Nuevas estrategias terapéuticas para la prevención del ictus en pacientes con fibrilación auricular: perspectiva desde atención primaria

Llisterri Caro, J.L.; Polo García, J.; Martí Canales, J.C.; Barrios Alonso, V.

Publicado en Semergen.2011; 37 :352-9 - vol.37 núm 07

Leer en: English

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Resumen

Resumen

La fibrilación auricular (FA) es la arritmia sostenida más frecuente, la que produce mayor número de ingresos hospitalarios y la principal causa de ictus de origen cardioembólico. Según recomiendan las guías de práctica clínica la estrategia terapéutica en la FA tiene como objetivos prioritarios, y no excluyentes, la corrección del trastorno del ritmo con reversión a ritmo sinusal, el control de la frecuencia cardiaca y la prevención de la tromboembolia. El tratamiento anticoagulante oral con warfarina o acenocumarol constituye la piedra angular para prevenir el ictus en pacientes con FA y ha sido el tratamiento de referencia durante más de medio siglo. Su uso en la práctica clínica, aunque está ampliamente reconocido, precisa una monitorización regular para mantener la dosis correcta, lo cual dificulta su aceptación por parte de pacientes y médicos. Los nuevos antitrombóticos orales sintéticos suponen un avance importante en la prevención del ictus y embolia sistémica de los pacientes con FA. Alguno de ellos, como es el caso de dabigatran, ha sido recientemente aprobado en EE.UU. y Canadá en la indicación de prevención de complicaciones tromboembólicas arteriales en pacientes con FA. Si se aprueba esta indicación en nuestro país, como es de esperar, el protagonismo del Sintrom^® no durará mucho tiempo.

Palabras clave Ictus. Fibrilación auricular. Anticoagulantes. Atención primaria.

Revisión de citomegalovirus

 infección por CMV y enfermedad en recién nacidos, infantes, niños y adolescentes uptodate 19.1.pdf

 Diagnóstico de citomegalovirus uptodate 19.1.pdf

 epidemiología, manifestaciones, y tratamiento de infeccion por CMV en inmunocompetentes uptodate 19.1.pdf

Book review

On the Cover of Sunday's Book Review 'That Used to Be Us' By THOMAS L. FRIEDMAN AND MICHAEL MANDELBAUM Reviewed by DAVID FRUM Stepping forward as "frustrated optimists," Thomas L. Friedman and Michael Mandelbaum address the grim situation of a slumping American economy. ADVERTISEMENT Also in the Book Review 'Arguably: Essays' By CHRISTOPHER HITCHENS Reviewed by BILL KELLER Christopher Hitchens's latest essays bear "the full consciousness that they might be my very last." 'The Art of Fielding' By CHAD HARBACH Reviewed by GREGORY COWLES This first novel revolves around a gifted but vulnerable ballplayer.  Excerpt: The Art of Fielding Arab Springs 'Anatomy Of a Disappearance' By HISHAM MATAR Reviewed by ROBERT F. WORTH In the Libyan writer Hisham Matar's second novel, the protagonist's father, an exiled dissident, is kidnapped.  Up Front: Robert F. Worth  Excerpt: 'Anatomy of a Disappearance' 'Rock The Casbah ' By ROBIN WRIGHT Reviewed by MOHAMAD BAZZI Robin Wright contends that the Arab world's young people are at the vanguard of a sweeping and seductive cultural revolution.  Excerpt: 'Rock the Casbah' 'The Missing Martyrs' By CHARLES KURZMAN Reviewed by BERNARD HAYKEL A decade after 9/11, a sociologist says the mystery isn't why so many Muslims turn to terrorism, but why so few. 'Literary Brooklyn' By EVAN HUGHES Reviewed by SHARIFA RHODES-PITTS Starting with Walt Whitman, writers have flocked to Brooklyn. 'Crossbones' By NURUDDIN FARAH Reviewed by HIRSH SAWHNEY Nuruddin Farah's novel offers a close look at Somalia, and its pirates. 'Jane Fonda: The Private Life of a Public Woman' By PATRICIA BOSWORTH Reviewed by VANESSA GRIGORIADIS Actor, sex kitten, political activist, exercise guru, philanthropist: Jane Fonda is constantly evolving.  Excerpt: 'Jane Fonda: The Private Life of a Public Woman' 'Birds of Paradise' By DIANA ABU-JABER Reviewed by CRISTINA GARCÍA Diana Abu-Jaber's novel presents the lushness of Miami, and a teenager lost in it. 'Holy War' By NIGEL CLIFF Reviewed by ERIC ORMSBY Vasco da Gama hoped to recruit Indian Christians against Islam. 'The Arrogant Years' By LUCETTE LAGNADO Reviewed by DEB OLIN UNFERTH Lucette Lagnado's tenacious mother is at the heart of this memoir, a follow-up to "The Man in the White Sharkskin Suit."  Excerpt: 'The Arrogant Years' 'The Neighborhood Project' By DAVID SLOAN WILSON Reviewed by JERRY A. COYNE David Sloan Wilson wants to apply the principles of evolutionary biology to solve everyday community problems. 'The Girl In the Polka-Dot Dress' By BERYL BAINBRIDGE Reviewed by WILLIAM BOYD Robert Kennedy's assassination and a 20-something Englishwoman come together in Beryl Bainbridge's posthumous novel.

