Novedades en el manejo del paciente con FA: actualización tras AHA 2016
22/11/2016 19:30h Casa del Corazón, Madrid
http://manejofa.secardiologia.es
#manejoFA
Seguimiento de pacientes con FA y SCA tras intervención coronaria percutánea. Evidencia con ACOD
Dr. Marcelo Sanmartín Fernández, Hospital Universitario Ramón y Cajal (Madrid)
Novedades en el manejo del paciente con FA: actualización tras AHA 2016
22/11/2016 19:30h Casa del Corazón, Madrid
http://manejofa.secardiologia.es
#manejoFA
Pacientes con FA que sufren un SCA y son sometidos a intervención coronaria percutánea. Guías y preguntas abiertas
Dr. Antonio Fernández Ortiz, Hospital Universitario Clínico San Carlos (Madrid)
Presentación utilizada por el Dr. Domingo Pascual Figal en el directo online ‘Lo mejor en Insuficiencia Cardiaca de ESC Múnich 2018’, realizado el 19 de septiembre de 2018 en la Casa del Corazón
Novedades en el manejo del paciente con FA: actualización tras AHA 2016
22/11/2016 19:30h Casa del Corazón, Madrid
http://manejofa.secardiologia.es
#manejoFA
Pacientes con FA que sufren un SCA y son sometidos a intervención coronaria percutánea. Guías y preguntas abiertas
Dr. Antonio Fernández Ortiz, Hospital Universitario Clínico San Carlos (Madrid)
Presentación utilizada por el Dr. Domingo Pascual Figal en el directo online ‘Lo mejor en Insuficiencia Cardiaca de ESC Múnich 2018’, realizado el 19 de septiembre de 2018 en la Casa del Corazón
Excelencia en el Manejo del Síndrome Coronario Agudo.
Cambiando el paradigma de tratamiento de los pacientes con Cardiopatía Isquémica.
15/04/2015 18:00h - 20:00h Casa del corazón. Sociedad Española de Cardiología
http://cvvt.secardiologia.es
Antiagregación en los pacientes con Cardiopatía Isquémica
Dr. Héctor Bueno Zamora. Hospital General Universitario Gregorio Marañón (Madrid)
Presentación "Manejo de la antiagregación ajustada a las pruebas de reactividad plaquetaria. Experiencia, Resultados y futuro de un programa nacional" del Dr. Daniel Aradi durante la Mesa Redonda de Antiagregación de la XXV Reunión Anual de la Sección de Hemodinámica y Cardiología Intervencionista (SHCI) de 2014 en Córdoba.
http://www.theheart.org/web_slides/1225049.do
A randomized double-blind, double-dummy trial on MAGELLAN (VTE Prophylaxis in Medically Ill Patients) to show noninferiority of rivaroxaban to enoxaparin at 10 days and superiority at 35 days
Novedades en el manejo de la enfermedad cardiovascular en los principales congresos del año 2016
29/11/2016 18:00h Casa del Corazón, Madrid
http://cvvt.secardiologia.es
Perspectiva del cardiólogo clínico
Dr. Domingo Marzal Martín. Complejo Hospitalario de Mérida (Badajoz)
Presentación "Análisis de coste efectividad con los nuevos antiagregantes. Causas de infra-utilización en España" del Dr. José Luis Ferreiro durante la Mesa Redonda de Antiagregación de la XXV Reunión Anual de la Sección de Hemodinámica y Cardiología Intervencionista (SHCI) de 2014 en Córdoba.
SOLACI Chile Congress 2011. Dr.Ajay Kirtane. Drug-Eluting Stents for Multivessel PCI: Indications and Outcomes. Find more presentations on the web site: www.solaci.org/
Ponencia presentada por la Dra. Lina Badimon Maestro en el directo online ‘Estudio ODYSSEY OUTCOMES: los expertos opinan’, realizado el 20 de noviembre de 2018 en la Casa del Corazón
Ponencia presentada por el Dr. Juan José Gómez Doblas en el directo online ‘Fármacos que mejoran el pronóstico cardiovascular’, realizado en la Casa del Corazón el 5 de junio de 2018
XXVII Reunión anual de la sección de Hemodinámica y Cardiología Intervencionista
16 y 17 de junio de 2016 León
http://secardiologia.es/xxvii-reunion-anual-de-la-seccion-de-hemodinamica-y-cardiologia-intervencionista
Novedades en farmacología en intervencionismo
Antonio Fernández Ortiz (Hosp. Clínico San Carlos. Madrid)
Novedades en el manejo del paciente con FA: actualización tras AHA 2016
22/11/2016 19:30h Casa del Corazón, Madrid
http://manejofa.secardiologia.es
#manejoFA
Anticoagulación en pacientes sometidos a cardioversión y ablación
Dr. José Luis Merino Llorens, Hospital Universitario La Paz (Madrid)
Lo mejor del Congreso ACC Washington 2017
21/03/2017 14:00h Casa del Corazón, Madrid
http://acc17.secardiologia.es
#PostACC17
Lo mejor en dislipemias
Dr. Vicente Arrarte Esteban, Hospital General Universitario de Alicante
@varrarte
Excelencia en el Manejo del Síndrome Coronario Agudo.
