ABSTRACT
La enfermedad valvular cardíaca es una condición muy frecuente en la población general y un porcentaje considerable de estos pacientes requieren un tratamiento intervencionista sobre su valvulopatía para lograr atenuar su evolución natural. En este contexto, en la actualidad ha aumentado el uso de las prótesis valvulares biológicas para su tratamiento y, con ello, surge el dilema del manejo antitrombótico en estos pacientes en términos de prevención de tromboembolias y eventos hemorrágicos. ¿Cuál es el fármaco más efectivo y seguro en el período posoperatorio temprano? ¿Qué antitrombóticos podemos utilizar en el período posoperatorio tardío? ¿Qué estrategia seguimos cuando el paciente presenta otras indicaciones de anticoagulación? El objetivo de esta revisión es valorar la evidencia actual respecto al tratamiento antitrombótico en pacientes portadores de prótesis valvulares biológicas con y sin indicaciones adicionales de anticoagulación.
Heart valve disease is a very common condition in the general population and a considerable percentage of these patients require interventional treatment for their valve disease to mitigate its natural evolution. In this context, the use of biological prosthetic valves for their treatment has now increased, and with this, the dilemma of antithrombotic management in these patients arises, in terms of prevention of thromboembolism and hemorrhagic events. What is the most effective and safe drug in the early postoperative period? What antithrombotics can we use in the late postoperative period? What strategy do we follow when the patient presents other indications for anticoagulation? The objective of this review is to assess the current evidence regarding antithrombotic treatment in patients with biological prosthetic valves with and without additional indications for anticoagulation.
A valvopatia é uma condição muito comum na população geral e uma porcentagem considerável desses pacientes necessita de tratamento intervencionista para sua valvopatia para amenizar sua evolução natural. Nesse contexto, o uso de próteses valvares biológicas para seu tratamento tem aumentado, e com isso surge o dilema do manejo antitrombótico nesses pacientes em termos de prevenção de tromboembolismo e eventos hemorrágicos. Qual é o fármaco mais eficaz e seguro no pós-operatório imediato? Que antitrombóticos podemos usar no pós-operatório tardio? Que estratégia seguimos quando o paciente apresenta outras indicações de anticoagulação? O objetivo desta revisão é avaliar as evidências atuais sobre o tratamento antitrombótico em pacientes com próteses valvares biológicas com e sem indicações adicionais de anticoagulação.
Subject(s)
Humans , Thromboembolism/drug therapy , Bioprosthesis , Heart Valve Prosthesis , Fibrinolytic Agents/therapeutic use , Postoperative Complications , Postoperative Hemorrhage/drug therapyABSTRACT
Abstract Telomerase enzyme is necessary for the elongation of telomeres while telomerase being critical for aging and cancer. Metformin, ibuprofen, and acetylsalicylic acid used in this research are drugs that millions of people already use and that many are likely to use in future. In this study, the effects of these drugs on telomerase activity of Mus musculus swiss albino mice in liver tissue were investigated and the telomerase activity was measured with a PCR-ELISA based kit. In the study a possible connection between telomerase enzyme activity and activities of antioxidant enzymes was also investigated by determining the activity of superoxide dismutase (SOD) and catalase enzymes. The data obtained show that metformin slightly decreased telomerase enzyme activity in low dose application; however, this change was not statistically significant. In ibuprofen application, there was a significant inhibitory effect when high doses were used; whereas, there was a slight inhibitory effect at low doses. In acetylsalicylic acid application, a slight activator effect was detected; it was not statistically significant, though. Metformin was observed to increase catalase and SOD activities in general while low and high doses of acetyl salicylic acid showed different effects. In addition, ibuprofen caused a statistically significant increase in liver SOD values. It is important to note that this study demonstrated a significant inhibitory effect of ibuprofen on telomerase enzyme activity in animal models..
Subject(s)
Animals , Male , Female , Mice , Aspirin/adverse effects , Ibuprofen/adverse effects , Telomerase/analysis , Metformin/adverse effects , CatalaseABSTRACT
Os anticoagulantes e antiagregantes plaquetários são medicamentos utilizados por uma grande parcela da população mundial. Eles são utilizados para prevenir que pacientes de risco desenvolvam doenças cardiovasculares, como o infarto agudo do miocárdio (IAM) ou o acidente vascular cerebral (AVC). Por serem muito utilizados, constantemente o cirurgião-dentista poderá se deparar em sua rotina clínica, com pacientes usuários de anticoagulantes ou antiagregantes. Neste caso, o profissional precisará estar ciente das normas mais atuais de manejo com cada um dos tipos de medicamentos, para que o tratamento seja realizado com sucesso. No presente trabalho, é proposto um Protocolo Operacional Padrão (POP), que pode ser seguido no momento de realizar cirurgias orais em pacientes em uso de Varfarina, Ácido Acetil Salicílico, Heparina de Baixo Peso Molecular, Heparina Não Fracionada, Rivaroxabana e Clopidogrel.
