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1.
Ther Adv Respir Dis ; 13: 1753466619878556, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31558116

RESUMO

Most physicians understand venous thromboembolism (VTE) to be an acute and time-limited disease. However, pathophysiological and epidemiological data suggest that in most patients VTE recurrence risk is not resolved after the first 6 months of anticoagulation. Recurrence rates are high and potentially life-threatening. In these cases, it would make sense to prolong anticoagulation for an undetermined length of time. However, what about the bleeding rates, induced by prolonged anticoagulation? Would they not outweigh the benefit of reducing the VTE recurrent risk? How long should anticoagulation be continued, and should all patients suffering from VTE be provided with extended anticoagulation? This review will address the most recent data concerning extended anticoagulation in VTE secondary prophylaxis. The reviews of this paper are available via the supplementary material section.

2.
Respiration ; 98(3): 253-262, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31390642

RESUMO

Acute pulmonary embolism (PE) impairs hemodynamics, gas exchange, and lung mechanical capacity. Considering PE pathophysiology, most attention has been paid to hemodynamic impairment. However, the most prevalent symptoms in PE patients come from gas exchange alterations, which have not been in the spotlight for many years. Pulmonary physiology and consequent gas exchange impairment play a pivotal role in the high risk of death from PE. In this review, we will look at the pathophysiology of PE, from the vascular occlusion to the resultant heterogeneity in pulmonary perfusion and gas exchange impairment, discussing in detail its causes and consequences.

3.
Curr Opin Pulm Med ; 25(5): 391-397, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31365371

RESUMO

PURPOSE OF REVIEW: To understand the global distribution of different forms of pulmonary hypertension. RECENT FINDINGS: Different registries have explored the epidemiological characteristics of pulmonary hypertension. Interestingly, there is a clear difference in the prevalence of different forms of pulmonary hypertension in developed regions in comparison with less developed countries. This finding suggests not only that extrapolation of data should be avoided but also that the known prevalence of pulmonary hypertension might be underestimated. SUMMARY: Pulmonary hypertension might be more prevalent than what is currently believed. Specific forms of pulmonary hypertension distributed worldwide might characterize an unrecognized burden that still have to be properly approached. This highlights the heterogeneity of pulmonary hypertension around the world. It is clear that more epidemiological data are still needed as well as studies addressing management alternatives in these specific regions.

4.
Eur Respir Rev ; 28(151)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30918022

RESUMO

Cancer-associated thrombosis (CAT) is a condition in which relevance has been increasingly recognised both for physicians that deal with venous thromboembolism (VTE) and for oncologists. It is currently estimated that the annual incidence of VTE in patients with cancer is 0.5% compared to 0.1% in the general population. Active cancer accounts for 20% of the overall incidence of VTE. Of note, VTE is the second most prevalent cause of death in cancer, second only to the progression of the disease, and cancer is the most prevalent cause of deaths in VTE patients. Nevertheless, CAT presents several peculiarities that distinguish it from other VTE, both in pathophysiology mechanisms, risk factors and especially in treatment, which need to be considered. CAT data will be reviewed in this review.


Assuntos
Anticoagulantes/uso terapêutico , Coagulação Sanguínea/efeitos dos fármacos , Fibrinolíticos/uso terapêutico , Neoplasias/complicações , Trombose/tratamento farmacológico , Anticoagulantes/efeitos adversos , Fibrinolíticos/efeitos adversos , Hemorragia/induzido quimicamente , Humanos , Incidência , Neoplasias/sangue , Neoplasias/mortalidade , Prevalência , Recidiva , Medição de Risco , Fatores de Risco , Trombose/sangue , Trombose/etiologia , Trombose/mortalidade , Resultado do Tratamento
6.
J Bras Pneumol ; : 0, 2018 Jun 07.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29898008
7.
J Bras Pneumol ; : 0, 2018 Jun 07.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29898007

RESUMO

Acute pulmonary thromboembolism (APTE) is a highly prevalent condition (104-183 cases per 100,000 person-years) and is potentially fatal. Approximately 20% of patients with APTE are hypotensive, being considered at high risk of death. In such patients, immediate lung reperfusion is necessary in order to reduce right ventricular afterload and to restore hemodynamic stability. To reduce pulmonary vascular resistance in APTE and, consequently, to improve right ventricular function, lung reperfusion strategies have been developed over time and widely studied in recent years. In this review, we focus on advances in the indication and use of systemic thrombolytic agents, as well as lung reperfusion via endovascular and classical surgical approaches, in APTE.

