Medicina de Emergências

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

 

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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

 

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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

 

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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

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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.

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Estudo randomizado | Estratégia ativa para o diagnóstico de embolia pulmonar não melhorou o desfecho em pacientes hospitalizados com exacerbação de DPOC.

8 Out, 2021 | 11:07h

Effect of a Pulmonary Embolism Diagnostic Strategy on Clinical Outcomes in Patients Hospitalized for COPD Exacerbation: A Randomized Clinical Trial – JAMA (gratuito por tempo limitado)

 

Comentário no Twitter

Among patients hospitalized for an exacerbation of #COPD, addition of an active diagnostic strategy for pulmonary embolism to usual care compared with usual care alone did not improve a composite set of health outcomes https://t.co/7mOi5lOBD8

— JAMA (@JAMA_current) October 5, 2021

 

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Estudo randomizado | Mais um estudo mostra que plasma convalescente não melhora os desfechos em pacientes criticamente doentes com Covid-19.

5 Out, 2021 | 11:32h

Effect of Convalescent Plasma on Organ Support–Free Days in Critically Ill Patients With COVID-19 A Randomized Clinical Trial – JAMA

Commentary: Convalescent plasma futile as treatment for critically ill COVID-19 patients, study finds – University of Pittsburgh

Conteúdos relacionados:

RCT: Convalescent plasma does not improve outcomes and may be harmful to hospitalized patients with COVID-19.

NIH study shows no significant benefit of convalescent plasma for COVID-19 outpatients with early symptoms.

M-A: Convalescent plasma is safe but does not improve outcomes in the treatment of COVID-19.

RECOVERY Trial: No benefit from convalescent plasma in patients admitted to hospital with COVID-19.

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[Comunicado de imprensa – ainda não publicado] Merck anuncia que o antiviral oral Molnupiravir reduziu o risco de internação ou morte em cerca de 50%, comparado ao placebo, em pacientes com COVID-19 leve ou moderada.

4 Out, 2021 | 10:38h

Merck and Ridgeback’s Investigational 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 in Positive Interim Analysis of Phase 3 Study

Comentários:

Expert reaction to interim analysis of oral antiviral molnupiravir – Science Media Centre

Merck’s antiviral pill reduces hospitalization of Covid patients, a possible game-changer for treatment – STAT

Covid antiviral pill can halve risk of hospitalization – BBC

Why Merck’s Covid-19 pill molnupiravir could be so important – Vox

‘Unquestionably a game changer!’ Antiviral pill cuts COVID-19 hospitalization risk – Researchers excited about Merck drug, but caution data are preliminary and price is high – Science

 

Comentários no Twitter

.@DrEricDing convinced many that stopping the #molnupiravir trial early for benefit was a good idea

But it was NOT

Large body of evidence suggests that stopping early for benefit biases the results: overestimates the benefits of the treatment #EBM https://t.co/b3tHEtliO0 https://t.co/LwuCgqcY0C pic.twitter.com/vyPWc0nd37

— Kari Tikkinen (@KariTikkinen) October 2, 2021

(fio – clique para saber mais)

💡BREAKING—New oral anti-viral drug *molnupiravir* cuts risk of #COVID19 hospitalization and death **in HALF** in a randomized trial. Results so astounding that the trial is being stopped early, and Merck plans to apply for emergency authorization ASAP. 🧵 https://t.co/g8JGNzvuRg pic.twitter.com/K1SwC3QFXS

— Eric Feigl-Ding (@DrEricDing) October 1, 2021

 

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Trombose e trombocitopenia imune induzidas por vacina: resumo da diretriz NICE.

4 Out, 2021 | 10:36h

Vaccine induced immune thrombocytopenia and thrombosis: summary of NICE guidance – The BMJ

Diretriz original: NICE COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis.

Conteúdos relacionados:

Clinical features of vaccine-induced immune thrombocytopenia and thrombosis.

Review: Clinical characteristics and pharmacological management of COVID-19 vaccine–induced immune thrombotic thrombocytopenia with cerebral venous sinus thrombosis.

Vaccine-induced immune thrombotic thrombocytopenia: what we know and do not know.

Very rare cases of thrombosis with thrombocytopenia syndrome (TTS) after AstraZeneca vaccine: a global safety database analysis – the estimated rate of TTS after the first dose was 8.1 per million vaccinees; after the second dose, the estimated rate was 2.3 per million vaccinees. (vários artigos e fontes sobre o tema)

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Triagem de terapia intensiva sob uma excepcional escassez de recursos.

4 Out, 2021 | 10:26h

Intensive care triage under exceptional resource scarcity – Swiss Medical Weekly

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