Anticoagulation quality and complications of using vitamin k antagonists in the cardiac surgery outpatient clinic

ABSTRACT Introduction: In patients with mechanical prosthetic heart valves or atrial fibrillation requiring anticoagulation to prevent thromboembolic events, several factors influence adherence and anticoagulation complications. Objective: To evaluate the factors that interfere with the quality and complications of anticoagulation with vitamin K antagonists. Methods: A retrospective cohort study of 100 patients, in the period from 2011 to 2014, was performed. Anticoagulation conditions in the last year, regarding the presence of complications (embolisms/bleeding) and inadequate treatment were assessed: achievement of less than 8 annual prothrombin times and International Normalized Ratio outside therapeutic target in more than 40% of prothrombin times. Results: There were 31 complications (22 minor bleeding without hospitalization and 9 major complications: 7 bleeding with hospitalization and two emboli); 70 were with International Normalized Ratio outside the target in more than 40% of the tests and 36 with insufficient number of prothrombin times. Socioeconomic factors, anticoagulant type and anticoagulation reason had no relationship with complications or with inadequate treatment. There were more complications in patients with longer duration of anticoagulation (P=0.001). Women had more International Normalized Ratio outside the target range (OR 2.61, CI:1.0-6.5; P=0.04). Patients with lower number of annual prothrombin times had longer times of anticoagulation (P=0.03), less annual consultations (P=0.02) and less dose adjustments (P=0.003). Patients with longer duration of anticoagulation have more complications (P=0.001). Conclusion: There was a high rate of major complications and International Normalized Ratio was outside the goal. Less annual prothrombin times was related to longer duration of anticoagulation, less annual consultations and less dose adjustments. More major complications occurred in patients with longer duration of anticoagulation.

Hipertensão arterial de difícil controle e o polimorfismo A1166C do gene AT1 / Difficult-to-treat hypertension and AT1 A1166C gene polymorphism

Fundamentos: Polimorfismos presentes em genes que codificam proteínas do sistema renina-angiotensina aldosterona (SRAA) estão associados com o quadro de hipertensão arterial sistêmica (HAS) em algumas populações. Estudos demonstram a relação entre o polimorfismo A1166C no gene do receptor tipo 1 da angiotensina II (AT1) com a HAS, mas os dados ainda são controversos. Objetivo: Analisar a presença deste polimorfismo em pacientes portadores de HAS resistente da região dos Campos Gerais (PR), Brasil. Materiais e Métodos: Grupos de pacientes com hipertensão de fácil (G1) (n = 34) e difícil controle medicamentoso (G2) (n = 39) foram analisados quanto ao polimorfismo mencionado, utilizando-se a técnica de Polymerase Chain Reaction­ Restriction Fragment Lenght Polymorphism (PCR-RFLP). Os pacientes foram categorizados em três genótipos: AA, AC e CC. As frequências alélicas e genotípicas foram calculadas para cada grupo e os dados confrontados com as características metabólicas e antropométricas dos indivíduos. Resultados: não houve diferença entre os grupos quanto a sexo e idade. O índice de massa corporal (IMC), pressão arterial sistólica (PAS), diastólica (PAD) e número de anti-hipertensivos utilizados foram maiores no G2. Asfrequências alélicas e genotípicas mostraram-se semelhantes entre os grupos (p > 0,05). Conclusão: Nesta população, este polimorfismo não está associado ao fácil ou difícil controle da pressão arterial (PA). Possivelmente, outros fatores devem estar influenciando a HAS nestes pacientes

