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1.
Blood Adv ; 5(3): 872-888, 2021 02 09.
Artículo en Inglés | MEDLINE | ID: mdl-33560401

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19)-related critical illness and acute illness are associated with a risk of venous thromboembolism (VTE). OBJECTIVE: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in decisions about the use of anticoagulation for thromboprophylaxis for patients with COVID-19-related critical illness and acute illness who do not have confirmed or suspected VTE. METHODS: ASH formed a multidisciplinary guideline panel and applied strict management strategies to minimize potential bias from conflicts of interest. The panel included 3 patient representatives. The McMaster University GRADE Centre supported the guideline-development process, including performing systematic evidence reviews (up to 19 August 2020). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment. RESULTS: The panel agreed on 2 recommendations. The panel issued conditional recommendations in favor of prophylactic-intensity anticoagulation over intermediate-intensity or therapeutic-intensity anticoagulation for patients with COVID-19-related critical illness or acute illness who do not have confirmed or suspected VTE. CONCLUSIONS: These recommendations were based on very low certainty in the evidence, underscoring the need for high-quality, randomized controlled trials comparing different intensities of anticoagulation. They will be updated using a living recommendation approach as new evidence becomes available.


Asunto(s)
Anticoagulantes/uso terapéutico , Tromboembolia Venosa/tratamiento farmacológico , /complicaciones , Enoxaparina/uso terapéutico , Medicina Basada en la Evidencia , Guías como Asunto , Humanos , Sociedades Médicas , Tromboembolia Venosa/complicaciones
2.
Medicina (Kaunas) ; 57(2)2021 Jan 26.
Artículo en Inglés | MEDLINE | ID: mdl-33530544

RESUMEN

Traditionally, the management of patients with pulmonary embolism has been accomplished with anticoagulant treatment with parenteral heparins and oral vitamin K antagonists. Although the administration of heparins and oral vitamin K antagonists still plays a role in pulmonary embolism management, the use of these therapies are limited due to other options now available. This is due to their toxicity profile, clearance limitations, and many interactions with other medications and nutrients. The emergence of direct oral anticoagulation therapies has led to more options now being available to manage pulmonary embolism in inpatient and outpatient settings conveniently. These oral therapeutic options have opened up opportunities for safe and effective pulmonary embolism management, as more evidence and research is now available about reversal agents and monitoring parameters. The evolution of the pharmacological management of pulmonary embolism has provided us with better understanding regarding the selection of anticoagulants. There is also a better understanding and employment of anticoagulants in pulmonary embolism in special populations, such as patients with liver failure, renal failure, malignancy, and COVID-19.


Asunto(s)
Anticoagulantes/uso terapéutico , Fibrinolíticos/uso terapéutico , Embolia Pulmonar/tratamiento farmacológico , Administración Oral , Anticoagulantes/administración & dosificación , Fibrinolíticos/administración & dosificación , Humanos , Fallo Hepático/complicaciones , Neoplasias/complicaciones , Insuficiencia Renal/complicaciones , Factores de Riesgo
3.
Medicine (Baltimore) ; 100(7): e24695, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607810

RESUMEN

RATIONALE: Cisplatin is one of the key drugs that is frequently used for treating various types of malignancies. Although renal and digestive toxicities are well-known cisplatin-related toxicities, attention should also be paid to acute aortic thrombosis, a relatively rare but potentially fatal disorder caused by cisplatin. Additionally, D-dimer is mainly measured to detect venous thromboembolism or disseminated intravascular coagulation, whereas its usefulness for detecting aortic thrombosis remains unclear. Here, we report a case of squamous cell lung cancer treated with cisplatin-based chemotherapy, wherein acute aortic thrombosis was diagnosed based on elevated D-dimer levels. PATIENT CONCERNS: A 65-year-old man with stage IV squamous cell lung cancer presented with elevated D-dimer levels during treatment with second-line chemotherapy with cisplatin and S-1. Contrast-enhanced computed tomography (CT) revealed an intramural thrombus, which had not been previously identified, extending from the abdominal aorta to the common iliac artery. DIAGNOSES: We diagnosed the patient as having acute aortic thrombosis caused by cisplatin. INTERVENTIONS: The patient received intravenous administration of unfractionated heparin for 9 days followed by oral warfarin. OUTCOMES: One month after initiating treatment, the patient's D-dimer levels decreased to the normal range, and contrast-enhanced CT revealed that the thrombi had nearly completely disappeared without any sequelae or organ damage. LESSONS: Our findings revealed that cisplatin can cause acute aortic thrombosis and that regular measurements of D-dimer levels before and during chemotherapy may contribute to the early detection of acute aortic thrombosis.


