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2.
Int. j. cardiovasc. sci. (Impr.) ; 35(1): 88-94, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1356309

ABSTRACT

Abstract Background Vitamin K antagonists (VKA) are indicated for the prevention of thromboembolic events and reduction of mortality in patients with atrial fibrillation and patients with valvular prostheses. However, their use is associated with bleeding complications and hospitalizations. Predictors of hospital admission for bleeding in these patients are poorly known. Objectives To define the predictors for hospitalization of VKA users who seek emergency care due to bleeding. Methods Single-center, cross-sectional study, with retrospective analysis of electronic medical records from 03/01/2012 to 02/27/2017. Clinical and laboratory variables were compared between patients who were hospitalized and those who were not. A logistic regression model as used, in which the variables were included using the Backward stepwise method, with a p value of 0.05 as the input criterion, a removal value of 0.20 and a confidence interval of 95%. The p-value was considered statistically significant when <0.05. Results A total of 510 patients with bleeding were included, of whom 158 were hospitalized. Predictors of hospitalization were: INR at supratherapeutic levels (OR 3.45; P <0.01; 95% CI 1.58 - 7.51), gastrointestinal bleeding (OR 2.36; P <0.01; CI 95% 1.24 - 4.50), drop in hemoglobin (OR 6.93; P <0.01; 95% CI 3.67 - 13.07), heart failure (OR 1.96; P 0.01; 95% CI 1.16 - 3.30) and need for blood transfusion (OR 8.03; P <0.01; 95% CI 2.98 - 21.64). Conclusion Drop in hemoglobin, heart failure, INR at supratherapeutic levels, gastrointestinal bleeding and need for blood transfusion were associated with hospitalization. Identification of these factors in the initial evaluation would help to define which patients will demand more intensive care.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Vitamin K/antagonists & inhibitors , Warfarin , Hemorrhage , Hospitalization , Platelet Aggregation , Cross-Sectional Studies , Retrospective Studies , Emergency Medical Services , Emergency Service, Hospital
3.
Cuad. Hosp. Clín ; 62(2): 35-41, dic. 2021. ilus.
Article in Spanish | LILACS | ID: biblio-1358050

ABSTRACT

INTRODUCCIÓN: la fibrilación auricular es la arritmia más frecuente, siendo una patología trombogénica, por lo que en la mayoría de los casos es necesaria la anticoagulación. Uno de los agentes más usados es la warfarina y su efecto se determina mediante el INR y el tiempo que el paciente se mantiene en rango terapéutico, denominado Tiempo en Rango Terapéutico. OBJETIVO: determinar el Tiempo en Rango Terapéutico en pacientes con Fibrilación Auricular que acuden a consulta externa de cardiología en el Instituto Nacional del Tórax MATERIALES Y MÉTODOS: se hizo la revisión de expedientes clínicos de pacientes que acudieron a consulta externa de cardiología con fibrilación auricular de 2017 a 2019 y se calculó el TTR mediante el método de Rosendaal y porcentaje de INRs en rango terapéutico RESULTADOS: de 212 pacientes dentro del universo se incluyeron en el estudio 49 pacientes. La edad promedio fue de 67,49 ±12,33 años, con un 63,3% de pacientes de sexo femenino. El TTR calculado por método de Rosendaal fue de 34±25,98% y el TTR calculado por porcentaje de INRs en rango fue de 31,31±24,01%. El porcentaje de pacientes con TTR adecuado (≥70%) fue del 10,2%. CONCLUSIÓN: los pacientes con fibrilación auricular anticoagulados con warfarina que acuden a consulta externa de cardiología del Instituto Nacional del Tórax presentan un nivel inadecuado de Tiempo en rango terapéutico. (AU)


INTRODUCTION: atrial fibrillation is the most frequent arrhythmia, being a thrombogenic pathology, so anticoagulation is necessary in most cases. One of the most used agents is warfarin and its effect is determined by the INR and the time that the patient remains in the therapeutic range, called Time in Therapeutic Range OBJECTIVE: to determine the Time in Therapeutic Range in patients with Atrial Fibrillation who attend outpatient cardiology consultation at the Instituto Nacional del Tórax MATERIALS AND METHODS: the clinical records of patients who attended the outpatient cardiology consultation with atrial fibrillation from 2017 to 2019 were reviewed and the TTR was calculated using the Rosendaal method and percentage of INRs in the therapeutic range RESULTS: of 212 patients within the universe, 49 patients were included in the study. The average age was 67.49 ± 12.33 years, with 63.3% of female patients. The TTR calculated by the Rosendaal method was 34 ± 25.98% and the TTR calculated by percentage of INRs in range was 31.31 ± 24.01%. The percentage of patients with adequate TTR (≥70%) was 10.2%. CONCLUSION: patients with atrial fibrillation anticoagulated with warfarin who attend the outpatient clinic of cardiology of the Instituto Nacional del Tórax present an inadequate level of Time in therapeutic range.(AU)


