Rivaroxaban to prevent major clinical outcomes in non-hospitalised patients with COVID-19 : the CARE – COALITION VIII randomised clinical trial

Background: COVID-19 progression is associated with an increased risk of arterial and venous thrombosis. Randomised trials have demonstrated that anticoagulants reduce the risk of thromboembolism in hospitalised patients with COVID-19, but a benefit of routine anticoagulation has not been demonstrated in the outpatient setting. Methods: We conducted a randomised, open-label, controlled, multicentre study, evaluating the use of rivaroxaban in mild or moderate COVID-19 patients. Adults ≥18 years old, with probable or confirmed SARS-CoV-2 infection, presenting within ≤7 days from symptom onset with no clear indication for hospitalization, plus at least 2 risk factors for complication, were randomised 1:1 either to rivaroxaban 10 mg OD for 14 days or to routine care. The primary efficacy endpoint was the composite of venous thromboembolic events, need of mechanical ventilation, acute myocardial infarction, stroke, acute limb ischemia, or death due to COVID-19 during the first 30 days. ClinicalTrials.gov: NCT04757857. Findings: Enrollment was prematurely stopped due to sustained reduction in new COVID-19 cases. From September 29th, 2020, through May 23rd, 2022, 660 patients were randomised (median age 61 [Q1-Q3 47–69], 55.7% women). There was no significant difference between rivaroxaban and control in the primary efficacy endpoint (4.3% [14/327] vs 5.8% [19/330], RR 0.74; 95% CI: 0.38–1.46). There was no major bleeding in the control group and 1 in the rivaroxaban group. Interpretation: On light of these findings no decision can be made about the utility of rivaroxaban to improve outcomes in outpatients with COVID-19. Metanalyses data provide no evidence of a benefit of anticoagulant prophylaxis in outpatients with COVID-19. These findings were the result of an underpowered study, therefore should be interpreted with caution

South american guidelines for cardiovascular disease prevention and rehabilitation

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Anestesiologia baseada em evidências: o que é e como praticar

JUSTIFICATIVA E OBJETIVOS: Os princípios da Medicina baseada em evidências têm sido aplicados à Anestesiologia. A proposta dessa revisão é abordar os fundamentos para a prática da Medicina baseada em evidências e fornecer exemplos de como esses princípios podem ser incorporados à prática diária. Até o momento da conclusão desse artigo, não foi encontrado nenhum trabalho sobre Anestesiologia baseada em evidências na literatura médica brasileira, o que determinou a sua realização. CONTEÚDO: Este artigo consiste de revisão que aborda um novo paradigma da Medicina e como ele pode ser aplicado à Anestesiologia. CONCLUSÕES: A Anestesiologia baseada em evidências constitui a integração da melhor evidência científica disponível à experiência clínica do anestesiologista e às expectativas do paciente, visando à melhoria do cuidado com ele

Incidence and risk factors of aplastic anemia in Latin American countries: the LATIN case-control study

Associations between aplastic anemia and numerous drugs, pesticides and chemicals have been reported. This study conducted in Latin American countries shows a low incidence of aplastic anemia in this region of the world. Frequent exposure to benzene-based products increases this risk, while any association with specific drugs is uncertain

V diretriz da Sociedade Brasileira de Cardiologia sobre tratamento do infarto agudo do miocárdio com supradesnível do segmento ST

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V diretriz da Sociedade Brasileira de Cardiologia sobre tratamento do infarto agudo do miocárdio com supradesnível do segmento ST

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