19 results on '"Ariane Vieira Scarlatelli Macedo"'
Search Results
2. Recommendations for the management of cardiovascular risk in patients with chronic myeloid leukemia on tyrosine kinase inhibitors: risk assessment, stratification, treatment and monitoring
- Author
-
Laura Fogliatto, Andre Abdo, Monika Conchon, Carla Maria Boquimpani de Moura, Carolina Maria Pinto Domingues Carvalho Silva, Vaneuza Araujo Moreira Funke, Fernanda S Seguro, José Francisco Kerr Saraiva, Ariane Vieira Scarlatelli Macedo, and Marilia Harumi Higushi dos Santos
- Subjects
medicine.medical_specialty ,Referral ,Protein kinase inhibitors ,Review Article ,Disease ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Diabetes mellitus ,medicine ,Immunology and Allergy ,Diseases of the blood and blood-forming organs ,Framingham Risk Score ,Hematology ,business.industry ,Guideline ,Leukemia, myeloid ,medicine.disease ,Cardiovascular diseases ,Risk factors ,Risk management ,RC633-647.5 ,Risk assessment ,business ,Dyslipidemia ,030215 immunology - Abstract
This manuscript summarizes the results of the consensus meeting composed of hematologists and cardiologists to establish recommendations for the prevention and follow-up of cardiovascular (CV) risk in patients with chronic myeloid leukemia (CML) treated with BCR-ABL tyrosine kinase inhibitors (TKIs) from the point of view of clinical practice and from the perspective of hematology consultation.In the first medical appointment, the CV risk factors should be identified to perform the baseline risk stratification, based on the Brazilian Guideline of Dyslipidemia and Atherosclerosis Prevention Update (risk levels: very high, high, intermediate and low).Once stratified, the treatment of the CV risk factors should be administered. If the patient presents risk factors, such as hypertension, diabetes, renal disease, smoking and hypercholesterolemia, the evaluation and initial treatment may be done by the hematologist, being an option the request for evaluation by a specialist. If the patient has a history of previous CV disease, we recommend referral to a specialist. As the CV risk score is dynamic and the control of risk factors can reduce the patient risk, this expert consensus recommends that the re-evaluation of the CV risk after the baseline should be performed at 3 months, 6 months and 12 months. After this period, it should be done annually and, for specific patients, at the clinician's discretion.The evaluation of the baseline CV risk and the safe administration of a TKI allow the patient to benefit from the maximum treatment, avoiding unwanted effects.
- Published
- 2021
3. Diretriz Brasileira de Cardio-oncologia – 2020
- Author
-
Carlos M. Campos, Paulo M. Hoff, Anelisa Coutinho, Silvia Moulin Ribeiro Fonseca, Vanderson Rocha, Maria Del Pilar Estevez Diz, Diego Ribeiro Garcia, Stephanie Itala Rizk, Ricardo Pavanello, Cesar Higa Nomura, Bruna Morhy Borges Leal Assunção, Cristina Salvadori Bittar, Wilson Mathias Junior, Gustavo Spadaccia dos Santos Fernandes, Marcelo Westerlund Montera, Clarissa Maria de Cerqueira Mathias, Maria Veronica Camara dos Santos, Cecilia Cruz, Marcelo Antônio Cartaxo Queiroga Lopes, Thiago Liguori Feliciano da Silva, Juliana Barbosa Sobral Alves, Manuel Maria Ramos Valente Neto, Carlos Eduardo Negrão, Ana O. Hoff, Roberto Kalil Filho, Maria Carolina Feres de Almeida Soeiro, Marcus Vinícius Bolívar Malachias, Patricia Tavares Felipe Marcatti, Carlos E. Rochitte, Dirceu R. Almeida, Fernando Meton de Alencar Camara Vieira, José Antonio Franchini Ramires, Ariane Vieira Scarlatelli Macedo, Isabela Bispo Santos da Silva Costa, Marianna Deway Andrade Dracoulakis, Laura Testa, Ludhmila Abrahão Hajjar, Aristóteles Comte de Alencar Filho, Yana Novis, Andre Deeke Sasse, Helano Freitas, Luís Beck-da-Silva, Marilia Harumi Higuchi dos Santos Rehder, Silvia Moreira Ayub Ferreira, Ibraim Pinto, Silvia Marinho Martins Alves, Evanius Garcia Wiermann, Maria da Consolação Vieira Moreira, Renata do Val, Juliana Pereira, Antonio Felipe Simão, Carolina Maria Pinto Domingues Carvalho Silva, Veronica Cristina Quiroga Fonseca, João C.N. Sbano, and Julia Tizue Fukushima
- Subjects
medicine.medical_specialty ,education.field_of_study ,business.industry ,Population ,MEDLINE ,Cancer ,Economic shortage ,Disease ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,RC666-701 ,Epidemiology ,Life expectancy ,Medicine ,Diseases of the circulatory (Cardiovascular) system ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,education ,Health policy - Abstract
1. Introduction Cardiovascular disease (CVD) and cancer are currently the leading causes of mortality worldwide and in Brazil.– The recent demographic and epidemiological transitions in Brazil have determined an increase in the population’s life expectancy, today around 76 years, and a change in the health profile, in which chronic diseases and their complications prevail. These factors pose important challenges and require the development of a health policy agenda for the management of the ongoing transitions. The technological advances, the shortage [...]
- Published
- 2020
4. Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the <scp>C</scp> ardio‐ <scp>O</scp> ncology <scp>S</scp> tudy <scp>G</scp> roup of the <scp>H</scp> eart <scp>F</scp> ailure <scp>A</scp> ssociation of the <scp>E</scp> uropean <scp>S</scp> ociety of <scp>C</scp> ardiology in collaboration with the <scp>I</scp> nternational <scp>C</scp> ardio‐ <scp>O</scp> ncology <scp>S</scp> ociety
- Author
-
Johann Bauersachs, Petar M. Seferovic, Teresa López-Fernández, Ovidiu Chioncel, Ronald M. Witteles, Michael G. Fradley, Bonnie Ky, Daniel J. Lenihan, Thomas Thum, Dragana Milojkovic, Paaladinesh Thavendiranathan, Javid Moslehi, Michael J. Mauro, Frank Ruschitzka, Thomas M. Suter, John D. Groarke, Jutta Bergler-Klein, Charlotte Manisty, Li Ling Tan, Vincent Khoo, Ariane Vieira Scarlatelli Macedo, Radek Pudil, Ashutosh Wechelaker, Dimitrios Farmakis, Y N Belenkov, Susan Dent, Hugues de Lavallade, Chris Plummer, Susannah Stanway, Alain Cohen-Solal, Tomas G. Neilan, Alexander R. Lyon, Fortunato Ciardiello, Andrew J.S. Coats, M. Sol Andres, Daniela Cardinale, Hadi Skouri, David Wright, Ana Barac, Christoph Maack, Stuart D. Rosen, Christine Brezden-Masley, Zaza Iakobishvili, Robert F. Cornell, Markus S. Anker, Aaron L. Sverdlov, Helena M. Earl, Carlo G. Tocchetti, Ludhmila Abrahão Hajjar, Stephan von Haehling, Joerg Herrmann, and Rudolf A. de Boer
- Subjects
Cardiotoxicity ,medicine.medical_specialty ,Chemotherapy ,business.industry ,medicine.medical_treatment ,Cancer ,Risk management tools ,030204 cardiovascular system & hematology ,medicine.disease ,3. Good health ,03 medical and health sciences ,0302 clinical medicine ,Trastuzumab ,Internal medicine ,Heart failure ,Cardiology ,medicine ,Cardiology and Cardiovascular Medicine ,Risk assessment ,business ,Multiple myeloma ,medicine.drug - Abstract
This position statement from the Heart Failure Association of the European Society of Cardiology Cardio-Oncology Study Group in collaboration with the International Cardio-Oncology Society presents practical, easy-to-use and evidence-based risk stratification tools for oncologists, haemato-oncologists and cardiologists to use in their clinical practice to risk stratify oncology patients prior to receiving cancer therapies known to cause heart failure or other serious cardiovascular toxicities. Baseline risk stratification proformas are presented for oncology patients prior to receiving the following cancer therapies: anthracycline chemotherapy, HER2-targeted therapies such as trastuzumab, vascular endothelial growth factor inhibitors, second and third generation multi-targeted kinase inhibitors for chronic myeloid leukaemia targeting BCR-ABL, multiple myeloma therapies (proteasome inhibitors and immunomodulatory drugs), RAF and MEK inhibitors or androgen deprivation therapies. Applying these risk stratification proformas will allow clinicians to stratify cancer patients into low, medium, high and very high risk of cardiovascular complications prior to starting treatment, with the aim of improving personalised approaches to minimise the risk of cardiovascular toxicity from cancer therapies.
