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1.
Int J Clin Pharm ; 39(2): 478-482, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28188509

RESUMO

Background Few studies assess the use of non-vitamin K antagonist oral anticoagulants (NOACs) in daily practice for the prevention of thromboembolic complications associated to nonvalvular atrial fibrillation (AF). Objectives Describe NOACs' use and analyze its prescribing pattern. Evaluate possible factors associated to adverse events (AEs) and the applicability of prescription support forms. Methods We included patients with AF treated with a NOAC during 2014 in three primary healthcare centers in Barcelona, Spain. Demographic and clinical data was collected, as well as embolic and bleeding risk and reported AEs. Results A total of 101 patients were included, with a median age of 75 years. The NOACs most frequently prescribed were dabigatran and rivaroxaban. An 87.2% of the patients were receiving the recommended dosage. A potential bleeding risk was present in 47% of the subjects. Ten AEs were reported, of which eight hemorrhages. Patients who presented an AE were >65 years and had a higher proportion of concomitant treatment and/or co-morbidities that could prompt to bleeding (p < 0.001). Conclusions Current treatment practice is according to regulatory agencies' recommendations. Close monitoring is especially needed in patients >65 years and at higher risk of bleeding. Prescription support forms help good prescribing and identifying potential individuals at high risk of AEs.


Assuntos
Anticoagulantes/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Hemorragia/epidemiologia , Atenção Primária à Saúde/estatística & dados numéricos , Tromboembolia/prevenção & controle , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Feminino , Hemorragia/induzido quimicamente , Humanos , Masculino , Padrões de Prática Médica , Fatores de Risco , Espanha/epidemiologia
2.
Transpl Int ; 28(11): 1345-9, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26073850

RESUMO

Hepatitis C positive kidney transplant (KT) recipients are a difficult-to-treat subpopulation. Interferon-based therapies are contraindicated (or at least not used) in KT patients, due to the risk of allograft rejection, its poor tolerability and the low rates of sustained virological response (SVR) achieved with these therapies. Nevertheless, the use of direct-acting antiviral drugs (DAAs) will certainly provide new opportunities for hepatitis C treatment in the KT setting. Here, we report the case of a KT recipient with decompensated cirrhosis who received antiviral therapy with sofosbuvir, simeprevir, and ribavirin during 24 weeks while awaiting liver transplantation. Hepatitis C was eradicated, and the patient was removed from the transplant list. Although there is no safety and efficacy data regarding the use of DAAs in the KT setting, this case suggests that KT recipients may benefit from the use of new antiviral drugs with high SVR rates and an excellent safety profile.


Assuntos
Antivirais/administração & dosagem , Hepatite C/complicações , Transplante de Rim , Cirrose Hepática/complicações , Insuficiência Renal/complicações , Simeprevir/administração & dosagem , Sofosbuvir/administração & dosagem , Administração Oral , Aloenxertos , Feminino , Genótipo , Rejeição de Enxerto , Hepacivirus , Hepatite C/tratamento farmacológico , Humanos , Imunossupressores/química , Rim/virologia , Cirrose Hepática/tratamento farmacológico , Transplante de Fígado , Pessoa de Meia-Idade , Insuficiência Renal/cirurgia , Transplantados , Resultado do Tratamento , Listas de Espera
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