REMO HOLANDA DE MENDONCA FURTADO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
19 resultados
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conferenceObject EFFECT OF TICAGRELOR AND CLOPIDOGREL ON CORONARY MICROCIRCULATION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION(2019) SCANAVINI FILHO, Marco Antonio; BERWANGER, Otavio; MATHIAS JUNIOR, Wilson; AGUIAR, Miguel Osman; CHIANG, Hsu Po; BARACIOLI, Luciano Moreira; LIMA, Felipe Gallego; MENEZES, Fernando Reis; DALCOQUIO, Talia; FURTADO, Remo Holanda M.; LUCA, Fabio Augusto De; UEZATO, Delcio; RAMIRES, Jose Antonio Franchini; KALIL FILHO, Roberto; NICOLAU, Jose CarlosconferenceObject ACUTE CORONARY SYNDROMES IN THE VERY OLD: THERAPIES AND OUTCOME IN THE LONG-TERM FOLLOW-UP(2014) NICOLAU, Jose C.; FRANCI, Andre; BARBOSA, Carlos; BARACIOLI, Luciano; FURTADO, Remo; GIANNETTI, Natali; GIRALDEZ, Roberto; LIMA, Felipe; FRANKEN, Marcelo; RAMIRES, Jose; KALIL-FILHO, Roberto; FERRAZ, Thiago- Platelet function, coagulation and fibrinolysis in patients with previous coronary and cerebrovascular ischemic events(2019) BARBOSA, Carlos Jose Dornas Goncalves; BARREIROS, Renata de Souza; FRANCI, Andre; ARANTES, Flavia Bittar Brito; FURTADO, Remo Holanda de Mendonca; STRUNZ, Celia Maria Cassaro; ROCHA, Tania Rubia Flores da; BARACIOLI, Luciano Moreira; RAMIRES, Jose Antonio Franchini; KALIL-FILHO, Roberto; NICOLAU, Jose CarlosOBJECTIVES: Ischemic stroke (IS) or transient ischemic attack (TIA) history is present in 4-17% of patients with coronary artery disease (CAD). This subgroup of patients is at high risk for both ischemic and bleeding events. The aim of this study was to determine the role of platelet aggregability, coagulation and endogenous fibrinolysis in patients with CAD and previous IS or TIA. METHODS: A prospective case-control study that included 140 stable CAD patients divided into two groups: the CASE group (those with a previous IS/TIA, n=70) and the CONTROL group (those without a previous IS/TIA, n=70). Platelet aggregability (VerifyNow Aspirin (R) and VerifyNow P2Y12 (R)), coagulation (fibrinogen and thromboelastography by Reorox (R)) and endogenous fibrinolysis (D dimer and plasminogen activator inhibitor-1) were evaluated. RESULTS: Patients in the CASE group presented significantly higher systolic blood pressure levels (135.84 +/- 16.09 vs 123.68 +/- 16.11, p <0.01), significantly more previous CABG (25.71% vs 10%, p=0.015) and significantly higher calcium channel blocker usage (42.86% vs 24.29%, p=0.02) than those in the control group. In the adjusted models, low triglyceride values, low hemoglobin values and higher systolic blood pressure were significantly associated with previous IS/TIA (CASE group). Most importantly, platelet aggregability, coagulation and fibrinolysis tests were not independently associated with previous cerebrovascular ischemic events (CASE group). CONCLUSION: Platelet aggregability, coagulation and endogenous fibrinolysis showed similar results among CAD patients with and without previous IS/TIA. Therefore, it remains necessary to identify other targets to explain the higher bleeding risk presented by these patients.