- Published
- 2020
5. Continuing versus suspending angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: Impact on adverse outcomes in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)--The BRACE CORONA Trial
- Author
-
Christopher B. Granger, Guilherme D'Andréa Saba Arruda, Renata Junqueira Moll-Bernardes, Natalia Zerbinatti Salvador, Olga Ferreira de Souza, Andrea Silvestre de Souza, Denilson Campos de Albuquerque, Renato D. Lopes, John H. Alexander, Ariane Vieira Scarlatelli Macedo, Pedro Gabriel Melo de Barros e Silva, Mayara Fraga Santos, Lilian Mazza, C. Michael Gibson, and Andre Feldman
- Subjects
medicine.medical_specialty ,Myocarditis ,Virus Integration ,Pneumonia, Viral ,Angiotensin-Converting Enzyme Inhibitors ,Clinical Trials, Phase IV as Topic ,Peptidyl-Dipeptidase A ,030204 cardiovascular system & hematology ,Article ,Renin-Angiotensin System ,Angiotensin Receptor Antagonists ,Betacoronavirus ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Pragmatic Clinical Trials as Topic ,medicine ,Humans ,Multicenter Studies as Topic ,Decompensation ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Pandemics ,Stroke ,Randomized Controlled Trials as Topic ,Inpatients ,biology ,SARS-CoV-2 ,business.industry ,COVID-19 ,Angiotensin-converting enzyme ,medicine.disease ,Discontinuation ,Withholding Treatment ,Respiratory failure ,Heart failure ,biology.protein ,Angiotensin-Converting Enzyme 2 ,Coronavirus Infections ,Cardiology and Cardiovascular Medicine ,business ,Brazil - Abstract
Background Angiotensin-converting enzyme-2 (ACE2) may increase due to upregulation in patients using angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB). Because renin-angiotensin system blockers increase levels of ACE2, a protein that facilitates coronavirus entry into cells, there is concern that these drugs could increase the risk of developing a severe and fatal form of COVID-19. The impact of discontinuing ACEI and ARBs in patients with COVID-19 remains uncertain. DESIGN BRACE CORONA is a pragmatic, multicenter, randomized, phase IV, clinical trial that aims to enroll around 500 participants at 32 sites in Brazil. Participants will be identified from an ongoing national registry of suspected and confirmed cases of COVID-19. Eligible patients using renin-angiotensin system blockers (ACEI/ARBs) with a confirmed diagnosis of COVID-19 will be randomized to a strategy of continued ACEI/ARB treatment versus temporary discontinuation for 30 days. The primary outcome is the median days alive and out of the hospital at 30 days. Secondary outcomes include progression of COVID-19 disease, all-cause mortality, death from vascular causes, myocardial infarction, stroke, transient ischemic attack, new or worsening heart failure, myocarditis, pericarditis, arrhythmias, thromboembolic events, hypertensive crisis, respiratory failure, hemodynamic decompensation, sepsis, renal failure, troponin, B-type natriuretic peptide, N-terminal-pro hormone and D-dimer levels. Summary BRACE CORONA will evaluate whether the strategy of continued ACEI/ARB therapy compared with temporary discontinuation of these drugs impacts clinical outcomes among patients with COVID-19., Graphical abstractUnlabelled Image
- Published
- 2020
6. Therapeutic versus prophylactic anticoagulation for patients admitted to hospital with COVID-19 and elevated D-dimer concentration (ACTION): an open-label, multicentre, randomised, controlled trial
- Author
-
Estêvão Lanna Figueiredo, Dario Rafael Abregu Diaz, Alexandre Biasi Cavalcanti, Aline de Oliveira Twardowsky, Alexandre de Matos Soeiro, Marianna Deway Andrade Dracoulakis, Renato D. Lopes, Vinicius Santana Nunes, Anne Cristine Silva Fernandes, Júlia de Aveiro Morata, Mauro E. Hernandes, Gilson Soares Feitosa-Filho, Manoel Fernandes Canesin, Lilia Nigro Maia, Vicente C.S. Dantas, Viviane C Veiga, Ana Thereza Rocha, Otavio Gebara, Remo H.M. Furtado, Lilian Mazza Barbosa, Sueli V Santos, Leonardo Meira de Faria, Lorena Souza Viana, Aryadne Lyrio de Oliveira, Flávia Ribeiro Machado, Idelzuíta Leandro Liporace, Diego Aparecido Rios Queiroz, Fernando Carvalho Neuenschwander, Regis Goulart Rosa, Mariana Silveira de Alcântara Chaud, Livia Maria Garcia Melro, Ariane Vieira Scarlatelli Macedo, Patrícia O. Guimarães, Priscilla de Aquino Martins, John H. Alexander, Eduardo Ramacciotti, Luiz Eduardo Fonteles Ritt, Alvaro Avezum, Luciano Cesar Pontes Azevedo, Lucas Tramujas, Luciana Armaganijan, Rodolfo Godinho Souza Dourado Lima, Bruna Bronhara, Germano Emílio Conceição-Souza, Marcelo Basso Gazzana, Pedro Gabriel Melo de Barros e Silva, Otavio Berwanger, Lucas P. Damiani, Duke University Medical Center, Brazilian Clinical Research Institute, HCor Research Institute, Hospital Samaritano Paulista, Hospital Israelita Albert Einstein, Universidade de São Paulo (USP), Science Valley Research Institute, Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Hospital Estadual Dr Jayme Santos Neves, Hospital Cárdio Pulmonar, Escola Bahiana de Medicina, Universidade Federal da Bahia (UFBA), Hospital Vera Cruz, Hospital Da Bahia, Hospital Naval Marcílio Dias, Hospital Santa Paula, Santa Casa de Misericórdia de Votuporanga, Universidade Estadual Paulista (UNESP), Brazilian Research in Intensive Care Network, BP—A Beneficência Portuguesa de São Paulo, Universidade Estadual de Londrina (UEL), Hospital Felício Rocho, Santa Casa de Misericórdia da Bahia–Hospital Santa Izabel, Centro Universitário Faculdade de Tecnologia e Ciências, Hospital Moinhos de Vento, Instituto Dante Pazzanese de Cardiologia, Hospital de Amor de Barretos (Pio XII), Hospital de Base de São José do Rio Preto, Instituto Socrates Guanaes, Hospital Sírio Libanês Research and Education Institute, and Hospital Alemão Oswaldo Cruz
- Subjects
Adult ,Male ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Endpoint Determination ,Population ,Hemorrhage ,030204 cardiovascular system & hematology ,law.invention ,Fibrin Fibrinogen Degradation Products ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Rivaroxaban ,Elevated D-dimer ,law ,Internal medicine ,Correspondence ,medicine ,Humans ,030212 general & internal medicine ,Enoxaparin ,education ,Blood Coagulation ,Aged ,education.field_of_study ,business.industry ,Heparin ,SARS-CoV-2 ,Anticoagulants ,COVID-19 ,Articles ,General Medicine ,Middle Aged ,Patient Discharge ,COVID-19 Drug Treatment ,Hospitalization ,Treatment Outcome ,Relative risk ,Female ,Open label ,business ,Brazil ,medicine.drug - Abstract
