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Controvérsias na Anticoagulação Oral: Continuar ou Interromper os Anticoagulantes Orais durante a Intervenção Estomatológica?; The Debate Concerning Oral Anticoagulation: Whether to Suspend Oral Anticoagulants During Dental Treatment

António, Natália; Castro, Graça; Ramos, Domingo; Machado, António; Gonçalves, Lino; Macedo, Tice; Providência, Luís A.
Fonte: Sociedade Portuguesa de Cardiologia Publicador: Sociedade Portuguesa de Cardiologia
Tipo: Artigo de Revista Científica
POR
Relevância na Pesquisa
56.62%
A abordagem dos doentes cronicamente anticoagulados com necessidade de intervenções estomatológicas continua a suscitar grande controvérsia. O aumento do risco hemorrágico associado aos procedimentos estomatológicos sob anticoagulação oral deve ser pesado relativamente ao risco trombótico acrescido causado pela interrupção da terapêutica antitrombótica. Em cirurgia oral minor, a mortalidade e morbilidade é superior nos episódios tromboembólicos comparativamente aos episódios hemorrágicos. A informação científica disponível não apoia a interrupção da terapêutica anticoagulante oral para cirurgia oral minor. É intenção dos autores propor um protocolo para a abordagem clínica dos doentes cronicamente anticoagulados com necessidade de tratamento estomatológico, de forma a minimizar, quer o risco tromboembólico, quer o risco hemorrágico.; The management of patients taking long-term oral anticoagulants who require dental surgery is still highly controversial. The risk of bleeding associated with dental treatment under oral anticoagulants must be weighed against the risk of thromboembolism associated with suspension of antithrombotic therapy. Mortality and morbidity associated with thromboembolic events are higher than those associated with hemorrhagic events after minor oral surgery procedures. Evidence-based information does not support oral anticoagulant suspension before minor oral surgery. The authors propose a management protocol for chronically anticoagulated patients who require a dental procedure...

Avaliação da qualidade de vida relacionada à saúde, adesão ao tratamento medicamentoso e auto eficácia de indivíduos  submetidos a um programa educacional após iniciarem o uso de anticoagulante oral; Evaluation of quality of life related to health, adhesion to drug treatment and self-efficscy of individuals submitted to an educational program after starting the use of an oral antocoagulant.

Pelegrino, Flávia Martinelli
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 16/07/2013 PT
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Os anticoagulantes orais são fármacos que agem aumentando o tempo de coagulação sanguínea, úteis na ocorrência de certas doenças que levam a formação de trombos intravasculares. Portanto, controles constantes dos níveis sanguíneos são necessários para um tratamento seguro. Algumas estratégias, como a intervenção educativa, vem demonstrando bons resultados. No presente estudo, o objetivo principal foi avaliar a qualidade de vida relacionada à saúde, adesão ao tratamento e autoeficácia de pacientes que iniciaram o uso de anticoagulantes orais segundo a participação em um programa educativo (Grupo Intervenção) ou o recebimento do cuidado de rotina (Grupo Controle). Como objetivos secundários, comparamos o estado de saúde percebido e a presença de sintomas de ansiedade e depressão entre os grupos. Trata-se de um estudo experimental com designação aleatória em dois grupos (Intervenção ou Controle). Há aprovação do Comitê de Ética em Pesquisa e registro na base ClinicalTrials.gov. Realizado no Hospital Estadual de Ribeirão Preto, foram incluídos pacientes que iniciaram o uso de anticoagulantes orais para tratamento clínico pela primeira vez, maiores de 18 anos e com avaliação cognitiva adequada. A estratificação e a aleatorização dos sujeitos foram obtidas por The Outpatient Bleeding Risk Index e por blocos...

