Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 133
Filter
1.
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
2.
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
3.
Brasília; s.n; 7 jul. 2020.
Non-conventional in Portuguese | PIE, 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
4.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 11(5): 1312-1318, out.-dez. 2019. ilus
Article in English, Portuguese | SES-SP, LILACS, BDENF, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-1022225

ABSTRACT

Objective: The study's purpose has been to relate the drug interactions of oral anticoagulants with other medications used by elderly people hospitalized in a cardiology hospital. Methods: It is a prospective exploratory study with 16 elderly people taking oral anticoagulant, who were hospitalized at a governmental cardiology institution in São Paulo State over the period from November to December 2017. Results: Among 73 medicines prescribed and analyzed in the Micromedex 2.0, 24 (33.3%) interacted with Warfarin, the only prescribed oral anticoagulant. There were found Omeprazole (70; 97.2%); Dipyrone (68; 94.4%); Simvastatin (43; 59.72%); Enoxaparin (42; 58.33%); Amiodarone (29; 40.27%); Sertraline (28; 38.88%); Spironolactone (21; 29.16%); and Atenolol (11; 15.27%), whose interactions could either potentialize or inhibit the anticoagulant action. Considering the interactions, 14 (58.33%) were of moderate severity, 10 (41.66%) of high severity and 14 (58.33%) of fast effect. Conclusion: Polypharmacy and the use of oral anticoagulants in elderly patients bearing heart diseases are common events. Moreover, a better understanding about drug interactions is also required, bearing in mind that they can either potentialize or decrease the anticoagulant effect, with high or moderate severity


Objetivo: Relacionar as interações medicamentosas dos anticoagulantes orais com os medicamentos utilizados por idosos internados em hospital cardiológico. Método: Estudo exploratório, prospectivo, com 16 idosos em uso de anticoagulantes orais, internados numa instituição cardiológica governamental de São Paulo entre novembro e dezembro de 2017. Resultados: Dentre 73 medicamentos prescritos e analisados no Micromedex 2.0, 24 (33,3%) interagiam com a Varfarina, único anticoagulante oral prescrito. Encontrou-se Omeprazol (70;97,2%); Dipirona (68;94,4%); Sinvastatina (43;59,72%); Enoxaparina (42;58,33%); Amiodarona (29;40,27%); Sertralina (28;38,88%); Espironolactona (21;29,16%); e Atenolol (11;15,27%), cujas interações poderiam potencializar ou inibir a ação anticoagulante. Das interações, 14 (58,33%) eram de gravidade moderada, 10 (41,66%) maior e 14 (58,33%) de efeito rápido. Conclusão: A polifarmácia e o uso de anticoagulante oral em idosos cardiopatas é comum e, conhecer as interações medicamentosas, é imperativa, considerando que potencializam ou diminuem a ação anticoagulante, com gravidade maior ou moderada


Objetivo: Relacionar las interacciones medicamentosas de los anticoagulantes orales con los medicamentos utilizados por ancianos internados em um hospital cardiológico. Método:Estudio exploratorio, prospectivo, con 16 ancianos en uso de anticoagulantes orales, internados en una institución cardiológica gubernamental de São Paulo entre noviembre y diciembre de 2017. Resultados:Entre 73 medicamentos prescritos y analizados en el Micromedex 2.0, 24 (33,3%) interactuaban con la Varfarina, único anticoagulante oral prescrito. Se encontró Omeprazol (70, 97,2%); Dipirona (68, 94,4%); Sinvastatina (43, 59,72%); Enoxaparina (42, 58,33%); Amiodarona (29, 40,27%); Sertralina (28, 38,88%); Espironolactona (21, 29,16%); y Atenolol (11, 15,27%), cuyas interacciones podrían potenciar o inhibir la acción anticoagulante. De las interacciones, 14 (58,33%) eran de gravedad moderada, 10 (41,66%) mayor y 14 (58,33%) de efecto rápido. Conclusión: La polifarmacia y el uso de anticoagulante oral en ancianos cardiopatas es común y, conocer las interacciones medicamentosas, es imperativa, considerando que potencian o disminuyen la acción anticoagulante, con gravedad mayor o moderada


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Warfarin/therapeutic use , Drug Interactions , Drug-Related Side Effects and Adverse Reactions , Anticoagulants/therapeutic use , Warfarin/adverse effects , Health of the Elderly , Anticoagulants/adverse effects
5.
Actual. osteol ; 15(2): 78-93, mayo - ago. 2019. ilus.
Article in Spanish | LILACS | ID: biblio-1048450