Made available in DSpace on 2022-04-29T08:29:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-06-12 Background: COVID-19 is associated with a prothrombotic state leading to adverse clinical outcomes. Whether therapeutic anticoagulation improves outcomes in patients hospitalised with COVID-19 is unknown. We aimed to compare the efficacy and safety of therapeutic versus prophylactic anticoagulation in this population. Methods: We did a pragmatic, open-label (with blinded adjudication), multicentre, randomised, controlled trial, at 31 sites in Brazil. Patients (aged ≥18 years) hospitalised with COVID-19 and elevated D-dimer concentration, and who had COVID-19 symptoms for up to 14 days before randomisation, were randomly assigned (1:1) to receive either therapeutic or prophylactic anticoagulation. Therapeutic anticoagulation was in-hospital oral rivaroxaban (20 mg or 15 mg daily) for stable patients, or initial subcutaneous enoxaparin (1 mg/kg twice per day) or intravenous unfractionated heparin (to achieve a 0·3–0·7 IU/mL anti-Xa concentration) for clinically unstable patients, followed by rivaroxaban to day 30. Prophylactic anticoagulation was standard in-hospital enoxaparin or unfractionated heparin. The primary efficacy outcome was a hierarchical analysis of time to death, duration of hospitalisation, or duration of supplemental oxygen to day 30, analysed with the win ratio method (a ratio >1 reflects a better outcome in the therapeutic anticoagulation group) in the intention-to-treat population. The primary safety outcome was major or clinically relevant non-major bleeding through 30 days. This study is registered with ClinicalTrials.gov (NCT04394377) and is completed. Findings: From June 24, 2020, to Feb 26, 2021, 3331 patients were screened and 615 were randomly allocated (311 [50%] to the therapeutic anticoagulation group and 304 [50%] to the prophylactic anticoagulation group). 576 (94%) were clinically stable and 39 (6%) clinically unstable. One patient, in the therapeutic group, was lost to follow-up because of withdrawal of consent and was not included in the primary analysis. The primary efficacy outcome was not different between patients assigned therapeutic or prophylactic anticoagulation, with 28 899 (34·8%) wins in the therapeutic group and 34 288 (41·3%) in the prophylactic group (win ratio 0·86 [95% CI 0·59–1·22], p=0·40). Consistent results were seen in clinically stable and clinically unstable patients. The primary safety outcome of major or clinically relevant non-major bleeding occurred in 26 (8%) patients assigned therapeutic anticoagulation and seven (2%) assigned prophylactic anticoagulation (relative risk 3·64 [95% CI 1·61–8·27], p=0·0010). Allergic reaction to the study medication occurred in two (1%) patients in the therapeutic anticoagulation group and three (1%) in the prophylactic anticoagulation group. Interpretation: In patients hospitalised with COVID-19 and elevated D-dimer concentration, in-hospital therapeutic anticoagulation with rivaroxaban or enoxaparin followed by rivaroxaban to day 30 did not improve clinical outcomes and increased bleeding compared with prophylactic anticoagulation. Therefore, use of therapeutic-dose rivaroxaban, and other direct oral anticoagulants, should be avoided in these patients in the absence of an evidence-based indication for oral anticoagulation. Funding: Coalition COVID-19 Brazil, Bayer SA. Duke Clinical Research Institute Duke University Medical Center Brazilian Clinical Research Institute HCor Research Institute Hospital Samaritano Paulista Academic Research Organization Hospital Israelita Albert Einstein Instituto do Coração Universidade de São Paulo Instituto do Câncer do Estado de São Paulo Hospital das Clínicas da Faculdade de Medicina Universidade de São Paulo Science Valley Research Institute Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center Hospital Estadual Dr Jayme Santos Neves Hospital Cárdio Pulmonar Escola Bahiana de Medicina Universidade Federal da Bahia Hospital Vera Cruz Hospital Da Bahia Hospital Naval Marcílio Dias Hospital Santa Paula Santa Casa de Misericórdia de Votuporanga Hospital das Clínicas da Faculdade de Medicina de Botucatu Brazilian Research in Intensive Care Network BP—A Beneficência Portuguesa de São Paulo Hospital Universitário da Universidade Estadual de Londrina Hospital Felício Rocho Santa Casa de Misericórdia da Bahia–Hospital Santa Izabel Centro Universitário Faculdade de Tecnologia e Ciências Hospital Moinhos de Vento Instituto Dante Pazzanese de Cardiologia Hospital de Amor de Barretos (Pio XII) Hospital de Base de São José do Rio Preto Anesthesiology Pain and Intensive Care Department Federal University of São Paulo Instituto Socrates Guanaes Hospital Sírio Libanês Research and Education Institute International Research Center Hospital Alemão Oswaldo Cruz Hospital das Clínicas da Faculdade de Medicina de Botucatu
- Published
- 2021
7. Randomized Clinical Trial to Evaluate a Routine Full Anticoagulation Strategy in Patients with Coronavirus Infection (SARS-CoV2) Admitted to Hospital: Rationale and Design of the ACTION (AntiCoagulaTlon cOroNavirus)–Coalition IV Trial
- Author
-
Renato D. Lopes, Priscilla de Aquino Martins, Luciano Cesar Pontes Azevedo, Flávia Ribeiro Machado, Alvaro Avezum, John H. Alexander, Alexandre Biasi Cavalcanti, Regis Goulart Rosa, Eduardo Ramacciotti, Luiz Eduardo Fonteles Ritt, Viviane C Veiga, Lucas Petri Damini, Coalition Covid Brazil Iv Investigators, Pedro Gabriel Melo de Barros e Silva, Remo H.M. Furtado, Ariane Vieira Scarlatelli Macedo, Bruna Bronhara, and Otavio Berwanger
- Subjects
medicine.medical_specialty ,Randomization ,Time Factors ,medicine.medical_treatment ,Trial Designs ,coronavirus ,Administration, Oral ,Hemorrhage ,030204 cardiovascular system & hematology ,Drug Administration Schedule ,law.invention ,Fibrin Fibrinogen Degradation Products ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Rivaroxaban ,law ,Oxygen therapy ,Internal medicine ,Medicine ,Humans ,030212 general & internal medicine ,Enoxaparin ,anticoagulation ,Stroke ,business.industry ,Oxygen Inhalation Therapy ,COVID-19 ,Anticoagulants ,Thrombosis ,medicine.disease ,Clinical trial ,Hospitalization ,Regimen ,Cardiology and Cardiovascular Medicine ,business ,Brazil ,medicine.drug ,severe acute respiratory syndrome coronavirus 2 - Abstract
Background : Observational studies have suggested a higher risk of thrombotic events in patients with coronavirus disease 2019 (COVID-19). Moreover, elevated D-dimer levels have been identified as an important prognostic marker in COVID-19 directly associated with disease severity and progression. Prophylactic anticoagulation for hospitalized COVID-19 patients might not be enough to prevent thrombotic events; therefore, therapeutic anticoagulation regimens deserve clinical investigation. Design : ACTION is an academic-led, pragmatic, multicenter, open-label, randomized, phase IV clinical trial that aims to enroll around 600 patients at 40 sites participating in the Coalition COVID-19 Brazil initiative. Eligible patients with a confirmed diagnosis of COVID-19 with symptoms up to 14 days and elevated D-dimer levels will be randomized to a strategy of full-dose anticoagulation for 30 days with rivaroxaban 20 mg once daily (or full-dose heparin if oral administration is not feasible) versus standard of care with any approved venous thromboembolism (VTE) prophylaxis regimen during hospitalization. A confirmation of COVID-19 was mandatory for study entry, based on specific tests used in clinical practice (RT-PCR, antigen test, IgM test) collected before randomization, regardless of in the outpatient setting or not. Randomization will be stratified by clinical stability at presentation. The primary outcome is a hierarchical analysis of mortality, length of hospital stay, or duration of oxygen therapy at the end of 30 days. Secondary outcomes include the World Health Organization's 8-point ordinal scale at 30 days and the following individual efficacy outcomes: incidence of VTE, acute myocardial infarction, stroke, systemic embolism, major adverse limb events, duration of oxygen therapy, disease progression, and biomarkers. The primary safety outcomes are major or clinically relevant non-major bleeding according to the International Society on Thrombosis and Haemostasis criteria. Summary : The ACTION trial will evaluate whether in-hospital therapeutic anticoagulation with rivaroxaban for stable patients, or enoxaparin for unstable patients, followed by rivaroxaban through 30 days compared with standard prophylactic anticoagulation improves clinical outcomes in hospitalized patients with COVID-19 and elevated D-dimer levels. ClinicalTrials.gov : NCT04394377.
