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Marta Lígia Vieira Melo, Andreza Alverga, Bruno Galdino Moreira, Francisco Guilherme Leite Linhares de Sá, Maria Alice Vieira Melo de Lima, Weverton Flôr Patricio, Ubiraídys de Andrade Isidório, and Elisangela Vilar de Assis. "Manejo clínico da Fibrilação Atrial: uma revisão integrativa das evidências atuais." Journal of Education Science and Health 2, no. 2 (April 15, 2022): 1–15. http://dx.doi.org/10.52832/jesh.v2i2.102.
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O objetivo do presente estudo é verificar evidências acerca do gerenciamento clínico da fibrilação atrial caracterizando os principais métodos diagnósticos, assim comot as estratégias terapêuticas mais utilizadas. Trata-se de uma revisão integrativa da literatura, realizada pela seleção de estudos indexados na PUBMED de 2015 a 2021. Utilizaram-se os termos orientados pelos Medical Subject Headings (MeSH): “Atrial Fibrillation”, “Treatment”, “Diagnosis”, “Management”, combinados pelo operador booleano “AND”, os quais propiciaram 218 artigos que, após leitura de títulos e resumos, reduziram-se a 41 estudos e, posteriormente, a 20 após suas leituras na íntegra. O manejo clínico da FA é discutido pelo controle de frequência, controle de ritmo e anticoaguloterapia. As drogas utilizadas em cada estratégia possuem ressalvas na sua utilização e seu uso na emergência requer monitorização contínua. A escolha da terapêutica deve ser individualizada. A estratégia de controle de frequência parece ser a terapêutica mais segura, tendo o controle de ritmo certas ressalvas. A terapia anticoagulante é primordial para evitar desfechos desfavoráveis, mas deve ser avaliada pelo perfil de comorbidades do paciente.
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Cyrany, Jiří, Kateřina Hejcmanová, Renata Chloupková, Ondřej Ngo, Ondřej Májek, Miroslav Zavoral, Štěpán Suchánek, Stanislav Rejchrt, and Ilja Tachecí. "Is it possible to individualize discontinuation of anticoagulant therapy before preventive colonoscopy?" Gastroenterologie a hepatologie 76, no. 5 (October 31, 2022): 386–91. http://dx.doi.org/10.48095/ccgh2022386.
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Summary: Background: Hot-snare polypectomy is a standard method for removal of polyps larger than 10 mm. It is recommended to discontinue anticoagulant therapy before this procedure to reduce a bleeding risk. In contrast, diagnostic colonoscopy and cold-snare polypectomy up to 10 mm are considered safe during uninterrupted anticoagulation therapy (with only omission of the direct oral anticoagulant therapy on the day of the procedure). The increasing number of anticoagulated individuals undergoing a colorectal cancer screening program leads to efforts to individualize the interruption of anticoagulation therapy. Aim: Estimation of probability that adenomatous polyp over 10 mm is detected during preventive colonoscopy in the Czech Republic in particular population groups according to gender and age. Methods: We retrospectively analyzed data from prospective database (Registry of Preventive Colonoscopies) covering screening colonoscopies and colonoscopies indicated for immunochemical faecal occult blood test positivity (FIT-positive). A distinction was made between adenoma polyps ≤10 mm and >10 mm. The patient was categorized according to the largest polyp diameter in case of detection of multiple polyps. Results: Between 2016 and 2020, 16,942 and 52,052 adenomatous polyps were found during 55,546 screenings and 119,229 FIT-positive colonoscopies, representing adenoma detection rate (ADR) of 31% and 44%, respectively. The estimate of probability of significant polyp detection (over 10 mm) and the need of hot-snare polypectomy ranged widely (2.3–21.6%) depending on age, sex and indication. It can be estimated to 7% in females and 5–10% in males undergoing screening colonoscopy. For colonoscopies indicated for positive stools for occult bleeding, this probability is approximately two to three times higher in FIT-positive colonoscopies: it exceeds 10% in woman over 60 years of age and is 15% and more in men of all ages (over 20% in men over 60 years of age). Conclusions: The decision to discontinue anticoagulation therapy prior to preventive colonoscopy can be individualized with respect to the indication (screening vs. FIT-positive), age and gender of examined person – we prefer to discontinue the anticoagulation therapy in FIT-positive people over 60 years and/or of male gender. The individual thromboembolic risk during interruption of anticoagulation therapy must be considered depending on the specific indication (e. g. CHA2DS2 VASc score in atrial fibrillation). Key words: colonoscopy – anticoagulant therapy – direct-acting oral anticoagulants – cancer screening – personalized medicine
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Darrieux, Francisco, and Tan Chen Wu. "TERAPIA ANTICOAGULANTE NA ABLAÇÃO E CARDIOVERSÃO ELÉTRICA DA FIBRILAÇÃO ATRIAL." Revista da Sociedade de Cardiologia do Estado de São Paulo 27, no. 3 (July 15, 2017): 205–10. http://dx.doi.org/10.29381/0103-8559/20172703205-10.
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Stepanović-Petrović, Radica, and Katarina Nastić. "Direct oral anticoagulants: A new chapter in anticoagulation therapy." Arhiv za farmaciju 70, no. 5 (2020): 249–68. http://dx.doi.org/10.5937/arhfarm2005249s.
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Thromboembolic events are the leading cause of morbidity and mortality worldwide. From the second half of the 20th century, vitamin K antagonists (VKAs), warfarin and acenocoumarol, were the only anticoagulants taken orally. The major reform in anticoagulation therapy was made by the advent of direct oral anticoagulants (DOACs), about 10 years ago. Direct thrombin inhibitor (dabigatran) and direct inhibitors of factor Xa (rivaroxaban, apixaban, edoxaban, and betrixaban) have demonstrated favorable risk/benefit ratio. Compared to warfarin, DOACs are associated with a predictable pharmacokinetic profile, lower severe bleeding complications, particularly intracranial hemorrhages, and minimal drug interactions. Moreover, DOACs achieve a rapid onset of action and have shown comparable efficacy with warfarin and low molecular weight heparin (LMWH) in clinical trials. As a result, DOACs are now replacing VKAs and LMWH for many indications including stroke and systemic embolism prevention in nonvalvular atrial fibrillation, prevention, and treatment of venous thromboembolism and thromboprophylaxis following total knee/hip replacement surgery. In addition, rivaroxaban (in combination with aspirin alone or aspirin and clopidogrel) is used in the prevention of atherothrombotic events following acute coronary syndrome with elevated cardiac biomarkers. In case of severe bleeding complications under DOACs treatment, antidotes are available; idarucizumab for dabigatran reversal and andexanet alfa for rivaroxaban and apixaban.
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Rocha Pinto, Carlos Eduardo, Eduarda Teodoro Bueno, Tales Sousa Coutinho Ferreira Pires, Breno Souza Brito, Paulo Víctor Innocencio Póvoa de Castro, and Bruno Cezario Costa Reis. "Uso de Novos Anticoagulantes em pacientes com Fibrilação Atrial." Revista de Saúde 11, no. 2 (December 10, 2020): 20–24. http://dx.doi.org/10.21727/rs.v11i1.2229.