ABSTRACT

Los hallazgos osteológicos se intensi!caron en los últimos años. Se demostró que el esqueleto se comporta, además de sus funciones clásicas, como un órgano de secreción endocrina que sintetiza al menos dos hormonas: el factor de crecimiento de !broblastos 23 (FGF-23) y la osteocalcina (Ocn). La Ocn es un péptido pequeño que contiene 3 residuos de ácido glutámico. Estos residuos se carboxilan postraduccionalmente, quedando retenida en la matriz ósea. La forma decarboxilada en el primer residuo de ácido glutámico (GluOcn) fue reportada por poseer efectos biológicos; la resorción ósea es el mecanismo clave para su bioactivación. La presente revisión se centra en los conocimientos actuales sobre la función hormonal de la Ocn. A la fecha se reporta que la Ocn regularía el metabolismo energético aumentando la proliferación de células ` pancreáticas, y la secreción de insulina y de adiponectina. Sobre el músculo esquelético actuaría favoreciendo la absorción y el catabolismo de nutrientes. La función reproductiva masculina estaría regulada mediante el estímulo a las células de Leydig para sintetizar testosterona; en el desarrollo cerebral y la cognición, la Ocn aumentaría la síntesis de neurotransmisores monoaminados y disminuiría el neurotransmisor inhibidor GABA. Si bien son indispensables mayores evidencias para dilucidar los mecanismos reguladores por medio de los cuales actuaría la Ocn, los resultados enumerados en los distintos estudios experimentales establecen la importancia de este novedoso integrante molecular. Dilucidar su rol dentro de estos procesos interrelacionados en seres humanos abriría la posibilidad de utilizar a la Ocn en el tratamiento de enfermedades endocrino-metabólicas. (AU)


Osteological !ndings have intensi!ed in recent years. The skeleton behaves as an endocrine secretion organ that synthesizes at least two hormones: osteocalcin (Ocn) and !broblast growth factor 23 (FGF-23). Ocn is a small peptide that contains 3 glutamic acid residues. After translation, these residues are carboxylated to make possible its retention into the bone matrix. Decarboxylation on the !rst glutamic acid residue (GluOcn) has been reported to have biological effects. Bone resorption is the key mechanism for its bioactivation. This review focuses on current knowledge on Ocn hormonal function. It has been reported that Ocn regulates energy metabolism by increasing the proliferation of pancreatic ` cells, and the secretion of insulin and adiponectin. On the skeletal muscle, it may act by favoring the absorption and catabolism of nutrients. Male reproductive function might be regulated by stimulating Leydig cells to synthesize testosterone. Regarding brain development and cognition, Ocn would increase monoamine neurotransmitters synthesis and decrease inhibitory neurotransmitter GABA. Although more evidence is needed to elucidate the regulatory mechanisms of Ocn, different experimental studies establish the importance of this novel molecular mediator. Clarifying its role within interrelated processes in humans, might open the possibility of using Ocn in different treatments of endocrine-metabolic diseases. (AU)


Subject(s)
Animals , Osteocalcin/metabolism , Osteocalcin/therapeutic use , Skeleton/physiology , Skeleton/metabolism , Skeleton/pathology , Warfarin/therapeutic use , Cardiovascular Diseases/prevention & control , Osteocalcin/biosynthesis , Osteocalcin/chemistry , Diabetes Mellitus, Type 2/prevention & control , Endocrine System Diseases/therapy , Energy Metabolism/physiology , Insulin-Secreting Cells/physiology , Fertility , Fibroblast Growth Factors/metabolism , Genitalia, Male/metabolism , Infertility/prevention & control , Metabolic Diseases/therapy , Neoplasms/prevention & control
6.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(3): 255-260, jul.-set. 2019. tab
Article in English, Portuguese | LILACS | ID: biblio-1023043

ABSTRACT

Os maiores avanços no tratamento das arritmias cardíacas, que geraram propostas de mudança e/ou incorporação de novas tecnologias de tratamento medicamentoso ou intervencionista, referem-se à fibrilação atrial, arritmia sustentada mais frequente na prática clínica, razão pela qual demos maior ênfase a essa análise. Os últimos estudos que têm proporcionado revisões, atualizações e perspectivas das principais diretrizes mundiais são os que envolvem as comparações dos esquemas de combinações de anticoagulação e antiagregação plaquetária em pacientes com fibrilação atrial no contexto da doença arterial coronariana com intervenção planejada ou imediata, bem como os que envolvem a estratégia de ablação por cateteres com opção no início do tratamento da fibrilação atrial nos pacientes com insuficiência cardíaca com fração de ejeção reduzida


The greatest advances in the treatment of cardiac arrhythmias, which have led to proposals of change and/or the incorporation of new drug or intervention treatment technologies, relate to atrial fibrillation, the most common sustained arrhythmia in medical practice, which is why we have placed more emphasis on it in this analysis. The latest studies to have revised, updated, and offered new perspectives on the principal global guidelines are those that involve comparisons of regimens that combine anticoagulation and antiaggregation of platelets in patients with atrial fibrillation within the context of coronary artery disease with planned or immediate intervention, as well of those that involve a catheter ablation strategy as an option at the beginning of treatment for atrial fibrillation in patients with heart failure with reduced ejection fraction


Subject(s)
Humans , Male , Female , Arrhythmias, Cardiac/physiopathology , Arrhythmias, Cardiac/therapy , Atrial Fibrillation , Warfarin/therapeutic use , Coronary Artery Disease , Stents , Aspirin/therapeutic use , Guidelines as Topic/standards , Catheter Ablation/methods , Hemorrhage , Anticoagulants
7.
Arq. neuropsiquiatr ; 77(2): 80-83, Feb. 2019. tab
Article in English | LILACS | ID: biblio-983886