- Published
- 2021
8. Implications for Clinical Practice from a Multicenter Survey of Heart Failure Management Centers
- Author
-
Edval Gomes dos Santos, Luís Beck da Silva, Fernando Carvalho Neuenschwander, Otavio Rizzi Coelho Filho, Ricardo Mourilhe-Rocha, Henrique T. Moreira, Lucia Brandão de Oliveira, Sergio Emanuel Kaiser, Luiz Cláudio Danzmann, Felipe da Silva Paulitsch, Flavio de Souza Brito, José Albuquerque de Figueiredo Neto, Priscila Raupp-da-Rosa, Lilia Nigro Maia, Andre Rodrigues Duraes, Marcus Andrade, Carolina Maria Nogueira Pinto, Silvia Marinho Martins, Lucimir Maia, Erwin Soliva Junior, Juliano Novaes Cardoso, Edimar Alcides Bocchi, Ariane Vieira Scarlatelli Macedo, Antonio Delduque de Araujo Ravessa, Costantino Roberto Costantini, Paulo Frederico Esteves, Antonio Carlos Pereira-Barretto, Laercio Uemura, Maria Christiane Valeria Braga Braile-Sternieri, João Mariano Sepulveda, Vitor Sérgio Kawabata, Luis Henrique W. Gowdak, Altamiro Reis da Costa, Juliana Sanajotti Nakamuta, Heno Ferreira Lopes, Ruy Felipe Melo Viégas, Maria da Consolação Vieira Moreira, Sandrigo Mangili, Estevão Lanna Figueiredo, Amberson Vieira de Assis, Olimpio R França Neto, Ricardo Jorge de Queiroz e Silva, Marcus Vinicius Simões, Dirceu R. Almeida, José Carlos Aidar Ayoub, Alberto de Almeida Las Casas, Felipe Neves de Albuquerque, Lidia Zytynski Moura, Humberto Villacorta, Salvador Rassi, José F. Vilela-Martin, João David de Souza Neto, Bruno Biselli, and Conrado Roberto Hoffmann Filho
- Subjects
medicine.medical_specialty ,Medicine (General) ,medicine.medical_treatment ,Disease Management Program ,Clinical Decision-Making ,Education Monitoring ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Drug treatment ,0302 clinical medicine ,R5-920 ,Surveys and Questionnaires ,Internal medicine ,medicine ,Humans ,Multidisciplinary Treatment ,030212 general & internal medicine ,Heart Failure ,Rehabilitation ,business.industry ,Disease Management ,General Medicine ,Baseline data ,medicine.disease ,Clinical Practice ,Cross-Sectional Studies ,Private practice ,Heart failure ,Multicenter survey ,Observational study ,Original Article ,business ,Brazil - Abstract
OBJECTIVES: This observational, cross-sectional study based aimed to test whether heart failure (HF)-disease management program (DMP) components are influencing care and clinical decision-making in Brazil. METHODS: The survey respondents were cardiologists recommended by experts in the field and invited to participate in the survey via printed form or email. The survey consisted of 29 questions addressing site demographics, public versus private infrastructure, HF baseline data of patients, clinical management of HF, performance indicators, and perceptions about HF treatment. RESULTS: Data were obtained from 98 centers (58% public and 42% private practice) distributed across Brazil. Public HF-DMPs compared to private HF-DMP were associated with a higher percentage of HF-DMP-dedicated services (79% vs 24%; OR: 12, 95% CI: 94-34), multidisciplinary HF (MHF)-DMP [84% vs 65%; OR: 3; 95% CI: 1-8), HF educational programs (49% vs 18%; OR: 4; 95% CI: 1-2), written instructions before hospital discharge (83% vs 76%; OR: 1; 95% CI: 0-5), rehabilitation (69% vs 39%; OR: 3; 95% CI: 1-9), monitoring (44% vs 29%; OR: 2; 95% CI: 1-5), guideline-directed medical therapy-HF use (94% vs 85%; OR: 3; 95% CI: 0-15), and less B-type natriuretic peptide (BNP) dosage (73% vs 88%; OR: 3; 95% CI: 1-9), and key performance indicators (37% vs 60%; OR: 3; 95% CI: 1-7). In comparison to non- MHF-DMP, MHF-DMP was associated with more educational initiatives (42% vs 6%; OR: 12; 95% CI: 1-97), written instructions (83% vs 68%; OR: 2: 95% CI: 1-7), rehabilitation (69% vs 17%; OR: 11; 95% CI: 3-44), monitoring (47% vs 6%; OR: 14; 95% CI: 2-115), GDMT-HF (92% vs 83%; OR: 3; 95% CI: 0-15). In addition, there were less use of BNP as a biomarker (70% vs 84%; OR: 2; 95% CI: 1-8) and key performance indicators (35% vs 51%; OR: 2; 95% CI: 91,6) in the non-MHF group. Physicians considered changing or introducing new medications mostly when patients were hospitalized or when observing worsening disease and/or symptoms. Adherence to drug treatment and non-drug treatment factors were the greatest medical problems associated with HF treatment. CONCLUSION: HF-DMPs are highly heterogeneous. New strategies for HF care should consider the present study highlights and clinical decision-making processes to improve HF patient care.
- Published
- 2021
9. Guidance on diagnosis, prevention and treatment of thromboembolic complications in COVID-19: a position paper of the Brazilian Society of Thrombosis and Hemostasis and the Thrombosis and Hemostasis Committee of the Brazilian Association of Hematology, Hemotherapy and Cellular Therapy
- Author
-
Erich Vinicius De Paula, Cyrillo Cavalheiro Filho, Maria Chiara Chindamo, Suely Meireles Rezende, Joyce M. Annichino-Bizzacchi, João Carlos de Campos Guerra, Marcelo Melzer Teruchkin, Ariane Vieira Scarlatelli Macedo, Ana Clara Kneese Virgilio do Nascimento, Tayana Teixeira Mello, Fernanda Andrade Orsi, Fernanda de Oliveira Santos, Ana Thereza Rocha, Dayse Maria Lourenço, Eduardo Ramacciotti, and Dirceu Hamilton Cordeiro Campêlo
- Subjects
medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Disease ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Coagulopathy ,Internal medicine ,Health care ,Hemotherapy ,Immunology and Allergy ,Medicine ,Intensive care medicine ,Hematology ,Coronavirus disease 2019 ,business.industry ,lcsh:RC633-647.5 ,Prevention ,lcsh:Diseases of the blood and blood-forming organs ,medicine.disease ,Thrombosis ,Treatment ,Hemostasis ,Position paper ,business ,030215 immunology ,Venous thromboembolism - Abstract
Hemostatic abnormalities and thrombotic risk associated with coronavirus disease 2019 (COVID-19) are among the most discussed topics in the management of this disease. The aim of this position paper is to provide the opinion of Brazilian experts on the thromboprophylaxis and management of thrombotic events in patients with suspected COVID-19, in the sphere of healthcare in Brazil. To do so, the Brazilian Society of Thrombosis and Hemostasis (BSTH) and the Thrombosis and Hemostasis Committee of the Brazilian Association of Hematology, Hemotherapy and Cellular Therapy (ABHH) have constituted a panel of experts to carefully review and discuss the available evidence about this topic. The data discussed in this document was reviewed by May 9, 2020. Recommendations and suggestions reflect the opinion of the panel and should be reviewed periodically as new evidence emerges.
