolia/prevenção & controle , Tomografia Computadorizada por Raios X/métodos , Ácido Tranexâmico/uso terapêutico , Resultado do Tratamento , Vitamina K/antagonistas & inibidores , Vitamina K/uso terapêutico
17.
G Ital Nefrol ; 36(1)2019 Feb.
Artigo em Italiano | MEDLINE | ID: mdl-30758149

RESUMO

Non-valvular atrial fibrillation (AF) is the most frequent arrhythmia in the general population and its prevalence increases with age. The prevalence and incidence of AF is high in patients with chronic kidney failure (CKD). The most important complication associated with AF, both in the general population and in that with CKD, is thromboembolic stroke. For this reason, in patients with AF, the Guidelines indicate oral anticoagulant therapy (OAT) with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) for thromboembolic risk prevention. Patients with severe CKD and, in particular, with end stage renal disease (ESRD) undergoing renal replacement therapy, often have both a high thromboembolic and hemorrhagic risk and therefore present both an indication and a contraindication to OAT. In addition, patients with severe or ESRD were excluded from trials that showed the efficacy of different antithrombotic drugs in patients with AF. Thus there is no evidence of the effectiveness of OAT in this population. This review deals with the issues related to OAT in patients with severe or end stage CKD and the possible use of percutaneous closure of the left auricula (LAAO), recently proposed as an alternative in patients with an absolute contraindication of OAT in this population.


Assuntos
Anticoagulantes/efeitos adversos , Apêndice Atrial/cirurgia , Fibrilação Atrial/complicações , Contraindicações de Medicamentos , Falência Renal Crônica/complicações , Acidente Vascular Cerebral/prevenção & controle , Tromboembolia/prevenção & controle , Administração Oral , Anticoagulantes/administração & dosagem , Antitrombinas/administração & dosagem , Fibrilação Atrial/cirurgia , Hemorragia/etiologia , Hemorragia/prevenção & controle , Humanos , Falência Renal Crônica/terapia , Terapia de Substituição Renal , Acidente Vascular Cerebral/etiologia , Tromboembolia/etiologia
18.
Therapie ; 74(2): 245-248, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30683443

RESUMO

Anticoagulants are essential for the treatment of cardiovascular illnesses. With the ageing population in the West countries, and the consequent increase in the frequency of thrombogenic heart diseases oral anticoagulants represent a not insignificant portion of drug consumption. Over the past few years, direct oral anticoagulants (DOACs) have been marketed because they are easier to use than vitamine K antagonists (VKAs). The introduction of these drugs has raised two main issues: (1) progress of the switch from VKAs to DOACs; (2) the comparison of adverse drug reactions (primarily hemorrhagic) on DOACs compared to indirect oral anticoagulants (IOAs). This article is confined to discussing oral anticoagulants, focusing on the two issues outlined above, and the potential answers that may be found in pharmacoepidemiology studies.


Assuntos
Anticoagulantes/administração & dosagem , Doenças Cardiovasculares/tratamento farmacológico , Farmacoepidemiologia , Administração Oral , Anticoagulantes/efeitos adversos , Doenças Cardiovasculares/complicações , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Humanos , Tromboembolia/tratamento farmacológico , Tromboembolia/prevenção & controle , Vitamina K/antagonistas & inibidores
19.
Cardiovasc Diabetol ; 18(1): 12, 2019 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-30691466

