ALEXANDRE DE MATOS SOEIRO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
4 resultados
Resultados de Busca
Agora exibindo 1 - 4 de 4
- Platelet Reactivity in Patients With Acute Coronary Syndromes Awaiting Surgical Revascularization(2021) NAKASHIMA, Carlos A. K.; DALLAN, Luis A. O.; LISBOA, Luiz A. F.; JATENE, Fabio B.; HAJJAR, Ludhmila A.; SOEIRO, Alexandre M.; FURTADO, Remo H. M.; DALCOQUIO, Talia F.; BARACIOLI, Luciano M.; LIMA, Felipe G.; V, Roberto R. C. Giraldez; SILVA, Bianca A.; COSTA, Mateus S. S.; STRUNZ, Celia M. C.; DALLAN, Luis R. P.; BARBOSA, Carlos J. D. G.; BRITTO, Flavia A. B.; FARKOUH, Michael E.; GURBEL, Paul A.; NICOLAU, Jose C.BACKGROUND Dual antiplatelet therapy is recommended for patients with acute coronary syndromes (ACS). Approximately 10% to 15% of these patients will undergo coronary artery bypass graft (CABG) surgery for index events, and current guidelines recommend stopping clopidogrel at least 5 days before CABG. This waiting time has clinical and economic implications. OBJECTIVES This study aimed to evaluate if a platelet reactivity-based strategy is noninferior to standard of care for 24-h post-CABG bleeding. METHODS In this randomized, open label noninferiority trial, 190 patients admitted with ACS with indications for CABG and on aspirin and P2Y(12) receptor inhibitors, were assigned to either control group, P2Y(12) receptor inhibitor withdrawn 5 to 7 days before CABG, or intervention group, daily measurements of platelet reactivity by Multiplate analyzer (Roche Diagnostics GmbH, Vienna, Austria) with CABG planned the next working day after platelet reactivity normalization (predefined as >= 46 aggregation units). RESULTS Within the first 24 h of CABG, the median chest tube drainage was 350 ml (interquartile range [IQR]: 250 to 475 ml) and 350 ml (IQR: 255 to 500 ml) in the intervention and control groups, respectively (p for noninferiority <0.001). The median waiting period between the decision to undergo CABG and the procedure was 112 h (IQR: 66 to 142 h) and 136 h (IQR: 112 to 161 h) (p < 0.001), respectively. In the intention-to-treat analysis, a 6.4% decrease in the median in-hospital expenses was observed in the intervention group (p = 0.014), with 11.2% decrease in the analysis per protocol (p = 0.003). CONCLUSIONS A strategy based on platelet reactivity-guided is noninferior to the standard of care in patients with ACS awaiting CABG regarding peri-operative bleeding, significantly shortens the waiting time to CABG, and decreases hospital expenses. (C) 2021 by the American College of Cardiology Foundation.
conferenceObject Preliminary Analysis of the Symptoms and Quality of Life After Discharge in Noncritically Ill Patients with COVID-19: The ACTIV-4a and ATTACC Randomized Controlled Trial(2022) HUBEL, K. A.; GREENSTEIN, Y. Y.; VENUGOPAL, V.; LAI, Y.; BERGER, J. S.; CHANG, S. Y.; COLOVOS, C.; SHAH, F.; ISLAM, M.; JIMENEZ, J.; KHAN, M.; KORNBLITH, L. Z.; LAWLER, P. R.; GADDH, M.; MOISES, J.; GUERRERO, R. Morillo; NKEMDIRIM, W.; REYNOLDS, H. R.; AMIGO, J. Seijas; SOEIRO, A.; WAHID, L.; ZAHRA, A.; GOLIGHER, E. C.; ZARYCHANSKI, R.; CUSHMAN, M.; GONG, M. N.- Effect of a Strategy of Comprehensive Vasodilation vs Usual Care on Mortality and Heart Failure Rehospitalization Among Patients With Acute Heart Failure The GALACTIC Randomized Clinical Trial(2019) KOZHUHAROV, Nikola; GOUDEV, Assen; FLORES, Dayana; MAEDER, Micha T.; WALTER, Joan; SHRESTHA, Samyut; GUALANDRO, Danielle Menosi; OLIVEIRA JUNIOR, Mucio Tavares