Anticoagulants and antiplatelet agents are drugs used by a large portion of the world population. They are used to prevent at-risk patients from developing cardiovascular diseases, such as acute myocardial infarction (AMI) or stroke (stroke). Because they are widely used, the dental surgeon may constantly encounter patients using anticoagulants or anti-aggregating agents in their clinical routine. In this case, the professional will need to be aware of the most current management standards with each type of medication, so that the treatment is carried out successfully. In the present work, a Standard Operational Protocol (POP) is proposed, which can be followed when performing oral surgeries on patients using Warfarin, Acetyl Salicylic Acid, Low Molecular Weight Heparin, Unfractionated Heparin, Rivaroxaban and Clopidogrel.
Subject(s)
Platelet Aggregation Inhibitors , Clinical Protocols , Dentists , Anticoagulants , Surgery, OralABSTRACT
Introducción: El empleo de agentes antiagregantes plaquetarios se ve cada día más extendido en la población mundial. La decisión en relación al manejo endoscópico de este tratamiento debe estar basada en el tipo de indicación médica que justifica el uso de estos medicamentos. Se realizó una revisión de los artículos publicados en las bases de datos Pubmed, Scielo, Medline y Cochrane, relacionados con el tema. Objetivo: Profundizar en los conocimientos relacionados con la terapia antiplaquetaria periendoscópica digestiva. Desarrollo: Los antiagregantes plaquetarios son clave en el tratamiento y prevención de eventos trombóticos vasculares, cardíacos o cerebrales. Se han establecido las indicaciones de los antitrombóticos, también se ha evaluado el riesgo tromboembólico al suspender el tratamiento. El riesgo tromboembólico puede ser bajo o alto, por lo que se debe evaluar el riesgo - beneficio de suspender la terapia en este contexto. Todos los procedimientos endoscópicos presentan un riesgo de hemorragia, se considera el bajo riesgo de sangrado por debajo del 1 y alto riesgo por encima del 1 por ciento. La decisión acerca de la antiagregación en el periodo perioperatorio/ periprocedimiento, no solo depende del balance entre el riesgo trombótico y hemorrágico, sino también del tipo y la indicación del tratamiento antiplaquetario. Conclusiones: La antiagregación plaquetaria en pacientes que serán sometidos a procederes gastrointestinales intervencionistas se observa cada vez con mayor frecuencia. Esto hace necesario el conocimiento acerca de la valoración del riesgo de fenómenos trombóticos al interrumpir estos fármacos, junto con la determinación del riesgo potencial de sangrado según el procedimiento endoscópico realizado(AU)
Introduction: The use of platelet antiaggregant agents is increasingly widespread in the world population. The decision regarding the endoscopic management of this treatment should be based on the type of medical indication that justifies the use of these medications. A review of the articles published in the Pubmed, Scielo, Medline and Cochrane databases related to the subject was made. Objective: To deepen the knowledge related to periendoscopic digestive antiplatelet therapy. Development: Platelet antiaggregant are key in the treatment and prevention of vascular, cardiac or cerebral thrombotic events. Just as the indications of antithrombotic agents have been established, the thromboembolic risk has also been evaluated when treatment is suspended. The thromboembolic risk may be low or high, so the risk-benefit of discontinuing therapy in this context should be evaluated. All endoscopic procedures present a risk of bleeding considering the low risk of bleeding below 1 percent and high risk above 1 percent. The decision about anti-aggregation in the perioperative / periprocedural period depends not only on the balance between thrombotic and hemorrhagic risks, but also on the type and indication of antiplatelet therapy. Conclusions: Platelet anti-aggregation in patients who will undergo interventional gastrointestinal procedures is observed more and more frequently. This makes knowledge about the risk assessment of thrombotic phenomena necessary when interrupting these drugs, together with the determination of the potential risk of bleeding according to the endoscopic procedure performed(AU)
Subject(s)
Humans , Blood Platelets , Platelet Aggregation Inhibitors , Risk Assessment , Perioperative PeriodABSTRACT
Resumen: Introducción: Aún existe controversia en cuanto a la tromboprofilaxis para la disminución de la enfermedad tromboembólica en la cirugía ortopédica mayor. Objetivo: Responder la siguiente pregunta: ¿existe diferencia en la efectividad y seguridad en el manejo antitrombótico de pacientes con un régimen tradicional de enoxaparina contra ácido acetilsalicílico? Material y métodos: Las cirugías se llevaron a cabo por tres cirujanos, se aleatorizó la muestra y los pacientes fueron sometidos a los criterios del estudio. Evaluamos eficacia y seguridad así como la necesidad de reingreso y variables secundarias como infección, infarto agudo de miocardio, enfermedad vascular cerebral y muerte con un seguimiento de 90 días. Resultados: El total de la muestra fue de 402 pacientes, 214 en el grupo de enoxaparina y 188 en el de aspirina. Se presentaron cinco casos (1.24%) con enfermedad tromboembólica, tres (1.4%) enoxaparina y dos (1.06%) aspirina sin diferencia significativa (p = 0.23). En cuanto a seguridad, el sangrado mayor fue cero en ambos grupos, presentándose sangrado menor en siete pacientes (1.74%), cuatro (1.86%) fueron del grupo enoxaparina y tres (1.59%) del grupo aspirina sin diferencias significativas (p = 0.82). Los resultados secundarios mostraron cinco (1.24%) infecciones de herida quirúrgica superficiales y un IAM en los primeros 30 días del procedimiento en el grupo de enoxaparina. Conclusión: La aspirina como monoterapia es segura y eficaz en profilaxis antitrombótica en pacientes operados de artroplastía total de rodilla.
