TANIA RUBIA FLORES DA ROCHA

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina

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Agora exibindo 1 - 10 de 22
  • conferenceObject
    ACUTE KIDNEY INJURY ASSOCIATED TO INCREASED PLATELET ADHESION AND AGGREGATION IN CRITICALLY ILL CANCER PATIENTS
    (2015) HUNG, James; ROCHA, Tania R. Flores da; D'AMICO, Elbio A.; YU, Luis
  • bookPart
    Diagnóstico laboratorial das alterações da hemostasia
    (2016) ROCHA, Tania Rubia Flores da; D'AMICO, Elbio Antonio; CHAMONE, Dalton de Alencar Fischer
  • conferenceObject
    Endogenous Heparinoid Effects during Bacterial Infections in Patients with Cirrhosis Do Not Impair Thombin Generation: A Prospective Study
    (2018) MOTTA, Marina; ROCHA, Tania Rubia Flores; MIGITA, Beatriz Yuri; BATISTA, Juliana Medeiros; D'AMICO, Elbio Antonio; D'ALBUQUERQUE, Lutz Augusto Cameiro; CARRILHO, Flair Jose; FARIAS, Alberto Q.
  • article 3 Citação(ões) na Scopus
    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 Carlos
    OBJECTIVES: 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.
  • article 19 Citação(ões) na Scopus
    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 Carlos
    Background 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
    FRESH FROZEN PLASMA TRANSFUSION IN PATIENTS WITH CIRRHOSIS AND COAGULOPATHY: EFFECT ON CONVENTIONAL COAGULATION TESTS AND THROMBOMODULIN-MODIFIED THROMBIN GENERATION
    (2019) RASSI, Amanda Bruder; D'AMICO, Elbio Antonio; TRIPODI, Armando; ROCHA, Tania Rubia Flores; MIGITA, Beatriz; FERREIRA, Caroline Marcondes; CARRILHO, Flair Jose; FARIAS, Alberto Q.
  • article 0 Citação(ões) na Scopus
    Preservation of platelet function in patients with cirrhosis and thrombocytopenia undergoing esophageal variceal ligation
    (2020) SOUZA, Evandro de Oliveira; D'AMICO, Elbio Antonio; ROCHA, Tania Rubia Flores da; FERREIRA, Caroline Marcondes; BATISTA, Juliana Medeiros; D'ALBUQUERQUE, Luiz Augusto Carneiro; CARRILHO, Flair Jose; FARIAS, Alberto Queiroz
    Background: Thrombocytopenia is a possible risk factor for bleeding after band ligation of esophageal varices. However, elevated von Willebrand factor (VWF) in cirrhosis improves platelet function and could decrease this risk. Our objective was to assess platelet function in patients with cirrhosis undergoing esophageal variceal ligation (EVL). Methods: The assessment consisted of platelet count, antigen and activity of VWF and VWF-cleaving protease ADAMTS-13 activity, and a platelet adhesion and aggregation test simulating vascular flow in vivo (Impact-R (R)) prior to EVL. Results: Totally 111 patients were divided into three groups according to platelet count: (1) < 50 x 10(9)/L (n = 38, 34.2%); (2) 50 x 10(9)/L to 100 x 10(9)/L (n = 47, 42.3%); and (3) > 100 x 10(9) /L (n = 26, 23.4%). No statistically significant difference was found in the aggregate size of platelets [group 1: 41.0 (31.8-67.3) mu m(2); group 2: 47.0 (33.8-71.3) mu m(2); and group 3: 47.0 (34.0-66.0) mu m(2); P = 0.60] and no significant correlation was found between aggregate size and platelet count (Spearman r = 0.07; P = 0.47). Surface coverage was 4.1% (2.8%-6.7%), 8.5% (4.0%-10.0%), and 9.0% (7.1%-12.0%) (P < 0.001) in groups 1, 2 and 3, respectively and correlated with platelet count (Spearman r = 0.39; P < 0.0001). There was no significant difference between groups in VWF or ADAMTS-13. Post-EVL bleeding occurred in six (5.4%) patients (n = 2 in group 1, n = 1 in group 2, and n = 3 in group 3; P = 0.32). Patients with bleeding had higher MELD scores [15.0 (11.3-20.3) versus 12.0 (10.0-15.0); P = 0.025], but no difference was demonstrated for platelet function parameters. Conclusion: Platelet function is preserved even in the presence of thrombocytopenia, including in the patients with post-EVL bleeding.
