Você está na página 1de 34

Pertinncia da Aplicao dos

Anticoagulantes Orais No Antivitamina-K


(NOACs) na Fibrilhao Auricular
Alberto Sarmento
Orientadora: Dra. Ana Maria Almeida
Directora do Ncleo da BI: Dra. Marli Loureiro
10-02-2016
UCSP S. Tiago

Trombose Arterial vs Trombose Venosa

Trombose Arterial vs Trombose Venosa


Factores de risco comuns:

The Rotterdam Study, 1990-1999

Rate per 1000 person-years

Incidence rates of atrial fibrillation by gender and age (N=6432)

30,0
25,0
20,0

All

15,0

Men

10,0

Women

5,0
0,0
60-64

65-69

70-74

75-79

Age Groups (years)

80-84

85

Agentes Anticoagulantes

Anticoagulantes Orais: Varfarina


Mecanismo de Aco

Anticoagulantes Orais: Varfarina


Farmacologia

Anticoagulantes Orais: Varfarina


Monitorizao

Anticoagulantes Orais: Varfarina


Dose

Anticoagulantes Orais: Varfarina


RAM

investigao

Anticoagulantes Orais: Varfarina


RAM

segura

Anticoagulantes Orais: Varfarina


RAM

Anticoagulantes Orais: Varfarina


Problemas Especiais

Anticoagulantes Orais: NOACs

Score CHA2DS2VASc

Escala CHA2DS2VASc

Score HAS - BLED

SAMe-TT2R2 Score

Using this score in a newly diagnosed, non-anticoagulated AF patient

Score results guide


0-2 suggests a the patient would benefit from a VKA
>2 would indicate the use of alternative strategies (e.g. NOAC)

VKA, Vitamin K Antagonist; NOAC, non-VKA oral anticoagulant

Uso de ACOs (varfarina) em idosos:


- Estratgias que visam reduzir o risco de sangramento:
No utilizar dose de ataque.
Identificar e evitar interaes medicamentosas.
Aconselhar sobre a importncia de dieta consistente e equilibrada em vit. K
Identificar fatores de comorbilidade que possam interferir no controle da ACO
Avaliar no incio do Tx: probabilidade de adeso ao Tx e ao controle do INR
Reavaliar periodica/ a relao risco/benefcio do uso do ACO
Antendendo s caractersticas e riscos nesta subpopulao, importa avaliar o risco
estimado de tromboembolismo e de complicaes hemorrgicas; e outros factores,
incluindo: situao socioeconmica, adeso ao tratamento, qualidade da
monitorizao laboratorial do INR e, possivelmente, existncia de equipe
multidisciplinar especializada no controle da anticoagulao oral

Concluses
Based on stroke risk scores (CHADS and CHA2DS2VASc) and bleeding risk
(HAS-BLED), anticoagulation therapy is recommended for AF, while
balancing the risks of thrombosis versus bleeding.
Oral anticoagulants such as Warfarin and the Non-vitamin K antagonist OACs
(NOACs) have been indicated and are compared regarding their
effectiveness and safety.
Barriers to OAC use and NOAC use are discussed.
Prospective trial data from international registries on adherence and
persistence with NOACs are presented.

Referncias Bibliogrficas Gerais


[1] 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart
Association Task Force on Practice Guidelines and the Heart Rhythm Society. January CT, et al. J Am Coll Cardiol. 2014 Dec 2;64(21):e1-76. Erratum in: J
Am Coll Cardiol. 2014 Dec 2;64(21):2305-7.
{2] Harrison's Principles of Internal Medicine 19/E. 2015
[3[ Jan Heeringa. Epidemiology of atrial fibrillation in the general population. 2009
Manual de Cardiogeriatria, Programa de Educao Mdica Continuada

Obrigado pela ateno

alberto.sarmento@gmail.com