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A fibrilação atrial apresenta como complicação a ocorrência de eventos tromboembólicos, sendo necessária, como forma de prevenção, a implementação de anticoagulantes no tratamento desse grupo de pacientes. Porém, o grande desafio atualmente é buscar uma terapia que traga benefícios, diminuindo o risco de eventos isquêmicos, mas que também evolua com baixo risco de eventos adversos, sendo o principal deles o sangramento, especialmente em populações de alto risco, como idosos, portadores de FA associada à Doença renal crônica em estágio terminal e pacientes com associação entre FA e coronariopatias. Novos estudos surgiram com o objetivo de avaliar a eficácia dos novos anticoagulantes não inibidores de vitamina K, como Dabigatrana, Rivaroxabana e Apixabana, tendo em vista a dificuldade do controle desses pacientes com a Varfarina, atual terapia padrão. É importante frisar que apesar da busca por diminuição de sua incidência, sangramentos importantes podem eventualmente surgir, sendo recomendadas ações de suporte básico de vida, e posterior avaliação, não só quanto a interrupção da terapia anticoagulante, mas também reversão de seu efeito, a partir do uso de drogas antagonistas, como Idarucizumab e Andexanet-alfa.
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Trailov, Dunja, and Nebojša Despotović. "Complications at usage of the new anticoagulant therapy in elderly patients." Medicinski podmladak 72, no. 2 (2021): 1–4. http://dx.doi.org/10.5937/mp72-27624.
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Introduction: New anticoagulant therapy (DOAC) was introduced few years ago. It is an alternative therapy for antagonists of vitamin K (VKA) in prevention and therapy of diseases with different etiology. Despite their advantages, bleeding stays a major complication. The fact is that there are no significant researches on this topic. Aim: To analyze the incidence of bleeding as a complication in patients treated with dabigatran. Material and methods: A retrospective study was conducted including 60 patients older than 65 years with nonvalvular atrial fibrillation treated with anticoagulant therapy. Half of this number was taking dabigatran (examined group) and half was taking warfarin (control group). Apart from demographical and clinical parameters, incidence, type and localization of bleeding was also followed. Results: In the group of patients who were taking dabigatran, in 13.3% of cases bleeding occurred as a complication of therapy. Among them, gastrointestinal bleeding was the most common (75%), but also hematomas on the body occurred (25%) and the therapy was immediately discontinued. In 45% of patients taking warfarin, bleeding was verified as a complication. From that number, 33.5% had gastrointestinal bleeding and epistaxis, 8.6% hematomas and 24.4% hematuria. By comparing these two groups, it can be concluded that incidence of bleeding in the group taking dabigatran was significantly lower than in the group taking warfarin (p = 0.038). Conclusion: In the examined group of patients older than 65, who were taking dabigatran, a significantly lower percentage of bleeding as a complication was noticed, compared to the control group taking VKA.
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Raščanin, Anastasija, Dušan Bastać, Mila Bastać, Maja Mladenović, Igor Đorđioski, and Ivana Arandjelović. "The significance of oral anticoagulant therapy in the prevention of thromboembolic complications in patients with atrial fibrillation during a 14-year follow-up: Case report." Timocki medicinski glasnik 47, no. 2-3 (2022): 126–31. http://dx.doi.org/10.5937/tmg2202126r.
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INTRODUCTION. Atrial fibrillation (AF) is the most common long-term arrhythmia and represents one of the main public health problems primarily due to the aging of the general population, in which this arrhythmia occurs more often and causes thromboembolic stroke. Cardioembolic stroke associated with AF is usually severe, highly recurrent, and often fatal or with permanent disability of specific stroke risk factors/modifiers. Common risk factors are summarized in a risk factor-based clinical score called the CHA2DS2-VASc Score. Poor INR control increases the risk of both thromboembolic and hemorrhagic complications, and the optimal balance between the benefits and risks of using oral VKAs is achieved when the TTR, or time in the therapeutic range, is ≥ 70% [9]. We present the case of a female patient that confirms the importance of oral anticoagulant therapy when the INR is in the therapeutic range between 2-3, in the largest number of measurements in the successful prevention of recurrent thromboembolic complications during a 14-year follow-up. CASE REPORT: We present a 60-year-old MD patient who first came to the Office of Internal Medicine "Dr. Bastać" in 2008 due to a feeling of instability and heart palpitations. Due to grade II hypertension, which is not well regulated, she has been taking antihypertensive therapy for the past two years, treats elevated cholesterol with statins, and states that in two years and a year before her first examination at the Office of Internal Medicine "Dr. Bastać", she had two minor strokes verified by MSCT of the endocranium. In our patient, a high CHA2DS2-VASc score of 4 was calculated (hypertension, female gender and previous stroke) and the estimated annual risk for stroke is 9.27% (TABLE 2). Her bleeding risk - HAS BLED Score is moderate and is 2 (hypertension, CVI). Based on CHA2DS2-VASc, the risk of adverse thromboembolic events is high and requires the introduction of oral anticoagulant therapy. The patient in therapy receives acenocoumarol according to the scheme so that the value of PT/INR is between 2.0 and 3.0. Good anticoagulation is defined as having 3 to 4 PT/INR values in the therapeutic range (similar to TTR 50 to 60% of the time), while poor anticoagulation is: 0-2 measured INR values in the therapeutic range (TTR <50%) [3]. In our patient, the TTR is about 70%, which represents excellent anticoagulation. During 14 years of monitoring for three months, as well as at the recent control on 04/29/2022. the patient feels well, with no new thromboembolic complications and no bleeding episodes. CONCLUSION. Antithrombotic therapy with vitamin K antagonists can achieve good anticoagulation and long-term successful prevention of repeated cardioembolic strokes in patients with atrial fibrillation. We emphasize the need for highly motivated patients to regularly monitor the level of anticoagulation via INR and the full engagement of the prescribing physician. In this case, we emphasize the frequent problem of delays in the introduction of anticoagulation therapy in atrial fibrillation. Stroke prevention is the cornerstone of care for patients with atrial fibrillation.
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De Sousa Borges, Tatiane Roberto, Márcia De Fátima da Silva Meyer, and Sérgio Henrique Simonetti. "Adesão ao uso de anticoagulante oral cumarínico por pacientes portadores de fibrilação atrial." Nursing (São Paulo) 24, no. 274 (March 1, 2021): 5419–32. http://dx.doi.org/10.36489/nursing.2021v24i274p5419-5432.