Subject(s)
Atrial Fibrillation , Warfarin , International Normalized Ratio
5.
Rev. colomb. cardiol ; 28(4): 353-359, jul.-ago. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1351932

ABSTRACT

Resumen Objetivo: Establecer las características demográficas, clínicas y terapéuticas de los pacientes anticoagulados atendidos en las clínicas de anticoagulación del Hospital Universitario Fundación Santa Fe de Bogotá (HUFSFB) y del Hospital Universitario San Vicente Fundación Medellín (HUSVF), en los años 2015 y 2016. Método: Se realizó un estudio descriptivo, retrospectivo y transversal. La población de referencia la conformaron los pacientes atendidos en las clínicas de anticoagulación del HUSVF y el HUFSFB en el periodo comprendido entre marzo de 2015 y marzo de 2016. La información se tomó de los registros clínicos de ambos hospitales y para el análisis se utilizó estadística descriptiva. Resultados: Se evaluaron 502 pacientes en las dos clínicas de anticoagulación, con una edad promedio de 64 años en el HUFSFB y de 61 años en el HUSVF. La principal indicación de anticoagulación fue fibrilación o flutter auricular en el HUSVF (46.5%) y enfermedad tromboembólica venosa en el HUFSFB (69.7%). El 100% de los pacientes del HUSVF fueron anticoagulados con warfarina, frente a solo el 23% de los del HUFSFB; el tiempo en rango terapéutico fue del 69% en el HUFSFB y del 55% en el HSVF. Se presentó retrombosis en tres pacientes en cada una de las instituciones, y los eventos de sangrado fueron 7 (3,8%) en el HUFSFB y 30 (9,3%) en el HUSVF. Conclusiones: Las diferencias administrativas entre las dos instituciones se ven reflejadas en los resultados obtenidos. Existe, ligada al sistema de salud de nuestro país, una gran diferencia en la población, las enfermedades y el acceso a los servicios y a los medicamentos.


Abstract Objective: To establish the demographic, clinical and therapeutic characteristics of the anticoagulated patients treated at the anticoagulation clinics of Fundación Santa Fe de Bogotá (HUSVF) and Hospital Universitario San Vicente Fundación Medellin (HUFSFB), between 2015 and 2016. Method: A transversal retrospective descriptive study was carried out. The reference population consist in patients treated in the anticoagulation clinics of the HUSVF in Medellin and the HUFSFB in Bogotá between March 2015 to 2016. The information was taken from the clinical records of both hospitals and descriptive statistics were used for the data analysis. Results: A total of 502 patients were evaluated in both anticoagulation clinics. Patients' average age in HUFSFB was 64 years while in HUSVF was 61; the main pathology that required anticoagulation was the fibrillation/auricular flutter in HUSVF (46,5%) and venous thromboembolic disease in HUFSFB (69.7%). 100% of HUSVF patients are anticoagulated using warfarin and only 23% of those in HUFSFB; the time in therapeutic range (TTR) was 69% in HUFSFB and 55% in HSVF. Re-thrombosis was presented in 3 patients in each of the institutions and the bleeding events were 7 (3.8%) in HUFSFB and 30 (9.3%) in HUSVF. Conclusions: The administrative differences between the two institutions are reflected in the results obtained; there is a great difference in the population, pathologies, access to services and medicines, linked to the health system of our country.


Subject(s)
Humans , Warfarin , Anticoagulants
7.
Int. j. cardiovasc. sci. (Impr.) ; 34(2): 116-121, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1154561

ABSTRACT

Abstract Background Traditionally, the most effective therapy in the prevention of stroke in patients with atrial fibrillation (AF) has been oral anticoagulation with vitamin K inhibitors, particularly warfarin, whose disadvantages and adverse effects have led to their replacement by "direct oral anticoagulants", as factor X inhibitor. Objectives This study aimed to conduct a brief approach on atrial fibrillation (AF) and use of Rivaroxaban, and to comparatively evaluate the prothrombin time / International Normalized Ratio (PT/INR) in patients with AF in use of this oral anticoagulant, depending on the time elapsed between the last administration of the drug and the time of blood sample venipuncture. Methods We evaluated 34 patients with AF in use of Rivaroxaban by using PT / INR, distributed into a subgroup with blood collection time ≤ 12 hours (n = 7) and > 12 hours after the last drug intake (n = 27). Mann-Whitney test was used to compare the groups and p < 0.05 was considered significant. Results An analysis as a function of time between the Rivaroxaban intake and blood collection, revealed that PT / INR suffers the greatest effect up to 12 hours after ingestion of the drug, dropping to levels close to normal in subsequent hours before the next dose. Conclusion We concluded that, in contrast to warfarin, the knowledge of the time interval between drug intake and blood collection from patients taking Rivaroxaban is essential to properly interpret a laboratory test to assess hemostasis, particularly PT and its derivatives. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Atrial Fibrillation/drug therapy , Rivaroxaban/pharmacology , Prothrombin Time , Atrial Fibrillation/prevention & control , Warfarin/pharmacology , Risk Assessment , International Normalized Ratio
8.
Bol. méd. postgrado ; 37(1): 21-26, Ene-Jun 2021. graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1147874

