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a talidomida &#233; um dos medicamentos mais utilizados para essa condi&#231;&#227;o&#44; por ser efetiva e apresentar menores efeitos adversos em longo prazo&#44; quando comparada aos corticosteroides ou outros imunossupressores&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a> Por outro lado&#44; o uso dessa medica&#231;&#227;o e seus similares no tratamento do mieloma m&#250;ltiplo&#44; principalmente quando associada a corticosteroides e quimioter&#225;picos&#44; demonstrou risco aumentado para eventos vasculares tromboemb&#243;licos&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">At&#233; recentemente&#44; atribu&#237;a&#8208;se esse risco &#224; doen&#231;a hematol&#243;gica de base&#59; por outro lado&#44; principalmente nas &#250;ltimas duas d&#233;cadas&#44; diversos relatos de eventos tromboemb&#243;licos em pacientes utilizando talidomida e corticosteroides em associa&#231;&#227;o com outras condi&#231;&#245;es que n&#227;o mieloma m&#250;ltiplo foram publicados&#44; ressaltando&#8208;se diversos casos em pacientes de hansen&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">5&#8211;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Recentemente&#44; um estudo transversal realizado no estado de Minas Gerais evidenciou a preval&#234;ncia de trombose venosa profunda &#40;TVP&#41; em 10&#37; dos casos de efeitos adversos &#224; talidomida&#46; Dos dez pacientes que sofreram o efeito tromboemb&#243;lico&#44; nove fizeram uso concomitante de prednisona&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">A fim de explorar essa associa&#231;&#227;o&#44; realizamos estudo transversal anal&#237;tico incluindo todos os pacientes de hansen&#237;ase multibacilar atendidos no Servi&#231;o de Dermatologia do Hospital das Cl&#237;nicas da Faculdade de Medicina de Botucatu &#8208; UNESP e seguidos por pelo menos quatro meses&#44; visto que as rea&#231;&#245;es hans&#234;nicas tipo 2 e o uso da talidomida normalmente se iniciam ap&#243;s o in&#237;cio da poliquimioterapia e os fen&#244;menos tromb&#243;ticos foram relatados ocorrerem em m&#233;dia 45 a 90 dias ap&#243;s o uso da medica&#231;&#227;o em pacientes oncol&#243;gicos&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Os dados foram obtidos entre fevereiro de 2020 e janeiro de 2022 por meio de pesquisa em prontu&#225;rio eletr&#244;nico de pacientes atendidos no ambulat&#243;rio de hansen&#237;ase do respectivo servi&#231;o de dermatologia entre os anos de 2012 e 2021&#44; ap&#243;s aprova&#231;&#227;o do Comit&#234; de &#201;tica em Pesquisa &#40;CAAE&#58; 57896422&#46;6&#46;0000&#46;5411 &#124; Parecer 5&#46;410&#46;411&#41;&#46; 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com idade m&#233;dia de 55 &#40;&#177;14&#41; anos&#44; dos quais 68&#44;5&#37; eram homens&#44; acompanhados por per&#237;odo mediano de 39 &#40;1 q&#8208;3 q&#58; 19&#8208;70&#41; meses&#59; 22&#44;5&#37; dos pacientes eram tabagistas&#44; sem associa&#231;&#227;o com sexo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;59&#41;&#46; Durante o per&#237;odo estudado&#44; 19 pacientes apresentaram eritema nodoso hans&#234;nico em atividade e foram tratados com talidomida e corticosteroide concomitantemente&#46; Desses pacientes&#44; cinco sofreram algum ECV &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Ocorreram tr&#234;s epis&#243;dios de trombose venosa profunda &#40;TVP&#41; nos membros inferiores&#44; um infarto agudo do mioc&#225;rdio e um infarto espl&#234;nico com trombose mural a&#243;rtica&#46; Todos os eventos observados ocorreram durante o uso combinado das medica&#231;&#245;es &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; Nenhum ECV ocorreu no grupo de pacientes que n&#227;o recebeu as medica&#231;&#245;es concomitantemente&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Al&#233;m disso&#44; ressalta&#8208;se a alta preval&#234;ncia de tabagismo nos casos de ECV&#44; que apesar de elevada n&#227;o foi estatisticamente significante &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;07&#41;&#46; Por outro lado&#44; entre os usu&#225;rios de talidomida&#44; o tabagismo esteve associado &#224; ocorr&#234;ncia de ECV &#40;60&#37;<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>7&#44;4&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02 &#8211; teste exato de Fisher&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0050" class="elsevierStylePara elsevierViewall">No presente estudo&#44; identificamos taxa de 26&#44;3&#37; &#40;5&#47;19&#41; de ECV e 15&#44;8&#37; &#40;3&#47;19&#41; de TVP em pacientes hansenianos que receberam talidomida e prednisona conjuntamente&#59; no entanto&#44; considerando todos os usu&#225;rios de talidomida&#44; as taxas foram de 15&#44;6&#37; &#40;5&#47;32&#41; e 9&#44;4&#37; &#40;3&#47;32&#41;&#44; respectivamente&#46; Tamb&#233;m devemos observar que muitos desses pacientes eram tabagistas&#46; Por outro lado&#44; em pacientes de mieloma m&#250;ltiplo recebendo talidomida e dexametasona o risco de TVP sem profilaxia foi relatado em at&#233; 25&#37;&#44; o que se aproxima de nossos resultados&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Nas &#250;ltimas d&#233;cadas&#44; acumularam&#8208;se relatos de casos de eventos