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Master's Dissertation
DOI
https://doi.org/10.11606/D.60.2017.tde-23112017-114125
Document
Author
Full name
Helen Palmira Miranda de Camargo Souza
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2017
Supervisor
Committee
Pereira, Leonardo Régis Leira (President)
Moriel, Patricia
Pazin Filho, Antonio
Varallo, Fabiana Rossi
Title in Portuguese
Fatores de risco para reações adversas à varfarina em pacientes hospitalizados: um estudo de coorte
Keywords in Portuguese
Anticoagulante
Farmacovigilancia
Pacientes hospitalizados
Varfarina
Abstract in Portuguese
A varfarina é considerada um dos principais fármacos anticoagulantes orais, com o uso clínico a mais de 60 anos, contudo sua utilização ainda remete preocupação quanto aos riscos de suas reações adversas, sendo a hemorragia um dos eventos mais graves. Diante disso, o objetivo deste estudo foi avaliar a incidência das reações adversas decorrente ao uso da varfarina (RAV), em um hospital de alta complexidade, caracterizar o perfil dos pacientes e identificar os principais fatores de risco para as RAV, bem como a conduta diante das ocorrências. Para tal, foi realizado um estudo de coorte prospectivo com o monitoramento durante o período de internação de 309 usuários de varfarina, realizando a identificação das RAV por meio da busca ativa de indicadores, e a avaliação dos fatores de risco e classificação das ocorrências. Dessa forma, encontrou-se a incidência de 12% (n=37) para RAV, com média de idade de 56 anos, não se observando risco superior entre os idosos, ou quanto ao sexo, diferentes etnias, possuir hábitos tabágicos e etilismo. Em relação as ocorrências 51,4% dos pacientes apresentaram RAV grave, enquanto para 21,6% a RAV foi responsável de forma direta ou indiretamente pela morte do paciente. Observou-se média 25,8 fármacos entre os pacientes com RAV em comparação a 13,4 para os pacientes que não apresentaram a ocorrência, 24,3% dos pacientes com RAV foram admitidos no centro de terapia intensiva (CTI), e 75,7% apresentaram tempo de internação superior a 15 dias. Entre os fatores de risco observados, destacou-se a piora da função renal (RR 12,85. IC95% 5,19; 31,77), redução da albumina (RR 2,24. IC95% 1,64; 3,06), o elevado número de medicamentos (RR 3,36. IC95% 1,66; 6,78), e de interações medicamentosas com risco superior para os fármacos dipirona, lactulose, quetiapina, ranitidina e polivitamicos. A prescrição de concentrado de hemácias (51,4%), plasma fresco (48,7%) e vitamina K (43,2%) foram as condutas mais frequentes na reversão e manejo das RAV. Em conclusão as RAV apresentaram elevada gravidade entre os pacientes, com altas taxas de transfusões, ampliação no tempo de internação, no número de medicamentos utilizados e na frequência de admissões no CTI.
Title in English
Risk factors for adverse reactions to use of warfarin inpatient: a cohort study
Keywords in English
Anticoagulante
Inpatient
Pharmacovigilance
Warfarin
Abstract in English
Warfarin is one of the main oral anticoagulant drugs in use for more than 60 years. However, its use still raises concerns about the risks of its adverse reactions, and hemorrhage is one of the most serious events. Therefore, the objective of this study was to evaluate the incidence of adverse reactions due to the use of warfarin (RAV) in a high complexity hospital, to characterize the patients' profile and to identify the main risk factors for RAV, as well as the conduct in the face of occurrences. A prospective cohort study was carried out with the monitoring during the hospitalization period of 309 warfarin users, performing the identification and classification of the RAV through an active search of indicators, and the evaluation of risk factors of them. Thus, the incidence of 12% (n = 37) was found for RAV, with a mean age of 56 years, with no higher risk among the elderly, or with regard to gender, different ethnicities, smoking habits, and alcoholism. Regarding the occurrences, 51.4% of the patients presented severe RAV, whereas for 21.6% the RAV was directly or indirectly responsible for the death of the patient. We observed a mean of 25.8 drugs among patients with RAV compared to 13.4 for patients who did not present this event, 24.3% of patients with RAV were admitted to the intensive care unit (ICU), and 75.7% had hospitalization time of more than 15 days. Among the risk factors observed highlights renal function worsened (RR 12.85, IC95% 5.19; 31.77), albumin reduction (RR 2.24, IC95% 1.64; 3.06), the high number of medications (RR 3.36, IC95% 1.66; 6.78) and drug interactions for the metamizole, lactulose, quetiapine, ranitidine and poly vitamin drugs. The prescription of packed red blood cells (51.4%), fresh plasma (48.7%) and vitamin K (43.2%) were the most frequent behaviors in the reversion and management of RAV. In conclusion, the RAV presented high severity among the patients, with high transfusion rates, the increase in the length of hospital stay, number of used medications, and admission frequency in ICU.
 
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Release Date
2019-11-23
Publishing Date
2021-04-12
 
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