O doente sob terapêutica anticoagulante oral e a intervenção farmacêutica

Oliveira, Cláudia Sofia Godinho André da Graça
Fonte: Universidade de Lisboa Publicador: Universidade de Lisboa
Tipo: Dissertação de Mestrado
Publicado em //2012 POR
Relevância na Pesquisa
46.62%
Tese de mestrado, Farmácia (Cuidados Farmacêuticos), Universidade de Lisboa, Faculdade de Farmácia, 2012; Os antagonistas da vitamina K são anticoagulantes orais com efectividade comprovada na prevenção e tratamento de episódios tromboembólicos, que constituem a terceira causa de morte por doença cardiovascular. Devido à variabilidade da dose-resposta, a terapêutica com estes fármacos requer monitorização da razão normalizada internacional (INR), educação contínua do doente e boa comunicação entre doentes e profissionais de saúde. Realizaram-se três estudos epidemiológicos visando o conhecimento da evolução do consumo dos anticoagulantes orais em Portugal, a caracterização do perfil do doente sob terapêutica anticoagulante oral e sua correlação com o controlo do INR, bem como a caracterização da intervenção farmacêutica nas farmácias comunitárias portuguesas neste âmbito. A recolha de dados foi efectuada a partir de uma base de dados do Infarmed (estudo 1), por aplicação de questionários a 241 doentes sob terapêutica anticoagulante oral (estudo 2) e a 126 farmacêuticos comunitários (estudo 3). Foi realizada uma análise descritiva para todas as variáveis e a associação estatística entre estas e o controlo do INR foi avaliada através do teste de x2. No estudo 1 verificou-se um crescimento de 66% do consumo dos anticoagulantes orais em Portugal entre 2000 e 2007...

Antithrombin III in patients on long-term oral anticoagulants.

Bull, H; Mackie, I; Brozović, M; Woodings, D
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /12/1980 EN
Relevância na Pesquisa
46.69%
The antithrombin III (AT III) concentration in plasma was measured in 63 patients on oral anticoagulant treatment (mean age 57.7 years), 26 healthy laboratory controls (mean age 28 years), and 21 patients attending the hypertensive clinic who had never been on oral anticoagulants (mean age 50 years). Three methods were used to measure AT III: a coagulation assay, a chromogenic substrate assay, and an immunological assay. In patients on oral anticoagulants, the mean values for AT III in the three assays were: 124%, 107%, and 96% respectively. The mean AT III concentration in laboratory staff was 103.4%, 94%, and 104.1% for the three assays; patients attending the hypertensive clinic had AT III concentrations indistinguishable from those in patients on oral anticoagulants: 117.9%, 110.5%, and 93.9%. The difference between both patient groups and laboratory staff was statistically highly significant, but no difference was demonstrated between patients on anticoagulant treatment and those not receiving it. Our results show that the increase in the functional AT III concentration (measured by coagulation and chromogenic assays) observed in patients on oral anticoagulants is probably due to the effects of age and underlying disease rather than to the anticoagulant treatment itself.

Battle of oral anticoagulants in the field of atrial fibrillation scrutinized from a clinical practice (the real world) perspective

Altman, Raul; Vidal, Hector O
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Publicado em 27/07/2011 EN
Relevância na Pesquisa
46.59%
Warfarin has a long history of benefit and has become the gold standard medication for the prevention of ischemic stroke in patients with atrial fibrillation. Nevertheless, it is far from perfect and there is no doubt that new drugs must be found to replace warfarin. The new oral anticoagulants that are on the market or awaiting approval or under research offer some benefits but not enough to replace warfarin until results of additional studies can show an adequate balance between effectiveness/safety and cost/benefit. There are several issues concerning the new oral anticoagulants. It is essential that the effect of any anticoagulant can be measured in plasma. But to date, there is no test to assess the effect or therapeutic range for the new oral anticoagulants. There is no antidote to neutralize the action of the new drugs in cases of bleeding or when acute surgical intervention is necessary. Dabigatran requires dose adjustment in patients with moderate renal impairment and is contraindicated in patients with severe renal failure. Rivaroxaban should be used with caution in patients with severe renal impairment. Apixaban excretion is also partly dependent on renal function, although the impact of renal insufficiency has not yet been determined. How anticoagulant bridging can be done before surgery has not yet been established. In conclusion...

