RESUMO
OBJECTIVE: Accurate prediction of survival prognosis is helpful to guide clinical decision-making. The aim of this study was to develop a model using machine learning techniques to predict the occurrence of composite thromboembolic events (CTEs) in elderly patients with atrial fibrillation(AF). These events encompass newly diagnosed cerebral ischemia events, cardiovascular events, pulmonary embolism, and lower extremity arterial embolism. METHODS: This retrospective study included 6,079 elderly hospitalized patients (≥ 75 years old) with AF admitted to the People's Liberation Army General Hospital in China from January 2010 to June 2022. Random forest imputation was used for handling missing data. In the descriptive statistics section, patients were divided into two groups based on the occurrence of CTEs, and differences between the two groups were analyzed using chi-square tests for categorical variables and rank-sum tests for continuous variables. In the machine learning section, the patients were randomly divided into a training dataset (n = 4,225) and a validation dataset (n = 1,824) in a 7:3 ratio. Four machine learning models (logistic regression, decision tree, random forest, XGBoost) were trained on the training dataset and validated on the validation dataset. RESULTS: The incidence of composite thromboembolic events was 19.53%. The Least Absolute Shrinkage and Selection Operator (LASSO) method, using 5-fold cross-validation, was applied to the training dataset and identified a total of 18 features that exhibited a significant association with the occurrence of CTEs. The random forest model outperformed other models in terms of area under the curve (ACC: 0.9144, SEN: 0.7725, SPE: 0.9489, AUC: 0.927, 95% CI: 0.9105-0.9443). The random forest model also showed good clinical validity based on the clinical decision curve. The Shapley Additive exPlanations (SHAP) showed that the top five features associated with the model were history of ischemic stroke, high triglyceride (TG), high total cholesterol (TC), high plasma D-dimer, age. CONCLUSIONS: This study proposes an accurate model to stratify patients with a high risk of CTEs. The random forest model has good performance. History of ischemic stroke, age, high TG, high TC and high plasma D-Dimer may be correlated with CTEs.
Assuntos
Fibrilação Atrial , Técnicas de Apoio para a Decisão , Aprendizado de Máquina , Valor Preditivo dos Testes , Tromboembolia , Humanos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Feminino , Masculino , Idoso , Estudos Retrospectivos , Medição de Risco , China/epidemiologia , Tromboembolia/epidemiologia , Tromboembolia/diagnóstico , Tromboembolia/etiologia , Fatores de Risco , Idoso de 80 Anos ou mais , Incidência , Prognóstico , Fatores Etários , Reprodutibilidade dos Testes , População do Leste AsiáticoRESUMO
OBJECTIVE: to analyze the association between coronavirus disease infection and thromboembolic events in people with cancer in the first year of the pandemic. METHOD: case-control study carried out by collecting medical records. The selected cases were adults with cancer, diagnosed with a thromboembolic event, treated in the selected service units during the first year of the pandemic. The control group included adults with cancer without a diagnosis of a thromboembolic event. Pearson's chi-square test was applied to verify the association between risk factors and the outcome and logistic regression techniques were applied to identify the odds ratio for the occurrence of a thromboembolic event. RESULTS: there were 388 cases and 440 control cases included in the study (ratio 1/1). Females predominated, who were white, with mean age of 58.2 (±14.8) years. Antineoplastic chemotherapy was the most used treatment and coronavirus disease was identified in 11.59% of participants. In the case group, deep vein thrombosis was more prevalent. CONCLUSION: the study confirmed the hypothesis that coronavirus disease infection did not increase the chance of thromboembolic events in people with cancer. For the population studied, the factors that were associated with these events were those related to cancer and its treatment. HIGHLIGHTS: (1) Deep vein thrombosis was what prevailed in the studied population. (2) Chemotherapy increased the chance of thromboembolic events by 65%. (3) Thromboembolic events showed a significant association with a higher death rate as the outcome. (4) COVID-19 did not increase the risk of thromboembolic events in people with cancer.
