Impact of baseline hemorrhagic risk on the benefit of bivalirudin versus unfractionated heparin in patients treated with coronary angioplasty: A meta-regression analysis of randomized trials

BACKGROUND: Bivalirudin significantly reduces 30-day major and minor bleeding compared with unfractionated heparin (UFH), while resulting in similar or lower rates of ischemic events in both patients with stable and unstable coronary disease undergoing percutaneous coronary intervention. We performed a meta-analysis of randomized trials to evaluate the impact of bivalirudin compared with UFH, with or without glycoprotein IIb/IIIa receptor inhibitors (GPI), on the rates of mortality, myocardial infarction (MI), and major bleeding. METHODS: We searched electronic databases for randomized controlled trials with >100 patients comparing bivalirudin (+/-provisional GPI) with UFH with either routine or provisional GPI in patients undergoing percutaneous coronary intervention. The principal efficacy end points were mortality and MI within 30 day, whereas major bleeding was the principal safety end point. We assessed the benefit of bivalirudin for each efficacy end point relative to the baseline bleeding risk, using the control (UFH) major bleeding rate as proxy for that risk. RESULTS: A total of 12 randomized trials that enrolled 33,261 patients were included. Overall, there was no significant difference in mortality and MI between bivalirudin monotherapy and UFH (+/-GPI), whereas major bleeding was significantly lower with bivalirudin. Bivalirudin reduced major and minor bleeding across the entire bleeding risk spectrum. CONCLUSIONS: Bivalirudin significantly reduces major and minor bleeding regardless of the estimated baseline hemorrhagic risk

Características químicas de solo cultivado com soja e irrigado com água residuária da suinocultura Chemical characteristics of the soil cultivated with soybean and irrigated with swine wastewater

Neste trabalho se avaliou a distribuição "in situ" de fósforo (P), matéria orgânica (MO), potássio (K), cálcio (Ca), magnésio (Mg), capacidade de troca catiônica (T), alumínio (Al), soma de bases (S), saturação por bases (V) e do pH, em um solo cultivado com soja irrigada com água residuária proveniente da suinocultura (ARS), com níveis de concentração de 0, 25, 50 e 75%. Constituiu-se um esquema fatorial a partir dos quatros níveis de concentração da ARS, das profundidades de 20, 40 e 60 cm com cinco repetições. Os resultados encontrados demonstraram diferenças significativas apenas para P, K e T no perfil do solo. Para todas as características na profundidade de 60 cm, os respectivos níveis de concentração estiveram bastante próximos aos níveis iniciais, ou seja, antes da aplicação dos tratamentos.<br>In this work the distribution was evaluated "in situ" of phosphorus (P), organic matter (MO), potassium (K), calcium (Ca), magnesium (Mg), cation exchange capacity (CEC), aluminum (Al), sum of bases (S), base saturation (V) and pH of a soil cultivated with soybean and irrigated with swine wastewater in the 0, 25, 50 and 75% levels. The factorial scheme was constituted by the 20, 40 and 60 cm soil depths and four wastewater levels with five repetitions. The results showed that significant difference occurred only for P, K and CEC in the soil profile. However, in all parameters, the 60 cm soil depth showed that the concentrations levels are similar to before the aplication of treatments