ABC | Volume 110, Nº3, March 2018

Editorial Oliveira & Ferreira Yellow fever and cardiovascular disease Arq Bras Cardiol. 2018; 110(3):207-210 Figure 1 – Algorithm for the management of antiplatelet drugs in patients with coronary stents implanted within less than 12 months and yellow fever with neither active bleeding nor blood dyscrasia signs. ASA: acetylsalicylic acid. Yellow fever in patients with coronary stent implantation ≤ 12 months Stent implantation < 3 months Stent implantation ≥ 3 months Platelet count > 50,000/mm 3 Platelet count > 50,000/mm 3 Platelet count 30,000-50,000/mm 3 Platelet count 30,000-50,000/mm 3 Platelet count < 30,000/mm 3 Platelet count < 30,000/mm 3 Maintain ASA and P2Y12 inhibitor, with daily platelet count PRECISE-DAPT PRECISE-DAPT Suspend ASA and P2Y12 inhibitor, with in-hospital daily platelet count Maintain only ASA, with in-hospital daily platelet count Suspend ASA and P2Y12 inhibitor, with in-hospital daily platelet count < 25 points < 25 points ≥ 25 points ≥ 25 points Maintain ASA and P2Y12 inhibitor, with in-hospital daily platelet count Maintain only ASA, with in-hospital daily platelet count Maintain ASA and P2Y12 inhibitor, with daily platelet count Maintain only ASA, with daily platelet count likelihood of clinical deterioration. This recommendation is based on the previous demonstration that the suspension or reduction of those drugs in heart failure proved to be deleterious in other situations of clinical agudization. 18 Thus, similarly to diuretics and ACE inhibitors, statins should be avoided even in moderate severity cases, mainly because of their potential hepatotoxic effect. Finally, the vaccine against YF should not be contraindicated based only on the presence of an underlying heart disease, even in patients with previous infarction and/or heart failure. For those patients, the criteria are the same already recommended by the Ministry of Health, with vaccination preferably indicated in the presence of high likelihood of exposure to the virus and low risk for adverse effects. 14 In the context of heart disease, only transplanted patients should not be vaccinated, because they are on chronic immunosuppressive therapy. There is an increasing need for further and more detailed studies that assess how arboviral and cardiovascular diseases interact from both the individual and epidemiological viewpoints. In addition, the ineffective control of those epidemics is clearly related to socioeconomic deficiencies and failures in the environmental and urban planning processes, mainly in developing countries. The combination of such factors might be the intersection point, to where investments and research should be primarily directed. 209