Resumo Objetivo: Descrever a segurança e eficácia da embolização das artérias prostáticas (EAP) em pacientes com próstatas muito aumentadas (≥ 200 cm3). Materiais e Métodos: Este estudo retrospectivo incluiu 18 pacientes consecutivos com hiperplasia prostática benigna portadores de próstatas ≥ 200 cm3 (idade média de 74 anos), que foram submetidos a EAP para tratar sintomas de trato urinário inferior moderados a graves. Resultados: A EAP foi tecnicamente bem-sucedida em 17 pacientes (94,4%). Falha clínica (IPSS ≥ 8) foi detectada em dois pacientes durante o seguimento (11,1%). Observamos melhora significativa em todos os parâmetros relevantes aos três meses de acompanhamento: IPSS: 15,7 vs. 2,9; qualidade de vida: 5,2 vs. 1,0); PSA: 11,4 vs. 1,82 ng/mL; pico de fluxo urinário: 7,45 vs. 18,6 mL/s); volume prostático: 252,4 vs. 151,6 cm3; e volume urinário residual: 143,7 vs. 28,3 mL - p < 0,05 para todos). Um paciente (5,6%) apresentou eliminação de tecido prostático e hematúria autolimitada durante o seguimento, que não necessitou de tratamento específico. Conclusão: A EAP em pacientes com próstata muito aumentada foi segura e eficaz, com significativas melhoras clínica, urodinâmica e imaginológica.

Abstract Objective: To describe the safety and efficacy of prostatic artery embolization (PAE) in patients with a markedly enlarged prostate. Materials and Methods: This was a retrospective study including 18 consecutive patients (mean age, 74 years) with benign prostatic hyperplasia, all with a prostate volume ≥ 200 cm3, who were enrolled to receive PAE for the treatment of moderate-to-severe lower urinary tract symptoms. Results: The PAE procedure was technically successful in 17 patients (94.4%). During follow-up, clinical failure (defined as an International Prostate Symptom Score [IPSS] ≥ 8) was observed in two (11.1%) of those 18 patients. At 3 months of follow-up, there was significant improvement over baseline in all relevant outcome measures: total IPSS (from 15.7 to 2.9); IPSS quality of life score (from 5.2 to 1.0); prostate specific antigen (from 11.4 to 1.82 ng/mL); peak urinary flow rate (from 7.45 to 18.6 mL/s); prostate volume (from 252.4 to 151.6 cm3); and post-void residual volume (from 143.7 to 28.3 mL)-p < 0.05 for all. Of the 18 patients, one (5.6%) presented detachment of prostate tissue and self-limited hematuria, which did not require specific treatment. Conclusion: In patients with a markedly enlarged prostate, PAE proved to be safe and effective, resulting in significant improvements in clinical, imaging, and urodynamic parameters.

Resumo A perspectiva territorial de análise de dados favorece o planejamento de políticas sociais equânimes. Este artigo analisa a distribuição socioespacial dos homicídios dolosos em São José dos Campos, sede de Região Metropolitana em São Paulo, Brasil, entre 2015 e 2017, considerando os processos históricos de urbanização e estruturação do espaço urbano. O estudo é exploratório, fundamentado na análise estatística descritiva e georreferenciada dos homicídios dolosos ocorridos no município entre 2015 e 2017. Houve tendência de redução da taxa global e concentração espacial nas zonas de piores indicadores sociais e expansão urbana recente, impulsionada por políticas habitacionais. A pesquisa alerta para o papel das políticas públicas habitacionais na criação de territórios de violência.

Abstract The risk of violent deaths tends do increase in areas of precarious infrastructure. This paper aims to analyze the socio-spatial distribution of homicides in São José dos Campos (SJC), located in the Metropolitan Region in the state of São Paulo, Brazil, from 2015 to 2017, considering the urbanization and urban space structuring processes. The exploratory study, based on secondary data, is grounded on descriptive statistical and spatial analysis of the homicides that occurred in SJC between 2015 and 2017. The overall rate tended to decline in the period and the deaths occurred mainly in two zones of poorer social indicators and recent urban sprawl boosted by housing policies. The research is a warning against the role of public policies in creating violent territories.