Abstract: Introduction: There is still controversy regarding thrombo-prophylaxis for the reduction of thromboembolic disease in major orthopedic surgery. Objective: To answer the following question: is there a difference in the effectiveness and safety in the antithrombotic management of patients with a traditional regimen of enoxaparin against acetyl salicylic acid? Material and methods: The surgeries were performed by 3 surgeons; the sample was randomized and the patients were subjected to the study criteria. We evaluated efficacy and safety as well as the need for readmission and secondary variables such as infection, acute myocardial infarction (AMI), cerebral vascular disease and death with a follow-up of 90 days. Results: The total sample was 402 patients; 214 in the enoxaparin group and 188 in the aspirin group. There were 5 cases (1.24%) with thromboembolic disease, 3 (1.4%) enoxaparin and 2 (1.06%) aspirin without significant difference (p = 0.23). In terms of safety, major bleeding was zero in both groups, with minor bleeding in 7 patients (1.74%), 4 (1.86%) were from the enoxaparin group and 3 (1.59%) from the aspirin group without significant differences (p = 0.82). Secondary outcomes showed 5 (1.24%) superficial surgical wound infections and one AMI in the first 30 days of the procedure in the enoxaparin group. Conclusion: Aspirin as monotherapy is safe, effective in antithrombotic prophylaxis in patients operated on total knee arthroplasty.
ABSTRACT
Resumen El ácido acetilsalicílico (Aspirina) es un inhibidor irreversible de la acetil ciclooxigenasa (COX) y su actividad no es restaurada hasta la formación de nuevas plaquetas. Sus efectos benéficos terapéuticos cardiovasculares lo han convertido en la piedra angular del tratamiento del paciente con enfermedad arterial coronaria. Existe una población de pacientes con indicación absoluta para su uso; sin embargo, la presencia o antecedente de hipersensibilidad a esta molécula conlleva un alto riesgo de complicaciones no relacionadas con enfermedad cardiovascular. En algunos de estos pacientes es crucial conocer e implementar protocolos de desensibilización para el ácido acetilsalicílico y, de esta manera, continuar con el uso de esta estrategia terapéutica necesaria e idónea en esta población.
Abstract Acetylsalicylic acid (Aspirin) is an irreversible inhibitor of acetyl cyclooxygenase (COX) and its activity is not restored until new platelets are formed. Its beneficial therapeutic cardiovascular effects have made it the cornerstone of the treatment of patients with coronary artery disease. There is a population of patients with absolute indication for its use, however, the presence or history of hypersensitivity to this molecule leads to a high risk of complications unrelated to their cardiovascular disease. It is vital to know and implement in some of these patients, desensitization protocols for acetyl salicylic acid and in this way to continue the use of this therapeutic strategy necessary and appropriate in this population.
Subject(s)
Humans , Male , Female , Aspirin , Guideline , Coronary Disease , Intensive Care Units , Myocardial InfarctionABSTRACT
Aim: The effect of acetylsalicylic acid (ASA) on thiol levels was studied in a rat model of azaserine carcinogenesis. Materials and Methods: ASA and azaserine were applied to the animals to research changes in cellular sulfhydryl (–SH) content and variations in free and protein-bound molecules containing the –SH group. Such effects in rats injected with azaserine were investigated at low (200 ppm) and high (400 ppm) concentrations of ASA over a relatively short (6 months) and a relatively long (12 months) period. Results: Changes in the hepatic, pancreatic, and renal –SH contents were also determined. Conclusion: Compared to the other tissues studied, the liver contained the highest levels of both free and protein-bound –SH
ABSTRACT
The clinical treatment of sepsis has always been a problem. Sepsis is characterized by high morbidity, high mortality and high treatment costs.Platelets were previously thought to play a major role in hemostasis and thrombosis.In recent years, it has been found that platelets are very important in inflammation and immune regulation as well as in hemostasis and thrombosis. Antiplatelet therapy can reduce release of inflammation and immunomodulatory mediators by attenuating platelet activation, thereby alleviating the inflammatory response in sepsis. This paper reviews the mechanism of platelet involvement in sepsis and the clinical progress of antiplatelet drugs in managing sepsis.
ABSTRACT
Volumetric absorptive microsampling (VAMS) is a novel sampling technique that allows for the collection of an accurate volume of blood by dipping a microsampler tip. The purpose of this study is to compare the requirement of a stabilizing reagent for the conventional venous blood sampling method versus VAMS in the analytical measurement of the concentration of acetylsalicylic acid. A high-performance liquid chromatography with mass spectrometry (LC-MS/MS) method was developed and validated for the accurate determination of acetylsalicylic acid in human blood. The blood samples spiked with acetylsalicylic acid with and without stabilizing reagent were absorbed into VAMS tips. In the whole blood sample, the same concentration was shown regardless of the addition of the stabilizing reagent, but the concentration decreased when the stabilizing reagent was not added to the VAMS sample. To apply the VAMS technology as a new blood sampling method, stabilizing reagents should be added before the analysis of acetylsalicylic acid concentration.