ABSTRACT

El tratamiento anticoagulante oral con fármacos inhibidores de la vitamina K como la warfarina se viene utilizando desde hace décadas para la terapia y prevención de la enfermedad tromboembólica con efectos secundarios ampliamente conocidos, pero con una utilidad clínica bien contrastada. El objetivo de este estudio fue determinar la proporción de mortalidad y hospitalización de la consulta de anticoagulación y trombosis del Centro Cardiovascular Regional ASCARDIO en el año 2017 para lo cual se realizó un estudio descriptivo transversal que incluyó una muestra de 294 pacientes. La principal indicación de anticoagulación fue la fibrilación auricular (73%) seguida de la enfermedad tromboembólica venosa (13%) e isquemia miocárdica (9%). Se registró una mortalidad de 11,7% siendo la principal causa de muerte de origen cardíaco (58%). La edad promedio de los pacientes fallecidos fue de 65 años, siendo 53% del sexo femenino; para el momento de la muerte, el 65% de los pacientes estaba tomando warfarina. La hospitalización se observó en el 10% de la muestra siendo la principal causa de la misma la cardíaca (60%) seguida de causas hemorrágicas (18%); de los pacientes hospitalizados, la edad promedio fue de 66 años siendo 52% del sexo femenino; el 90% de los pacientes estaba tomando warfarina al momento de la hospitalización. El análisis de riesgo para mortalidad y hospitalización según causa y estatus de warfarina no mostró significancia estadística. No se evidenció relación de riesgo estadísticamente significativa entre muerte, hospitalización y estatus de la warfarina. Hubo mayor proporción de muertes (45%) y hospitalización (17%) en el grupo que ingresó con diagnóstico de isquemia miocárdica(AU)


Oral anticoagulant treatment with vitamin K inhibitor drugs such as warfarin has been used for decades for the therapy and prevention of thromboembolic disease with widely known side effects but with well-proven clinical utility. To determine the proportion of mortality and hospitalization of the anticoagulation and thrombosis clinic of the ASCARDIO Regional Cardiovascular Center in 2017 a descriptive cross-sectional study was carried out that included a sample of 294 patients. The results show that the main indication for anticoagulation was atrial fibrillation (73%) followed by venous thromboembolic disease (13%) and myocardial ischemia (9%). An 11.7% mortality rate was observed. The mean age of the deceased was 65 years with a slight prevalence of the female sex (53%). The main cause of death was cardiac (58%) and 65% of the deceased patients were taking warfarin at the moment of death. A 10% hospitalization rate was observed with an average age of hospitalized patients of 66 years; 52% were females. The main cause of hospitalization was cardiac (60%) followed by hemorrhage (18%) and 90% of the patients were taking warfarin at the time of hospitalization. The risk analysis for mortality and hospitalization according to cause and status of warfarin did not show statistical significance. There was a higher proportion of deaths (45%) and hospitalization (17%) in the group admitted with a diagnosis of myocardial ischemia(AU)


Subject(s)
Humans , Male , Female , Aged , Vitamin K/antagonists & inhibitors , Warfarin/therapeutic use , Venous Thrombosis/drug therapy , Anticoagulants , Atrial Fibrillation/drug therapy , Thromboembolism , Vascular Diseases , Myocardial Ischemia/drug therapy
10.
Rev. Ciênc. Méd. Biol. (Impr.) ; 19(3): 514-517, dez 5, 2020.
Article in Portuguese | LILACS | ID: biblio-1358034

ABSTRACT

Introdução: a Síndrome Antifosfolípide é caracterizada por eventos trombóticos e perdas gestacionais de repetição e é considerada a trombofilia adquirida mais comum. Quando não está associada a alguma doença do tecido conectivo é dita primária e seu tratamento é baseado em anticoagulação por longo período com warfarin. Isso requer controle rigoroso do tempo de protrombina realizada pela monitoração dos valores de INR para que se evite em um extremo o risco de sangramento e em outro o risco de trombose. Objetivo: realizar uma revisão daa literatura sobre polimorfismos genéticos da citocromo P450 na síndrome antifosfolipide. Metodologia: revisão narrativa da literatura. Resultados: embora investigações tenham identificado a influência de vários genes na resposta ao warfarin, a maioria das evidências sugere um papel mais importante para o polimorfismo de dois genes: o gene do citocromo P450(CYP)2C9 (CYP2C9) e o gene do complexo redutase epóxido vitamina K 1 (VKORC1). De fato, o warfarin é administrado como uma mistura racêmica de S ­ e R-warfarin e estes enantiômeros são extensivamente metabolizados no fígado por diferentes enzimas do citocromo P450(CYP), com a CYP2C9 servindo como a principal enzima no metabolismo da S-warfarin. Nesse sentido, a farmacogenética da terapia com warfarin é relevante para melhorar a segurança e a efetividade dessa terapia. Polimorfismos estruturais no gene CYP2C9 criam variantes alélicos que codificam enzimas com diferentes atividades catalíticas. As freqüências alélicas destes variantes diferem entre diferentes grupos étnicos, sem estudos no Brasil em pacientes com SAF. Conclusão: o conhecimento da presença de polimorfismos genéticos da citocromo P450 em usuários de warfarin é de fundamental importância. Desde que sangramentos ou alvos subterapeuticos podem advir da presença dessas alterações genéticas.


