Thesis (Ph. D.)--Chemical Engineering, Georgia Institute of Technology, 2006. / Chaikof, Elliot, Committee Chair ; Hanson, Stephen, Committee Member ; Lollar, John "Pete", Committee Member ; Sambanis, Athanassios, Committee Member ; Yoganathan, Ajit, Committee Member.

Thesis (Ph. D.)--Oregon State University, 2007. / Printout. Includes bibliographical references. Also available on the World Wide Web.

Discovery of cheap, nontoxic and readily available antiatherosclerotic drugs is an extraordinary challenge in this modern world. Atherosclerosis and cardiovascular diseases have been predicted to be the leading cause of death by the year 2030. Hence, this thesis was designed to search for plant (s) with anti-atherogenic properties, investigate its possible side effects and extrapolate its likely mechanism(s) of action. An ethnobotanical survey was employed in identification of locally important plants used for the management and treatment of cardiovascular diseases and its predisposing factors in Nkonkobe Municipality, Eastern Cape in South Africa. Information on the names of plants, their parts used and methods of preparation was collected through a questionnaire which was administered to herbalists, traditional healers and rural dwellers. The most frequently used plant (Rhizomes of Tulbaghia violacea Harv.) was investigated for toxicity using brine shrimp lethality (in vitro) and in vivo toxicity test (acute and subchronic) on rats to determine safety dosage. The in vitro antioxidant and free radical scavenging activity of the plant was investigated using models such as 1,1-diphenyl-2- picrylhydrazyl (DPPH), superoxide anions, hydrogen peroxide (H2O2), nitric oxide (NO), 2,2’- azinobis [3-ethylbenzothiazoline-6-sulfonic acid] diammonium salt (ABTS), lipid peroxidation inhibition and the ferric reducing agent. Phytochemical content and the effect of oral administration of fresh methanolic extract rhizomes of Tulbaghia violacea (250, 500 mg/kg. bwt/day) on Lipid peroxidation (TBARS), serum and tissue antioxidant enzymes in normal, hypercholesterolemic and diet induced atherogenic rats were also assessed. More so, the potential of the extract (250 and 500 mg/kg. bwt) to protect against atherogenic diet (4 percentage cholesterol 1 pecentage cholic acid and 0.5 percentage thiouracil) induced fatty streaks formation, dyslipidemia, oxidative stress and endothelial dysfunction was also investigated. Ethnobotanical study revealed that 19 plant species are used for the treatment of heart related diseases in the Municipality. 53 percentage of the plants mentioned were used for the management of chest pain, 47 percentage for high blood pressure, 42 percent for heart disease, 16 percentage for stroke and 11 percentage for the treatment of hypercholesterolemia. Tulbaghia violacea was repeatedly mentioned as the plant species used for the treatment of high blood pressure and predisposing factors in the study area. The brine shrimp cytotoxicity test revealed that fresh, dried methanolic extracts and essential oil of the T. violacea exhibited a high degree of cytotoxic activity with IC50 values of 18.18 (fresh) and 19.24 (dried) μg/ml. An IC50 value of 12. 59 μg/ml was obtained for the essential oil of the plant. The low cytotoxicity values obtained, suggested that rhizome of T. violacea may serve as a potential source of antimicrobial and anticancer agents. In vivo acute study of single oral administration of 5g/kg dose does not produce mortality or significant behavioral changes during 14 days observation. In the sub-chronic study, the extract (250, 500 mg/kg/bwt/ day) administered for a period of 28 days showed no mortality or morbidity. The weekly body and organ weight of the rats showed no significant differences between the control and the rats treated with the extract. The extract at all doses does not show any effect on of biomarkers of liver or renal damage. However, a significant decrease in the activity of ƔGT was observed in the extract treated groups. Hematological evaluation revealed that oral administration of fresh methanolic extracts of rhizomes of T. violacea does not cause anaemia or leucocytosis in the animals. Furthermore, histopathology results of the internal organs revealed no detectable inflammation. These results demonstrated that the rhizome extract of T. violacea was potentially safe for consumption orally even in chronic concentration. In vitro antioxidant evaluation showed that the essential oil, fresh and dried methanolic extracts exhibited potent antioxidant activities in a concentration dependent manner. Phytochemical investigation reveals that the fresh and the dry extract of RTV are rich in flavonoid, flavonol, phenols, tannin and proanthocyanidin, while the essential oil contained dimethy disulfide, dimethyl