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Objetivo: avaliar a adesão do paciente com Fibrilação Atrial em Terapia com anticoagulante oral cumarínico. Método: Estudo descritivo-exploratório, transversal e prospectivo com intervenção não randomizado de abordagem quantitativa, realizado com 40 participantes, aplicou-se o Escore de Adesão Simonetti e a Escala de Avaliação Analógica Visual e após a intervenção educativa para análise de Time in Therapeutic Range sob CAAE: 79973017.1.0000.5462. Resultado: Identificou-se que 5% apresentaram risco baixo de adesão, 60% risco médio e 35% risco alto. Após análise dos oito meses do TTR pré e pós-intervenção, não houve mudança significativa entre os períodos (p=0,638). Conclusão: Evidenciou-se que o grupo de baixa adesão manteve melhor tempo na faixa terapêutica relacionado ao médio e alto risco. Indicativo este de maior impacto da intervenção educativa realizada pelo enfermeiro.
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Spagnuolo Brunello, Luis Fernando, Gustavo Andrade de Figueiredo, and Leonardo Andrade Mulinari. "Ocorrência de Fibrilação Atrial Subclínica no Acompanhamento de Pacientes Portadores de Marcapasso Cardíaco." Journal of Cardiac Arrhythmias 32, no. 1 (2019): 25–29. http://dx.doi.org/10.24207/jac.v32i1.003_pt.
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Objetivo: O marcapasso cardíaco registra a fi brilação atrial (FA). Essa condição pode causar graves consequências hemodinâmicas aos pacientes, que devem ser assistidos por médico cardiologista. Este estudo objetivou documentar e investigar, em um hospital terciário, a prevalência de FA subclínica em portadores de marcapasso cardíaco. Métodos: Entre julho de 2015 e abril de 2016, foram atendidos 196 pacientes portadores de marcapasso em caráter ambulatorial. Desses, 60 apresentaram arritmias cardíacas registradas pelo marcapasso e foram convidados a participar do estudo. A coleta de dados foi feita por meio de entrevista estruturada contendo quatro questões: sexo, idade, acompanhamento com cardiologista e uso de anticoagulantes. Resultados:Foi registrada FA subclínica em 35 (17,8%) do total de 196 pacientes. Desses 35, 16 (45,7%) não realizavam acompanhamento regular em serviço de cardiologia e 29 (82,8%) não faziam uso de medicamento anticoagulante. Não foram encontradas relações estatisticamente signifi cativas entre idade, acompanhamento com cardiologista e presença ou ausência da FA subclínica nos pacientes estudados. Conclusão: Uma parcela signifi cativa dos pacientes portadores de marcapasso atendidos ambulatorialmente tem FA registrada pelo dispositivo. No entanto, ainda que essencial, quase metade desses não faz acompanhamento clínico com cardiologista e menos de um quinto com FA faz uso de terapia anticoagulante.
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Souza, Marcus V. Leitão de, and Fernanda Satake Novaes. "Icterícia grave e miocardiopatia tireotóxica com trombo atrial." Arquivos Brasileiros de Endocrinologia & Metabologia 56, no. 7 (October 2012): 456–60. http://dx.doi.org/10.1590/s0004-27302012000700008.
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Icterícia relacionada à tireotoxicose, e não como efeito das drogas antitireoidianas, é uma complicação rara que, em geral, ocorre na presença de insuficiência cardíaca (IC) ou hepatite. Apresentamos o caso de mulher de 54 anos de idade, branca, diagnóstico de hipertireoidismo por doença de Graves com icterícia associada a despeito da suspensão prévia de metimazol. A bilirrubina oscilava em valores elevados entre 30,0 e 52,3 mg/dL, as transaminases eram pouco elevadas com valores de ALT, na admissão, de 46 U/I e AST de 87 U/I; coagulograma e proteínas encontravam-se no limite inferior da normalidade, sendo TAP 68% e albumina = 2,5 g/dL. Sorologias para hepatites foram negativas. Após a primeira dose de radioiodoterapia (RT), a bilirrubina atingiu seu valor máximo, que coincidiu com período de pior exacerbação da IC. A bilirrubina normalizou-se após quatro semanas da segunda dose de RT com a estabilização da IC e a normalização dos hormônios tireoidianos. Discutimos as possíveis etiologias de icterícia severa em pacientes hipertireoideos, assim como a difícil terapia anticoagulante com varfarina.
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Uslar, Thomas, and Jaime Anabalón. "Is percutaneous closure of the left atrial appendage comparable to anticoagulants for atrial fibrillation?" Medwave 15, suppl2 (August 19, 2015): e6218-e6218. http://dx.doi.org/10.5867/medwave.2015.6218.
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Júnior, Irineu Lopes de Alcântara, Angelo Bruno Pagoto, Ingrid Loureiro de Queiroz Lima, Tayrel dos Anjos Silva, Marcio Jadson Marialva Eliziario, Bárbara Aparecida de Souza E Souza, Armando Hiroyuki Mori Júnior, Bárbara Pires Ihara, Irilane de Alcântara Figueira, and Ismael Henrique Azevedo De Alcântara. "Anticoagulantes nas síndromes coronarianas agudas: uma revisão sistemática." Revista Eletrônica Acervo Saúde 13, no. 2 (February 18, 2021): e6591. http://dx.doi.org/10.25248/reas.e6591.2021.
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Objetivo: Realizar uma revisão sistemática acerca dos anticoagulantes nas síndromes coronarianas agudas (SCA). Métodos: Foi realizada pesquisa em bases eletrônicas em busca de estudos controlados randomizados ou estudos observacionais retrospectivos ou prospectivos que abordassem acerca do uso de anticoagulantes orais em pacientes com síndrome coronariana aguda. A pesquisa incluiu artigos publicados de 2010 a 2019, em inglês ou em português. A seleção ocorreu por dois avaliadores independentes. Resultados: A idade média encontrada foi de mais de 60 anos e a indicação clínica mais comum de anticoagulantes orais foram em pacientes que se submeteram à intervenção coronariana percutânea em decorrência de uma SCA e evoluíram com fibrilação atrial, sendo o mais utilizado a Varfarina. O uso de terapia antitrombótica tripla (anticoagulante + varfarina + clopidogrel) esteve associado a aumento do risco de sangramento com eficácia semelhante quando comparado com uso de aspirina e clopidogrel isolados. Considerações finais: O uso da terapia tripla deve levar em consideração fatores acerca do risco hemorrágico para que seus benefícios superem os riscos.
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Lasek-Bal, Anetta, Damian Ziaja, and Krzysztof Ziaja. "Stent implantation into intracranial part of internal carotid artery in a patient with recurrent stroke, atrial fibrillation and iatrogenic bleeding during anticoagulant therapy." Advances in Interventional Cardiology 1 (2013): 75–82. http://dx.doi.org/10.5114/pwki.2013.34030.
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Potpara, Tatjana, and Marija Polovina. "Safety of oral anticoagulant therapy for thromboprophylaxis in atrial fibrillation: Results of the randomized clinical trials phase III and their clinical implications." Srce i krvni sudovi 33, no. 4 (2014): 204–10. http://dx.doi.org/10.5937/siks1403204p.