ABSTRACT

ABSTRACT Objectives: To compare warfarin and dabigatran for thromboembolic event prevention in patients with nonvalvular atrial fibrillation or atrial flutter. Methods: This was a retrospective cohort of participants with nonvalvular atrial fibrillation or atrial flutter using either warfarin or dabigatran in a reference center in Brazil. Results: There were 112 patients (mean age 65.5 years), with 55.3% using warfarin. The median duration of follow-up was 1.9 years for warfarin and 1.6 years for dabigatran (p = 0.167). Warfarin patients had a higher median of medical appointments per year (8.3 [6.8-10.4] vs 3.1 [2.3-4.2], p < 0.001) and the frequency of minor bleeding was more than four times higher (17.7% vs 4.0%, p = 0.035). Among patients with prior stroke, those using warfarin had 2.6 times more medical appointments for person-years of follow-up (8.5 vs 3.3). There was no major bleeding or embolic event during follow-up period. Conclusion: The dabigatran group had a lower frequency of minor bleeding and number of medical appointments than the warfarin group, without more embolic events or major bleeding.


RESUMO Objetivos: Comparar varfarina e dabigatrana para prevenção de eventos tromboembólicos em pacientes com fibrilação atrial não valvar ou flutter (FA). Métodos: Coorte retrospectiva de pacientes com FA em uso de varfarina ou dabigatrana em serviço especializado no Brasil. Resultados: Foram avaliados 112 pacientes (média idade 65,5), com 55,3% no grupo varfarina. A mediana do tempo de seguimento foi de 1,9 anos para o grupo varfarina e 1,6 para dabigatrana (p = 0,167). No grupo varfarina houve maior mediana de consultas médicas (CM) por ano (8,3[6,8-10,4] vs. 3,1[2,3-4,2], p < 0,001), com frequência de sangramento menor quatro vezes maior (17,7% vs. 4,0%, p = 0,035). Nos pacientes com acidente vascular cerebral isquêmico prévio, o grupo varfarina teve 2,6 vezes mais CM por pessoas-ano de seguimento (8,5 vs. 3,3). Não houve sangramento maior ou eventos embólicos no período de seguimento. Conclusão: Pacientes em uso de dabigatrana tiveram menor número de sangramento menor e CM que aqueles em uso de varfarina, sem aumentar eventos embólicos ou sangramentos maiores.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Atrial Fibrillation/prevention & control , Atrial Flutter/prevention & control , Thromboembolism/prevention & control , Warfarin/therapeutic use , Dabigatran/therapeutic use , Anticoagulants/therapeutic use , Atrial Fibrillation/complications , Atrial Flutter/complications , Thromboembolism/etiology , Brazil , Retrospective Studies , Risk Factors , Follow-Up Studies , Treatment Outcome , Statistics, Nonparametric , Stroke/etiology , Stroke/prevention & control , Ambulatory Care Facilities , Hemorrhage/prevention & control , Anti-Arrhythmia Agents/therapeutic use
8.
Rev. APS ; 22(1)20190101.
Article in Portuguese | LILACS | ID: biblio-1102636

ABSTRACT

O objetivo deste trabalho foi avaliar o conhecimento sobre a terapia anticoagulante antes e depois da aplicação de um vídeo educativo em pacientes ambulatoriais em uso de varfarina atendidos por um hospital público. O conhecimento dos pacientes foi avaliado por seis perguntas, sendo calculado o percentual de respostas certas. Identificou-se os pacientes com percentual de acerto ≥ 60%, e para avaliar o conhecimento adquirido com o vídeo foi determinado o acerto antes e depois da visualização para a pergunta sobre qual é a indicação da varfarina. A análise estatística univariada e os testes MacNemer e Mann­Witney foram realizadas no SPSS 21.0. O vídeo foi avaliado por 62 pacientes, sendo que 41 (66,1%) tinham até seis meses de tratamento. O conhecimento sobre a indicação da varfarina aumentou após o vídeo (p = 0,006). Não houve diferença significativa entre o percentual de acertos considerando tempo de tratamento ≥ 6 meses ou < 6 meses (p = 0,775). O vídeo ajudou a esclarecer dúvidas sobre anticoagulação de 98,4% dos pacientes. Os resultados sugerem que o material audiovisual elaborado pode contribuir para ampliar o conhecimento sobre o tratamento com varfarina e, consequentemente, proporcionar aumento das taxas de adesão ao tratamento com anticoagulante e aumentar a segurança dos pacientes.


