Emergências e Terapia Intensiva

Estudo randomizado | Não há benefício da terapia antitrombótica (aspirina ou apixabam) para pacientes ambulatoriais com COVID-19 sintomática clinicamente estáveis.

13 Out, 2021 | 12:56h

Effect of Antithrombotic Therapy on Clinical Outcomes in Outpatients With Clinically Stable Symptomatic COVID-19: The ACTIV-4B Randomized Clinical Trial – JAMA

Editorial: Antithrombotic Therapy for Outpatients With COVID-19: Implications for Clinical Practice and Future Research – JAMA

 

Comentário no Twitter

Data do not support the use of aspirin or apixaban in the outpatient setting to reduce the major adverse cardiovascular or pulmonary consequences associated with symptomatic but clinically stable #SARSCoV2 infection https://t.co/SH6OefXOCj #COVID19

— JAMA (@JAMA_current) October 11, 2021

 

---

Teste do D-dímero para excluir embolia pulmonar tem utilidade clínica limitada em pacientes internados com COVID-19 – A maioria dos pacientes, com ou sem embolia pulmonar, apresenta níveis elevados.

13 Out, 2021 | 12:54h

D-Dimer Testing for the Exclusion of Pulmonary Embolism Among Hospitalized Patients With COVID-19 – JAMA Network Open

Comentário: D-Dimer Level Not Useful for Ruling Out PE in COVID-19 Patients – HealthDay

---

Como o antiviral molnupiravir disparou na corrida por um medicamento contra COVID.

13 Out, 2021 | 12:48h

How antiviral pill molnupiravir shot ahead in the COVID drug hunt – Nature

Conteúdos relacionados:

What we know — and don’t know — about Merck’s new Covid-19 pill.

[Press release – not published yet] Merck announces oral antiviral Molnupiravir reduced the risk of hospitalization or death by approximately 50 Percent compared to placebo for patients with mild or moderate COVID-19.

Merck’s Covid-19 pill is great news but may not be a game-changer.

Video | A Pill For COVID? A Doctor Explains Molnupiravir.

---

Estudo randomizado | Em pacientes com acidente vascular encefálico isquêmico e oclusão de grande vaso, a trombectomia combinada com aspiração de contato e retirada por stent (stent retriever) não foi melhor do que o stent retriever isolado.

13 Out, 2021 | 12:37h

Effect of Thrombectomy With Combined Contact Aspiration and Stent Retriever vs Stent Retriever Alone on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion: The ASTER2 Randomized Clinical Trial – JAMA (link para o resumo – $ para o texto completo)

Comentários:

Little Benefit From Adding Aspiration to Thrombectomy for Stroke – Medscape (necessário cadastro gratuito)

Combo Thrombectomy Approach No Better for Large Vessel Strokes – MedPage Today (necessário cadastro gratuito)

 

Comentário no Twitter

Clinical trial found the rate of near-total or total reperfusion at the end of the endovascular procedure was not significantly different for patients receiving thrombectomy with contact aspiration and stent retriever combined vs stent retriever alone https://t.co/SQTEnysFBG

— JAMA (@JAMA_current) September 28, 2021

 

---

Estudo randomizado por cluster | Intervenção de gestão de antibióticos reduziu, de modo seguro, o uso de antibióticos de amplo espectro em pacientes internados com pneumonia adquirida na comunidade moderadamente grave.

13 Out, 2021 | 12:28h

Narrow-spectrum antibiotics for community-acquired pneumonia in Dutch adults (CAP-PACT): a cross-sectional, stepped-wedge, cluster-randomised, non-inferiority, antimicrobial stewardship intervention trial – The Lancet Infectious Diseases (link para o resumo – $ para o texto completo)

---

Estudo randomizado | Dose terapêutica de heparina se mostrou superior à dose profilática ou à dose intermediária para tromboprofilaxia em pacientes de alto risco internados com COVID-19.