Asunto(s)
Enfermedades de la Aorta/patología , Cisplatino/toxicidad , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Trombosis/inducido químicamente , Administración Intravenosa , Administración Oral , Anciano , Anticoagulantes/administración & dosificación , Anticoagulantes/uso terapéutico , Antineoplásicos/toxicidad , Carcinoma de Células Escamosas/tratamiento farmacológico , Productos de Degradación de Fibrina-Fibrinógeno/efectos de los fármacos , Heparina/administración & dosificación , Heparina/uso terapéutico , Humanos , Neoplasias Pulmonares/patología , Masculino , Estadificación de Neoplasias/métodos , Trombosis/diagnóstico por imagen , Trombosis/tratamiento farmacológico , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Warfarina/administración & dosificación , Warfarina/uso terapéutico
4.
Medicine (Baltimore) ; 100(4): e24008, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530197

RESUMEN

RATIONALE: Cerebrovascular accidents (CVAs) after percutaneous coronary intervention (PCI), although rare, are associated with high in-hospital morbidity and mortality rates. Cerebral venous thrombosis (CVT) is an uncommon cause of CVAs compared with arterial disease but is associated with favorable outcomes in most cases. We present a rare case of CVT following a simple PCI procedure with stent implantation, which has not been previously reported in the literature. PATIENT CONCERNS: A 78-year-old woman with hypertension, hyperlipidemia, and coronary artery disease received simple PCI with stent implantation. After PCI, she developed a throbbing headache with nausea and vomiting, with her blood pressure increasing to 190/100 mmHg. Drowsiness, disorientation, and neck stiffness were noted. Neurological complication due to the PCI procedure was highly suspected. DIAGNOSIS: Noncontrast brain computed tomography was performed along with emergency neurological consultation, and the patient was diagnosed as having acute CVT. INTERVENTIONS: The patient was treated with anti-intracranial pressure therapy and anticoagulation therapy through low-molecular-weight heparin and was subsequently treated with warfarin. OUTCOMES: After treatment, the patient's symptoms and signs gradually subsided, and her clinical condition improved. She was discharged with full recovery thereafter. LESSONS: A case of acute CVT, a rare, and atypical manifestation of venous thromboembolism and CVA, complicated simple PCI with stent implantation. During PCI, identifying patients with a high risk of a CVA is critical, and special care should be taken to prevent this devastating complication.


Asunto(s)
Trombosis Intracraneal/etiología , Intervención Coronaria Percutánea/efectos adversos , Accidente Cerebrovascular/etiología , Trombosis de la Vena/etiología , Anciano , Anticoagulantes/uso terapéutico , Femenino , Humanos , Trombosis Intracraneal/terapia , Accidente Cerebrovascular/terapia , Trombosis de la Vena/terapia
5.
Bone Joint J ; 103-B(2): 222-233, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33517730

RESUMEN

AIMS: Current guidelines recommend surgery within 48 hours among patients presenting with hip fractures; however, optimal surgical timing for patients on oral anticoagulants (OACs) remains unclear. Individual studies are limited by small sample sizes and heterogeneous outcomes. The aim of this study was to conduct a systematic review and meta-analysis to summarize the effect of pre-injury OACs on time-to-surgery (TTS) and all-cause mortality among older adults with hip fracture treated surgically. METHODS: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to 14 October 2019 to identify studies directly comparing outcomes among hip fracture patients receiving direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) prior to hospital admission to hip fracture patients not on OACs. Random effects meta-analyses were used to pool all outcomes (TTS, in-hospital mortality, and 30-day mortality). RESULTS: A total of 34 studies (involving 39,446 patients) were included in our systematic review. TTS was 13.7 hours longer (95% confidence interval (CI) 9.8 to 17.5; p < 0.001) among hip fracture patients on OACs compared to those not on OACs. This translated to a three-fold higher odds of having surgery beyond the recommended 48 hours from admission (odds ratio (OR) 3.0 (95% CI 2.1 to 4.3); p = 0.001). In-hospital mortality was higher (OR 1.4 (95% CI 1.0 to 1.8); p < 0.03) among anticoagulated patients. Among studies comparing anticoagulants, there was no statistically significant difference in time-to-surgery between patients taking a DOAC compared to a VKA. CONCLUSION: Patients presenting with a hip fracture who were taking OACs prior to injury experience a delay in time-to-surgery and higher mortality than non-anticoagulated patients. Patients on DOACs may be at risk of further delays. Evaluating expedited surgical protocols in hip fracture patients on OACs is an urgent priority, with the potential to decrease morbidity and mortality in this group of high-risk patients. Cite this article: Bone Joint J 2021;103-B(2):222-233.