This paper aims to evaluate the knowledge of anticoagulant therapy before and after application of an educational video in outpatients using warfarin under the care of a public hospital. The knowledge of the patients was evaluated with six questions by calculating the percentage of correct answers. The patients with a ≥ 60% percentage of correct answers were identified and to assess the knowledge acquired with the video, the amount of correct answers to the question of what is the warfarin indicate was determined before and after the video. Univariate statistical analysis and MacNemer and Mann-Whitney tests were performed with SPSS 21.0. The video was rated by 62 patients, from which 41 (66.1%) had up to six months of treatment. Knowledge of the indication of warfarin increased after the video (p = 0.006). There was no significant difference between the percentage of correct answers of patients considering treatment time ≥6 months and <6 months (p = 0.775). The video helped answer questions about anticoagulation from 98.4% of the patients. The results suggest that the elaborated audiovisual material can help to expand knowledge about treatment with warfarin and thus provide increased adherence rates to anticoagulation treatment and increase patient safety.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Audiovisual Aids , Warfarin/therapeutic use , Health Knowledge, Attitudes, Practice , Patient Education as Topic/methods , Medication Adherence , Anticoagulants/therapeutic use
9.
Rev. gaúch. enferm ; 40: e20190083, 2019. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1043015

ABSTRACT

Resumo OBJETIVO Identificar as crenças relacionadas à adesão a dieta de pacientes tratados com anticoagulante oral. MÉTODO Estudo descritivo, norteado pela Theory of Reasoned Action, realizado com 57 pacientes em uso contínuo de anticoagulantes orais, atendidos em ambulatório cardiológico geral em João Pessoa/PB e especializado em anticoagulação no Recife/PE. Os dados foram coletados no período de fevereiro a maio de 2017, com aplicação de formulário com perguntas abertas, por meio de entrevista, e submetidos a análise descritiva. RESULTADOS As crenças comportamentais positivas mais referidas foram melhorar a saúde/tratamento no ambulatório geral e controlar a coagulação, no serviço especializado. Filhos, esposo(a), médicos(as) e pais se destacaram, proporcionalmente, em ambos os cenários, como crenças normativas positivas. CONCLUSÃO No ambulatório especializado em anticoagulação oral os pacientes agregam mais crenças específicas acerca da interferência da dieta rica em vitamina K sobre a coagulação, quando comparados com os do ambulatório cardiológico geral.


Resumen OBJETIVO Identificar las creencias relacionadas con la adhesión a la dieta de pacientes tratados con anticoagulante oral. MÉTODO Estudio descriptivo, orientado por la Theory of Reasoned Action, realizado con 57 pacientes en uso continuo de anticoagulantes orales, atendidos en ambulatorio cardiológico general en João Pessoa y especializado en anticoagulación en Recife. Se recolectaron los datos en el período de febrero a mayo de 2017, aplicándose un formulario con preguntas abiertas, por medio de entrevista, y sometido al análisis descriptivo. RESULTADOS Las creencias con conductas positivas más referidas fueron mejorar la salud/el tratamiento en el ambulatorio general y controlar la coagulación en el servicio especializado. Hijos, esposos, médicos y padres se destacaron, proporcionalmente, en ambos escenarios, como creencias normativas positivas. CONCLUSIÓN En el ambulatorio especializado en anticoagulación oral los pacientes agregan más creencias específicas acerca de la interferencia de la dieta rica en vitamina K sobre la coagulación, cuando comparados con los del ambulatorio cardiológico general.


Abstract OBJECTIVE Identify the beliefs related to adherence to diet of patients treated with oral anticoagulant. METHOD Descriptive study, guided by the Theory of Reasoned Action, conducted with 57 patients in continuous use of oral anticoagulants, attended at a general cardiology outpatient clinic in João Pessoa and specialized in anticoagulation in Recife. Data were collected from February to May 2017, with an application form with open questions, through an interview, and submitted to a descriptive analysis. RESULTS The most mentioned positive behavioral beliefs were to improve health/treatment in the general outpatient clinic and to control coagulation, in the specialized service. Children, spouses, doctors, and parents stood out proportionally in both scenarios as positive normative beliefs. CONCLUSION In the outpatient clinic specializing in oral anticoagulation, patients add more specific beliefs about the interference of vitamin K-rich diet on coagulation, when compared to those in the general cardiology outpatient clinic.


Subject(s)
Humans , Male , Female , Warfarin/therapeutic use , Health Knowledge, Attitudes, Practice , Patient Compliance/psychology , Diet/psychology , Anticoagulants/therapeutic use , Cross-Sectional Studies , Administration, Oral , International Normalized Ratio , Feeding Behavior/psychology , Middle Aged
10.
J. vasc. bras ; 18: e20180111, 2019. tab
Article in Portuguese | LILACS | ID: biblio-1012628

ABSTRACT

Contexto A trombose venosa profunda (TVP) afeta anualmente cerca de dez milhões de pessoas no mundo e tem como principais complicações a embolia pulmonar e a síndrome pós-trombótica. O tratamento padrão é a anticoagulação, que pode ser realizada com heparinas, antagonistas da vitamina K, fondaparinux ou, mais recentemente, com anticoagulantes orais diretos (direct oral anticoagulants, DOACs). Os anticoagulantes diminuem a progressão do trombo e facilitam os mecanismos trombolíticos naturais, fato conhecido como recanalização, que pode ocorrer em graus e tempos variados, influenciados por diversos fatores, dentre eles o tipo de anticoagulação utilizado. Objetivos Avaliar o grau e o tempo de recanalização através da análise de laudos de eco-Doppler colorido (EDC) de pacientes com TVP tratados com DOACs ou com heparina + varfarina. Métodos Foram avaliados retrospectivamente os dados demográficos e os laudos dos EDC dos pacientes com TVP, tratados entre janeiro de 2009 a dezembro de 2016. Os pacientes foram divididos em dois grupos, de acordo com a terapêutica utilizada: Grupo I (heparina + varfarina): 26 pacientes; Grupo II (rivaroxabana): 51 pacientes. Os principais itens observados foram o grau e o tempo para a recanalização. Resultados Foram observadas taxas de recanalização aos 30, 90 e 180 dias de 10%, 52,5% e 78,9%, respectivamente, no Grupo I, e de 55,3%, 83,5% e 92,4%, respectivamente, no Grupo II, com diferença estatisticamente significativa (p = 0,041). Conclusões Ambos os tratamentos promoveram recanalização. Houve recanalização mais precoce no grupo de pacientes que utilizaram a rivaroxabana