Bosentan and oral anticoagulants in HIV patients: what we can learn of cases reported so far

Morales-Molina, José Antonio; Martínez-de la Plata, Juan Enrique; Urquízar-Rodríguez, Olivia; Molina-Arrebola, María Angustias
Fonte: PAGEPress Publications Publicador: PAGEPress Publications
Tipo: Artigo de Revista Científica
Publicado em 10/10/2011 EN
Relevância na Pesquisa
46.59%
Pulmonary arterial hypertension is an infrequent but nevertheless serious life-threatening severe complication of HIV infection. It can be treated with bosentan and oral anticoagulants. Bosentan could induce the acenocoumarol metabolism and it increases the INR values. Until now, no study of interaction between bosentan and oral anticoagulants in HIV patients has reported. So we present a case of this interaction between these drugs and we reviewed MEDLINE to identify all the papers published so far. In our case, several weeks after increasing dose of bosentan acenocoumarol dose had to be progressively increased to 70 mg/week (+33%) without obtaining an adequate INR level (2.0–3.0). Forty-nine days later, we achieved a therapeutic INR with 90 mg/week of warfarin. The use of bosentan and oral anticoagulants together in these patients require a closer monitoring during first weeks of treatment, after increasing the bosentan dose and even during longer periods of time.

Tutorial in oral antithrombotic therapy: Biology and dental implications

Fakhri, Hamid R.; Janket, Sok J.; Jackson, Elizabeth A.; Baird, Alison E.; Dinnocenzo, Richard; Meurman, Jukka H.
Fonte: Medicina Oral S.L. Publicador: Medicina Oral S.L.
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
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Objectives: Recent developments of new direct oral anticoagulants that target specific clotting factors necessitate understanding of coagulation biology. The objective of this tutorial is to offer dental professionals a review of coagulation mechanisms and the pharmacodynamics of the conventional and new oral anticoagulants. Also, we summarized the dental implications of the conventional and new anticoagulants. Method: We searched Medline using search terms “antithrombotic”, “antihemostasis” or “anticoagulation” and combined them with the search results of “dental”, “oral surgery” or “periodontal”. We restricted the results to “human” and “English”. Results: The early coagulation cascade, the new cell-based coagulation model, the pharmacokinetics and pharmacodynamics of conventional antithrombotics, and new oral anticoagulants were reviewed. The new direct factor Xa inhibitors and the direct thrombin inhibitor (s), called direct oral anticoagulants (DOAs) have rapid onset of action, fast elimination on cessation, and fewer drug-drug or drug-food interactions than warfarin. However, the lack of antidotes raises concerns that some dental procedures may trigger serious hemorrhagic events. Additionally...

Clinical review: Clinical management of new oral anticoagulants: a structured review with emphasis on the reversal of bleeding complications

Lazo-Langner, Alejandro; Lang, Eddy S; Douketis, James
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.6%
New oral anticoagulants, including dabigatran, rivaroxaban, and apixaban, have been recently approved for primary and secondary prophylaxis of thromboembolic conditions. However, there is no clear strategy for managing and reversing their anticoagulant effects. We aimed to summarize the available evidence for clinical management and reversal of bleeding associated with new oral anticoagulants. Using a systematic review approach, we aimed to identify studies describing reversal strategies for dabigatran, rivaroxaban, and apixaban. The search was conducted using Medline, EMBASE, HealthSTAR, and grey literature. We included laboratory and human studies. We included 23 studies reported in 37 out of 106 potentially relevant references. Four studies were conducted in humans and the rest were in vitro and in vivo studies. The majority of the studies evaluated the use of prothrombinase complex concentrate (PCC), either activated or inactivated, and recombinant activated factor VII (rFVIIa). Other interventions were also identified. Laboratory studies suggest that hemostatic parameters and bleeding might be partially or completely corrected by PCC for rivaroxaban better than dabigatran. Studies in humans suggest that PCC might reverse the effects of rivaroxaban better than dabigatran assessed by hemostatic tests. We were not able to locate studies evaluating the clinical efficacy of these agents. The best available evidence suggests that PCC (activated or inactivated) might be the best option for reversing new anticoagulants. Evidence for rFVIIa is less compelling. There might be differences in the efficacy of reversing agents for different anticoagulants. Studies assessing the clinical efficacy of these reversal agents are urgently needed.

Practical management of new oral anticoagulants after total hip or total knee arthroplasty

Klauser, W.; Dütsch, M.
Fonte: Springer Milan Publicador: Springer Milan
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
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Within the past 5 years, the oral anticoagulants rivaroxaban, apixaban, and dabigatran etexilate have been approved for the prevention of venous thromboembolism in adult patients after elective hip or knee arthroplasty in the European Union and many other countries worldwide. These agents differ from the previously available anticoagulants because they selectively and directly inhibit a single factor in the coagulation cascade—rivaroxaban and apixaban inhibit Factor Xa, and dabigatran inhibits Factor IIa (thrombin)—potentially enhancing the predictability of their anticoagulant effect. Currently, although some guidelines provide recommendations for the use of rivaroxaban, dabigatran etexilate, and apixaban in clinical practice, there are still questions regarding the optimal practical management of patients receiving these agents. This article briefly reviews the practical limitations associated with conventional anticoagulants, discusses potential issues with the practical management of the newer oral anticoagulants, and provides clinical experience from a single institution where rivaroxaban and dabigatran etexilate have been used within their approved indications.