conferenceObject Do women have worse response to P2Y12 antagonists than men after acute coronary syndrome?(2016) NICOLAU, J. C.; FERRARI, A. G.; DALCOQUIO, T.; FURTADO, R. H. M.; SCANAVINI, M. A.; NAKASHIMA, C. A. K.; ARANTES, F. B. B.; MENEZES, F. R.; LIMA, F. G.; BARACIOLI, L. M.; STRUNZ, C. M. C.; RAMIRES, J. A. F.; KALIL, R.- Drug Interaction Between Clopidogrel and Ranitidine or Omeprazole in Stable Coronary Artery Disease: A Double-Blind, Double Dummy, Randomized Study(2016) FURTADO, Remo Holanda de Mendonca; GIUGLIANO, Robert Patrick; STRUNZ, Celia Maria Cassaro; CAVALHEIRO FILHO, Cyrillo; RAMIRES, Jose Antonio Franchini; KALIL FILHO, Roberto; LEMOS NETO, Pedro Alves; PEREIRA, Alexandre Costa; ROCHA, Tania Rubia; FREIRE, Beatriz Tonon; D'AMICO, Elbio Antonio; NICOLAU, Jose CarlosBackground Proton-pump inhibitors (PPIs) are often prescribed to patients receiving dual antiplatelet therapy (DAPT). However, this class of medication, especially omeprazole, has been associated with a reduction in clopidogrel efficacy, leading many clinicians to substitute omeprazole with ranitidine. Objectives Our objective was to compare the antiplatelet effect of clopidogrel before and after the addition of omeprazole or ranitidine. Methods We measured platelet aggregability at baseline and after 1 week of clopidogrel 75 mg daily. Subjects were then randomized in a double-blinded, double-dummy fashion to omeprazole 20 mg twice daily (bid) or ranitidine 150 mg bid. We repeated aggregability tests after 1 additional week, using VerifyNow P2Y12 (TM) (Accumetrics; San Diego, CA, USA), depicting aggregability as percent inhibition of platelet aggregation (IPA). Results We enrolled 41 patients in the omeprazole group and 44 in the ranitidine group. IPA was significantly decreased after the addition of omeprazole to clopidogrel (from 26.3 +/- 32.9 to 17.4 +/- 33.1 %; p = 0.025), with no statistical significant changes observed in the ranitidine group (from 32.6 +/- 28.9 to 30.1 +/- 31.3 %; p = 0.310). The comparison of IPA in both groups at the end of the follow-up showed a trend toward significance (p = 0.07, 95 % confidence interval [CI] -1.19 to 26.59); after excluding homozygous patients for 2C19*2 genotype, the comparison of IPA between the groups reached statistical significance (32.7 +/- 30.8 vs. 17.7 +/- 33.4 %, respectively, for ranitidine and omeprazole groups; p = 0.04). Conclusions Unlike omeprazole, ranitidine did not influence platelet aggregability response to clopidogrel.
conferenceObject DO PATIENTS WITHOUT SIGNIFICANT CORONARY OBSTRUCTIONS HAVE BETTER OUTCOME IN THE LONG RUN POST-ACUTE MYOCARDIAL INFARCTION?(2014) NICOLAU, Jose C.; FRANKEN, Marcelo; FERRAZ, Thiago; BARACIOLI, Luciano; LIMA, Felipe Gallego; GIRALDEZ, Roberto; FURTADO, Remo; GIANNETTI, Natali; KALIL-FILHO, Roberto; RAMIRES, Jose- Influence of Direct Thrombin Inhibitor and Low Molecular Weight Heparin on Platelet Function in Patients with Coronary Artery Disease: A Prospective Interventional Trial(2020) ARANTES, Flavia B. B.; MENEZES, Fernando R.; FRANCI, Andre; BARBOSA, Carlos J. D. G.; DALCOQUIO, Talia F.; NAKASHIMA, Carlos A. K.; BARACIOLI, Luciano M.; FURTADO, Remo H. M.; NOMELINI, Quintiliano S. S.; RAMIRES, Jose A. F.; KALIL FILHO, Roberto; NICOLAU, Jose C.Introduction The interaction between anticoagulants and platelet function is complex. Previous publications showed mixed results regarding the role of heparins in platelet aggregation. On the other hand, the direct thrombin inhibitor (DTI) dabigatran might enhance the risk of myocardial infarction in patients with atrial fibrillation, which could be related to increased platelet aggregability. Methods This was a prospective, interventional study of patients with chronic coronary artery disease (CAD) taking low-dose aspirin. The objective of the current study was to compare the effects of dabigatran versus enoxaparin on platelet aggregability. Subjects initially were on orally administered dabigatran for 5 days followed by subcutaneously administered enoxaparin after a 30-day washout period. Platelet function was assessed at baseline and after each intervention by multiple electrode aggregometry (MEA-ASPI) (primary endpoint), serum thromboxane B2 (TXB2), VerifyNow Aspirin (TM), and coagulation tests (secondary endpoints). Results Compared to baseline MEA-ASPI values, dabigatran increased platelet aggregation while enoxaparin decreased platelet aggregation (+ 5 U +/- 24.1 vs - 6 U +/- 22.2, respectively, p = 0.012). The TXB2 assay showed the same pattern (+ 2 pg/ml for dabigatran vs - 13 pg/ml for enoxaparin, p = 0.011). None of the additional tests showed significant differences between the groups. Individually, compared to baseline TXB2 results, enoxaparin significantly decreased platelet activation [33 (16.5-95) pg/mL vs 20 (10-52) pg/mL, respectively, p = 0.026], but no significant differences were observed with dabigatran. Conclusions DTI and anti-Xa drugs exert opposite effects on platelet function. A significant decrease in platelet activation through COX1 (also known as prostaglandin G/H synthase 1) was observed with enoxaparin, but no significant differences in platelet function were observed with dabigatran.