vasculares tromboemb&#243;licos durante o uso concomitante das medica&#231;&#245;es estudadas em pacientes de hansen&#237;ase&#46; Porto et al&#46; &#40;2019&#41; relataram 16 casos de TVP&#44; a maioria em homens&#44; como em nossa amostra&#44; de modo que recomendam a profilaxia com AAS 100<span class="elsevierStyleHsp" style=""></span>mg&#47;dia quando dessa associa&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a> Somado a este relato&#44; existem diversos outros semelhantes&#44; por&#233;m provenientes de diferentes pa&#237;ses&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">6&#44;7&#44;11&#44;12</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Sharma et al&#46; avaliaram a seguran&#231;a do uso de talidomida em 25 pacientes com diferentes doen&#231;as dermatol&#243;gicas&#44; tendo observado cinco casos &#40;20&#37;&#41; de TVP&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">13</span></a> A fisiopatologia dos efeitos tromboemb&#243;licos da talidomida n&#227;o &#233; totalmente compreendida&#44; por&#233;m em estudos com animais observou&#8208;se a redu&#231;&#227;o do tempo de sangramento&#44; de trombina e de protrombina e aumento dos n&#237;veis s&#233;ricos do fator IX e fibrinog&#234;nio&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a> Por outro lado&#44; &#233; frequente o achado de anticorpos antifosfol&#237;pides &#40;AAF&#41; em pacientes hansenianos&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a> Um estudo de 2018 observou a presen&#231;a de AAF em seis de sete pacientes com hansen&#237;ase multibacilar que apresentaram evento tromboemb&#243;lico&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a> Associa&#231;&#227;o da persist&#234;ncia de AAF com a idade&#44; carga bacilar e forma cl&#237;nica em pacientes com hansen&#237;ase tamb&#233;m j&#225; foi relatada&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a> Apesar de a maioria dos relatos de eventos vasculares com o uso da talidomida serem venosos&#44; h&#225; relatos de eventos arteriais em pacientes utilizando talidomida para mieloma m&#250;ltiplo&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a> Do mesmo modo&#44; em estudo com pacientes com mieloma m&#250;ltiplo em uso de talidomida foram observados sete eventos tromboemb&#243;licos entre 23 pacientes&#44; dois desses eventos foram arteriais&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">O presente estudo apresenta limita&#231;&#245;es por ser monoc&#234;ntrico&#44; retrospectivo e identificar n&#250;mero reduzido de eventos&#44; por&#233;m demonstra resultados concordantes com a literatura&#44; extendendo as observa&#231;&#245;es provenientes de outras condi&#231;&#245;es cl&#237;nicas&#44; como o mieloma m&#250;ltiplo&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#227;o</span><p id="par0070" class="elsevierStylePara elsevierViewall">Pacientes hansenianos multibacilares em tratamento de rea&#231;&#227;o tipo 2 com talidomida e corticosteroides apresentam risco significante de ECV&#44; devendo&#8208;se estar atento a sinais sugestivos desses eventos&#44; principalmente em pacientes com fatores de risco adicionais para ECV&#44; como o tabagismo&#46; Estudos prospectivos s&#227;o necess&#225;rios para esclarecer essas observa&#231;&#245;es&#44; assim como avaliar o benef&#237;cio de medidas profil&#225;ticas para esses eventos em pacientes hansenianos&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0075" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0080" class="elsevierStylePara elsevierViewall">Melissa de Almeida Corr&#234;a Alfredo&#58; Elabora&#231;&#227;o do texto&#59; participa&#231;&#227;o efetiva na proped&#234;utica&#59; revis&#227;o de literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Juliano Vilaverde Schmitt&#58; Elabora&#231;&#227;o do texto&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o&#59; participa&#231;&#227;o efetiva na proped&#234;utica&#59; revis&#227;o de literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o&#59; aprova&#231;&#227;o do manuscrito&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Anna Carolina Miola&#58; Participa&#231;&#227;o efetiva na coleta de dados&#59; elabora&#231;&#227;o do texto&#59; participa&#231;&#227;o efetiva na proped&#234;utica&#59; revis&#227;o de literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o do manuscrito&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Simone de P&#225;dua Milagres&#58; Participa&#231;&#227;o efetiva na coleta de dados&#59; elabora&#231;&#227;o do texto&#59; participa&#231;&#227;o efetiva na proped&#234;utica&#59; revis&#227;o de literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o do manuscrito&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Joel Carlos Lastoria&#58; Revis&#227;o cr&#237;tica do manuscrito&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o&#59; aprova&#231;&#227;o do manuscrito&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflito de interesses</span><p id="par0105" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A talidomida &#233; a medica&#231;&#227;o de escolha para o tratamento de rea&#231;&#245;es hans&#234;nicas tipo 2 e frequentemente &#233; associada aos corticosteroides&#46; O uso dessas medica&#231;&#245;es no mieloma m&#250;ltiplo