Alternative to oral dicoumarin anticoagulants: Considerations in dental care

Mingarro-de-León, Ana; Chaveli-López, Begonya
Fonte: Medicina Oral S.L. Publicador: Medicina Oral S.L.
Tipo: Artigo de Revista Científica
Publicado em 01/12/2013 EN
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Introduction: For over 50 years, vitamin K antagonists such as warfarin (Aldocumar®) and acenocoumarol (Sintrom®) have been the gold standard for reducing the risk of cerebrovascular events. In the last 5 years alternative anticoagulants have been evaluated that act directly upon a concrete target within the coagulation cascade, thereby affording a more predictable anticoagulant effect. The present study offers an update on the new oral anticoagulants and reviews the implications referred to the dental care of patients administered these substances. Material and methods: An exhaustive PubMed-Medline and Cochrane Library search was made of the main alternatives to conventional oral anticoagulation, covering those studies published in English and Spanish over the last 10 years. Specialized textbooks and pharmaceutical catalogs were also consulted. A total of 184 articles were identified, of which 76 met the inclusion criteria. Results: The new oral anticoagulants dabigatran, rivaroxaban and apixaban are safe and effective, and offer a series of advantages, including rapid action, no need for constant monitoring, few drug and food interactions, and a broad therapeutic margin. These drugs are expensive, however, and some lack a specific antidote...

New oral anticoagulants: are coagulation units still required?

Altman, Raul
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Publicado em 03/02/2014 EN
Relevância na Pesquisa
46.75%
Chronic antithrombotic therapy involves the use of anticoagulants, antiplatelets given either as monotherapy or in combination for the prevention of thrombotic complications. The most feared and sometimes fatal complication with this therapy is bleeding. It should be considered a “golden rule” that a drug or combination of drugs that maximizes efficiency (decreased thromboembolic risk) will probably be less safe (increased risk of bleeding), and this holds true either for single therapy or during combined therapy. The chances of bleeding indicated by risk tables can be useful but show only a snapshot, and the biological, social, environmental, and drug changes and therapeutic adherence also determine changes in the risk of thrombosis and bleeding. Bleeding is an eventuality that occurs in places of “locus minoris resistentiae,” and the results of careful phase 3 studies thus cannot be completely predictive of outcomes when a medication is introduced on the pharmaceutical market. With the use of warfarin, the International Normalized Ratio (INR) that has been established to indicate adequately balanced therapy is between 2.0 and 3.0. With the new oral anticoagulants, the pharmaceutical companies emphasize that it is not necessary to monitor anticoagulant effects. In studies with different doses of new oral anticoagulants...

New oral anticoagulants in patients with nonvalvular atrial fibrillation: a review of pharmacokinetics, safety, efficacy, quality of life, and cost effectiveness

Mani, Helen; Lindhoff-Last, Edelgard
Fonte: Dove Medical Press Publicador: Dove Medical Press
Tipo: Artigo de Revista Científica
Publicado em 17/06/2014 EN
Relevância na Pesquisa
46.62%
Atrial fibrillation (AF) continues to be a leading cause of cerebrovascular morbidity and mortality resulting from cardioembolic stroke. Oral anticoagulation therapy has been shown to decrease the incidence of cardioembolic stroke in patients with AF by more than 50%. Appropriate use of anticoagulation with vitamin K antagonists requires precise adherence and monitoring. A number of factors that potentially induce patients’ dissatisfaction reduce quality of patient life. New direct oral anticoagulants, such as the direct factor Xa inhibitors rivaroxaban, apixaban, edoxaban, and the thrombin inhibitor dabigatran, were developed to overcome the limitations of the conventional anticoagulant drugs. However, models to optimize the benefit of therapy and to ensure that therapy can be safely continued are missing for the new oral anticoagulants. This review will briefly describe the new oral anticoagulants dabigatran, rivaroxaban, apixaban, and edoxaban with focus on their use for prevention of embolic events in AF. Moreover, it will discuss the safety, efficacy, cost data, and benefit for patients’ quality of life and adherence.