Fármacos adyuvantes por vía neuroaxial

Fármacos adyuvantes por vía neuroaxial Dr. José Emilio Mille-Loera, Dr. Alfonso Ramírez-Guerrero, Dr. Guillermo Aréchiga-Ornelas Subdirector de Servicios Médicos. Instituto Nacional de Cancerología, México. Anestesiólogo Hospital Médica Sur, México. Jefe de la Unidad de Dolor Perioperatorio. Departamento de Anestesiología, Hospital General de Occidente, Guadalajara, Jal. Revista Mexicana de Anestesiología Vol. 33. Supl. 1, Abril-Junio 2010 INTRODUCCIÓN Los analgésicos opioides han sido reconocidos durante mucho tiempo, como el tratamiento más efectivo para el dolor. En el siglo 17, Thomas Sydenham (Médico Inglés) escribió: «Acerca de los remedios con los que Dios otorgó al hombre para aliviar su sufrimiento, ninguno es tan universal y tan eficaz como el opio». Pese a su gran capacidad para aliviar el dolor, los opioides tienen un importante número de efectos colaterales desagradables, como las náuseas, vómito, prurito, tolerancia, retención urinaria y depresión respiratoria. Durante cientos de años, estos medicamentos fueron usados sin conocer su mecanismo de acción. No fue sino hasta 1971 cuando se conocieron los primeros receptores específicos en el cerebro y la médula espinal.  http://www.medigraphic.com/pdfs/rma/cma-2010/cmas101e.pdf

Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

En este día...

ON THIS DAY

On This Day: September 10

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On Sept. 10, 1919, New York City welcomed home Gen. John J. Pershing and 25,000 soldiers who had served in the United States 1st Division during World War I.

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On Sept. 10, 1934, Roger Maris, the professional baseball player who held the record for home runs in a single season from 1961 to 1998, was born. Following his death on Dec. 14, 1985, his obituary appeared in The Times.

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On This Date

1608	John Smith was elected president of the Jamestown colony council in Virginia.
1813	Oliver H. Perry sent the message, "We have met the enemy, and they are ours," after an American naval force defeated the British in the Battle of Lake Erie in the War of 1812.
1846	Elias Howe of Spencer, Mass., received a patent for the sewing machine.
1919	New York City welcomed home Gen. John J. Pershing and 25,000 soldiers who had served in the U.S. 1st Division during World War I.
1924	A judge in Chicago sentenced Nathan Leopold Jr. and Richard Loeb to life in prison for the murder of 14-year-old Bobby Franks - a "thrill killing" that had shocked the nation.
1935	Sen. Huey P. Long, the "Kingfish" of Louisiana politics, died two days after being shot in Baton Rouge.
1948	American-born Mildred Gillars, the Nazi wartime radio broadcaster known as "Axis Sally," was indicted in Washington, D.C., for treason.
1955	"Gunsmoke" premiered on CBS.
1963	Twenty black students entered public schools in Birmingham, Tuskegee and Mobile, Ala., following a standoff between federal authorities and Gov. George C. Wallace.
1977	A convicted murderer became the last person to be executed by the guillotine in France.
1988	Steffi Graf of West Germany achieved tennis' Grand Slam - winning all four major tournaments in a calendar year - by taking the U.S. Open women's title.
2000	The Andrew Lloyd Webber musical "Cats" closed after 7,485 performances over nearly 18 years as the longest-running show in Broadway history.
2000	NBC's "The West Wing" won a record nine Emmy awards, including best drama series.
2002	Switzerland became the 190th member of the United Nations.
2003	Swedish Foreign Minister Anna Lindh, 46, was stabbed in a Stockholm department store; she died the next day.

Current Birthdays

Actor Colin Firth turns 51 years old today.

AP Photo/Mark J. Terrill

Actor Ryan Phillippe turns 37 years old today.

AP Photo/Peter Kramer

1929	Arnold Palmer, Golfer, turns 82
1931	Philip Baker Hall, Actor, turns 80
1945	Jose Feliciano, Singer, turns 66
1948	Bob Lanier, Basketball Hall of Famer, turns 63
1950	Joe Perry, Rock musician (Aerosmith), turns 61
1953	Amy Irving, Actress, turns 58
1957	Kate Burton, Actress, turns 54
1960	David Lowery, Rock singer, musician, turns 51
1963	Randy Johnson, Baseball player, turns 48
1963	Sean O'Bryan, Actor, turns 48
1964	John E. Sununu, Former U.S. senator, R-N.H., turns 47
1968	Big Daddy Kane, Rapper, turns 43
1968	Guy Ritchie, Director, turns 43
1976	Gustavo Kuerten, Tennis player, turns 35
1980	Mikey Way, Rock musician (My Chemical Romance), turns 31
1984	Matthew Followill, Rock musician (Kings of Leon), turns 27
1974	Sanjaya Malakar, Singer ("American Idol"), turns 37

Historic Birthdays

Roger Maris9/10/1934 - 12/14/1985American professional baseball player.Go to obituary »

?	Alonso Perez Medina-Sidonia 9/10/1550 - ?/?/1619 Spanish naval commander
83	Sir John Soane 9/10/1753 - 1/20/1837 English Neoclassical architect
74	William Torrey Harris 9/10/1835 - 11/5/1909 American public school educator and philosopher
92	John Lynch 9/10/1847 - 11/2/1939 American politician; served in Mississippi legislature and U.S. Congress during Reconstruction
64	Carl Van Doren 9/10/1885 - 7/18/1950 American novelist, biographer and critic
54	Franz Werfel 9/10/1890 - 8/26/1945 German Expressionist poet, playwright and novelist
83	Elsa Schiaparelli 9/10/1890 - 11/13/1973 Italian-born French dress designer
69	Arthur Holly Compton 9/10/1892 - 3/15/1962 American Nobel Prize-winning physicist (1927)
71	Cyril Connolly 9/10/1903 - 11/26/1974 English critic, novelist and founder of Horizon magazine