est&#225; associado a risco de eventos cardiovasculares&#44; por&#233;m h&#225; escassez de estudos que avaliem esse risco em pacientes hansenianos&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar a ocorr&#234;ncia de eventos cardiovasculares em pacientes com hansen&#237;ase multibacilar e sua rela&#231;&#227;o com o uso de talidomida e prednisona&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo transversal anal&#237;tico envolvendo todos os pacientes com diagn&#243;stico de hansen&#237;ase multibacilar atendidos no servi&#231;o de Dermatologia entre os anos 2012 e 2022&#44; por meio de prontu&#225;rio eletr&#244;nico&#46; Foram considerados eventos vasculares tromboemb&#243;licos tanto arteriais quanto venosos&#44; incluindo infarto agudo do mioc&#225;rdio&#46; A vari&#225;vel independente principal foi o uso concomitante de talidomida e prednisona durante o seguimento&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos 89 pacientes&#44; dos quais 19 utilizaram talidomida e prednisona concomitantemente&#46; Houve cinco eventos &#40;26&#44;3&#37;&#41; cardiovasculares&#44; tr&#234;s deles foram trombose venosa profunda&#46; O uso combinado dos dois medicamentos esteve associado aos eventos &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#44;46 &#91;3&#44;92&#8211;10&#44;65&#93;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">N&#250;mero reduzido de eventos&#44; estudo monoc&#234;ntrico retrospectivo&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Corrobora&#8208;se a hip&#243;tese de associa&#231;&#227;o entre eventos cardiovasculares e o uso concomitante de talidomida e prednisona&#44; contudo h&#225; necessidade de estudos prospectivos mais robustos para melhor esclarecimento&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tempo de uso TH&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TVP membro inferior D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70 m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infarto espl&#234;nico e trombose mural a&#243;rtica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IAM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TVP il&#237;aco&#8208;femoral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74 m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vari&#225;vel&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Com ECV e uso de TH<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem ECV com uso de TH<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem uso de TH<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>57 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Raz&#227;o de preval&#234;ncia95&#37; IC<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sexo feminino<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;28&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;62 &#40;0&#44;10 a 3&#44;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tempo seguimento &#40;meses&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;39&#8211;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;33&#8211;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">34 &#40;17&#8211;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Idade in&#237;cio seguimento &#40;anos&#41;<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">46&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes <span class="elsevierStyleItalic">mellitus</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;18&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;19&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;05 &#40;0&#44;17&#8211;6&#44;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Hipertens&#227;o arterial sist&#234;mica<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10 &#40;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">23 &#40;40&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;52 &#40;0&#44;71&#8211;3&#44;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Tabagismo<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;7&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2&#44;96 &#40;1&#44;29&#8211;6&#44;81&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Usou TH com CT no seguimento<a class="elsevierStyleCrossRefs" href="#tblfn0010"><span class="elsevierStyleSup">a&#44;b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#44;46 &#40;3&#44;92&#8211;10&#44;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;01</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Tempo de uso TH &#40;meses&#41;<a class="elsevierStyleCrossRefs" href="#tblfn0010"><span class="elsevierStyleSup">a&#44;c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;6&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13 &#40;3&#8211;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Dose di&#225;ria &#40;mg&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">100 &#40;100&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">100 &#40;100&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;81&nbsp;\t\t\t\t\t\t\n
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Eventos cardiovasculares em pacientes hansenianos multibacilares e o uso de talidomida associada a corticosteroides
Melissa de Almeida Corrêa Alfredo
Autor para correspondência
melissa.alfredo@gmail.com

Autor para correspondencia.