Anticoagulation in Patients Aged ≥75 years with Atrial Fibrillation: Role of Novel Oral Anticoagulants

Ng, Kuan H.; Hart, Robert G.; Eikelboom, John W.
Fonte: Springer Healthcare Publicador: Springer Healthcare
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.59%
Atrial fibrillation (AF) is an important cause of preventable, disabling stroke and is increasingly prevalent with advancing age. As life expectancies increase around the world, AF-related stroke is a growing global public health concern. Most AF patients are elderly (≥75 years old) and increasing age is a consistent independent risk factor for AF-associated stroke. Warfarin anticoagulation is highly effective for stroke prevention in AF patients, but is underutilized especially in the elderly. Although elderly patients are at increased risk of hemorrhage with oral anticoagulants, the benefit for ischemic stroke reduction exceeds the risk of hemorrhage for most elderly patients. Consequently, age alone should not be considered a contraindication for anticoagulation. Novel oral anticoagulants such as dabigatran, rivaroxaban and apixaban are at least as effective as warfarin in preventing strokes in patients with AF. Relative to warfarin, these novel agents reduce the risk of intracranial hemorrhage, the most devastating complication of anticoagulation therapy in elderly AF patients. The novel oral anticoagulants are especially appealing for stroke prevention in elderly patients with AF.

Management of the Bleeding Patient Receiving New Oral Anticoagulants: A Role for Prothrombin Complex Concentrates

Baumann Kreuziger, Lisa M.; Keenan, Joseph C.; Morton, Colleen T.; Dries, David J.
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.67%
Ease of dosing and simplicity of monitoring make new oral anticoagulants an attractive therapy in a growing range of clinical conditions. However, newer oral anticoagulants interact with the coagulation cascade in different ways than traditional warfarin therapy. Replacement of clotting factors will not reverse the effects of dabigatran, rivaroxaban, or apixaban. Currently, antidotes for these drugs are not widely available. Fortunately, withholding the anticoagulant and dialysis are freqnently effective treatments, particularly with rivaroxaban and dabigatran. Emergent bleeding, however, requires utilization of Prothrombin Complex Concentrates (PCCs). PCCs, in addition to recombinant factor VIIa, are used to activate the clotting system to reverse the effects of the new oral anticoagulants. In cases of refractory or emergent bleeding, the recommended factor concentrate in our protocols differs between the new oral anticoagulants. In patients taking dabigatran, we administer an activated PCC (aPCC) [FELBA] due to reported benefit in human in vitro studies. Based on human clinical trial evidence, the 4-factor PCC (Kcentra) is suggested for patients with refractory rivaroxaban- or apixaban-associated hemorrhage. If bleeding continues...

Restraints to Anticoagulation Prescription in Atrial Fibrillation and Attitude Towards the New Oral Anticoagulants; Impedimentos à Prescrição de Anticoagulação na Fibrilhação Auricular e Atitude Face aos Novos Anticoagulantes Orais

Pereira-Da-Silva, Tiago; Serviço de Cardiologia. Hospital de Santa Marta (CHLC). Lisboa. Portugal.; Souto Moura, Teresa; Serviço de Medicina Interna 1.4. Hospital de São José (CHLC). Lisboa. Portugal.; Azevedo, Luísa; Serviço de Medicina Interna 1.4
Fonte: Ordem dos Médicos Publicador: Ordem dos Médicos
Tipo: info:eu-repo/semantics/article; article; info:eu-repo/semantics/publishedVersion Formato: application/pdf
Publicado em 31/05/2013 POR
Relevância na Pesquisa
46.85%
Introduction and Objectives: To evaluate the prescription rate of oral anticoagulants in atrial fibrillation, the factors associated with non-prescription, the reasons referred by the physicians for not prescribing anticoagulants including the new generation anticoagulants, and to perform a medium term follow-up assessment. Materials and Methods: Prospective study on consecutive patients with atrial fibrillation with hospital discharge. The CHA2DS2VASc and HASBLED scores, associated comorbidities and medication prescribed before and at discharge were assessed. At discharge, the reason for not prescribing oral anticoagulants and the new oral anticoagulants was indicated by the physician in a questionnaire. Exclusion: absolute contraindication for anticoagulation, CHA2DS2VASc ≤ 1 and valvular disease. Follow-up data were obtained one year after the recruitment of the first patient. Results: 103 candidates for oral anticoagulants were identified (79.6 ± 8.0 years; CHA2DS2VASc 5.8 ± 1.4; HASBLED 2.6 ± 1.0; HASBLED ≥ 3 in 55.3%); the anticoagulants were prescribed in 34.0% of the candidates. The factors associated with non-prescription were, in decreasing order of relevance: previous use of antiplatelet agents, bedridden and/or demented patient...

