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1.
Infectio ; 25(4): 293-295, oct.-dic. 2021. tab, graf
Artículo en Español | LILACS, COLNAL | ID: biblio-1286725

RESUMEN

Resumen La trombosis venosa cerebral (TVC) es una presentación clínica poco común del tromboembolismo venoso caracterizada por cefalea, crisis convulsivas, déficits neurológicos focales y papiledema. El diagnóstico es confirmado con Tomografía axial computarizada (TAC) de cráneo y Resonancia magnética nuclear (RMN) cerebral. La TVC tiene una relación importante con el virus de inmunodeficiencia humana (VIH), ya que los pacientes VIH positivos cursan con hiperviscosidad san guínea, alteraciones de factores anticoagulantes endógenos y riesgo de sobreinfección, entre otros; que predisponen a estados protrombóticos y lesión vascular como lo es la TVC. El tratamiento de la TVC es terapia anticoagulante, por lo general se utiliza heparina no fraccionada o heparina de bajo peso molecular para la fase aguda y anticoagulantes orales como la warfarina para el mantenimiento posterior. Reportamos el primer caso documentado de TVC en un paciente VIH positivo en Colombia.


Abstract Cerebral venous thrombosis (CVT) is a rare clinical presentation of venous thromboembolism characterized by headache, seizures, neurological deficits and papi lledema. The diagnosis is confirmed using computed tomography scan (CT scan) and magnetic resonance imaging (MRI) of the brain. CVT has an important relationship with the human immunodeficiency virus (HIV) given that HIV-positive patients may present with blood hyperviscosity, irregular levels of endogenous anticoagulation factors and risk of sepsis among others, that predispose to prothrombotic states and vascular injury such as CVT. The treatment of CVT is anticoagulant therapy, generally unfractionated heparin or low molecular weight heparin for the early phase and oral anticoagulants such as warfarin for the late phase. This case reports the first documented case of CVT in an HIV positive patient in Colombia.


Asunto(s)
Humanos , Masculino , Adulto , Tromboembolia Venosa , Cráneo , Encéfalo , Imagen por Resonancia Magnética , VIH , Cefalea , Hepatitis B
2.
Anesthesiol Clin ; 39(4): 727-742, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34776106

RESUMEN

Pharmacologic thromboprophylaxis from venous thromboembolism (VTE) and thrombocytopenia in pregnancy results in conditions that may preclude the use of neuraxial anesthesia due to a perceived risk of spinal/epidural hematoma. Spinal epidural hematoma is a recognized complication in patients who are hypocoagulable and may lead patients to undergo general anesthesia for delivery or other procedures, which carries numerous complications in obstetric care. A robust understanding of maternal physiologic changes in coagulation status, review of consensus statements, and safety bundles may help to maximize the use of neuraxial anesthesia in obstetric patients who might otherwise be denied these anesthetic techniques.


Asunto(s)
Anestesia Epidural , Anestesia Obstétrica , Anestesia Raquidea , Hematoma Espinal Epidural , Trombocitopenia , Tromboembolia Venosa , Anestesia Epidural/efectos adversos , Anestesia Obstétrica/efectos adversos , Anestesia Raquidea/efectos adversos , Anticoagulantes/efectos adversos , Femenino , Hematoma Espinal Epidural/prevención & control , Humanos , Embarazo , Trombocitopenia/inducido químicamente , Trombocitopenia/complicaciones , Tromboembolia Venosa/prevención & control
3.
Acta Biomed ; 92(5): e2021287, 2021 11 03.
Artículo en Inglés | MEDLINE | ID: mdl-34738598

