RESUMO
Several plant protein inhibitors with anticoagulant properties have been studied and characterized, including the Delonix regia trypsin inhibitor (DrTI). This protein inhibits serine proteases (trypsin) and enzymes directly involved in coagulation, such as plasma kallikrein, factor XIIa, and factor XIa. In this study, we evaluated the effects of two new synthetic peptides derived from the primary sequence of DrTI in coagulation and thrombosis models to understand the mechanisms involved in the pathophysiology of thrombus formation as well as in the development of new antithrombotic therapies. Both peptides acted on in vitro hemostasis-related parameters, showing promising results, prolonging the Partially Activated Thromboplastin Time (aPTT) and inhibited platelet aggregation induced by adenosine diphosphate (ADP) and arachidonic acid. In murine models, for arterial thrombosis induced by photochemical injury, and platelet-endothelial interactions monitored by intravital microscopy, both peptides at doses of 0.5 mg/kg significantly extended the time of artery occlusion and modified the platelet adhesion and aggregation pattern with no changes in bleeding time, demonstrating the high biotechnological potential of both molecules.
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BACKGROUND: (p-BthTX-I)2 K, a dimeric analog peptide derived from the C-terminal region of phospholipase A2-like bothropstoxin-I (p-BthTX-I), is resistant to plasma proteolysis and inhibits severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains with weak cytotoxic effects. Complications of SARS-CoV-2 infection include vascular problems and increased risk of thrombosis; therefore, studies to identify new drugs for treating SARS-CoV-2 infections that also inhibit thrombosis and minimize the risk of bleeding are required. OBJECTIVES: To determine whether (p-BthTX-I)2 K affects the hemostatic system. METHODS: Platelet aggregation was induced by collagen, arachidonic acid, and adenosine diphosphate (ADP) in the Chronolog Lumi-aggregometer. The coagulation activity was evaluated by determining activated partial thromboplastin clotting time (aPTT) and prothrombin time (PT) with (p-BthTX-I)2 K (5.0-434.5 µg) or 0.9% NaCl. Arterial thrombosis was induced with a 540 nm laser and 3.5-20 mg kg- 1 Rose Bengal in the carotid artery of male C57BL/6J mice using (p-BthTX-I)2 K. Bleeding time was determined in mouse tails immersed in saline at 37 °C after (p-BthTX-I)2 K (4.0 mg/kg and 8.0 mg/kg) or saline administration. RESULTS: (p-BthTX-I)2 K prolonged the aPTT and PT by blocking kallikrein and FXa-like activities. Moreover, (p-BthTX-I)2 K inhibited ADP-, collagen-, and arachidonic acid-induced platelet aggregation in a dose-dependent manner. Further, low concentrations of (p-BthTX-I)2 K extended the time to artery occlusion by the formed thrombus. However, (p-BthTX-I)2 K did not prolong the bleeding time in the mouse model of arterial thrombosis. CONCLUSION: These results demonstrate the antithrombotic activity of the peptide (p-BthTX-I)2 K possibly by kallikrein inhibition, suggesting its strong biotechnological potential.
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The anti-inflammatory effects of the plant protease inhibitor BbCI (Bauhinia bauhinioides cruzipain inhibitor), which blocks elastase, cathepsin G, and L, and proteinase 3 has been demonstrated. Here, we investigated the recombinant rBbCI-His(6) (containing a histidine tail) in an experimental venous thrombosis model of vena cava (VC) ligature in rats, comparing to heparin. We evaluate the effects of the inhibitors (native or recombinant) or heparin on the activated partial thromboplastin time (aPTT) and prothrombin time (PT) in human and rat plasmas. The rats undergoing treatment received a saline solution or increasing concentrations of rBbCI-His(6), heparin, or a mixture of both. After 4 h of ligature VC, thrombus, if present was removed and weighed. aPTT, PT, and cytokines were measured in blood collected by cardiac puncture. aPTT, PT, and bleeding time (BT) were also measured at the time of VC (vena cava) ligature. rBbCI-His(6) (0.45 or 1.40 mg/kg) does not alter aPTT, PT or BT. No differences in coagulation parameters were detected in rBbCI-His(6) treated rats at the time of VC ligature or when the thrombus was removed. There was a significant decrease in the weight of thrombus in the animals of the groups treated with the rBbCI-His(6) (1.40 mg/kg), with the rBbCI-His(6) mixture (1.40 mg/kg) + heparin (50 IU/kg) and heparin (100 IU/kg) in relation to control group (saline). The growth-related oncogene/keratinocyte chemoattractant (GRO/KC) serum levels in rats treated with rBbCI-His(6) (1.40 mg/kg) or heparin (200 IU/kg) were reduced. In the experimental model used, rBbCI-His(6) alone had an antithrombotic effect, not altering blood clotting or bleeding time.