Subject(s)
Humans , Aspirin , Chromatography, Liquid , Indicators and Reagents , Mass Spectrometry , MethodsABSTRACT
OBJECTIVE:To establish the method for simultaneous contents determination of 5 kinds of acid and alkaline componentsin anti-cold compound preparation. METHODS:HPLC method was adopted. The workstation was Auto·Blend Plus software of ACQUITY Arc system. The determination was performed on Discovery?HS F5-5 column with mobile phase consisted of acid mixture-base mixture-methanol-0.3% triethylamine (gradient elution) at the flow rate of 1.0 mL/min. The detection wavelengths were set at 270 nm (acetaminophen,salicylamide,chlorphenamine maleate,triprolidine hydrochloride) and 299 nm (aspirin). The column temperature was 35 ℃,the sample size was 20 μ L. RESULTS:The linear ranges of acetaminophen, salicylamide,acetylsalicylic acid,chlorphenamine maleate,triprolidine hydrochloride were 26-411 μ g/mL(r＝0.999 6),16-254 μg/mL(r＝0.999 8),16-748 μg/mL(r＝0.998 1),35-565 μg/mL(r＝0.999 8)and 25-404 μg/mL(r＝0.999 7),respectively. LOQ were 3.6,3.1,4.0,9.6,6.3 μ g/mL;LOD were 1.9,1.3,1.4,2.9,2.3 μ g/mL,respectively. RSDs of intermediate precision, stability and reproducibility tests were all lower than 2%. Average recoveries were 100.0%-102.0%(RSD＝0.59%,n＝9), 95.2%-101.0%(RSD＝1.55%,n＝9),96.2%-99.9%(RSD＝1.24%,n＝9),96.2%-101.5%(RSD＝1.57%,n＝9),96.3%-98.9%(RSD＝0.83%,n＝9),respectively. RSDs of durability tests were lower than 3%. CONCLUSIONS:The method is simple, accurate,precise,stable,reproducible and durable,and can be used for simultaneous contents determination of 5 kinds of acid and alkaline components in anti-cold compound preparation.
ABSTRACT
PURPOSE: To investigate the incidence of venous thromboembolism (VTE) after total knee arthroplasty (TKA) with chemoprophylaxis using acetylsalicylic acid (AA) or rivaroxaban in Korean patients. MATERIALS AND METHODS: Between May 2011 and November 2013, 268 TKA patients (330 cases) were randomly allocated to 3 groups (group A: subcutaneous injection of 5,000 IU low-molecular-weight heparin for 2 days followed by oral administration of 100 mg AA for 5 days; group X7: oral administration of 10mg rivaroxaban for 7 days; and group X10: oral administration of 10 mg rivaroxaban for 10 days). Multidetector-row computed tomography (MDCT) was performed at 10 days and 3 months postoperatively to evaluate VTE changes. RESULTS: The VTE incidence was 38.2%, 20.0%, and 10.0% in groups A, X7, and X10, respectively (p < 0.001). Pulmonary embolism (PE) was identified in 19.1%, 10.0%, and 2.7% in groups A, X7, and X10, respectively (p < 0.001). Proximal or symptomatic deep vein thrombosis (DVT) occurred primarily in group A, but the incidence was not significantly different among groups. On follow-up MDCT, PE was resolved completely with treatment in 29/30 (96.7%), and so was asymptomatic distal DVT in 24/27 (88.8%) without treatment. CONCLUSIONS: Rivaroxaban had a lower incidence of overall VTE than AA, but no difference was observed in symptomatic VTE. The 10-day course of rivaroxaban had a lower incidence of overall VTE than the 7-day course.
Subject(s)
Humans , Administration, Oral , Arthroplasty , Arthroplasty, Replacement, Knee , Aspirin , Chemoprevention , Follow-Up Studies , Heparin, Low-Molecular-Weight , Incidence , Injections, Subcutaneous , Knee , Multidetector Computed Tomography , Pulmonary Embolism , Rivaroxaban , Venous Thromboembolism , Venous ThrombosisABSTRACT
Edible films are an alternative to the traditional methods of food preservation. Agro-industry produces big amounts of by-products which could be utilized as raw materials for the production of valuable products. In the present work, banana peelpowder and banana peel films were elaborated. Banana peel powder was characterized by the total starch and apparent amylose content together with solubility index and swelling power. Tension resistance, water vapor permeability, opacity, solubility and thickness were measured on the edible films of the present work. Banana peel powder showed appreciable amounts of starch (38.11% ± 3.9) an apparent amylose (42.22% ± 2.18). Therefore banana peel could be utilized on the elaboration of edible films. However, banana peel powder showed low values of solubility (11.41% ± 0.27) and swelling power (4.83% ± 0.15). Physical characteristics of edible films based on banana peel were similar to those produced with starch only, exceptuating water vapor permeability
Las películas comestibles son una alternativa cada vez más estudiada como método de conservación de alimentos. La agroindustria genera una importante cantidad de residuos con gran potencial para ser transformados en productos con valor comercial. En el presente trabajo se elaboró harina de cáscara de plátano y películas a partir de la misma. Se caracterizó la harina de corteza de plátano a través de su contenido de almidón total, amilosa aparente, índice de solubilidad y poder de hinchamiento y a las películas se evaluó la resistencia a la tensión, permeabilidad al vapor de agua, opacidad, solubilidad y espesor. La harina de cáscara de plátano presentó un importante contenido de almidón (38.11% ± 3.9) y amilosa aparente (42.22% ± 2.18), determinándose que es un material adecuado para elaborar recubrimientos comestibles. Sin embargo, presenta bajos valores de solubilidad (11.41% ± 0.27) y poder de hinchamiento (4.83% ± 0.15). Las características físicas de las películas comestibles elaboradas demostraron ser similares a los resultados obtenidos en recubrimientos de almidón puro, a excepción de la permeabilidad al vapor de agua.