Perfil sócio demográfico e clínico de pacientes em uso de anticoagulantes orais; El perfil socio demográficos y clínicas de los pacientes en uso de los anticoagulantes orales; Socio-demographic and clinical profile of patients using oral anticoagulants

PELEGRINO, Flávia Martinelli; DANTAS, Rosana Aparecida Spadoti; CORBI, Inaiara Scalçone de Almeida; CARVALHO, Ariana Rodrigues da Silva
Fonte: Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Publicador: Universidade Federal do Rio Grande do Sul. Escola de Enfermagem
Tipo: Artigo de Revista Científica
POR
Relevância na Pesquisa
56.59%
Este estudo teve como objetivo investigar o perfil sócio-demográfico, clínico e laboratorial de indivíduos em seguimento ambulatorial devido ao uso de anticoagulantes orais. O estudo foi descritivo, transversal, realizado no ambulatório de anticoagulação oral de um hospital terciário do interior do estado de São Paulo. Os dados foram coletados por entrevistas e consultas aos prontuários dos pacientes. Participaram 180 sujeitos, a maioria do sexo feminino (65,6%), com idade média de 55 anos, em uso de varfarina (83,3%) há mais de 6,9 anos, devido à presença de prótese cardíaca metálica (50%). Os resultados obtidos fornecem subsídios para os enfermeiros planejarem à assistencia aos usuários de anticoagulação oral com vistas a diminuição de possíveis complicações relacionadas à terapia e ao aumento da adesão ao tratamento.; Este estudio tiene como objetivo investigar el perfil sócio-demográfico, clínico y de laboratorio, período de seguimiento, porque las personas en el uso de los anticoagulantes orales. El estudio fue descriptivo, transversal, realizado en la clínica de anticoagulación oral en un hospital terciario en el estado de São Paulo, Brasil. Los datos fueron obtenídos a través de entrevistas y consultas con los registros médicos de los pacientes. Participaron 180 sujetos...

New perspectives and recommendations for anticoagulant therapy post orthopedic surgery

Kropf,Marcelo; Bergami,Cleidson Alves; Leal,Felipe Dias; Passos,Claudia Oliveira Dias; Gonsalves,Zilda de Santana; Marques,Isabela Laudares; Mota,Isabela Azevedo; Gonçalves,Marcele Lima Monte
Fonte: Universidade de São Paulo, Faculdade de Ciências Farmacêuticas Publicador: Universidade de São Paulo, Faculdade de Ciências Farmacêuticas
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2011 EN
Relevância na Pesquisa
46.6%
Anticoagulant therapy is essential for the prevention of risks associated with the formation of thrombus in patients after surgery, especially in orthopedics. Recently, new oral anticoagulants were introduced in the therapeutic arsenal. This fact is important, because the current drug of choice in clinical practice is enoxaparin, a low molecular weight heparin. As all injecting drugs, enoxaparin may reduce patients' adherence to treatment by dissatisfaction with and resistance to the administration. This article reviews the available literature on the overall utility of these innovative medicines, approaching the pharmacology, the compared efficacy in relation to current agents, and the potential targets for new agents, as well as points to new trends in research and development. The article also contributes with a practical guide for use and recommendations to health professionals, especially focusing on the reversibility of hemorrhagic events, and discusses the importance of convenience/satisfaction of use, the cost of treatment, and the risk-benefit profile for patients.

