RESUMO
Objetivo: Analizar la relacion entre el numero de ingresos hospitalarios (IH) por episodios cardiovasculares (EC) y el numero de muertes en pacientes en tratamiento con clopidogrel asociado o no a un inhibidor de la bomba de protones (IBP).Material y metodos: Estudio de cohortes retrospectivo. Se selecciono a pacientes que estaban tomando clopidogrel de cuatro centros de salud de dos areas sanitarias de Galicia (datos obtenidos del programa de homologacion sanitaria de recetas a (..)(AU)
Objective: To analyze the ratio of hospitalizations (NH) due to cardiovascular events (CE) and mortality in patients treated with clopidogrel in association or not to a proton pump inhibitors (PPI). Material and methods: A retrospective cohort study was performed. Patients who were taking clopidogrel and who belonged to four health centers in PC in two different health areas from Galicia (the data was obtained of the health care homologation program of prescriptions from the Sub-Department of Pharmacy) were selected. The study period included January 2007-March 2009. Computerized medical records and records in paper format were analyzed to determine the prescription of PPI and whether the patient had any NH as a result of CE (AMI, ACS, stroke, TIA, bypass, stroke and/or peripheral artery disease). The data were analyzed using the SPSS statistical program and a descriptive and statistical analysis was performed (CHI-square test and ANOVA test).Results: A total of 304 patients who fulfilled the inclusion criteria (65.5% male and 34.5% women) were enrolled. A total of 58.6% of the patients were treated with clopidogrel and a PPI. Of these 58.6% required hospitalization due to a CE versus 14.3%, when no PPI was associated. This means a 2.1 times higher risk of suffering a NH. Omeprazole was the PPI most used (73.65%).Conclusions: The results obtained indicate a probable interaction between PPI and clopidogrel, it not being possible to establish its clinical importance. This does not imply that it may have serious repercussions for the health of the patients (AU)
Assuntos
Humanos , Inibidores da Bomba de Prótons/farmacocinética , Doenças Cardiovasculares/epidemiologia , Inibidores da Agregação Plaquetária/farmacocinética , Interações Medicamentosas , Fatores de RiscoRESUMO
El objetivo del presente trabajo es protocolizar la coordinación entre niveles asistenciales para el control de la anticoagulación oral desde los centros de salud de atención primaria. Se describe una experiencia de coordinación entre el servicio de hematología del hospital de referencia y los farmacéuticos de atención primaria de dos centros de salud para la educación sanitaria y el seguimiento de los pacientes que reciben tratamiento con anticoagulantes orales. En el artículo se detallan las actividades en las que el farmacéutico de atención primaria participa en relación con el servicio de hematología, los profesionales del centro de salud de atención primaria y el propio paciente. Durante un periodo de nueve meses se realizó seguimiento farmacoterapéutico a 143 pacientes adscritos a dos centros de salud de atención primaria. La media de edad de los pacientes en seguimiento fue de 71 años (índice de confianza [IC] 95%: 69,5-72,9), 76 de ellos mujeres (53,1%) y 67 hombres (46,8%). El consumo diario de cuatro o más medicamentos era del 76,9% en la muestra. Por estas características, era previsible que el paciente presentara otros problemas de salud diferentes a los que requieren anticoagulación (que implican frecuentes cambios en su farmacoterapia y, en consecuencia, interacciones farmacológicas e interacciones medicamento-enfermedad que se abordan en el centro de salud de atención primaria). La coordinación entre el personal de atención primaria y el servicio de hematología permitió resolver determinadas situaciones en el centro de salud y evitó la derivación de estos pacientes a atención especializada (AU)
The purpose of this work was to develop a protocol for coordination among health care levels aimed at the achievement of oral anticoagulation control in primary care health centers. The authors report their experience involving coordination between a referral hospital hematology service and primary care pharmacists from two primary care centers for health education and follow-up of patients receiving oral anticoagulant therapy. This article provides a detailed description of the activities in which the primary care pharmacist collaborates with the hematology service, other professionals at the primary care health center and the patient himself. The follow-up of a total of 143 patients from two primary care health centers who received pharmaceutical care was carried out over a 9-month period. There were 76 women (53.1%) and 67 men (46.8%) with a mean age of 71 years (95% CI: 69.5-72.9). In all, 76.9% of these patients were taking four or more drugs on a daily basis. Given this circumstance, they would be expected to have additional health problems other than those for which the anticoagulation therapy was required. This implies frequent changes in their drug therapy and, in consequence, drug interactions and drug-disease interactions, which are treated in the primary health care center. Coordination between primary care professionals and the hematology service makes it possible to resolve certain situations in the primary health care center, thus making it unnecessary to refer patients to specialized care (AU)
Assuntos
Humanos , Monitoramento de Medicamentos/métodos , Anticoagulantes/uso terapêutico , Colaboração Intersetorial , Tratamento Farmacológico/métodos , Atenção Primária à Saúde , Educação em SaúdeRESUMO
En nuestra práctica clínica diaria en la consulta dePediatría es frecuente la prescripción de antibióticospara el tratamiento de infecciones bacterianas devariada etiología, pero no tenemos la impresión deque exista una importante toxicidad de los mismosen niños, lo que nos puede llevar a olvidar que, aunqueno sean frecuentes, existen reacciones adversas,algunas graves, y que tenemos la obligación denotificarlas a nuestras Autoridades Sanitarias. Presentamosel caso clínico de un niño de 4 años conhepatitis en posible relación con la ingesta previa declaritromicina, con total reversibilidad clínico-analíticade las manifestaciones presentadas, tal como serefleja en la ficha técnica del fármaco entre los posiblesefectos adversos poco frecuentes. El caso nosha parecido de interés en la medida que nos sirvacomo recordatorio de nuestra obligación como profesionalessanitarios de declarar las sospechas deposibles reacciones adversas a fármacos a los Sistemasde Farmacovigilancia de nuestras ComunidadesAutónomas, con objeto de mejorar su seguridad,intentando mantener en todo momento una relaciónbeneficio-riesgo favorable para la población
In our daily clinical practice in the pediatric consultingroom, prescribing antibiotics for the treatment ofbacterial infections of diverse etiology it is very common.We do not have the impression that there existany important toxicity of these antibiotics in children,what can lead us to forget that, although uncommon,there are adverse reactions, some of themquite serious, and that we have the obligation of reportingthem to our Health Authorities. We presentthe clinical case of a 4 year-old boy with hepatitis,possibly related to the previous intake of clarithromycin,with a complete clinical and analytical reversalof the observed clinical manifestations. The notedreversal of the symptoms matches the possible butinfrequent adverse effects which appear in the summaryof product´s characteristics. We find this casevery interesting, since it can be useful as a reminderof our obligations as health professionals. Theseobligations would include reporting to the PharmacovigilanceSystems of our Autonomous Communitiesany suspected possible adverse reactions to drugswith the objective of improving their safety, as wellas trying to maintain at all times a benefit-risk relationshipin favour of the population