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CORREIA, Thais R., Josiane M. COSTA, Ana C. VIEGAS, Jéssica S. MALTA, Mayara O. ORTIZ, Raênya C. NASCIMENTO, Caryne M. BERTOLLO, and Maria A. MARTINS. "O impacto da intervenção educacional na segurança do paciente geriátrico com fibrilação atrial em uso de varfarina." Revista Brasileira de Farmácia Hospitalar e Serviços de Saúde 12, no. 4 (November 25, 2021): 696. http://dx.doi.org/10.30968/rbfhss.2021.124.0696.
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Objetivo: Identificar contribuições de uma intervenção educacional no conhecimento de pacientes geriátricos sobre aspectos de segurança no tratamento com a varfarina. Métodos: Estudo de intervenção de caráter longitudinal conduzido em uma clínica de anticoagulação de um hospital público universitário localizado em Minas Gerais, realizado com pacientes geriátricos que possuíam diagnóstico de fibrilação atrial valvar ou não valvar em uso de varfarina. Os participantes responderam a um questionário sobre conhecimentos gerais da terapia anticoagulante com varfarina, validado no Brasil (OAK test) e analisado por meio de um comitê de juízes especialistas para seleção das questões sobre segurança desse instrumento no presente estudo. Posteriormente os pacientes participaram de uma intervenção educacional centrada no paciente e no autocuidado, o desfecho analisado foi a pontuação do teste de conhecimento sobre anticoagulação antes (T0), imediatamente após (T1) e seis meses após (T2) a intervenção. Os dados foram analisados de forma descritiva por meio de frequências absolutas e relativas. Os dados foram analisados de forma descritiva por meio de frequências absolutas e relativas. Resultados: 43 pacientes com idade média de 71±7,6 anos, com predominância do sexo feminino 25; 58,1% e média de escolaridade de 5±4,8 anos participaram do estudo. As questões analisadas pelos juízes 1, 2, 3, 4, 5, 6, 9, 12, 13, 15, 17, 19 e 20 tiveram IVC avaliado em 1,0, as questões 7, 10, 16 e 18 tiveram IVC avaliado em 0,92, as questões 8 e 14 tiveram IVC abaixo de 0,78 e foram avaliados em 0,75 e 0,58 respectivamente, sendo assim excluídas do estudo. Para a maioria das questões identificou-se melhoria no conhecimento dos pacientes sobre segurança no tratamento após a intervenção educacional (P<0,05). As questões para as quais não se identificou aumento do conhecimento estavam relacionadas à quando procurar atendimento médico em situações de urgência e aos riscos de hemorragia. Conclusão: O oferecimento de intervenção educacional apresentou melhora do conhecimento sobre segurança do tratamento anticoagulante pelos participantes, considerando as questões do OAK test que apresentaram IVC > 0,75, segundo avaliação os juízes.
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De Carvalho, Adelino Moreira, Danilo Aparecido Carriel, Monica Santos De Almeida, Otavio Risbane Pereira Franciole, Pedro Henrique de Freitas Reis, and Stepherson Gabriel Alves. "Cardioversão elétrica em tempos de pandemia - Relato de Caso." Brazilian Journal of Development 9, no. 1 (January 2, 2023): 311–25. http://dx.doi.org/10.34117/bjdv9n1-023.
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INTRODUÇÃO: a pandemia de Covid-19, produzida pelo SARS-CoV-2, congestionou os serviços de atendimento médico em todo o mundo. Nesta condição, especialmente nos países onde a assistência médica não está bem estruturada, priorizou-se o atendimento dos casos de Covid-19 e de urgências e emergências médicas, postergando a assistência a outras situações de saúde por prazos frequentemente longos. A documentação registrada mostra que, assim, muitas doenças agravaram-se, lesões graves se estabeleceram e muitas mortes prematuras ocorreram. Nosso caso clínico retrata o longo calvário de um paciente portador de fibrilação atrial que vivenciou, juntamente com seus familiares, esse momento desafiador da nossa história assistencial à saúde. OBJETIVOS: demonstrar como uma pandemia pode refletir drasticamente no cuidar da saúde e qualidade de vida de paciente; discutir aspectos destacados deste caso clínico quanto a desafios encontrados para resolvê-lo. RELATO DO CASO: paciente de 74 anos, sem sintomas, em exame de rotina, apresentou fibrilação atrial de frequência média de 65 bpm. O ecocardiograma transesofágico (ETE) revelou trombos em apêndice atrial esquerdo, o que impediu a imediata cardioversão elétrica sincronizada (CES). Na tentativa de desfazer os trombos, recebeu 5 mg de apixabana de 12 em 12h por 45 dias. Novo ETE indicou manutenção dos trombos. A seguir, recebeu warfarina prevista para mais 45 dias, com doses de 2,5 a 5mg/dia, de acordo com o INR, que se manteve estável entre 2,0 e 3,0. Mais um ETE foi realizado ao final do tratamento, entretanto, os trombos persistiram. Assim, baseando em publicações cientificas apoiando a segurança de apixabana em doses maiores e prolongadas, a exemplo do longo tratamento habitual para trombose venosa profunda, prescreveu-se apixabana 10mg de 12-12h por 10 dias, isto é, dose dobrada em relação aos habituais 5mg de 12 em 12h. Em sequência, por mais 35 dias, administrou-se a dose habitual, perfazendo um total de 45 dias. Após este tratamento, o ETE revelou ausência dos trombos. Agendou-se a CES. Entretanto, os casos de Covid-19 aumentaram vertiginosamente e postergou-se a CES. Mantido com apixabana diariamente, em doses habituais, meses depois, após outro ETE confirmando cavidades cardíacas sem trombos, novo agendamento para CES foi feito e novo grande surto de Covid-19 ocorreu. Mais uma vez, foi cancelada a CES. Finalmente, após 21 meses, após ETE confirmar ausência de trombos intracardíacos, realizou-se a CES com sucesso. CONCLUSÕES: a estrutura de atenção à saúde pública precisa estar preparada para sua missão nas condições: rotineiras, epidêmicas e pandêmicas. Preparo adequado evita agravamento de doenças, mortes e sobretudo, sofrimento; quanto mais longa a demora para tratar fibrilação atrial menor a possibilidade de conversão a ritmo sinusal e de sua manutenção; a permanência de trombos intracavitários cardíacos pós-terapia anticoagulante é relativamente frequente; o modelo de terapia anticoagulante bem sucedido neste caso clínico pode contribuir como uma sugestão para tratar trombos persistentes em cavidades cardíacas.
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Castro, Cíntia Maria Mesquita de, Lílian Moreira do Prado, Renata Flávia Abreu Da Silva, Paulo Sérgio Marcellini, Allan Peixoto de Assis, and Andrezza Serpa Franco. "Comportamento glicêmico de pacientes em pós-operatório de cirurgia cardíaca: estudo de coorte [Glycemic behavior of patients in the postoperative period of heart surgery: cohort study] [Comportamiento glucémico de pacientes en postoperatorio de cirugía cardíaca: estudio de cohorte]." Revista Enfermagem UERJ 30, no. 1 (July 27, 2022): e64079. http://dx.doi.org/10.12957/reuerj.2022.64079.