Introduction: antiphospholipid Syndrome is characterized by thrombotic events and repeated pregnancy losses and is considered the most common acquired thrombophilia. When it is not associated with any connective tissue disease, it is said to be primary and its treatment is based on long-term anticoagulation with warfarin. This requires strict control of the prothrombin time performed by monitoring the INR values to avoid the risk of bleeding at one extreme and the risk of thrombosis at the other. Objective: To perform a review of the literature on genetic polymorphisms of cytochrome P450 in antiphospholipid syndrome. Methods: narrative literature review Results: although investigations have identified the influence of several genes on the response to warfarin, most evidence suggests a more important role for the polymorphism of two genes: the cytochrome P450 (CYP) 2C9 (CYP2C9) gene and the reductase complex gene vitamin K 1 epoxide (VKORC1). In fact, warfarin is administered as a racemic mixture of S ­ and R-warfarin and these enantiomers are extensively metabolized in the liver by different enzymes of cytochrome P450 (CYP), with CYP2C9 serving as the main enzyme in the metabolism of S-warfarin . In this sense, the pharmacogenetics of warfarin therapy is relevant to improve the safety and effectiveness of this therapy. Structural polymorphisms in the CYP2C9 gene create allelic variants that encode enzymes with different catalytic activities. The allele frequencies of these variants differ between different ethnic groups, with no studies in Brazil in patients with APS. Conclusion: knowledge of the presence of genetic polymorphisms of cytochrome P450 in users of warfarin is of fundamental importance. Since bleeding or subtherapeutic targets may result from the presence of these genetic changes.


Subject(s)
Humans , Aged , Polymorphism, Genetic , Autoimmune Diseases , Warfarin , Antiphospholipid Syndrome , Anticoagulants , Review
11.
Geriatr., Gerontol. Aging (Impr.) ; 14(4): 228-235, 31-12-2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1151608

ABSTRACT

INTRODUÇÃO: A fibrilação atrial aumenta o risco de eventos cerebrovasculares em cinco vezes. A anticoagulação reduz a incidência e a gravidade desses eventos, entretanto muitos pacientes deixam de receber tromboprofilaxia. OBJETIVOS: Avaliar a prevalência de fibrilação atrial em pacientes idosos acompanhados em um hospital universitário e identificar o percentual desses pacientes com prescrição de anticoagulantes. Os objetivos secundários foram identificar as opções terapêuticas, as justificativas para não indicar o uso e os fatores associados à ineficácia e/ou ausência de tratamento. METODOLOGIA: Em estudo transversal, uma amostra consecutiva de 1.630 pacientes do Hospital de Clínicas O de Porto Alegre foi rastreada entre abril e junho de 2017. Fibrilação atrial foi identificada em 220 (13,50%) indivíduos, dos quais 145 foram avaliados com base na revisão de prontuários e questionário telefônico. A associação entre as variáveis e os desfechos foi analisada por meio do Teste U de Mann-Whitney e do teste do qui-quadrado. RESULTADOS: A prevalência de fibrilação atrial foi de 13,50%. Em 77,93%, havia i-r anticoagulante prescrito. Em 76,11% dos anticoagulados, a opção foi varfarina. Houve tendência de não prescrição para idosos com histórico de sangramento (risco relativo ­ RR = 2,32; índice de confiança de 95% - IC95% 0,95 - 5,64; p = 0,06) e quedas (RR = 2,02; IC95% 0,82 - 5,03; p = 0,08). Houve associação significativa entre maior grau de limitação funcional e maior índice de tratamento no alvo terapêutico (razão de prevalência ­ RP = 022; IC95% 0,06 - 0,87; p = 0,04). CONCLUSÃO: A prevalência de fibrilação atrial foi de 13,5% e, em 77,93% dos casos, havia prescrição de anticoagulante. Houve associação entre incapacidade funcional e melhor índice de anticoagulação no alvo terapêutico.


