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[PMID]:29338536
[Au] Autor:Kupka D; Sibbing D
[Ad] Endereço:a Department of Cardiology , LMU München , Munich , Germany.
[Ti] Título:P2Y receptor inhibitors: an evolution in drug design to prevent arterial thrombosis.
[So] Source:Expert Opin Drug Metab Toxicol;14(3):303-315, 2018 Mar.
[Is] ISSN:1744-7607
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: P2Y12 inhibitors are a critical component of dual antiplatelet therapy (DAPT), which is the superior strategy to prevent arterialthrombosis in patients with acute coronary syndromes (ACS) and undergoing stent implantation.. Areas covered: Basic science articles, clinical studies, and reviews from 1992-2017 were searched using Pubmed library to collet impactful literature. After an introduction to the purinergic receptor biology, this review summarizes current knowledge on P2Y12 receptor inhibitors. Furthermore, we describe the subsequent improvements of next-generation P2Y12 receptor inhibitors facing the ambivalent problem of bleeding events versus prevention of arterial thrombosis in a variety of clinical settings. Therefore, we summarize data from relevant preclinical and clinical trials of currently approved P2Y12 receptor inhibitors (clopidogrel, prasugrel, ticagrelor, cangrelor) and provide strategies of drug switching and management of bleeding events. Expert opinion: An enormous amount of pharmacologic and clinical data is available for the application of P2Y12 receptor inhibitors. Today prasugrel, ticagrelor and clopidogrel are the standard of care drugs during dual antiplatelet therapy for ACS patients, but have considerable rates of bleeding. Recent and future clinical trials will provide evidence for subsequent escalation and de-escalation strategies of P2Y12 receptor inhibition. These data may pave the way for an evidence-based, individualized P2Y12 receptor inhibitor therapy.
[Mh] Termos MeSH primário: Desenho de Drogas
Antagonistas do Receptor Purinérgico P2Y/farmacologia
Trombose/prevenção & controle
[Mh] Termos MeSH secundário: Síndrome Coronariana Aguda/complicações
Síndrome Coronariana Aguda/tratamento farmacológico
Animais
Quimioterapia Combinada
Hemorragia/induzido quimicamente
Hemorragia/epidemiologia
Seres Humanos
Inibidores da Agregação de Plaquetas/administração & dosagem
Inibidores da Agregação de Plaquetas/efeitos adversos
Inibidores da Agregação de Plaquetas/farmacologia
Antagonistas do Receptor Purinérgico P2Y/administração & dosagem
Antagonistas do Receptor Purinérgico P2Y/efeitos adversos
Trombose/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Platelet Aggregation Inhibitors); 0 (Purinergic P2Y Receptor Antagonists)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180118
[St] Status:MEDLINE
[do] DOI:10.1080/17425255.2018.1428557


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[PMID]:29441970
[Au] Autor:Ohkura N; Ohnishi K; Taniguchi M; Nakayama A; Usuba Y; Fujita M; Fujii A; Ishibashi K; Baba K; Atsumi G
[Ti] Título:Anti-platelet effects of chalcones from Koidzumi (Ashitaba) .
[So] Source:Pharmazie;71(11):651-654, 2016 Nov 02.
[Is] ISSN:0031-7144
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:Angelica keiskei Koidzumi (Ashitaba) is a traditional folk medicine that is also regarded in Japan as a health food with potential antithrombotic properties. The ability of the major chalcones, xanthoangelol (XA) and 4-hydroxyderricin (4-HD) extracted from Ashitaba roots to inhibit platelet aggregation activity in vitro was recently determined. However, the anti-platelet activities of Ashitaba chalcones in vivo have remained unclear. The present study examines the anti-platelet effects of Ashitaba exudate and its constituent chalcones using mouse tail-bleeding models that reflect platelet aggregation in vivo. Ashitaba exudate and the major chalcone subtype XA, suppressed the lipopolysaccharide (LPS)-induced shortening of mouse tail bleeding. However, trace amounts of other Ashitaba chalcone subtypes including xanthoangelols B (XB), D (XD), E (XE) and F (XF) did not affect tail bleeding. These results suggest that the major chalcone subtype in Ashitaba, XA, has anti-platelet-activities in vivo.