- Published
- 2020
10. Comparative Studies on the Anticoagulant Profile of Branded Enoxaparin and a New Biosimilar Version
- Author
-
Leandro Barile Agati, Roberto Augusto Caffaro, Ahmed Kouta, Fakiha Siddiqui, Charles A. Carter, Debra Hoppensteadt, Ariane Vieira Scarlatelli Macedo, Dalia Qneibi, Jawed Fareed, and Eduardo Ramacciotti
- Subjects
lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.drug_class ,business.industry ,Anticoagulant ,heparinox ,Anticoagulants ,Biosimilar ,Original Manuscript ,Hematology ,General Medicine ,Heparin ,Pharmacology ,USP ,lcsh:RC666-701 ,medicine ,lovenox ,Humans ,LMWHs ,Blood Coagulation Tests ,Enoxaparin ,biosimilar ,generic LMWH ,business ,medicine.drug - Abstract
Low molecular weight heparins (LMWH) represent depolymerized heparin prepared by various methods that exhibit differential, biochemical and pharmacological profiles. Enoxaparin is prepared by benzylation followed by alkaline depolymerization of porcine heparin. Upon the expiration of its patent, several biosimilar versions of enoxaparin have become available. Heparinox (Sodic enoxaparine; Cristália Produtos Químicos Farmacêuticos LTDA, Sao Paulo, Brazil) is a new biosimilar form of enoxaparin. We assessed the molecular weight and the biochemical profile of Heparinox and compared its properties to the original branded enoxaparin (Lovenox; Sanofi, Paris, France). Clotting profiles compared included activated clotting time, activated partial thromboplastin time (aPTT), and thrombin time (TT). Anti-protease assays included anti-factor Xa and anti-factor IIa activities. Thrombin generation was measured using a calibrated automated thrombogram and thrombokinetic profile included peak thrombin, lag time and area under the curve. USP potency was determined using commercially available assay kits. Molecular weight profiling was determined using high performance liquid chromatography. We determined that Heparinox and Lovenox were comparable in their molecular weight profile. Th anticoagulant profile of the branded and biosimilar version were also similar in the clot based aPTT and TT. Similarly, the anti-Xa and anti-IIa activities were comparable in the products. No differences were noted in the thrombin generation inhibitory profile of the branded and biosimilar versions of enoxaparin. Our studies suggest that Heparinox is bioequivalent to the original branded enoxaparin based upon in vitro tests however will require further in vivo studies in animal models and humans to determine their clinical bioequivalence.
- Published
- 2020
11. Drug–Drug Interactions of 257 Antineoplastic and Supportive Care Agents With 7 Anticoagulants: A Comprehensive Review of Interactions and Mechanisms
- Author
-
Felipe Iwamoto, Eduardo Ramacciotti, Eliana T. Samano, Ariane Vieira Scarlatelli Macedo, Suzete Yamashiro, Érique José Farias Peixoto de Miranda, and Thamy Takahashi
- Subjects
Drug ,anticoagulants ,lcsh:Diseases of the circulatory (Cardiovascular) system ,media_common.quotation_subject ,Pharmacology ,Fondaparinux ,030226 pharmacology & pharmacy ,Dabigatran ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Edoxaban ,immune system diseases ,parasitic diseases ,antineoplastic agents ,Medicine ,Humans ,Drug Interactions ,heterocyclic compounds ,media_common ,Rivaroxaban ,business.industry ,Warfarin ,virus diseases ,Hematology ,General Medicine ,biochemical phenomena, metabolism, and nutrition ,DOACs ,Drug class ,chemistry ,lcsh:RC666-701 ,030220 oncology & carcinogenesis ,supportive care drugs ,drug–drug interactions ,Apixaban ,Original Article ,business ,medicine.drug - Abstract
Data on drug–drug interactions (DDI) of antineoplastic drugs with anticoagulants is scarce. We aim to evaluate factors associated with DDI of antineoplastic and supportive care drugs with anticoagulants resulting in modification of pharmacokinetics of these last mentioned. A literature review on DDI databases and summaries of products characteristics (SmPC) was done. Drug–drug interactions of 257 antineoplastic and supportive care drugs with direct oral anticoagulants (DOACs), warfarin, enoxaparin, or fondaparinux were categorized as no clinically significant expected DDI, potentially weak DDI, potentially clinically significant DDI, and recommendation against coadministration. Logistic regression models were performed to analyze the association between the dependent variable potentially clinically significant interaction/recommendation against coadministration and the mechanisms of DDI. Of the 1799 associations, 84.4% were absence of DDI, 3.6% potentially weak DDI, 10.2% potentially clinically relevant DDI, and 2.0% recommendation against coadministration. Warfarin has higher DDI potential than other anticoagulants. Enoxaparin and fondaparinux have fewer DDI than others. There was no difference between DOACs. Drug–drug interactions with apixaban and rivaroxaban was independently associated with the absence of CYP3A4 competition, P-glycoprotein inhibition, CYP3A4 induction, and drug class of tyrosine kinase inhibitors. Drug–drug interactions with dabigatran and edoxaban was associated with inhibition of P-glycoprotein and tyrosine kinase inhibitors. Warfarin, induction of CYP3A4, and inhibition of CYP2C9. Enoxaparin and fondaparinux, only tyrosine kinase inhibitors. Direct oral anticoagulants did not differ regarding DDI with antineoplastic agents. Warfarin presented more DDI than other anticoagulants. P-glycoprotein inhibition and CYP3A4 induction were independently associated with DDI of antineoplastic agents with DOACs.
- Published
- 2020
12. Advances in the Treatment of Cardiac Amyloidosis
- Author
-
Marcelo Dantas Tavares de Melo, Breno Moreno de Gusmão, Pedro Vellosa Schwartzmann, Ariane Vieira Scarlatelli Macedo, and Otavio R. Coelho-Filho
- Subjects
Tafamidis ,medicine.medical_specialty ,Amyloid ,Biopsy ,Clinical Decision-Making ,Cardiomyopathy ,Heart failure ,030204 cardiovascular system & hematology ,Multimodal Imaging ,Transthyretin ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Restrictive cardiomyopathy ,medicine ,AL amyloidosis ,Animals ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Intensive care medicine ,Light chain ,biology ,business.industry ,Cardio-oncology (MG Fradley, Section Editor) ,Amyloidosis ,Disease Management ,medicine.disease ,Prognosis ,Combined Modality Therapy ,Treatment Outcome ,Oncology ,Cardiac amyloidosis ,chemistry ,biology.protein ,Disease Susceptibility ,Amyloid cardiomyopathy ,business ,Cardiomyopathies ,Biomarkers - Abstract
Opinion statementCardiac amyloidosis is associated with a high mortality rate, a long delay between the first signs and the diagnosis but a short interval between diagnosis and death. This scenario has changed recently due to improved disease awareness among doctors and significant progress in diagnosis thanks to multimodal imaging and a multidisciplinary approach. Therefore, during the last few years, we have had access to specific therapies for those patients. Those therapies are quite different depending on the type of amyloidosis, but there has been real progress. Systemic light chain amyloidosis (AL) with cardiac involvement is the most common form of cardiac amyloidosis. The severity of heart disease dictates the prognosis in AL amyloidosis. Advances in chemotherapy and immunotherapy that suppress light chain production have improved the outcomes. These recent improvements in survival rates have enabled therapies such as implanted cardiac defibrillators and heart transplantation that were usually not indicated for patients with advanced light chain amyloid cardiomyopathy to now be applied in selected patients. For transthyretin amyloidosis (ATTR), the second most common form of amyloidosis with cardiac involvement, there is also significant progress in treatment. Until recently, we had no specific therapy for ATTR cardiomyopathy (ATTR-CM), though now disease-modifying therapies are available. Therapies that stabilize transthyretin, such as tafamidis, have been shown to improve outcomes for patients with ATTR-CM. Modern treatments that stop the synthesis of TTR through gene silencing, such as patisiran and inotersen, have shown positive results for patients with TTR amyloidosis. Significant progress has been made in the treatment of amyloid cardiomyopathy, and hopefully, we will see even more progress with the spread of those treatments. We now can be optimistic about patients with this disease.