Assuntos
Bauhinia/enzimologia , Proteínas de Plantas/farmacologia , Inibidores de Serina Proteinase/farmacologia , Trombose , Animais , Bauhinia/genética , Coagulação Sanguínea/efeitos dos fármacos , Humanos , Masculino , Elastase Pancreática/antagonistas & inibidores , Elastase Pancreática/sangue , Tempo de Tromboplastina Parcial , Proteínas de Plantas/química , Proteínas de Plantas/genética , Ratos , Ratos Wistar , Proteínas Recombinantes/genética , Proteínas Recombinantes/farmacologia , Inibidores de Serina Proteinase/química , Inibidores de Serina Proteinase/genética , Trombose/sangue , Trombose/tratamento farmacológicoRESUMO
The purpose of antithrombotic therapy is the prevention of thrombus formation and/or its extension with a minimum risk of bleeding. The inhibition of a variety of proteolytic processes, particularly those of the coagulation cascade, has been reported as a property of plant protease inhibitors. The role of trypsin inhibitors (TIs) from Delonix regia (Dr) and Acacia schweinfurthii (As), members of the Kunitz family of protease inhibitors, was investigated on blood coagulation, platelet aggregation, and thrombus formation. Different from Acacia schweinfurthii trypsin inhibitor (AsTI), Delonix regia trypsin inhibitor (DrTI) is a potent inhibitor of FXIa with a Kiapp of 1.3 × 10-9 M. In vitro, both inhibitors at 100 µg corresponding to the concentrations of 21 µM and 15.4 µM of DrTI and AsTI, respectively, increased approximately 2.0 times the activated partial thromboplastin time (aPTT) in human plasma compared to the control, likely due to the inhibition of human plasma kallikrein (huPK) or activated factor XI (FXIa), in the case of DrTI. Investigating in vivo models of arterial thrombus formation and bleeding time, DrTI and AsTI, 1.3 µM and 0.96 µM, respectively, prolonged approximately 50% the time for total carotid artery occlusion in mice compared to the control. In contrast to heparin, the bleeding time in mice treated with the two inhibitors did not differ from that of the control group. DrTI and AsTI inhibited 49.3% and 63.8%, respectively, ex vivo murine platelet aggregation induced by adenosine diphosphate (ADP), indicating that these protein inhibitors prevent arterial thrombus formation possibly by interfering with the plasma kallikrein (PK) proteolytic action on the intrinsic coagulation pathway and its ability to enhance the platelet aggregation activity on the intravascular compartment leading to the improvement of a thrombus.
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Plantas/química , Calicreína Plasmática/metabolismo , Inibidores de Proteases/uso terapêutico , Trombose/tratamento farmacológico , Animais , Modelos Animais de Doenças , Humanos , Camundongos , Inibidores de Proteases/farmacologiaAssuntos
Animais , Camundongos , Trombose Venosa , Prevenção de Doenças , Fibrinolíticos , Hemorragia , Terapêutica , Heparina , Modelos Animais , AnticoagulantesRESUMO
OBJECTIVE: The purpose of this study was to evaluate the long term clinical and ultrasonographic outcomes of thrombophilic patients with deep venous thrombosis (DVT). METHOD: Cohort study, retrospective case-control with cross-sectional analysis. Thirty-nine thrombophilic patients and 25 non-thrombophilic patients were assessed 76.3 ± 45.8 months after diagnosis. Demographic and family data were collected, as well as data from clinical and therapeutic progress, and physical and ultrasound examinations of the limbs were performed. Groups were matched for age and gender and the variables studied were compared across groups. RESULTS: Deep venous thrombosis was more frequent in women. The most common thrombophilias were antiphospholipid syndrome and factor V Leiden mutation. There was no difference between groups in terms of the number of pregnancies or miscarriages and the majority of women did not become pregnant after DVT. Non-spontaneous DVT prevailed. Proximal DVT and DVT of the left lower limb were more frequent, and the main risk factor was use of oral contraceptives. All patients were treated with anticoagulation. There was a higher frequency of pulmonary embolism in non-thrombophilic patients. Most patients considered themselves to have a "normal life" after DVT and reported wearing elastic stockings over at least 2 years. Seventy-one percent of patients had CEAP > 3, with no difference between groups. Deep venous reflux was more frequent in thrombophilic patients. CONCLUSION: There were no significant differences between groups with respect to most of the variables studied, except for a higher frequency of pulmonary embolism in non-thrombophilic patients and greater frequency of deep venous reflux in thrombophilic patients. .