[Mh] Termos MeSH primário: Angelica/química
Chalconas/farmacologia
Inibidores da Agregação de Plaquetas/farmacologia
[Mh] Termos MeSH secundário: Animais
Chalconas/química
Hemorragia/tratamento farmacológico
Lipopolissacarídeos/antagonistas & inibidores
Lipopolissacarídeos/farmacologia
Masculino
Camundongos
Camundongos Endogâmicos ICR
Raízes de Plantas/química
Agregação Plaquetária/efeitos dos fármacos
Inibidores da Agregação de Plaquetas/química
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Chalcones); 0 (Lipopolysaccharides); 0 (Platelet Aggregation Inhibitors)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE
[do] DOI:10.1691/ph.2016.6678


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[PMID]:29400026
[Au] Autor:El Bakkouri W; Blanc R; Benzakin S; Abdellaoui A; Boyeldieu L; Ayache D
[Ti] Título:[Innovations in interventional radiology applied to the field of otolaryngology: A pictorial essay].
[So] Source:Rev Laryngol Otol Rhinol (Bord);136(3):91-5, 2015.
[Is] ISSN:0035-1334
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:The management of hypervascular ENT tumors is usually complex and requires a multidisciplinary approach because of the risk of serious intra-operative bleeding and of potential injuries to cranial nerves and/or large cervical vessels. Over the last four decades, advances in neuro-interventional radio­logical procedures have produced a range of adjunctive endo­vascular techniques in addition to conventional surgery. A pictorial essay in ENT specialty is presented in this article highlighting the most relevant innovations in interventional radiology.
[Mh] Termos MeSH primário: Otolaringologia
Radiologia Intervencionista
[Mh] Termos MeSH secundário: Hemorragia/terapia
Seres Humanos
Artéria Oftálmica
Neoplasias da Retina/tratamento farmacológico
Retinoblastoma/tratamento farmacológico
Zumbido/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180206
[St] Status:MEDLINE


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[PMID]:29292966
[Au] Autor:Lindeman E
[Ad] Endereço:Läkemedelsverket - Giftinformationscentralen Stockholm, Sweden Läkemedelsverket - Giftinformationscentralen Stockholm, Sweden.
[Ti] Título:Målstyrd antidotterapi vid reversering av dabigatran..
[So] Source:Lakartidningen;114, 2017 Dec 05.
[Is] ISSN:1652-7518
[Cp] País de publicação:Sweden
[La] Idioma:swe
[Ab] Resumo:Goal-directed administration of antidote for reversal of dabigatran anticoagulation Idarucizumab is a monoclonal antibody fragment that acts as an antidote to dabigatran. Idarucizumab is indicated in dabigatran-associated serious bleeds and to reverse dabigatran anticoagulation before acute surgical interventions or invasive medical procedures. The recommended dose of 5 g idarucizumab is sufficient to achieve a lasting restoration of coagulation in most patients. In a number of cases however, notably in deliberate overdoses and in accumulation of dabigatran in renal failure, repeated doses of idarucizumab may be necessary to avoid persisting or rebound anticoagulation. This article gives a brief explanation of the mechanisms responsible for this phenomenon and argues that it should be anticipated. Serial monitoring of APTT or dTT in patients treated with idarucizumab should enable the early detection of treatment failure or rebound anticoagulation and, if clinically indicated, prompt administration of additional doses of antidote.
[Mh] Termos MeSH primário: Anticorpos Monoclonais Humanizados
Antídotos
Dabigatrana/antagonistas & inibidores
[Mh] Termos MeSH secundário: Anticorpos Monoclonais Humanizados/administração & dosagem
Anticorpos Monoclonais Humanizados/farmacologia
Antídotos/administração & dosagem
Antídotos/farmacologia
Antitrombinas/administração & dosagem
Antitrombinas/efeitos adversos
Antitrombinas/farmacologia
Dabigatrana/administração & dosagem
Dabigatrana/efeitos adversos
Dabigatrana/farmacologia
Monitoramento de Medicamentos
Hemorragia/induzido quimicamente
Hemorragia/prevenção & controle
Seres Humanos
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Monoclonal, Humanized); 0 (Antidotes); 0 (Antithrombins); 97RWB5S1U6 (idarucizumab); I0VM4M70GC (Dabigatran)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180103
[St] Status:MEDLINE


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[PMID]:29357388
[Au] Autor:Han Y; Kim HJ; Kong KA; Kim SJ; Lee SH; Ryu YJ; Lee JH; Kim Y; Shim SS; Chang JH
[Ad] Endereço:Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea.