Asunto(s)
Anticoagulantes/uso terapéutico , Fijación de Fractura , Fracturas de Cadera/cirugía , Tromboembolia/tratamiento farmacológico , Tromboembolia/prevención & control , Tiempo de Tratamiento , Administración Oral , Fracturas de Cadera/complicaciones , Fracturas de Cadera/mortalidad , Humanos , Tromboembolia/complicaciones , Resultado del Tratamiento
7.
Artículo en Inglés | MEDLINE | ID: mdl-33572570

RESUMEN

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease. Bilateral pneumonia, acute respiratory failure, systemic inflammation, endothelial dysfunction and coagulation activation are key features of severe COVID-19. Fibrinogen and D-dimer levels are typically increased. The risk for venous thromboembolism is markedly increased, especially in patients in the intensive care unit despite prophylactic dose anticoagulation. Pulmonary microvascular thrombosis has also been described and the risk for arterial thrombotic diseases also appears to be increased while bleeding is less common than thrombosis, but it can occur. Evaluation for venous thromboembolism may be challenging because symptoms of pulmonary embolism overlap with COVID-19, and imaging studies may not be feasible in all cases. The threshold for evaluation or diagnosis of thromboembolism should be low given the high frequency of these events. Management and treatment are new challenges due to the paucity of high-quality evidence regarding efficacy and safety of different approaches to prevent or treat thromboembolic complications of the disease. All inpatients should receive thromboprophylaxis unless contraindicated. Some institutional protocols provide more aggressive anticoagulation with intermediate or even therapeutic dose anticoagulation for COVID-19 patients admitted to ICU. Therapeutic dose anticoagulation is always appropriate to treat deep venous thrombosis or pulmonary embolism, unless contraindicated. This article reviews evaluation and management of coagulation abnormalities in individuals with COVID-19.


Asunto(s)
Trastornos de la Coagulación Sanguínea , Gestión de Riesgos , Tromboembolia Venosa , Anticoagulantes/uso terapéutico , Trastornos de la Coagulación Sanguínea/complicaciones , Trastornos de la Coagulación Sanguínea/tratamiento farmacológico , Humanos , Tromboembolia Venosa/complicaciones , Tromboembolia Venosa/tratamiento farmacológico
9.
J Med Vasc ; 46(1): 22-27, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33546817

RESUMEN

Cerebral venous thrombosis (CVT) is a rare but serious complication of ulcerative colitis (UC) with a high morbidity and mortality rate. CVT is not usually readily recognized and treatment may be delayed, impacting on the prognosis. Here we are reporting 2 cases of CVT occurring during a relapse of ulcerative colitis (UC) with review of literature. The first patient was a 27-year-old woman with chronic UC who presented with headaches during a relapse of chronic UC. She was found to have cerebral venous sinus thrombosis. The second one was a 45-year-old man who presented with seizures and focal neurological symptom during a relapse of chronic UC. He was found to have cerebral venous sinus thrombosis complicated by left temporal infarction. Both of them were treated with therapeutic anticoagulation with good improvement. The presence of neurological signs in a patient with UC mostly during exacerbation period, should alert health professionals about the possibility of a CVT.