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Objetivo: comparar o comportamento glicêmico dos pacientes em pós-operatório de cirurgia cardíaca valvar e de revascularização do miocárdio, submetidos ao mesmo protocolo de controle glicêmico, e avaliar a incidência de hipoglicemia e mortalidade intra-hospitalar dessa população. Método: estudo de coorte, retrospectivo, quantitativo, que avaliou 354 prontuários de cirurgias realizadas em 2016. Resultados: pacientes revascularizados apresentaram maiores médias glicêmicas (149,14±36,03), maior uso de insulina e coeficiente de variação (23,30%). Entretanto, a incidência de hipoglicemia foi maior entre valvares (35,32%), mais acometidos por lesão renal aguda (6,58%), terapia de substituição renal (11,97%) e mortalidade hospitalar (6,58%). Conclusão: evidenciou-se uma população heterogênea com desfechos clínicos que caracterizaram os valvares como mais criticos, devido a maior número de portadores de fibrilaçao atrial, maior tempo de CEC, e maior uso de vasoaminas e corticosteroides. Logo, é necessário conhecer as particularidades de cada população, para gerenciar protocolos específicos de controle glicêmico para diferentes perfis epidemiológicos.ABSTRACTObjective: to compare the glycemic behavior of patients in the postoperative period of valve heart surgery and myocardial revascularization, submitted to the same glycemic control protocol and to assess the incidence of hypoglycemia and mortality and in-hospital mortality in this population. Method: cohort, retrospective, quantitative study that evaluated 354 medical records of surgeries performed in 2016. Results: revascularized patients had higher blood glucose means (149,14±36.03), greater use of insulin and higher coefficient of variation (23.30%). However, the incidence of hypoglycemia was higher (35.32%) valve patients, more affected by acute kidney injury (6.58%), renal replacement therapy (11.97%) and hospital mortality (6.58%). Conclusion: a heterogeneous population with clinical outcomes that characterized the valves as more critical, due to a greater number of patients with atrial fibrillation, longer CEC time, and greater use of vasoamines and corticosteroids. It is necessary to know the particularities of each population, in order to manage specific glycemic control protocols for different epidemiological profiles.RESUMENObjetivo: comparar el comportamiento glucémico de pacientes en postoperatorio de cirugía valvular y revascularización miocárdica, sometidos al mismo protocolo de control glicémico y evaluar la incidencia de hipoglucemia y mortalidad hospitalaria en esta población. Método: estudio de cohorte, retrospectivo, cuantitativo que evaluó 354 historias clínicas, entre agosto y octubre de 2020, de cirugías realizadas en 2016. Resultados: pacientes revascularizados presentaron mayores medias de glucemia (149,14±36,03), mayor uso de insulina y mayor coeficiente de variación (23,30%). Aunque, la incidencia de hipoglucemia fue mayor (35,32%) entre las válvulas, que se vieron más afectadas por daño renal agudo (6,58%), terapia de reemplazo renal (11,97%) y mortalidad hospitalaria (6,58%). Conclusión: el estudio mostró una población heterogénea con resultados clínicos que caracterizaron a las válvulas como más críticas, debido a un mayor número de pacientes con fibrilación auricular, mayor tiempo de CEC y mayor uso de vasoaminas y corticoides. Por tanto, es necesario conocer las particularidades de cada población, para gestionar el control glucémico con protocolos específicos para diferentes perfiles epidemiológicos.
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Anne, Pratibha, Rupa Koothirezhi, Ugorji Okorie, Minh Tam Ho, Brittany Monceaux, Cesar Liendo, Sheila Asghar, and Oleg Chernyshev. "833 Evolution of sleep disordered breathing types in heart failure." Sleep 44, Supplement_2 (May 1, 2021): A324—A325. http://dx.doi.org/10.1093/sleep/zsab072.830.
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Abstract Introduction Central sleep apnea is commonly seen in patients with heart failure. Here we present a case demonstrating shifting of predominant apneic events from central to obstructive type after placement of left ventricular assist device (LVAD) in end stage heart failure patient. Report of case(s) Case Presentation: 66 year-old African American male has past medical history of chronic congestive heart failure diabetes, hypertension, paroxysmal atrial fibrillation, anemia, hypothyroidism, chronic kidney disease and sleep apnea. Prior to his LVAD placement, his left ventricular ejection fraction (EF) was <10%. Patient was diagnosed with central sleep apnea with AHI of 58 (with 92% of apneic events being central events), oxygen nadir of 74%. Subsequently, patient had LVAD placed for symptomatic heart failure and repeat polysomnogram repeated at six month demonstrated an improved AHI of 45.8 with predominantly obstructive and mixed apneic events, with only 12.5% being central events. Conclusion This case report highlights not only the improvement of the sleep apnea in CHF treated with LVAD but also shows the shift of apneic events from predominantly central to obstructive type post LVAD. Support (if any) 1. Henein MY, Westaby S, Poole-Wilson PA, Cowie MR, Simonds AK. Resolution of central sleep apnoea following implantation of a left ventricular assist device. Int J Cardiol. 2010 Feb 4;138(3):317–9. PMID: 18752859. 2. Köhnlein T, Welte T, Tan LB, Elliott MW. Central sleep apnoea syndrome in patients with chronic heart disease: a critical review of the current literature. Thorax. 2002 Jun;57(6):547–54. PMID: 12037232 3. Monda C, Scala O, Paolillo S, Savarese G, Cecere M, D’Amore C, Parente A, Musella F, Mosca S, Filardi PP. Apnee notturne e scompenso cardiaco: fisiopatologia, diagnosi e terapia [Sleep apnea and heart failure: pathophysiology, diagnosis and therapy]. G Ital Cardiol (Rome). 2010 Nov;11(11):815–22. Italian. PMID: 21348318.
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Centemero, Marinella, Luiz Tanajura, and Fausto Feres. "Antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention: triple versus dual therapy." Journal of Transcatheter Interventions, January 15, 2021, 1–10. http://dx.doi.org/10.31160/jotci202129a202015.
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The ideal antithrombotic management in patients with atrial fibrillation undergoing elective percutaneous coronary intervention or in acute coronary syndrome has not been definitively established yet. Dual antiplatelet therapy (aspirin and P2Y12 receptor inhibitors) reduces stent thrombosis and subsequent ischemic events. In turn, the presence of atrial fibrillation requires oral anticoagulation to prevent stroke and other thromboembolic complications. However, the combination of these two treatments, known as triple therapy, increases the risk of severe bleeding, with a negative prognostic impact. The use of direct anticoagulants, which reduce bleeding rates compared to warfarin, together with the maintenance of only one antiplatelet agent (P2Y12 inhibitors), known as dual therapy, may be a safer alternative in these patients. In this article, we reviewed several randomized studies comparing triple versus dual therapy, as well as meta-analyses with such studies, and the approaches suggested by the most recent guidelines, discussing the advantages and disadvantages of these treatments, in terms of safety and efficacy in this important and growing subgroup of patients.
