RESUMO
We report a case of a man in his 70s who developed haemoptysis 3 days after commencing sildenafil. Before postulating a potential connection between sildenafil use and haemoptysis, it is important to rule out potential other causative factors and comorbidities. The patient suffers from multiple medical conditions and takes various medications. On examination, no abnormalities were discovered. There were no recent significant changes in his bloodwork. Cessation of sildenafil coincided with spontaneous symptom resolution. Chest CT was performed, and no abnormalities were reported. Pseudohaemoptysis or malignancy may be the main differential diagnoses of haemoptysis in elderly patients with multiple comorbidities. Concurrent anticoagulation of the patient may predispose to haemoptysis and is likely to be of greater clinical concern.
Assuntos
Hemoptise , Citrato de Sildenafila , Humanos , Citrato de Sildenafila/efeitos adversos , Masculino , Hemoptise/induzido quimicamente , Idoso , Tomografia Computadorizada por Raios X , Diagnóstico Diferencial , Vasodilatadores/efeitos adversosRESUMO
BACKGROUND: Iopamidol is a non-ionic, water-soluble iodine contrast agent that is considered safe for intravenous or intra-arterial administration and is widely used both in the general population and in patients undergoing oncological treatment. While adverse reactions to iopamidol have been documented, to date, no pulmonary and gastric hemorrhages induced by iopamidol have been reported in oncology patients. We report the first case of this complication. CASE PRESENTATION: We report the case of a 60-year-old woman with marginal zone lymphoma who was receiving antineoplastic therapy. As part of the investigation for the condition, she underwent chest enhancement CT with iopamidol. Shortly thereafter(within five minutes), she experienced hemoptysis and hematemesis. She was intubated and admitted to the intensive care unit. Pre- and post-contrast images demonstrated the course of the hemorrhage. Flexible bronchoscopy and gastroscopy on the following day showed no active bleeding, and the patient recovered completely after antiallergy treatment. We speculate that contrast-induced hypersensitivity was the most likely cause of the transient pulmonary and gastric bleeding. CONCLUSION: Although rare, the complications of iopamidol, which may cause allergic reactions in the lungs and stomach, should be considered.
Assuntos
Meios de Contraste , Hemoptise , Iopamidol , Linfoma de Zona Marginal Tipo Células B , Tomografia Computadorizada por Raios X , Humanos , Feminino , Pessoa de Meia-Idade , Meios de Contraste/efeitos adversos , Linfoma de Zona Marginal Tipo Células B/tratamento farmacológico , Linfoma de Zona Marginal Tipo Células B/complicações , Iopamidol/efeitos adversos , Iopamidol/administração & dosagem , Hemoptise/induzido quimicamente , Hemorragia Gastrointestinal/induzido quimicamente , Pneumopatias/induzido quimicamente , Broncoscopia , Hematemese/induzido quimicamenteRESUMO
Anabolic-androgenic steroids (AASs) are commonly implicated in thromboembolic events but rarely cause diffuse alveolar haemorrhage. We report the case of a Caucasian man in his late 40s who was consuming supratherapeutic doses of AAS and presented with shortness of breath and haemoptysis. Chest imaging showed bilateral patchy infiltrates in the lungs with diffuse blood throughout the airways on bronchoscopy. Extensive infectious and autoimmune workup were unremarkable. The patient then developed right foot ischaemia and was found to have extensive aortic and bilateral lower extremity arterial thrombosis. Anticoagulation was attempted despite haemoptysis. Thrombectomy procedures were unsuccessful and the patient eventually developed worsening rhabdomyolysis requiring intubation and bilateral amputation. His clinical condition continued to worsen and he passed away 10 days after admission. This case highlights the rare synchronous occurrence of two life-threatening complications secondary to anabolic steroid abuse which can pose a significant diagnostic and therapeutic challenge for clinicians.