Subject(s)
Permeability , Steam , Food Industry , Musa , Food PreservationABSTRACT
Compounding pharmacies have been cited by some athletes as being responsible for compounding capsules contaminated with drugs banned by the International Olympic Committee (IOC). Therefore, the present study was carried out to quantify the amount of residue remaining in the equipment and utensils used for compounding capsules after standard cleaning procedures. For this purpose, captopril (CAP) and acetylsalicylic acid (ASA) were used since these are hard to clean, in addition to hydrochlorothiazide (HTZ) as a banned drug by the IOC. The amounts of residues found in the equipment were: 181.0 ± 91.8, 1208 ± 483.8 and 431.7 ± 71.3 ppm for ASA, CAP and HTZ, respectively. The continuous compounding of these drugs, followed each time by the standard cleaning procedure, showed a linear accumulation of residues for ASA (r2=0.96) and CAP (r2= 0.88). The residues quantified were greater than the FDA limit for impurities for CAP (>0.1%) but not for HTZ. However, the HTZ residue may be detected in the urine of athletes on IOC tests. Therefore, it was concluded that compounding pharmacies should therefore improve their cleaning procedures and test these in order to attain limits below 10 ppm, thereby avoiding the contamination of other products...
As farmácias de manipulação têm sido citadas por alguns atletas como sendo responsáveis pela manipulação de cápsulas contaminadas com fármacos proibidos pelo Comitê Olímpico Internacional (COI). Portanto, o presente estudo foi realizado para quantificar o montante de resíduo remanescente nos equipamentos e utensílios usados para manipular cápsulas após o procedimento padrão de limpeza. Para este propósito, o captopril (CAP) e o ácido acetilsalicílico (ASA) foram usados por serem fármacos de difícil remoção e a hidroclorotiazida (HTZ), por ser um fármaco proibido pelo COI. As quantidades de resíduos encontradas nos equipamentos após a limpeza foram 181,0 ± 91,8, 1208 ± 483,8 e 431,7 ± 71,3 ppm para ASA, CAP e HTZ, respectivamente. A manipulação contínua dos fármacos seguida pelo procedimento de limpeza mostrou acúmulo de resíduo linear para ASA (r2=0,96) e CAP (r2=0,88). A quantidade de resíduo de CAP foi maior que o limite de impureza sugerido pelo FDA (>0,1%), mas não para HTZ, mas mesmo assim, o resíduo de HTZ pode ser detectado na urina dos atletas submetidos aos testes do COI. Em conclusão, as farmácias de manipulação deveriam, portanto, melhorar o procedimentos de limpeza e testá-los para que alcancem limites abaixo de 10 ppm para evitar contaminação nos outros produtos...
Subject(s)
Humans , Chemical Phenomena , Pharmacies/supply & distribution , Laboratory Equipment , Aspirin , Captopril , Good Manipulation Practices , Hydrochlorothiazide , Quality ControlABSTRACT
Objetivo: Determinar los patrones de prescripción del ácido acetilsalicílico, además de los costos y variables asociados a su utilización en una población de pacientes afiliados al Sistema General de Seguridad Social en Salud (SGSSS) de Colombia en el año 2014. Métodos: Estudio descriptivo de corte transversal. Mediante una base de datos de aproximadamente 3,5 millones de pacientes afiliados al SGSSS de Colombia en 88 ciudades, se seleccionaron pacientes a quienes se les dispensó ácido acetilsalicílico entre el 1.° de enero el30 de marzo de 2014 de manera ininterrumpida. Se analizaron variables sociodemográficas, farmacológicas y de comedicación. Resultados: Un total de 69.807 pacientes recibieron aspirina durante el periodo evaluado, con una edad promedio de 66,7 ± 12,1 años; el 57,1% eran hombres; el 99,8% tomaban alguna comedicación: el 94,8% antihipertensivos; el 22,4% antihipertensivos, antidiabéticos e hipolipemiantes de manera concomitante; el 95,4% estaban en monoterapia con aspirina, y el 4,6% recibían terapia combinada con 2 o más antiagregantes plaquetarios. El análisis multivariado encontró mayor probabilidad de recibir terapia combinada en Bogotá, Barranquilla y Cartagena. La dosis usual fue 100 mg/día y la dosis diaria, definida por 1.000 habitantes/día, fue 19,9. Conclusiones: La prescripción de ácido acetilsalicílico en Colombia se realizó a las dosis recomendadas por la Organización Mundial de la Salud para la prevención del riesgo cardiovascular, y su proporción de uso es inferior cuando se compara con la de otras poblaciones.