, Juliano Vilaverde Schmitt, Anna Carolina Miola, Simone de Pádua Milagres, Joel Carlos Lastoria
Departamento de Infectologia, Dermatologia, Diagnóstico por Imagem e Radioterapia, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brasil
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">A hansen&#237;ase &#233; doen&#231;a infectocontagiosa causada por <span class="elsevierStyleItalic">Mycobacterium leprae</span>&#44; com evolu&#231;&#227;o cr&#244;nica frequentemente interrompida por per&#237;odos de agudiza&#231;&#227;o de sintomas&#44; denominados rea&#231;&#245;es hans&#234;nicas&#46; A doen&#231;a apresenta espectro variado de manifesta&#231;&#245;es cl&#237;nicas dependendo do padr&#227;o de resposta imune predominante do hospedeiro contra o bacilo&#46; As rea&#231;&#245;es hans&#234;nicas do tipo 2&#44; ou eritema nodoso hans&#234;nico&#44; ocorrem em pacientes com a forma multibacilar da doen&#231;a e podem persistir ou recorrer por v&#225;rios anos ap&#243;s o t&#233;rmino do tratamento antimicrobiano&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Atualmente&#44; a talidomida &#233; um dos medicamentos mais utilizados para essa condi&#231;&#227;o&#44; por ser efetiva e apresentar menores efeitos adversos em longo prazo&#44; quando comparada aos corticosteroides ou outros imunossupressores&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a> Por outro lado&#44; o uso dessa medica&#231;&#227;o e seus similares no tratamento do mieloma m&#250;ltiplo&#44; principalmente quando associada a corticosteroides e quimioter&#225;picos&#44; demonstrou risco aumentado para eventos vasculares tromboemb&#243;licos&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">At&#233; recentemente&#44; atribu&#237;a&#8208;se esse risco &#224; doen&#231;a hematol&#243;gica de base&#59; por outro lado&#44; principalmente nas &#250;ltimas duas d&#233;cadas&#44; diversos relatos de eventos tromboemb&#243;licos em pacientes utilizando talidomida e corticosteroides em associa&#231;&#227;o com outras condi&#231;&#245;es que n&#227;o mieloma m&#250;ltiplo foram publicados&#44; ressaltando&#8208;se diversos casos em pacientes de hansen&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">5&#8211;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Recentemente&#44; um estudo transversal realizado no estado de Minas Gerais evidenciou a preval&#234;ncia de trombose venosa profunda &#40;TVP&#41; em 10&#37; dos casos de efeitos adversos &#224; talidomida&#46; Dos dez pacientes que sofreram o efeito tromboemb&#243;lico&#44; nove fizeram uso concomitante de prednisona&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">A fim de explorar essa associa&#231;&#227;o&#44; realizamos estudo transversal anal&#237;tico incluindo todos os pacientes de hansen&#237;ase multibacilar atendidos no Servi&#231;o de Dermatologia do Hospital das Cl&#237;nicas da Faculdade de Medicina de Botucatu &#8208; UNESP e seguidos por pelo menos quatro meses&#44; visto que as rea&#231;&#245;es hans&#234;nicas tipo 2 e o uso da talidomida normalmente se iniciam ap&#243;s o in&#237;cio da poliquimioterapia e os fen&#244;menos tromb&#243;ticos foram relatados ocorrerem em m&#233;dia 45 a 90 dias ap&#243;s o uso da medica&#231;&#227;o em pacientes oncol&#243;gicos&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Os dados foram obtidos entre fevereiro de 2020 e janeiro de 2022 por meio de pesquisa em prontu&#225;rio eletr&#244;nico de pacientes atendidos no ambulat&#243;rio de hansen&#237;ase do respectivo servi&#231;o de dermatologia entre os anos de 2012 e 2021&#44; ap&#243;s aprova&#231;&#227;o do Comit&#234; de &#201;tica em Pesquisa &#40;CAAE&#58; 57896422&#46;6&#46;0000&#46;5411 &#124; Parecer 5&#46;410&#46;411&#41;&#46; Foram exclu&#237;dos pacientes com seguimento curto &#40;menos de quatro meses&#41; e paucibacilares&#44; assim como aqueles sem diagn&#243;stico estabelecido para hansen&#237;ase&#46; Foram considerados os eventos cardiovasculares &#40;ECV&#41; tanto arteriais quanto venosos&#46; O tempo de seguimento foi definido at&#233; o final do acompanhamento dermatol&#243;gico com alta ambulatorial&#44; ou at&#233; a ocorr&#234;ncia de um evento tromboemb&#243;lico&#46; Os dados coletados foram sexo&#44; idade ao in&#237;cio do tratamento&#44; tempo de seguimento&#44; ocorr&#234;ncia de evento&#44; tipo de evento&#44; uso de talidomida durante o seguimento associada ou n&#227;o a corticosteroides&#44; relato de hipertens&#227;o arterial sist&#234;mica &#40;HAS&#41;&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> &#40;DM&#41; ou tabagismo durante o seguimento&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0035" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos no estudo 89 pacientes