Systematic review of randomized controlled trials of new anticoagulants for venous thromboembolism prophylaxis in major orthopedic surgeries, compared with enoxaparin

Background: In the past 10 years, new anticoagulants (NACs) have been studied for venous thromboembolism (VTE) prophylaxis. Objective: To evaluate the risk/benefit profile of NACs versus enoxaparin for VTE prophylaxis in major orthopedic surgery. Methods: A systematic review of double-blind randomized phase III studies was performed. The search strategy was run from 2000 to 2011 in the main medical electronic databases in any language. Independent extraction of articles was performed by 2 authors using predefined data fields, including study quality indicators. Results: Fifteen published clinical trials evaluating fondaparinux, rivaroxaban, dabigatran, and apixaban were included. Primary efficacy (any deep vein thrombosis [DVT], nonfatal pulmonary embolism, or all-cause mortality) favored fondaparinux (relative risk [RR] 0.50; 95% CI, 0.39, 0.63) and rivaroxaban (RR, 0.50; 95% CI, 0.34, 0.73) over enoxaparin, although significant heterogeneity was observed in both series. The primary efficacy of dabigatran at 220 mg, apixaban, and bemiparin were similar, with RRs of 1.02 (95% CI, 0.86, 1.20), 0.63 (95% CI, 0.39, 1.01), and 0.87 (95% CI, 0.65, 1.17), respectively. The primary efficacy of dabigatran at 150 mg (RR, 1.20; 95% CI, 1.03, 1.41), was inferior to enoxaparin. The incidence of proximal DVT favored apixaban (RR, 0.45; 95% CI, 0.27, 0.75) only. Rivaroxaban (RR, 0.45; 95% CI, 0.27, 0,77) and apixaban (RR, 0.38; 95% CI, 0.16, 0.90) produced significantly lower frequencies of symptomatic DVT. The incidence of major VTE favored rivaroxaban (RR, 0.44; 95% CI, 0.25, 0.81), only. Bleeding risk was similar for all NACs, except fondaparinux (RR, 1.27; 95% CI, 1.04, 1.55), which exhibited a significantly higher any-bleeding risk compared with enoxaparin, and apixaban (RR, 0.88; 95% CI, 0.79, 0.99), which was associated with a reduced risk of any bleeding. Alanine amino transferase was significantly lower with 220 mg of dabigatran, (RR, 0.67; 95% CI, 0.79, 0.99) than with enoxaparin. Conclusions: NACs can be considered alternatives to conventional thromboprophylaxis regimens in patients undergoing elective major orthopedic surgery, depending on clinical characteristics and cost-effectiveness. The knowledge of some differences concerning efficacy or safety profile, pointed out in this systematic review, along with the respective limitations, may be useful in clinical practice. © 2013 Elsevier Inc. All rights reserved.

Validation of the English version of the UNESP-Botucatu multidimensional composite pain scale for assessing postoperative pain in cats

Background: A scale validated in one language is not automatically valid in another language or culture. The purpose of this study was to validate the English version of the UNESP-Botucatu multidimensional composite pain scale (MCPS) to assess postoperative pain in cats. The English version was developed using translation, back-translation, and review by individuals with expertise in feline pain management. In sequence, validity and reliability tests were performed.Results: Of the three domains identified by factor analysis, the internal consistency was excellent for 'pain expression' and 'psychomotor change' (0.86 and 0.87) but not for 'physiological variables' (0.28). Relevant changes in pain scores at clinically distinct time points (e.g., post-surgery, post-analgesic therapy), confirmed the construct validity and responsiveness (Wilcoxon test, p < 0.001). Favorable correlation with the IVAS scores (p < 0.001) and moderate to very good agreement between blinded observers and 'gold standard' evaluations, supported criterion validity. The cut-off point for rescue analgesia was > 7 (range 0-30 points) with 96.5% sensitivity and 99.5% specificity.Conclusions: The English version of the UNESP-Botucatu-MCPS is a valid, reliable and responsive instrument for assessing acute pain in cats undergoing ovariohysterectomy, when used by anesthesiologists or anesthesia technicians. The cut-off point for rescue analgesia provides an additional tool for guiding analgesic therapy. © 2013 Brondani et al.; licensee BioMed Central Ltd.

Leitura do fotojornalismo na escola: uma experiência com alunos da escola básica

Pós-graduação em Educação - FFC

O emprego do presente indicativo em entrevistas com enfoque no passado

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Fraseologismos zoônimos: elaboração de base de dados Português-Francês

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Dicionário onomasiológico de expressões cromáticas da fauna e flora:

Pós-graduação em Estudos Linguísticos - IBILCE

Dicionário multilíngue de regência verbal: equivalentes em francês

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Estudo sobre as expressões idiomáticas e o uso de dicionários especiais da língua portuguesa no ensino fundamental

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Uma abordagem do funcionamento discursivo das construções adversativas sob a ótica da gramaticalização

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Estruturação do conhecimento e relações semânticas: uma ontologia para o domínio da naonociência e nanotecnologia

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

A Tradução juramentada espanhol-português de atas de assembléias de associados: questões de equivalência terminológica

Pós-graduação em Estudos Linguísticos - IBILCE

Os provérbios relativos aos Sete Pecados Capitais

Pós-graduação em Estudos Linguísticos - IBILCE

A tradução juramentada espanhol-português de estatutos sociais: questões de equivalência terminológica

Pós-graduação em Estudos Linguísticos - IBILCE

Práticas letradas/escritas na internet: marcas do outro no processo de textualização via MSN

Pós-graduação em Estudos Linguísticos - IBILCE

A concordância verbal na língua falada na região noroeste do Estado de São Paulo

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)