New perspectives and recommendations for anticoagulant therapy post orthopedic surgery

Kropf, Marcelo; Bergami, Cleidson Alves; Leal, Felipe Dias; Passos, Claudia Oliveira Dias; Gonsalves, Zilda de Santana; Marques, Isabela Laudares; Mota, Isabela Azevedo; Gonçalves, Marcele Lima Monte
Fonte: Universidade de São Paulo. Faculdade de Ciências Farmacêuticas Publicador: Universidade de São Paulo. Faculdade de Ciências Farmacêuticas
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; ; ; ; Formato: application/pdf
Publicado em 01/12/2011 ENG
Relevância na Pesquisa
46.6%
A terapia anticoagulante é fundamental para a prevenção de riscos associados à formação de trombos em pacientes pós-cirúrgicos, principalmente em ortopedia. Recentemente, novos anticoagulantes orais foram introduzidos no arsenal terapêutico. Tal fato é importantíssimo, visto que o atual medicamento de primeira escolha na prática clínica é a enoxaparina, uma heparina de baixo peso molecular. Por ser de uso injetável, a enoxaparina pode diminuir a adesão do paciente ao tratamento, devido à insatisfação e à resistência quanto à via de administração. Este artigo revisa a literatura disponível sobre a utilidade total desses medicamentos inovadores ao abordar a farmacologia, a eficácia em comparação com os agentes atuais e os alvos potenciais para novos agentes, bem como aponta as novas tendências em pesquisa e desenvolvimento. O artigo também contribui com um guia prático de uso e recomendações aos profissionais de saúde, com um enfoque especial sobre a reversibilidade de eventos hemorrágicos e, finalmente, discute a importância da conveniência/satisfação de uso, o custo de tratamento e o perfil risco-benefício para o paciente.; Anticoagulant therapy is essential for the prevention of risks associated with the formation of thrombus in patients after surgery...

Cost-Effectiveness of Non-Vitamin K Antagonist Oral Anticoagulants for Atrial Fibrillation in Portugal; Custo-Efectividade dos Novos Anticoagulantes Orais na Fibrilhação Auricular em Portugal

Costa, J; Fiorentino, F; Caldeira, D; Inês, M; Lopes Pereira, C; Pinheiro, L; Vaz-Carneiro, A; Borges, M; Gouveia, M
Fonte: Elsevier Publicador: Elsevier
Tipo: Artigo de Revista Científica
Publicado em 23/11/2015 ENG
Relevância na Pesquisa
66.59%
INTRODUCTION AND OBJECTIVES:Recently, three novel non-vitamin K antagonist oral anticoagulants received approval for reimbursement in Portugal for patients with non-valvular atrial fibrillation (AF). It is therefore important to evaluate the relative cost-effectiveness of these new oral anticoagulants in Portuguese AF patients. METHODS: A Markov model was used to analyze disease progression over a lifetime horizon. Relative efficacy data for stroke (ischemic and hemorrhagic), bleeding (intracranial, other major bleeding and clinically relevant non-major bleeding), myocardial infarction and treatment discontinuation were obtained by pairwise indirect comparisons between apixaban, dabigatran and rivaroxaban using warfarin as a common comparator. Data on resource use were obtained from the database of diagnosis-related groups and an expert panel. Model outputs included life years gained, quality-adjusted life years (QALYs), direct healthcare costs and incremental cost-effectiveness ratios (ICERs). RESULTS:Apixaban provided the most life years gained and QALYs. The ICERs of apixaban compared to warfarin and dabigatran were €5529/QALY and €9163/QALY, respectively. Apixaban was dominant over rivaroxaban (greater health gains and lower costs). The results were robust over a wide range of inputs in sensitivity analyses. Apixaban had a 70% probability of being cost-effective (at a threshold of €20 000/QALY) compared to all the other therapeutic options. CONCLUSIONS:Apixaban is a cost-effective alternative to warfarin and dabigatran and is dominant over rivaroxaban in AF patients from the perspective of the Portuguese national healthcare system. These conclusions are based on indirect comparisons...

Importance of dose selection in novel oral anticoagulants for atrial fibrillation

Grip,Laura T.; Giugliano,Robert P.
Fonte: Elsevier Publicador: Elsevier
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2012 EN
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There are several excellent alternatives to warfarin on the horizon for atrial fibrillation. Results from the trials, as well as pharmacokinetic data from the edoxaban studies, suggest that dose selection, based on pharmacokinetic and pharmacodynamic properties, is a critical component in the development of novel anticoagulants. Greater flexibility in dosing with edoxaban and the opportunity for dose adjustment throughout the ENGAGE AF-TIMI 48 trial may be advantageous in the competitive field of novel oral anticoagulants.