OBJETIVO: O objetivo deste estudo foi avaliar os resultados clínicos e ultra-sonográficos a longo prazo de pacientes com trombofilia com trombose venosa profunda (TVP). MÉTODO: Estudo de coorte, caso-controle retrospectivo, com análise transversal. Trinta e nove pacientes trombofilia e 25 pacientes não-trombofilia foram avaliados 76,3 ± 45,8 meses após o diagnóstico. Os dados demográficos e familiares foram coletadas, bem como dados de evolução clínica e terapêutica, e exames físicos e ultra-som dos membros foram realizados. Os grupos foram pareados por idade e sexo e as variáveis estudadas foram comparadas entre os grupos. RESULTADOS: A trombose venosa profunda foi mais freqüente em mulheres. As trombofilias mais comuns foram síndrome antifosfolípide e mutação do fator V Leiden. Não houve diferença entre os grupos em termos do número de casos de gravidez ou aborto e que a maioria das mulheres não engravidar após TVP. TVP não-espontâneo prevaleceu. TVP proximal e TVP de membro inferior esquerdo foram mais freqüentes, eo principal fator de risco foi o uso de contraceptivos orais. Todos os pacientes foram tratados com anticoagulação. Houve uma maior frequência de embolia pulmonar em pacientes não-trombofilia. A maioria dos pacientes se consideravam ter uma "vida normal" depois de TVP e relatou uso de meias elásticas durante pelo menos 2 anos. Setenta e um por cento dos pacientes tiveram CEAP> 3, não havendo diferença entre os grupos. Refluxo venoso profundo foi mais freqüente em pacientes com trombofilia. CONCLUSÃO: Não houve diferenças significativas entre os grupos em relação à maioria das variáveis estudadas, com exceção de uma maior frequência de embolia pulmonar em pacientes não-trombofilia e maior freqüência de refluxo venoso profundo em pacientes trombofilia.
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Humanos , Feminino , Embolia Pulmonar/terapia , Trombose Venosa , Varfarina/efeitos adversos , Estudos de Coortes , Ecocardiografia Doppler , Fatores de RiscoRESUMO
Passion fruit (Passiflora edulis Sims f. flavicarpa) is popularly known for its sedative and calming properties and is consumed as a fresh fruit or as a juice. The clinical observation of blood incoagulability associated with excessive consumption of passion fruit juice, in a patient treated with warfarin, prompted the current study to investigate in vitro the presence of blood clotting inhibitors in Passiflora edulis Sims f. flavicarpa extract. After purification process, two compounds of distinct molecular weight and inhibitory action were better characterized. One is a trypsin inhibitor similar to inhibitors from Bowman-Birk family, named PeTI-I12, and other is a compound active in coagulation that prolongs aPTT and PT, but does not change TT. The aim of this study is to provide evidence that passion fruit extract's components play a role on hemostasis and therefore may be relevant in the handling of patients treated with anticoagulants or suffering hemorrhagic diseases.