Cambiando el paradigma de tratamiento de los pacientes con Cardiopatía Isquémica.
15/04/2015 18:00h - 20:00h Casa del corazón. Sociedad Española de Cardiología
http://cvvt.secardiologia.es
Antiagregación en los pacientes con Cardiopatía Isquémica
Dr. Héctor Bueno Zamora. Hospital General Universitario Gregorio Marañón (Madrid)
Presentación "Manejo de la antiagregación ajustada a las pruebas de reactividad plaquetaria. Experiencia, Resultados y futuro de un programa nacional" del Dr. Daniel Aradi durante la Mesa Redonda de Antiagregación de la XXV Reunión Anual de la Sección de Hemodinámica y Cardiología Intervencionista (SHCI) de 2014 en Córdoba.
http://www.theheart.org/web_slides/1225049.do
A randomized double-blind, double-dummy trial on MAGELLAN (VTE Prophylaxis in Medically Ill Patients) to show noninferiority of rivaroxaban to enoxaparin at 10 days and superiority at 35 days
Novedades en el manejo de la enfermedad cardiovascular en los principales congresos del año 2016
29/11/2016 18:00h Casa del Corazón, Madrid
http://cvvt.secardiologia.es
Perspectiva del cardiólogo clínico
Dr. Domingo Marzal Martín. Complejo Hospitalario de Mérida (Badajoz)
Presentación "Análisis de coste efectividad con los nuevos antiagregantes. Causas de infra-utilización en España" del Dr. José Luis Ferreiro durante la Mesa Redonda de Antiagregación de la XXV Reunión Anual de la Sección de Hemodinámica y Cardiología Intervencionista (SHCI) de 2014 en Córdoba.
SOLACI Chile Congress 2011. Dr.Ajay Kirtane. Drug-Eluting Stents for Multivessel PCI: Indications and Outcomes. Find more presentations on the web site: www.solaci.org/
Ponencia presentada por la Dra. Lina Badimon Maestro en el directo online ‘Estudio ODYSSEY OUTCOMES: los expertos opinan’, realizado el 20 de noviembre de 2018 en la Casa del Corazón
Ponencia presentada por el Dr. Juan José Gómez Doblas en el directo online ‘Fármacos que mejoran el pronóstico cardiovascular’, realizado en la Casa del Corazón el 5 de junio de 2018
XXVII Reunión anual de la sección de Hemodinámica y Cardiología Intervencionista
16 y 17 de junio de 2016 León
http://secardiologia.es/xxvii-reunion-anual-de-la-seccion-de-hemodinamica-y-cardiologia-intervencionista
Novedades en farmacología en intervencionismo
Antonio Fernández Ortiz (Hosp. Clínico San Carlos. Madrid)
Novedades en el manejo del paciente con FA: actualización tras AHA 2016
22/11/2016 19:30h Casa del Corazón, Madrid
http://manejofa.secardiologia.es
#manejoFA
Anticoagulación en pacientes sometidos a cardioversión y ablación
Dr. José Luis Merino Llorens, Hospital Universitario La Paz (Madrid)
Lo mejor del Congreso ACC Washington 2017
21/03/2017 14:00h Casa del Corazón, Madrid
http://acc17.secardiologia.es
#PostACC17
Lo mejor en dislipemias
Dr. Vicente Arrarte Esteban, Hospital General Universitario de Alicante
@varrarte
Lo mejor del Congreso ACC Washington 2017
21/03/2017 14:00h Casa del Corazón, Madrid
http://acc17.secardiologia.es
#PostACC17
Lo mejor en riesgo vascular y anticoagulación en FA
Dra. Rosa Fernández Olmo, Complejo Hospitalario de Jaén
@MAROSFO
Visión multidisciplinar del control de HTA
23/11/16 18:30h Casa del Corazón, Madrid
http://controlhta.secardiologia.es
#controlHTA
Paciente con angina de esfuerzo y revascularización incompleta
Dra. Almudena Castro Conde, Hospital Universitario La Paz (Madrid)
@almucastro01
Visión multidisciplinar del control de HTA
23/11/16 18:30h Casa del Corazón, Madrid
http://controlhta.secardiologia.es
#controlHTA
Paciente con cardiopatía isquémica y diabético
Dra. Elena Bello Martínez, Internista. Hospital General Universitario Gregorio Marañón (Madrid)
Coincidencias y discrepancias en las indicaciones de ACOD en España
19/10/2016 20:00 Casa del Corazón, Madrid
Sección RV y BOEHRINGER-INGELHEIM
http://acodccaa.secardiologia.es
#ACODCCAA
Anticoagulación 3.0 con idarucizumab
Dr. José Luis López-Sendón Hentschel, Hospital Universitario La Paz (Madrid)
@JoseLopezSendon
Novedades en el manejo de la enfermedad cardiovascular en los principales congresos del año 2016
29/11/2016 18:00h Casa del Corazón, Madrid
http://cvvt.secardiologia.es
Perspectiva del cardiólogo intervencionista
Dr. Juan Miguel Ruiz Nodar. Hospital General Universitario de Alicante
Visión multidisciplinar del control de HTA
23/11/16 18:30h Casa del Corazón, Madrid
http://controlhta.secardiologia.es
#controlHTA
Paciente con insuficiencia cardiaca y HTA