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"TERAPIA ANTICOAGULANTE NO IDOSO: FOCO NA FIBRILAÇÃO ATRIAL." Revista da Sociedade de Cardiologia do Estado de São Paulo 27, no. 3 (July 15, 2017): 243–50. http://dx.doi.org/10.29381/0103-8559/20172703243-50.
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Kawilarang, Michael S., Iman Y. Suhartono, Elfan Moeljono, Loretta C. Wangko, Agnes L. Panda, and Reginald L. Lefrandt. "PROFILE OF ATRIAL FIBRILATION IN PROF. R.D. KANDOU HOSPITAL MANADO FROM SEPTEMBER 2012 – FEBRUARY 2013." JURNAL BIOMEDIK (JBM) 5, no. 2 (September 23, 2013). http://dx.doi.org/10.35790/jbm.5.2.2013.2595.
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Abstrak: Fibrilasi atrial merupakan gangguan irama jantung menetap yang paling sering dijumpai di praktek sehari-hari, ditandai oleh adanya aktivasi atrium yang tidak terorganisasi dan kontraksi atrium dan ventrikel yang tidak terkoodinasi. Meskipun banyak laporan mengenai fibrilasi atrial di Indonesia, tetapi hal ini belum pernah dilaporkan di Sulawesi Utara. Penelitian ini bertujuan untuk mendapatkan profil fibrilasi atrial di Manado. Data diambil dari pasien fibrilasi atrial di Bagian Jantung dan Pembuluh Darah, Prof R D Kandou, Manado, sejak September 2012-Februari 2013. Variabel yang diamati ialah jenis kelamin, usia, penyakit penyerta, ekokardiografi, dan terapi. Sebanyak 84 pasien diikutsertakan dalam penelitian ini, terdiri dari 42 laki-laki dan 42 perempuan dengan usia 21-84 tahun dengan rincian 53 pasien berusia ≥60 tahun dan 30 pasien <60 tahun. Pada 59 pasien yang dilakukan ekokardiografi, 39 pasien (66,1%) mempunyai fraksi ejeksi ≥55%; dan 20 pasien (33,9%) <55% (rerata 55,8%). Pembesaran atrium kiri ditemukan pada 33 pasien (55,9%) dan trombus pada 13 pasien (22%). Penyakit penyerta yang ditemukan ialah: hipertensi pada 35 pasien (41,7%); gagal jantung 40 pasien (40,76%); penyakit jantung koroner 20 pasien (23,8%); penyakit jantung katub 21 pasien (25%); penyakit paru 6 pasien (7%); hipertiroid 5 pasien (6%); dan tanpa penyakit penyerta 1 pasien (1,2%). Pada 70 pasien (83,3%) diberikan terapi bisoprolol; 2 pasien (2,4%) digoksin; 3 pasien (3,5%) amiodaron; 7 pasien (8,4%) bisoprolol dan digoksin; dan 2 (2,4%) bisoprolol dan amiodaron. Obat antikoagulan oral diberikan pada 28 pasien (33,03%), dan aspirin pada 40 pasien (47,6%). Stroke ditemukan pada 4 pasien (4,8%); satu orang diantaranya meninggal akibat stroke. Simpulan: Fibrilasi atrial lebih sering ditemukan pada usia lanjut. Gagal jantung dan hipertensi merupakan penyakit penyerta yang tersering, sehingga perlu diwaspadai. Bisoprolol merupakan pilihan terapi yang tersering diberikan, dan angka komplikasi dan kematiannya rendah. Kata kunci: fibrilasi atrial, penyakit penyerta, terapi. Abstract: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical practice characterized by disorganized atrial activation and uncoordinated contraction of the atria and ventricle. Although there are many reports regarding the profile of atrial fibrillation (AF) in Indonesia, none have been published in North Sulawesi. This study aimed to provide epidemiological data regarding atrial fibrillation profile in Manado. We reviewed medical records of outpatients diagnosed with AF in the Department of Cardiology and Vascular Medicine, Prof. Dr. R.D. Kandou Hospital, Manado, from September 2012-February 2013. Relevant variables such as gender, age, co-morbids, echocardiography, and medical therapy were documented. The results showed that a total of 84 patients with AF were enrolled in the study. There were 42 males (50%) and 42 females (50%) with age ranges from 21 to 84 years (mean 60.74 years), of these 53 patients (63%) were ≥60 years and 31 patients (37%) <60 years. From the total 84 patients, 59 patients underwent echocardiography examinations: 39 patients (66.1%) had ejection fraction (EF) ≥55%; and 20 patients (33.9%) had EF <55% (mean 55.8%). Left atrial enlargement was found in 33 patients (55.9%) and thrombus was found in 13 patients (22%). Besides suffering from AF, 35 patients (41.7%) had hypertension, 40 (40.76%) had congestive heart failure, 20 (23.8%) had coronary artery disease, 21 (25%) had valvular heart diseases, 6 (7%) had pulmonary diseases, 5 (6%) had hyperthyroidism, and 1 (1.2%) had no comorbid. Seventy patients (83.3%) were treated with bisoprolol, 2 (2.4%) with digoxin, 3 (3.5%) with amiodarone, 7 (8.4%) with bisoprolol and digoxin, and 2 (2.4%) with bisoprolol and amiodarone. Oral anticoagulant was used in 28 patients (33.3%), and aspirin in 40 patients (47.6%). Strokes were found in four patients (4.8%); one died due to stroke. Conclusion: The prevalence of AF was higher in the elderly. Congestive heart failure and hypertension were the most common co-morbids found, thus, greater awareness is needed. Bisoprolol was used as the highest proportion of treatment in AF patients, and the complication and mortality rates were low. Keywords: atrial fibrillation, comorbids, therapy.
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Morelato, Renato Lirio, Ana Clara de Barros Pretti, Bruno pignatonruschi de Aragão, Luíza Moulin Rezende, Cristiano Ventorim de Barros, Flavio Takemi Kataoka, Luciene Lage da Motta, and Alessandra Tieppo. "Hemorragia digestiva refratária por uso de anticoagulante direto em paciente octogenário portador de fibrilação atrial crônica: relato de caso." Estudos Interdisciplinares em Ciências Sociais e da Saúde 1, no. 1 (2020). http://dx.doi.org/10.5935/2675-7397.20200011.
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Esteve Pastor, M., F. Marin, M. Anguita, M. Sanmartin, C. Rafols, V. Roldan, C. Perez, et al. "Oral anticoagulation therapy with rivaroxaban in elderly patients with atrial fibrillation. Results from EMIR study." European Heart Journal 42, Supplement_1 (October 1, 2021). http://dx.doi.org/10.1093/eurheartj/ehab724.2811.