[Ti] Título:Diagnosis of small pulmonary lesions by transbronchial lung biopsy with radial endobronchial ultrasound and virtual bronchoscopic navigation versus CT-guided transthoracic needle biopsy: A systematic review and meta-analysis.
[So] Source:PLoS One;13(1):e0191590, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Advances in bronchoscopy and CT-guided lung biopsy have improved the evaluation of small pulmonary lesions (PLs), leading to an increase in preoperative histological diagnosis. We aimed to evaluate the efficacy and safety of transbronchial lung biopsy using radial endobronchial ultrasound and virtual bronchoscopic navigation (TBLB-rEBUS&VBN) and CT-guided transthoracic needle biopsy (CT-TNB) for tissue diagnosis of small PLs. METHODS: A systematic search was performed in five electronic databases, including MEDLINE, EMBASE, Cochrane Library Central Register of Controlled Trials, Web of Science, and Scopus, for relevant studies in May 2016; the selected articles were assessed using meta-analysis. The articles were limited to those published after 2000 that studied small PLs ≤ 3 cm in diameter. RESULTS: From 7345 records, 9 articles on the bronchoscopic (BR) approach and 15 articles on the percutaneous (PC) approach were selected. The pooled diagnostic yield was 75% (95% confidence interval [CI], 69-80) using the BR approach and 93% (95% CI, 90-96) using the PC approach. For PLs ≤ 2 cm, the PC approach (pooled diagnostic yield: 92%, 95% CI: 88-95) was superior to the BR approach (66%, 95% CI: 55-76). However, for PLs > 2 cm but ≤ 3 cm, the diagnostic yield using the BR approach was improved to 81% (95% CI, 75-85). Complications of pneumothorax and hemorrhage were rare with the BR approach but common with the PC approach. CONCLUSIONS: CT-TNB was superior to TBLB-rEBUS&VBN for the evaluation of small PLs. However, for lesions greater than 2 cm, the BR approach may be considered considering its diagnostic yield of over 80% and the low risk of procedure-related complications.
[Mh] Termos MeSH primário: Pneumopatias/diagnóstico
Neoplasias Pulmonares/diagnóstico
[Mh] Termos MeSH secundário: Biópsia por Agulha/efeitos adversos
Biópsia por Agulha/métodos
Broncoscopia/efeitos adversos
Broncoscopia/métodos
Endossonografia/efeitos adversos
Endossonografia/métodos
Hemoptise/etiologia
Hemorragia/etiologia
Seres Humanos
Biópsia Guiada por Imagem/efeitos adversos
Biópsia Guiada por Imagem/métodos
Pneumopatias/diagnóstico por imagem
Pneumopatias/patologia
Neoplasias Pulmonares/diagnóstico por imagem
Neoplasias Pulmonares/patologia
Pneumotórax/etiologia
Tomografia Computadorizada por Raios X/métodos
Interface Usuário-Computador
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180123
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191590


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[PMID]:29406052
[Au] Autor:Hegde R; Li S; Gupta N; Cohen S
[Ad] Endereço:Department of Radiology, Bridgeport Hospital-Yal`e New Haven Health System, Bridgeport, Connecticut. Electronic address: rahulhegde@gmail.com.
[Ti] Título:Aortic Intramural Hemorrhage Secondary to Penetrating Atherosclerotic Ulcers.
[So] Source:Am J Med Sci;355(2):e5-e6, 2018 Feb.