Deep venous thrombosis (DVT) strikes around ten million people worldwide every year and is associated with major complications including pulmonary embolism and post-thrombotic syndrome. Anticoagulation is the standard treatment, with administration of heparins, vitamin K antagonists, fondaparinux, or, more recently, direct oral anticoagulants (DOACs). Anticoagulants reduce thrombus progression and facilitate natural thrombolytic mechanisms, leading to a phenomenon known as recanalization, which can occur in varying degrees and over variable periods of time, under influence from many different factors, including the type of anticoagulation employed. Objectives To evaluate the degree of recanalization and the time taken, by analysis of color Doppler ultrasonography (CDU) reports from patients with DVT treated with DOACs or with heparin + warfarin. Methods A retrospective analysis was conducted of demographic data and CDU reports from patients with DVT who had been treated from January 2009 to December 2016. These patients were classified into two groups, according to the treatment given: Group I (heparin + warfarin): 26 patients; or Group II (rivaroxaban): 51 patients. The primary outcomes assessed were degree of recanalization and time taken. Results Recanalization rates at 30, 90, and 180 days were 10%, 52.5%, and 78.9%, respectively, in Group I, and 55.3%, 83.5%, and 92.4%, respectively, in Group II, with statistically significant difference (p = 0.041). Conclusions Both treatments led to recanalization. Recanalization occurred earlier among patients treated with rivaroxaban


Subject(s)
Humans , Male , Female , Middle Aged , Warfarin/therapeutic use , Venous Thrombosis/therapy , Rivaroxaban/therapeutic use , Thromboembolism/diagnosis , Thromboembolism/therapy , Echocardiography/methods , Heparin/therapeutic use , Phlebography/methods , Ultrasonography/methods , Postthrombotic Syndrome/complications , Anticoagulants/therapeutic use
11.
Rev. bras. anestesiol ; 68(6): 645-649, Nov.-Dec. 2018. graf
Article in English | LILACS | ID: biblio-977409

ABSTRACT

Abstract Introduction: Advanced hepatic disease may - in addition to the widely recognized hemorrhagic complications - occur with thrombotic events. We describe the case of a cirrhotic patient taking warfarin and whose coagulation management during liver transplantation was guided by thromboelastometry (ROTEM®). Case report: A 56 year-old male patient diagnosed with alcohol cirrhosis using warfarin (2.5 mg.day−1) for partial portal vein thrombosis with the International Normalized Ratio (INR) of 2.14. At the beginning of surgery, the ROTEM® parameters were all normal. In the anhepatic phase, EXTEM and INTEM remained normal, but FIBTEM showed reduction of amplitude after 10 min and maximum clot firmness. Finally, in the neohepatic phase, there was a slight alteration in the hypocoagulability of most of the parameters of the EXTEM, INTEM and FIBTEM, besides a notable correction of the Coagulation Time (CT) in HEPTEM compared to the CT of the INTEM. Therefore, the patient did not receive any transfusion of blood products during surgery and in the postoperative period, being discharged on the 8th postoperative day. Discussion: Coagulation deficit resulting from cirrhosis distorts INR as a parameter of anticoagulation adequacy and as a determinant of the need for blood transfusion. Thus, thromboelastometry can provide important information for patient management.


Resumo Introdução: A doença hepática avançada pode, além das complicações hemorrágicas amplamente reconhecidas, ocorrer com eventos trombóticos. Descrevemos o caso de um paciente cirrótico em uso de varfarina, cujo manejo da coagulação durante o transplante de fígado foi guiado por tromboelastometria (ROTEM®). Relato de caso: Paciente do sexo masculino, 56 anos, diagnosticado com cirrose alcoólica, recebendo varfarina (2,5 mg.dia−1) para trombose parcial da veia porta, com razão normalizada internacional (INR) de 2,14. No início da cirurgia, os parâmetros ROTEM® estavam todos normais. Na fase não hepática, EXTEM e INTEM permaneceram normais, mas FIBTEM mostrou redução da amplitude após 10 min e firmeza máxima do coágulo. Por fim, na fase neo-hepática houve uma ligeira alteração da hipocoagulabilidade na maioria dos parâmetros de EXTEM, INTEM e FIBTEM, além de uma correção notável do tempo de coagulação (CT) de HEPTEM em comparação com o CT de INTEM. Portanto, o paciente não recebeu transfusão de hemoderivados durante a cirurgia e no período pós-operatório, obteve alta no oitavo dia de pós-operatório. Discussão: O déficit de coagulação resultante da cirrose distorce o INR como um parâmetro da adequação da anticoagulação e como um determinante da necessidade de transfusão de sangue. Portanto, a tromboelastometria pode fornecer informações importantes para o manejo do paciente.