Dr. Domingo Marzal Martín, Complejo Hospitalario de Mérida (Badajoz)
@domingomarzal
Lo mejor del Congreso SEC Zaragoza 2016
08/11/16 18:00h Casa del Corazón, Madrid
http://sec16.secardiologia.es
#PostSEC16
Lo mejor en Arritmias
Dr. Javier Jiménez Candil, Hospital Universitario de Salamanca
Lo mejor del Congreso SEC Zaragoza 2016
08/11/16 18:00h Casa del Corazón, Madrid
http://sec16.secardiologia.es
#PostSEC16
Lo mejor en Riesgo CV
Dr. Enrique Otero Chulián, Hospital Universitario Puerta del Mar (Cádiz)
@ptoreal
Reunión Institucional 2017 - Socios estrategicos y Colaboradores
Dr. Andrés Íñiguez Romo, Presidente SEC
Conferencias de Consenso SEC
http://secardiologia.es/institucional/reuniones-institucionales/otros-proyectos/conferencias-de-consenso
Lo mejor del Congreso SEC Zaragoza 2016
08/11/16 18:00h Casa del Corazón, Madrid
http://sec16.secardiologia.es
#PostSEC16
Lo mejor en Insuficiencia Cardiaca y Cardiología Clínica
Dr. Javier Torres Llergo, Complejo Hospitalario Universitario de Jaén
@JTLLERGO
Reunión Institucional 2017 - Formación
Dr. Manuel Anguita Sánchez, Presidente de la COmisión de Formación
Conferencias de Consenso SEC
http://secardiologia.es/institucional/reuniones-institucionales/otros-proyectos/conferencias-de-consenso
Sesión clínica del Servicio de Neurología del Hospital Universitario Central de Asturias. Los intertítulos están ilustrados con fotos históricas del Hospital General de Asturias.
Tanto se habla de esta patología que se ha vuelto tan frecuente entre la población mundial, y sin embargo aun se debe conocer más, de este, catalogado por la OMS, "Enemigo silencioso".
Visión multidisciplinar del control de HTA
23/11/16 18:30h Casa del Corazón, Madrid
http://controlhta.secardiologia.es
#controlHTA
Paciente con HTA e insuficiencia renal
Dr. Julián Segura de la Morena, Nefrólogo. Hospital Universitario 12 de Octubre (Madrid). Presidente SEH-LELHA
@juliansegura25
Innovación y Calidad en el Sistema Nacional de Salud
Miércoles, 25 de Junio de 2014 17:00h
http://debateSEC.secardiologia.es
Proyecto INCARDIO
Dr. José Luis López-Sendón Hentschel
Coordinador del proyecto SEC: INCARDIO
Lo mejor del Congreso ACC Washington 2017
21/03/2017 14:00h Casa del Corazón, Madrid
http://acc17.secardiologia.es
#PostACC17
Lo mejor en hemodinámica
Dr. Eduardo Alegría Barrero, Hospital Universitario de Torrejón (Madrid)
@edualegria79
Dyslipidemia management an evidence based approachDr Vivek Baliga
How is dyslipidemia managed in clinical practice? Here is a short review on how current guidelines are shaping clinical practice, and how saroglitazar is playing a role in it.
The Changing Role of PARP Inhibitors in the Treatment of Ovarian Cancerbkling
In recent years, researchers have been looking into using a class of drugs called PARP inhibitors to prevent the progression and recurrence of ovarian cancer. Dr. Kathleen Moore of Stephenson Cancer Center, Principal Investigator of the SOLO-1 trial, explains how the results of this trial may affect ovarian cancer patients and where research on ovarian cancer treatment is headed next.
Impact of access site on bleeding and ischemic events in patients with non-ST-segment elevation myocardial infarction treated with prasugrel at the time of percutaneous coronary intervention or as pretreatment at the time of diagnosis: the ACCOAST access substudy
Cardiogestión
Casa del Corazón
Madrid 15 de septiembre de 2016
Actualización de los nuevos anticoagulantes orales en base a datos en práctica clínica real
Domingo Marzal Martín
Ponencia presentada por la Dra. Marisol Bravo Amaro en el CardioTV Live ‘Debatiendo estrategias actuales para la reducción de eventos CV tras síndrome coronario agudo reciente’, realizado el 21 de mayo de 2024 en la Casa del Corazón
Ponencia presentada por el Dr. Armando Oterino Manzanas en el CardioTV Live ‘Debatiendo estrategias actuales para la reducción de eventos CV tras síndrome coronario agudo reciente’, realizado el 21 de mayo de 2024 en la Casa del Corazón
Ponencia presentada por la Dra. Miriam Martín Toro en el CardioTV Live ‘Debatiendo estrategias actuales para la reducción de eventos CV tras síndrome coronario agudo reciente’, realizado el 21 de mayo de 2024 en la Casa del Corazón
Ponencia presentada por los Dres. M.ª Dolores Mesa Rubio, Javier Mora Robles, Margarita Reina Sánchez, M.ª José Castillo Moraga y José Luis Bianchi Llave en el CardioTV Focus, publicado el 25 de abril de 2024 en la Casa del Corazón (Madrid).