conferenceObject THE ROLE OF ORAL BETA BLOCKER IN A REAL-WORLD POPULATION WITH NON-ST SEGMENT ELEVATION ACUTE CORONARY SYNDROMES(2017) NICOLAU, Jose C.; FERRARI, Aline; COELHO, Gabriela M. M.; NAKASHIMA, Carlos A. K.; LIMA, Viviane M.; DALCOQUIO, Talia; FURTADO, Remo; MENEZES, Fernando; RAMIRES, Jose; KALIL-FILHO, Roberto; BARACIOLI, LucianoconferenceObject Mean platelet volume and platelet reactivity in acute coronary syndromes: is there a correlation?(2016) NICOLAU, J. C.; DALCOQUIO, T. F.; FERRARI, A. G.; FURTADO, R. H. M.; NAKASHIMA, C. A. K.; SCANAVINI, M. A.; ARANTES, F. B. B.; MENEZES, F. R.; BARACIOLI, L. M.; RAMIRES, J. A. F.; STRUNZ, C. M. C.; KALIL, R.- Platelet Reactivity and Coagulation Markers in Patients with COVID-19(2021) BERTOLIN, Adriadne J.; DALCOQUIO, Talia F.; SALSOSO, Rocio; FURTADO, Remo H. de M.; KALIL-FILHO, Roberto; HAJJAR, Ludhmila A.; SICILIANO, Rinaldo F.; KALLAS, Esper G.; BARACIOLI, Luciano M.; LIMA, Felipe G.; GIRALDEZ, Roberto R.; CAVALHEIRO-FILHO, Cyrillo; VIEIRA, Alexandra; STRUNZ, Celia M. C.; GIUGLIANO, Robert P.; TANTRY, Udaya S.; GURBEL, Paul A.; NICOLAU, Jose C.Introdution COVID-19 is associated with an increased risk of thrombotic events. However, the contribution of platelet reactivity (PR) to the aetiology of the increased thrombotic risk associated with COVID-19 remains unclear. Our aim was to evaluate PR in stable patients diagnosed with COVID-19 and hospitalized with respiratory symptoms (mainly dyspnoea and dry cough), in comparison with a control group comprised of non-hospitalized healthy controls. Methods Observational, case control study that included patients with confirmed COVID-19 (COVID-19 group, n = 60) and healthy individuals matched by age and sex (control group, n = 60). Multiplate electrode aggregometry (MEA) tests were used to assess PR with adenosine diphosphate (MEA-ADP, low PR defined as < 53 AUC), arachidonic acid (MEA-ASPI, low PR < 86 AUC) and thrombin receptor-activating peptide 6 (MEA-TRAP, low PR < 97 AUC) in both groups. Results The rates of low PR with MEA-ADP were 27.5% in the COVID-19 group and 21.7% in the control group (OR = 1.60, p = 0.20); with MEA-ASPI, the rates were, respectively, 37.5% and 22.5% (OR = 3.67, p < 0.001); and with MEA-TRAP, the incidences were 48.5% and 18.8%, respectively (OR = 9.58, p < 0.001). Levels of d-dimer, fibrinogen, and plasminogen activator inhibitor 1 (PAI-1) were higher in the COVID-19 group in comparison with the control group (all p < 0.05). Thromboelastometry was utilized in a subgroup of patients and showed a hypercoagulable state in the COVID-19 group. Conclusion Patients hospitalized with non-severe COVID-19 had lower PR compared to healthy controls, despite having higher levels of d-dimer, fibrinogen, and PAI-1, and hypercoagulability by thromboelastometry.