Assuntos
Tromboembolia , Trombose , Masculino , Humanos , Esteróides Androgênicos Anabolizantes , Hemoptise/induzido quimicamente , Hemorragia/induzido quimicamente , Trombose/induzido quimicamente , Trombose/diagnóstico por imagemRESUMO
A 66-year-old man with squamous cell carcinoma had been receiving chemoradiation therapy after stereotactic radiotherapy for brain metastases. Atezolizumab was initiated as second-line therapy, after which the patient became progression- and recurrence-free. Four days after his second dose of tozinameran (BNT162b2, Pfizer-BioNTech), the patient developed persistent hemoptysis. The patient had no thrombocytopenia or coagulation abnormalities. Bronchoscopy revealed active bleeding from the left lingual tracheal branch. The patient was intubated and admitted to the intensive care unit because of increased bleeding. Subsequently, left bronchial artery embolization was performed using a Serescue. Hemostasis was achieved after the procedure, and the patient was discharged 7 days after the onset of hemoptysis. Vaccination against coronavirus disease has been reported to be associated with thrombosis and cerebral hemorrhage, and the hemoptysis in this case was suspected to be induced by vaccination. In summary, the benefits of vaccination exceeded the risks of adverse events in a patient with cancer. However, in conditions such as after chemoradiation, especially in patients with radiation pneumonitis wherein the vasculature is vulnerable, patients should be carefully monitored for hemorrhagic events after vaccination.
Assuntos
Broncoscopia/métodos , Vacinas contra COVID-19/administração & dosagem , Carcinoma de Células Escamosas/complicações , Hemoptise/diagnóstico , Neoplasias Pulmonares/complicações , Idoso , Vacina BNT162 , Vacinas contra COVID-19/efeitos adversos , Carcinoma de Células Escamosas/terapia , Hemoptise/induzido quimicamente , Hemoptise/complicações , Humanos , Neoplasias Pulmonares/terapia , Masculino , Vacinação/efeitos adversosRESUMO
BACKGROUND: Mechanical ventilation in intensive care for 48 h or longer is associated with the acute respiratory distress syndrome (ARDS), which might be present at the time ventilatory support is instituted or develop afterwards, predominantly during the first 5 days. Survivors of prolonged mechanical ventilation and ARDS are at risk of considerably impaired physical function that can persist for years. An early pathogenic mechanism of lung injury in mechanically ventilated, critically ill patients is inflammation-induced pulmonary fibrin deposition, leading to thrombosis of the microvasculature and hyaline membrane formation in the air sacs. The main aim of this study was to determine if nebulised heparin, which targets fibrin deposition, would limit lung injury and thereby accelerate recovery of physical function in patients with or at risk of ARDS. METHODS: The Can Heparin Administration Reduce Lung Injury (CHARLI) study was an investigator-initiated, multicentre, double-blind, randomised phase 3 trial across nine hospitals in Australia. Adult intensive care patients on invasive ventilation, with impaired oxygenation defined by a PaO2/FiO2 ratio of less than 300, and with the expectation of invasive ventilation beyond the next calendar day were recruited. Key exclusion criteria were heparin allergy, pulmonary bleeding, and platelet count less than 50âXâ109/L. Patients were randomly assigned 1:1, with stratification by site and using blocks of variable size and random seed, via a web-based system, to either unfractionated heparin sodium 25â000 IU in 5 mL or identical placebo (sodium chloride 0·9% 5 mL), administered using a vibrating mesh membrane nebuliser every 6 h to day 10 while invasively ventilated. Patients, clinicians, and investigators were masked to treatment allocation. The primary outcome was the Short Form 36 Health Survey Physical Function Score (out of 100) of survivors at day 60. Prespecified secondary outcomes, which are exploratory, included development of ARDS to day 5 among at-risk patients, deterioration of the Murray Lung Injury