Assuntos
COVID-19 , Neoplasias , Tromboembolia , Humanos , COVID-19/complicações , COVID-19/epidemiologia , Feminino , Estudos de Casos e Controles , Masculino , Neoplasias/complicações , Neoplasias/epidemiologia , Pessoa de Meia-Idade , Tromboembolia/epidemiologia , Tromboembolia/etiologia , Idoso , Fatores de Risco , Adulto , PandemiasRESUMO
Cancer is associated with a hypercoagulable state and is a well-known independent risk factor for venous thromboembolism, whereas the association between cancer and arterial thromboembolism is less well established. Arterial thromboembolism, primarily defined as myocardial infarction or stroke is significantly more frequent in patients with cancer, independently of vascular risk factors and associated with a three-fold increase in the risk of mortality. Patients with brain cancer, lung cancer, colorectal cancer and pancreatic cancer have the highest relative risk of developing arterial thromboembolism. Antithrombotic treatments should be used with caution due to the increased risk of haemorrhage, as specified in current practice guidelines.
Assuntos
Neoplasias , Tromboembolia , Humanos , Tromboembolia/etiologia , Tromboembolia/epidemiologia , Tromboembolia/diagnóstico , Neoplasias/complicações , Neoplasias/epidemiologia , Fatores de Risco , França/epidemiologia , IdiomaAssuntos
Neoplasias , Rivaroxabana , Rivaroxabana/uso terapêutico , Humanos , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Resultado do Tratamento , Tromboembolia Venosa/tratamento farmacológico , Inibidores do Fator Xa/uso terapêutico , Medicina Baseada em Evidências , Anticoagulantes/uso terapêutico , Tromboembolia/prevenção & controle , Tromboembolia/etiologia , Tromboembolia/tratamento farmacológico , Comorbidade , Prevalência , Fatores de RiscoRESUMO
OBJECTIVES: The objectives of the study were to (1) study risk factors of thrombotic complications in coronavirus disease 2019 (COVID-19) pneumonitis, and (2) study progression of thrombotic complications after COVID-19 pneumonitis and its outcome. MATERIALS AND METHODS: A total of 50 COVID-19-positive admitted patients were studied using a purposive random sampling method. A questionnaire was used to collect data from patients' case records. RESULTS: Diabetes (42%) and hypertension (40%) were common comorbidities. The most common presentation of patients was thromboembolism, followed by cerebrovascular accident (CVA) and myocardial infarction (MI). Around 32% of patients died during the course of treatment. Deaths were more commonly seen in the age-group of 56 years or above than in those below 56 years. Death rates were higher among the group of patients with diabetes, hypertension, and ischemic heart diseases than the group of patients without those diseases, respectively. Patients in whom intubation was needed had a higher death rate than those without the need for it. The mean C-reactive protein (CRP) value was higher in patients who died than in those who survived. The death rate was lower in patients who were thrombolysed than in those who were not, in both pulmonary embolism and MI cases. CONCLUSION: The most common age-group admitted to the hospital was 46-55 years. The two most common underlying risk factors were diabetes and hypertension. Three common presentations of patients were thromboembolism, followed by CVA and MI. Around 32% of patients died during the course of treatment. Deaths were more commonly seen in the age-group of 56 years or above than in those below 56 years. Death rates were higher among the group of patients with diabetes, hypertension, and ischemic heart diseases than the group of patients without those diseases, respectively. Patients in whom intubation was needed had a higher death rate than those without the need for it. The mean CRP value was higher in patients who died than in those who survived.