Asunto(s)
Colitis Ulcerosa/complicaciones , Trombosis de los Senos Intracraneales/etiología , Adulto , Anticoagulantes/uso terapéutico , Femenino , Humanos , Persona de Mediana Edad , Recurrencia , Factores de Riesgo , Trombosis de los Senos Intracraneales/diagnóstico por imagen , Trombosis de los Senos Intracraneales/tratamiento farmacológico , Resultado del Tratamiento
10.
BMJ ; 372: n311, 2021 02 11.
Artículo en Inglés | MEDLINE | ID: mdl-33574135

RESUMEN

OBJECTIVE: To evaluate whether early initiation of prophylactic anticoagulation compared with no anticoagulation was associated with decreased risk of death among patients admitted to hospital with coronavirus disease 2019 (covid-19) in the United States. DESIGN: Observational cohort study. SETTING: Nationwide cohort of patients receiving care in the Department of Veterans Affairs, a large integrated national healthcare system. PARTICIPANTS: All 4297 patients admitted to hospital from 1 March to 31 July 2020 with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and without a history of anticoagulation. MAIN OUTCOME MEASURES: The main outcome was 30 day mortality. Secondary outcomes were inpatient mortality, initiating therapeutic anticoagulation (a proxy for clinical deterioration, including thromboembolic events), and bleeding that required transfusion. RESULTS: Of 4297 patients admitted to hospital with covid-19, 3627 (84.4%) received prophylactic anticoagulation within 24 hours of admission. More than 99% (n=3600) of treated patients received subcutaneous heparin or enoxaparin. 622 deaths occurred within 30 days of hospital admission, 513 among those who received prophylactic anticoagulation. Most deaths (510/622, 82%) occurred during hospital stay. Using inverse probability of treatment weighted analyses, the cumulative incidence of mortality at 30 days was 14.3% (95% confidence interval 13.1% to 15.5%) among those who received prophylactic anticoagulation and 18.7% (15.1% to 22.9%) among those who did not. Compared with patients who did not receive prophylactic anticoagulation, those who did had a 27% decreased risk for 30 day mortality (hazard ratio 0.73, 95% confidence interval 0.66 to 0.81). Similar associations were found for inpatient mortality and initiation of therapeutic anticoagulation. Receipt of prophylactic anticoagulation was not associated with increased risk of bleeding that required transfusion (hazard ratio 0.87, 0.71 to 1.05). Quantitative bias analysis showed that results were robust to unmeasured confounding (e-value lower 95% confidence interval 1.77 for 30 day mortality). Results persisted in several sensitivity analyses. CONCLUSIONS: Early initiation of prophylactic anticoagulation compared with no anticoagulation among patients admitted to hospital with covid-19 was associated with a decreased risk of 30 day mortality and no increased risk of serious bleeding events. These findings provide strong real world evidence to support guidelines recommending the use of prophylactic anticoagulation as initial treatment for patients with covid-19 on hospital admission.


Asunto(s)
Anticoagulantes/uso terapéutico , Enoxaparina/uso terapéutico , Tromboembolia/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/efectos adversos , Enoxaparina/efectos adversos , Femenino , Hemorragia/inducido químicamente , Humanos , Masculino , Persona de Mediana Edad , Admisión del Paciente , Tromboembolia/virología , Factores de Tiempo , Estados Unidos/epidemiología
12.
BMJ Case Rep ; 14(1)2021 Jan 26.
Artículo en Inglés | MEDLINE | ID: mdl-33500300

RESUMEN

We describe the case of a healthy patient with moderate COVID-19 infection without thrombophilia nor coronary disease background who presented with a relapsing thrombotic occlusion of the right coronary artery despite normal oxygenation, adequate antiaggregation and prophylactic anticoagulation. Prophylactic anticoagulation recommendations in COVID-19 were inadequate for this patient. Further data are needed to propose full-dose therapeutic anticoagulation for patients with coronary thrombosis and COVID-19 infection. This could nevertheless be considered even in mild forms of COVID-19.