  • conferenceObject
    Fresh Frozen Plasma Transfusion Ameliorates INR and aPTT but Does Not Increase Thrombomodulin-Corrected Thrombin Generation in Patients with Cirrhosis
    (2016) RASSI, Amanda Bruder; ROCHA, Tania R. F. R.; FARIAS, Alberto Q.; MARIANO, Livia Caroline Barbosa; D'AMICO, Elbio Antonio
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    Preservation of Thrombin Generation in Cirrhosis Despite Abnormal Results of INR/ Prothrombin Time: Implication for Invasive Procedures
    (2018) FARIAS, Alberto Q.; FERREIRA, Caroline Marcondes; D'AMICO, Elbio Antonio; SOUZA, Evandro Oliveira; BATISTA, Juliana Medeiros; ROCHA, Tania Rubia Flores; CARRILHO, Flair Jose
  • article 65 Citação(ões) na Scopus
    Fresh frozen plasma transfusion in patients with cirrhosis and coagulopathy: Effect on conventional coagulation tests and thrombomodulin-modified thrombin generation
    (2020) RASSI, Amanda Bruder; D'AMICO, Elbio Antonio; TRIPODI, Armando; ROCHA, Tania Rubia Flores da; MIGITA, Beatriz Yuri; FERREIRA, Caroline Marcondes; CARRILHO, Flair Jose; FARIAS, Alberto Queiroz
    Background & Aims: The efficacy of fresh frozen plasma (FFP) transfusion in enhancing thrombin generation in patients with cirrhosis and impaired conventional coagulation tests has not been sufficiently explored. Thus, we aimed to assess the effect of FFP transfusion on thrombin generation in these patients. Methods: Fifty-three consecutive patients receiving a standard dose of FFP to treat bleeding and/or before invasive procedures - if international normalized ratio (INR)/prothrombin time (PT) ratio were >= 1.5 - were prospectively enrolled. The primary endpoint was the amelioration of endogenous thrombin potential (ETP) with thrombomodulin (ETP-TM) after transfusion, which corresponds to the total amount of generated thrombin. INR/PT ratio and activated partial thromboplastin time (aPTT) were also assessed before and after transfusion. Results: FFP enhanced ETP-TM by 5.7%, from 973 (731-1,258) to 1,028 (885-1,343 nM x min; p = 0.019). Before transfusion, evidence of normal or high ETP-TM was found in 94% of patients, even in those with bacterial infections. Only 1 (1.9%) patient had ETP-TM values reverting to the normal range after transfusion. Notably, no patients with low ETP-TM had bleeding. The median decrease in ETP-TM was 8.3% and the mean was 12.8% in 18 (34%) patients after transfusion (from 1,225 [1,071-1,537] to 1,124 [812-1,370] nM x min; p <= 0.0001). Similar responses to FFP transfusion were observed in patients with compensated and acute decompensated cirrhosis, acute-on-chronic liver failure, infection or shock. FFP significantly ameliorated INR and aPTT values (p <0.0001), but in a minority of patients the values were reduced to less than the cut-off point of 1.5. Conclusions: FFP transfusion enhanced thrombin generation and ameliorated conventional coagulation tests to normal values in a limited number of patients, and slightly decreased thrombin generation in 34% of cases. Lay summary: Transfusion of fresh frozen plasma in patients with cirrhosis only slightly improves coagulation test values in a limited number of patients and even appears to worsen them in a third of cases. Transfusion for the purpose of preventing or treating bleeding events could cause inherent risks and costs without clear benefits. (C) 2019 Published by Elsevier B.V. on behalf of European Association for the Study of the Liver.