Resumo O ambiente é um dos determinantes sociais da saúde. No Brasil, as habitações sociais, financiadas por políticas públicas, tendem a ser erguidas em espaços desprovidos de infraestrutura urbana e a posse da casa se acompanha de incertezas na condução da vida cotidiana. Este trabalho visa investigar o uso do questionário de qualidade de vida WHOQOL - 100 como instrumento de análise da qualidade de vida de uma população atendida por política habitacional, integrando os campos da saúde coletiva e do planejamento urbano. O questionário foi respondido por 101 moradores de um conjunto habitacional de São José dos Campos, um município paulista de grande porte. Encontraram-se baixos escores de autoavaliação de qualidade de vida, ambiente e subjetividade comparados aos dados disponíveis em publicações acadêmicas que avaliam, no geral, populações adoecidas. Os resultados permitiram avaliar de modo objetivo a relação entre ambiente e qualidade de vida, subsidiando a formulação e implantação de políticas sociais integradas às habitacionais para garantia dos direitos sociais de populações carentes.

Abstract The environment is one of the social determinants of health. In Brazil, social housing, financed by housing policies, tends to be built in spaces devoid of urban infrastructure and home ownership is accompanied by uncertainties in the conduct of daily life. This work aims to investigate the use of the WHOQOL - 100 quality of life questionnaire as an instrument for analyzing the quality of life of people attended by housing policy, integrating the fields of public health and urban planning, especially with regard to housing policies. The questionnaire was applied to 101 residents of a housing complex in São José dos Campos, a large city in São Paulo. Low self-assessment scores for quality of life, environment and subjectivity were found, compared to data available in academic publications, which assess, in general, sick populations. The results allowed, in the studied housing complex, to objectively assess the relationship between environment and quality of life, subsidizing the formulation and implementation of social policies integrated with housing policies to guarantee the social rights of the target populations of housing policies.

Resumo O ambiente é um dos determinantes sociais da saúde. No Brasil, as habitações sociais, financiadas por políticas públicas, tendem a ser erguidas em espaços desprovidos de infraestrutura urbana e a posse da casa se acompanha de incertezas na condução da vida cotidiana. Este trabalho visa investigar o uso do questionário de qualidade de vida WHOQOL - 100 como instrumento de análise da qualidade de vida de uma população atendida por política habitacional, integrando os campos da saúde coletiva e do planejamento urbano. O questionário foi respondido por 101 moradores de um conjunto habitacional de São José dos Campos, um município paulista de grande porte. Encontraram-se baixos escores de autoavaliação de qualidade de vida, ambiente e subjetividade comparados aos dados disponíveis em publicações acadêmicas que avaliam, no geral, populações adoecidas. Os resultados permitiram avaliar de modo objetivo a relação entre ambiente e qualidade de vida, subsidiando a formulação e implantação de políticas sociais integradas às habitacionais para garantia dos direitos sociais de populações carentes.

Abstract The environment is one of the social determinants of health. In Brazil, social housing, financed by housing policies, tends to be built in spaces devoid of urban infrastructure and home ownership is accompanied by uncertainties in the conduct of daily life. This work aims to investigate the use of the WHOQOL - 100 quality of life questionnaire as an instrument for analyzing the quality of life of people attended by housing policy, integrating the fields of public health and urban planning, especially with regard to housing policies. The questionnaire was applied to 101 residents of a housing complex in São José dos Campos, a large city in São Paulo. Low self-assessment scores for quality of life, environment and subjectivity were found, compared to data available in academic publications, which assess, in general, sick populations. The results allowed, in the studied housing complex, to objectively assess the relationship between environment and quality of life, subsidizing the formulation and implementation of social policies integrated with housing policies to guarantee the social rights of the target populations of housing policies.