trisulfide, (methyl methylthio) methyl, 2,4-dithiapentane (11.35 percent) and (methylthio) acetic acid, 2- (methylthio) ethanol, 3-(methylthio) - and propanenitrile (7.20 percent). The fresh extract had higher radicals scavenging activity than the essential oil or dried extract, with 50 percentage inhibition of DPPH, hydrogen peroxide and lipid peroxidation at a concentration of 35.0 ± 0.12, 19.3 ± 0.11 and 17.9 ± 0.15 μg/ml respectively. Oral administration of methanolic extract of RTV in 125, 250 and 500 mg/kg to female Wistar rats significantly inhibited reduction of glutathione (GSH), superoxide dismutase (SOD) and catalase (CAT). The extracts also inhibited (p< 0.05) lipid peroxidation in normal, high cholesterol and diet induced atherosclerosis fed rats in a dose dependant manner. Also the extract (250 and 500 mg/kg/bwt/day) caused a significant (p<0.05) improvement in body weight of treated animals compared with untreated hypercholesterolemia control rats. The extracts also protected significantly (p<0.05) against atherogenic diet induced liver damage or fatty streaks formation in the aorta as revealed by histological examination. The anti-cholesterolemia and anti-atherosclerotic activities of the extract compared favorably well with standard drugs Gemfibrozil and Atorvastatin respectively. Conclusively, rhizomes of T. violacea possess significant anti-atherogenic activity and its mechanism of action(s) may be due to its antioxidant and anti-hypercholesterolemia properties. The results of this study also suggested that rhizome of T. violacea is relatively safe for human consumption and it may be used as an alternative to garlic.

Made available in DSpace on 2014-06-11T19:25:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-08-28Bitstream added on 2014-06-13T18:29:10Z : No. of bitstreams: 1 sabino_aj_me_araca.pdf: 203707 bytes, checksum: 2e1c3c45b12f8f08080a961981b5bb46 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Objetivou-se obter valores eritrocitários de referência para avestruzes criados em sistema comercial na Região de São José do Rio Preto, São Paulo, Brasil. Para tal foi padronizada a forma de colheita de sangue, comparando o efeito de dois diferentes anticoagulantes (ácido etilenodiaminotetracético sódico - EDTA e heparina sódica) na morfometria e integridade dos eritrócitos permitindo concluir que, para fins de análises quantitativa e morfométrica dos parâmetros eritrocitários de avestruzes, a heparina sódica (10 U/mL sangue) é um anticoagulante mais adequando do que o EDTA sódico (2 mg/ mL sangue). Foram analisadas 240 amostras de sangue heparinizadas de avestruzes de ambos sexos, divididos em três diferentes faixas etárias: 4├13meses; 13 ├ 22 meses e 22 ├ 30 meses. Utilizando-se método analítico padrão, verificou-se que os valores de eritrócitos, hemoglobina, hematócrito, volume corpuscular médio (VCM), hemoglobina corpuscular média (HCM), concentração da hemoglobina corpuscular média (CHCM), o diâmetro maior e menor dos eritrócitos sofrem influência do sexo (fêmeas) e faixa etária. Concluiu-se deste estudo que para adequada interpretação clínica dos valores eritrocitários dos avestruzes deve-se levar em consideração o tipo de anticoagulante utilizado para obtenção da amostra e valores de referência que considere as particularidades do sexo e da idade. / The aim of this study was to obtain the reference values of erythrocyte indices for ostriches raised in a commercial system in the region of São José do Rio Preto, São Paulo State, Brazil. To achieve the purpose of the study, we standardized a blood specimen collection comparing the effect of two different anticoagulants such as Ethylenediaminetetraacetic Acid sodium (EDTA) and Heparin sodium on the erythrocyte morphometry and integrity, which made possible to conclude that for the purposes of quantitative and morphometric analyses of the erythrocyte parameters of ostriches, the heparin sodium (10 U/mL of blood) is a much more appropriated anticoagulant than the EDTA sodium (2 mg/mL of blood). We analyzed 240 heparinized blood samples of both male and female ostriches divided into different age groups: 4 ├ 13 months; 13 ├ 22 months; and 22 ├ 30 months. Using a standard analytical method it was observed that the erythrocytes, hemoglobin, hematocrit, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH); mean corpuscular hemoglobin concentration (MCHC) values, and both the greater and the smaller diameters of the erythrocytes are under the influence of gender and age group. It was concluded that to have an appropriate clinical interpretation of the erythrocyte indices of the ostriches it should be taken into account the type of the anticoagulant used to obtain the sample and the reference values considering the peculiarities of ostriches’ gender and age.