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Abstract Background Atrial fibrillation (AF) in elderly patients increases both bleeding and thromboembolic risks. Elderly patients benefit as much from anticoagulation therapy with positive net clinical benefit. However, there have been few studies that focused on the efficacy and safety of direct oral anticoagulants in elderly patients. The aim of this subanalysis from EMIR study was to assess the effectiveness of rivaroxaban in patients older than 75 years old. Methods EMIR Study (acronym from 'Estudio observacional para la identificaciόn de los factores de riesgo asociados a eventos cardiovasculares Mayores en pacientes con fIbrilaciόn auricular no valvular tratados con un anticoagulante oral directo (Rivaroxaban)') was an observational, multicenter, post-authorization and prospective study that involved AF patients under oral anticoagulation with rivaroxaban at least 6 months before enrolment. We analyzed baseline clinical characteristics and adverse events after 2.5 years of follow up. Results We analyzed 1,433 patients with median age of 74.7 (67.7–81.6). Of them 691 (48.2%) were ≥75 years. Elderly patients had higher prevalence of cardiovascular risk factors such previous stroke (16.8% vs 8.5%; p<0.001), heart failure (25.0% vs 20.6%; p<0.001), higher CHA2DS2-VASc (4.4±1.3 vs 2.7±1.2; p<0.001) and HAS-BLED (1.9±1.0 vs 1.2±1.0; p<0.001) scores. After 2.5 (2.2–2.6) years of follow-up, we observed low rate of adverse events in patients under rivaroxaban therapy. We observed higher rate of adverse events in elderly population for thromboembolic events (1.13%/year vs 0.36%/year; p=0.017) and major bleeding events (1.80%/year vs 0.36%/year; p<0.001) but those adverse rates were lower than expected according to previous studies (i.e. ROCKET-AF trial, rivaroxaban group had 4.86%/year of major bleeding or in XANTUS study was 3.2%/year of major bleeding in patients >75 years). We did not observe differences between groups from MACE (1.13%/year vs 1.01%/year; p=0.875) or cardiovascular death (0.86%/year vs 0.42%/year; p=0.170). Conclusion In real-world elderly population, rivaroxaban showed higher rates of thromboembolic and major bleeding events in elderly patients but with annual rates lower than expected according to previous studies like ROCKET-AF or XANTUS. Similar annual rates in elderly were observed for MACE and cardiovascular mortality than in younger patients, being rivaroxaban a good therapeutic alternative even for the elderly. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Bayer Hispania S.L.
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Esteve Pastor, M., F. Marin, M. Anguita, M. Sanmartin, C. Rafols, F. Arribas Ynsaurriaga, G. Baron Esquivas, et al. "2MACE score predicts cardiovascular adverse events in real-world atrial fibrillation patients under rivaroxaban therapy. Data from EMIR study." European Heart Journal 42, Supplement_1 (October 1, 2021). http://dx.doi.org/10.1093/eurheartj/ehab724.2484.
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Abstract Background Atrial Fibrillation (AF) patients have higher risk of major adverse cardiovascular events (MACEs). In 2015, the 2MACE score (2 points for metabolic syndrome and age ≥75, and 1 point for myocardial infarction [MI] or revascularization, congestive heart failure [ejection fraction ≤40%] and thromboembolism [stroke or transient ischemic attack]) was described to stratify cardiovascular risk and 2MACE≥3 was related with high risk of MACE in AF patients but a long-term validation in prospective patients under direct anticoagulants has not been performed yet. The aim of this study was to analyse the incidence of cardiovascular events and to validate the 2MACE score as predictor of MACEs. Methods EMIR study [acronym from 'Estudio observacional para la identificaciόn de los factores de riesgo asociados a eventos cardiovasculares Mayores en pacientes con fIbrilaciόn auricular no valvular tratados con un anticoagulante oral directo (Rivaroxaban)'] was an observational, multicenter, post-authorization and prospective study that involved AF patients under oral anticoagulation with rivaroxaban at least 6 months before enrolment. We analyzed baseline clinical characteristics and adverse events after 2.5 years of follow up: annual incidence of thromboembolic events, MACE (composite of nonfatal MI, coronary revascularization and cardiac death) and cardiovascular mortality were analyzed. Results We analyzed 1,433 patients (55.5% women, mean 74.2±9.7 years). 385 (26.9%) patients had 2MACE score ≥3 and of those high-risk patients, 42.1% had previous coronary disease, 12.5% had previous peripheral artery disease, 40.7% had diabetes mellitus, 39% heart failure and 50% had chronic kidney disease (GFR<60 ml/min). After 2.5 (2.2–2.6) years of follow-up, we observed patients with 2MACE score ≥3 had higher rate of adverse events (Table), specially of higher rate of cardiovascular mortality and MACE. Patients with 2MACE score ≥3 had RR 4.09 (2.59–6.45; p<0.001) for MACE. Indeed, patients with 2MACE score ≥3 had around 6-fold risk of cardiovascular death due heart failure than patients with 2MACE score <3 (0.17%/year vs 1.09%/year; p=0.003). 2MACE score had suitable predictive performance for MACE (AUC 0.638 [(0.534–0.742); p=0.010). Conclusion In a Real-world AF patients under rivaroxaban therapy from EMIR registry, the 2MACE score is a good predictor of long-term cardiovascular events, MACE and major bleeding. A 2MACE score ≥3 categorize patients at “high-risk” with almost 4-fold risk of MACE in a long-term follow-up. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Bayer Hispania S.L. Table 1. Adverse events according to 2MACE
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Esteve-Pastor, María Asunción, José Miguel Rivera-Caravaca, Vanessa Roldán, Marcelo Sanmartín Fernández, Fernando Arribas, Jaime Masjuan, Vivencio Barrios, et al. "Predicting performance of the HAS-BLED and ORBIT bleeding risk scores in patients with atrial fibrillation treated with Rivaroxaban: Observations from the prospective EMIR Registry." European Heart Journal - Cardiovascular Pharmacotherapy, November 1, 2022. http://dx.doi.org/10.1093/ehjcvp/pvac060.
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Abstract Background Assessing bleeding risk during the decision-making process of starting oral anticoagulation (OAC) therapy in atrial fibrillation (AF) patients is essential. Several bleeding risk scores have been proposed for vitamin K antagonist users but, few studies have focused on validation of these bleeding risk scores in patients taking direct oral anticoagulants (DOACs). The aim was to compare the predictive ability of HAS-BLED and ORBIT bleeding risk scores in AF patients taking rivaroxaban in the EMIR (‘Estudio observacional para la identificación de los factores de riesgo asociados a eventos cardiovasculares mayores en pacientes con fibrilación auricular no valvular tratados con un anticoagulante oral directo [Rivaroxaban]) Study. Methods EMIR Study was an observational, multicenter, post-authorization and prospective study that involved AF patients under OAC with rivaroxaban at least 6 months before enrolment. We analyzed baseline clinical characteristics and adverse events after 2.5 years of follow up and validated the predictive ability of HAS-BLED and ORBIT scores for major bleeding (MB) events. Results We analyzed 1 433 patients with mean age of 74.2 ± 9.7 (44.5% female). Mean HAS-BLED score was 1.6 ± 1.0 and ORBIT score was 1.1 ± 1.2. The ORBIT score categorised a higher proportion of patients as ‘low risk’ (87.1%) compared to 53.5% using the HAS-BLED score. There were 33 MB events (1.04%/year) and 87 patients died (2.73%/year). Both HAS-BLED and ORBIT had good predictive ability for MB [AUC 0.770, (95%CI 0.693–0.847; P < 0.001) and AUC 0.765 (95%CI 0.672–0.858; P < 0.001), respectively]. There was a non-significant difference for discriminative ability of the 2 tested scores (P = 0.930) and risk reclassification in terms of NRI −5.7 (CI95% −42.4–31.1; P = 0.762). HAS-BLED score showed the best calibration and ORBIT score showed the largest mismatch in calibration, particularly in higher predicted risk patients. Conclusions In a prospective real-world AF population under rivaroxaban from EMIR registry, the HAS-BLED score had good predictive performance and calibration compared to ORBIT score for major bleeding events. ORBIT score presented worse calibration than HAS-BLED in this DOAC treated population.