Background: Polymorphisms in genes encoding proteins of the renin-angiotensin-aldosterone system (RAAS) are associated with systemic arterial hypertension (SAH) in some populations. Some reports demonstrated the relationship between the angiotensin II type 1 receptor (AT1) A1166C gene polymorphism with SAH, but the data are still controversial. Objective: To analyze the presence of this polymorphism in patients porting difficult-to-treat SAH from Campos Gerais region (PR), Brazil. Materials and Methods: Groups of patients porting hypertension easy (G1) (n = 34) and difficult-to-treat using drugs (G2) (n = 39) were analyzed according to the polymorphism mentioned, using the Polymerase Chain Reaction­ Restriction Fragment Lenght Polymorphism (PCR-RFLP) technique. The patients were categorized into three genotypes: AA, AC and CC. The allele and genotype frequencies were calculated and the results were compared with metabolic and anthropometric characteristics of the patients. Results: There was no difference between groups regarding gender and age. The body mass index (BMI), systolic and diastolic blood pressures and the number of antihypertensive drugs were higher in G2. The allele and genotype frequencies were similar between the groups (p > 0.05). Conclusions: In this population, the polymorphism analyzed is not associated with easy or difficult-to-treat SAH. Possibly, other factors are influencing the hypertension in these patients

Relação do polimorfismo C825T do gene GNB3 e hipertensão arterial sistêmica de difícil controle / Relationship between C825T polymorphism of the GNB3 gene and dificult-to-treat hypertension

Fundamentos: O polimorfismo C825T do gene GNB3 está associado à hipertensão arterial sistêmica (HAS) em algumas populações já analisadas, porém alguns estudos se mostram controversos no que se refere a esta relação. Objetivo: Avaliar a relação do polimorfismo C825T do gene GNB3 com a HAS de difícil controle medicamentoso em hipertensos de Campos Gerais, PR - Brasil. Métodos: Em relação ao polimorfismo C825T de GNB3, foram determinados os genótipos de 60 hipertensos, os quais foram estratificados em dois grupos (fácil e difícil controle medicamentoso), por meio da técnica de PCR-RFLP (Polymerase Chain Reaction - Restriction Fragment Lenght Polymorphism). Foram avaliadas as frequências alélicas e genotípicas, utilizando-se o teste do qui-quadrado de Pearson, com correção de Yates e odds ratio (OR). Resultados: Não houve diferenças entre os grupos, quando comparadas as frequências alélicas e genotípicas, indicando que a população está em equilíbrio. A probabilidade de o paciente possuir o polimorfismo e a HAS de difícil controle foi 53,5 % (OR=1,15; IC95 % = 0,41-3,26), analisando-se os genótipos. Já a análise dos alelos, separadamente, mostrou uma associação de 55,4 % (OR=1,24; IC95 % = 0,59-2,57). Conclusão: Nesta população não foi encontrada relação entre o polimorfismo C825T do gene GNB3 e a HAS de difícil controle, indicando que outros fatores estão influenciando a manifestação dessa doença nestes pacientes.

Background: C825T polymorphism of the GNB3 gene is associated with systemic arterial hypertension (SAH) in some studied populations, although certain studies are controversial in terms of this relationship. Objective: To evaluate the relationship between C825T polymorphism of the GNB3 gene and difficult-to-treat SAH among hypertensive patients in Campos Gerais, Paraná State, Brazil. Methods: With regard to C825T polymorphism of the GNB3 gene, the genotypes were defined for sixty hypertensive patients divided in 2 groups (easy and difficult-to-treat with drugs), using the Polymerase Chain Reaction - Restriction Fragment Length Polymorphism (PCR-RFLP) technique. The allele and genotype frequencies were assessed through the Pearson chi-square test, with Yates correction and odds ratio (OR). Results: There were no differences between the groups when comparing the allele and genotype frequencies, indicating that the population is in equilibrium. The probability that a patient has polymorphism with difficult-to-treat SAH reached 53.5% (OR=1.15, 95%CI = 0.41-3.26), analyzing the genotypes. A separate allele analysis showed an association of 55.4% (OR=1.24, 95%CI = 0.59-2.57). Conclusion: No relationship was found in this population between C825T polymorphism of the GNB3 gene and difficult-to-treat SAH, indicating that other factors are influencing the appearance of this disease among these patients.