8.
Clinics (Sao Paulo) ; 73: e216, 2018 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-29791520

RESUMO

OBJECTIVES: Chronic thromboembolic pulmonary hypertension is one of the most prevalent forms of pulmonary hypertension and is a major complication of acute pulmonary embolism. One mainstay of chronic thromboembolic pulmonary hypertension treatment is lifelong anticoagulation. The recent advent of direct oral anticoagulants for acute pulmonary embolism treatment has provided a viable and effective alternative for treating this condition. However, little is known about the efficacy of this new class of drugs for treating chronic thromboembolic pulmonary hypertension. We aimed to evaluate the safety and efficacy of direct oral anticoagulants in the treatment of chronic thromboembolic pulmonary hypertension. METHODS: A cohort of chronic thromboembolic pulmonary hypertension patients who initiated treatment with direct oral anticoagulants between June 2015 and November 2016 were enrolled in this study. RESULTS: Sixteen patients used rivaroxaban, three used dabigatran and one used apixaban for a mean follow-up of 20.9 months. The mean age was 51 years, and eighteen patients were classified as functional class II/III. Eight patients underwent a pulmonary endarterectomy and exhibited clinical, hemodynamic and functional improvement and currently continue to use direct oral anticoagulants. No episode of venous thromboembolism recurrence was identified during the follow-up period, but there was one episode of major bleeding after a traumatic fall. CONCLUSIONS: Although direct oral anticoagulants appear to be a safe and effective alternative for treating chronic thromboembolic pulmonary hypertension, larger studies are needed to support their routine use.


Assuntos
Antitrombinas/administração & dosagem , Dabigatrana/administração & dosagem , Hipertensão Pulmonar/tratamento farmacológico , Embolia Pulmonar/tratamento farmacológico , Pirazóis/administração & dosagem , Piridonas/administração & dosagem , Administração Oral , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Resultado do Tratamento , Vitamina K/antagonistas & inibidores
10.
J. bras. pneumol ; 44(3): 237-243, May-June 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-954560

RESUMO

ABSTRACT Acute pulmonary thromboembolism (APTE) is a highly prevalent condition (104-183 cases per 100,000 person-years) and is potentially fatal. Approximately 20% of patients with APTE are hypotensive, being considered at high risk of death. In such patients, immediate lung reperfusion is necessary in order to reduce right ventricular afterload and to restore hemodynamic stability. To reduce pulmonary vascular resistance in APTE and, consequently, to improve right ventricular function, lung reperfusion strategies have been developed over time and widely studied in recent years. In this review, we focus on advances in the indication and use of systemic thrombolytic agents, as well as lung reperfusion via endovascular and classical surgical approaches, in APTE.


RESUMO O tromboembolismo pulmonar (TEP) agudo é uma condição altamente prevalente (104-183 por 100.000 pessoas-ano) e potencialmente fatal. Aproximadamente 20% dos pacientes com TEP agudo apresentam-se hipotensos, sendo considerados pacientes com alto risco de morte. Nesses casos, a necessidade de reperfusão pulmonar imediata é mandatória para reduzir a pós-carga do ventrículo direito e restaurar a condição hemodinâmica do paciente. Visando a redução da resistência vascular pulmonar no TEP agudo e, por consequência, a melhora na função ventricular direita, estratégias de reperfusão pulmonar foram desenvolvidas com passar do tempo e vêm sendo muito estudadas nos últimos anos. Avanços na indicação e no uso de trombolíticos sistêmicos, reperfusão pulmonar via abordagem endovascular ou abordagem cirúrgica clássica no TEP agudo são os focos desta revisão.

12.
Clinics ; 73: e216, 2018. tab
Artigo em Inglês | LILACS-Express | ID: biblio-890747

RESUMO

OBJECTIVES: Chronic thromboembolic pulmonary hypertension is one of the most prevalent forms of pulmonary hypertension and is a major complication of acute pulmonary embolism. One mainstay of chronic thromboembolic pulmonary hypertension treatment is lifelong anticoagulation. The recent advent of direct oral anticoagulants for acute pulmonary embolism treatment has provided a viable and effective alternative for treating this condition. However, little is known about the efficacy of this new class of drugs for treating chronic thromboembolic pulmonary hypertension. We aimed to evaluate the safety and efficacy of direct oral anticoagulants in the treatment of chronic thromboembolic pulmonary hypertension. METHODS: A cohort of chronic thromboembolic pulmonary hypertension patients who initiated treatment with direct oral anticoagulants between June 2015 and November 2016 were enrolled in this study. RESULTS: Sixteen patients used rivaroxaban, three used dabigatran and one used apixaban for a mean follow-up of 20.9 months. The mean age was 51 years, and eighteen patients were classified as functional class II/III. Eight patients underwent a pulmonary endarterectomy and exhibited clinical, hemodynamic and functional improvement and currently continue to use direct oral anticoagulants. No episode of venous thromboembolism recurrence was identified during the follow-up period, but there was one episode of major bleeding after a traumatic fall. CONCLUSIONS: Although direct oral anticoagulants appear to be a safe and effective alternative for treating chronic thromboembolic pulmonary hypertension, larger studies are needed to support their routine use.