More than 18 million people in 188 countries have been diagnosed as having coronavirus disease (COVID-19), and COVID-19 has been responsible for more than 600,000 deaths worldwide. Brazil is now the second most affected country globally. Faced with this scenario, various public health measures and changes in the daily routines of hospitals were implemented to stop the pandemic. Patients with hepatocellular carcinoma (HCC) are at an increased risk for severe COVID-19 as they present with two major diseases: cancer and concomitant chronic liver disease. The COVID-19 pandemic can significantly impact the management of HCC patients from diagnosis to treatment strategies. These patients need special attention and assistance at this time, especially since treatment for tumors cannot be delayed in most cases. The aim of this guideline was to standardize the management of HCC patients during the COVID-19 pandemic. This document was developed, on the basis of the best evidence available, by a multidisciplinary team from Instituto do Câncer do Estado de São Paulo (ICESP), and Instituto Central of the Hospital das Clínicas da Universidade de São Paulo (HC-FMUSP), which are members of the São Paulo Clínicas Liver Cancer Group.

Resumo Este trabalho, fruto de pesquisa histórica e sociológica, é uma análise exploratória do Planejamento Urbano como sistema simbólico. Por meio de um estudo de caso, com análise documental, investiga o poder simbólico contido nos planos de intervenção urbana propostos para o Banhado de São José dos Campos - SP, área de proteção ambiental que abriga uma comunidade de traços urbano-rurais e tem sido alvo de diversas propostas de planejamento urbano nos últimos 60 anos. A análise evidenciou que o ideário e as ações do planejamento urbano contribuem, historicamente, para a construção de uma representação social que idealiza a paisagem e a destitui das pessoas que a habitam. Esse posicionamento é reforçado pela produção acadêmica e influencia e direciona proposições segregacionistas do uso e manejo da unidade de conservação urbana, formalizadas nos planos diretores.

ABSTRACT This historical and sociological research explores urban planning as a symbolic system. By means of a case study, and the use of documental analysis, it asses the symbolic capital contained in urban planning propositions developed for the Banhado, an Environmental Protected Area of São José dos Campos - SP, which houses an urban-rural community. The area has been a target of several urban planning propositions in the last 60 years. The analysis showed that the field of ideas and the actions held by urban planners have historically contributed to the construction of a social representation that excludes the dwellers from the idealized landscape. Such position is reinforced by the academic production and influence and guide segregationist propositions for the use and management of urban environmental protected areas, institutionalized in directive urban plans.

RESUMEN La presente investigación es un análisis histórico y sociológica respeto a la Planificación Urbana como sistema simbólico. A través de un estudio de caso y análisis documental se investiga el poder simbólico presente en los planos de intervención urbana propuestos para el área conocida por “Banhado”, en São José dos Campos, SP. El local, una área de protección ambiental (APA), abriga una comunidad de rasgos urbano-rurales que, en los últimos 60 años, fue objeto de propuestas de planificación urbana. El trabajo de investigación dejo claro que los ideales y las acciones de planificación urbana contribuyeron, históricamente, a la construcción de una representación social que idealiza el paisaje y al mismo tiempo lo destituye de las personas que lo habitan. Esta postura es reforzada por la producción académica que, a su vez, ejerce influencia y direcciona las proposiciones segregacionistas de uso y manejo del unidad de protección ambiental urbana formalizadas en los Planos Directores.