- Published
- 2020
13. Antiplatelet Therapy in Breast Cancer Patients Using Hormonal Therapy: Myths, Evidence and Potentialities – Systematic Review
- Author
-
Wolney de Andrade Martins, Antonio José Lagoeiro Jorge, Andréa de Melo Leite, and Ariane Vieira Scarlatelli Macedo
- Subjects
0301 basic medicine ,Oncology ,Selective Estrogen Receptor Modulators ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,Antineoplastic Agents, Hormonal ,medicine.medical_treatment ,Breast Neoplasms ,Review Article ,Indicators of Morbidity and Mortality ,03 medical and health sciences ,Moduladores Seletivos do Receptor Estrogênio ,Breast cancer ,Breast Neoplasms/drug therapy ,Cloridrato de Raloxifeno ,Internal medicine ,medicine ,Adjuvant therapy ,Humans ,Tamoxifeno ,Aspirina ,Adverse effect ,Raloxilene Hydrochloride ,Aspirin ,Evidence-Based Medicine ,business.industry ,medicine.disease ,Cardiovascular Diseases/prevention & control ,Clinical trial ,Tamoxifen ,030104 developmental biology ,lcsh:RC666-701 ,Doenças Cardiovasculares/prevenção & controle ,Neoplasias da Mama/tratamento farmacológico ,Hormonal therapy ,Female ,Hormone therapy ,Indicadores de Morbimortalidade ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
Breast cancer is the most frequently diagnosed tumor in women worldwide, with a significant impact on morbidity and mortality. Chemotherapy and hormone therapy have significantly reduced mortality; however, the adverse effects are significant. Aspirin has been incorporated into clinical practice for over 100 years at a low cost, making it particularly attractive as a potential agent in breast cancer prevention and as an adjunct treatment to endocrine therapy in the prophylaxis of cardiovascular complications. The objective of this study was to evaluate the role of aspirin in reducing the incidence of breast cancer and to evaluate the impact of its use on morbidity and mortality and reduction of cardiovascular events as adjuvant therapy during breast cancer treatment with selective estrogen receptor modulators. A systematic review was performed using the PRISMA methodology and PICO criteria, based on the MEDLINE, EMBASE and LILACS databases. The original articles of clinical trials, cohort, case-control studies and meta-analyses published from January 1998 to June 2017, were considered. Most studies showed an association between the use of selective estrogen receptor modulators and the increase in thromboembolic events. The studies suggest a protective effect of aspirin for cardiovascular events during its concomitant use with selective estrogen receptor modulators and in the prevention of breast cancer. This systematic review suggests that aspirin therapy combines the benefit of protection against cardiovascular events with the potential reduction in breast cancer risk, and that the evaluation of the benefits of the interaction of endocrine therapy with aspirin should be further investigated. Resumo O câncer de mama é o tumor mais frequentemente diagnosticado em mulheres de todo o mundo, com impacto importante na morbimortalidade. A quimioterapia e a terapia hormonal reduziram significativamente a mortalidade, mas os efeitos adversos são consideráveis. A aspirina está incorporada à prática clínica há mais de 100 anos, com baixo custo, tornando-a particularmente atraente como potencial agente na prevenção do câncer de mama e auxiliar durante o tratamento endócrino, na profilaxia de complicações cardiovasculares. Objetivou-se avaliar o papel da aspirina na redução da incidência do câncer de mama e avaliar o impacto de seu uso na morbimortalidade e na redução de eventos cardiovasculares como terapia adjuvante durante o tratamento do câncer de mama com moduladores seletivos do receptor do estrogênio. Procedeu-se à revisão sistemática utilizando-se a metodologia PRISMA e os critérios PICO, nas bases MEDLINE, EMBASE e LILACS. Foram considerados os artigos originais do tipo ensaio clínico, coorte, caso-controle e metanálises, publicados no período de janeiro de 1998 até junho de 2017. Na maioria dos estudos, houve relação entre o uso dos moduladores seletivos do receptor do estrogênio e o aumento de eventos tromboembólicos. Os estudos sugerem efeito protetor da aspirina para eventos cardiovasculares em uso concomitante aos moduladores seletivos do receptor do estrogênio e na prevenção do câncer de mama. Esta revisão sistemática sugere que o tratamento com aspirina combina o benefício da proteção contra eventos cardiovasculares com a potencial redução do risco de câncer de mama, e que a avaliação dos benefícios da interação da terapia endócrina com a aspirina deve ser melhor investigada.
- Published
- 2018
14. Targeting the Renin-Angiotensin-Aldosterone System in Obesity
- Author
-
Ariane Vieira Scarlatelli Macedo
- Subjects
medicine.medical_specialty ,Doenças Cardiovasculares ,Left Ventricular Hypertrofy ,Insuficiência Cardíaca ,Minieditorial ,Sistema Renina-Angiotensina ,Diet, High-Fat ,Renin-Angiotensin System ,Internal medicine ,Hipertrofia Ventricular Esquerda ,Renin–angiotensin system ,Prevalence ,Animals ,Medicine ,Diseases of the circulatory (Cardiovascular) system ,Prevalência ,Obesity ,Rats, Wistar ,Heart Failure ,business.industry ,Papillary Muscles ,Physical Functional Performance ,medicine.disease ,Myocardial Contraction ,Rats ,Endocrinology ,Obesidade ,Cardiovascular Diseases ,RC666-701 ,Short Editorial ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Obesity has been associated with chronic activation of the renin-angiotensin-aldosterone system and with significant changes in cardiac performance. Objective To assess the impact of a blockade of angiotensin-II receptor type 1 (AT1receptor) on morphology and on myocardial functional performance in rats with high-fat diet- induced obesity. Methods Wistar rats (n=48) were submitted to control (2.9 kcal/g) or high-fat (3.6 kcal/g) diet for 20 weeks. After the 16thweek they were divided into four groups: Control (CO), Obese (OB), Control Losartan (CL) and Obese Losartan (OL). CL and OL received losartan (30 mg/kg/day) in drinking water for four weeks. Subsequently, body composition, systolic blood pressure (SBP) and echocardiographic variables were analyzed. Papillary muscle function was assessed at baseline with 2.50 mM calcium concentration ([Ca2+]o) and after inotropic maneuvers: post-pause potentiation (PPP), [Ca2+]oelevation, and during beta-adrenergic stimulation with isoproterenol. Analysis of the results was performed by the Two-Way ANOVA and by the appropriate comparison test. The level of significance was set at 5%. Results Although SBP change had been not maintained at the end of the experiment, obesity was associated with cardiac hypertrophy and with increased left ventricle posterior wall shortening velocity. In the study of papillary muscles in basal condition, CL showed lower developed tension maximum negative variation velocity (-dT/dt) than CO. The 60s PPP promoted lower -dT/dt and maximum developed tension (DT) in OB and CL compared with CO, and higher relative DT variation and maximum positive variation velocity (+dT/dt) in OL compared with CL and OB. Under 1.5, 2.0, and 2.5mM [Ca2+]o, the OL group showed higher -dT/dt than CL. Conclusion Losartan improves myocardial function in high-fat diet-induced obesity. (Arq Bras Cardiol. 2020;115(1):17-28).