multibacilares&#44; com idade m&#233;dia de 55 &#40;&#177;14&#41; anos&#44; dos quais 68&#44;5&#37; eram homens&#44; acompanhados por per&#237;odo mediano de 39 &#40;1 q&#8208;3 q&#58; 19&#8208;70&#41; meses&#59; 22&#44;5&#37; dos pacientes eram tabagistas&#44; sem associa&#231;&#227;o com sexo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;59&#41;&#46; Durante o per&#237;odo estudado&#44; 19 pacientes apresentaram eritema nodoso hans&#234;nico em atividade e foram tratados com talidomida e corticosteroide concomitantemente&#46; Desses pacientes&#44; cinco sofreram algum ECV &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Ocorreram tr&#234;s epis&#243;dios de trombose venosa profunda &#40;TVP&#41; nos membros inferiores&#44; um infarto agudo do mioc&#225;rdio e um infarto espl&#234;nico com trombose mural a&#243;rtica&#46; Todos os eventos observados ocorreram durante o uso combinado das medica&#231;&#245;es &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; Nenhum ECV ocorreu no grupo de pacientes que n&#227;o recebeu as medica&#231;&#245;es concomitantemente&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Al&#233;m disso&#44; ressalta&#8208;se a alta preval&#234;ncia de tabagismo nos casos de ECV&#44; que apesar de elevada n&#227;o foi estatisticamente significante &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;07&#41;&#46; Por outro lado&#44; entre os usu&#225;rios de talidomida&#44; o tabagismo esteve associado &#224; ocorr&#234;ncia de ECV &#40;60&#37;<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>7&#44;4&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02 &#8211; teste exato de Fisher&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0050" class="elsevierStylePara elsevierViewall">No presente estudo&#44; identificamos taxa de 26&#44;3&#37; &#40;5&#47;19&#41; de ECV e 15&#44;8&#37; &#40;3&#47;19&#41; de TVP em pacientes hansenianos que receberam talidomida e prednisona conjuntamente&#59; no entanto&#44; considerando todos os usu&#225;rios de talidomida&#44; as taxas foram de 15&#44;6&#37; &#40;5&#47;32&#41; e 9&#44;4&#37; &#40;3&#47;32&#41;&#44; respectivamente&#46; Tamb&#233;m devemos observar que muitos desses pacientes eram tabagistas&#46; Por outro lado&#44; em pacientes de mieloma m&#250;ltiplo recebendo talidomida e dexametasona o risco de TVP sem profilaxia foi relatado em at&#233; 25&#37;&#44; o que se aproxima de nossos resultados&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Nas &#250;ltimas d&#233;cadas&#44; acumularam&#8208;se relatos de casos de eventos vasculares tromboemb&#243;licos durante o uso concomitante das medica&#231;&#245;es estudadas em pacientes de hansen&#237;ase&#46; Porto et al&#46; &#40;2019&#41; relataram 16 casos de TVP&#44; a maioria em homens&#44; como em nossa amostra&#44; de modo que recomendam a profilaxia com AAS 100<span class="elsevierStyleHsp" style=""></span>mg&#47;dia quando dessa associa&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a> Somado a este relato&#44; existem diversos outros semelhantes&#44; por&#233;m provenientes de diferentes pa&#237;ses&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">6&#44;7&#44;11&#44;12</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Sharma et al&#46; avaliaram a seguran&#231;a do uso de talidomida em 25 pacientes com diferentes doen&#231;as dermatol&#243;gicas&#44; tendo observado cinco casos &#40;20&#37;&#41; de TVP&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">13</span></a> A fisiopatologia dos efeitos tromboemb&#243;licos da talidomida n&#227;o &#233; totalmente compreendida&#44; por&#233;m em estudos com animais observou&#8208;se a redu&#231;&#227;o do tempo de sangramento&#44; de trombina e de protrombina e aumento dos n&#237;veis s&#233;ricos do fator IX e fibrinog&#234;nio&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a> Por outro lado&#44; &#233; frequente o achado de anticorpos antifosfol&#237;pides &#40;AAF&#41; em pacientes hansenianos&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a> Um estudo de 2018 observou a presen&#231;a de AAF em seis de sete pacientes com hansen&#237;ase multibacilar que apresentaram evento tromboemb&#243;lico&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a> Associa&#231;&#227;o da persist&#234;ncia de AAF com a idade&#44; carga bacilar e forma cl&#237;nica em pacientes com hansen&#237;ase tamb&#233;m j&#225; foi relatada&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a> Apesar de a maioria dos relatos de eventos vasculares com o uso da talidomida serem venosos&#44; h&#225; relatos de eventos arteriais em pacientes utilizando talidomida para mieloma m&#250;ltiplo&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a> Do mesmo modo&#44; em estudo com pacientes com