RESUMEN

BACKGROUND: Although cardiac troponins are valuable tools for risk stratification in patients with venous thromboembolism (VTE), their significance remains elusive in diagnosing venous thrombosis. METHODS: D-dimer (age-adjusted cut-off) and high-sensitivity cardiac troponin I (HS-cTnI; reference limit, <10.5 ng/L in women and <17.8 ng/L in men) were measured in 2199 consecutive patients (1106 women and 1093 men; mean age, 63±20 years), admitted to the Emergency Department of the University Hospital of Parma during a 3-month period. Overall, 53 patients were finally diagnosed with VTE (12 with deep vein thrombosis and 41 with pulmonary embolism). RESULTS: The diagnostic performance (area under the curve; AUC) of D-dimer and HS-cTnI was 0.70 and 0.71 for all VTE episodes, 0.70 and 0.63 for deep vein thrombosis (DVT), 0.70 and 0.74 for pulmonary embolism (PE), respectively. The combination of positive values of both biomarkers yielded better diagnostic performance than D-dimer values alone for diagnosing PE (AUC, 0.80; p<0.001 vs. D-dimer alone), but not for diagnosing DVT (AUC, 0.73; p=0.458 vs. D-dimer alone). In patients with PE, positive HS-cTnI values in patients with concomitantly positive D-dimer values yielded identical diagnostic sensitivity compared to D-dimer positivity alone (i.e., 1.00), but nearly double diagnostic specificity (i.e., 0.71 vs. 0.40). Positive HS-cTnI values (AUC, 0.68), but not D-dimer positivity (AUC, 0.51), were associated with 30-day hospital readmission of VTE patients. CONCLUSIONS: The results of this study open intriguing opportunities for combining HS-cTnI and D-dimer in the diagnostic approach of patients with PE.


Asunto(s)
Tromboembolia Venosa , Adulto , Anciano , Anciano de 80 o más Años , Servicio de Urgencia en Hospital , Femenino , Productos de Degradación de Fibrina-Fibrinógeno , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Troponina I , Tromboembolia Venosa/diagnóstico
4.
Circ Cardiovasc Qual Outcomes ; 14(11): e008005, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34724801

RESUMEN

BACKGROUND: Consensus statements have recommended against the use of direct oral anticoagulants (DOACs) in venous thromboembolism (VTE) for patients ≥120 kg and ≥40 kg/m2. We sought to determine use and outcomes of DOACs for VTE across weight and body mass index (BMI). METHODS: We performed a retrospective cohort study of patients with first-time VTE 2013 to 2018 that were treated with DOAC or warfarin in the Veterans Health Administration. The Veterans Health Administration has implemented system-wide guidance for patient selection and shared decision-making for use of DOACs in VTE at extremes of weight. We stratified patients by weight and BMI and assessed (1) association of weight and BMI category to outcomes in those prescribed DOAC; and (2) association of DOAC, as compared to warfarin, to outcomes by weight and BMI categories. Outcomes of interest included major bleeding, clinically relevant nonmajor bleeding, and recurrent VTE. RESULTS: The analysis cohort included 51 871 patients prescribed DOAC or warfarin within 30 days of index VTE diagnosis (age 64.5±13.1 years; 6.0% female; median weight 93.4 kg [25th-75th: 80.5-108.6 kg]). For patients ≥120 kg (N=6934 patients), 38.4% were treated with DOAC, as compared to 45.4% of those ≥60 to <100 kg (N=30 645; P<0.0001). DOAC prescription was not associated with major bleeds, clinically relevant nonmajor bleeds, or recurrent VTE for those in higher weight and BMI categories as compared to those in average weight and BMI categories. DOAC prescription, as compared to warfarin, was not associated with increased recurrent VTE in any weight or BMI category. CONCLUSIONS: Patients ≥120 kg and ≥40 kg/m2 with VTE are frequently prescribed DOAC by the Veterans Health Administration, without an increase in bleeding or recurrent VTE. These findings suggest DOACs can be safe and effective in this population and may argue for broader adoption of pharmacy policies that promote careful patient selection and shared decision making.


Asunto(s)
Tromboembolia Venosa , Administración Oral , Anciano , Anticoagulantes/efectos adversos , Índice de Masa Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/tratamiento farmacológico , Tromboembolia Venosa/epidemiología , Salud de los Veteranos
5.
BMJ Case Rep ; 14(11)2021 Nov 18.
Artículo en Inglés | MEDLINE | ID: mdl-34794977

RESUMEN

Current literature suggests an increased risk of venous thromboembolism (VTE) in people living with HIV (PLWH) with poorly controlled viraemia and immunodeficiency. VTE treatment guidelines do not specifically address anticoagulation management in PLWH. We report a case of a 33-year-old woman diagnosed with an unprovoked pulmonary embolism (PE) and deemed protein S deficient. Three years later, she was diagnosed with AIDS. Antiretroviral therapy (ART) was promptly initiated with viral suppression and immune reconstitution within 12 months. Eight years after her initial PE, the patient self-discontinued warfarin. Multiple repeat protein S values were normal. ART without anticoagulation has continued for 3 years with no thrombotic events. This case describes a patient with VTE presumably secondary to undiagnosed HIV with possible consequent acquired protein S deficiency. Additional research is needed to understand the characteristics of PLWH with VTE who may warrant long-term anticoagulation as opposed to shorter courses.


