RESUMO
Rivaroxaban is one of the new oral anticoagulants (NOACs). It has many potential advantages in comparison with Vitamin K Antagonists (VKA). It has a predictable anticoagulant effect and does not theoretically require biological monitoring. It is also characterized by less food and drug interactions. However, due to major risks associated with over- and under-dosage, its optimal use in patients should be carefully followed by health care professionals. The aim of this article is to provide recommendations for pharmacists on the practical use of Xarelto in its different approved indications. This document is adapted from the practical user guide of rivaroxaban which was developed by an independent group of Belgian experts in the field of thrombosis and haemostasis.
Assuntos
Anticoagulantes/uso terapêutico , Morfolinas/uso terapêutico , Tiofenos/uso terapêutico , Trombose Venosa/prevenção & controle , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Humanos , Morfolinas/administração & dosagem , Morfolinas/efeitos adversos , Farmacêuticos , Rivaroxabana , Tiofenos/administração & dosagem , Tiofenos/efeitos adversos , Vitamina K/antagonistas & inibidoresRESUMO
The authors report the case of a 32 year old woman who was shot with a shotgun. Acute inferior wall infarction was detected fortuitously on electrocardiography and coronary angiography showed occlusion of the right coronary artery with lead shot. The single coronary lesion, absence, of other cardiac complications (haemopericardium, cardiac perforation, ...) and the favourable outcome with conservative medical treatment has not been previously reported to the authors' knowledge.
Assuntos
Infarto do Miocárdio/etiologia , Traumatismos Torácicos/complicações , Ferimentos por Arma de Fogo/complicações , Adulto , Angiografia Coronária , Trombose Coronária/diagnóstico , Trombose Coronária/etiologia , Vasos Coronários/lesões , Eletrocardiografia , Emergências , Feminino , Humanos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Prognóstico , Traumatismos Torácicos/cirurgia , Resultado do Tratamento , Ferimentos por Arma de Fogo/cirurgiaRESUMO
Sudden cardiac death frequently results from ventricular fibrillation (VF). While VF is frequently the eventual mode of death in patients with abnormal ventricular substrates, it has also been described in patients with structurally normally hearts. Until recently, the management of patients who have survived sudden cardiac death has focused on treating the consequences by implantation of a defibrillator. However, such therapy remains restricted in many countries, is associated with a prohibitive cost to the community, and may be a cause of significant morbidity in patients with frequent episodes or storms of arrhythmia. Evidence emerging from the study of fibrillation both in the atria and the ventricle suggests an important role for triggers arising from the Purkinje network or the right ventricular outflow tract in the initiation of VF. Initial experience in patients with idiopathic VF and even those with VF associated with abnormal repolarization syndromes (LQT or Brugada syndrome) or myocardial infarction suggests that long term suppression of recurrent VF may be feasible by the elimination of these triggers. With the development of new mapping and ablation technologies, and greater physician experience, catheter ablation of VF, with the ultimate aim of curing such patients at risks of sudden cardiac death, may not be an unrealistic goal in the future.
Assuntos
Fibrilação Ventricular/patologia , Fibrilação Ventricular/cirurgia , Eletrocardiografia , Humanos , Síndrome do QT Longo/cirurgia , Infarto do Miocárdio/complicações , Seleção de Pacientes , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/fisiopatologiaAssuntos
Neoplasias Cardíacas/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Idoso , Ecocardiografia Transesofagiana , Feminino , Fluordesoxiglucose F18 , Humanos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Compostos RadiofarmacêuticosRESUMO
The authors report the case of a 67-year-old woman, with mitral valve prolapse, for more than 20 years. She recently complained of attacks of syncope and clinical ventricular tachycardia; ventricular fibrillation was induced during programmed stimulation. The patient seemed to be at high risk for sudden cardiac death, and was therefore treated with an automatic implantable defibrillator. The pathophysiology and risk factors of sudden cardiac death in mitral valve prolapse are discussed.
Assuntos
Prolapso da Valva Mitral/complicações , Taquicardia Ventricular/etiologia , Fibrilação Ventricular/etiologia , Idoso , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Feminino , Humanos , Prolapso da Valva Mitral/terapia , Fatores de Risco , Síncope/etiologia , Taquicardia Ventricular/terapia , Fibrilação Ventricular/terapiaRESUMO
To test the theoretical superiority of irrigated tip catheters to achieve complete cavotricuspid isthmus block, a 4-mm cooled tip catheter was compared to a conventional 8-mm tip catheter with a double temperature sensor in the cavotricuspid isthmus (CTI) ablation. The study prospectively enrolled 60 patients (47 men, mean 65 +/- 10 years) with common flutter divided in group 1 (n = 30) assigned to an 8-mm tip catheter versus group 2 (n = 30), assigned to an internal circuit, irrigated tip catheter. Linear radiofrequency applications were performed in a point-by-point protocol to achieve complete CTI block. Complete CTI block was achieved in 29 patients in each group. Mean durations of procedure and fluoroscopy were 91 versus 90 and 40 versus 33 minutes in group 1 versus 2, respectively, (NS). The mean number/patient of RF pulses to interrupt atrial flutter was four in group 1 and eight in group 2 (P = 0.034), and 11 and 13, respectively, to interrupt CTI conduction (NS). The total energy delivered was similar in both groups (29,237 vs 23,236 W/s, NS). CTI ablation with a conventional 8-mm tip catheter versus an irrigated tip catheter was associated with similar success rates, procedure duration, and fluoroscopic exposure. The technical complexity of the cooled tip catheter renders it less competitive.