[Is] ISSN:1538-2990
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Aorta Torácica/diagnóstico por imagem
Aortografia
Aterosclerose/diagnóstico por imagem
Hemorragia/diagnóstico por imagem
Tomografia Computadorizada por Raios X
[Mh] Termos MeSH secundário: Idoso
Feminino
Seres Humanos
[Pt] Tipo de publicação:CASE REPORTS; LETTER
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180207
[St] Status:MEDLINE


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Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
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[PMID]:29466159
[Au] Autor:Anderson DR; Dunbar M; Murnaghan J; Kahn SR; Gross P; Forsythe M; Pelet S; Fisher W; Belzile E; Dolan S; Crowther M; Bohm E; MacDonald SJ; Gofton W; Kim P; Zukor D; Pleasance S; Andreou P; Doucette S; Theriault C; Abianui A; Carrier M; Kovacs MJ; Rodger MA; Coyle D; Wells PS; Vendittoli PA
[Ad] Endereço:From the Departments of Medicine (D.R.A.), Surgery (M.D.), and Community Health and Epidemiology (P.A.), Dalhousie University, and the Nova Scotia Health Authority (S. Pleasance, S. Doucette, C.T., A.A.), Halifax, the Department of Surgery, University of Toronto, Toronto (J.M.), the Departments of M
[Ti] Título:Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty.
[So] Source:N Engl J Med;378(8):699-707, 2018 02 22.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Clinical trials and meta-analyses have suggested that aspirin may be effective for the prevention of venous thromboembolism (proximal deep-vein thrombosis or pulmonary embolism) after total hip or total knee arthroplasty, but comparisons with direct oral anticoagulants are lacking for prophylaxis beyond hospital discharge. METHODS: We performed a multicenter, double-blind, randomized, controlled trial involving patients who were undergoing total hip or knee arthroplasty. All the patients received once-daily oral rivaroxaban (10 mg) until postoperative day 5 and then were randomly assigned to continue rivaroxaban or switch to aspirin (81 mg daily) for an additional 9 days after total knee arthroplasty or for 30 days after total hip arthroplasty. Patients were followed for 90 days for symptomatic venous thromboembolism (the primary effectiveness outcome) and bleeding complications, including major or clinically relevant nonmajor bleeding (the primary safety outcome). RESULTS: A total of 3424 patients (1804 undergoing total hip arthroplasty and 1620 undergoing total knee arthroplasty) were enrolled in the trial. Venous thromboembolism occurred in 11 of 1707 patients (0.64%) in the aspirin group and in 12 of 1717 patients (0.70%) in the rivaroxaban group (difference, 0.06 percentage points; 95% confidence interval [CI], -0.55 to 0.66; P<0.001 for noninferiority and P=0.84 for superiority). Major bleeding complications occurred in 8 patients (0.47%) in the aspirin group and in 5 (0.29%) in the rivaroxaban group (difference, 0.18 percentage points; 95% CI, -0.65 to 0.29; P=0.42). Clinically important bleeding occurred in 22 patients (1.29%) in the aspirin group and in 17 (0.99%) in the rivaroxaban group (difference, 0.30 percentage points; 95% CI, -1.07 to 0.47; P=0.43). CONCLUSIONS: Among patients who received 5 days of rivaroxaban prophylaxis after total hip or total knee arthroplasty, extended prophylaxis with aspirin was not significantly different from rivaroxaban in the prevention of symptomatic venous thromboembolism. (Funded by the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT01720108 .).
[Mh] Termos MeSH primário: Artroplastia de Quadril
Artroplastia do Joelho
Aspirina/uso terapêutico
Inibidores do Fator Xa/uso terapêutico
Inibidores da Agregação de Plaquetas/uso terapêutico
Complicações Pós-Operatórias/prevenção & controle
Rivaroxabana/uso terapêutico
Tromboembolia Venosa/prevenção & controle
[Mh] Termos MeSH secundário: Idoso
Aspirina/efeitos adversos
Método Duplo-Cego
Inibidores do Fator Xa/efeitos adversos
Hemorragia/induzido quimicamente
Seres Humanos
Masculino
Meia-Idade
Inibidores da Agregação de Plaquetas/efeitos adversos
Fatores de Risco
Rivaroxabana/efeitos adversos
[Pt] Tipo de publicação:EQUIVALENCE TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Factor Xa Inhibitors); 0 (Platelet Aggregation Inhibitors); 9NDF7JZ4M3 (Rivaroxaban); R16CO5Y76E (Aspirin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMoa1712746


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[PMID]:29390265
[Au] Autor:Liu SY; Zeng B; Deng JB
[Ti] Título:Massive retroperitoneal hemorrhage secondary to femoral artery puncture: A case report and review of literature.
