RESUMO
For many years anticoagulation has played a role in the prevention and management of thromboembolic complications associated with acute myocardial infarction. However, the role of heparin therapy after pharmacologic thrombolysis in myocardial infarction remains controversial. Debate continues regarding the necessity of heparin treatment after thrombolytic therapy as well as the mode by which it is administered. The purpose of this review is to summarize the findings of clinical trials designed to evaluate the effectiveness and safety of heparin as an adjuvant agent to thrombolytic therapy in acute myocardial infarction. Data regarding the clinical effectiveness of heparin are presented. Information and recommendations regarding the optimal dose, route of administration, timing of initiation, and duration of heparin treatment are provided.
Assuntos
Heparina/administração & dosagem , Infarto do Miocárdio/tratamento farmacológico , Terapia Trombolítica/enfermagem , Relação Dose-Resposta a Droga , Esquema de Medicação , Quimioterapia Combinada , Heparina/efeitos adversos , Humanos , Infarto do Miocárdio/enfermagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
Omeprazole is a substituted benzimidazole that has gained widespread use in the treatment of acidic and peptic ulcer disease. Adverse events with the drug are rare and involve mainly the gastrointestinal and central nervous systems. Skin inflammation, urticaria, pruritus, alopecia, and dry skin have been reported in 0.5-1.5% of patients. To date, no published report has linked angioedema with omeprazole. We report a case of a 34-year-old woman with cellulitis, ulcerative erosive esophagitis, and gastric and duodenal ulcers who developed several hypersensitivity reactions characterized by shortness of breath, wheezing, cough, mild angioedema, and total body urticaria and pruritus. These symptoms correlated with the addition of omeprazole to her regimen and the timing of its administration. A previous case report prompted a rechallenge with enteric-coated omeprazole granules removed from the capsule shell. Recurrence of the adverse events suggested an allergy to the drug itself and not the capsule. Angioedema can be a life-threatening allergic reaction requiring immediate treatment. Rechallenge using omeprazole with or without the capsule shell should be done only in a hospital setting where prompt action can be taken in the event of an emergency.