Assuntos
COVID-19 , Centros de Atenção Terciária , Humanos , Pessoa de Meia-Idade , COVID-19/complicações , COVID-19/epidemiologia , COVID-19/mortalidade , Masculino , Feminino , Estudos Retrospectivos , Índia/epidemiologia , Adulto , Fatores de Risco , Trombose/epidemiologia , Trombose/etiologia , Idoso , Tromboembolia/epidemiologia , Tromboembolia/etiologia , Hipertensão/epidemiologia , Hipertensão/complicações , Hospitalização/estatística & dados numéricos , Infarto do Miocárdio/epidemiologia , Comorbidade , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , SARS-CoV-2RESUMO
METHODS: Due to demographic change, the number of polytraumatized geriatric patients (> 64 years) is expected to further increase in the coming years. In addition to the particularities of the accident and the associated injury patterns, prolonged inpatient stays are regularly observed in this group. The aim of the evaluation is to identify further factors that cause prolonged inpatient stays. A study of the data from the TraumaRegister DGU® from 2016-2020 was performed. Inclusion criteria were an age of over 64 years, intensive care treatment in the GAS-region, and an Injury Severity Score (ISS) of at least 16 points. All patients who were above the 80th percentile for the average length of stay or average intensive care stay of the study population were defined as so-called long-stay patients. This resulted in a prolonged inpatient stay of > 25 days and an intensive care stay of > 13 days. Among other, the influence of the cause of the accident, injury patterns according to body regions, the occurrence of complications, and the influence of numerous clinical parameters were examined. RESULTS: A total of 23,026 patients with a mean age of 76.6 years and a mean ISS of 24 points were included. Mean ICU length of stay was 11 ± 12.9 days (regular length of stay: 3.9 ± 3.1d vs. prolonged length of stay: 12.8 ± 5.7d) and mean inpatient stay was 22.5 ± 18.9 days (regular length of stay: 20.7 ± 15d vs. 35.7 ± 22.3d). A total of n = 6,447 patients met the criteria for a prolonged length of stay. Among these, patients had one more diagnosis on average (4.6 vs. 5.8 diagnoses) and had a higher ISS (21.8 ± 6 pts. vs. 26.9 ± 9.5 pts.) Independent risk factors for prolonged length of stay were intubation duration greater than 6 days (30-fold increased risk), occurrence of sepsis (4x), attempted suicide (3x), presence of extremity injury (2.3x), occurrence of a thromboembolic event (2.7x), and administration of red blood cell concentrates in the resuscitation room (1.9x). CONCLUSIONS: The present analysis identified numerous independent risk factors for significantly prolonged hospitalization of the geriatric polytraumatized patient, which should be given increased attention during treatment. In particular, the need for a smooth transition to psychiatric follow-up treatment or patient-adapted rehabilitative care for geriatric patients with prolonged immobility after extremity injuries is emphasized by these results.
Assuntos
Transfusão de Sangue , Fraturas Ósseas , Tempo de Internação , Tentativa de Suicídio , Humanos , Masculino , Feminino , Idoso , Fatores de Risco , Idoso de 80 Anos ou mais , Tentativa de Suicídio/estatística & dados numéricos , Transfusão de Sangue/estatística & dados numéricos , Fraturas Ósseas/epidemiologia , Tromboembolia/epidemiologia , Tromboembolia/etiologia , Escala de Gravidade do Ferimento , Traumatismo Múltiplo/epidemiologiaRESUMO
Female sex has been suggested as a risk modifier for stroke in patients with atrial fibrillation (AF) with comorbid prevalent stroke risk factors. Management has evolved over time towards a holistic approach that may have diminished any sex difference in AF-related stroke. In a nationwide cohort of AF patients free from oral anticoagulant treatment, we examine the time trends in stroke risk overall and in relation to risk differences between male and female patients. Here we show that among 158,982 patients with AF (median age 78 years (IQR: 71 to 85); 52% female) the 1-year thromboembolic risk was highest between 1997-2000 with a risk of 5.6% and lowest between 2013-2016 with a risk of 3.8%, declining over the last two decades. The excess stroke risk for female vs male patients has also been declining, with risk-score adjusted relative risk estimates suggesting limited sex-difference in recent years.
Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Humanos , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/complicações , Feminino , Masculino , Idoso , Acidente Vascular Cerebral/epidemiologia , Idoso de 80 Anos ou mais , Fatores de Risco , Estudos de Coortes , Fatores Sexuais , Anticoagulantes/uso terapêutico , Pessoa de Meia-Idade , Tromboembolia/epidemiologia , Tromboembolia/etiologiaRESUMO
BACKGROUND AND OBJECTIVES: In patients with mechanical heart valves and recent intracranial hemorrhage (ICH), clinicians need to balance the risk of thromboembolism during the period off anticoagulation and the risk of hematoma expansion on anticoagulation. The optimal timing of anticoagulation resumption is unknown. We aimed to investigate the relationship between reversal therapy and ischemic stroke, between duration off anticoagulation and risk of ischemic strokes or systemic embolism and between timing of anticoagulation resumption and risk of rebleeding and ICH expansion. METHODS: We conducted a retrospective cohort observational study in 3 tertiary hospitals. Consecutive adult patients with mechanical heart valves admitted for ICH between January 1, 2000, and July 13, 2022, were included. The primary end points of our study were thromboembolic events (cerebral, retinal, or systemic) while off anticoagulation and ICH expansion after anticoagulation resumption (defined by the following criteria: increase by one-third in intracerebral hematoma volume, increase by one-third in convexity subdural hemorrhage diameter, or visually unequivocal expansion of other ICH locations to the naked eye). RESULTS: A total of 171 patients with mechanical heart valves who experienced ICH were included in the final analysis. Most of the patients (79.5%) received reversal therapy for anticoagulation. Patients who received anticoagulation reversal therapy did not have increased risk of thromboembolic complications. Time off anticoagulation was not associated with risk of ischemic stroke; only 2 patients had a stroke within 7 days of the ICH, and both had additional major risk factors of thromboembolism. The rate of ischemic stroke/transient ischemic attack while off anticoagulation was lower than the rate of ICH expansion once anticoagulation was resumed (6.4% vs 9.9%). Furthermore, patients who developed ICH expansion had higher mortality compared with patients who had ischemic stroke while being off anticoagulation (41% vs 9%). Use of intravenous heparin bridging upon resumption of warfarin was strongly associated with increased risk of ICH expansion as compared with restarting warfarin without a heparin bridge. DISCUSSION: Withholding anticoagulation for at least 7 days after ICH may be safe in patients with mechanical heart valves. Heparin bridging during anticoagulation resumption may be associated with increased risk of bleeding.
Assuntos
Anticoagulantes , Hemorragias Intracranianas , Tromboembolia , Humanos , Masculino , Feminino , Anticoagulantes/efeitos adversos , Anticoagulantes/administração & dosagem , Idoso , Estudos Retrospectivos , Pessoa de Meia-Idade , Hemorragias Intracranianas/induzido quimicamente , Hemorragias Intracranianas/epidemiologia , Tromboembolia/prevenção & controle , Tromboembolia/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , AVC Isquêmico , Fatores de Tempo , Fatores de Risco , Idoso de 80 Anos ou maisRESUMO
PURPOSE OF REVIEW: Thromboembolic complications are a major contributor to global mortality. The relationship between inflammation and coagulation pathways has become an emerging research topic where the role of the innate immune response, and specifically neutrophils in "immunothrombosis" are receiving much attention. This review aims to dissect the intricate interplay between histones (from neutrophils or cellular damage) and the haemostatic pathway, and to explore mechanisms that may counteract the potentially procoagulant effects of those histones that have escaped their nuclear localization. RECENT FINDINGS: Extracellular histones exert procoagulant effects via endothelial damage, platelet activation, and direct interaction with coagulation proteins. Neutralization of histone activities can be achieved by complexation with physiological molecules, through pharmacological compounds, or via proteolytic degradation. Details of neutralization of extracellular histones are still being studied. SUMMARY: Leveraging the understanding of extracellular histone neutralization will pave the way for development of novel pharmacological interventions to treat and prevent complications, including thromboembolism, in patients in whom extracellular histones contribute to their overall clinical status.