Made available in DSpace on 2016-12-08T16:24:19Z (GMT). No. of bitstreams: 1 PGCA14MA140.pdf: 91454 bytes, checksum: d7f6d38c8c463559f1c52096a57acd9b (MD5) Previous issue date: 2014-07-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Clinical hematology is a tool that allows diagnosing of diseases and can act as a prognostic indicator of pathological conditions in fish. The aim of this study was the evaluation of hematological parameters of Nile tilapia (Oreochromis niloticus) with different anesthetics and samples obtained with different anticoagulants. Thirty fishes, apparently healthy, with average weight of 473 ± 35.50 g and mean total length of 29.33 ± 0.37 cm, acquired in the commercial pisciculture localized in the municipality Lages ( SC ) were used. The animals were randomly divided into three groups (n = 10). The anesthetic induction was performed according to the groups with eugenol in a concentration of 70 mg L-1 of water (GE), with Benzocaine hydrochloride (100 mg L-1) (GB) and without anesthesia (GC/control group). The blood samples were obtained by venipuncture of the caudal vessels and placed into microtubes containing sodium heparin or Na2EDTA and subsequently processed. The results were analyzed by Sigma Stat for Windows, the paired t-test for data between different anticoagulants belonging to the same group and analysis of variance followed by Tukey test for comparison of means between groups (p &#8804; 0.05) being used. Most of the observed changes in erythrogram were higher with the anticoagulant heparin and benzocaine group compared with the control group. However the leukocyte count, the values obtained were higher with Na2EDTA anticoagulant in all groups, suggesting that heparin can cause cell clustering. Based on these results it is concluded that anesthetics tested minimized the effect of stress caused by handling and invasive procedures when compared to the control group and the anticoagulant heparin caused less hemolysis compared with Na2EDTA for this species. Thus, the hematologic variations from samples obtained with different anesthetics protocols and / or different anticoagulants should be considered for the species Oreochromis niloticus / A hematologia clínica é uma ferramenta que permite a realização de diagnóstico de doenças e pode atuar como um indicador prognóstico das condições patológicas de peixes. O objetivo deste estudo foi avaliar os valores hematológicos de tilápias do Nilo (Oreochromis niloticus) submetidas a diferentes anestésicos e amostras obtidas com diferentes anticoagulantes. Foram utilizados trinta peixes, aparentemente saudáveis, com peso médio de 473±35,50g e comprimento total médio de 29,33±0,37cm, adquiridos de piscicultura comercial localizada no município de Lages (SC). Os animais foram divididos aleatoriamente em três grupos (n=10) conforme a forma de indução: grupo eugenol (GE), na concentração de 70mg L-1, grupo cloridrato de benzocaína (GB) na concentração de 100mg L-1 e grupo controle (GC) sem o uso de anestésicos. As amostras de sangue foram obtidas por venopunção dos vasos caudais e acondicionadas em microtubos contendo heparina sódica ou Na2EDTA e posteriormente processadas. Os resultados foram avaliados pelo Sigma Stat for Windows, sendo utilizado o testet pareado para dados entre diferentes anticoagulantes pertencentes ao mesmo grupo e à análise de variância, seguida de teste de Tukey para comparação das médias entre grupos (p&#8804;0,05). A maioria das alterações observadas no eritrograma foram superiores com o anticoagulante heparina e no grupo benzocaína, comparados com o grupo controle. Porém no leucograma, os valores obtidos foram maiores com o anticoagulante Na2EDTA em todos os grupos, sugerindo que a heparina pode causar aglomeração celular. Baseado nos resultados encontrados conclui-se que os anestésicos testados minimizaram o efeito do estresse causado por manipulações e procedimentos invasivos quando comparado ao grupo controle e a heparina foi o anticoagulante que causou menor hemólise quando comparado com o Na2EDTA para esta espécie. Assim, as variações hematológicas a partir de amostras obtidas com diferentes protocolosanestésicos e/ou diferentes anticoagulantes devem ser consideradas para a espécie Oreochromis niloticus