mieloma m&#250;ltiplo em uso de talidomida foram observados sete eventos tromboemb&#243;licos entre 23 pacientes&#44; dois desses eventos foram arteriais&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">O presente estudo apresenta limita&#231;&#245;es por ser monoc&#234;ntrico&#44; retrospectivo e identificar n&#250;mero reduzido de eventos&#44; por&#233;m demonstra resultados concordantes com a literatura&#44; extendendo as observa&#231;&#245;es provenientes de outras condi&#231;&#245;es cl&#237;nicas&#44; como o mieloma m&#250;ltiplo&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#227;o</span><p id="par0070" class="elsevierStylePara elsevierViewall">Pacientes hansenianos multibacilares em tratamento de rea&#231;&#227;o tipo 2 com talidomida e corticosteroides apresentam risco significante de ECV&#44; devendo&#8208;se estar atento a sinais sugestivos desses eventos&#44; principalmente em pacientes com fatores de risco adicionais para ECV&#44; como o tabagismo&#46; Estudos prospectivos s&#227;o necess&#225;rios para esclarecer essas observa&#231;&#245;es&#44; assim como avaliar o benef&#237;cio de medidas profil&#225;ticas para esses eventos em pacientes hansenianos&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0075" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0080" class="elsevierStylePara elsevierViewall">Melissa de Almeida Corr&#234;a Alfredo&#58; Elabora&#231;&#227;o do texto&#59; participa&#231;&#227;o efetiva na proped&#234;utica&#59; revis&#227;o de literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Juliano Vilaverde Schmitt&#58; Elabora&#231;&#227;o do texto&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o&#59; participa&#231;&#227;o efetiva na proped&#234;utica&#59; revis&#227;o de literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o&#59; aprova&#231;&#227;o do manuscrito&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Anna Carolina Miola&#58; Participa&#231;&#227;o efetiva na coleta de dados&#59; elabora&#231;&#227;o do texto&#59; participa&#231;&#227;o efetiva na proped&#234;utica&#59; revis&#227;o de literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o do manuscrito&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Simone de P&#225;dua Milagres&#58; Participa&#231;&#227;o efetiva na coleta de dados&#59; elabora&#231;&#227;o do texto&#59; participa&#231;&#227;o efetiva na proped&#234;utica&#59; revis&#227;o de literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o do manuscrito&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Joel Carlos Lastoria&#58; Revis&#227;o cr&#237;tica do manuscrito&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o&#59; aprova&#231;&#227;o do manuscrito&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflito de interesses</span><p id="par0105" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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            0 => "Hansen&#237;ase"
            1 => "Talidomida"
            2 => "Trombose venosa"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A talidomida &#233; a medica&#231;&#227;o de escolha para o tratamento de rea&#231;&#245;es hans&#234;nicas tipo 2 e frequentemente &#233; associada aos corticosteroides&#46; O uso dessas medica&#231;&#245;es no mieloma m&#250;ltiplo est&#225; associado a risco de eventos cardiovasculares&#44; por&#233;m h&#225; escassez de estudos que avaliem esse risco em pacientes hansenianos&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar a ocorr&#234;ncia de eventos cardiovasculares em pacientes com hansen&#237;ase multibacilar e sua rela&#231;&#227;o com o uso de talidomida e prednisona&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo transversal anal&#237;tico envolvendo todos os pacientes com diagn&#243;stico de hansen&#237;ase multibacilar atendidos no servi&#231;o de Dermatologia entre os anos 2012 e 2022&#44; por meio de prontu&#225;rio eletr&#244;nico&#46; Foram considerados eventos vasculares tromboemb&#243;licos tanto arteriais quanto venosos&#44; incluindo infarto agudo do mioc&#225;rdio&#46; A vari&#225;vel independente principal foi o uso concomitante de talidomida e prednisona durante o seguimento&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos 89 pacientes&#44; dos quais 19 utilizaram talidomida e prednisona concomitantemente&#46; Houve cinco eventos &#40;26&#44;3&#37;&#41; cardiovasculares&#44; tr&#234;s deles foram trombose venosa profunda&#46; O uso combinado dos dois medicamentos esteve associado aos eventos &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#44;46 &#91;3&#44;92&#8211;10&#44;65&#93;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">N&#250;mero reduzido de eventos&#44; estudo monoc&#234;ntrico retrospectivo&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Corrobora&#8208;se a hip&#243;tese de associa&#231;&#227;o entre eventos cardiovasculares e o uso concomitante de talidomida e prednisona&#44; contudo h&#225; necessidade de estudos prospectivos mais robustos para melhor esclarecimento&#46;</p></span>"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Como citar este artigo&#58; Alfredo MA&#44; Schmitt JV&#44; Miola AC&#44; Milagres SP&#44; Lastoria JC&#46; Cardiovascular events associated with thalidomide and prednisone in leprosy type 2 reaction&#46; An Bras Dermatol&#46; 2024&#59;99&#58;53&#8211;6&#46;</p>"
