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Uso de estatina reduz tromboembolismo venoso?

SBPT II CURSO NACIONAL DE CIRCULAÇÃO PULMONAR. Uso de estatina reduz tromboembolismo venoso?. Daniel Waetge UFRJ. Estatinas = Inibidores da HMG-CoA redutase. Estatinas e síntese de colesterol. Acetil-CoA. Estatina. HMG-CoA. HMG-CoA Redutase. Mevalonato. Colesterol.

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Uso de estatina reduz tromboembolismo venoso?

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  1. SBPT II CURSO NACIONAL DE CIRCULAÇÃO PULMONAR Uso de estatina reduz tromboembolismo venoso? Daniel Waetge UFRJ

  2. Estatinas = Inibidores da HMG-CoA redutase • Estatinas e síntese de colesterol

  3. Acetil-CoA Estatina HMG-CoA HMG-CoA Redutase Mevalonato Colesterol

  4. Estatinas = Inibidores da HMG-CoA redutase • Estatinas e síntese de colesterol • Efeitos colesterol-indenpendentes • Aumentodadisponibilidade do óxidonítrico • Estabilizaçãodaplacaateroesclerótica • Reduçãodarespostainflamatória • Propriedades antitrombóticas • Regulaçãodaangiogenese • Disfunçãoendotelial StainsandBloodCoagulation. ArteriosclerThrombVasc Biol. 2005;25:287 Pleiotropiceffectsofstatins.ArteriosclerThrombVasc Biol. 2001;21:1712 Antiatherothrombotic properties of statins. Implications for cardiovascular event reduction. JAMA. 1998;279:1643 Newnonlipideffects of statins and their clinical relevance in cardiovascular disease. ThrombHaemost. 2004;91:1065

  5. Effect of statins on a wide range of health outcomes: a cohort study validated by comparison with randomized trials Br J Clin Pharmacol 67:1 99–109 2008

  6. Ação das estatinas em diversas doenças • Infecções: Pandemic influenza: a potential role for statins in treatment and prophylaxis. Clin Infect Dis 2006; 43: 199–205 • Sepse: US Pharm. 2008;33(2):HS-3-HS-15 • Câncer: Statins and risk of cancer: a systematic review and metaanalysis. Int J Cancer 2007; 120:833.Should we lower cholesterol as much as possible? BMJ 2006; 332: 1330–2 • Demência: Statins and the risk of dementia. Lancet 2000; 356: 1627–31 • Fraturas: Statinas and the risk of hip fractures in elderly patients. JAMA 2000; 283:3211 • Olhos: Cataract and the use of statins: a case–control study. QJM 2003; 96:337. A case-control study of age related macular degeneration and use of statins. Br J Ophth 2005; 89: 1171 • Neurológico: Statins, neuromuscular degenerative disease and an ALS-like syndrome: an analysis of individual case safety reports from vigibase. Drug Saf 2007; 30:515 • Doenças imunológicas: Statins as antiinflammatory and immunomodulatory agents: a future in rheumatologic therapy? Arthritis Rheum 2006; 54: 393–407

  7. Coagulaçãosanguínea: reaçõesmodificadaspelasestatinas Undas, A. Arterioscler Thromb Vasc Biol 2005;25:287-294

  8. Coagulaçãosanguínea: reaçõesmodificadaspelasestatinas BIOCHEMISTRY 2002 (67) 1

  9. Estudos iniciais que procuravam estabelecer a relação entre estatinas e prevenção de TEV • The anti-thrombotic effects of statins. JACC 1999;33:1305-1307. Kearney D. • Heart and Estrogen/Progestin Replacement Study. Postmenopausal hormone therapy increases risk for VTE disease. Ann Intern Med 2000;132:689-696. Grady D. • Use of Statins and the Subsequent Development of Deep Vein Thrombosis Arch Intern Med. 2001;161:1405-1410 • …

  10. Rate of deep vein thrombosis (DVT) among men and women according to agent RR 22% de redução da TVP Ray, J. G. et al. Arch Intern Med 2001;161:1405-1410.

  11. Justification of the Use of Statins in Primary Prevention: an Intervention Trial Using Rosuvastatin (JUPITER) • 20 mg de rosuvastatina diária comparada com placebo: • Reduziria a frequência de eventos cardiovasculares “major” • Reduziria a ocorrência de TEV (“end-point” secundário) NEJM 2008 e NEJM 2009

  12. Volume 359(21), 20 Nov 2008, p 2195–2207

  13. Volume 360(18), 30 April 2009, p 1851–1861

  14. 0,67% 0,38% A Randomized Trial of Rosuvastatin in the Prevention of VTE. NEJM 2009 360(18)1851

  15. 26 pcts(0,29 %) 0,67% 0,38% NNT = 344 A Randomized Trial of Rosuvastatin in the Prevention of VTE. NEJM 2009 360(18)1851

  16. Incidência cumulativa de TEV A Randomized Trial of Rosuvastatin in the Prevention of VTE. NEJM 2009 360(18)1851

  17. A new indication for statins to prevent venous thromboembolism? Not yet. Cushman M. J Thromb Haemost 2009; 7: 511–3.

  18. Uso profilático de estatinas • Sub grupos onde a doença tem maior incidência seriam mais beneficiados? • Profilaxia primária: • câncer, cirurgia de alto risco, HAP, obesidade, idosos, síndrome antifosfolipídico... • Profilaxia secundária?

  19. Uso de estatina reduz tromboembolismo venoso?

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