Objective: Determine the prescribing patterns of acetylsalicylic acid, costs and variables associated with its use in a population of patients affiliated to the Colombian Health System in 2014. Methods: Cross-sectional descriptive study. Using a database of approximately 3.5 million patients beneficiaries of the Colombian Health System in 88 cities; patients who were dispensed with acetylsalicylic acid continuously since 1st of January to 30th of March 2014 were selected. Sociodemographic, co-medication and pharmacologic variables were analyzed. Results: A total of 69,807 patients were receiving aspirin during the assessment period with a mean age of 66.7 ± 12.1 years; 57.1% were male; 99.8% received some co-medication: 94.8% received antihypertensive agents; 22.4% were receiving antihypertensive, antidiabetic and lipid-lowering drugs concomitantly; 95.4% were receiving monotherapy with aspirin, and 4.6% received combination therapy with 2 or more antiplatelet agents. Multivariate analysis found that it was more likely to receive combination therapy in Bogota, Barranquilla and Cartagena. The usual dose was 100 mg and defined daily dose/1,000 inhabitants/day was 19.9. Conclusions: The prescription of acetylsalicylic acid in Colombia was made at recommended doses by the WHO for the prevention of cardiovascular risk; and their frequency of use was lower when compared with other populations.
Subject(s)
Humans , Male , Aged , Aspirin , Pharmacoepidemiology , Health Evaluation , Platelet Aggregation Inhibitors , Risk FactorsABSTRACT
Objetivo: la anticoagulación oral es el tratamiento recomendado para la prevención del accidente cerebrovascular en pacientes con fibrilación auricular. Sin embargo, muchos pacientes reciben ácido acetilsalicílico (AAS) como monoterapia. Nuestro objetivo fue investigar si los pacientes con fibrilación auricular se beneficiaban del AAS como monoterapia para la prevención de accidente cerebrovascular. Métodos y resultados: estudio retrospectivo de los pacientes con diagnóstico clínico de fibrilación auricular ingresados en el Registro Nacional Sueco de Pacientes entre el 1 de julio de 2005 y el 1 de enero de 2009, combinado con datos del Registro Nacional de Medicamentos Recetados. Las variables evaluables fueron accidente cerebrovascular isquémico, evento tromboembólico, hemorragia intracraneana, y sangrado mayor. La población en estudio consistió en 115.185 pacientes con fibrilación auricular, 58.671 de los cuales recibieron AAS como monoterapia y 56.514 no recibieron ningún tratamiento antitrombótico a nivel basal. La media de seguimiento fue de 1,5 años. El tratamiento con AAS se asoció a un mayor riesgo de presentar un accidente cerebrovascular isquémico y eventos tromboembólicos comparado con la ausencia de tratamiento antitrombótico. Conclusión: el AAS como monoterapia en la prevención del accidente cerebrovascular provocado por fibrilación auricular no posee ningún efecto discernible de protección contra el accidente cerebrovascular, y puede incluso aumentar el riesgo de accidente cerebrovascular isquémico en pacientes añosos. Por lo tanto, nuestros datos avalan las nuevas recomendaciones de las guías europeas, en el sentido que no debería utilizarse el AAS como monoterapia en la prevención del accidente cerebrovascular provocado por la fibrilación auricular.
Aims: Oral anticoagulation is the recommended treatment for stroke prevention in patients with atrial fibrillation. Notwithstanding, many patients are treated with acetylsalicylic acid (ASA) as monotherapy. Our objective was to investigate if atrial fibrillation patients benefit from ASA as monotherapy for stroke prevention. Methods and results: retrospective study of patients with a clinical diagnosis of atrial fibrillation between 1 July 2005 and 1 January 2009 in the National Swedish Patient register, matched with data from the National Prescribed Drugs register. Endpoints were ischaemic stroke, thrombo-embolic event, intracranial haemorrhage, and major bleeding. The study population consisted of 115 185 patients with atrial fibrillation, of whom 58 671 were treated with ASA as monotherapy and 56 514 were without any antithrombotic treatment at baseline. Mean follow-up was 1.5 years. Treatment with ASA was associated with higher risk of ischaemic stroke and thrombo-embolic events compared with no antithrombotic treatment. Conclusion: acetylsalicylic acid as monotherapy in stroke prevention of atrial fibrillation has no discernable protective effect against stroke, and may even increase the risk of ischaemic stroke in elderly patients. Thus, our data support the new European guidelines recommendation that ASA as monotherapy should not be used as stroke prevention in atrial fibrillation.