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        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0040">Trabalho realizado no Departamento de Infectologia&#44; Dermatologia&#44; Diagn&#243;stico por Imagem e Radioterapia&#44; Faculdade de Medicina&#44; Universidade Estadual Paulista&#44; Botucatu&#44; SP&#44; Brasil&#46;</p>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sexo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">HAS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tempo de seguimento&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tempo de uso TH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TVP il&#237;aco&#8208;femoral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TVP membro inferior D&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70 m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10 m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infarto espl&#234;nico e trombose mural a&#243;rtica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IAM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TVP il&#237;aco&#8208;femoral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74 m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 m&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vari&#225;vel&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Com ECV e uso de TH<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem ECV com uso de TH<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem uso de TH<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>57 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Raz&#227;o de preval&#234;ncia95&#37; IC<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Sexo feminino<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">16 &#40;28&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;62 &#40;0&#44;10 a 3&#44;69&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Tempo seguimento &#40;meses&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">56 &#40;39&#8211;56&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;33&#8211;86&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">34 &#40;17&#8211;55&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Idade in&#237;cio seguimento &#40;anos&#41;<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">54&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes <span class="elsevierStyleItalic">mellitus</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;18&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11 &#40;19&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;05 &#40;0&#44;17&#8211;6&#44;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipertens&#227;o arterial sist&#234;mica<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10 &#40;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;40&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;52 &#40;0&#44;71&#8211;3&#44;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tabagismo<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;7&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15 &#40;26&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2&#44;96 &#40;1&#44;29&#8211;6&#44;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Usou TH com CT no seguimento<a class="elsevierStyleCrossRefs" href="#tblfn0010"><span class="elsevierStyleSup">a&#44;b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;51&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#44;46 &#40;3&#44;92&#8211;10&#44;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;01</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tempo de uso TH &#40;meses&#41;<a class="elsevierStyleCrossRefs" href="#tblfn0010"><span class="elsevierStyleSup">a&#44;c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;6&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;3&#8211;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dose di&#225;ria &#40;mg&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 &#40;100&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">100 &#40;100&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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