The identification and characterisation of Cryptosporidiumgenotypes and subtypes are fundamental to the study of cryptosporidiosis epidemiology, aiding in prevention and control strategies. The objective was to determine the genetic diversity ofCryptosporidium in samples obtained from hospitals of Rio de Janeiro, Brazil, and Buenos Aires, Argentina. Samples were analysed by microscopy and TaqMan polymerase chain reaction (PCR) assays forCryptosporidium detection, genotyped by nested-PCR-restriction fragment length polymorphism (RFLP) analysis of the 18S rRNA gene and subtyped by DNA sequencing of the gp60 gene. Among the 89 samples from Rio de Janeiro, Cryptosporidium spp were detected in 26 by microscopy/TaqMan PCR. In samples from Buenos Aires,Cryptosporidium was diagnosed in 15 patients of the 132 studied. The TaqMan PCR and the nested-PCR-RFLP detected Cryptosporidium parvum, Cryptosporidium hominis, and co-infections of both species. In Brazilian samples, the subtypes IbA10G2 and IIcA5G3 were observed. The subtypes found in Argentinean samples were IbA10G2, IaA10G1R4, IaA11G1R4, and IeA11G3T3, and mixed subtypes of Ia and IIa families were detected in the co-infections. C. hominis was the species more frequently detected, and subtype family Ib was reported in both countries. Subtype diversity was higher in Buenos Aires than in Rio de Janeiro and two new subtypes were described for the first time.

OBJECTIVE: The purpose of this study was to explore the researcher's perspectives on genomic medicine (GM) and its consequences in the decision-making process regarding the health policy in Mexico. MATERIALS AND METHODS: An exploratory qualitative research was conducted (semi-structured questionnaire). The study was conducted during the II National Congress of GM (25 - 27th October 2006). RESULTS: We identified four categories amongst the researcher's perspectives regarding the applicability of GM and the political feasibility of the genomics research. Some researchers believe that the 3P's of GM (Predictive, Personalized, Preventive) have generated "inflated expectations" on the real impact on public health (PH). Opinions were divided among those who believed that GM is the new 'paradigm' of PH and those who thought that GM is part of a set of tools for PH. CONCLUSION: To improve the health conditions of the Mexican population, GM must be part in the solution of the PH problems, but we need a realistic view.

OBJETIVO: Explorar las perspectivas de los investigadores en medicina genómica y cómo incide esta última en las políticas de salud en México. MATERIAL Y MÉTODOS: Se realizó una investigación cualitativa a partir de entrevistas semiestructuradas, durante el II Congreso Nacional de de Medicina Genómica celebrado en México del 25 al 27 de octubre de 2006. RESULTADOS: Se identificaron cuatro categorías con respecto a la aplicabilidad de la medicina genómica y la viabilidad política de la investigación genómica. Algunos investigadores consideran que las tres "P" de la medicina genómica, predictiva, personalizada y preventiva, generaron "expectativas exageradas" sobre su impacto real en salud pública. Las opiniones se dividieron entre aquéllos que consideran la medicina genómica como el nuevo "paradigma" de salud pública y quienen piensan que se trata más bien de una herramienta de la salud pública. CONCLUSIÓN: Si bien no cabe duda que la medicina genómica constituye uno de los campos de la salud pública orientados a mejorar las condiones de salud de los mexicanos, no deben perderse de vista sus alcances reales.

OBJECTIVE: The purpose of this study was to explore the researcher's perspectives on genomic medicine (GM) and its consequences in the decision-making process regarding the health policy in Mexico. MATERIALS AND METHODS: An exploratory qualitative research was conducted (semi-structured questionnaire). The study was conducted during the II National Congress of GM (25 - 27th October 2006). RESULTS: We identified four categories amongst the researcher's perspectives regarding the applicability of GM and the political feasibility of the genomics research. Some researchers believe that the 3P's of GM (Predictive, Personalized, Preventive) have generated "inflated expectations" on the real impact on public health (PH). Opinions were divided among those who believed that GM is the new 'paradigm' of PH and those who thought that GM is part of a set of tools for PH. CONCLUSION: To improve the health conditions of the Mexican population, GM must be part in the solution of the PH problems, but we need a realistic view.