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Aerial parts of Bridelia micrantha, a semi-deciduous tree are widely used in African traditional medical practice in the treatment of painful inflammatory conditions of the joints. This study evaluated the anti-inflammatory activities of the methanol leaf extract of Bridelia micrantha using acute, sub-acute and chronic models of inflammation in Wistar rats. In the carrageenan-induced acute inflammation model, 400 mg/kg of extract produced 71.79 % edema inhibition while 200 mg/kg of the extract produced 55.13 % inhibition relative to 56.41 % inhibition of the rat paw edema with 200 mg/kg of Acetylsalicylic Acid (ASA) within 5 h. In the histamineinduced rat paw edema model, the extract exhibited 72.97 % protection at 400 mg/kg compared to 83.33 % edema inhibition with phenylbutazone (100 mg/kg) after 6 h. In the sub-acute model using formaldehyde-induced paw edema, 400 mg/kg of extract showed 59.77 % (0.35±0.03) inhibition after 24 h, while 54.02 % inhibition was produced by 200 mg/kg of extract and 200 mg/kg of ASA produced 56.32 % (0.38±0.04) inhibition when compared with the negative control group (0.87±0.05). In the cotton pellet-induced granuloma test, 400 mg/kg of extract gave 52.55 % (40.57±1.3) protection, while 200 mg/kg extract gave 47.25 % protection and 200 mg/kg ASA gave 49.38 % (43.25±1.8) when compared with normal saline treated group (85.5±3.2) after 7 days. The results obtained in this study showed that Bridelia micrantha leaf extract exhibited potent anti-inflammatory activities thus authenticating its acclaimed anti-inflammatory efficacy. It was concluded that the extract of Bridelia micrantha may be a potential anti-inflammatory agent in alleviating edema associated with arthritis and musculo-skeletal pains in humans.
ABSTRACT
Objective: To investigate the influence of a regular oral use of acetylsalicylic acid in the prevalence of actinic keratosis. Methods: A case-control study with dermatologic outpatients above 50 years of age assessed between 2009 and 2011. Cases were defined as those who had been under regular use of oral acetylsalicylic acid for more than six consecutive months. The assessment focused on: age, sex, skin-type, tobacco smoking, use of medication, occurrence of individual or family skin cancer, and sunscreen and sun exposure habits. Actinic keratoses were counted in the medial region of the face and upper limbs. Counts were adjusted by co-variables based on a generalized linear model. Results: A total of 74 cases and 216 controls were assessed. The median time of acetylsalicylic acid use was 36 months. Cases differed from controls as to the highest age, highest prevalence of use of angiotensin-converting enzyme inhibitors and fewer keratosis on the face and on the upper limbs (p<0.05). The multivariate model showed that the use of acetylsalicylic acid was associated to lower counts of face actinic keratosis and upper-limb erythematous actinic keratosis (p<0.05), regardless of other risk factors. Conclusion: The regular use of oral acetylsalicylic acid for more than six months was associated to a lower prevalence of actinic keratosis, especially facial and erythematous ones. .
Objetivo: Queratoses actínicas são proliferações atípicas de queratinócitos com potencial para se transformarem em carcinoma invasivo. Estudos clínicos e laboratoriais têm observado um efeito preventivo de anti-inflamatórios não hormonais no desenvolvimento de diversas neoplasias. Neste estudo, investigamos a influência do uso regular do ácido acetilsalicílico na prevalência de queratoses actínicas. Métodos: Estudo caso-controle com pacientes dermatológicos acima de 50 anos de idade, avaliados entre 2009 e 2011. Os casos foram definidos como aqueles que estavam sob uso regular de ácido acetilsalicílico por via oral por mais de seis meses consecutivos. Avaliou-se idade, sexo, fototipo, tabagismo, uso de medicamentos, ocorrência de câncer de pele no indivíduo ou na família, hábitos de proteção e exposição solar. As queratoses actínicas foram contadas nos membros superiores e região medial da face. As contagens foram ajustadas pelas covariáveis em um modelo linear generalizado. Resultados: Um total de 74 casos e 216 controles foi avaliado. O tempo médio de uso de ácido acetilsalicílico foi de 36 meses. Casos diferiam dos controles quanto a idade mais elevada, maior prevalência de uso de inibidores da enzima conversora da angiotensina e menos queratoses na face e membros superiores (p <0,05). O modelo multivariado mostrou que o uso do ácido acetilsalicílico esteve associado a contagens mais baixas de queratoses actínicas na face de queratoses não hipertróficas nos membros superiores (p <0,05). Conclusão: O uso regular do ácido acetilsalicílico por via oral por mais de seis meses esteve associado a uma menor prevalência de queratose actínica, especialmente faciais e eritematosas. .