Asunto(s)
Infecciones por VIH , Deficiencia de Proteína S , Embolia Pulmonar , Tromboembolia Venosa , Adulto , Anticoagulantes/uso terapéutico , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Humanos , Deficiencia de Proteína S/complicaciones , Deficiencia de Proteína S/tratamiento farmacológico , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/etiología , Recurrencia , Factores de Riesgo
6.
World J Gastroenterol ; 27(40): 6757-6774, 2021 Oct 28.
Artículo en Inglés | MEDLINE | ID: mdl-34790006

RESUMEN

The risk of thromboembolism (TE) is increased in patients with inflammatory bowel disease (IBD), mainly due to an increased risk of venous TE (VTE). The risk of arterial TE (ATE) is less pronounced, but an increased risk of cardiovascular diseases needs to be addressed in IBD patients. IBD predisposes to arterial and venous thrombosis through similar prothrombotic mechanisms, including triggering activation of coagulation, in part mediated by impairment of the intestinal barrier and released bacterial components. VTE in IBD has clinical specificities, i.e., an earlier first episode in life, high rates during both active and remission stages, higher recurrence rates, and poor prognosis. The increased likelihood of VTE in IBD patients may be related to surgery, the use of medications such as corticosteroids or tofacitinib, whereas infliximab is antithrombotic. Long-term complications of VTE can include post-thrombotic syndrome and high recurrence rate during post-hospital discharge. A global clot lysis assay may be useful in identifying patients with IBD who are at risk for TE. Many VTEs occur in IBD outpatients; therefore, outpatient prophylaxis in high-risk patients is recommended. It is crucial to continue focusing on prevention and adequate treatment of VTE in patients with IBD.


Asunto(s)
Colitis , Enfermedades Inflamatorias del Intestino , Tromboembolia Venosa , Trombosis de la Vena , Anticoagulantes/uso terapéutico , Humanos , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Enfermedades Inflamatorias del Intestino/epidemiología , Factores de Riesgo , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/etiología
11.
Zhonghua Yi Xue Za Zhi ; 101(41): 3417-3421, 2021 Nov 09.
Artículo en Chino | MEDLINE | ID: mdl-34758546

RESUMEN

Objective: To analyze the incidence and risk factors for postoperative venous thromboembolism(VTE) in patients with stage Ⅰa non-small-cell lung cancer(NSCLC), so as to find evidence for further research of prophylactic anticoagulation. Methods: A total of 132 patients with stage Ⅰa NSCLC, 42 males and 90 females aged from 26 to 79 years with an average of (57±10) years, were retrospectively included in this study. All of them underwent surgical treatment at the Department of Thoracic Surgery of Beijing Chaoyang Hospital Affiliated with Capital Medical University from January 2017 to October 2020. A lower extremity venous ultrasound was performed before and after the operation. Participants were divided into VTE group (n=11) or non-VTE group (n=121) according to whether or not VTE occurred after operation. The surgical conditions, test indicators, imaging information, pathology information were compared between the two groups. Logistic regression analysis was performed to test the associations of VET with putative risks factors in which significant differences were observed. The independent risk factors of VET were determined by this way. Results: Postoperative VTE occurred in 11 cases (8.3%), including 10 cases (90.9%) of deep vein thrombosis (DVT) of lower limbs and 1 case (9.1%) of DVT complicated with pulmonary embolism (PE). The mean age of Patients in the VTE group was older than that in non-VTE Group ((65±9) years vs (57±10) years, P=0.009). On the fifth day after operation, patients in both groups had significantly higher D-dimer level compared with that before operation (3.18(1.55, 5.15) vs 1.54(1.09, 2.57); 2.66(1.17, 4.65) vs 1.34(0.78, 2.04))(both P<0.05). The value of neuron-specific enolase (NSE) and the number of lymph nodes removed during the operation in the VTE group were significantly higher than those in the non-VTE group ((21.54±12.37) vs (14.72±5.75); (19.7±8.2) vs (13.0±7.9)) (both P<0.05). There was no statistically significant difference in the approach of surgery, imaging features (tumor location, vascular cluster signs, etc.), and pathological information (pathological types, etc.) (all P>0.05). The logistic regression analysis showed that the number of lymph nodes removed during the operation was an independent risk factor related to the occurrence of VTE (OR=1.306, 95%CI:1.000-1.600,P<0.05). Conclusions: The incidence of postoperative VTE in patients with stage Ⅰa NSCLC is approximately 8.3%. The number of lymph nodes removed during the operation may be an independent risk factor for postoperative VTE in patients with stage Ⅰa NSCLC.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Embolia Pulmonar , Tromboembolia Venosa , Anciano , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/etiología
12.
Khirurgiia (Mosk) ; (11): 76-82, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-34786919