OBJETIVO: Explorar las perspectivas de los investigadores en medicina genómica y cómo incide esta última en las políticas de salud en México. MATERIAL Y MÉTODOS: Se realizó una investigación cualitativa a partir de entrevistas semiestructuradas, durante el II Congreso Nacional de de Medicina Genómica celebrado en México del 25 al 27 de octubre de 2006. RESULTADOS: Se identificaron cuatro categorías con respecto a la aplicabilidad de la medicina genómica y la viabilidad política de la investigación genómica. Algunos investigadores consideran que las tres "P" de la medicina genómica, predictiva, personalizada y preventiva, generaron "expectativas exageradas" sobre su impacto real en salud pública. Las opiniones se dividieron entre aquéllos que consideran la medicina genómica como el nuevo "paradigma" de salud pública y quienen piensan que se trata más bien de una herramienta de la salud pública. CONCLUSIÓN: Si bien no cabe duda que la medicina genómica constituye uno de los campos de la salud pública orientados a mejorar las condiones de salud de los mexicanos, no deben perderse de vista sus alcances reales.

Analisa a transformação da cidade de São José dos Campos em Estância Climatérica para o tratamento da tuberculose pulmonar, condição oficialmente instituída em 1935. Por meio de análise do periódico editado pelos tisiologistas da cidade, Boletim Médico, e de fontes correlatas, são analisadas a motivação e as estratégias desse grupo profissional na conversão da pacata cidade de São José dos Campos em centro de referência para a cura da tuberculose. A investigação dos argumentos técnicos que ampararam esse projeto reforça a constatação de que a condição de estância era, simultaneamente, ameaça à população da cidade e motriz da economia local, baseada, até a década de 1950, quase que exclusivamente na exploração da doença.

The article explores the transformation of the city of São José dos Campos, which in 1935 received the official designation of "health resort" for the treatment of pulmonary tuberculosis. Research of Boletim Médico (a periodical published by the city's tuberculosis specialists) and of other, related sources grounds this analysis of both the motives and the strategies of this professional group when the quiet little town of São José dos Campos was transformed into a major center for tuberculosis cures. This examination of the technical arguments in support of the project reinforces the idea that the city's status as a health resort was both a threat to city residents and also a driving force behind the local economy, based almost exclusively on exploiting the disease through the 1950s.

Síndrome da aorta média (SAM) é uma condição clínica caracterizada por estenose segmentar ou difusa da aorta, hipertensão arterial e claudicação de membros inferiores. A principal causa da SAM é a arterite de Takayasu. A estenose segmentar pode estar localizada na aorta suprarrenal, renal ou infrarrenal e com alta propensão de lesões estenóticas concomitantes das artérias renais e viscerais. A gravidade da hipertensão arterial é a principal indicação para o tratmento. A técnica endovascular para o tratamento da síndrome da aorta média tem bons resultados e é a menos invasiva. No presente artigo, é descrito o tratamento com sucesso de uma estenose da aorta toracoabdominal com recanalização da artéria mesentérica superior através de angioplastia em uma mulher de 34 anos portadora de arterite de Takayasu e hipertensão arterial grave.

Middle aortic syndrome (MAS) is a clinical condition characterized by segmental or diffuse narrowing of the aorta, hypertension, and lower limb claudication. The main cause of MAS is Takayasu’s arteritis. Segmental aortic stenosis may be located at the suprarenal, renal or infrarenal aorta with high tendency to concomitant stenosis in both the renal and visceral arteries. Severity of hypertension is the primary indication for intervention. Endovascular therapy is a minimally invasive treatment for MAS and may provide good results. In the present report, we describe a successful endovascular treatment of stenosis of the thoracoabdominal aorta with recanalization of the superior mesenteric artery using angioplasty in a 34-year-old woman with Takaysu’s arteritis and severe hypertension.