Asunto(s)
/complicaciones , Oclusión Coronaria/etiología , Trombosis Coronaria/etiología , Anticoagulantes/uso terapéutico , /fisiopatología , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Oclusión Coronaria/diagnóstico por imagen , Oclusión Coronaria/prevención & control , Trombosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Recurrencia
13.
Medicine (Baltimore) ; 100(1): e24230, 2021 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-33429821

RESUMEN

INTRODUCTION: Although venous thromboembolism (VTE) is relatively rare after unicompartmental knee arthroplasty (UKA), symptomatic pulmonary embolism (PE) can be fatal. Whether routine thromboprophylaxis or thrombolytic treatment is necessary for patients undergoing UKA remains unclear. Here, we present a case of delayed pulmonary embolism after UKA. PATIENT CONCERNS: A 57-year-old women underwent cemented UKA for left localized medial knee pain. There were no risk factors of VTE besides high BMI before surgery. 2 months after surgery, the patient presented with dyspnea and palpitation, and these symptoms could not be alleviated after rest. DIAGNOSIS: An arterial blood gas analysis showed decreased PO2, SO2 and PCO2. Pulmonary CTA showed multiple pulmonary embolism in the trunk of the right lower pulmonary artery and the branch of the left lower pulmonary arteries. The final diagnosis was delayed pulmonary embolism after UKA. INTERVENTIONS: Urokinase thrombolysis was administered intravenously. Low molecular weight heparin and warfarin were prescribed for anticoagulation. OUTCOMES: The patient's symptoms abated, and chest CTA showed that the pulmonary embolism had dissolved. No further thrombosis has been observed for more than 6 years. CONCLUSIONS: We presented an unusual case of delayed pulmonary embolism after UKA. Despite the low incidence, its life-threatening nature makes it imperative for surgeons to be well-informed about thrombosis and pay more attention to its prevention strategies.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/efectos adversos , Osteoartritis de la Rodilla/cirugía , Embolia Pulmonar/diagnóstico , Anticoagulantes/uso terapéutico , Angiografía por Tomografía Computarizada , Diagnóstico Diferencial , Femenino , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Infusiones Intravenosas , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/etiología , Activador de Plasminógeno de Tipo Uroquinasa/administración & dosificación , Warfarina/uso terapéutico
14.
Medicine (Baltimore) ; 100(1): e24235, 2021 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-33429823

RESUMEN

RATIONALE: Catheter-related thrombosis is a serious complication of lung transplantation under venovenous extracorporeal membrane oxygenation (ECMO). Although ECMO-related thrombosis is not uncommon, there are few reports of giant hollow catheter thrombosis in lung transplantation under venovenous ECMO (ECMO). Blood loss and transfusion of coagulation factors may promote ECMO-related thrombosis. Hollow catheter thrombus was not detected on ultrasonography performed after initiation of ECMO. Therefore, it is essential to identify, manage, and reduce or avoid such thrombosis. PATIENT CONCERNS: We report a rare case of a 43-year-old man with advanced silicosis who developed a massive hollow catheter thrombus during lung transplantation. Anticoagulant therapy did not affect the size of the thrombus. DIAGNOSIS: Giant hollow catheter thrombosis was diagnosed by ultrasonography. Thrombosis from the right external iliac vein to the inferior vena cava was found in the shape of the ECMO pipe. INTERVENTIONS: Heparin was prescribed as an anticoagulant. OUTCOMES: Anticoagulant therapy did not affect the size of the thrombus during 2 weeks. The patient developed an infection and died of multiple organ failure. CONCLUSION: It is uncommon for massive hollow thrombus to occur during venovenous-ECMO-assisted lung transplantation. Fibrinogen and prothrombin complexes promote the formation of thrombus, and the measurement of the wall thickness of ECMO catheter may help to detect such thrombus.


Asunto(s)
Oxigenación por Membrana Extracorpórea/efectos adversos , Trasplante de Pulmón , Trombosis/diagnóstico , Adulto , Anticoagulantes/administración & dosificación , Anticoagulantes/uso terapéutico , Catéteres/efectos adversos , Diagnóstico Diferencial , Resultado Fatal , Heparina/administración & dosificación , Heparina/uso terapéutico , Humanos , Masculino , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/tratamiento farmacológico , Trombosis/diagnóstico por imagen , Trombosis/tratamiento farmacológico
15.
Rev Med Suisse ; 17(720-1): 20-23, 2021 Jan 13.
Artículo en Francés | MEDLINE | ID: mdl-33443825

RESUMEN

Direct oral anticoagulants (DOAC) represent commonly prescribed drugs in everyday clinical practice for indications such as atrial fibrillation, prevention of venous thromboembolic disease (VTE) after major orthopaedic surgery, treatment of deep vein thrombosis and pulmonary embolism, and long term prevention of VTE recurrence. More recently, the efficacy of DOAC has been demonstrated in new clinical situations, such as heparin-induced thrombocytopenia, cancer-associated VTE and secondary prevention of cardiovascular events in patients with atherothrombotic arterial disease. This article's aims is to present the recent data on which these new indications are based.