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Seguimiento de pacientes con FA y SCA tras intervención coronaria percutánea. Evidencia con ACOD
1. Novedades en el manejo del paciente con FA: actualización tras AHA 2016
Seguimiento de pacientes con FA
y SCA tras intervención coronaria
percutánea: ACOD
Marcelo Sanmartín
Hospital Universitario Ramón y Cajal
Madrid
2. Novedades en el manejo del paciente con FA: actualización tras AHA 2016
*CrCl 30–49 ml/min: 10 mg OD; #first dose 72–96 hours after sheath removal; ‡clopidogrel (75 mg daily)
(alternative use of prasugrel or ticagrelor allowed, but capped at 15%); §ASA (75–100 mg daily) plus clopidogrel (75 mg daily)
(alternative use of prasugrel or ticagrelor allowed, but capped at 15%); ¶first dose 12–72 hours after sheath removal
1. Janssen Scientific Affairs, LLC. 2016. https://clinicaltrials.gov/ct2/show/NCT01830543 [accessed 10 Oct 2016];
2. Gibson CM et al, Am Heart J 2015;169:472–478e5; 3. Gibson CM et al, New Engl J Med 2016; doi: 10.1056/NEJMoa1611594
Patients With Atrial Fibrillation Undergoing
Coronary Stent Placement: PIONEER AF-PCI
Design: An open-label, randomized, controlled phase IIIb safety study
Rivaroxaban 15 mg OD*# plus single antiplatelet‡
End of treatment
(12 months)
Rivaroxaban 2.5 mg BID#
plus DAPT§
VKA (INR 2.0–3.0)¶
plus DAPT§
Rivaroxaban 15 mg OD*
plus low-dose ASA
VKA plus low-dose ASA
N=2,124
1:1:1
Population:
patients with
paroxysmal,
persistent or
permanent
NVAF
undergoing PCI
(with stent
placement)
R
1 mo: 16%
6 mos: 35%
12 mos: 49%
1 mo: 16%
6 mos: 35%
12 mos: 49%
Decision for
DAPT
duration: 1,
6 or 12
months
DAPT duration
(1 or 6 months)
12 mos:
100%Estrategia “WOEST”
Estrategia “ATLAS”
Estrategia “Guías-antivitaminaK”
3. Novedades en el manejo del paciente con FA: actualización tras AHA 2016
*Some patients excluded due to site violation of GCP guideline; no patients were lost to follow-up
Gibson CM et al, New Engl J Med 2016; doi: 10.1056/NEJMoa1611594
PIONEER AF-PCI Study Flow
2,236 screened
2,124 enrolled
112 not eligible
709 randomized
to Group 1
709 randomized
to Group 2
706 randomized
to Group 3
696 received ≥1 dose
No DAPT stratification
706 received ≥1 dose
1 month DAPT: 108
6 months DAPT: 248
12 months DAPT: 350
697 received ≥1 dose
1 month DAPT: 113
6 months DAPT: 243
12 months DAPT: 341
696 in safety analysis
694 in efficacy analysis*
706 in safety analysis
704 in efficacy analysis*
697 in safety analysis
695 in efficacy analysis*
ITT
analysis set
Safety
analysis set
709 randomized
to Group 1
709 randomized
to Group 2
706 randomized
to Group 3
696 received ≥1 dose
No DAPT stratification
706 received ≥1 dose
1 month DAPT: 108
6 months DAPT: 248
12 months DAPT: 350
697 received ≥1 dose
1 month DAPT: 113
6 months DAPT: 243
12 months DAPT: 341
696 in safety analysis
694 in efficacy analysis*
706 in safety analysis
704 in efficacy analysis*
697 in safety analysis
695 in efficacy analysis*
4. Primary reason for early discontinuation from treatment period
0
5
10
15
20
25
30
Early
discontinuations
(all-cause)
Adverse event Bleeding adverse
event
Death Non-compliance
with study drug
Physician
decision
Patient decision
Earlydiscontinuations(n)
Group 3 (VKA plus DAPT) (n=697)
Group 2 (rivaroxaban 2.5 mg BID plus DAPT) (n=706)
Group 1 (rivaroxaban 15 mg OD plus single antiplatelet) (n=696)
More Patients in the VKA Group Discontinued
Treatment Early than in Either Rivaroxaban Group
** **
*
** **
*p=0.016; **p<0.001
Gibson CM et al, New Engl J Med 2016; doi: 10.1056/NEJMoa1611594]
Early discontinuations were highest in the VKA plus DAPT group; discontinuation due to
patient decision was significantly higher in this group vs both rivaroxaban groups.