Orientador: Paulo César Ciarlini / Banca: José Juradir Fagliari / Banca: Suely Regina Mogami Bomfim / Resumo: Objetivou-se obter valores eritrocitários de referência para avestruzes criados em sistema comercial na Região de São José do Rio Preto, São Paulo, Brasil. Para tal foi padronizada a forma de colheita de sangue, comparando o efeito de dois diferentes anticoagulantes (ácido etilenodiaminotetracético sódico - EDTA e heparina sódica) na morfometria e integridade dos eritrócitos permitindo concluir que, para fins de análises quantitativa e morfométrica dos parâmetros eritrocitários de avestruzes, a heparina sódica (10 U/mL sangue) é um anticoagulante mais adequando do que o EDTA sódico (2 mg/ mL sangue). Foram analisadas 240 amostras de sangue heparinizadas de avestruzes de ambos sexos, divididos em três diferentes faixas etárias: 4├13meses; 13 ├ 22 meses e 22 ├ 30 meses. Utilizando-se método analítico padrão, verificou-se que os valores de eritrócitos, hemoglobina, hematócrito, volume corpuscular médio (VCM), hemoglobina corpuscular média (HCM), concentração da hemoglobina corpuscular média (CHCM), o diâmetro maior e menor dos eritrócitos sofrem influência do sexo (fêmeas) e faixa etária. Concluiu-se deste estudo que para adequada interpretação clínica dos valores eritrocitários dos avestruzes deve-se levar em consideração o tipo de anticoagulante utilizado para obtenção da amostra e valores de referência que considere as particularidades do sexo e da idade. / Abstract: The aim of this study was to obtain the reference values of erythrocyte indices for ostriches raised in a commercial system in the region of São José do Rio Preto, São Paulo State, Brazil. To achieve the purpose of the study, we standardized a blood specimen collection comparing the effect of two different anticoagulants such as Ethylenediaminetetraacetic Acid sodium (EDTA) and Heparin sodium on the erythrocyte morphometry and integrity, which made possible to conclude that for the purposes of quantitative and morphometric analyses of the erythrocyte parameters of ostriches, the heparin sodium (10 U/mL of blood) is a much more appropriated anticoagulant than the EDTA sodium (2 mg/mL of blood). We analyzed 240 heparinized blood samples of both male and female ostriches divided into different age groups: 4 ├ 13 months; 13 ├ 22 months; and 22 ├ 30 months. Using a standard analytical method it was observed that the erythrocytes, hemoglobin, hematocrit, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH); mean corpuscular hemoglobin concentration (MCHC) values, and both the greater and the smaller diameters of the erythrocytes are under the influence of gender and age group. It was concluded that to have an appropriate clinical interpretation of the erythrocyte indices of the ostriches it should be taken into account the type of the anticoagulant used to obtain the sample and the reference values considering the peculiarities of ostriches' gender and age. / Mestre

A varfarina é um anticoagulante oral, antivitamina K, amplamente utilizado na prevenção de trombos intravasculares de diferentes etiologias. Exige um controle rigoroso e complexo em decorrência da sua interação com outros fármacos e alimentos, o que pode interferir na Qualidade de Vida Relacionada à Saúde (QVRS) dos usuários. Intervenções educativas têm sido utilizadas para diminuir o impacto dessa terapia na QVRS. O objetivo principal deste estudo foi comparar o efeito na QVRS de duas intervenções educativas em pacientes que iniciaram o uso de varfarina pela primeira vez durante a internação, aos três e seis meses após a alta. Como objetivos secundários, comparamos a presença de sintomas de ansiedade e depressão e a adequação do valor do International Normalized Ratio (INR) na faixa terapêutica indicada, entre os grupos. Este foi um estudo experimental com designação aleatória nos dois grupos. Os pacientes do grupo intervenção (GI) receberam o programa educativo com seguimento por telefone após a alta e os do grupo controle (GC) receberam o programa educativo sem o acompanhamento telefônico. O estudo foi aprovado por Comitê de Ética em Pesquisa e foi registrado na base ClinicalTrials.gov. A pesquisa foi conduzida no Hospital Estadual de Ribeirão Preto e no Hospital Estadual de Américo Brasiliense. Foram incluídos pacientes que iniciaram o uso da varfarina, pela primeira vez, maiores de 18 anos e com telefone para contato. O programa educativo foi norteado pela teoria de Bandura e composto por informações verbais e escritas sobre o tratamento, as quais foram apresentadas durante a internação. Os participantes do GI receberam cinco contatos telefônicos para o reforço dessas informações, após