[So] Source:Medicine (Baltimore);96(50):e8724, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: A rare case of massive bleeding with rupture of the branch artery deriving from uterine artery was reported in the present study. PATIENT CONCERNS: A 29-year old female patient received embolism of malformed cerebral vessels. Ten hours after the operation, a sudden drop in blood pressure occurred. The patient developed coma and shock, and again underwent interventional angiography, which revealed bleeding at the right femoral artery puncture site of the first interventional procedure. The bleeding sign disappeared by pressure dressing. At 19 hours after stable condition, blood pressure fell again, and it was considered that recurrent bleeding occurred at the femoral artery puncture point. Therefore surgical suture of punctured blood vessel was performed. Then the condition was stabilized again. After another 20 hours, the third times blood pressure dropped. The third interventional angiography displayed a rupture of the branch artery deriving from the right uterine artery. Blood pressure of the patient elevated after embolism of right uterine artery, and the condition gradually stabilized. DIAGNOSES: The massive bleeding with rupture of the branch artery deriving from uterine artery seconded huge retroperitoneal hematoma after femoral artery puncture. INTERVENTIONS: The patient underwent three times interventional treatment including an embolism of malformed cerebral vessels, a right femoral artery interventional treatment, an embolism of the branch artery deriving from the right uterine artery and one time of surgical suture of punctured blood vessel. OUTCOMES: Half a month of comprehensive treatment later, the patient was discharged from the hospital. LESSONS: Massive bleeding with rupture of branch of artery deriving from the uterine artery following grain retroperitoneal hemorrhage is extremely rare, to the best of our knowledge, it has not been previously reported. The rupture of branch of artery deriving from the uterine artery should be considered as one the differential diagnosis in the retroperitoneal hemorrhage when the bleeding cause was not found. Endovascular trans-arterial embolism was a safe, effective, and minimally invasive therapeutic option.
[Mh] Termos MeSH primário: Artéria Femoral/lesões
Hemorragia/etiologia
Punções/efeitos adversos
Espaço Retroperitoneal
[Mh] Termos MeSH secundário: Adulto
Feminino
Artéria Femoral/cirurgia
Hemorragia/terapia
Seres Humanos
Ruptura Espontânea
Artéria Uterina/lesões
Embolização da Artéria Uterina
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008724


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[PMID]:29231094
[Au] Autor:Raskob GE; van Es N; Verhamme P; Carrier M; Di Nisio M; Garcia D; Grosso MA; Kakkar AK; Kovacs MJ; Mercuri MF; Meyer G; Segers A; Shi M; Wang TF; Yeo E; Zhang G; Zwicker JI; Weitz JI; Büller HR; Hokusai VTE Cancer Investigators
[Ad] Endereço:From the University of Oklahoma Health Sciences Center, College of Public Health, Oklahoma City (G.E.R.); the Department of Vascular Medicine, Academic Medical Center, University of Amsterdam (N.E., H.R.B.), and ITREAS, Academic Research Organization (A.S.) - both in Amsterdam; the Department of Vas
[Ti] Título:Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism.