- Published
- 2020
15. Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19
- Author
-
Jeffer L de Moraes, C. Michael Gibson, Andre Feldman, Thiago Ceccatto de Paula, Renato D. Lopes, Renata Junqueira Moll-Bernardes, Vitor A. Loures, Jacqueline Miranda, Rafael A. M. Domiciano, Ricardo G G de Oliveira, Rodrigo M Dionísio, Denilson Campos de Albuquerque, Márcia Noya-Rabelo, Andréa Silvestre de Sousa, Noara B Ribeiro, Pedro Gabriel Melo de Barros e Silva, Ariane Vieira Scarlatelli Macedo, Cleverson Neves Zukowski, Olga Ferreira de Souza, Lilian Mazza, Bárbara Elaine de Jesus Abufaiad, Thyago A. B. Furquim, John H. Alexander, Alan M Hamilton, Guilherme D'Andréa Saba Arruda, Karla G. D. Giusti, Bruno Santana Bandeira, Tiago Mendonça dos Santos, Italo Bruno dos Santos Sousa, Christopher B. Granger, João Luiz Fernandes Petriz, Angelina Camiletti, Fabio Augusto de Luca, and Adriana M Pimentel
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Angiotensin-Converting Enzyme Inhibitors ,01 natural sciences ,law.invention ,Angiotensin Receptor Antagonists ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Interquartile range ,Internal medicine ,Humans ,Medicine ,030212 general & internal medicine ,Myocardial infarction ,0101 mathematics ,Adverse effect ,Original Investigation ,Brugada Syndrome ,SARS-CoV-2 ,business.industry ,010102 general mathematics ,COVID-19 ,General Medicine ,Odds ratio ,medicine.disease ,Hospitals ,Discontinuation ,Respiratory failure ,Hemodialysis ,business - Abstract
Importance: It is unknown whether angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) have a positive, neutral, or negative effect on clinical outcomes in patients with coronavirus disease 2019 (COVID-19). Objective: To determine whether discontinuation compared with continuation of ACEIs or ARBs changed the number of days alive and out of the hospital through 30 days. Design, Setting, and Participants: A randomized clinical trial of 659 patients hospitalized in Brazil with mild to moderate COVID-19 who were taking ACEIs or ARBs prior to hospitalization (enrolled: April 9-June 26, 2020; final follow-up: July 26, 2020). Interventions: Discontinuation (n = 334) or continuation (n = 325) of ACEIs or ARBs. Main Outcomes and Measures: The primary outcome was the number of days alive and out of the hospital through 30 days. Secondary outcomes included death, cardiovascular death, and COVID-19 progression. Results: Among 659 patients, the median age was 55.1 years (interquartile range [IQR], 46.1-65.0 years), 14.7% were aged 70 years or older, 40.4% were women, and 100% completed the trial. The median time from symptom onset to hospital admission was 6 days (IQR, 4-9 days) and 27.2% of patients had an oxygen saturation of less than 94% of room air at baseline. In terms of clinical severity, 57.1% of patients were considered mild at hospital admission and 42.9% were considered moderate. There was no significant difference in the number of days alive and out of the hospital in patients in the discontinuation group (mean, 21.9 days [SD, 8 days]) vs patients in the continuation group (mean, 22.9 days [SD, 7.1 days]) and the mean ratio was 0.95 (95% CI, 0.90-1.01). There also was no statistically significant difference in death (2.7% for the discontinuation group vs 2.8% for the continuation group; odds ratio [OR], 0.97 [95% CI, 0.38-2.52]), cardiovascular death (0.6% vs 0.3%, respectively; OR, 1.95 [95% CI, 0.19-42.12]), or COVID-19 progression (38.3% vs 32.3%; OR, 1.30 [95% CI, 0.95-1.80]). The most common adverse events were respiratory failure requiring invasive mechanical ventilation (9.6% in the discontinuation group vs 7.7% in the continuation group), shock requiring vasopressors (8.4% vs 7.1%, respectively), acute myocardial infarction (7.5% vs 4.6%), new or worsening heart failure (4.2% vs 4.9%), and acute kidney failure requiring hemodialysis (3.3% vs 2.8%). Conclusions and Relevance: Among patients hospitalized with mild to moderate COVID-19 and who were taking ACEIs or ARBs before hospital admission, there was no significant difference in the mean number of days alive and out of the hospital for those assigned to discontinue vs continue these medications. These findings do not support routinely discontinuing ACEIs or ARBs among patients hospitalized with mild to moderate COVID-19 if there is an indication for treatment. Trial Registration: ClinicalTrials.gov Identifier: NCT04364893.
- Published
- 2021
16. Alteração Contrátil Segmentar Ventricular Esquerda é Preditor Independente de Cardiotoxicidade em Pacientes com Câncer de Mama em Tratamento Quimioterápico
- Author
-
José Luiz Padilha da Silva, Sebastian I. Sarvari, Márcio Vinícius Lins de Barros, Ariane Vieira Scarlatelli Macedo, Patricia Tavares Felipe, Monica Hermont Faleiros, and Thor Edvardsen
- Subjects
Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Antraciclinas ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Logistic regression ,Ventricular Dysfunction, Left ,0302 clinical medicine ,Trastuzumab ,Risk Factors ,Anthracyclines ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,Ejection fraction ,Middle Aged ,Echocardiography ,Cardiology ,Original Article ,Female ,Cardiology and Cardiovascular Medicine ,Tratamento Farmacológico ,medicine.drug ,Adult ,medicine.medical_specialty ,Antineoplastic Agents ,Breast Neoplasms ,Disfunção Ventricular Esquerda ,03 medical and health sciences ,Breast cancer ,Drug Therapy ,Internal medicine ,medicine ,Humans ,Doxorubicin ,Cardiotoxicidade ,Aged ,Chemotherapy ,Cardiotoxicity ,business.industry ,Myocardium ,Stroke Volume ,medicine.disease ,Logistic Models ,ROC Curve ,lcsh:RC666-701 ,business ,Neoplasias da Mama - Abstract
Background: Chemotherapeutic agents of anthracyclines class and humanized monoclonal antibodies are effective treatments for breast cancer, however, they present a potential risk of cardiotoxicity. Several predictors have been recognized as predictors in the development of cardiac toxicity, and the evaluation of left ventricular segmental wall motion abnormalities (LVSWMA) has not been studied. Objective: To analyze prospectively the role of LVSWMA among echocardiographic parameters in the prediction of development of cardiotoxicity in breast cancer patients undergoing treatment with chemotherapy. Methods: Prospective cohort of patients diagnosed with breast cancer and in chemotherapy treatment with potential cardiotoxicity medications including doxorubicin and trastuzumab. Transthoracic echocardiograms including speckle tracking strain echocardiography were performed at standard times before, during and after the treatment to assess the presence (or lack thereof) of cardiotoxicity. Cardiotoxicity was defined by a 10% decrease in the left ventricular ejection fraction, on at least one echocardiogram. Multivariate logistic regression models were used to verify the predictors related to the occurrence of cardiotoxicity over time. Results: Of the 112 patients selected (mean age 51,3 ± 12,9 years), 18 participants (16.1%) had cardiotoxicity. In the multivariate analysis using the logistic regression model, those with LVWMA (OR = 6.25 [CI 95%: 1.03; 37.95], p < 0,05), LV systolic dimension (1.34 [CI 95%: 1.01; 1.79], p < 0,05) and global longitudinal strain by speckle tracking (1.48 [CI 95%: 1.02; 2.12], p < 0,05) were strongly associated with cardiotoxicity. Conclusion: In the present study, we showed that LVWMA, in addition to global longitudinal strains, were strong predictors of cardiotoxicity and could be useful in the risk stratification of these patients. Resumo Fundamento: Os agentes quimioterápicos da classe das antraciclinas e dos anticorpos monoclonais humanizados são tratamentos eficazes para o câncer de mama, entretanto, apresentam alto risco de cardiotoxicidade. Diversos parâmetros têm sido reconhecidos como preditores no desenvolvimento de toxicidade cardíaca, sendo que a avaliação da alteração contrátil segmentar ventricular esquerda (ACSVE) ainda não foi estudada. Objetivo: Analisar a associação entre o surgimento de ACSVE e o desenvolvimento de cardiotoxicidade em pacientes com câncer de mama em tratamento com quimioterapia. Métodos: Coorte prospectiva de pacientes diagnosticados com câncer de mama e em tratamento quimioterápico com doxorrubicina e/ou trastuzumab. Foram realizados ecocardiogramas transtorácicos antes, durante e depois do tratamento para avaliar a presença ou não de cardiotoxicidade. A cardiotoxicidade foi definida por um decréscimo de 10% na fração de ejeção do ventrículo esquerdo, em pelo menos um ecocardiograma. Modelos de regressão logística multivariada foram utilizados para verificar os fatores preditores na ocorrência de cardiotoxicidade ao longo do tempo. Resultados: Dos 112 pacientes selecionados (idade média = 51,3 ± 12,9 anos), 18 (16,1%) apresentaram cardiotoxicidade. Na análise multivariada os pacientes com ACSVE (OR = 6,25 [IC 95%: 1,03; 37,95], p < 0,05), diâmetro sistólico do VE (OR = 1,34 [IC 95%:1,01; 1,79], p < 0,05) e strain longitudinal global pela técnica de speckle tracking (OR = 1,48 [IC 95%: 1,02; 2,12], p < 0,05) foram preditores significativos e independentes na predição de cardiotoxidade. Conclusão: Mostramos que ACSVE, bem como a redução do strain longitudinal global foram preditores independentes para cardiotoxicidade, podendo ser úteis na estratificação de risco destes pacientes.