There were no patients lost to follow up.
Cause of early discontinuation
5. Baseline Demographics Were Similar
Between Groups (1)
Characteristic Group 1
Rivaroxaban 15 mg OD
plus single antiplatelet
(N=709)
Group 2
Rivaroxaban 2.5 mg
BID plus DAPT
(N=709)
Group 3
VKA plus DAPT
(N=706)
Age, years, mean ± SD 70.4±9.1 70.0±9.1 69.9±8.7
Female sex, n (%) 181 (25.5) 174 (24.5) 188 (26.6)
CrCl, ml/min, mean ± SD 78.3±31.3 77.5±31.8 80.7±30.0
≥30–<60 ml/min, n (%) 194 (28.8) 196 (28.8) 175 (26.2)
<30 ml/min, n (%) 8 (1.2) 7 (1.0) 2 (0.3)
CHA2DS2-VASc score, mean ± SD* 3.73±1.69 3.78±1.62 3.82±1.55
0–1, n (%) 77 (10.9) 75 (10.6) 51 (7.2)
≥2, n (%) 632 (89.1) 634 (89.4) 655 (92.8)
HAS-BLED score, mean ± SD* 3.00±0.91 2.92±0.96 2.99±0.91
0–2, n (%) 196 (27.6) 227 (32.0) 208 (29.3)
≥3, n (%) 513 (72.4) 482 (68.0) 498 (70.5)
Type of AF, n (%)
Persistent 146 (20.6) 146 (20.6) 149 (21.1)
Permanent 262 (37.0) 238 (33.6) 243 (34.5)
Paroxysmal 300 (42.4) 325 (45.8) 313 (44.4)
*Values calculated from data in published manuscript (not explicitly stated)
Gibson CM et al, New Engl J Med 2016; doi: 10.1056/NEJMoa1611594
6. Baseline Demographics Were Similar
Between Groups (2)
Characteristic Group 1
Rivaroxaban 15 mg OD
plus single antiplatelet
(N=709)
Group 2
Rivaroxaban 2.5 mg
BID plus DAPT
(N=709)
Group 3
VKA plus DAPT
(N=706)
P2Y12 inhibitor at baseline, n (%)
Clopidogrel 660 (93.1) 664 (93.7) 680 (96.3)
Prasugrel 12 (1.7) 11 (1.6) 5 (0.7)
Ticagrelor 37 (5.2) 34 (4.8) 21 (3.0)
Urgency of revascularization, n (%)
Elective 428 (60.4) 430 (60.6) 449 (63.6)
Urgent 281 (39.6) 279 (39.4) 257 (36.4)
Type of index event, n (%)
NSTEMI 130 (18.5) 129 (18.4) 123 (17.8)
STEMI 86 (12.3) 97 (13.8) 74 (10.7)
Unstable angina 145 (20.7) 148 (21.1) 164 (23.7)
Type of stent, n (%)
Drug-eluting stent 464 (65.4) 471 (66.8) 468 (66.5)
Bare metal stent 231 (32.6) 220 (31.2) 224 (31.8)
Both 14 (2.0) 14 (2.0) 12 (1.7)
Gibson CM et al, New Engl J Med 2016; doi: 10.1056/NEJMoa1611594]
7. 12,7 15,9 16,9
10,5 13,1 14,2
9,6
9,0 8,1
10,4 9,2 9,9
65,0 60,7 64,4
64,4
66,6 63,6
3,9 4,5
3,7
4,4
3,3 4,1
8,9 10,0 7,0 10,3 7,9 8,2
0
10
20
30
40
50
60
70
80
90
100
All regions
(N=651)
North
America
(N=60)
Latin
America
(N=43)
Western
Europe
(N=237)
Eastern
Europe
(N=276)
Asia-Pacific
(N=35)
TTR(%)
INR ≥3.2
INR ≥3.0–<3.2
INR ≥2.0–<3.0
INR ≥1.8–<2.0
INR <1.8
Proportion of Time in Therapeutic Range
(TTR) by Region for the VKA Subjects
Average TTR (INR 2.0–3.0) was 65%
Gibson CM et al, New Engl J Med 2016; doi: 10.1056/NEJMoa1611594
TTR by region (safety analysis set)
8. Novedades en el manejo del paciente con FA: actualización tras AHA 2016
Kaplan-Meier Estimates of First Occurrence
of Clinically Significant Bleeding Events
Gibson CM et al, New Engl J Med 2016; doi: 10.1056/NEJMoa1611594]
TIMImajor,TIMIminororbleeding
requiringmedicalattention(%)
Time (days)
Rivaroxaban 15 mg OD plus single antiplatelet vs VKA plus DAPT: HR=0.59; (95% CI 0.47–0.76); p<0.001
Rivaroxaban 2.5 mg BID plus DAPT vs VKA plus DAPT: HR=0.63 (95% CI 0.50–0.80); p<0.001
30
25
20
15
10
5
0
0 30 60 90 180 270 360
26.7%
18.0%
16.8%
Group 2 (Rivaroxaban
2.5 mg BID plus DAPT)
Group 1 (Rivaroxaban
15 mg OD plus single
antiplatelet)
Group 3 (VKA plus DAPT)
ARR
8.7%
ARR
9.9%
NNT= 12 NNT=11
9. Novedades en el manejo del paciente con FA: actualización tras AHA 2016
Bleeding Endpoints Using TIMI Criteria
(Primary Analysis)
Kaplan-Meier Estimates Hazard Ratio (95% CI)
Overall
Riva +
P2Y12
(N=696)
Riva +
DAPT
(N=706)
Comb.
