14 research outputs found
Clinical Trials Using Vasodilators in Pulmonary Arterial Hypertension:Where Do We Go from Here?
No full textRecomendaciones de manejo de los anticoagulantes orales directos (DOACs) anti Xa y anti IIa
No full textLos anticoagulantes orales directos han surgido como una de las herramientas que ha cambiado el manejo de la enfermedad trombótica en los últimos 15 años. Sus ventajas, desde el punto de vista de la facilidad de uso y menor riesgo de sangrado, especialmente de sangrado cerebral, han posicionado a estos nuevos anticoagulantes como la primera alternativa de tratamiento en las dos indicaciones más frecuentes en que necesitamos estas drogas, la fibrilación auricular y la enfermedad tromboembólica venosa. Sin embargo, no todos los pacientes pueden recibir estos agentes, no todos los anticoagulantes directos tienen las mismas pro- piedades y fundamentalmente, no todas las enfermedades con indicación de un anticoagulante pueden tratarse con ellos;con lo cual es necesario que todos los profesionales que están involucrados en el manejo de estos medicamentos estén obligados a conocerlos en profundidad, para poder decidir el mejor tratamiento en cada caso particular. Este documento de posición de expertos de diferentes especialidades de Argentina, presenta lineamientos para el uso correcto de los anticoagulantes directos en base a nueva evidencia y a la experiencia de uso de un amplio grupo de profesionales. La forma de relacionarnos con el tratamiento anticoagulante hacambiado. Los médicos que trabajamos con ellos también debemos hacerlo.Fil: Ceresetto, José Manuel. Hospital Británico de Buenos Aires; ArgentinaFil: Tajer, Carlos Daniel. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; ArgentinaFil: Duboscq, Cristina. Hospital Británico de Buenos Aires; ArgentinaFil: Bottaro, Federico. Hospital Británico de Buenos Aires; ArgentinaFil: Casais, Patricia. Centro de Hematologia Pavlovsky; ArgentinaFil: Korin, Jorge. Sanatorio de Los Arcos; ArgentinaFil: Fondevila, Carlos. Clínica Bazterrica; ArgentinaFil: Giumelli, Carla. Instituto de Cardiologia de Corrientes; ArgentinaFil: Scazziota, Alejandra. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Rossi, Andrea. Fundación Favaloro; ArgentinaFil: Botto, Fernando. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Aris Cancela, Maria Ester. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Martinuzzo, Marta Elba. Hospital Italiano de Buenos Aires; ArgentinaFil: Zaidel, Ezequiel. Sanatorio Guemes Sociedad Anonima.; ArgentinaFil: Fitz Maurice, Mario. Hospital General de Agudos Bernardino Rivadavia ; Gobierno de la Ciudad Autonoma de Buenos Aires;Fil: Bahit, Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva y Traslacional. Fundación Ineco Rosario Sede del Incyt | Instituto de Neurología Cognitiva. Instituto de Neurociencia Cognitiva y Traslacional. Fundación Ineco Rosario Sede del Incyt | Fundación Favaloro. Instituto de Neurociencia Cognitiva y Traslacional. Fundación Ineco Rosario Sede del Incyt; ArgentinaFil: Vazquez, Fernando. Hospital Italiano de Buenos Aires; ArgentinaFil: Molnar, Soledad. Universidad Católica de Córdoba. Facultad de Medicina. Clínica Universitaria Reina Fabiola; ArgentinaFil: Salzberg, Simón. Clínica Bazterrica; ArgentinaFil: Negri Aranguren, Pedro. Instituto Privado de Hematologia y Hemoterapia Parana; ArgentinaFil: Da Rosa, Claudio. Universidad Austral. Hospital Universitario Austral; ArgentinaFil: Fedele, José Luis. Hospital Privado de Rosario; ArgentinaFil: Comignani P. Hospital Británico de Buenos Aires; ArgentinaFil: Pombo, Gonzalo. Sanatorio Mater Dei;Fil: Raña, Pablo. Clinica Dr Roberto Raña; ArgentinaFil: Adamczuk, Yolanda. Hospital Gral de Agudos Enrique Tornu; ArgentinaFil: Marti, Alejandra. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; ArgentinaFil: Charask, Adrian. Clínica Bazterrica; ArgentinaFil: Sánchez Luceros, Analía Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentin
Rescue policy for discarded liver grafts: a single-centre experience of transplanting livers ‘that nobody wants’
No full textAbstractBackgroundThere is a worldwide need to expand the donor liver pool. We report a consecutive series of elective candidates for liver transplantation (LT) who received ‘livers that nobody wants’ (LNWs) in Argentina.MethodsBetween 2006 and 2009, outcomes for patients who received LNWs were analysed and compared with outcomes for a control group. To be defined as an LNW, an organ is required to fulfil two criteria. Firstly, each liver must be officially offered and refused more than 30 times; secondly, the liver must be refused by at least 50% of the LT programmes in our country before our programme can accept it. Principal endpoints were primary graft non-function (PNF), mortality, and graft and patient survival.ResultsWe transplanted 26 LNWs that had been discarded by a median of 12 centres. A total of 2666 reasons for refusal had been registered. These included poor donor status (n= 1980), followed by LT centre (n= 398) or recipient (n= 288) conditions. Incidences of PNF (3.8% vs. 4.0%), in-hospital mortality (3.8% vs. 8.0%), 1-year patient (84% vs. 84%) and graft (84% vs. 80%) survival were equal in the LNW and control groups.ConclusionsTransplantable livers are unnecessarily discarded by the transplant community. External and internal supervision of the activity of each LT programme is urgently needed to guarantee high standards of excellence
Statins but not aspirin reduce thrombotic risk assessed by thrombin generation in diabetic patients without cardiovascular events: the RATIONAL trial.