Assuntos
Anticoagulantes/farmacologia , Coagulação Sanguínea/efeitos dos fármacos , Passiflora/química , Peptídeo Hidrolases/metabolismo , Extratos Vegetais/farmacologia , Inibidores de Proteases/farmacologia , Sequência de Aminoácidos , Anticoagulantes/química , Estabilidade Enzimática , Frutas/química , Dados de Sequência Molecular , Extratos Vegetais/química , Inibidores de Proteases/química , Tempo de Protrombina , Inibidor da Tripsina de Soja de Bowman-Birk/química , Inibidor da Tripsina de Soja de Bowman-Birk/farmacologia , Inibidores da Tripsina/química , Inibidores da Tripsina/farmacologiaRESUMO
INTRODUCTION: Effective strategies for prevention of venous thromboembolism (VTE) are widely available, but still remain underused, mainly in our country. OBJECTIVE: Our aim was to verify whether the implementation of a guideline for VTE prophylaxis for surgical patients influenced the prescription of prophylaxis by the medical staff. METHODS: This was a retrospective preintervention-postintervention study. Charts of 150 patients before guideline implementation (BGI) and 150 after (AGI) were randomized among all patients admitted during one year in each period. INCLUSION CRITERIA: >40 years-old, major abdominal or orthopedic surgeries. EXCLUSION CRITERIA: Incomplete files and use of anticoagulants for any reason at admission. Data registered: demographic data, reference to VTE risk factors, VTE prophylaxis prescription, diagnosis of deep venous thrombosis or pulmonary embolism during hospitalization. Results. The two groups, BGI and AGI were similar for demographic data and duration of prophylaxis (5.6 x 6.6 days). Frequency of prophylaxis in percentages was BGI x AGI respectively, before surgery: pharmacologic prophylaxis (PP), 6 x 9; graduated compression stockings (GCS), 4 x 3; intermittent pneumatic compression (IPC), 2 x 3. After surgery: PP, 53 x 53; GCS, 23 x 40 (P<0.05); IPC, 26 x 32. Including all patients, prophylaxis was prescribed for 60.5% BGI and 66.5% AGI, but was considered adequate only in 34% BGI and 32% AGI. CONCLUSION: Adoption of a guideline, although increasing concern about prophylaxis, expressed by greater use of GCS, only minimally improved quality of prophylaxis , indicating that other active and continuous interventions are necessary to enforce compliance.
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Fidelidade a Diretrizes/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios , Tromboembolia Venosa/prevenção & controle , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/estatística & dados numéricos , Guias de Prática Clínica como Assunto/normas , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/estatística & dados numéricos , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios/classificaçãoRESUMO
INTRODUÇÃO: Estratégias efetivas para profilaxia do tromboembolismo venoso (TEV) são amplamente disponíveis, mas são ainda subutilizadas, principalmente no nosso meio. OBJETIVO: Avaliar o efeito da implementação de diretriz para profilaxia do TEV, em pacientes cirúrgicos, sobre a conduta da equipe de saúde na prescrição dessa profilaxia. Método. Estudo retrospectivo pré-intervenção - pós-intervenção. Prontuários de 150 pacientes antes e 150 depois da implementação de uma diretriz para a profilaxia (AID e DID) foram sorteados dentre pacientes de mais de 40 anos internados para cirurgia maior abdominal ou ortopédica. Foram registrados dados demográficos, referência a risco de TEV no prontuário, prescrição de profilaxia para TEV e diagnóstico de TEV durante a internação. RESULTADOS: Não houve diferença entre os dois grupos, AID e DID, quanto aos dados demográficos e ao tempo de profilaxia (5,6 x 6,6 dias). A frequência de profilaxia AID x DID antes da cirurgia foi: profilaxia farmacológica (PF), 6 por cento x 9 por cento; meias de compressão graduada (MCG), 4 por cento x 3 por cento; compressão pneumática intermitente (CPI), 2 por cento x 3 por cento. Após cirurgia: PF 53 por cento x 53 por cento; MCG, 23 por cento x 40 por cento (P<0,05); CPI, 26 por cento x 32 por cento . No total, AP, foi prescrita profilaxia para 60,5 por cento dos pacientes AID e para 66,5 por cento DID, mas a profilaxia foi considerada adequada em 34 por cento dos pacientes AID e em 32 por cento DID. Conclusão. A adoção do protocolo, embora com maior a preocupação com a profilaxia, traduzida pelo aumento na prescrição de MCG, melhorou minimamente sua qualidade, indicando a necessidade de outras intervenções ativas e contínuas para aumentar a aderência ao mesmo.