Assuntos
Histonas , Humanos , Histonas/metabolismo , Neutrófilos/metabolismo , Coagulação Sanguínea , Animais , Ativação Plaquetária , Trombose/metabolismo , Tromboembolia/etiologia , Tromboembolia/metabolismo , Espaço Extracelular/metabolismoRESUMO
Oral anticoagulants are widely used in the home care of patients who require prevention and treatment of thromboembolic diseases. The irrational use of anticoagulants may cause thrombosis and hemorrhage. Currently, there are no national or international guidelines or consensus providing recommendations for home management of oral anticoagulants. Therefore, the Hospital Pharmacy Professional Committee of the Chinese Pharmaceutical Association organized domestic experts in the fields of clinical pharmacy, cardiovascular surgery, cardiovascular medicine, vascular surgery, respiratory medicine and laboratory science to sort out the relevant issues and compile the expert consensus on the home management of oral anticoagulants. The main contents of this consensus include pharmacological monitoring of oral anticoagulants, the process and precautions of carrying out home management of oral anticoagulants, and treatment of some special conditions during home management, with the aim of enhancing the safety and effectiveness of oral anticoagulants' usage and reducing the adverse events.
Assuntos
Anticoagulantes , Humanos , Administração Oral , Anticoagulantes/uso terapêutico , Anticoagulantes/administração & dosagem , China , Consenso , Monitoramento de Medicamentos , Serviços de Assistência Domiciliar , Tromboembolia/prevenção & controleRESUMO
Non-ischemic papillary muscle rupture (PMR) is rare. PMR caused by myocarditis in the presence of concurrent infective endocarditis (IE) and myocardial infarction (MI) has not been described. We report a 46-year-old male with recurrent MRSA bacteremia who presented in septic shock and suffered cardiac arrest. Echocardiography revealed acute mitral valve regurgitation resulting from posteromedial PMR. An intra-aortic balloon pump was implanted. Angiography revealed thrombotic occlusion of a small distal left circumflex artery. Emergent mitral valve replacement surgery was performed. MRSA myocarditis and IE were diagnosed by tissue cultures. Coexistence of myocarditis, IE, and MI poses a challenge in determining etiology.
Assuntos
Endocardite Bacteriana , Staphylococcus aureus Resistente à Meticilina , Infarto do Miocárdio , Miocardite , Músculos Papilares , Infecções Estafilocócicas , Humanos , Masculino , Pessoa de Meia-Idade , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico , Miocardite/diagnóstico , Miocardite/complicações , Miocardite/microbiologia , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Tromboembolia/etiologia , EcocardiografiaRESUMO
BACKGROUND: There is currently a lack of evidence for the comparative effectiveness of Andexanet alpha and four-factor prothrombin complex concentrate (4F-PCC) in anticoagulation reversal of direct oral anticoagulants (DOACs). The primary aim of our systematic review was to verify which drug is more effective in reducing short-term all-cause mortality. The secondary aim was to determine which of the two reverting strategies is less affected by thromboembolic events. METHODS: A systematic review and meta-analysis was performed. RESULTS: Twenty-two studies were analysed in the systematic review and quantitative synthesis. In all-cause short-term mortality, Andexanet alpha showed a risk ratio (RR) of 0.71(95% CI 0.37-1.34) in RCTs and PSMs, compared to 4F-PCC (I2 = 81%). Considering the retrospective studies, the pooled RR resulted in 0.84 (95% CI 0.69-1.01) for the common effects model and 0.82 (95% CI 0.63-1.07) for the random effects model (I2 = 34.2%). Regarding the incidence of thromboembolic events, for RCTs and PSMs, the common and the random effects model exhibited a RR of 1.74 (95% CI 1.09-2.77), and 1.71 (95% CI 1.01-2.89), respectively, for Andexanet alpha compared to 4F-PCC (I2 = 0%). Considering the retrospective studies, the pooled RR resulted in 1.21 (95% CI 0.87-1.69) for the common effects model and 1.18 (95% CI 0.86-1.62) for the random effects model (I2 = 0%). CONCLUSION: Considering a large group of both retrospective and controlled studies, Andexanet alpha did not show a statistically significant advantage over 4F-PCC in terms of mortality. In the analysis of the controlled studies alone, Andexanet alpha is associated with an increased risk of thromboembolic events. CLINICAL TRIAL REGISTRATION: PROSPERO: International prospective register of systematic reviews, 2024, CRD42024548768.