[So] Source:N Engl J Med;378(7):615-624, 2018 02 15.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Low-molecular-weight heparin is the standard treatment for cancer-associated venous thromboembolism. The role of treatment with direct oral anticoagulant agents is unclear. METHODS: In this open-label, noninferiority trial, we randomly assigned patients with cancer who had acute symptomatic or incidental venous thromboembolism to receive either low-molecular-weight heparin for at least 5 days followed by oral edoxaban at a dose of 60 mg once daily (edoxaban group) or subcutaneous dalteparin at a dose of 200 IU per kilogram of body weight once daily for 1 month followed by dalteparin at a dose of 150 IU per kilogram once daily (dalteparin group). Treatment was given for at least 6 months and up to 12 months. The primary outcome was a composite of recurrent venous thromboembolism or major bleeding during the 12 months after randomization, regardless of treatment duration. RESULTS: Of the 1050 patients who underwent randomization, 1046 were included in the modified intention-to-treat analysis. A primary-outcome event occurred in 67 of the 522 patients (12.8%) in the edoxaban group as compared with 71 of the 524 patients (13.5%) in the dalteparin group (hazard ratio, 0.97; 95% confidence interval [CI], 0.70 to 1.36; P=0.006 for noninferiority; P=0.87 for superiority). Recurrent venous thromboembolism occurred in 41 patients (7.9%) in the edoxaban group and in 59 patients (11.3%) in the dalteparin group (difference in risk, -3.4 percentage points; 95% CI, -7.0 to 0.2). Major bleeding occurred in 36 patients (6.9%) in the edoxaban group and in 21 patients (4.0%) in the dalteparin group (difference in risk, 2.9 percentage points; 95% CI, 0.1 to 5.6). CONCLUSIONS: Oral edoxaban was noninferior to subcutaneous dalteparin with respect to the composite outcome of recurrent venous thromboembolism or major bleeding. The rate of recurrent venous thromboembolism was lower but the rate of major bleeding was higher with edoxaban than with dalteparin. (Funded by Daiichi Sankyo; Hokusai VTE Cancer ClinicalTrials.gov number, NCT02073682 .).
[Mh] Termos MeSH primário: Anticoagulantes/uso terapêutico
Dalteparina/uso terapêutico
Neoplasias/complicações
Piridinas/uso terapêutico
Tiazóis/uso terapêutico
Tromboembolia Venosa/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Idoso
Anticoagulantes/efeitos adversos
Dalteparina/efeitos adversos
Seguimentos
Hemorragia/induzido quimicamente
Heparina de Baixo Peso Molecular/efeitos adversos
Heparina de Baixo Peso Molecular/uso terapêutico
Seres Humanos
Análise de Intenção de Tratamento
Estimativa de Kaplan-Meier
Masculino
Meia-Idade
Piridinas/efeitos adversos
Recidiva
Tiazóis/efeitos adversos
Tromboembolia Venosa/etiologia
[Pt] Tipo de publicação:EQUIVALENCE TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Heparin, Low-Molecular-Weight); 0 (Pyridines); 0 (Thiazoles); NDU3J18APO (edoxaban); S79O08V79F (Dalteparin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171213
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMoa1711948


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[PMID]:29363105
[Au] Autor:Hakoum MB; Kahale LA; Tsolakian IG; Matar CF; Yosuico VE; Terrenato I; Sperati F; Barba M; Schünemann H; Akl EA
[Ad] Endereço:Family Medicine, American University of Beirut, Beirut, Lebanon, 1107 2020.
[Ti] Título:Anticoagulation for the initial treatment of venous thromboembolism in people with cancer.