Asunto(s)
Anticoagulantes/administración & dosificación , Anticoagulantes/uso terapéutico , Fibrilación Atrial/tratamiento farmacológico , Embolia Pulmonar/tratamiento farmacológico , Tromboembolia Venosa/prevención & control , Trombosis de la Vena/tratamiento farmacológico , Administración Oral , Humanos , Tromboembolia Venosa/tratamiento farmacológico
16.
BMJ Case Rep ; 14(1)2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33452066

RESUMEN

A 53-year-old man with diabetes came to the emergency department with fever and dry cough for 5 days, swelling of the left leg for 2 days, shortness of breath and chest pain for 1 hour. He had raised temperature, tachycardia, tachypnoea, reduced oxygen saturation and swollen tender left leg on examination. The frontal chest radiograph showed bilateral ground-glass opacities; he tested positive for COVID-19 with elevated D-dimer. The colour Doppler examination of the left leg revealed acute deep vein thrombosis (DVT) of the common femoral and the popliteal veins. The chest CT showed bilateral diffuse ground-glass opacities predominantly involving peripheral zones and the lower lobes. The CTPA revealed left pulmonary thromboembolism (PTE), treated with low-molecular-weight heparin. COVID-19 predominantly affects the respiratory system. DVT and PTE are common in COVID-19 but lethal. They should be diagnosed early by clinical and radiological examinations and treated promptly with anticoagulants.


Asunto(s)
/complicaciones , Embolia Pulmonar/etiología , Trombosis de la Vena/etiología , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Alanina/análogos & derivados , Alanina/uso terapéutico , Antibacterianos/uso terapéutico , Anticoagulantes/uso terapéutico , Antiparasitarios/uso terapéutico , Antivirales/uso terapéutico , /diagnóstico , /terapia , Angiografía por Tomografía Computarizada , Diabetes Mellitus Tipo 2/complicaciones , Doxiciclina/uso terapéutico , Vena Femoral , Productos de Degradación de Fibrina-Fibrinógeno , Glucocorticoides/uso terapéutico , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Ivermectina/uso terapéutico , Masculino , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno , Vena Poplítea , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/terapia , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler en Color , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/terapia
17.
Mayo Clin Proc ; 96(1): 52-65, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33413835

RESUMEN

OBJECTIVE: To investigate the influences of non-vitamin K antagonist oral anticoagulants (NOACs) on rates of initiations of oral anticoagulants (OACs) and outcomes among elderly patients with atrial fibrillation (AF). METHODS: From January 1, 2009, to December 31, 2015, 33,539 newly-diagnosed AF patients older than 85 years old who survived more than 180 days after AF diagnosis were studied. Temporal trends regarding OAC initiation rates after incident AF were analyzed. The 1-year risks of ischemic stroke, intracranial hemorrhage, and mortality of incident AF patients diagnosed each year were compared with that of the year 2009. RESULTS: Initiation rates of OACs after AF was newly diagnosed in the elderly significantly increased from 9.5% to 34.3%, mainly due to the introduction of NOACs (from 0% to 26.2%). Several clinical factors were associated with OACs underuse, including chronic obstructive pulmonary disease, abnormal renal function, anemia, and history of bleeding. Compared with year 2009 (incidence rate, 5.55%/year), the 1-year risk of ischemic stroke after AF diagnosis decreased in the era of NOACs (incidence rate, 4.20%/year; adjusted hazard ratio [aHR], 0.748 in year 2012; 4.39%/year, aHR, 0.789 in 2014; 2.75%/year; aHR, 0.513 in year 2015; all P<.01, except for year 2013, 4.80%/year [P=.07]). Also, the risks of mortality were lower in years 2012 to 2015, while the risk of ICH remained unchanged. CONCLUSION: Initiation rates of OACs after AF was newly diagnosed in the elderly significantly increased following the introduction of NOACs. A lower risk of ischemic stroke, mortality, and composite adverse events was observed, which was temporally associated with the increasing prescription rates of OACs.