13.
Arq Bras Cardiol ; 109(3 Supl 1): 1-104, 2017 Jan-Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29044300
14.
Arq. bras. cardiol ; 109(3,supl.1): 1-104, Sept. 2017. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-887936
15.
Orphanet J Rare Dis ; 12(1): 74, 2017 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-28427470

RESUMO

BACKGROUND: Lymphangioleiomyomatosis (LAM) is included within group 5 of the current PH classification (unclear multifactorial mechanisms). However, data regarding the occurrence of PH in LAM are scarce. The aims of the study were to describe the prevalence and characteristics of PH in a large cohort of LAM patients with different levels of severity, and to evaluate the role of echocardiography and carbon monoxide diffusion capacity (DLCO) as screening methods for PH in LAM. METHODS: One hundred five LAM patients underwent transthoracic echocardiography, pulmonary function tests (PFTs) and 6-min walk test (6MWT). Patients with a suspicion of PH on echocardiography, defined by the presence of estimated systolic pulmonary artery pressure (PAP) over 35 mmHg or PFT showing DLco below 40% of the predicted value, underwent right heart catheterisation to confirm the diagnosis of PH. RESULTS: Eight patients (7.6%) had PH confirmed on right heart catheterisation, six patients (5.7%) had a pre-capillary pattern and two patients (1.9%) had a post-capillary profile. Only one patient (1%) had mean PAP over 35 mmHg. Patients with PH had lower FEV1 and DLCO in PFTs and greater oxygen desaturation and dyspnea intensity during 6MWT compared with those without PH. In 63% of the patients with confirmed PH, the right heart catheterisation was performed based only on DLCO result. CONCLUSIONS: The prevalence of PH is low in LAM patients. Pulmonary hypertension in LAM is typically mild and significantly associated with pulmonary parenchymal involvement. Carbon monoxide diffusion capacity significantly improved the identification of PH in LAM patients.


Assuntos
Monóxido de Carbono/metabolismo , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/epidemiologia , Linfangioleiomiomatose/diagnóstico , Linfangioleiomiomatose/epidemiologia , Adulto , Ecocardiografia , Feminino , Humanos , Hipertensão Pulmonar/metabolismo , Hipertensão Pulmonar/patologia , Linfangioleiomiomatose/metabolismo , Linfangioleiomiomatose/patologia , Masculino , Pessoa de Meia-Idade , Prevalência , Testes de Função Respiratória
16.
In. Kalil Filho, Roberto; Fuster, Valetim; Albuquerque, Cícero Piva de. Medicina cardiovascular reduzindo o impacto das doenças / Cardiovascular medicine reducing the impact of diseases. São Paulo, Atheneu, 2016. p.803-812.
Monografia em Português | LILACS | ID: biblio-971569
17.
BMC Pulm Med ; 15: 118, 2015 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-26459359

RESUMO

BACKGROUND: Schistosomiasis associated pulmonary arterial hypertension (Sch-PAH) might represent the most prevalent form of PAH worldwide. In Sch-PAH, the presence of aneurismal dilation of the pulmonary artery has been described, although it is still a matter of debate whether on average the pulmonary artery is more enlarged in Sc-PAH than IPAH. METHODS: We retrospectively evaluated patients with IPAH (n = 25) and Sch-PAH (n = 22) who underwent computed tomography pulmonary angiogram and right heart catheterization. RESULTS: Sch-PAH patients were older and presented less severe hemodynamic profiles. Main pulmonary artery diameter (MPAD) was greater in Sch-PAH than IPAH (4.5 ± 1.8 vs 3.7 ± 1.1 cm, p = 0.018). For the same level of mean pulmonary artery pressure, the MPAD in Sch-PAH was 0.89 cm larger than in IPAH (Covariance model p = 0.02). CONCLUSION: This study demonstrated that pulmonary artery enlargement is more pronounced in Sch-PAH than IPAH, independently of mean pulmonary artery pressure level, suggesting that this is more likely a feature of Sch-PAH.


Assuntos
Aneurisma/diagnóstico por imagem , Hipertensão Pulmonar Primária Familiar/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Esquistossomose/complicações , Adulto , Angiografia , Feminino , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/etiologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Retrospectivos
18.
Curr Hypertens Rep ; 17(6): 556, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26054384

RESUMO

Our understanding of the pathophysiology of pulmonary arterial hypertension (PAH) has increased substantially in the past decades. More accurate diagnosis and increased options for treatment have given researchers the opportunity to better explore the response to medical therapy and prognosis. As a result, the use of biomarkers and prognostic indicators for this devastating disease has been widely investigated. Biomarkers and prognostic indicators have also been more frequently incorporated into the design of new clinical trials. This approach has helped the pulmonary hypertension (PH) community step forward in the search for effective treatments for PAH. However, no single biomarker has shown significant superiority in predicting prognosis or patient response and an integrative approach is necessary to understand which combination of markers should be used in each of the clinical scenarios that characterize the management of PAH.