RESUMEN

This review is devoted to the management of primary artery thrombosis (PAT). This disease was always considered only as a part of other venous thromboembolic events, in particular isolated pulmonary embolism (PE). Various studies show that PAT can develop as an independent event without concomitant damage to extra-vessels. PAT is characterized by own typical signs as primary and recurrent event that can determine special strategies of treatment. However, there are no studies devoted to this problem. We can only make some assumptions about PAT anticoagulation (AC) considering data on isolated PE comprising PAT. These data are available in PADIS-PE, ASPIRE, EINSTEIN-PE, Hokusai-VTE studies underlying modern guidelines of various societies. In the absence of studies on PAT AC these guidelines should regulate PAT AC approaches. AC is recommended in all cases of PE except isolated subsegmental PAT in ambulatory patients. Duration of AC depends on risk factors (major or minor). Anticoagulation for PAT following chronic inflammatory diseases is still disputable.


Asunto(s)
Embolia Pulmonar , Trombosis , Tromboembolia Venosa , Trombosis de la Vena , Anticoagulantes , Humanos , Arteria Pulmonar , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamiento farmacológico , Trombosis/diagnóstico , Trombosis/tratamiento farmacológico , Trombosis/etiología
13.
Rev Med Chil ; 149(6): 881-887, 2021 Jun.
Artículo en Español | MEDLINE | ID: mdl-34751347

RESUMEN

BACKGROUND: Cesarean section increases four times the risk of venous thromboembolism compared to vaginal delivery. The Royal College of Obstetricians and Gynecologists guidelines are used at our service. A written alert was designed to stratify patients at high, intermediate or low risk making a suggestion for thromboprophylaxis. AIM: To assess the compliance with the guidelines and to evaluate the impact of a written alert in the thromboprophylaxis compliance in women subjected to caesarean section. PATIENTS AND METHODS: Review of medical records of 233 women aged 19 to 32 years, subjected to a caesarean section in a Gynecology Service, between 2016-2017. RESULTS: Compliance with recommendations was observed in 29% of patients (68/233), 86% in the low-risk group, 26% in the intermediate risk group and 100% in the high risk group. In 41/233 (18%) of patients, a written alert was included in the medical record. Compliance with recommendations in the presence of the written alert was 61% (25/41 women) compared to 22% (43/192) in those lacking the alert (p < 0.01). In women whose emergency caesarean section was the only risk factor, the compliance with the recommendation was 8%, compared with 30% among those who had at least one thrombotic risk factor associated with caesarean section (p < 0.01). CONCLUSIONS: In this cross-sectional study, we observed a low compliance with thromboprophylaxis guidelines in cesarean women. We observed that the use of a written alert improved the compliance with thromboprophylaxis.


Asunto(s)
Cesárea , Tromboembolia Venosa , Anticoagulantes , Cesárea/efectos adversos , Estudios Transversales , Femenino , Humanos , Cooperación del Paciente , Embarazo , Tromboembolia Venosa/etiología , Tromboembolia Venosa/prevención & control
14.
Acta Clin Croat ; 60(2): 314-316, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-34744284

RESUMEN

Numerous disorders of coagulation and fibrinolysis have been reported in patients with thyroid diseases, especially with hyperthyroidism. Most articles are focused on deep vein thrombosis risk, however, few of them describe association between hyperthyroidism and pulmonary embolism. We report a case of a 43-year-old woman with long-term uncontrolled hyperthyroidism complicated by venous thromboembolism. The potential mechanisms could be endothelial dysfunction, decreased fibrinolytic activity, and increased levels of coagulation factors. Thyroid evaluation should be recommended in patients with unprovoked venous thromboembolic events.


