RESUMO
WHAT IS KNOWN AND OBJECTIVE: Free-floating thrombi in the right heart occur in a subset of patients with pulmonary embolism with high rates of mortality if untreated. Treatment of choice is controversial and likely patient specific as studies have failed to consistently show a significant difference in mortality between options. CASE SUMMARY: We present a case of a 45-year-old female with a mobile right heart thrombus treated with ultra-slow, low-dose t-PA infusion in combination with heparin. WHAT IS NEW AND CONCLUSION: Ultra-slow, low-dose infusion of t-PA may be an option for treatment of mobile intracardiac thrombi.
Assuntos
Cardiopatias/tratamento farmacológico , Heparina/uso terapêutico , Trombose/tratamento farmacológico , Ativador de Plasminogênio Tecidual/administração & dosagem , Feminino , Humanos , Pessoa de Meia-Idade , Embolia Pulmonar/tratamento farmacológicoRESUMO
WHAT IS KNOWN AND OBJECTIVE: Prothrombin complex concentrate (PCC) is a plasma-derived concentrate used to replenish clotting factors. There are limited recommendations for treating coagulopathy induced by direct oral anticoagulants (DOAC). Data are limited regarding both total dose and repeated dosing with this population. CASE SUMMARY: We describe a case of an adult patient anticoagulated with apixaban who received two 35 unit/kg doses of PCC resulting in suspected pulmonary embolism. WHAT IS NEW AND CONCLUSION: Treatment of DOAC-induced bleeding remains an "off-label" indication for PCC. Additional doses should be given with caution if given at all and patients monitored closely.
Assuntos
Fatores de Coagulação Sanguínea/administração & dosagem , Inibidores do Fator Xa/efeitos adversos , Embolia Pulmonar/etiologia , Pirazóis/efeitos adversos , Piridonas/efeitos adversos , Idoso , Fatores de Coagulação Sanguínea/efeitos adversos , Inibidores do Fator Xa/administração & dosagem , Hemorragia/induzido quimicamente , Hemorragia/terapia , Humanos , Masculino , Uso Off-Label , Embolia Pulmonar/patologia , Pirazóis/administração & dosagem , Piridonas/administração & dosagemRESUMO
WHAT IS KNOWN AND OBJECTIVE: Cryptococcus neoformans, a common opportunistic pathogen among patients with human immunodeficiency virus (HIV) infection, lymphoproliferative disorders and other conditions causing immunosuppression, can be differentiated from other yeasts using biochemical tests as well as culture results and direct histopathological examination. CASE SUMMARY: We present a case of a 78-year-old man with Cryptococcal meningitis and false-negative cerebrospinal fluid culture results following receipt of capecitabine. WHAT IS NEW AND CONCLUSION: Patients receiving immunosuppressive agents are at higher risk of developing invasive fungal infections, and all patient medications should be reviewed to identify those with potential antifungal properties.