- Published
- 2018
17. Is it time for a specific score for venous thromboembolism risk assessment for non-solid tumors?
- Author
-
Ariane Vieira Scarlatelli Macedo and Eduardo Ramacciotti
- Subjects
Male ,Chemotherapy ,medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,medicine.medical_treatment ,MEDLINE ,Cancer ,Venous Thromboembolism ,General Medicine ,equipment and supplies ,medicine.disease ,Risk Assessment ,Thrombosis ,Oncology ,Quality of life ,Neoplasms ,Internal medicine ,Humans ,Medicine ,Female ,cardiovascular diseases ,Risk assessment ,business ,Venous thromboembolism - Abstract
Cancer patients have a high incidence of venous thromboembolism (VTE), VTE recurrence, bleeding and reduced quality of life (1). Thrombosis is the second most common cause of death in cancer patients (2). VTE prophylaxis is not routinely recommended for all outpatients with cancer undergoing chemotherapy.
- Published
- 2019
18. Caso 01/2006: insuficiência cardíaca progressiva em homem de 44 anos de idade
- Author
-
Jussara Bianchi Castelli, Léa Maria Macruz Ferreira Demarchi, Paulo Jorge Moffa, Maria Clementina Pinto Giorgi, Tiago Senra Garcia dos Santos, and Ariane Vieira Scarlatelli Macedo
- Subjects
lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,lcsh:RC666-701 ,business.industry ,RC666-701 ,Heart failure ,Internal medicine ,Cardiology ,Diseases of the circulatory (Cardiovascular) system ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease - Published
- 2006
19. Infarto fatal do miocárdio em mulher de 88 anos de idade
- Author
-
Ariane Vieira Scarlatelli Macedo, Eulógio Emílio Martinez Filho, Paulo Jorge Moffa, Cesar José Grupi, Paulo Sampaio Gutierrez, and Petter Libby
- Subjects
Gynecology ,medicine.medical_specialty ,business.industry ,medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Editor da Secao: Alfredo Jose Mansur (ajmansur@incor.usp.br) Editores Associados: Desiderio Favarato (dclfavarato@incor.usp.br) Vera Demarchi Aiello (anpvera@incor.usp.br) Correspondencia: Paulo Sampaio Gutierrez InCor Av. Dr. Eneas de Carvalho Aguiar, 44 05403-000 Sao Paulo, SP E-mail: anppaulo@incor.usp.br Mulher de 88 anos de idade procurou atendimento medico (29/12/2003) com queixa de dor epigastrica de 4 horas de duracao acompanhada de vomitos. A paciente sabia ser portadora de hipertensao arterial de longa data. Ha dois anos havia sofrido acidente vascular cerebral, sem sequelas motoras. Ha tres meses surgiu dispneia desencadeada por esforcos moderados e edema de membros inferiores. Negava sincope. O exame fisico (3/10/2003) revelou frequencia cardiaca 68 bpm, pressao arterial 180x80 mmHg. O exame dos pulmoes foi normal. O exame do coracao revelou bulhas normofoneticas e sopro sistolico leve em area mitral. O exame do abdome foi normal e havia edema ++/4 em membros inferiores. A paciente fazia uso de losartan 50 mg, hidroclorotiazida 50 mg e acido acetilsalicilico 100 mg diarios. O eletrocardiograma (30/09/2003) revelou dissociacao atrioventricular com ritmo juncional, frequencia de 50 bpm, duracao de QRS de 80 mseg, com baixa voltagem no plano frontal (fig. 1). Os exames laboratoriais revelaram hemoglobina 15 g/dl, hematocrito 45%, potassio de 5,8 mEq/l (sangue hemolisado) e sodio 138 mEq/l. Foi feito o diagnostico de doenca do no sinusal e prosseguiu a avaliacao laboratorial, incluindo monitorizacao eletrocardiografica ambulatorial. A monitoracao eletrocardiografica ambulatorial de 24 horas de duracao pelo sistema Holter (18/11/2003) revelou ritmo predominante sinusal, tres extra-sistoles ventriculares em taquicardia ventricular e uma extra-sistole ventricular isolada. Havia frequentes extra-sistoles atriais (645/h), das quais 570 isoladas, 36 pareadas e um episodio de taquicardia atrial com tres batimentos. Foram diagnosticadas varias pausas sinusais de 4,3 seg em vigilia, entre 20 e 21 horas (figs. 2 e 3). Na evolucao apresentou (29/12/2003) dor epigastrica de 4 horas de duracao acompanhada de vomitos. O exame fisico (19/12/2003) revelou frequencia cardiaca 80 bpm, pressao arterial 180x100 mmHg, estertores crepitantes em bases de ambos hemitorax. O restante do exame fisico nao revelou dados positivos. O eletrocardiograma (29/12/2003) demonstrou ritmo sinusal, frequencia de 72 bpm; area eletricamente negativa ântero-septal e supradesnivelamento de segmento ST de V1 a V3 e infradesnivelado em derivacoes II, III, aVF, V5 e V6. As alteracoes persistiram apos o uso de 5 mg de dinitrato de isossorbida administrado por via sublingual (fig. 4). Os exames laboratoriais revelaram 1 mg/dl de creatinina, 43 mg/dl de ureia, 139 mEq/l de sodio, 5,8 mEq/l de potassio, 49,4 ng/ml de CKMB e 7,8 ng/ml de troponina. Foi feito o diagnostico de infarto do miocardio e foram administrados 200 mg de acido acetilsalicilico por via oral e nitroglicerina por via endovenosa. Houve controle da pressao arterial e a paciente foi encaminhada para a cinecoronariografia para reperfusao coronaria mecânica por angioplastia. A cineangiografia, realizada 60 minutos apos a chegada da paciente ao hospital, nao revelou obstrucoes em coronarias, apesar da presenca de area discinetica em paredes ântero-lateral e apical de ventriculo esquerdo. Apresentou parada cardiorrespiratoria em assistolia, sem resposta as manobras de ressuscitacao e faleceu (30/12/2003).
- Published
- 2005
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.