a alta hospitalar. Ambos os grupos tiveram dois encontros presenciais, aos três e aos seis meses, para avaliação das variáveis desfechos: QVRS (avaliada pela versão brasileira da Duke Anticoagulation Satisfaction Scale - DASS) e sintomas de ansiedade e de depressão (avaliados pelas subescalas da Hospital Anxiety and Depression Scale - HADS). Para comparar o DASS e as escalas do HADS, realizamos teste t de Student para amostras independentes. Para compararmos os grupos ao longo do tempo, em relação à QVRS, foi realizada Análise da Variância (ANOVA) para medidas repetidas, tendo como fatores o tempo (três e seis meses), o grupo (intervenção ou controle) e uma interação de tempo por grupo. O nível de significância adotado foi de 0,05. Os grupos eram similares quanto às caracterizações sociodemográfica e clínica. A maioria dos participantes eram casados, do sexo feminino e com média de idade de 55 anos (D.P=15). As indicações mais frequentes para o início da varfarina foram trombose venosa profunda e tromboembolismo pulmonar. Não encontramos diferenças estatisticamente significantes entre as médias de QVRS, ansiedade e depressão dos dois grupos, aos três e aos seis meses após a alta / Warfarin is an oral anticoagulant, antivitamin K, widely used in the prevention of intravascular thrombi of different etiologies. It requires rigorous and complex control as a result of its interaction with other drugs and foods, which may interfere with users\' Quality of Life Related to Health (HRQoL). Educational interventions have been used to lessen the impact of this therapy. The main objective was to compare the HRQoL, at three and six months after discharge, of two groups of patients who started using warfarin for the first time during hospitalization. Secondary objectives, were to compare the presence of anxiety and depression symptoms and the adequacy of the International Normalized Ratio (INR) value in the indicated therapeutic range, between the groups. It is an experimental study with random designation in two groups. The patients in the intervention group (IG) received the educational program with telephone follow-up after discharge and those in the control group (CG) received the educational program without telephone follow-up. The study was approved by the Research Ethics Committee and was enrolled in the ClinicalTrials.gov database. The research was conducted at the State Hospital of Ribeirão Preto and the Hospital Estadual de Américo Brasiliense and included patients who started using warfarin for the first time, over 18 years and with a telephone to contact. The educational program was guided by the Bandura Theory and was composed of verbal and written information about the treatment and approached during hospitalization. GI participants received five telephone contacts to reinforce this information after discharge. Both groups had two face-to-face meetings at three and six months for the evaluation of the outcome variables: HRQOL (assessed by the Brazilian version of the Duke Anticoagulation Satisfaction Scale - DASS) and symptoms of anxiety and depression (assessed by the subscales of Hospital Anxiety and Depression Scale - HADS). To compare the DASS and the HADS scales, we performed Student\'s t-test for independent samples. In order to compare the groups over time, in relation to HRQoL, we performed Variance Analysis (ANOVA) for repeated measures, taking as factors the time (three and six months), the group (intervention or control) and a time interaction per group. The level of significance was set at 0.05. The groups were similar in sociodemographic and clinical characterization. The majority of the participants were married, female and with an average age of 55 years (D.P = 15). The most frequent indications for the initiation of warfarin were deep venous thrombosis and pulmonary thromboembolism. We did not find statistically significant differences between the means of HRQoL, anxiety and depression of the two groups at three and six months after discharge