No full textThe systematic use of aspirin and statins in patients with diabetes and no previous cardiovascular events is controversial. We sought to assess the effects of aspirin and statins on the thrombotic risk assessed by thrombin generation (TG) among patients with type II diabetes mellitus and no previous cardiovascular events.Prospective, randomized, open, blinded to events evaluation, controlled, 2×2 factorial clinical trial including 30 patients randomly allocated to aspirin 100 mg/d, atorvastatin 40 mg/d, both or none. Outcome measurements included changes in TG levels after treatment (8 to 10 weeks), assessed by a calibrated automated thrombogram. At baseline all groups had similar clinical and biochemical profiles, including TG levels. There was no interaction between aspirin and atorvastatin. Atorvastatin significantly reduced TG measured as peak TG with saline (85.09±55.34 nmol vs 153.26±75.55 nmol for atorvastatin and control groups, respectively; p = 0.018). On the other hand, aspirin had no effect on TG (121.51±81.83 nmol vs 116.85±67.66 nmol, for aspirin and control groups, respectively; p = 0.716). The effects of treatments on measurements of TG using other agonists were consistent.While waiting for data from ongoing large clinical randomized trials to definitively outline the role of aspirin in primary prevention, our study shows that among diabetic patients without previous vascular events, statins but not aspirin reduce thrombotic risk assessed by TG.ClinicalTrials.gov NCT00793754
Liver Transplantation without Perioperative Transfusions Single-Center Experience Showing Better Early Outcome and Shorter Hospital Stay
No full textBackground. Significant amounts of red blood cells (RBCs) transfusions are associated with poor outcome after liver transplantation (LT). We report our series of LT without perioperative RBC (P-RBC) transfusions to evaluate its influence on early and long-term outcomes following LT. Methods. A consecutive series of LT between 2006 and 2011 was analyzed. P-RBC transfusion was defined as one or more RBC units administrated during or ≤48 hours after LT. We divided the cohort in “No-Transfusion” and “Yes-Transfusion.” Preoperative status, graft quality, and intra- and postoperative variables were compared to assess P-RBC transfusion risk factors and postoperative outcome. Results. LT was performed in 127 patients (“No-Transfusion” = 39 versus “Yes-Transfusion” = 88). While median MELD was significantly higher in Yes-Transfusion (11 versus 21; P=0.0001) group, platelet count, prothrombin time, and hemoglobin were significantly lower. On multivariate analysis, the unique independent risk factor associated with P-RBC transfusions was preoperative hemoglobin (P<0.001). Incidence of postoperative bacterial infections (10 versus 27%; P=0.03), median ICU (2 versus 3 days; P=0.03), and hospital stay (7.5 versus 9 days; P=0.01) were negatively influenced by P-RBC transfusions. However, 30-day mortality (10 versus 15%) and one- (86 versus 70%) and 3-year (77 versus 66%) survival were equivalent in both groups. Conclusions. Recipient MELD score was not a predictive factor for P-RBC transfusion. Patients requiring P-RBC transfusions had worse postoperative outcome. Therefore, maximum efforts must be focused on improving hemoglobin levels during waiting list time to prevent using P-RBC in LT recipients
ALBUMIN: CREATININ RATIO STRONGLY PREDICTS ADVERSE OUTCOMES IN NON ST SEGMENT ELEVATION ACUTE CORONARY SYNDROMES
No full textBaseline characteristics of patients randomized to receive atorvastatin or control.
No full text<p>Baseline characteristics of patients randomized to receive atorvastatin or control.</p
Baseline characteristics of patients randomized to receive aspirin or control.
No full text<p>Baseline characteristics of patients randomized to receive aspirin or control.</p
Baseline levels of thrombin generation in patients randomized to aspirin and atorvastatin.
No full text<p>PTG, peak thrombin generation; LT, lag time.</p