Subject(s)
Humans , Male , Thrombelastography , Warfarin/therapeutic use , Blood Coagulation , Monitoring, Intraoperative/methods , Liver Transplantation , Anticoagulants/therapeutic use , Venous Thrombosis/etiology , Venous Thrombosis/prevention & control , Venous Thrombosis/blood , Liver Cirrhosis/surgery , Liver Cirrhosis/complications , Liver Cirrhosis/blood , Middle Aged
12.
J. vasc. bras ; 17(4)out.-dez. 2018. graf, tab
Article in Portuguese | LILACS | ID: biblio-969128

ABSTRACT

A number of limitations of standard therapy with warfarin for deep vein thrombosis (DVT) have been established. This overview of systematic reviews presents the baseline results for efficacy and safety of the new direct oral anticoagulants (DOACs) thrombin inhibitors, and activated factor X (Xa) inhibitors in patients with DVT. Searches were run on PubMed and the Cochrane Database of Systematic Reviews. Twenty-three studies were retrieved, and one systematic review was judged eligible. This review scored maximum according to AMSTAR criteria and included 7,596 patients for analysis of thrombin inhibitors and 16,356 patients for analysis of factor Xa inhibitors. The results of the meta-analysis indicate that DOACs are similar for DVT treatment when compared to standard treatment with warfarin. The incidence of major bleeding is somewhat lower in patients treated with factor Xa inhibitors and similar to standard therapy when treated with direct thrombin inhibitors


A terapia padrão com varfarina para a trombose venosa profunda (TVP) tem uma série de limitações já estabelecidas. Essa revisão de revisões sistemáticas elenca os principais resultados de eficácia e segurança dos anticoagulantes orais diretos (DOACs), inibidores da trombina e do fator X ativado (Xa), em pacientes com TVP. A pesquisa foi realizada nas bases PubMed e Cochrane Database of Systematic Reviews. Foram recuperados 23 estudos, e uma revisão sistemática foi considerada elegível. Essa revisão atingiu escore máximo no AMSTAR e incluiu 7.596 pacientes para análise dos inibidores da trombina e 16.356 pacientes para a análise dos inibidores do fator Xa. Os resultados da metanálise indicam que os DOACs apresentam eficácia similar à terapia padrão no tratamento da TVP. A incidência de sangramento maior é um pouco menor nos pacientes tratados com os inibidores do fator Xa e similar à terapia padrão no tratamento com inibidores diretos da trombina


Subject(s)
Humans , Male , Female , Review , Venous Thrombosis/therapy , Anticoagulants/therapeutic use , Warfarin/therapeutic use , Heparin/therapeutic use , Thrombin , Risk Factors , Drug Interactions , Venous Thromboembolism/therapy , Factor Xa Inhibitors/therapeutic use , Rivaroxaban/therapeutic use , Dabigatran/therapeutic use , Hemorrhage
13.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(3): 286-290, jul.-ago. 2018. tab
Article in English, Portuguese | LILACS | ID: biblio-916534

ABSTRACT

A fibrilação atrial (FA) é a arritmia cardíaca mais comum na população com uma prevalência de 1-2%, além disso, está associada a um risco, aproximadamente cinco vezes maior de acidente vascular cerebral do que na população em geral. A anticoagulação é a melhor maneira de prevenir os eventos tromboembólicos. A varfarina é utilizada há décadas como uma droga segura e eficaz, desde que rigorosamente controlada. Nos últimos anos, foram desenvolvidas novas classes de anticoagulantes orais: inibidores diretos da trombina e inibidores do fator Xa, conhecidos como anticoagulantes orais de ação direta (DOACs). Tanto a cardioversão elétrica quanto a cardioversão farmacológica estão associadas a um maior risco de eventos tromboembólicos durante o primeiro mês após o procedimento (5-7%). No entanto, com a utilização de nticoagulantes essa taxa é inferior a 1%. No presente artigo, faremos uma revisão das principais evidências científicas relacionadas ao uso da dabigatrana, rivaroxabana, apixabana e edoxabana durante a cardioversão e uma abordagem prática com o manejo antitrombótico em diferentes cenários clínicos (cardioversão em pacientes com uso prévio de DOACs, cardioversão em pacientes com FA com duração maior ou menor que 48 horas sem anticoagulação)


Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice with a prevalence of 1-2%, and is associated with an almost 5-fold increase in the risk of stroke compared to the general population. Anticoagulation is the best way to prevent thromboembolic events. Warfarin has been used for decades as a safe and effective drug, provided it is strictly controlled. In recent years, new classes of oral anticoagulants have been developed: direct thrombin inhibitors and factor Xa inhibitors, known as direct oral anticoagulants (DOACs). Both electrical and pharmacological cardioversion are associated with an increased risk of thromboembolic events during the first month after the procedure (5-7%). However, with the use of anticoagulants, this rate is less than 1%. In this article, we will review the main scientific evidence related to the use of dabigatran, rivaroxaban, apixaban and edoxaban during cardioversion and a practical approach with antithrombotic management in different clinical scenarios (cardioversion of patients in previous use of DOACs, cardioversion of patients not using oral anticoagulants with episodes of AF longer or shorter than 48 h)