A manutenção do RNI (Relação Normalizada Internacional), um exame específico feito em usuários de anticoagulantes orais, determinam os resultados individuais de quem se mantém na faixa terapêutica ou não. De acordo com as diretrizes Europeias (2015) e Americanas (2014), a faixa terapêutica recomendada para Fibrilação Atrial e demais eventos tromboembólicos é de 2 a 3, e para portadores de prótese valvar mecânicas, de 2,5 a 3,5. As complicações referentes ao exceder a faixa são classificadas em sangramentos, caso venha interferir e diminuir a faixa a possibilidade de ocorrer eventos trombóticos. As inferências relacionadas às complicações devidas à alteração do RNI estão associadas ao uso inadequado do medicamento, interações medicamentosas e alimentares, problemas de saúde, procedimentos invasivos e cirúrgicos, dentre outros fatores como estresse, atividade física, emagrecimento e aumento de peso. A intervenção baseada na educação em saúde por meio de um instrumento que estratifique e aponte com precisão os fatores de não permanência na faixa facilitará a adesão ao tratamento e, consequentemente, diminuirá os riscos de vida desta população. O presente objetivo principal foi avaliar e identificar os fatores que interferem na adesão de usuários de ACO (Anticoagulação Oral) e propor um escore de adesão aos usuários de Anticoagulante Oral para a manutenção na faixa terapêutica. Trata-se de um estudo analítico, observacional, transversal e abordagem quantitativa, realizado em um Centro de Anticoagulação Oral de um Hospital Público especializado em Cardiologia vinculado a Secretaria do Estado de São Paulo. Participaram deste estudo 607 usuários de ACO que atenderam aos critérios de inclusão: idade acima de 18 anos, alfabetizados e cadastrados no Sistema de ACO e que iniciaram o uso após duas semanas. Para o modelo de desenvolvimento, optou-se pelo desfecho o RNI alterado e as variáveis preditoras foram determinadas em manipulação do medicamento, interações medicamentosas e da dieta, atividade física, procedimentos e cirurgias, uso adequado do medicamento, problemas de saúde, outros fatores. A coleta de dados foi feita pelo pesquisador e foram realizadas, na parte I, questões relacionadas à caracterização e, na parte II, questões de perfil clínico. Antes, aplicou-se o TCLE após o consentimento e aprovação do usuário. Os dados do perfil sociodemográficos foram apresentados em absolutos e porcentagens, foram consideradas as variáveis que apresentaram nível de significância menor que 5% na análise exploratória ou que foram consideradas de relevância clínica, foram submetidas a um modelo de regressão logística múltipla. Participaram 607 usuários de ACO; o perfil sociodemográfico da população foi de 52% gênero feminino, 57% casados, faixa etária maior que 60 anos 62%, ensino fundamental incompleto 42%, provenientes de São Paulo 93%. As variáveis com nível de significância menor que 5% na análise multivariada: escolaridade, renda familiar, uso inadequado, interação medicamentosa, procedimentos invasivos, interações alimentar, atividade física, condições clínicas, outros fatores e complicações próprias do uso do ACO. Foram identificadas variáveis prognósticas: renda familiar, uso inadequado, procedimento invasivo, interação medicamentosa, hábitos alimentares, condições clínicas, outros fatores (estresse, emagrecimento, perda de peso). O C Statistic para o Escore de Adesão Simonetti & Mancussi foi de 0,94. Em usuários de Anticoagulante oral, o escore de adesão Simonetti & Mancussi mostrou-se de aplicabilidade fácil e exequível, com alto valor preditivo mediante os fatores intervenientes da adesão e permitiu o direcionamento para tomadas de decisões objetivas e direcionadas para o problema, facilitando a melhoria da adesão e manutenção na faixa ideal. / Maintaining the INR (International Normalized Ratio), a specific blood test performed in users of oral anticoagulants, determines the individual outcomes of those within or not the therapeutic range. According to the European (2015) and American (2014) guidelines, the therapeutic range recommended for atrial fibrillation and other thromboembolic events is 2 to 3. For those with mechanical valve prosthesis, the therapeutic range is 2.5 to 3.5. Bleeding can occur as a complication when the therapeutic range is exceeded whereas thrombotic events can occur when the therapeutic range is not reached. The inferences related to the complications due to changes in the INR are associated with inappropriate use of medication, drug and food interactions, health problems, invasive and surgical procedures, and other factors such as stress, physical activity, weight loss and weight gain. Interventions based on health education through instruments that stratify and accurately identify the factors keeping people out of the therapeutic INR range will facilitate adherence to treatment and consequently reduce the risks to life in this population. This