RESUMO

Atrial fibrillation (AF) is one of the most common arrhythmias in elderly people. The risk of thromboembolic stroke is increased in AF patients, especially those with diabetes. Anticoagulant therapy, such as warfarin and non-vitamin K oral anticoagulants (NOACs), is recommended for diabetic patients with AF. However, recent guidelines do not preferentially recommend NOACs over warfarin for diabetic patients. Variability of glycemic control in diabetic patients could affect the pharmacokinetics and anticoagulant activity of warfarin, therefore, the risk-benefit balance of warfarin is prone to be compromised in diabetic patients with AF. Furthermore, since warfarin inhibits the vitamin K-dependent gamma-glutamyl carboxylation of proteins, including osteocalcin and matrix Gla protein, use of warfarin may increase the risk of osteoporotic bone fracture and vascular calcification, both of which are the leading causes of morbidity that diminish the quality of life in diabetic patients. Even though the cost of NOACs is high, NOACs may be preferable to warfarin for the treatment of diabetic patients with AF.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Coagulação Sanguínea/efeitos dos fármacos , Diabetes Mellitus/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Tromboembolia/prevenção & controle , Varfarina/administração & dosagem , Administração Oral , Fatores Etários , Anticoagulantes/efeitos adversos , Anticoagulantes/farmacocinética , Fibrilação Atrial/sangue , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Tomada de Decisão Clínica , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Feminino , Humanos , Masculino , Fraturas por Osteoporose/induzido quimicamente , Fraturas por Osteoporose/epidemiologia , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Tromboembolia/sangue , Tromboembolia/diagnóstico , Tromboembolia/epidemiologia , Resultado do Tratamento , Calcificação Vascular/induzido quimicamente , Calcificação Vascular/epidemiologia , Varfarina/efeitos adversos , Varfarina/farmacocinética
20.
PLoS One ; 14(1): e0210170, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30605492

RESUMO

AIMS: To assess the impact of the introduction of direct oral anticoagulants upon the outcomes from elective electrical cardioversion for atrial fibrillation. METHODS: This is a retrospective comparison of delay to elective cardioversion with different anticoagulants. The data was gathered from a large regional hospital from January 2013 to September 2017. There were 3 measured outcomes: 1) the time in weeks from referral to the date of attempted electrical cardioversion; 2) the proportion of patients who were successfully cardioverted; and 3) the proportion of patients who remained in sinus rhythm by the 12 week follow-up. Time-to-cardioversion was non-parametrically distributed so was analysed with Kruskal-Wallis testing and Mann-Whitney-U testing. Maintenance of sinus rhythm was analysed using z-testing. RESULTS: 1,374 patients were submitted to cardioversion. The referrals for cardioversion were either from primary care or from cardiologists. At the time of cardioversion, 789 cases were anticoagulated on warfarin (W), 215 on apixaban (A) and 370 on rivaroxaban (R). All 3 cohorts were initially compared independently using Kruskal-Wallis testing. This demonstrated a significant difference in the delay (measured in weeks) between the A and W group (A = 7, W = 9, P<0.00001); the R and W group (R = 7, W = 9, P<0.00001) and no difference between R and A (A = 7, R = 7, P = 0.92). As there was no difference between the A and R groups, they were combined to form the AR group. The AR group was compared to the W group using Mann-Whitney-U testing which demonstrated a significant delay between the groups (AR = 7, W = 9, P<0.00001). Excluding patients with prior or unknown attempts of cardioversion (n = 791), the W patients (n = 152) were less successful in achieving sinus rhythm at cardioversion than the AR (n = 431) group (W = 95% vs AR = 99% P = 0.04). However at 12 weeks, incidence of sinus rhythm was significantly different (W = 40% vs AR = 49% P = 0.049). These groups were compared by z testing. At 12 weeks' follow-up there was no statistical difference in rate of adverse consequences between the AR group and the W group, but the rate of adverse consequences was too low to draw further conclusions. CONCLUSION: DOACs appear to significantly shorten the latency between the decision to cardiovert and the cardioversion procedure by at least 2 weeks compared to warfarin in a real-world setting. In this study, patients who had not previously been cardioverted who were anticoagulated with warfarin had a significantly lower probability of conversion to sinus rhythm and a significantly lower probability to remain in sinus rhythm at the 12 week follow-up compared to the combined apixaban and rivaroxaban group.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/terapia , Flutter Atrial/terapia , Cardioversão Elétrica/efeitos adversos , Tromboembolia/prevenção & controle , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pirazóis/administração & dosagem , Piridonas/administração & dosagem , Estudos Retrospectivos , Rivaroxabana/administração & dosagem , Tromboembolia/etiologia , Tempo para o Tratamento , Resultado do Tratamento , Varfarina/administração & dosagem
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