Asunto(s)
Hipertiroidismo , Embolia Pulmonar , Tromboembolia Venosa , Trombosis de la Vena , Adulto , Femenino , Humanos , Hipertiroidismo/complicaciones , Embolia Pulmonar/complicaciones , Trombosis de la Vena/complicaciones
15.
Medicine (Baltimore) ; 100(39): e27367, 2021 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-34596150

RESUMEN

ABSTRACT: Most studies on the prediction of venous thromboembolism (VTE) focused on hospitalized, surgery, and cancer patients or women receiving hormonal contraceptives or menopausal hormone therapy. No study considered diabetic and general populations to establish a VTE prediction model, especially in Asia. We developed a predictive model for VTE among type 2 diabetic patients and the general population.This study considered 2 nationwide retrospective cohort studies consisting of 52,427 diabetic participants and 508,664 participants from the general population aged 30 to 85 years during 2001 to 2004 in Taiwan. All participants were followed up until VTE event, death, or December 2011. The outcome event was VTE, including deep venous thrombosis and pulmonary embolism. Candidate predictors consisted of socio-demographic factors, diabetes-related factors and biomarkers, comorbidities, and medicine use. Our study followed the procedures proposed by the Framingham Heart Study to develop prediction models by using a Cox regression model. The predictive accuracy and performance characteristics were assessed using the area under curve of receiver operating characteristics curve and calibration of a risk score were performed by Hosmer-Lemeshow goodness-of-fit test.The common factors for persons with type 2 diabetes and general population included age, hospitalization status 1 year before the baseline, hypertension, chronic kidney disease, chronic obstructive pulmonary disease, and anti-diabetes medications; the specific factors for persons with type 2 diabetes consisted of body mass index, glycosylated hemoglobin A1C, and creatinine; and the factors for general population included gender, peripheral vascular disease, cancer, hypertension medication, cardiovascular medication, and non-steroidal anti-inflammatory drug. The area under curve of 3-, 5-, and 8-year VTE prediction models were 0.74, 0.71, and 0.69 in the diabetic population and 0.77, 0.76, and 0.75 in the general population, respectively.The new clinical prediction models can help identify a high risk of VTE and provide medical intervention in diabetic and general populations.


Asunto(s)
Diabetes Mellitus Tipo 2/epidemiología , Tromboembolia Venosa/etiología , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Bases de Datos Factuales , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Medición de Riesgo/métodos , Taiwán/epidemiología , Tromboembolia Venosa/epidemiología
17.
Artículo en Chino | MEDLINE | ID: mdl-34628828

RESUMEN

Objective:To investigate the incidence, risk factors, prevention and treatment of venous thromboembolism(VTE) after head and neck malignant tumor surgery. Methods:From February 2014 to February 2020, a total of 889 patients with head and neck malignant tumor treated in the Department of Otolaryngology Head and Neck Surgery of the Third Xiangya Hospital of Central South University were selected as the research objects. 16 patients with VTE were selected as the observation group, and 30 patients were randomly selected as the control group from 873 patients without VTE. The related evaluation indexes were analyzed by univariate and multivariate logistic regression. Results:①VTE occurred in 16 cases of 889 patients with head and neck malignancy, and the incidence of VET in head and neck malignant tumor patients was 1.80%. ② Univariate analysis showed that postoperative VTE was related to gender, age, BMI, preoperative PICC, operation time and bed rest time. Multivariate logistic regression analysis indicated that age≥60 years old(OR=0.087, 95%CI: 0.012-0.643), preoperative PICC(OR=0.133, 95%CI: 0.021-0.856) and operation time≥3 h(OR=0.119, 95%CI: 0.016-0.889) was an independent risk factor of VTE after head and neck malignant tumor operation (P<0.05). Conclusion:VTE is a serious complication after operation for head and neck malignant tumor. The risk factors of postoperative VTE include age≥60 years, preoperative PICC and operation time≥3 h. Early prevention and timely treatment are the key to reduce postoperative VTE mortality.