12 Out, 2021 | 11:22h

Efficacy and Safety of Therapeutic-Dose Heparin vs Standard Prophylactic or Intermediate-Dose Heparins for Thromboprophylaxis in High-risk Hospitalized Patients With COVID-19: The HEP-COVID Randomized Clinical Trial – JAMA Internal Medicine

Comentário convidado: Anticoagulant Therapy in Patients Hospitalized With COVID-19 – JAMA Internal Medicine

Estudos relacionados (alguns resultados conflitantes)

Another meta-analysis suggests standard-dose prophylactic anticoagulation is the best option for patients hospitalized with Covid-19.

M-A: Safety and efficacy of different prophylactic anticoagulation dosing regimens in critically and non-critically ill patients with COVID-19 – According to this analysis, standard-dose prophylactic anticoagulation should be the standard of care for hospitalized patients with COVID-19 who do not have an indication for therapeutic anticoagulation, irrespective of disease severity.

RCT: In noncritically ill patients hospitalized with Covid-19, therapeutic-dose anticoagulation with heparin increased the probability of survival to hospital discharge compared with usual-care thromboprophylaxis.

RCT: In critically ill patients with Covid-19, therapeutic anticoagulation with heparin did not result in improved outcomes compared to usual-care pharmacologic thromboprophylaxis.

RCT: In patients hospitalized with Covid-19 with elevated D-Dimer, a full-dose anticoagulation strategy based on rivaroxaban (full-dose heparins in unstable patients) + rivaroxaban to day 30 was not better than prophylactic anticoagulation and increased bleeding risk.

 

Comentário no Twitter

Thromboprophylaxis w therapeutic-dose LMWH reduced major thromboembolism and death by 32% compared with institutional standard heparin without increased major bleeding among #COVID19 inpatients with elevated D-dimers. The effect wasn't seen in ICU patients https://t.co/Wrgj2Ho5lv

— JAMA Internal Medicine (@JAMAInternalMed) October 7, 2021

 

---

Diretriz OMS | Detecção por antígeno no diagnóstico da infecção por SARS-CoV-2.

8 Out, 2021 | 12:33h

Antigen-detection in the diagnosis of SARS-CoV-2 infection – World Health Organization

Infográficos relacionados:

Use of antigen detection rapid diagnostic testing – World Health Organization

Diagnostic testing for SARS-CoV-2 infection – World Health Organization

 

Comentário no Twitter (fio – clique para saber mais)

Testing remains a critical component to the strategy to end the #COVID19 pandemic, and testing needs to be reliable, accessible, affordable, fast and linked to public health action.

So many around 🌍 have worked hard to increase testing capacities @WHOhttps://t.co/VDPdU0VK4g

— Maria Van Kerkhove (@mvankerkhove) October 7, 2021

 

---

Estudo mostra risco aumentado de síndrome de Guillain-Barré após vacina da J&J; a razão de taxas foi de 4,18 para uma janela de 42 dias.

8 Out, 2021 | 12:27h

Association of Receipt of the Ad26.COV2.S COVID-19 Vaccine With Presumptive Guillain-Barré Syndrome, February-July 2021 – JAMA

 

Comentário no Twitter

Study suggests a potential small but statistically significant safety concern for #GuillainBarré syndrome following receipt of the @JanssenUS #COVID19 vaccine; findings considered preliminary pending analysis of medical records to establish a definitive Dx https://t.co/yZjJVkp6BA

— JAMA (@JAMA_current) October 7, 2021

 

---

Estudo randomizado | Drenagem imediata não melhora os desfechos em comparação à intervenção tardia em pacientes com pancreatite necrotizante infectada.

8 Out, 2021 | 11:52h

Immediate versus Postponed Intervention for Infected Necrotizing Pancreatitis – New England Journal of Medicine

---

O que se sabe – e o que não se sabe – sobre a nova pílula da Merck para Covid-19.

8 Out, 2021 | 11:23h

What we know — and don’t know — about Merck’s new Covid-19 pill – STAT

Conteúdos relacionados:

[Press release – not published yet] Merck announces oral antiviral Molnupiravir reduced the risk of hospitalization or death by approximately 50 Percent compared to placebo for patients with mild or moderate COVID-19.

Merck’s Covid-19 pill is great news but may not be a game-changer.

Video | A Pill For COVID? A Doctor Explains Molnupiravir.

---