main objective was to assess and identify the factors interfering in adherence to users of OAC (oral anticoagulants) and to propose an adherence score for users of OAC to maintain the therapeutic range. It is an observational, analytical, cross-sectional and quantitative study performed in a center of oral anticoagulation of a public hospital specialized in Cardiology associated with the Secretaria of the State of São Paulo. The study included 607 users of OAC that met the inclusion criteria: 18 years old or older, literate and registered in the OAC system and started using OAC two weeks later. For the development model the chosen outcome was altered INR and the predictor variables were medication handling, drug and food interactions, physical activity, surgeries and procedures, adequate use of medication, health issues, other factors. Data were collected by the researcher. Part I of the questionnaire contained questions related to characterization and Part II questioned the clinical profile. Before data collection, the users signed the informed consent form. Data on the sociodemographic profile were presented in absolute frequencies and percentages. Variables with a significance level less than 5% in the exploratory analysis or those considered clinically relevant were submitted to a multiple logistic regression model. Six hundred seven OAC users participated in the study. The sociodemographic profile of the population was: 52% female, 57% married, 62% over 60 years old, 42% with incomplete primary education, 93%from São Paulo. The variables with a significance level less than 5% in the multivariate analysis were: education, family income, inadequate use, drug interactions, invasive procedures, food interactions, physical activity, clinical conditions, other factors and OAC-associated complications themselves. The identified prognostic variables were: family income, inadequate use, invasive procedure, drug interactions, dietary habits, clinical conditions, other factors (stress, getting thinner, weight loss). The C statistic for the Adherence score Simonetti & Mancussi was 0.94. In users of OAC, the adherence score Simonetti & Mancussi proved to be of easy and practical applicability, with high predictive value given the factors intervening on adherence and allowed for objective and problem-focused decision making, thereby facilitating improvement of adherence and maintenance of the optimal range.

Os anticoagulantes orais são fármacos que agem aumentando o tempo de coagulação sanguínea, úteis na ocorrência de certas doenças que levam a formação de trombos intravasculares. Portanto, controles constantes dos níveis sanguíneos são necessários para um tratamento seguro. Algumas estratégias, como a intervenção educativa, vem demonstrando bons resultados. No presente estudo, o objetivo principal foi avaliar a qualidade de vida relacionada à saúde, adesão ao tratamento e autoeficácia de pacientes que iniciaram o uso de anticoagulantes orais segundo a participação em um programa educativo (Grupo Intervenção) ou o recebimento do cuidado de rotina (Grupo Controle). Como objetivos secundários, comparamos o estado de saúde percebido e a presença de sintomas de ansiedade e depressão entre os grupos. Trata-se de um estudo experimental com designação aleatória em dois grupos (Intervenção ou Controle). Há aprovação do Comitê de Ética em Pesquisa e registro na base ClinicalTrials.gov. Realizado no Hospital Estadual de Ribeirão Preto, foram incluídos pacientes que iniciaram o uso de anticoagulantes orais para tratamento clínico pela primeira vez, maiores de 18 anos e com avaliação cognitiva adequada. A estratificação e a aleatorização dos sujeitos foram obtidas por The Outpatient Bleeding Risk Index e por blocos, respectivamente. Envelopes coloridos foram usados na designação dos grupos. O programa educativo foi norteado pela Teoria de Bandura e composto por informações verbais e por escrito do tratamento dados durante a internação e contatos telefônicos para o reforço dessas informações na primeira e quarta semanas após a alta hospitalar do participante. Na coleta dos dados foram aplicados os instrumentos: caracterização sociodemográfica e clínica, Duke Anticoagulation Satisfaction Scale, Medidas de Adesão ao Tratamento, Hospital Anxiety and Depression Scale, Escala Visual Analógica. As análises foram feitas pelo IBM Statistical Package for Social Science (SPSS) version 21.0. Foram realizadas análises descritivas de frequência