Subject(s)
Humans , Male , Female , Arrhythmias, Cardiac , Atrial Fibrillation , Electric Countershock , Emergencies , Intensive Care Units , Anticoagulants/therapeutic use , Thromboembolism/therapy , Warfarin/adverse effects , Warfarin/therapeutic use , Heparin/adverse effects , Heparin/therapeutic use , Factor Xa , Thrombolytic Therapy/methods , Prevalence , Review , Stroke/complications , Rivaroxaban/therapeutic use , Hemorrhage
16.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(1)jan.-mar. 2018. ilus
Article in Portuguese | LILACS | ID: biblio-906856

ABSTRACT

A diabetes mellitus é uma condição que pode estar ou não associada ao caráter hereditário, em que há pouca ou nenhuma liberação de insulina ou o organismo não é capaz de utilizar adequadamente a insulina produzida. Para o tratamento odontológico desses pacientes, é necessário ter conhecimento do controle glicêmico por meio do valor de hemoglobina glicada; avaliar histórico de crises de hipoglicemia; realizar consultas curtas e no período da manhã. Dentre as comorbidades dessa patologia, podemos citar a doença cardiovascular, que pode ser encontrada de várias maneiras, dentre elas na forma de síndrome coronariana aguda. O tratamento desses indivíduos deve ser sempre realizado de forma multidisciplinar. Assim, o objetivo do presente trabalho é, por meio de um relato de caso clínico, discutir a abordagem cirúrgica odontológica de um paciente com ambas as patologias citadas acima, em uso terapêutico de anticoagulante, antiagregante e hipoglicemiante oral


Diabetes mellitus is a condition that may or may not be hereditary, in which either there is little or no insulin release, or the body is not capable of properly utilizing the insulin produced. For dental treatment of these patients, it is necessary to be aware of glycemic control through the glycated hemoglobin level; to assess the history of hypoglycemia crises; and to provide short appointments during the mornings. One of the comorbidities of this pathology is cardiovascular disease, which can be found in several forms, including acute coronary syndrome. These individuals should always be treated in a multidisciplinary way. Thus, the aim of the present work is to discuss, through a clinical case report, the dental surgical approach to a patient with both of the above pathologies, under use of anticoagulant, antiplatelet drug, and oral hypoglycemic agent


Subject(s)
Humans , Male , Middle Aged , Acute Coronary Syndrome/physiopathology , Diabetes Mellitus , Mouth Rehabilitation/methods , Surgery, Oral/methods , Anticoagulants/therapeutic use , Aspirin/therapeutic use , Cardiovascular Diseases/physiopathology , Hypoglycemic Agents/therapeutic use , Metformin/therapeutic use , Platelet Aggregation Inhibitors/therapeutic use , Warfarin/therapeutic use
17.
Arq. neuropsiquiatr ; 76(1): 22-25, Jan. 2018. tab
Article in English | LILACS | ID: biblio-888342

ABSTRACT

ABSTRACT Objectives To describe anticoagulation characteristics in patients with cardiac complications from Chagas disease and compare participants with and without cardioembolic ischemic stroke (CIS). Methods A retrospective cohort of patients with Chagas disease, using anticoagulation, conducted from January 2011 to December 2014. Results Forty-two patients with Chagas disease who were using anticoagulation were studied (age 62.9±12.4 years), 59.5% female and 47.6% with previous CIS, 78.6% with non-valvular atrial fibrillation and 69.7% with dilated cardiomyopathy. Warfarin was used in 78.6% of patients and dabigatran (at different times) in 38%. In the warfarin group, those with CIS had more medical appointments per person-years of follow-up (11.7 vs 7.9), a higher proportion of international normalized ratios within the therapeutic range (57% vs 42% medical appointments, p = 0.025) and an eight times higher frequency of minor bleeding (0.64 vs 0.07 medical appointments). Conclusion Patients with Chagas disease and previous CIS had better control of INR with a higher frequency of minor bleeding.


RESUMO Objetivos descrever as características da anticoagulação em pacientes com manifestações cardíacas da doença de Chagas (MCDC) e comparar os participantes com sem acidente vascular cerebral isquêmico cardioembólico (AVCIC). Resultados 42 pacientes com MCDC em anticoagulação foram estudados (62,9 ± 12,4 anos), 59,5% do sexo feminino e 47,6% com AVCIC prévio, 78,6% portadores de fibrilação atrial não valvar e 69,7% com cardiomiopatia dilatada. Varfarina foi utilizada em 78,6% dos pacientes e dabigatrana em 38% (em momentos diferentes). No grupo da varfarina, aqueles com AVCIC tiveram mais consultas médicas por pessoas-ano de seguimento (11,7 vs 7,9), maior taxa de RNI na faixa terapêutica (57% vs 42% consultas médicas, p = 0,025) e uma frequência oito vezes maior de sangramento menor (0,64 vs. 0,07 consultas médicas). Conclusão pacientes com MCDC e AVCIC prévio têm melhor controle de RNI com maior frequência de sangramento menor.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Brain Ischemia/prevention & control , Chagas Cardiomyopathy/complications , Stroke/prevention & control , Embolism/prevention & control , Anticoagulants/therapeutic use , Warfarin/adverse effects , Warfarin/therapeutic use , Chagas Cardiomyopathy/blood , Retrospective Studies , Follow-Up Studies , International Normalized Ratio , Dabigatran/adverse effects , Dabigatran/therapeutic use , Hemorrhage/chemically induced , Anticoagulants/adverse effects
18.
Braz. oral res. (Online) ; 32: e56, 2018. tab, graf
Article in English | LILACS | ID: biblio-952163

