Major bleeding risk assessment in atrial fibrillation patients taking vitamin K antagonists

The use of risk scores for the assessment of major bleeding and stroke in patients with atrial fibrillation (AF) helps evaluate the risks and benefits of oral anticoagulation therapy. The aim of this study was to describe the percentage of patients receiving anticoagulants for non-valvular AF with a high risk of major bleeding based on the HAS-BLED score, as well as identify potential modifiable risk factors of bleeding and compare the risk of major bleeding with the risk of stroke. Methods: Retrospective cohort study involving patients of the anticoagulation outpatient clinic of the Division of Internal Medicine at Hospital de Clínicas de Porto Alegre. Major bleeding risk was estimated based on the HAS-BLED score and stroke risk was determined using the CHADS2 and CHA2 DS2 -VASc scores. Results: Sixty-three patients were investigated (mean age 74.3±10.9 years). The median HAS-BLED score was 2 points, 19 (30.2%) patients had a score ≥ 3 (high risk). The most prevalent modifiable risk factors were labile TP/INR (36.5%) and concomitant use of drugs (30.2%). The absolute risk of major bleeding based on the HAS-BLED score was higher than the risk of stroke in three (4.8%) and four (6.3%) patients in comparison with the CHADS2 and CHA2 DS2 -VASc score, respectively. Conclusions: We concluded that the percentage of patients with high risk of major bleeding is similar to the rate found in the national literature (30.2%). In addition, the most prevalent modifiable risk factors in our cohort were labile TP/INR and concomitant drug use...

Management of anticoagulation with vitamin K antagonists in a tertiary hospital outpatient clinic

INTRODUCTION: Atrial fibrillation (AF) is one of the main risk factors for stroke. Vitamin K antagonists (VKA) reduce this risk, and the effectiveness of this treatment is directly related to time in therapeutic range (TTR). This study aimed to report the TTR in patients with non-valvular AF at an anticoagulation outpatient clinic; and to describe the profile of this population of patients in terms of risk of stroke, as well as the occurrence of adverse events during the follow-up. METHODS: Retrospective cohort study involving patients of the anticoagulation outpatient clinic of the Department of Internal Medicine at Hospital de Clínicas de Porto Alegre. We evaluated outpatient visits, hospital admissions, and emergency visits from January to December 2011. TTR was calculated using the Rosendaal method. RESULTS: Sixty-three patients were investigated. Their mean age was 74.3±10.9 years. The CHADS2 score was ≥ 4 in 44.5% of the patients; 63.5% of them had a CHA2 DS2 -VASc score ≥ 5. The TTR was 64.8%. During follow-up, the incidence of overall bleeding was 31.7%, with major and minor bleeding rates of 4.8% and 34.9%, respectively. There were no other complications related to AF or anticoagulation. CONCLUSION: The patients achieved a TTR of 64.8% during follow-up, which is deemed appropriate and in agreement with the literature. Patients had high risk for stroke, and the incidence of minor bleeding was higher than the rate found in the literature, whereas the incidence of major bleeding was similar to the one found in previous studies

O uso de monitorização residencial de pressão arterial como estratégia para aumento do grau de controle de hipertensão arterial / The use of home blood pressure monitoring as a strategy for improved control of hypertension

Os agravos decorrentes de hipertensão arterial sistêmica ainda acometem grande parcela das populações mundiais, incluindo a brasileira, a despeito das inúmeras intervenções medicamentosas e não-medicamentosas conhecidas e eficazes. O entendimento e a adesão de pacientes a estas intervenções são indispensáveis para que se traduzam em melhor grau de controle populacional da hipertensão. A monitorização domiciliar de pressão arterial pode auxiliar nesse contexto e muitos ensaios clínicos randomizados têm sido feitos para testar sua eficácia. Os resultados não têm sido muito consistentes, e quando há modificações de esquemas terapêuticos com base nas medidas domiciliares o grau de controle avaliado por monitorização ambulatorial e no consultório pode ser menor. Estudos avaliando a eficácia isolada da monitorização domiciliar com aparelhos automáticos, sem modificações de esquemas posológicos planejados no consultório, ainda não foram realizados.

Genética da Esquizofrenia: um estudo de revisão / Genetics of Schizophrenia: a revision study

Não restam dúvidas sobre a importância da influência genética na esquizofrenia, mas a natureza exata dessa da transmissão genética ainda não está clara. Acredita-se que o componente genético consiste de múltiplos genes agindo de forma aditiva, sendo que o genótipo predisponente à esquisofrenia só seria manifesto quando o número de genes e de fatores não-genéticos presentes fosse maior do que um valor limiar. A Herança Multifatorial com Efeito do Limiar é o padrão mais aceito no que se refere a influência genética na esquisofrenia, sendo a base para a maioria dos estudos realizados na área. Os autores se propõe a apresentar uma revisão sobre o modelo genético atualmente aceito como participante na gênese da esquizofrenia, bem como analisar os diferentes estudos genéticos, desde os modelos mais antigos, como os estudos familiares, de gêmeos e de adoção, até os modernos estudos de genética molecular e suas contribuições para o entendimento desta doença.