INTRODUCTION: Atrial fibrillation increases five times the risk of stroke. Anticoagulation reduces the incidence of cerebrovascular events. However, many patients do not receive thromboprophylaxis. OBJECTIVES: To estimate the prevalence of atrial fibrillation in the older patients at a Brazilian university hospital and the proportion of anticoagulation prescription. Secondary objectives were to identify the therapeutic options, the main reasons for non-prescription and the factors associated with ineffectiveness or lack of treatment. METHODS: This was a cross-sectional study with a consecutive sample of 1,630 outpatients selected at Hospital de Clínicas de Porto Alegre between April and June of 2017. Atrial fibrillation was identified in 220 (13.50%) individuals. t Medical records from 145 patients were accessed, followed by a telephone interview. The association between variables and " outcomes was checked using the Mann-Whitney's U Test and a chi-squared test. RESULTS: The prevalence of atrial fibrillation was 13.50%. Anticoagulation therapy was prescribed in 77.93% of cases. In 76.11% of patients, warfarin was the chosen drug. < There was a tendency towards no prescription in patients with previous bleeding (RR = 2.32; 95%CI 0.95 - 5.64; p = 0.06) and falls (RR = 2.02; 95%CI 0.82 - 5.03; p = 0.08). We found an association between reduced functional capacity (Barthel's Activities of Daily Living Score < 80) and higher rate of anticoagulation in therapeutic target (RR = 0.22; 95%CI 0.06 - 0.87; p = 0.04). CONCLUSION: The prevalence of atrial fibrillation in this population was 13.50% and in 77.93% of cases anticoagulant were prescribed. Functional impairment was associated with a higher rate of anticoagulation in therapeutic target.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Atrial Fibrillation/drug therapy , Atrial Fibrillation/epidemiology , Anticoagulants/therapeutic use , Warfarin/therapeutic use , Brazil , Cerebral Infarction , Health of the Elderly
12.
Brasília; s.n; 7 jul. 2020.
Non-conventional in Portuguese | LILACS, BRISA, PIE | ID: biblio-1117630

ABSTRACT

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 17 artigos.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Betacoronavirus/drug effects , Steroids/therapeutic use , Technology Assessment, Biomedical , Vitamin D/therapeutic use , Warfarin/therapeutic use , Ivermectin/therapeutic use , Ceftriaxone/therapeutic use , Chloroquine/therapeutic use , Methotrexate/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Azithromycin/therapeutic use , Ritonavir/therapeutic use , Oseltamivir/therapeutic use , Interleukin 1 Receptor Antagonist Protein/therapeutic use , Lopinavir/therapeutic use , Infliximab/therapeutic use , Leflunomide/therapeutic use , Amoxicillin/therapeutic use , Hydroxychloroquine/therapeutic use , Mycophenolic Acid/therapeutic use
13.
Rev. chil. nutr ; 47(3): 470-477, jun. 2020. tab, graf
Article in English | LILACS | ID: biblio-1126146

ABSTRACT

Vitamin K is found in higher concentrations in dark green plant and in vegetable oils. The adequate intake of vitamin K is 90 and 120ug/day for adult elderly men and women, respectively. The main function of vitamin K is to act as an enzymatic cofactor for hepatic prothrombin synthesis, blood coagulation factors, and anticoagulant proteins. Prominent among the many available anticoagulants is warfarin, an antagonist of vitamin K, which exerts its anticoagulant effects by inhibiting the synthesis of vitamin K1 and vitamin KH2. From the beginning of the therapy it is necessary that the patients carry out the monitoring through the prothrombin time and the international normalized ratio. However, it is known that very low intake and/or fluctuations in vitamin K intake are as harmful as high consumption. In addition, other foods can interact with warfarin, despite their content of vitamin K. The aim of this study was to gather information on the drug interaction of warfarin with vitamin K and with dietary supplements and other foods.


La vitamina K se encuentra en concentraciones más altas en plantas de color verde oscuro y en aceites vegetales. La ingesta adecuada de vitamina K es de 90 y 120 ug/día para hombres y mujeres adultos mayores, respectivamente. La función principal de la vitamina K es actuar como un cofactor enzimático para la síntesis de protrombina hepática, factores de coagulación de la sangre y proteínas anticoagulantes. Entre los muchos anticoagulantes disponibles destaca la warfarina, un antagonista de la vitamina K, que ejerce sus efectos anticoagulantes al inhibir la síntesis de la vitamina K1 y la vitamina KH2. Desde el inicio de la terapia, es necesario que los pacientes realicen el monitoreo a través del tiempo de protrombina y la proporción normalizada internacional. Sin embargo, se sabe que una ingesta muy baja y/o fluctuaciones en la ingesta de vitamina K son tan dañinas como un consumo alto. Además, otros alimentos pueden interactuar con la warfarina, a pesar de su contenido de vitamina K. El objetivo de este estudio fue recopilar información sobre la interacción de los medicamentos de la warfarina con la vitamina K y con los suplementos dietéticos y otros alimentos.


Subject(s)
Humans , Vitamin K/antagonists & inhibitors , Warfarin/administration & dosage , Food-Drug Interactions , Anticoagulants/administration & dosage , Vitamin K/administration & dosage , Vitamin K/metabolism , Warfarin/metabolism , Dietary Supplements , International Normalized Ratio , Anticoagulants/metabolism
15.
Arq. bras. cardiol ; 114(3): 457-466, mar. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088898