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Aspirin/administration & dosage , Keratosis, Actinic/epidemiology , Administration, Oral , Brazil/epidemiology , Case-Control Studies , Habits , Keratosis, Actinic/drug therapy , Multivariate Analysis , Prevalence , Risk Factors , Skin Neoplasms/epidemiology , Sunlight/adverse effects , Time FactorsABSTRACT
Objective:To investigate the adverse effect of exposure to acetylsalicylic acid (ASA), diazinon (DIA) and their combination on oxidant/antioxidant status in rat erythrocytes and the ameliorating role of selenium (Se). Methods: Rats were oral administered ASA at the maximum administration dose (1 350 mg/personal/d=2.5 mg/kg body weight/d), DIA at a dose of 20 mg/kg body weight/d and Se at a dose of 200 μg/kg body weight/d and their combinations for 28 consecutive d. Results: Administration of DIA, ASA and ASA+DIA lead to a significant increment (P≤0.05) in lipid peroxidation as evidenced by the increase in erythrocytes MDA levels by 61.8%, 20.79%and 105.62%, respectively. Co-administration of Se to treated rats modulated the augmentation of MDA levels. Administration of DIA, ASA and ASA+DIA lead to significant decreases (P≤0.05) in the activities of catalase, superoxide dismutase and glutathione peroxidase enzymes when compared to the control group. The most influence and decreases in the activities of the aforementioned enzymes were observed in the treatments of ASA+DIA by 30.53%, 43.42%and 48.31%, respectively. However, co-administration of Se mitigated the significant decreases of superoxide dismutase, catalase and glutathione peroxidase activities to by 14.47%, 15, 36%and 12.29%. Conclusions: It can be concluded that DIA and ASA induced oxidative stress and lipid peroxidation in rat erythrocytes. The results reveal the pronounced ameliorating effect of Se in DIA and ASA intoxicated rats. It is supposed that antioxidant supplementation may be beneficial for the people using ASA for longer periods and exposure to pesticides.
ABSTRACT
O objetivo foi estimar a prevalência de uso de ácido acetilsalicílico (AAS) na prevenção das doenças cardiovasculares (DCV). Estudo transversal de base populacional, realizado em Pelotas, Rio Grande do Sul, Brasil, em 2010. Dois desfechos foram considerados: uso de AAS na prevenção primária (indivíduos > 40 anos com pelo menos dois fatores de risco (hipertensão arterial sistêmica, diabetes mellitus e/ou dislipidemia) e uso de AAS na prevenção secundária (história de angina/infarto e/ou acidente vascular encefálico). Os desfechos foram analisados de acordo com variáveis demográficas, socioeconômicas e de estilo de vida. A prevalência de uso de AAS foi de 24,8% na prevenção primária e 34,3% na prevenção secundária. Na prevenção primária o uso de AAS foi maior nos indivíduos de cor não branca, maior faixa etária e com pior autopercepção de saúde. Na prevenção secundária, a prevalência de uso foi maior nos indivíduos com maior faixa etária, maior classe social e ex-fumantes. As prevalências de uso de AAS encontradas estão muito abaixo do recomendado para prevenção das DCV.
The objective of this study was to estimate the prevalence of aspirin use in primary and secondary prevention of cardiovascular disease. A population-based cross-sectional study was conducted in Pelotas, Rio Grande do Sul State, Brazil, from January to May 2010. The study had two outcomes: 1) aspirin use in primary prevention (individuals > 40 years of age with at least two risk factors: hypertension, diabetes mellitus, and/or hyperlipidemia) and 2) aspirin use in secondary prevention (history of stroke and/or angina/myocardial infarction). The outcomes were analyzed based on demographic, socioeconomic, and lifestyle variables. Prevalence of aspirin use was 24.8% for primary prevention and 34.3% for secondary prevention. In primary prevention, aspirin use was more common in non-whites and older individuals and among those with worse self-rated health. For secondary prevention, aspirin use was more frequent among older and higher-income individuals and former smokers. Prevalence of aspirin use was well below recommended levels for prevention of cardiovascular diseases.
Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Aspirin/therapeutic use , Cardiovascular Diseases/prevention & control , Brazil , Cross-Sectional Studies , Cardiovascular Diseases/drug therapy , Life Style , Risk Factors , Socioeconomic FactorsABSTRACT
Introdução: Há evidência, embasada por estudos em modelos experimentais de infecção pelo Trypanosoma cruzi, e também por investigações histopatológicas em humanos com a doença de Chagas, de que distúrbios de natureza isquêmica participem da patogênese de lesões miocárdicas na fase crônica da moléstia. Esses distúrbios isquêmicos derivam de desregulação microcirculatória. Dor precordial atípica é sintoma comum em pacientes na fase crônica da doença de Chagas. Em substancial proporção desses pacientes, apesar da inexistência de obstruções coronárias angiograficamente detectáveis, documenta-se com cintilografia miocárdica a ocorrência de distúrbios perfusionais durante o estresse, que são reversíveis após repouso. Métodos: Estudo unicêntrico, prospectivo, de coorte única, com intervenção terapêutica seguida de reavaliação quantitativa, após 90 dias, da área ventricular apresentando alterações perfusionais isquêmicas inicialmente detectadas em pacientes cardiopatas chagásicos com coronárias angiograficamente normais. A cintilografia miocárdica de perfusão será executada com o método SPECT,antes e após 90 dias da intervenção terapêutica, tendo os estamibi-Tc99m como radiotraçador e o esforço físico ou o estímulo vasodilatador com dipiridamol como estressores. A intervenção terapêutica consistirá de ácido acetilsalicílico (dose de 100 mg diária) associado a verapamil (dose diária de160 mg, em duas tomadas de 80 mg). O desfecho primário do estudo será redução > 50% da área ventricular de isquemia miocárdica reversível calculada pelo mapa polar da cintilografia miocárdica de perfusão. Conclusões: Este é o primeiro estudo de intervenção terapêutica para atenuar ou reverter alterações miocárdicas isquêmicas de origem microvascular em pacientes com cardiopatia chagásica crônica.