Riva
(N=1402)
VKA +
DAPT
(N=697)
Riva + P2Y12
vs. VKA + DAPT
Riva + DAPT
vs. VKA + DAPT
Combined vs.
VKA + DAPT
Clinically
significant
bleeding
109
(16.8%)
117
(18.0%)
226
(17.4%)
167
(26.7%)
0.59 (0.47-0.76)
p<0.001
0.63 (0.50-0.80)
p<0.001
0.61 (0.50-0.75)
p<0.001
TIMI Major
14 (2.1%) 12 (1.9%) 26
(2.0%)
20 (3.3%) 0.66 (0.33-1.31)
p=0.234
0.57 (0.28-1.16)
p=0.114
0.61 (0.34-1.09)
p=0.093
TIMI minor
7
(1.1%)
7
(1.1%)
14
(1.1%)
13
(2.2%)
0.51 (0.20-1.28)
p=0.144
0.50 (0.20-1.26)
p=0.134
0.51 (0.24-1.08)
p=0.071
BRMA
93
(14.6%)
102
(15.8%)
195
(15.2%)
139
(22.6%)
0.61 (0.47-0.80)
p<0.001
0.67 (0.52-0.86)
p=0.002
0.64 (0.51-0.80)
p<0.001
Treatment-emergent period: period starting after the first study drug administration following randomization and ending 2 days after stop of study drug.
Clinically significant bleeding is the composite of TIMI major, TIMI minor, and BRMA events.
A subject could have more than component event. n = number of subjects with events, N = number of subjects at risk, % = KM estimate at the end of study.
Hazard ratios as compared to VKA group are based on the (stratified, only for Overall, 2.5 mg BID/15 mg QD comparing VKA) Cox proportional hazards model.
Log-Rank p-values as compared to VKA group are based on the (stratified, only for Overall 2.5 mg BID/15 mg QD comparing VKA) two-sided log rank test.
BRMA = Bleeding requiring medical attention, TIMI = Thrombolysis in myocardial infarction, CI = confidence interval, DAPT = dual antiplatelet therapy,
HR = hazard ratio, VKA = vitamin K antagonist
Gibson et al. AHA 2016
10. Novedades en el manejo del paciente con FA: actualización tras AHA 2016
Bleeding Events Using GUSTO &
BARC Scales (Pre-Specified Secondary Analyses)
Riva +
P2Y12
(N = 696)
Riva +
DAPT
(N = 706)
Combined
Riva
(N = 1402)
VKA + DAPT
(N = 697)
Group 1
vs Group 3
p-value
Group 2
vs Group 3
p-value
Combined
vs Group 3
p-value
GUSTO classification
Severe 7 (1.0%) 10 (1.4%) 17 (1.2%) 20 (2.9%) 0.012 0.060 0.007
Moderate 13 (1.9%) 10 (1.4%) 23 (1.6%) 9 (1.3%) 0.388 0.839 0.539
Mild 193 (27.7%) 214 (30.3%) 407 (29.0%) 255 (36.6%) <0.001 0.013 <0.001
BARC classification
Type 0 9 (1.3%) 14 (2.0%) 23 (1.6%) 10 (1.4%) 0.820 0.428 0.721
Type 1 (minimal) 125 (18.0%) 153 (21.7%) 278 (19.8%) 167 (24.0%) 0.006 0.307 0.029
Type 2 (actionable) 92 (13.2%) 91 (12.9%) 183 (13.1%) 126 (18.1%) 0.013 0.007 0.002
Type 3a 8 (1.2%) 7 (1.0%) 15 (1.1%) 12 (1.7%) 0.369 0.237 0.212
Type 3b (>5g, pressors) 13 (1.9%) 16 (2.3%) 29 (2.1%) 26 (3.7%) 0.035 0.108 0.025
Type 3c 2 (0.3%) 5 (0.7%) 7 (0.5%) 4 (0.6%) 0.687 >0.999 0.760
Type 4 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) - - -
Type 5a 1 (0.1%) 0 (0.0%) 0 (0.0%) 1 (0.1%) >0.999 0.497 .554
Type 5b (Definite Fatal) 1 (0.1%) 2 (0.3%) 3 (0.2%) 7 (1.0%) 0.070 0.106 0.019
BARC denotes Bleeding Academic Research Consortium, GUSTO Global Utilization Of Streptokinase and Tpa For Occluded Arteries
Probable fatal bleeding (type 5a) is bleeding that is clinically suspicious as the cause of death, but the bleeding is not directly observed and there is no
autopsy or confirmatory imaging.