ABSTRACT

Abstract Background: The safety and effectiveness of warfarin depend on anticoagulation control quality. Observational studies associate poor control with increased morbidity, mortality and healthcare costs. Objectives: To develop a profile of non-valvular atrial fibrillation (NVAF) patients treated with warfarin in a Brazilian private ambulatory and hospital setting, evaluate the quality of anticoagulation control, and its association with clinical and economic outcomes. Methods: This retrospective study, through a private health insurance dataset in Brazil, identified NVAF patients treated with warfarin between 01 MAY 2014 to 30 APRIL 2016, described their anticoagulation management, and quantified disease-related costs. Data on demographics, clinical history, concomitant medication and time in therapeutic range (TTR) of international normalized ratio (INR) values were retrieved. Patients were grouped into TTR quartiles, with good control defined as TTR ≥ 65% (Rosendaal method). Major bleeds and all-cause direct medical costs were calculated and compared between good and poor control subgroups. P-values < 0.05 were considered statistically significant. Results: The analysis included 1220 patients (median follow-up: 1.5 years; IQR: 0.5-2.0). On average, each patient received 0.95 monthly INR measurements (mean INR: 2.60 ± 0.88, with 26.1% of values < 2 and 24.8% > 3), (median TTR: 58%; IQR: 47-68%), (mean TTR: 56.6% ± 18.9%). Only 31% of patients were well-controlled (mean TTR: 78% ± 10%), with 1.6% having major bleeds within median follow-up, and direct medical costs per member per year (PMPY) of R$25,352(± R$ 37,762). Poorly controlled patients (69%) were associated with 3.3 times more major bleeds (5.3% vs. 1.6%; p < 0.01) and 40% higher costs (R$35,384 vs. R$25,352; p < 0.01). Conclusions: More than 60% of the patients were below the desired target and the associated costs were higher.


Resumo 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 ambulatorial e 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 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 com controle abaixo do ideal (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 significativamente maiores nesta população.


Subject(s)
Humans , Atrial Fibrillation , Stroke , Warfarin , Brazil , Retrospective Studies , Treatment Outcome , International Normalized Ratio , Anticoagulants
16.
Arq. bras. cardiol ; 114(3): 435-442, mar. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088893

ABSTRACT

Abstract Background: Atrial fibrillation (AF) ablation under uninterrupted warfarin use is safe and recommended by experts. However, there is some controversy regarding direct-acting oral anticoagulants for the same purpose. Objective: To evaluate the safety of AF ablation under uninterrupted anticoagulation with rivaroxaban. Methods: A series of 130 patients underwent AF radiofrequency ablation under uninterrupted rivaroxaban use (RIV group) and was compared to a control group of 110 patients under uninterrupted warfarin use (WFR group) and therapeutic International Normalized Ratio (INR). We analyzed death, rates of thromboembolic events, major and minor bleedings, activated clotting time (ACT) levels, and heparin dose in the procedure. The ablation protocol basically consisted of circumferential isolation of the pulmonary veins guided by electroanatomic mapping. It was adopted a statistical significance of 5%. Results: The clinical characteristics of the groups were similar, and the paroxysmal AF was the most frequent type (63% and 59%, RIV and WFR groups). A thromboembolic event occurred in the RIV group. There were 3 patients with major bleeding (RIV = 1 and WFR = 2; p = 0.5); no deaths. Basal INR was higher in the WFR group (2.5 vs. 1.2 ± 0.02; p < 0.0001), with similar basal ACT levels (123.7 ± 3 vs. 118 ± 4; p= 0, 34). A higher dose of venous heparin was used in the RIV group (9,414 ± 199 vs. 6,019 ± 185 IU; p < 0.0001) to maintain similar mean ACT levels during the procedure (350 ± 3 vs. 348.9 ± 4; p = 0.79). Conclusion: In the study population, AF ablation under uninterrupted rivaroxaban showed a safety profile that was equivalent to uninterrupted warfarin use with therapeutic INR.


Resumo Fundamento: A ablação de fibrilação atrial (FA) sob uso ininterrupto de varfarina é segura e recomendada por especialistas. Entretanto, há controvérsia quanto aos anticoagulantes orais de ação direta para o mesmo fim. Objetivo: Avaliar a segurança em realizar ablação de FA sob anticoagulação ininterrupta com rivaroxabana. Métodos: Uma série de 130 pacientes foi submetida à ablação com radiofrequência da FA sob uso ininterrupto de rivaroxabana (grupo RIV) e comparada a um grupo-controle de 110 pacientes que a fizeram sob uso ininterrupto de varfarina (grupo VRF) e relação normatizada internacional (RNI) terapêutica. Analisamos morte, taxas de eventos tromboembólicos, de sangramentos maiores e menores, níveis do tempo de coagulação ativado (TCA) e dose de heparina no procedimento. O protocolo da ablação consistiu basicamente em isolamento circunferencial das veias pulmonares guiado por mapeamento eletroanatômico. Significância estatística de 5% foi adotada. Resultados: As características clínicas dos grupos foram semelhantes e a FA paroxística mais frequente (63% e 59%, grupos RIV e VRF). Um evento tromboembólico ocorreu no grupo RIV. Foram três pacientes com sangramentos maiores (RIV = 1 e VRF = 2; p = 0,5); nenhum óbito. A RNI basal foi maior no grupo VRF (2,5 vs. 1,2 ± 0,02; p < 0,0001), com níveis de TCA basal semelhantes (123,7 ± 3 vs. 118 ± 4; p = 0,34). Maior dose de heparina venosa foi utilizada no grupo RIV (9.414 ± 199 vs. 6.019 ± 185 UI; p < 0,0001) para manter níveis médios de TCA semelhantes durante o procedimento (350 ± 3 vs. 348,9 ± 4; p = 0,79). Conclusão: Na população estudada, a ablação de FA sob rivaroxabana ininterrupta teve segurança equivalente à varfarina ininterrupta, com RNI terapêutica.