[So] Source:Cochrane Database Syst Rev;1:CD006649, 2018 01 24.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Compared with people without cancer, people with cancer who receive anticoagulant treatment for venous thromboembolism (VTE) are more likely to develop recurrent VTE. OBJECTIVES: To compare the efficacy and safety of three types of parenteral anticoagulants (i.e. fixed-dose low molecular weight heparin (LMWH), adjusted-dose unfractionated heparin (UFH), and fondaparinux) for the initial treatment of VTE in people with cancer. SEARCH METHODS: A comprehensive search included a major electronic search of the following databases: Cochrane Central Register of Controlled Trials (CENTRAL) (2018, Issue 1), MEDLINE (via Ovid) and Embase (via Ovid); handsearching of conference proceedings; checking of references of included studies; use of the 'related citation' feature in PubMed; and a search for ongoing studies. This update of the systematic review was based on the findings of a literature search conducted on 14 January 2018. SELECTION CRITERIA: Randomized controlled trials (RCTs) assessing the benefits and harms of LMWH, UFH, and fondaparinux in people with cancer and objectively confirmed VTE. DATA COLLECTION AND ANALYSIS: Using a standardized form, we extracted data in duplicate on study design, participants, interventions outcomes of interest, and risk of bias. Outcomes of interested included all-cause mortality, symptomatic VTE, major bleeding, minor bleeding, postphlebitic syndrome, quality of life, and thrombocytopenia. We assessed the certainty of evidence for each outcome using the GRADE approach. MAIN RESULTS: Of 15440 identified citations, 7387 unique citations, 15 RCTs fulfilled the eligibility criteria. These trials enrolled 1615 participants with cancer and VTE: 13 compared LMWH with UFH enrolling 1025 participants, one compared fondaparinux with UFH and LMWH enrolling 477 participants, and one compared dalteparin with tinzaparin enrolling 113 participants. The meta-analysis of mortality at three months included 418 participants from five studies and that of recurrent VTE included 422 participants from 3 studies. The findings showed that LMWH likely decreases mortality at three months compared to UFH (risk ratio (RR) 0.66, 95% confidence interval (CI) 0.40 to 1.10; risk difference (RD) 57 fewer per 1000, 95% CI 101 fewer to 17 more; moderate certainty evidence), but did not rule out a clinically significant increase or decrease in VTE recurrence (RR 0.69, 95% CI 0.27 to 1.76; RD 30 fewer per 1000, 95% CI 70 fewer to 73 more; moderate certainty evidence).The study comparing fondaparinux with heparin (UFH or LMWH) did not exclude a beneficial or detrimental effect of fondaparinux on mortality at three months (RR 1.25, 95% CI 0.86 to 1.81; RD 43 more per 1000, 95% CI 24 fewer to 139 more; moderate certainty evidence), recurrent VTE (RR 0.93, 95% CI 0.56 to 1.54; RD 8 fewer per 1000, 95% CI 52 fewer to 63 more; moderate certainty evidence), major bleeding (RR 0.82, 95% CI 0.40 to 1.66; RD 12 fewer per 1000, 95% CI 40 fewer to 44 more; moderate certainty evidence), or minor bleeding (RR 1.53, 95% CI 0.88 to 2.66; RD 42 more per 1000, 95% CI 10 fewer to 132 more; moderate certainty evidence)The study comparing dalteparin with tinzaparin did not exclude a beneficial or detrimental effect of dalteparin on mortality (RR 0.86, 95% CI 0.43 to 1.73; RD 33 fewer per 1000, 95% CI 135 fewer to 173 more; low certainty evidence), recurrent VTE (RR 0.44, 95% CI 0.09 to 2.16; RD 47 fewer per 1000, 95% CI 77 fewer to 98 more; low certainty evidence), major bleeding (RR 2.19, 95% CI 0.20 to 23.42; RD 20 more per 1000, 95% CI 14 fewer to 380 more; low certainty evidence), or minor bleeding (RR 0.82, 95% CI 0.30 to 2.21; RD 24 fewer per 1000, 95% CI 95 fewer to 164 more; low certainty evidence). AUTHORS' CONCLUSIONS: LMWH is possibly superior to UFH in the initial treatment of VTE in people with cancer. Additional trials focusing on patient-important outcomes will further inform the questions addressed in this review. The decision for a person with cancer to start LMWH therapy should balance the benefits and harms and consider the person's values and preferences.
[Mh] Termos MeSH primário: Anticoagulantes/uso terapêutico
Neoplasias/complicações
Tromboembolia Venosa/tratamento farmacológico
[Mh] Termos MeSH secundário: Dalteparina/uso terapêutico
Fibrinolíticos/uso terapêutico
Hemorragia/induzido quimicamente
Heparina/uso terapêutico
Heparina de Baixo Peso Molecular/uso terapêutico
Seres Humanos
Polissacarídeos/uso terapêutico
Ensaios Clínicos Controlados Aleatórios como Assunto
Recidiva
Prevenção Secundária
Tromboembolia Venosa/mortalidade
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Fibrinolytic Agents); 0 (Heparin, Low-Molecular-Weight); 0 (Polysaccharides); 7UQ7X4Y489 (tinzaparin); 9005-49-6 (Heparin); J177FOW5JL (fondaparinux); S79O08V79F (Dalteparin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180125
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD006649.pub7



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