Asunto(s)
Neoplasias de Cabeza y Cuello , Tromboembolia Venosa , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Incidencia , Persona de Mediana Edad , Periodo Posoperatorio , Factores de Riesgo , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/etiología
19.
JAMA ; 326(13): 1277-1285, 2021 10 05.
Artículo en Inglés | MEDLINE | ID: mdl-34609451

RESUMEN

Importance: Active search for pulmonary embolism (PE) may improve outcomes in patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD). Objective: To compare usual care plus an active strategy for diagnosing PE with usual care alone in patients hospitalized for COPD exacerbation. Design, Setting, and Participants: Randomized clinical trial conducted across 18 hospitals in Spain. A total of 746 patients were randomized from September 2014 to July 2020 (final follow-up was November 2020). Interventions: Usual care plus an active strategy for diagnosing PE (D-dimer testing and, if positive, computed tomography pulmonary angiogram) (n = 370) vs usual care (n = 367). Main Outcomes and Measures: The primary outcome was a composite of nonfatal symptomatic venous thromboembolism (VTE), readmission for COPD, or death within 90 days after randomization. There were 4 secondary outcomes, including nonfatal new or recurrent VTE, readmission for COPD, and death from any cause within 90 days. Adverse events were also collected. Results: Among the 746 patients who were randomized, 737 (98.8%) completed the trial (mean age, 70 years; 195 [26%] women). The primary outcome occurred in 110 patients (29.7%) in the intervention group and 107 patients (29.2%) in the control group (absolute risk difference, 0.5% [95% CI, -6.2% to 7.3%]; relative risk, 1.02 [95% CI, 0.82-1.28]; P = .86). Nonfatal new or recurrent VTE was not significantly different in the 2 groups (0.5% vs 2.5%; risk difference, -2.0% [95% CI, -4.3% to 0.1%]). By day 90, a total of 94 patients (25.4%) in the intervention group and 84 (22.9%) in the control group had been readmitted for exacerbation of COPD (risk difference, 2.5% [95% CI, -3.9% to 8.9%]). Death from any cause occurred in 23 patients (6.2%) in the intervention group and 29 (7.9%) in the control group (risk difference, -1.7% [95% CI, -5.7% to 2.3%]). Major bleeding occurred in 3 patients (0.8%) in the intervention group and 3 patients (0.8%) in the control group (risk difference, 0% [95% CI, -1.9% to 1.8%]; P = .99). Conclusions and Relevance: Among patients hospitalized for an exacerbation of COPD, the addition of an active strategy for the diagnosis of PE to usual care, compared with usual care alone, did not significantly improve a composite health outcome. The study may not have had adequate power to assess individual components of the composite outcome. Trial Registration: ClinicalTrials.gov Identifier: NCT02238639.


Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Embolia Pulmonar/diagnóstico , Tromboembolia Venosa , Anciano , Causas de Muerte , Angiografía por Tomografía Computarizada/estadística & datos numéricos , Intervalos de Confianza , Progresión de la Enfermedad , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Hemorragia/etiología , Hospitalización , Humanos , Masculino , Readmisión del Paciente , Enfermedad Pulmonar Obstructiva Crónica/terapia , Embolia Pulmonar/sangre , Embolia Pulmonar/etiología , Embolia Pulmonar/terapia , Recurrencia , España , Resultado del Tratamiento
20.
Rozhl Chir ; 100(8): 376-383, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34649444

RESUMEN

This review presents information on the epidemiology and current trends in the diagnosis and therapy of acute and chronic Achilles tendon ruptures in middle-aged and elderly patients. Epidemiological data show an increasing incidence of ruptures among the entire population, especially in patients over 65 years of age. Dynamic sonography has become the gold standard diagnostic assessment, facilitating even therapeutic decision- making. The well established conservative-functional therapy can in indicated cases achieve results comparable to those of surgical treatment. Minimally invasive suture techniques using aiming devices reduce the risk of surgical damage and soft tissue complications, particularly in noncompliant patients and patients with restricted perfusion. Reconstruction of chronic tendon ruptures is mostly performed using static techniques, especially the combination of V-Y plasty and fascial flaps. In addition to reruptures and infections, the currently discussed complications also include deep vein thrombosis where a more generous indication scheme of thromboprophylaxis is under consideration.


Asunto(s)
Tendón Calcáneo , Traumatismos de los Tendones , Tromboembolia Venosa , Tendón Calcáneo/cirugía , Anciano , Anticoagulantes , Humanos , Persona de Mediana Edad , Rotura , Traumatismos de los Tendones/diagnóstico , Traumatismos de los Tendones/cirugía , Resultado del Tratamiento
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