Assuntos
Anticoagulantes , Fatores de Coagulação Sanguínea , Humanos , Anticoagulantes/uso terapêutico , Anticoagulantes/efeitos adversos , Fatores de Coagulação Sanguínea/uso terapêutico , Fatores de Coagulação Sanguínea/farmacologia , Fator Xa/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Inibidores do Fator Xa/efeitos adversos , Proteínas Recombinantes , Tromboembolia/prevenção & controleRESUMO
Thromboembolic events are a common cause of morbidity and mortality with significant socioeconomic impact especially when young patients are affected. They are a rare medical event in young people and their clinical presentation can be mild or asymptomatic. The manifestation of symptoms and thrombotic events depends on both: the genetic mutations and the external risk factors that will induce the process. We present a case of a 34-year old young female, with three consecutive cerebrovascular insults in a period of ten years, and an acute myocardial infarction. There is a combination of gene mutations and polymorphism, with a predisposition to thromboembolic events. We emphasized the role of e-NOS (Endothelial nitric oxide synthase 786 T>C mutation) and the connection with smoking. The dual effect of the prolonged smoking and dysfunctional nitric oxide synthase in our young patient led to several thrombotic events. We discussed the various diagnostic tests and possible therapeutic and prophylactic strategies.
Assuntos
Predisposição Genética para Doença , Mutação , Óxido Nítrico Sintase Tipo III , Tromboembolia , Humanos , Feminino , Óxido Nítrico Sintase Tipo III/genética , Adulto , Tromboembolia/genética , Homozigoto , Fatores de Risco , Fumar/efeitos adversos , Infarto do Miocárdio/genética , FenótipoRESUMO
Heart failure (HF) is a common disorder associated with significant morbidity and mortality. It can increase the risk of thromboembolic events, which subsequently lead to increased risk of stroke, ischemic heart disease, thromboembolism, and death. Antithrombotic therapy has been investigated as a potential management strategy for HF patients in sinus rhythm, but its efficacy remains uncertain. Current guidelines do not recommend the routine use of antithrombotics in patients with HF in sinus rhythm without any other indication for their use. Several randomized controlled trials have investigated the efficacy of antithrombotics in HF patients in sinus rhythm. This article provides a concise review of the existing literature to assess the evidence supporting the use of antithrombotics in HF patients in sinus rhythm. The use of warfarin or other anticoagulants has demonstrated a lower risk of stroke but an increased risk of bleeding. The studies demonstrate that anticoagulant therapy in HF patients in sinus rhythm does not provide significant benefits in terms of overall ischemic events or death.