OBJETIVO: Estudar alterações morfológicas e histoquímicas nas ileocistoplastias em ratos fêmea. MÉTODOS: 16 ratos fêmea foram submetidos à ileocistoplastia, sacrificadas após oito semanas. O material coletado foi e dividido em quatro grupos para análise morfológica e histoquímica: Grupo I (controle) biópsia intestinal no momento da cirurgia; Grupo II - anastomose íleo-ileal; Grupo III - anastomose íleo-vesical e Grupo IV - segmento intestinal da neobexiga. Os parâmetros avaliados foram: displasia, metaplasia, processo inflamatório agudo e crônico, fibrose, atrofia, hipertrofia, conteúdo total de mucinas, sialomucinas e sulfomucinas. Utilizou-se os testes não-paramétricos de Wilcoxon e Mann-Whitney para estudo estatístico. RESULTADOS: Não houve displasia. Processo inflamatório agudo e atrofia ocorreram nos grupos II, III e IV, sem significância estatística. Metaplasia com significância estatística ocorreu somente no grupo III (p=0.012). Processo inflamatório crônico, fibrose e hipertrofia foram significantes nos grupos II, III e IV. Observou-se aumento significante no conteúdo total de mucinas no grupo IV (p=0.014) e redução no grupo III (p=0.013). Aumento significante de sialomucinas foi observado nos grupos III (p=0.003) e IV (p=0.002) e redução significante das sulfomucinas nos grupos III (p=0.013) e IV (p=0.008). CONCLUSÃO: Nas ileocistoplastias em ratos fêmea observou-se metaplasia escamosa, processo inflamatório crônico, fibrose, hipertrofia, aumento do conteúdo de sialomucinas, redução das sulfomucinas e alterações no conteúdo total de mucinas com significância estatística, bem como atrofia e processo inflamatório agudo em menor intensidade.

PURPOSE: To study morphologic and histochemical alterations arising at the ileocystoplasty site. METHODS: Sixteen Wistar female rats were subjected to ileocystoplasty and sacrificed after eight weeks. Material collected was divided into four groups for histological and histochemical studies: Group I (control) - isolated ileum segment removed during ileocystoplasty; Group II - ileoileal anastomosis; Group III - ileovesical anastomosis and Group IV - ileal segment from the neobladder. Histological and histochemical study assessed dysplasia, metaplasia, acute and chronic inflammation, fibrosis, atrophy, hypertrophy, total mucins, sialomucins and sulfomucins. The non-parametric Wilcoxon and Mann-Whitney tests were employed in statistical analysis. RESULTS: None of the groups presented dysplasia. Acute inflammation and atrophy occurred in Groups II, III and IV, not reaching statistical significance. Metaplasia was significant only in Group III (p=0.012). Chronic inflammation, fibrosis and hypertrophy were significant in Groups II, III and IV. There was a significant increase in total mucin content in Group IV (p=0.014) and a reduction in Group III (p=0.016). Increases in sialomucins were observed in samples for Groups III (p=0.003) and IV (p=0.002) along with reduced sulfomucins in samples from Groups III (p=0.013) and IV (p=0.008). CONCLUSION: Ileocystoplasty in female rats caused squamous metaplasia, chronic inflammatory infiltration, fibrosis, hypertrophy, increase in sialomucin content, reduction in sulfomucins, and alterations in total mucin content with statistical significance, as well acute inflammatory infiltration and muscular atrophy with less intensity.

O acesso totalmente percutâneo para o implante de endopróteses aórticas, através da preclose technique, é possível mesmo quando utilizadas bainhas introdutoras de elevado perfil. Relatamos sete casos de tratamento endovascular de doenças da aorta, todos realizados de modo percutâneo, e discutimos os principais aspectos desta técnica.

Total percutaneous access for aortic endograft delivery, using the preclose technique, is feasible even with the use of large-diameter introducer sheaths. We report seven cases of percutaneous approach in endovascular treatment of aortic diseases and discuss the main technical aspects.

