Os novos anticoagulantes orais na prática clínica / The new oral anticoagulants in clinicalpractice

Na tradição mitológica grega, Cila e Caribdis eram dois monstros marinhos que moravam nos lados opostos do estreito de Messina, entre a Calábria e a Sicília na Itália. Navegar nesse mar tornava-se extremamente difícil, desde que esses monstros estavam muito próximos, e tentar se afastar de Cila implicava passar muito próximo de Caribdis, e vice-versa. Esse cenário imaginário bem retrata a dificuldade que se encontra na prática clínica quando, no complexo cenário do mundo real, pesando entre o benefícioe o risco, deve-se indicar a anticoagulação aos pacientes. Os antagonistas da vitamina K foram a única classe de anticoagulantes orais disponíveis para os médicos por décadas. No entanto, com a recente entrada no mercado nacional de novos anticoagulantes orais, como dabigatran, rivaroxaban e apixaban, os clínicos têm agora uma escolha mais ampla. Este artigo busca fornecer uma revisão concisa desses novos medicamentos e uma abordagem prática para o seu uso clínico.

In the tradition Greek mythological, Scylla and Charybdis were two sea monsters placed on opposite sides of the strait of Messina, between Calabria and Sicily in Italy. To navigate at this sea was extremely difficult since these monsters were very close to each other and attempts to avoid Scylla implied passing very closed to Charybdis and vice versa. This imaginary scenario well depicts the difficulties that a practicing physician may encounter when, in the complex setting of "real-world" assessing between benefits and risks, should recommend the anticoagulation for ours patients. Vitamin K antagonists were the only class of oral anticoagulants available to clinicians for decades. However, given the recent approval and availability of new oral anticoagulants, such as dabigatran, rivaroxaban and apixaban, clinicians now have a broader choice. This article provides a concise review of these medications and a practical approach to their clinical use.

Ablaçäo por radiofrequência de taquicardia supraventricular incessante por via anômala de conduçäo retrógrada decremental / Radiofrequency Ablation of Incessant Supraventricular Tachycardia Due to Decremental Retrograde Conduction Via Anomalous Pathways

Woman, 46 years-old with incessant supraventricular tachycardia and tachycardiomyopathy. The diagnosis of a concealed retrograde long conduction time accessory pathway was obtained with the delay of the next atrial activation by delivering a ventricular premature beat during His bundle refratoriness. During electrophysiologic investigation the earliest atrial activation was found to be within the coronary sinus ostium. Two 25 watts applications of radiofrequency were followed by the interruption of the incessant supraventricular tachycardia. The patient has remained symptom free without recurrence for 60 days. Radiofrequency was effective for the treatment of this tachycardia