simples, de posição e de dispersão. Para a comparação das variáveis entre os grupos foi usado o teste T de Student não pareado. Para a comparação das frequências dos sintomas de ansiedade e depressão foi usada o teste Qui-quadrado ou o T de Student. Já a comparação das variáveis no início e no final do estudo em cada grupo foi obtida pelo teste T de Student pareado ou seu similar não paramétrico (teste de Wilcoxon). O Qui-quadrado foi aplicado para a comparação da ansiedade e depressão, antes e depois, em cada grupo. O nível de significância adotado foi de 5%. A comparação dos grupos mostrou características semelhantes, maioria de mulheres, casadas, idade próxima a 60 anos, Fibrilação Atrial ou Trombose Venosa Profunda como indicação para o início do anticoagulante oral. O Grupo Intervenção apresentou melhor qualidade de vida relacionada à saúde, maior adesão, maior autoeficácia diante do novo tratamento, o que possivelmente refletiu em menor ansiedade e depressão em relação ao Grupo Controle. Concluímos que a participação em um programa educacional proporcionou melhores desfechos em relação àqueles que receberam o cuidado de rotina. / Oral anticoagulants are drugs that act by increasing blood clotting time and are useful in the presence of certain diseases that lead to the formation of intravascular thrombi. Thus, constant controls of blood levels are necessary for a safe treatment. Some strategies such as educational intervention are showing good results. The main objective of the present study was to assess the quality of life related to health, adhesion to treatment and self-efficacy of patients who had started the use of oral anticoagulants according to the participation in an educational program (Intervention Group) or receiving routine care (Control Group). Secondary objectives were to compare the health status perceived and the presence of anxiety and depression symptoms between groups. This was an experimental study of random design conducted on two groups (Intervention and Control). The Research Ethics Committee approved the study, which was registered in the ClinicalTrials.gov database, and all subjects gave written informed consnet to participate. The study was conducted at the State Hospital of Ribeirão Preto and included patients who had started the use of oral anticoagulants for clinical treatment for the first time, who were older than 18 years and who had adequate cognitive function. The subjects were stratified and randomized using the Outpatient Bleeding Risk Index and by block, respectively. Colored envelopes were used for group allotment. The educational program was based on Bandura\'s theory and consisted of verbal and written information about the treatments applied during hospitalization and of telephone contacts for the reinfordcement of this information during the first and fourth weeks after hospital discharge of the patient. The following instruments were applied during data collection: sociodemographic and clinical characterization, Duke Anticoagulation Satisfaction Scale, Measurements of Adhesion to Treatment, Hospital Anxiety and Depression Scale, and Visual Analogue Scale. The analyses were carried out using the IBM Statistical Package for the Social Sciences (SPSS) version 21.0. Descriptive analyses of simple frequency, position and dispersal were performed. The unpaired Student t-test was used to compare the variables between groups, and the Chi-square or Student t-test was used to compare the frequency of anxiety and depression symptoms, while the paired Student t-test or the non-parametric Wilcoxon test was used to compare the variables at the beginning and at the end of the study in each group. The Chi-square test was applied to compare anxiety and depression before and after the study in each group. The levels of significance was set at 5%. Group comparison showed similar characteristics, a majority of women who were married and aged close to 60 years, and atrial fibrillation or deep venous thrombosis as the indication of the use of an oral anticoagulant. The Intervention Group showed better quality of life related to health, greater adhesion, and more self-efficacy when receiving the new treatment, a fact that possibly reflected lower anxiety and depression compared to the Control Group. We conclude that the participation in an educational program provided better outcomes compared to patients who received routine care.

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