Score (MLIS) to day 5, mortality at day 60, residence of survivors at day 60, and serious adverse events. Analyses followed the intention-to-treat principle. There was no imputation of missing data. The trial is registered with the Australian and New Zealand Clinical Trials Register, number ACTRN12612000418875 . FINDINGS: Between Sept 4, 2012, and Aug 23, 2018, 256 patients were randomised. Final follow-up was on Feb 25, 2019. We excluded three patients who revoked consent and one ineligible participant who received no intervention. Of 252 patients included in data analysis, the mean age was 58 years (SD 15), 157 (62%) were men, and 118 (47%) had ARDS. 128 (51%) patients were assigned to the heparin group and 124 (49%) to the placebo group, all of whom received their assigned intervention. Survivors in the heparin group (n=97) had similar SF-36 Physical Function Scores at day 60 compared to the placebo group (n=94; mean 53·6 [SD 31·6] vs 48·7 [35·7]; difference 4·9 [95% CI -4·8 to 14·5]; p=0·32). Compared with the placebo group, the heparin group had fewer cases of ARDS develop to day 5 among the at-risk patients (nine [15%] of 62 patients vs 21 [30%] of 71 patients; hazard ratio 0·46 [95% CI 0·22 to 0·98]; p=0·0431), less deterioration of the MLIS to day 5 (difference -0·14 [-0·26 to -0·02]; p=0·0215), similar day 60 mortality (23 [18%] of 127 patients vs 18 [15%] of 123 patients; odds ratio [OR] 1·29 [95% CI 0·66 to 2·53]; p=0·46), and more day 60 survivors at home (86 [87%] of 99 patients vs 73 [73%] of 100 patients; OR 2·45 [1·18 to 5·08]; p=0·0165). A similar number of serious adverse events occurred in each group (seven [5%] of 128 patients in the heparin group vs three [2%] of 124 patients in the placebo group; OR 2·33 [0·59 to 9·24]; p=0·23), which were a transient increase in airway pressure during nebulisation (n=3 in the heparin group), major non-pulmonary bleeding (n=2 in each group), haemoptysis (n=1 in the heparin group), tracheotomy site bleeding (n=1 in the heparin group), and hypoxaemia during nebulisation (n=1 in the placebo group). INTERPRETATION: In patients with or at risk of ARDS, nebulised heparin did not improve self-reported performance of daily physical activities, but was well tolerated and exploratory outcomes suggest less progression of lung injury and earlier return home. Further research is justified to establish if nebulised heparin accelerates recovery in those who have or are at risk of ARDS. FUNDING: Rowe Family Foundation, TR and RB Ditchfield Medical Research Endowment Fund, Patricia Madigan Charitable Trust, and The J and R McGauran Trust Fund.
Assuntos
Cuidados Críticos/métodos , Heparina/administração & dosagem , Respiração Artificial/efeitos adversos , Síndrome do Desconforto Respiratório/epidemiologia , Atividades Cotidianas , Administração por Inalação , Adulto , Idoso , Austrália/epidemiologia , Método Duplo-Cego , Feminino , Hemoptise/induzido quimicamente , Hemoptise/epidemiologia , Heparina/efeitos adversos , Mortalidade Hospitalar , Humanos , Hipóxia/induzido quimicamente , Hipóxia/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Nebulizadores e Vaporizadores , Placebos/administração & dosagem , Placebos/efeitos adversos , Síndrome do Desconforto Respiratório/diagnóstico , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/prevenção & controle , Autorrelato/estatística & dados numéricos , Índice de Gravidade de Doença , Sobreviventes/estatística & dados numéricos , Fatores de Tempo , Resultado do TratamentoRESUMO