Asunto(s)
Anticoagulantes/uso terapéutico , Fibrilación Atrial/complicaciones , Accidente Cerebrovascular/prevención & control , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Taiwán/epidemiología , Resultado del Tratamiento
18.
Am J Case Rep ; 22: e927011, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33384403

RESUMEN

BACKGROUND Pandemic coronavirus disease 2019 (COVID-19) originated in Wuhan, China, and is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Severe respiratory symptoms are a hallmark of the disease, which may also include complications related to a hypercoagulable state and central nervous system involvement. These complications can occur during either the acute or the recovery phase. The cerebral involvement typically manifests as intracranial hypertension, intracerebral hemorrhage, diffuse encephalopathy, or cerebral venous thrombosis. The hemorrhagic form of cerebral venous thrombosis can be a diagnostic challenge and is treated by anticoagulation therapy, despite the existence of an intracerebral hemorrhage. This report describes a case of superficial cerebral venous thrombosis and intracerebral hematoma in a 48-year-old man weeks after recovering from the acute phase of SARSCoV-2 infection. CASE REPORT A 48-year-old man with a past medical history of SARS-CoV-2 infection confirmed by SARS-CoV-2 reverse-transcription polymerase chain reaction presented with left upper-limb numbness, weakness, and impaired positional sensorium. After initial stabilization, noncontrast computerized tomography and magnetic resonance imaging confirmed an intracerebral hemorrhage with underlying cerebral venous thrombosis. The patient was successfully treated with enoxaparin anticoagulation therapy, and symptoms improved over the following 12 days. CONCLUSIONS Central nervous system venous thrombosis is an atypical presentation of the hypercoagulable state primarily seen in younger patients, and it can occur in a delayed fashion after recovery from mild forms of COVID-19.


Asunto(s)
/complicaciones , Hemorragia Cerebral/diagnóstico por imagen , Hematoma/diagnóstico por imagen , Trombosis Intracraneal/diagnóstico por imagen , Trombosis de la Vena/diagnóstico por imagen , Anticoagulantes/uso terapéutico , Hemorragia Cerebral/virología , Enoxaparina/uso terapéutico , Hematoma/virología , Humanos , Trombosis Intracraneal/tratamiento farmacológico , Trombosis Intracraneal/virología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/virología
20.
Blood Coagul Fibrinolysis ; 32(1): 44-49, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33417336

RESUMEN

There is an increasing evidence supporting the existence of coagulopathy in coronavirus disease 2019 (COVID-19) patients. Most of reports are mainly focused on d-dimer. Our objective is to describe coagulation parameters in these patients that could be involved in a hypercoagulate state and to test platelet function to see if there are short closure times. We analyzed coagulation samples from 80 patients admitted with COVID-19 in our hospital. We also tested platelet function by closure times in a small subgroup of patients. Most of samples had increased d-dimer (96.2%) (median of d-dimer: 1158 ng/ml FEU), increased fibrinogen (75.2%) (median: 5.23 g/l), increased factor VIII (86%) (median: 264.8 U/dl), decreased protein S (22.5% of women, 62.5% of men) (median: 62.8 and 68.5 U/dl, respectively), decreased protein C (7.6%) (median: 100 U/dl), decreased factor XII (25.3%) (median: 90.3 U/dl) and decreased antithrombin activity (21%) (median: 86 U/dl). International normalized ratio was higher than normal in 24 patients (30%) (median: 1.13). The activated partial thromboplastin time ratio was below the normal range in nine patients (11.2%) and above normal in three (3.75%) (median: 0.93). The closure times were short in the 20% and 40% of samples of collagen and ADP and collagen and epinephrine, respectively. Twelve of the 80 patients (15%) had a thrombotic event and all had several abnormal coagulation parameters related with increased thrombotic risk. The results of this study support a hypercoagulability state in COVID-19 patients and it may help to explain the microvascular thrombosis caused by the inflammatory response.


Asunto(s)
Anticoagulantes/uso terapéutico , Biomarcadores/sangre , Trastornos de la Coagulación Sanguínea/etiología , Productos de Degradación de Fibrina-Fibrinógeno/efectos adversos , Pruebas de Función Plaquetaria/métodos , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/farmacología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias
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