ABSTRACT

Abstract Given the growing trend towards medical indications for continuous use of anticoagulants, the number of patients on these medications continues to rise. The management of patients on oral anticoagulants requiring oral surgical procedures has aroused much controversy. Changes in an anticoagulation regimen are associated with an increased risk of thromboembolism. However, it seems logical and advantageous for the patients' health if surgery could be performed without any change to the anticoagulation therapy. In dentistry, high-power lasers have been poorly explored in this field. The hemostatic properties of high-power lasers could be helpful during oral soft tissue surgeries in anticoagulated patients. The aim of this study was to compare bleeding time in anticoagulated rats after lingual frenectomy performed with a scalpel or diode laser with bleeding time in healthy animals. Twenty-four male Wistar rats were assigned to four groups (n = 6): (CS) Control-Scalpel Surgery; (AS) Anticoagulated-Scalpel Surgery; (CL) Control-Laser (diode laser 810 nm/1.5 W) Surgery; and (AL) Anticoagulated-Laser Surgery (diode laser 810 nm/1.5 W). Warfarin administration was used to induce anticoagulation. Blood was blotted every 30 seconds with filter paper until bleeding stopped to verify bleeding time. Two blinded researchers performed the surgeries and collected the bleeding time data. Diode laser surgery led to complete hemostasis in rats during and after lingual frenectomy. Zero bleeding was assessed during surgeries and after diode laser surgeries in anticoagulated rats. Laser-induced hemostasis offered an alternative solution to the controversial issue of intraoperative and postoperative bleeding control in patients on anticoagulation therapy.


Subject(s)
Animals , Male , Blood Coagulation/radiation effects , Laser Coagulation/methods , Postoperative Hemorrhage/prevention & control , Lasers, Semiconductor/therapeutic use , Lingual Frenum/surgery , Thromboembolism , Warfarin/therapeutic use , Bleeding Time , Double-Blind Method , Reproducibility of Results , Risk Factors , Treatment Outcome , Rats, Wistar , Anticoagulants/therapeutic use
19.
Rev. costarric. cardiol ; 19(1/2): 5-8, ene.-dic. 2017. graf
Article in Spanish | LILACS | ID: biblio-900879

ABSTRACT

Resumen La fibrilación auricular es una de las cardiopatías con mayor prevalencia. Para escoger la terapia ideal se debe evaluar el riesgo hemorrágico con la escala de HASBLED y el riesgo de sufrir un evento cerebrovascular con la escala del CHADS VASC. Se recomienda utilizar el algoritmo de las guías ESC 2016 para prevención de un ictus por fibrilación auricular, donde los NOAC deben preferirse a los antagonistas de la vitamina K


Abstract Anticoagulation in patients with atrial fibrillation. What do clinical practice recommendations guidelines say? Atrial fibrillation is one of the most prevalent heart disease. In order to choose the ideal therapy, the risk of hemorrhagic risk should be evaluated with the HASBLED score and the risk of suffering a cerebrovascular event with the CHADSVASC score. It is recommended to use the algorithm of ESC 2016 guidelines for the prevention of stroke in atrial fibrillation, where NOAC should be preferred to vitamin K antagonists.


Subject(s)
Humans , Atrial Fibrillation , Warfarin/therapeutic use , Practice Guideline , Heart Diseases , Heart Failure , Anticoagulants
20.
Rev. costarric. cardiol ; 19(1/2): 9-11, ene.-dic. 2017. graf
Article in Spanish | LILACS | ID: biblio-900880

ABSTRACT

Resumen Los resultados de los ensayos clínicos con los anticoagulantes directos en pacientes con fibrilación auricular demuestra mayor eficacia en la prevención del ictus versus warfarina. Las guías de práctica clínica recomiendan que estos fármacos deberían preferirse a los antagonistas de la vitamina K para anticoagular los pacientes con fibrilación auricular no valvular.


Abstract Direct anticoagulants in patients with atrial fibrillation. From clinical trials to real-world records The results of clinical trials with direct anticoagulants in patients with atrial fibrillation show greater efficacy in the prevention of stroke versus warfarin. Clinical practice guidelines recommend that these drugs should be preferred to vitamin K antagonists to anticoagulate patients with non-valvular atrial fibrillation.


Subject(s)
Humans , Atrial Fibrillation , Warfarin/therapeutic use , Rivaroxaban/therapeutic use , Dabigatran/therapeutic use , Anticoagulants/therapeutic use
SELECTION OF CITATIONS
SEARCH DETAIL