Subject(s)
Humans , Atrial Fibrillation , Catheter Ablation , Warfarin , Treatment Outcome , Rivaroxaban , Anticoagulants
17.
Belo Horizonte; s.n; 2020. 186 p. ilus.
Thesis in Portuguese | LILACS, BBO | ID: biblio-1341929

ABSTRACT

O objetivo deste trabalho foi determinar a efetividade das terapias hemostáticas em indivíduos sob terapia anticoagulante a fim de evitar o sangramento por procedimentos odontológicos e descrever os fatores associados à qualidade de vida e saúde bucal entre pacientes em terapia anticoagulante oral com varfarina. Inicialmente foi desenvolvida uma revisão sistemática e meta-analise em rede que revisou os ensaios clínicos em diferentes bases de dados para determinar a efetividade das terapias hemostáticas. A extração de dados, a avaliação do risco de viés dos artigos incluídos (ferramentas de JBI e Cochrane) e a avaliação da certeza das evidências (GRADE) foram realizadas. Como resultados, foi verificado que o N-butil-2-cianoacrilato [RR -35,00 (95% CI - 107,12, -5,78)], sulfato de cálcio (CaSO4) [RR -5,62 (95% CI -11,41, -1,03)], e Ácido tranexâmico (TXA) [RR -3,46 (95% CI -7,63, -0,77)] mostraram efeitos benéficos em comparação com o placebo. No entanto, apenas o TXA apresentou efeitos benéficos com evidência de certeza moderada. N-butil-2-cianoacrilato e CaSO4 apresentaram evidência de certeza muito baixa. Não foram observadas diferenças entre agentes hemostáticos na prevenção de eventos de sangramento. Concluindo, os eventos de sangramento em indivíduos em anticoagulação oral diminuíram com o uso de TXA em comparação com o placebo. O N-butil-2-cianoacrilato e o CaSO4 também foram superiores ao placebo, mas a certeza das evidências era baixa. Para o tempo médio de sangramento, não foi observada diferença significativa nos agentes hemostáticos. Por outro lado, foi desenvolvido um estudo transversal, questionários validados avaliaram doença periodontal auto-relatada, variáveis demográficas e qualidade de vida relacionada à saúde bucal (QVRSB), usando a versão curta do instrumento Oral Health Impact Profile (OHIP-14), em pacientes anticoagulados de um Hospital de Belo Horizonte, Brasil. Após a calibração intra-examinador (Kappa = 0,95), um examinador avaliou a experiência dos pacientes com cárie dentária e a necessidade de próteses dentárias. A análise estatística envolveu proporções e medidas de tendência central. Modelos de regressão binomial negativos foram usados para estimar as razões de taxas (RR) e os intervalos de confiança de 95% (IC) correspondentes. A média do OHIP-14 foi de 10,62 (DP = 10,92). Um escore total do OHIP-14 mais alto (baixa QVRSB) foi associado ao grupo étnico, idade, auto-relato de doença periodontal, cárie dentária e auto-relato de saúde bucal. Concluindo, as doenças bucais entre indivíduos submetidos a terapia anticoagulante oral com varfarina é preocupante. Os fatores demográficos e clínicos têm uma influência na percepção de pacientes anticoagulados na QVRSB.


This study aimed to determine the effectiveness of hemostatic protocols in anticoagulated patients to prevent bleeding in dental procedures and describe the factors associated with quality of life and oral health-related to patients undergoing oral anticoagulant therapy with warfarin. In the first instance, in the systematic review and network meta-analysis, a search of the literature was conducted in different databases where clinical trials were evaluated to determine the effectiveness of hemostatic protocols. Data extraction and assessment of the risk of bias (JBI and Cochrane tools) of the included articles were performed. Assessment of the certainty of the evidence (GRADE) was also performed. As results we find that the N-butyl-2-cyanoacrylate [RR -35.00 (95% CI - 107.12, -5.78)], calcium sulfate (CaSO4) [RR -5.62 (95% CI -11.41, -1.03)], and tranexamic acid (TXA) [RR -3.46 (95% CI -7.63, -0.77)] showed beneficial effects compared to placebo. However, only TXA presented beneficial effects with moderate certainty evidence. N-butyl-2-cyanoacrylate and CaSO4 presented very low certainty evidence. No differences were observed between hemostatic agents in preventing bleeding events. Concluding, the bleeding events in individuals on oral anticoagulation decreased with the use of TXA compared to placebo. N-butyl-2-cyanoacrylate and CaSO4 were also superior to placebo, but the certainty of the evidence was low. For the mean bleeding time, no significant difference in hemostatic agents was observed. On the other hand, a the cross-sectional study was performed, validated questionnaires assessed self-reported periodontal disease, demographic variables, and OHRQoL, using the short version of the Oral Health Impact Profile (OHIP-14) instrument in anticoagulated patients at a Belo Horizonte, Brazil. After calibration (Kappa = 0,95), an examiner evaluated patients' experience with dental caries and the need for dental prostheses. Statistical analysis involved proportions and measures of central tendency. Negative binomial regression models were used to estimate the rate ratios (RR) and the corresponding 95% confidence interval (CI). The OHIP-14 mean was 10.62 (SD = 10.92). A higher OHIP-14 total score (low OHRQoL) was associated with an ethnic group, age, periodontal disease self-report, dental caries, and oral health self-report. Concluding, the burden of oral diseases among individuals undergoing OAT is worrisome. Additionally, demographic and clinical factors have an influence on the perception of anticoagulated patients on OHRQoL.


