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Dott. Marco Piccininno S.C. Cardiologia Ospedale Galliera, Genova. METABOLISMO. Rapido assorbimento. pro-farmaco. Non importanti interferenze con il cibo Concentrazioni plasmatiche stabili entro 3 giorni dall’inizio della terapia

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dott marco piccininno s c cardiologia ospedale galliera genova
Dott. Marco Piccininno

S.C. Cardiologia

Ospedale Galliera, Genova

slide5

METABOLISMO

Rapido

assorbimento

pro-farmaco

Non importanti interferenze con il cibo

Concentrazioni plasmatiche stabili entro 3 giorni dall’inizio della terapia

Farmacocinetica prevedibile (minima variabilità interindividuale)

rely results
RELY: results

-Dab 110 non inferior to Warfarin SSE prevention

-Dab 150 superior to Warfarin SSE prevention (-34%)

-Dab 150 reduced ischemic stroke(-25%)and CV death(-15%)

- Both doses reduced hemorragic stroke (-74% e – 69%)

-Dab 110 caused less major bleeding(-20%)

-No significant difference in CV and all-cause mortality

between the 2 doses of Dab

SSE= stroke & sistemic embolism

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PAZIENTE RELY

60%

40%

Follow-up visit

2 SETTIMANE

1 MESE

3 MESI

6 MESI

9 MESI

12 MESI

16 MESI

20 MESI

24 MESI

83 kg

Cl creat 69 ml/min

CC

71aa

> 85 aa = 4 %

Iperteso(80%) controllato (130/77, 60% βblock, 65% ACE/ARB, 45% stat.)

1/7 pregr. stroke (1/5 stroke+TIA), 1/6 pregr. IM, 1/4 DM, 1/3 HF

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Source of bleeding

Time of the last dose

Measure aPTT/TT

Measure creat/ cl.cr

Wait at least 30’ to assess the effect

aPTT and/or TT every 3 h

MODERATE-SEVERE BLEEDING: reduction in hemoglobin > 2 g/dl, trasfusion of > 2 U red cells, symptomatic bleeding in critical area (intraocular, intraspiinal, intramuscolar with compartimen syndrome, retroperitoneal, intraarticular, pericardial).

LIFE THREATENING BLEEDING: symptomatic intracranial bleeding, reduction in hemoglobin > 5 g/dl, trasfusion of > 4 U red cells, hypotension requiring inotropic agents, or bleeding requiring surgical interventions.