INTRODUCTION: Effective strategies for prevention of venous thromboembolism (VTE) are widely available, but still remain underused, mainly in our country. OBJECTIVE: Our aim was to verify whether the implementation of a guideline for VTE prophylaxis for surgical patients influenced the prescription of prophylaxis by the medical staff. METHODS: This was a retrospective preintervention-postintervention study. Charts of 150 patients before guideline implementation (BGI) and 150 after (AGI) were randomized among all patients admitted during one year in each period. Inclusion criteria: >40 years-old, major abdominal or orthopedic surgeries. Exclusion criteria: Incomplete files and use of anticoagulants for any reason at admission. Data registered: demographic data, reference to VTE risk factors, VTE prophylaxis prescription, diagnosis of deep venous thrombosis or pulmonary embolism during hospitalization. Results. The two groups, BGI and AGI were similar for demographic data and duration of prophylaxis (5.6 x 6.6 days). Frequency of prophylaxis in percentages was BGI x AGI respectively, before surgery: pharmacologic prophylaxis (PP), 6 x 9; graduated compression stockings (GCS), 4 x 3; intermittent pneumatic compression (IPC), 2 x 3. After surgery: PP, 53 x 53; GCS, 23 x 40 (P<0.05); IPC, 26 x 32. Including all patients, prophylaxis was prescribed for 60.5 percent BGI and 66.5 percent AGI, but was considered adequate only in 34 percent BGI and 32 percent AGI. CONCLUSION: Adoption of a guideline, although increasing concern about prophylaxis, expressed by greater use of GCS, only minimally improved quality of prophylaxis , indicating that other active and continuous interventions are necessary to enforce compliance.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fidelidade a Diretrizes/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios , Tromboembolia Venosa/prevenção & controle , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/estatística & dados numéricos , Guias de Prática Clínica como Assunto/normas , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/estatística & dados numéricos , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios/classificaçãoRESUMO
CONTEXTO: Os fatores de risco para doença aterosclerótica, que influenciam na evolução natural dessa doença, estão bem estabelecidos, assim como o benefício do programa de exercícios para pacientes claudicantes. Entretanto, faltam informações sobre a relação entres limitações clínicas e fatores de risco, com desempenho do programa de caminhadas e suas implicações na evolução e mortalidade destes pacientes. OBJETIVO: Comparar, ao longo do tempo, a distância de claudicação e sobrevida de pacientes claudicantes em ambulatório específico, com ou sem limitação para exercícios. MÉTODOS: Foi feito um estudo tipo coorte retrospectivo de 185 pacientes e 469 retornos correspondentes, no período de 1999 a 2005, avaliando-se dados demográficos, distância média de claudicação (CI) e óbito. Os dados foram analisados nos programas Epi Info, versão 3.2, e SAS, versão 8.2. RESULTADOS: A idade média foi de 60,9±11,1 anos, sendo 61,1 por cento do sexo masculino e 38,9 por cento do sexo feminino. Oitenta e sete por cento eram brancos, e 13 por cento, não-brancos. Os fatores de risco associados foram: hipertensão (69,7 por cento), tabagismo (44,3 por cento), dislipidemia (32,4 por cento) e diabetes (28,6 por cento). Nos claudicantes para menos de 500 m, a CI inicial em esteira foi de 154,0±107,6 m, e a CI final, de 199,8±120,5 m. Cerca de 45 por cento dos pacientes tinham alguma limitação clínica para realizar o programa de exercícios preconizado, como: angina (26,0 por cento), acidente vascular cerebral (4,3 por cento), artropatia (3,8 por cento), amputação menor ou maior com prótese (2,1 por cento) ou doença pulmonar obstrutiva crônica (1,6 por cento). Cerca de 11,4 por cento dos pacientes tinham infarto do miocárdio prévio, e 5,4 por cento deles usavam cardiotônico. O tempo de seguimento médio foi de 16,0±14,4 meses. A distância média de CI referida pelos pacientes aumentou 100 por cento (de 418,47 m para 817,74 m) ao longo de 2 anos, nos grupos não-limitante...
BACKGROUND: Risk factors for atherosclerotic disease acting on natural history are well established, as well as the benefits of physical training in the treatment of intermittent claudication (IC). However, current data do not provide enough information about the relationship between clinical limitations and risk factors and the performance of physical training and its implications on the evolution and mortality of these patients. OBJECTIVE: To compare the claudication distance and survival of patients with IC throughout time in a specific outpatient setting, with or without limitation for exercises. METHODS: A retrospective cohort study was performed to review the protocols of 185 patients and 469 returns, from 1999 to 2005, evaluating demographic data, average claudication distance and death. The data were analyzed using the software Epi-Info, version 3.2, and SAS, version 8.2. RESULTS: Mean age was 60.9±11.1 years; 61.1 percent were males and 38.9 percent were females; 87 percent were Caucasians and 13 percent were non-Caucasians. Associated risk factors were hypertension (69.7 percent), smoking (44.3 percent), dyslipidemia (32.4 percent), and diabetes (28.6 percent). For the patients with claudicating distance lower than 500 m, mean initial distance was 154.0±107.6 m and final distance was 199.8±120.5 m. About 45 percent of the patients had some clinical limitation to perform the prescribed exercise program, such as angina (26.0 percent), stroke (4.3 percent), osteoarthrosis (3.8 percent), previous minor or major amputation (2.1 percent), or chronic obstructive pulmonary disease (1.6 percent). About 11.4 percent of the patients had previous myocardial infarction, and 5.4 percent of them were using cardiotonic drugs. Mean follow-up time was 16.0±14.4 months. Mean claudication distance increased 100 percent (418.47 to 817.74 m) throughout 2 years in the group without limitation (p < 0.001) and in nonsmokers (p < 0.001). Survival rate...