Subject(s)
Quality of Life , Oral Health , Hemostatic Techniques , Dental Care , Anticoagulants , Periodontal Diseases , Warfarin , Cross-Sectional Studies
18.
Article in English | WPRIM | ID: wpr-785398

ABSTRACT

BACKGROUND: Differences in the performance of suggested warfarin dosing algorithms among different ethnicities and genotypes have been reported; this necessitates the development of an algorithm with enhanced performance for specific population groups. Previous warfarin dosing algorithms underestimated warfarin doses in VKORC1 1173C carriers. We aimed to develop and validate a new warfarin dosing algorithm for Korean patients with VKORC1 1173C.METHODS: A total of 109 patients carrying VKORC1 1173CT (N=105) or 1173CC (N=4) were included in this study. Multiple regression analysis was performed to deduce a new dosing algorithm. Following literature searches for genotype-guided warfarin dosing algorithms, 21 algorithms were selected and evaluated using the correlation coefficient (ρ) of actual dose and estimated dose, mean error, and root mean square error.RESULTS: The developed algorithm is as follows: maintenance dose (mg/week)=exp [3.223−0.009×(age)+0.577×(body surface area [BSA])+0.178×(sex)−0.481×(CYP2C9 genotype)+0.227×(VKORC1 genotype)]. Integrated variables explained 44% of the variance in the maintenance dose. The predicted and actual doses showed moderate correlation (ρ=0.641) with the best performance with a mean error of −1.30 mg/week. The proportion of underestimated groups was 17%, which was lower than with the other algorithms.CONCLUSIONS: This is the first study to develop and validate a warfarin dosing algorithm based on data from VKORC1 1173C carriers; it showed superior predictive performance compared with previously published algorithms.


Subject(s)
Genotype , Humans , Korea , Population Groups , Warfarin
20.
Korean Circulation Journal ; : 163-175, 2020.
Article in English | WPRIM | ID: wpr-786221

ABSTRACT

BACKGROUND AND OBJECTIVES: Although anticoagulation with warfarin is recommended as an international normalized ratio (INR) of prothrombin time between 2.0 and 3.0 and mean time in the therapeutic range (TTR) ≥70%, little has been proven that universal criteria might be suitable in Korean atrial fibrillation (AF) patients.METHODS: We analyzed 710 patients with non-valvular AF who took warfarin. INR value and clinical outcomes were assessed during 2-year follow-up. Intensity of anticoagulation was assessed as mean INR value and TTR according to target INR range. Primary net-clinical outcome was defined as the composite of new-onset stroke and major bleeding. Secondary net-clinical outcome was defined as the composite of new-onset stroke, major bleeding and death.RESULTS: Thromboembolism was significantly decreased when mean INR was over 1.6. Major bleeding was significantly decreased when TTR was over 70% and mean INR was less than 2.6. Mean INR 1.6–2.6 significantly reduced thromboembolism (adjusted hazard ratio [HR], 0.40; 95% confidence interval [CI], 0.19–0.85), major bleeding (HR, 0.43; 95% CI, 0.23–0.81), primary (HR, 0.50; 95% CI, 0.29–0.84) and secondary (HR, 0.45; 95% CI, 0.28–0.74) net-clinical outcomes, whereas mean INR 2.0–3.0 did not. Simultaneous satisfaction of mean INR 1.6–2.6 and TTR ≥70% was associated with significant risk reduction of major bleeding, primary and secondary net-clinical outcomes.CONCLUSIONS: Mean INR 1.6–2.6 was better than mean INR 2.0–3.0 for the prevention of thromboembolism and major bleeding. However, INR 1.6–2.6 and TTR ≥70% had similar clinical outcomes to INR 2.0–3.0 and TTR ≥70% in Korean patients with non-valvular AF.


Subject(s)
Atrial Fibrillation , Follow-Up Studies , Hemorrhage , Humans , International Normalized Ratio , Prothrombin Time , Risk Reduction Behavior , Stroke , Thromboembolism , Warfarin
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