FRANCISCA ALEXANDRA GAVILANES OLEAS
Projetos de Pesquisa
Unidades Organizacionais
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
6 resultados
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- Use of medical therapies before pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension patients with severe hemodynamic impairment(2020) CASTRO, Marcela Araujo; PILOTO, Bruna; FERNANDES, Caio Julio Cesar dos Santos; JARDIM, Carlos; SALIBE FILHO, William; OLEAS, Francisca Gavilanes; ALVES, Jose Leonidas; MORINAGA, Luciana Tamie Kato; HOETTE, Susana; TERRA FILHO, Mario; FREITAS FILHO, Orival; JATENE, Fabio Biscegli; SOUZA, RogerioChronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism, characterized by non-resolving fibro-thrombotic obstructions of large pulmonary arteries. Pulmonary endarterectomy (PEA) is the treatment of choice for the disease, significantly improving survival. Patients with worse hemodynamic profile have worse prognosis after surgery, raising the question of whether the use of medical therapy prior to surgery to optimize hemodynamics could improve outcomes. The aim of this study was to evaluate the role of medical therapy pre-PEA, according to the hemodynamic profile at the diagnosis. We retrospectively analyzed all patients submitted to PEA, from January 2013 to December 2017. Functional, clinical and hemodynamic data were collected to evaluate the main prognostic determinants. Patients were stratified according to the hemodynamic severity and use of targeted therapies prior to surgery. A total of 108 patients were included. Thirty-five patients (32,4%) used targeted therapy pre-PEA. The use of medical therapy delayed the surgical procedure by about 7 months. There was no difference in overall survival between patients that received targeted therapy and those treated only with supportive therapy (87.8% vs 80.3%, respectively, p = 0.426). Nevertheless, when analyzing the group of patients with severe hemodynamic impairment, defined by low cardiac output(< 3.7L/min) at baseline, patients treated with targeted therapies presented a significantly better one-year survival. In higher-risk CTEPH patients, characterized by the presence of low cardiac output, the use of targeted therapies prior to PEA was associated with better outcome, suggesting a potential role for pre-operative use of medical treatment in this particular subgroup.
- Reperfusion in acute pulmonary thromboembolism(2018) FERNANDES, Caio Julio Cesar dos Santos; JARDIM, Carlos Vianna Poyares; ALVES JR., Jose Leonidas; OLEAS, Francisca Alexandra Gavilanes; MORINAGA, Luciana Tamie Kato; SOUZA, Rogerio deAcute pulmonary thromboembolism (APTE) is a highly prevalent condition (104-183 cases per 100,000 person-years) and is potentially fatal. Approximately 20% of patients with APTE are hypotensive, being considered at high risk of death. In such patients, immediate lung reperfusion is necessary in order to reduce right ventricular afterload and to restore hemodynamic stability. To reduce pulmonary vascular resistance in APTE and, consequently, to improve right ventricular function, lung reperfusion strategies have been developed over time and widely studied in recent years. In this review, we focus on advances in the indication and use of systemic thrombolytic agents, as well as lung reperfusion via endovascular and classical surgical approaches, in APTE.
conferenceObject Survival In A Brazilian Cohort Of Incident Pah Patients(2014) ALVES, J. L.; SOUZA, R.; GAVILANES, F.; JARDIM, C.; FERNANDES, C.; MORINAGA, L.; HOETTE, S.- Effect of targeted therapies on survival of schistosomiasis associated pulmonary arterial hypertension(2017) PILOTO, Bruna Mamprim; CASTRO, Marcela Araujo; GAVILANES, Francisca; ALVES JR., Jose Leonidas; PRADA, Luis Felipe Lopes; MORINAGA, Luciana Tamie Kato; HOETTE, Susana; JARDIM, Carlos; FERNANDES, Caio Julio Cesar dos Santos; SOUZA, Rogerio
- Use of direct oral anticoagulants for chronic throm-boembolic pulmonary hypertension(2018) GAVILANES-OLEAS, Francisca Alexandra; ALVES-JR, Jose Leonidas; FERNANDES, Caio Julio Cesar; PRADA, Luis Felipe Lopes; SALIBE-FILHO, William; TERRA-FILHO, Mario; MORINAGA, Luciana; HOETTE, Susana; JARDIM, Carlos; SOUZA, RogerioOBJECTIVES: Chronic thromboembolic pulmonary hypertension is one of the most prevalent forms of pulmonary hypertension and is a major complication of acute pulmonary embolism. One mainstay of chronic thromboembolic pulmonary hypertension treatment is lifelong anticoagulation. The recent advent of direct oral anticoagulants for acute pulmonary embolism treatment has provided a viable and effective alternative for treating this condition. However, little is known about the efficacy of this new class of drugs for treating chronic thromboembolic pulmonary hypertension. We aimed to evaluate the safety and efficacy of direct oral anticoagulants in the treatment of chronic thromboembolic pulmonary hypertension. METHODS: A cohort of chronic thromboembolic pulmonary hypertension patients who initiated treatment with direct oral anticoagulants between June 2015 and November 2016 were enrolled in this study. RESULTS: Sixteen patients used rivaroxaban, three used dabigatran and one used apixaban for a mean follow-up of 20.9 months. The mean age was 51 years, and eighteen patients were classified as functional class Eight patients underwent a pulmonary endarterectomy and exhibited clinical, hemodynamic and functional improvement and currently continue to use direct oral anticoagulants. No episode of venous thromboembolism recurrence was identified during the follow-up period, but there was one episode of major bleeding after a traumatic fall. CONCLUSIONS: Although direct oral anticoagulants appear to be a safe and effective alternative for treating chronic thromboembolic pulmonary hypertension, larger studies are needed to support their routine use.
article Reflections on the use of thrombolytic agents in acute pulmonary embolism(2019) FERNANDES, Caio Julio Cesar dos Santos; JARDIM, Carlos Vianna Poyares; ALVES JR., Jose Leonidas; OLEAS, Francisca Alexandra Gavilanes; MORINAGA, Luciana Tamie Kato; SOUZA, Rogerio de