Importance: Higher coronary artery calcium (CAC) identifies individuals at increased atherosclerotic cardiovascular disease (ASCVD) risk. Whether it can also identify individuals likely to derive net benefit from aspirin therapy is unclear. Objective: To examine the association between CAC, bleeding, and ASCVD and explore the net estimated effect of aspirin at different CAC thresholds. Design, Setting, and Participants: Prospective population-based cohort study of Dallas Heart Study participants, free from ASCVD and not taking aspirin at baseline. Data were analyzed between February 1, 2020, and July 15, 2020. Exposures: Coronary artery calcium score in the following categories: 0, 1-99, and 100 or higher. Main Outcomes and Measures: Major bleeding and ASCVD events were identified from International Statistical Classification of Diseases and Related Health Problems, Ninth Revision codes. Meta-analysis-derived aspirin effect estimates were applied to observed ASCVD and bleeding rates to model the net effect of aspirin at different CAC thresholds. Results: A total of 2191 participants (mean [SD], age 44 [9.1] years, 1247 women [57%], and 1039 black individuals [47%]) had 116 major bleeding and 123 ASCVD events over a median follow-up of 12.2 years. Higher CAC categories (CAC 1-99 and ≥100 vs CAC 0) were associated with both ASCVD and bleeding events (hazard ratio [HR], 1.6; 95% CI, 1.1-2.4; HR, 2.6; 95% CI, 1.5-4.3; HR, 4.8; 95% CI, 2.8-8.2; P < .001; HR, 5.3; 95% CI, 3.6-7.9; P < .001), but the association between CAC and bleeding was attenuated after multivariable adjustment. Applying meta-analysis estimates, irrespective of CAC, aspirin use was estimated to result in net harm in individuals at low (<5%) and intermediate (5%-20%) 10-year ASCVD risk and net benefit in those at high (≥20%) ASCVD risk. Among individuals at lower bleeding risk, a CAC score of at least 100 identified individuals who would experience net benefit, but only in those at borderline or higher (≥5%) 10-year ASCVD risk. In individuals at higher bleeding risk, there would be net harm from aspirin irrespective of CAC and ASCVD risk. Conclusions and Relevance: Higher CAC is associated with both ASCVD and bleeding events, with a stronger association with ASCVD. A high CAC score identifies individuals estimated to derive net benefit from primary prevention aspirin therapy from those who would not, but only in the setting of lower bleeding risk and estimated ASCVD risk that is not low.
Assuntos
Aspirina/uso terapêutico , Aterosclerose/prevenção & controle , Doença da Artéria Coronariana/diagnóstico por imagem , Doença das Coronárias/mortalidade , Hemorragia/epidemiologia , Infarto do Miocárdio/epidemiologia , Inibidores da Agregação Plaquetária/uso terapêutico , Calcificação Vascular/diagnóstico por imagem , Adulto , Estudos de Coortes , Hemorragia Ocular/induzido quimicamente , Hemorragia Ocular/epidemiologia , Feminino , Hemorragia Gastrointestinal/induzido quimicamente , Hemorragia Gastrointestinal/epidemiologia , Hemoptise/induzido quimicamente , Hemoptise/epidemiologia , Hemorragia/induzido quimicamente , Acidente Vascular Cerebral Hemorrágico/induzido quimicamente , Acidente Vascular Cerebral Hemorrágico/epidemiologia , Humanos , Hemorragias Intracranianas/induzido quimicamente , Hemorragias Intracranianas/epidemiologia , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Prevenção Primária , Medição de Risco , Acidente Vascular Cerebral/epidemiologia , Tomografia Computadorizada por Raios XRESUMO
Immune checkpoint inhibitor (ICI)-related massive hemoptysis with cavitation has rarely been identified. Here, we report a case of advanced lung adenocarcinoma with lethal bleeding after eight cycles of pembrolizumab. A 55-year-old male was diagnosed with stage IV non-small cell lung cancer (NSCLC). Following confirmation of high programmed death-ligand 1 (PD-L1) expression of 60% cancer cells, he subsequently received pembrolizumab monotherapy. His symptoms and chest images significantly improved after four cycles of therapy. However, after eight cycles of immunotherapy, he presented with recurrence of bloody sputum and shortness of breath. Pembrolizumab was discontinued and a diagnosis of checkpoint inhibitor-associated pneumonitis (CIP) was made. When the CIP was absorbed after glucocorticoid therapy, the patient died of sudden massive hemoptysis with cavitation in the lesion. KEY POINTS: Although checkpoint inhibitor associated pneumonitis was the leading cause of ICI-related death, clinicians should be alerted to the finding that more attention should be given to hemoptysis attributed to ICI therapy in advanced lung cancer.