Assuntos
Hipertensão Pulmonar/sangue , Artérias/patologia , Biomarcadores/sangue , Humanos , Hipertensão Pulmonar/diagnóstico , Testes de Função Renal , Prognóstico , Qualidade de Vida
19.
Chest ; 147(2): 495-501, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25317567

RESUMO

BACKGROUND: Pulmonary arterial hypertension (PAH) is a rare and ultimately fatal disorder of the pulmonary vasculature. There is increasing interest in the worldwide characteristics of patients with PAH, although data coming from the Southern Hemisphere remain scarce. The objective of this study was to describe a cohort of incident patients with PAH from a large reference center in Brazil. METHODS: All consecutive patients who received a diagnosis of PAH by right-sided heart catheterization between 2008 and 2013 were included in the study. RESULTS: A total of 178 patients with newly diagnosed PAH were enrolled in the study (mean age, 46 years; female/male ratio, 3.3:1; 45.5% in New York Heart Association functional class III or IV). Idiopathic PAH (IPAH), connective tissue disease (CTD), and schistosomiasis-associated PAH (Sch-PAH) accounted for 28.7%, 25.8%, and 19.7% of all cases, respectively. The patients were treated with phosphodiesterase type 5 inhibitors (66%), endothelin receptor antagonists (27%), or a combination of both (5%). For the PAH group as a whole, the estimated survival rate 3 years after diagnosis was 73.9%. The prognosis for the patients with CTD was worse than that for the patients with IPAH and Sch-PAH (P = .03). CONCLUSIONS: The distribution of PAH causes and the baseline characteristics in our registry clearly differ from the previously published European and US-based registries. These differences highlight the importance of regional registries and also raise questions regarding the need to better account for such differences in future clinical trials.


Assuntos
Hipertensão Pulmonar/epidemiologia , Adulto , Brasil/epidemiologia , Comorbidade , Antagonistas dos Receptores de Endotelina/uso terapêutico , Feminino , Humanos , Hipertensão Pulmonar/tratamento farmacológico , Hipertensão Pulmonar/fisiopatologia , Incidência , Pneumopatias Parasitárias/epidemiologia , Masculino , Pessoa de Meia-Idade , Inibidores da Fosfodiesterase 5/uso terapêutico , Prognóstico , Sistema de Registros , Esquistossomose/epidemiologia
20.
Pulmäo RJ ; 24(2): 3-8, 2015. tab
Artigo em Português | LILACS | ID: lil-778783

RESUMO

A hipertensão pulmonar apresentou desenvolvimento bastante significativo nas últimas duas décadas, devido ao maior conhecimento fisiopatológico de suas mais diversas formas. Espelhando esse desenvolvimento, houve evolução da definição assim como do sistema de classificação da hipertensão pulmonar que divide os pacientes em 5 grupos distintos: hipertensão arterial pulmonar (HAP); Hipertensão pulmonar causada por doenças do coração esquerdo; Hipertensão pulmonar causada por doença pulmonar e/ou hipóxia; Hipertensão pulmonar tromboembólica crônica e Hipertensão pulmonar com mecanismos multifatoriais ou não esclarecidos. A classificação adequada dos pacientes é a base para a instituição terapêutica apropriada, particularmente considerando que a evidência atual que sustenta o uso das medicações disponíveis principalmente na doença arterial pulmonar. Sua adoção reforça a necessidade de avaliação diagnóstica abrangente em todos os casos de hipertensão pulmonar...


Pulmonary hypertension showed significant development in the last two decades due to higher pathophysiological knowledge of its various forms. Mirroring these developments, there was evolution of the definition as well as pulmonary hypertension classification system that divides patients into five groups: pulmonary arterial hypertension (PAH); Pulmonary hypertension caused by left heart diseases; Pulmonary hypertension caused by pulmonary disease and / or hypoxia; Chronic thromboembolic pulmonary hypertension and pulmonary hypertension with multifactorial mechanisms or unclear. The appropriate classification of patients is the basis for appropriate therapeutic institution particularly since the current evidence supporting the use of drugs available mainly in the lung artery disease. Its adoption reinforces the need for comprehensive diagnostic evaluation in all cases of pulmonary hypertension...


Assuntos
Humanos , Masculino , Feminino , Hipertensão Pulmonar/classificação , Hipertensão Pulmonar/etiologia , Circulação Pulmonar
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