BACKGROUND: Approximately one-half of Brazilian patients with hereditary hemochromatosis (HH) are neither homozygous for the C282Y mutation nor compound heterozygous for the H63D and C282Y mutations that are associated with HH in Caucasians. Other mutations have been described in the HFE gene as well as in genes involved in iron metabolism, such as transferrin receptor 2 (TfR2) and ferroportin 1 (SCL40A1). AIMS: To evaluate the role of HFE, TfR2 and SCL40A1 mutations in Brazilian subjects with HH. PATIENTS AND METHODS: Nineteen male subjects (median age 42 [range: 20-72] years) with HH were evaluated using the Haemochromatosis StripAssay A®. This assay is capable of detecting twelve HFE mutations, which are V53M, V59M, H63D, H63H, S65C, Q127H, P160delC, E168Q, E168X, W169X, C282Y and Q283, four TfR2 mutations, which are E60X, M172K, Y250X, AVAQ594-597del, and two SCL40A1 mutations, which are N144H and V162del. RESULTS: In our cohort, nine (47%) patients were homozygous for the C282Y mutation, two (11%) were heterozygous for the H63D mutation, and one each (5%) was either heterozygous for C282Y or compound heterozygous for C282Y and H63D. No other mutations in the HFE, TfR2 or SCL40A1 genes were observed in the studied patients. CONCLUSIONS: One-third of Brazilian subjects with the classical phenotype of HH do not carry HFE or other mutations that are currently associated with the disease in Caucasians. This observation suggests a role for other yet unknown mutations in the aforementioned genes or in other genes involved in iron homeostasis in the pathogenesis of HH in Brazil.

OBJETIVOS: Avaliar a utilidade da varfarina na prevenção dessas complicações nos pacientes de alto risco. MÉTODOS: Estudo clínico prospectivo, randomizado, cego, em pacientes submetidos ao primeiro implante transvenoso de DCEI, com FEVE<0,40 e/ou MPT ipsilateral ao implante definitivo. Após o procedimento, os pacientes foram randomizados para o uso diário de placebo ou varfarina. Avaliações clínicas e laboratoriais foram realizadas periodicamente. A pesquisa de obstruções venosas foi feita pela venografia por subtração digital, seis meses após o implante. De fevereiro de 2004 a novembro de 2006, foram selecionados 101 pacientes, havendo homogeneidade das características clínicas e operatórias de ambos os grupos (P=NS). RESULTADOS: No grupo Varfarina, 31,4% dos pacientes apresentaram obstruções venosas em comparação a 57,1% do grupo Placebo (RR= 0,57; IC 95%= 0,33 a 0,98; P= 0,015). No grupo Varfarina, 72% dos exames de INR realizados encontraram-se em nível terapêutico. Houve um caso de sangramento gastrintestinal, que justificou a interrupção do uso da varfarina e mudança para o grupo Placebo. CONCLUSÃO: Os resultados preliminares mostraram que o uso profilático da anticoagulação mostrou-se seguro e reduziu significativamente a incidência de obstruções venosas pós-implante de DCEI nos pacientes de alto risco.

OBJECTIVES: To evaluate the efficacy of prophylactic use of warfarin in patients with high risk of lead-associated thrombosis. METHODS: Clinical, prospective, randomized and blinded study, in patients submitted to first transvenous leads implantation with LVEF <0.40 and/or previous ipsilateral temporary pacing. After device implantation, patients were randomly assigned to placebo or warfarin. Periodical clinical and laboratorial evaluations were performed to anticoagulant management. After a six-month period, every patient was submitted to a digital subtraction venography. From February 2004 to November 2006, 101 patients underwent randomization. Baseline characteristics were similar in both groups (P=NS). RESULTS: Venographic analysis showed 31.4% of venous obstructions in patients assigned to warfarin as compared with 57.1% in patients assigned to placebo (RR= 0.57 [95% CI, 0.33 to 0.98]; P=0.015). In the warfarin group, 72% of the PT/INR tests were in therapeutic INR range. Only one patient required warfarin discontinuation and cross-over to placebo group due to gastrointestinal bleeding. CONCLUSIONS: These preliminary results showed that the anticoagulation therapy has been safe and reduced the frequency of venous thrombosis after transvenous cardiac devices implantation in high risk patients.