de; SABTI, Zaid; MUELLER, Beat; NOVEANU, Markus; SOCRATES, Thenral; ZILLER, Ronny; BAYES-GENIS, Antoni; SIONIS, Alessandro; SIMON, Patrick; MICHOU, Eleni; GUJER, Samuel; GORI, Tommaso; WENZEL, Philip; PFISTER, Otmar; CONEN, David; KAPOS, Ioannis; KOBZA, Richard; RICKLI, Hans; BREIDTHARDT, Tobias; MUENZEL, Thomas; ERNE, Paul; MUELLER, Christian; DIMOV, Bojidar; HARTWIGER, Sabine; HERR, Natascha; ISENRICH, Rahel; MOSIMANN, Tamina; TWERENBOLD, Raphael; BOEDDINGHAUS, Jasper; NESTELBERGER, Thomas; PUELACHER, Christian; FREESE, Michael; VOGELE, Janine; MEISSNER, Kathrin; MARTIN, Jasmin; STREBEL, Ivo; WUSSLER, Desiree; SCHUMACHER, Carmela; OSSWALD, Stefan; VOGT, Fabian; HILTI, Jonas; SCHWARZ, Jonas; FITZE, Brigitte; HARTWIGER, Sabine; ARENJA, Nisha; GLATZ, Bettina; RENTSCH, Katharina; BOSSA, Aline; JALLAD, Sergio; SOEIRO, Alexandre; JANSEN, Thomas; GEBEL, Gabriele; BOSSARD, Matthias; CHRIST, MichaelIMPORTANCE Short-term infusions of single vasodilators, usually given in a fixed dose, have not improved outcomes in patients with acute heart failure (AHF). OBJECTIVE To evaluate the effect of a strategy that emphasized early intensive and sustained vasodilation using individualized up-titrated doses of established vasodilators in patients with AHF. DESIGN, SETTING, AND PARTICIPANTS Randomized, open-label blinded-end-point trial enrolling 788 patients hospitalized for AHF with dyspnea, increased plasma concentrations of natriuretic peptides, systolic blood pressure of at least 100mmHg, and plan for treatment in a general ward in 10 tertiary and secondary hospitals in Switzerland, Bulgaria, Germany, Brazil, and Spain. Enrollment began in December 2007 and follow-up was completed in February 2019. INTERVENTIONS Patients were randomized 1:1 to a strategy of early intensive and sustained vasodilation throughout the hospitalization (n = 386) or usual care (n = 402). Early intensive and sustained vasodilation was a comprehensive pragmatic approach of maximal and sustained vasodilation combining individualized doses of sublingual and transdermal nitrates, low-dose oral hydralazine for 48 hours, and rapid up-titration of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or sacubitril-valsartan. MAIN OUTCOMES AND MEASURES The primary end pointwas a composite of all-cause mortality or rehospitalization for AHF at 180 days. RESULTS Among 788 patients randomized, 781 (99.1%; median age, 78 years; 36.9% women) completed the trial and were eligible for primary end point analysis. Follow-up at 180 days was completed for 779 patients (99.7%). The primary end point, a composite of all-cause mortality or rehospitalization for AHF at 180 days, occurred in 117 patients (30.6%) in the intervention group (including 55 deaths [14.4%]) and in 111 patients (27.8%) in the usual care group (including 61 deaths [15.3%]) (absolute difference for the primary end point, 2.8% [95% CI, -3.7% to 9.3%]; adjusted hazard ratio, 1.07 [95% CI, 0.83-1.39]; P =.59). The most common clinically significant adverse events with early intensive and sustained vasodilation vs usual care were hypokalemia (23% vs 25%), worsening renal function (21% vs 20%), headache (26% vs 10%), dizziness (15% vs 10%), and hypotension (8% vs 2%). CONCLUSIONS AND RELEVANCE Among patients with AHF, a strategy of early intensive and sustained vasodilation, compared with usual care, did not significantly improve a composite outcome of all-cause mortality and AHF rehospitalization at 180 days.
conferenceObject Preliminary Analysis of the Association Between Therapeutic-Dose Anticoagulation and Long Term Outcomes from the ACTIV-4a and ATTACC Multiplatform Adaptive Trial of Hospitalized Patients with COVID-19(2022) GREENSTEIN, Y. Y.; HUBEL, K.; VENUGOPAL, V.; LAI, Y.; BERGER, J. S.; CHANG, S. Y.; COLOVOS, C.; SHAH, F. A.; ISLAM, M.; CEJA, J. Jimenez; KHAN, M.; KORNBLITH, L. Z.; LAWLER, P. R.; GADDH, M.; MOISES, J.; GUERRERO, R. Morillo; NKEMDIRIM, W.; REYNOLDS, H. R.; AMIGO, J. Seijas; SOEIRO, A.; WAHID, L.; ZAHRA, A.; GOLIGHER, E. C.; ZARYCHANSKI, R.; CUSHMAN, M.; GONG, M. N.