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Aterosclerose/complicações , Aterosclerose/diagnóstico , Claudicação Intermitente/complicações , Terapia por Exercício/métodos , Fatores de RiscoRESUMO
Considerando a necessidade de controle rigoroso do paciente que faz uso do antagonista da vitamina K (AVK), o presente estudo teve como objetivo avaliar, no momento das consultas realizadas em um ambulatório de anticoagulação, o conhecimento do paciente e/ou da família sobre o tratamento com AVK, a partir das informações transmitidas no momento da alta hospitalr. Foram entrevistados 100 pacientes, e se constatou que as orientações realizadas deixaram dúvidas quanto a doença, dieta e cuidados com o uso do AVK. Os resultados apontam para a importância da organização do sistema de assistência à saúde.
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Humanos , Alta do Paciente , Anticoagulantes/uso terapêutico , Educação em SaúdeRESUMO
BACKGROUND: Diet composition is one of the factors that may contribute to intraindividual variability in the anticoagulant response to warfarin. AIM OF THE STUDY: To determine the associations between food pattern and anticoagulant response to warfarin in a group of Brazilian patients with vascular disease. METHODS: Recent and usual food intakes were assessed in 115 patients receiving warfarin; and corresponding plasma phylloquinone (vitamin K(1)), serum triglyceride concentrations, prothrombin time (PT), and International Normalized Ratio (INR) were determined. A factor analysis was used to examine the association of specific foods and biochemical variables with anticoagulant data. RESULTS: Mean age was 59 +/- 15 years. Inadequate anticoagulation, defined as values of INR 2 or 3, was found in 48% of the patients. Soybean oil and kidney beans were the primary food sources of phylloquinone intake. Factor analysis yielded four separate factors, explaining 56.4% of the total variance in the data set. The factor analysis revealed that intakes of kidney beans and soybean oil, 24-h recall of phylloquinone intake, PT and INR loaded significantly on factor 1. Triglycerides, PT, INR, plasma phylloquinone, and duration of anticoagulation therapy loaded on factor 3. CONCLUSIONS: Fluctuations in phylloquinone intake, particularly from kidney beans, and plasma phylloquinone concentrations were associated with variation in measures of anticoagulation (PT and INR) in a Brazilian group of patients with vascular disease.
Assuntos
Anticoagulantes/farmacologia , Coagulação Sanguínea/efeitos dos fármacos , Dieta , Tempo de Protrombina , Varfarina/farmacologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifibrinolíticos/administração & dosagem , Antifibrinolíticos/sangue , Coagulação Sanguínea/fisiologia , Análise Fatorial , Feminino , Humanos , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Triglicerídeos/sangue , Doenças Vasculares/sangue , Doenças Vasculares/tratamento farmacológico , Vitamina K 1/administração & dosagem , Vitamina K 1/sangueRESUMO
Contexto: A aplicação de uma estratégia baseada em um modelo clínico associado ao mapeamento duplex (MD) pode permitir um diagnóstico da trombose venosa profunda (TVP) mais seguro, eficaz e custo-efetivo. Objetivo: Testar o modelo clínico de Wells et al. associado ao MD e verificar a ocorrência de TVP nos pacientes categorizados quanto à probabilidade de apresentar a doença, e determinar se, a partir dos resultados obtidos, seria possível reduzir o número de exames seriados com o MD. Métodos: Os pacientes com suspeita clínica de TVP foram categorizados quanto à apresentação de TVP em baixa, moderada e alta probabilidade (BPMP), AP) e em seguida, submetidos ao MD. Pacientes com MD negativo repetiram o exame em 24-48 horas em 7 dias. Pacientes com exame positivo para TVP foram tratados. Todos os pacientes sem TVP foram convocados para reavaliação clínica em 3 meses. Resultados: A ocorrência de TVP entre os 489 pacientes avaliados foi de 39,1 por cento (191), sendo identificados no exame inicial e 3,5 por cento no exame seriado. Os índices de pacientes que apresentaram TVP foram de 6,1 por cento no grupo de BP, 26,9 por cento de MP e 79,5 por cento no grupo de AP. No exame...