Assuntos
Adenocarcinoma de Pulmão/complicações , Hemoptise/induzido quimicamente , Inibidores de Checkpoint Imunológico/efeitos adversos , Imunoterapia/efeitos adversos , Neoplasias Pulmonares/complicações , Adenocarcinoma de Pulmão/patologia , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
A 31-year non-smoker man, working in plastic making industry for 12 years presented with cough and streaking hemoptysis for 2 days. Computed tomography (CT) of chest showed patchy ground glass opacities with interlobular septal thickening in bilateral lung parenchyma. Fiber optic bronchoscopy (FOB) was done. Sequential lavage was taken which showed progressively increasing hemorrhagic fluid. His diffusion capacity for carbon monoxide (DLCO) was 38.08 mL/mmHg/Mi (126%) predicted on day 2 of admission, 32.36 ml/mmHg/Mi (106%) predicted on discharge and 39.63 mL/mmHg/Mi (130%) predicted on going back to work. He was diagnosed with plastic fume exposure related pulmonary alveolar hemorrhage.
Assuntos
Hemorragia/induzido quimicamente , Pneumopatias/patologia , Doenças Profissionais/induzido quimicamente , Exposição Ocupacional/efeitos adversos , Plásticos/efeitos adversos , Adulto , Broncoscopia/métodos , Monóxido de Carbono/análise , Tosse/diagnóstico , Tosse/etiologia , Hemoptise/induzido quimicamente , Hemoptise/diagnóstico , Hemorragia/diagnóstico , Humanos , Pneumopatias/induzido quimicamente , Pneumopatias/diagnóstico por imagem , Pneumopatias/fisiopatologia , Masculino , Doenças Profissionais/prevenção & controle , Exposição Ocupacional/prevenção & controle , Alvéolos Pulmonares/irrigação sanguínea , Alvéolos Pulmonares/patologia , Capacidade de Difusão Pulmonar/fisiologia , Tomografia Computadorizada por Raios X/métodosRESUMO
Diffuse alveolar hemorrhage (DAH) is an acute often life-threatening condition characterized by a variable combination of hemoptysis, dyspnoea, diffuse and bilateral ground glass pulmonary opacities, anemia and hypoxemia, that can be induced by different causes, including several drugs. We report here the case of a 25-year-old woman who has been admitted to our pulmonary clinic for the onset of chest pain, cough and haemoptysis, started one week after her first treatment with alemtuzumab for multiple sclerosis. Computed tomography (CT) scan of the chest at the admission showed diffuse and bilateral ground glass pulmonary opacities. Her symptoms resolved completely without any treatment, after the interruption of alemtuzumab, and CT scan of the chest performed one month later showed total disappearance of the pulmonary opacities.
Assuntos
Alemtuzumab/efeitos adversos , Pneumopatias/diagnóstico por imagem , Lesão Pulmonar/induzido quimicamente , Esclerose Múltipla/tratamento farmacológico , Tomografia Computadorizada por Raios X/métodos , Adulto , Alemtuzumab/administração & dosagem , Alemtuzumab/uso terapêutico , Antineoplásicos Imunológicos/administração & dosagem , Antineoplásicos Imunológicos/efeitos adversos , Antineoplásicos Imunológicos/uso terapêutico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/complicações , Dispneia/induzido quimicamente , Dispneia/diagnóstico , Feminino , Hemoptise/induzido quimicamente , Hemoptise/diagnóstico , Hemorragia/induzido quimicamente , Hemorragia/diagnóstico , Humanos , Pneumopatias/patologia , Lesão Pulmonar/complicações , Suspensão de TratamentoAssuntos
Transtornos Relacionados ao Uso de Cocaína/fisiopatologia , Cocaína/efeitos adversos , Dispneia/induzido quimicamente , Hemoptise/induzido quimicamente , Doenças Pulmonares Intersticiais/induzido quimicamente , Vaping/efeitos adversos , Administração por Inalação , Cocaína/administração & dosagem , Humanos , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/terapia , Masculino , Oxigenoterapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto JovemRESUMO
We present a very rare case of Sevoflurane Induced Diffuse Alveolar Haemorrhage in a young male patient with a closed tibial fracture after direct trauma to the right cruris. The patient was operated for tibial fracture, but diffuse alveolar haemorrhage developed after sevoflurane inhalation in the postoperative period following general anesthesia. Diffuse alveolar haemorrhage (DAH) is associated with inhalation injury from halogenated gases and reported as a unique entity in the literature that practicing clinicians should be aware of and consider in post-operative cases of acute respiratory distress. As DAH usually presents with symptoms the presence of hemoptysis, anemia, dyspnoea and radiological alveolar infiltrates, rapid detection of the aetiology and initiation of cause-directed treatment are of great importance on survival.