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Del Sindaco, Donatella, Maria Denitza Tinti, Giovanni Pulignano, Stefano Tolone, Giovanni Minardi, Massimo Uguccioni, and Antonio Lax. "Cardiac rehabilitation is safe and effective also in the elderly, but don't forget about drugs!" Monaldi Archives for Chest Disease 84, no. 1-2 (June 22, 2016). http://dx.doi.org/10.4081/monaldi.2015.737.
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<p>In the setting of heart failure (HF) pharmacotherapy demonstrates a quantifiable improvement in exercise tolerance also in HF with preserved ejection fraction (HFpEF). For patients with HFpEF, often older, with higher prevalence of hypertension, diabetes mellitus, atrial fibrillation and other comorbidities, endpoints such as quality of life and functional capacity may be more clinically relevant. However several study show as the use of ACE-I and B-blocker were lesser than expected. Beta-blocker therapy is the keystone of pharmacotherapy of HF patients and exercise training is the essential core of rehabilitation programs, it is important to elucidate the relationship between these therapies. Exercise training improves the clinical status of HF, improving left ventricular ejection fraction and improving quality of life, but it is possible that b-blocker may attenuate exercise training adaptations. Despite this, possible adverse b-blocker effects are just presumed and not confirmed by published randomized clinical trials. Metanalysis suggests that b-blocker compared with placebo enhances improvements in cardiorespiratory performance in exercise training intervention. Despite these evidences, prescription of gold standard therapy and adherence are still suboptimal and should be a priority goal for all CR program. </p><p><strong>Riassunto</strong></p><p>Nell’ambito dei pazienti con scompenso cardiaco (SC) la terapia farmacologica permette di ottenere un miglioramento della tolleranza all’esercizio fisico anche nei pazienti con frazione di eiezione conservata. Questi pazienti spesso più anziani, con una più elevata incidenza di ipertensione, diabete mellito, fibrillazione atriale e comorbidità, endpoints quali qualità della vita e capacità funzionale dovrebbero risultare più clinicamente rilevanti. Tuttavia molti studi mostrano come l’utilizzo di ACE-I e Beta-bloccanti sia minore di quanto ci si aspetterebbe. Va evidenziato comunque come la terapia beta-bloccante costituisca il cardine della terapia farmacologica dello SC e come l’esercizio fisico sia il cuore dei programmi di riabilitazione, pertanto è importante valutarne le possibili interazioni. L’esercizio fisico migliora lo stato clinico dei pazienti con SC, ma è possibile che la terapia con Beta-bloccanti possa attenuare questi vantaggi. Tale assunto tuttavia rimane solo presunto e non confermato dai risultati dei trial pubblicati. Infatti una metanalisi suggerisce che la terapia Beta-bloccante, confrontata con il placebo, migliori la performance cardiorespiratoria nel gruppo sottoposto ad esercizio fisico. Malgrado tali evidenze, la prescrizione di una terapia medica ottimale e l’aderenza alla stessa rimangono ancora non ottimali e dovrebbe rappresentare un obiettivo primario per tutti i programmi di riabilitazione. </p>
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Silva, Pedro Gabriel Melo de Barros, Henry Sznejder, Rafael Vasconcellos, Georgette M. Charles, Hugo Tannus F. Mendonça-Filho, Jack Mardekian, Rodrigo Nascimento, Stephen Dukacz, and Manuela Di Fusco. "Terapia de Anticoagulação em Pacientes com Fibrilação Atrial não Valvar em Ambiente de Cuidado de Saúde Privado no Brasil: Um Estudo no Mundo Real." Arquivos Brasileiros de Cardiologia, January 2020. http://dx.doi.org/10.36660/abc.20180076.
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Fundamento: A segurança e a eficácia da varfarina dependem da qualidade do controle da anticoagulação. Estudos observacionais associam controle deficiente com aumento de morbidade, mortalidade e custos com saúde. Objetivos: Desenvolver um perfil de pacientes com fibrilação atrial não valvar (FANV) tratados com varfarina em ambiente hospitalar privado brasileiro, avaliar a qualidade do controle da anticoagulação e sua associação com resultados clínicos e econômicos. Métodos: Este estudo retrospectivo, por meio de um grande conjunto de dados de seguros privados de saúde no Brasil, identificou pacientes com FANV tratados com varfarina entre 01 de maio de 2014 a 30 de abril de 2016, descreveu seu manejo da anticoagulação e quantificou os custos relacionados à doença. Foram recuperados dados demográficos, histórico clínico, medicação concomitante e tempo na faixa terapêutica (TTR) dos valores da razão normalizada internacional (RNI). Os pacientes foram agrupados em quartis de TTR, com um bom controle sendo definido como TTR ≥65% (método de Rosendaal). Sangramentos maiores e custos médicos diretos por todas as causas foram calculados e comparados entre subgrupos de controle bons e ruins. Valores de p < 0,05 foram considerados estatisticamente significantes. Resultados: A análise incluiu 1220 pacientes (mediana de seguimento: 1,5 anos; IIQ: 0,5–2,0). Em média, cada paciente recebeu 0,95 medidas mensais de RNI (RNI média: 2,60 ± 0,88, com 26,1% dos valores < 2 e 24,8% > 3), (mediana de TTR: 58%; IIQ: 47-68%), (TTR médio: 56,6% ± 18,9%). Apenas 31% dos pacientes estavam bem controlados (TTR médio: 78% ± 10%), com 1,6% apresentando grandes sangramentos na mediana do seguimento e custos médicos diretos por membro por ano (PMPY) de R$25.352 (± R$37.762). Pacientes mal controlados (69%) foram associados a 3,3 vezes mais sangramentos graves (5,3% vs. 1,6%; p <0,01) e custos 40% maiores (R$35.384 vs. R$25.352; p < 0,01). Conclusões: Mais de 60% dos pacientes estavam abaixo da meta desejada e os custos associados foram maiores. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)