Definite fatal bleeding (type 5b) is bleeding that is directly observed (by either clinical specimen [blood, emesis, stool, etc] or imaging) or confirmed on
autopsy.
Treatment-emergent period: period starting after the first study drug administration following randomization and ending 2 days after stop of study drug.
Gibson et al. AHA 2016
11. Novedades en el manejo del paciente con FA: actualización tras AHA 2016
Bleeding Events Using ISTH Scales
(Pre-Specified Secondary Analysis)
Riva +
P2Y12
(N = 696)
Riva +
DAPT
(N = 706)
Combined
Riva
(N = 1402)
VKA +
DAPT
(N = 697)
Group 1
vs Group 3
p-value
Group 2
vs Group 3
p-value
Combined
vs Group 3
p-value
ISTH classification
Major bleeding 27 (3.9%) 25 (3.5%) 52 (3.7%) 48 (6.9%) 0.013 0.005 0.001
Hemoglobin drop* 21 (3.0%) 19 (2.7%) 40 (2.9%) 34 (4.9%) 0.075 0.032 0.018
Transfusion†
15 (2.2%) 13 (1.8%) 28 (2.0%) 15 (2.2%) 0.997 0.677 0.813
Critical organ bleeding‡
6 (0.9%) 5 (0.7%) 11 (0.8%) 11 (1.6%) 0.224 0.125 0.093
Fatal 2 (0.3%) 2 (0.3%) 4 (0.3%) 5 (0.7%) 0.452 0.285 0.167
CRNM bleeding 90 (12.9%) 97 (13.7%) 187 (13.3%) 130 (18.7%) 0.003 0.013 0.001
Minimal bleeding 123 (17.7%) 151 (21.4%) 274 (19.5%) 163 (23.4%) 0.008 0.369 0.041
Treatment-emergent period: period starting after the first study drug administration following randomization and ending 2 days after stop of
study drug.
ISTH denotes International Society on Thrombosis and Haemostasis,
*Hemoglobin drop = a fall in hemoglobin of 2 g/dL or more.
† Transfusion = a transfusion of 2 or more units of packed red blood cells or whole blood.
‡ Critical organ bleeding are cases where investigator-reported bleeding site is either intracranial, intraspinal, intraocular, pericardial, intra-
articular, intramuscular with compartment syndrome or retroperitoneal
12. Novedades en el manejo del paciente con FA: actualización tras AHA 2016
Efficacy was Comparable Between All
Three Treatment Strategies*
*Trial not powered to definitively demonstrate either superiority or non-inferiority for efficacy endpoints
Gibson CM et al, New Engl J Med 2016; doi: 10.1056/NEJMoa1611594
CVdeath,MIorstroke(%)
Time (days)
8
6
4
2
0
0 30 60 90 180 270 360
Group 2 (Rivaroxaban
2.5 mg BID plus DAPT)
Group 1 (Rivaroxaban
15 mg OD plus single
antiplatelet)
Group 3 (VKA plus DAPT)
6.0%
5.6%
6.5%
Rivaroxaban 15 mg OD plus single antiplatelet vs VKA plus DAPT: HR=1.08; (95% CI 0.69–1.68); p=0.750
Rivaroxaban 2.5 mg BID plus DAPT vs VKA plus DAPT: HR=0.93 (95% CI 0.59–1.48); p=0.765
13. Novedades en el manejo del paciente con FA: actualización tras AHA 2016
0
1
2
3
4
5
6
7
Major adverse
CV events*
CV death MI Stroke Stent thrombosis
360-dayKaplan–Meier
estimate(%)
Group 3 (VKA plus DAPT) (n=695)
Group 2 (rivaroxaban 2.5 mg BID plus DAPT) (n=704)
Group 1 (rivaroxaban 15 mg OD plus single antiplatelet) (n=694)
Comparable Efficacy with Rivaroxaban
Strategies vs VKA plus DAPT
*Composite of CV death, MI and stroke
Gibson CM et al, New Engl J Med 2016; doi: 10.1056/NEJMoa1611594]
Components of composite endpoint and stent thrombosisComposite endpoint
Incidence of major adverse CV events was comparable between all three treatment strategies;
however, the trial was not powered for efficacy
14. Novedades en el manejo del paciente con FA: actualización tras AHA 2016
Major Adverse Cardiac Events
Kaplan-Meier Estimates Hazard Ratio (95% CI)
Overall
Riva +
P2Y12
(N=694)
Riva +
DAPT
(N=704)
VKA +
DAPT
(N=695)
Riva + P2Y12 vs.