Assuntos
Anestésicos Inalatórios/efeitos adversos , Hemoptise/induzido quimicamente , Hemorragia/induzido quimicamente , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/induzido quimicamente , Alvéolos Pulmonares/diagnóstico por imagem , Sevoflurano/farmacologia , Fraturas da Tíbia/cirurgia , Adulto , Anestesia Geral , Broncoscopia , Hemoptise/terapia , Humanos , Masculino , Complicações Pós-Operatórias/terapia , Período Pós-Operatório , Alvéolos Pulmonares/patologia , Tomógrafos Computadorizados , Resultado do TratamentoRESUMO
Haemoptysis is a worrying symptom for patients and can represent a diagnostic challenge for clinicians. We present the case of a 56-year-old woman who presented to the emergency department with acute haemoptysis and associated sudden-onset dyspnoea. The patient remained haemodynamically stable and there was no demonstrable drop in haemoglobin concentration. Following rigorous investigations, on further questioning, the patient recalled inadvertent inhalation of the rodenticide brodifacoum. This exposure was deemed to represent the cause of their acute haemoptysis, which subsequently fully resolved without intervention.
Assuntos
4-Hidroxicumarinas/intoxicação , Hemoptise/induzido quimicamente , Exposição por Inalação/efeitos adversos , Rodenticidas/intoxicação , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Intra-alveolar bleeding is a rare and severe medical emergency due to numerous causes. We report the clinical case of a patient who could contribute to extend the literature on this subject. The study included a 62-year old man, with a history of a trial fibrillation, under anti-vitamins K antagonist admitted with dyspnoea of sudden onset associated with haemoptysis and practising self-medication using non-steroidal anti-inflammatory drugs. X-rays and chest scan showed diffuse bilateral alveolar opacities. Haemostatic screening tests on admission showed non-coagulable INR. The diagnosis of intra-alveolar bleeding was clinically and radiologically suspected and then confirmed by bronchial endoscopy with broncho-alveolar lavage (BAL) which detected uniformly hemorrhagic liquid. Previous studies of similar complications occurring after anti-vitamins K antagonists assumption are rare. In conclusion, it seems very important to emphasize the interest of strict and optimal clinico-biological monitoring of patients treated in anti-vitamins K antagonists to avoid an overdose which could contribute to a life-threatening severe haemorrhagic event.
Assuntos
Acenocumarol/efeitos adversos , Anticoagulantes/efeitos adversos , Hemorragia/induzido quimicamente , Alvéolos Pulmonares/patologia , Acenocumarol/administração & dosagem , Anticoagulantes/administração & dosagem , Dispneia/induzido quimicamente , Hemoptise/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Vitamina K/antagonistas & inibidoresRESUMO
A patient diagnosed with centrally located advanced lung adenocarcinoma with signs of large vessels infiltration, strongly expressing PD-L1, was candidate to first-line pembrolizumab. He had not complained of any bleeding manifestation before immunotherapy. 5 days after the first dose of pembrolizumab, the patient experienced massive, fatal hemoptysis. Given the central localization of the tumor and the strong PD-L1 expression, a contribution of rapid disease shrinkage is envisaged in determining the fatal hemorrhagic event. An attentive clinical attitude should be dedicated in centrally located and vessel-infiltrating tumors strongly expressing PD-L1 and candidate to anti-PD-1/PD-L1 agents.
Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Hemoptise/induzido quimicamente , Neoplasias Pulmonares/tratamento farmacológico , Antifibrinolíticos/administração & dosagem , Antifibrinolíticos/efeitos adversos , Antineoplásicos Imunológicos/administração & dosagem , Antineoplásicos Imunológicos/efeitos adversos , Antígeno B7-H1/metabolismo , Carcinoma Pulmonar de Células não Pequenas/patologia , Evolução Fatal , Hemoptise/terapia , Humanos , Neoplasias Pulmonares/patologia , MasculinoAssuntos
Antivirais/efeitos adversos , Cidofovir/efeitos adversos , Pneumonia em Organização Criptogênica/induzido quimicamente , Hemoptise/induzido quimicamente , Infecções por Papillomavirus/tratamento farmacológico , Infecções Respiratórias/tratamento farmacológico , Administração por Inalação , Corticosteroides/uso terapêutico , Antivirais/administração & dosagem , Antivirais/uso terapêutico , Criança , Cidofovir/administração & dosagem , Terapia Combinada , Ensaios de Uso Compassivo , Substituição de Medicamentos , Feminino , Humanos , Lactente , Masculino , Nebulizadores e Vaporizadores , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/cirurgia , Infecções Respiratórias/complicações , Infecções Respiratórias/cirurgia , TraqueostomiaAssuntos
Acenocumarol/efeitos adversos , Anticoagulantes/efeitos adversos , Hemoptise/induzido quimicamente , Acenocumarol/administração & dosagem , Idoso , Anticoagulantes/administração & dosagem , Fibrilação Atrial/complicações , Comorbidade , Relação Dose-Resposta a Droga , Substituição de Medicamentos , Inibidores do Fator Xa/uso terapêutico , Hemoptise/diagnóstico por imagem , Humanos , Coeficiente Internacional Normatizado , Pulmão/diagnóstico por imagem , Masculino , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Trombofilia/tratamento farmacológico , Trombofilia/etiologia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Clinical variables including hypertension could be linked with major bleeding events and death beyond vitamin K antagonist (warfarin) or direct oral anti-coagulants (DOACs) treatment strategy. METHODS: Subgroup analysis of major bleeding (primary endpoint) associated with clinical variables, site of bleeding, ongoing antithrombotics, reversal treatment or blood transfusion, outcomes (secondary endpoints) was performed in patients with bleeding events submitted to hard 5:1 propensity-score matching for hypertension. RESULTS: Enrolled patients were 2,792 (mean age, 65.6 ± 19.9 years) during 2-year survey including 166,000 visits, of 200,000 inhabitants catchment area; 8,239 patients received warfarin and 3,797 DOACs. Hypertension account for 1,077 (39%) patients; major bleeding for 474 (17%); death for 29 (1%), and 72 (3%) on 1-month and 1-year, respectively. Hypertension, age, glucose, cancer, ischemic vascular disease, and CHA2D2VASc score were more likely to link with major bleeding. On multivariate analysis, only age (odds ratio [OR], 1.02; P < 0.001), CHA2DS2VASc score ≥ 2 (OR, 2.14; P = 0.001), and glucose (OR, 1.01; P = 0.005) were predictors of major bleeding. Kaplan-Meier analysis demonstrated patients with hypertension as compared with patients without showed 60% versus 20% death on 1-month (P < 0.001). Warfarin compared with DOACs was more likely to present with major bleeding (0.7% versus 0.2%; OR, 2.8; P = 0.005). Receiver operator characteristics analysis showed high value (0.61) of age and glucose over creatinine and systolic arterial pressure (P = NS). CONCLUSIONS: Four in 10 patients with major bleeding showed hypertension; of these 8 in 10 will die within 1 month. Warfarin compared with DOACs was more likely to present with major bleeding.