Assuntos
Fibrinolíticos , Insuficiência Cardíaca , Humanos , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/complicações , Fibrinolíticos/uso terapêutico , Anticoagulantes/uso terapêutico , Hemorragia/induzido quimicamente , Varfarina/uso terapêutico , Varfarina/efeitos adversos , Tromboembolia/prevenção & controle , Acidente Vascular Cerebral/prevenção & controle , Inibidores da Agregação Plaquetária/uso terapêuticoAssuntos
Anticoagulantes , Fibrilação Atrial , Ablação por Cateter , Hemorragia , Tromboembolia , Humanos , Fibrilação Atrial/cirurgia , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Tromboembolia/prevenção & controle , Tromboembolia/etiologia , Hemorragia/induzido quimicamente , Administração Oral , Medição de Risco , Fatores de RiscoAssuntos
Anticoagulantes , Fibrilação Atrial , Ablação por Cateter , Hemorragia , Tromboembolia , Humanos , Fibrilação Atrial/complicações , Fibrilação Atrial/cirurgia , Anticoagulantes/efeitos adversos , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Ablação por Cateter/efeitos adversos , Tromboembolia/prevenção & controle , Tromboembolia/etiologia , Hemorragia/induzido quimicamente , Fatores de RiscoRESUMO
BACKGROUND AND AIMS: Concerns about the safety of coronavirus disease 2019 (COVID-19) vaccines in patients with atrial fibrillation/flutter (AF/AFL) have arisen due to reports of thrombo-embolic events following COVID-19 vaccination in the general population. This study aimed to evaluate the risk of thrombo-embolic events after COVID-19 vaccination in patients with AF/AFL. METHODS: This was a modified self-controlled case-series study using a comprehensive nationwide-linked database provided by the National Health Insurance Service in South Korea to calculate incidence rate ratios (IRRs) of thrombo-embolic events. The study population included individuals aged ≥12 years who were either vaccinated (e.g. one or two doses) or unvaccinated during the period from February to December 2021. The primary outcome was a composite of thrombo-embolic events, including ischaemic stroke, transient ischaemic attack, and systemic thromboembolism. The risk period was defined as 0-21 days following COVID-19 vaccination. RESULTS: The final analysis included 124 127 individuals with AF/AFL. The IRR of thrombo-embolic events within 21 days after COVID-19 vaccination, compared with that during the unexposed control period, was 0.93 [95% confidence interval (CI) 0.77-1.12]. No significant risk variations were noted by sex, age, or vaccine type. However, patients without anticoagulant therapy had an IRR of 1.88 (95% CI 1.39-2.54) following vaccination. CONCLUSIONS: In patients with AF/AFL, COVID-19 vaccination was generally not associated with an increased risk of thrombo-embolic events. However, careful individual risk assessment is required when advising vaccination for those not on oral anticoagulant, as these patients exhibited an increased risk of thrombo-embolic events post-vaccination.
Assuntos
Fibrilação Atrial , Vacinas contra COVID-19 , COVID-19 , Tromboembolia , Humanos , Masculino , Tromboembolia/prevenção & controle , Tromboembolia/epidemiologia , Tromboembolia/etiologia , Feminino , Fibrilação Atrial/epidemiologia , Vacinas contra COVID-19/efeitos adversos , Pessoa de Meia-Idade , Idoso , COVID-19/prevenção & controle , COVID-19/epidemiologia , COVID-19/complicações , República da Coreia/epidemiologia , Adulto , SARS-CoV-2 , Flutter Atrial/epidemiologia , Adulto Jovem , Idoso de 80 Anos ou mais , Adolescente , Incidência , Vacinação/efeitos adversosRESUMO
Despite growing evidence over the last few years of the efficacy and safety of direct thrombus aspiration using a large bore distal access catheter as a type of mechanical thrombectomy procedure in acute stroke large-vessel occlusion patients, the experience and evidence of this technique for managing thromboembolic complications in endovascular aneurysm treatment is still limited and little research is available regarding this topic. We present a case of a thromboembolic occlusion of the left middle cerebral artery during the preprocedural angiograms of a large and fusiform left internal carotid artery aneurysm. This complication was successfully managed by navigating an already-placed distal access catheter intended for support during the opening of the flow-diverting stent; therefore, the thrombus was manually aspirated for two minutes, and Thrombolysis in Cerebral Infarction (TICI) scale 3 flow was restored. This case should encourage the use of a distal access catheter, already placed for aneurysm treatment, to perform zero-delay direct thrombus aspiration as a rescue approach for thromboembolic complications during endovascular treatments.