VKA + DAPT
Riva + DAPT
vs. VKA + DAPT
Adverse CV Event 41 (6.5%) 36 (5.6%) 36 (6.0%) 1.08 (0.69-1.68) p=0.750
0.93 (0.59-1.48)
p=0.765
CV Death 15 (2.4%) 14 (2.2%) 11 (1.9%)
1.29 (0.59-2.80)
p=0.523
1.19 (0.54-2.62)
p=0.664
MI 19 (3.0%) 17 (2.7%) 21 (3.5%)
0.86 (0.46-1.59)
p=0.625
0.75 (0.40-1.42)
p=0.374
Stroke 8 (1.3%) 10 (1.5%) 7 (1.2%)
1.07 (0.39-2.96)
p=0.891
1.36 (0.52-3.58)
p=0.530
Stent Thrombosis 5 (0.8%) 6 (0.9%) 4 (0.7%) 1.20 (0.32-4.45) p=0.790
1.44 (0.40-5.09)
p=0.574
Adverse CV Events +
Stent Thrombosis
41 (6.5%) 36 (5.6%) 36 (6.0%)
1.08 (0.69-1.68)
P=0.750
0.93 (0.59-1.48)
p=0.765
Treatment-emergent period: period starting after the first study drug administration following randomization and ending 2 days after stop of study drug.
A subject could have more than component event. n = number of subjects with events, N = number of subjects at risk, % = KM estimate at the end of study.
Hazard ratios as compared to VKA group are based on the (stratified, only for Overall, 2.5 mg BID/15 mg QD comparing VKA) Cox proportional hazards model.
Log-Rank p-values as compared to VKA group are based on the (stratified, only for Overall 2.5 mg BID/15 mg QD comparing VKA) two-sided log rank test.
CI = confidence interval, DAPT = dual antiplatelet therapy, HR = hazard ratio, VKA = vitamin K antagonist
6 Subjects were excluded from all efficacy analyses because of violations in Good Clinical Practice guidelines.
Gibson et al. AHA 2016
15. Novedades en el manejo del paciente con FA: actualización tras AHA 2016
Subgroup Analysis: Major Adverse Cardiac Events
16. Novedades en el manejo del paciente con FA: actualización tras AHA 2016
Subgroup Analysis: Major Adverse Cardiac Events
17. Novedades en el manejo del paciente con FA: actualización tras AHA 2016
28.4%
20.3%
20.3%
10.5%
5.4%
6.5%
CV
Bleeding
30
20
10
0
0
Proportionofpatientswhowere
rehospitalized(%)
30 60 90 180 270 360
Time (days)
Adverse events leading to hospitalization were classified by consensus panel blinded to treatment group as potentially related to either bleeding,
CV or other causes; Rehospitalizations do not include the index event and include the first rehospitalization after the index event.
Gibson CM et al, Circulation 2016; doi:10.1161/CIRCULATIONAHA.116.025783
Re-hospitalization Due to CV Events and Bleeding Were
Both Reduced with the Rivaroxaban Strategies
Group 2 (Rivaroxaban 2.5 mg BID plus DAPT)
Group 1 (Rivaroxaban 15 mg OD
plus single antiplatelet)
Group 3 (VKA plus DAPT)
Group 1 vs Group 3:
HR=0.68; (95% CI 0.54–0.85); p<0.001
ARR=8.1%; NNT=13
Group 2 vs Group 3:
HR=0.73 (95% CI 0.58–0.91); p=0.005
ARR=8.1%; NNT=13
CV
Group 1 vs Group 3:
HR=0.61; (95% CI 0.41–0.90); p=0.012
ARR=4.0%; NNT=25
Group 2 vs Group 3:
HR=0.51 (95% CI 0.34–0.77); p=0.001
ARR=5.1%; NNT=20
Bleeding
18. Novedades en el manejo del paciente con FA: actualización tras AHA 2016
“O PIONEERS!”
Circulation. 2016;134:00–00. DOI: 10.1161/CIRCULATIONAHA.116.025923
19. Novedades en el manejo del paciente con FA: actualización tras AHA 2016
PIONEER AF-PCI
Conclusions
• Administration of either rivaroxaban 15 mg OD plus a
single antiplatelet for 1 year, or rivaroxaban 2.5 mg BID
plus 1, 6 or 12 months of DAPT reduced the risk of
clinically significant bleeding compared with a standard
VKA plus DAPT strategy
• Although the study was not powered to detect differences
in efficacy endpoints, both rivaroxaban strategies
demonstrated similar efficacy compared with a standard
VKA plus DAPT strategy
• Both rivaroxaban strategies showed a reduced risk of
recurrent hospitalization
Gibson CM et al, New Engl J Med 2016; doi: 10.1056/NEJMoa1611594
20. Novedades en el manejo del paciente con FA: actualización tras AHA 2016
21. Novedades en el manejo del paciente con FA: actualización tras AHA 2016
22. Novedades en el manejo del paciente con FA: actualización tras AHA 2016