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2.
Ann Palliat Med ; 10(8): 8900-8908, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34488377

RESUMO

BACKGROUND: Effective anticoagulation is a prerequisite of continuous renal replacement therapy (CRRT). During CRRT, prolonged anticoagulant therapy should be administered to prevent extracorporeal clotting. The purpose of our study was to evaluate whether a low concentration of plasma trisodium citrate (TCA) was effective as an anticoagulation treatment for continuous veno-venous hemofiltration (CVVH). We also retrospectively analyzed the complications of regional citrate anticoagulation (RCA) in our hospital. METHODS: We conducted this single-center retrospective study at a tertiary academic hospital. The study period was from July 1, 2019 to January 1, 2021. CVVH using the RCA protocol during the study period was performed. The RCA protocol and complications were included and analyzed. The concentrations of citrate in the blood and plasma were calculated. RESULTS: In the current study, we used low-dose TCA as an anticoagulant in 288 CVVH runs for 78 patients. The median whole blood and plasma citrate concentrations were 2.13 mmol/L and 2.84 mmol/L, respectively. Although only a low concentration of citrate was used, RCA achieved expected anticoagulation and ensured the life span of the hemofilter during CVVH therapy. Although hypocalcemia was common during RCA, serious consequences could be prevented by timely adjustment of the protocol. Citrate intoxication was rare in patients without relative contraindications for citric acid. We did not find RCA-associated hypernatremia. CONCLUSIONS: We recommend the use of a low concentration of TCA (2.5-3.0 mmol/L in plasma) in extracorporeal solution in the RCA protocol. Although RCA may cause some complications, serious complications can be prevented. Mild hypocalcemia and transient metabolic alkalosis can be corrected in a timely manner. We do not believe hypernatremia is a complication of RCA if the RCA protocol is appropriately applied.


Assuntos
Terapia de Substituição Renal Contínua , Hemofiltração , Anticoagulantes/uso terapêutico , Citratos/uso terapêutico , Humanos , Estudos Retrospectivos
3.
Ann Palliat Med ; 10(8): 8939-8951, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34488381

RESUMO

BACKGROUND: A systematic review and meta-analysis were conducted to explore the clinical efficacy and coagulation function of regional citrate anticoagulation (RCA) in continuous renal replacement therapy (CRRT) in critically ill patients, to provide an effective treatment options for CRRT in severe patients. METHODS: The English databases Embase, Medline, PubMed, Ovid, Springer, and Web of Science were searched to screen for randomized controlled trials (RCTs) on RCA in the CRRT treatment of critically ill patients published before June 1, 2020. Meta analysis using the RevMan5.3 provided by the Cochrane collaboration network. The search terms included "citrate anticoagulation", "patient in severe condition", "CRRT", "clinical effect", and "coagulation function". RESULTS: ten articles meeting requirements were included, comprising 1,411 subjects. Meta-analysis results showed that after treatment, total calcium/ionized calcium (totCa/ionCa) [mean difference (MD) =0.05; 95% confidence interval (CI): (-0.02 to 0.12); Z=1.31; P=0.19], prothrombin time [MD =4.51; 95% CI: (2.77, 6.24); Z=5.10; P<0.00001], activated partial thromboplastin time [MD =2.56; 95% CI: (1.17, 3.95); Z=3.61; P=0.0003], and thrombin time [MD =4.22; 95% CI: (2.07, 6.36); Z=3.85; P=0.0001] all increased. However, platelet count [MD =-5.75; 95% CI: (-8.85, -2.64); Z=3.63; P=0.0003], cystatin [MD =-0.39; 95% CI: (-0.63, -0.15); Z=3.22; P=0.001], alanine aminotransferase [MD =-17.63; 95% CI: (-20.09, -15.16); Z=14.02; P<0.00001], aspartate aminotransferase [MD =-6.49; 95% CI: (-11.94, -1.04); Z=2.33; P=0.02], creatinine [MD =-3.70; 95% CI: (-5.08, -2.32); Z=5.24; P<0.00001], and total bilirubin [MD =-3.65; 95% CI: (-5.91, -1.40); Z=3.18; P=0.001] all decreased. Except for totCa/ionCa, the differences in other indicators were not statistically significant compared with the control group. DISCUSSION: RCA can significantly improve the clinical efficacy and blood coagulation indicators of CRRT for severely ill patients.


Assuntos
Terapia de Substituição Renal Contínua , Anticoagulantes/farmacologia , Anticoagulantes/uso terapêutico , Coagulação Sanguínea , Citratos/farmacologia , Ácido Cítrico/farmacologia , Ácido Cítrico/uso terapêutico , Humanos , Terapia de Substituição Renal , Resultado do Tratamento
4.
Neurol India ; 69(4): 1043-1044, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34507441

RESUMO

Hemorrhagic neuropathy is an extremely rare condition. This condition refers to bleed into or around a peripheral nerve, causing either an extra neural or an intraneural hematoma. When they do occur, it is usually due to iatrogenic/inherited coagulopathies or as a consequence of injections targeting nerves. We present a case of sciatic nerve palsy developed secondary to anticoagulant therapy (Warfarin). MRI imaging showed features of sciatic nerve hematoma following which warfarin was withdrawn. The patient showed symptomatic improvement and a follow up ultrasound of left thigh showed resolution of hematoma with normal sciatic nerve diameter. To the best of our knowledge there is limited available literature regarding nerve hematomas secondary to anticoagulation therapy. This complication should be promptly recognized and immediate steps should take place because of the favorable results of the early treatment.


Assuntos
Hematoma , Neuropatia Ciática , Anticoagulantes , Hematoma/induzido quimicamente , Hematoma/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Nervo Isquiático/diagnóstico por imagem , Neuropatia Ciática/induzido quimicamente , Neuropatia Ciática/diagnóstico por imagem , Ultrassonografia
5.
Bull World Health Organ ; 99(9): 653-660, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34475602

RESUMO

Poor control of cardiovascular disease accounts for a substantial proportion of the disease burden in developing countries, but often essential anticoagulant medicines for preventing strokes and embolisms are not widely available. In 2019, direct oral anticoagulants were added to the World Health Organization's WHO Model list of essential medicines. The aims of this paper are to summarize the benefits of direct oral anticoagulants for patients with cardiovascular disease and to discuss ways of increasing their usage internationally. Although the cost of direct oral anticoagulants has provoked debate, the affordability of introducing these drugs into clinical practice could be increased by: price negotiation; pooled procurement; competitive tendering; the use of patent pools; and expanded use of generics. In 2017, only 14 of 137 countries that had adopted national essential medicines lists included a direct oral anticoagulant on their lists. This number could increase rapidly if problems with availability and affordability can be tackled. Once the types of patient likely to benefit from direct oral anticoagulants have been clearly defined in clinical practice guidelines, coverage can be more accurately determined and associated costs can be better managed. Government action is required to ensure that direct oral anticoagulants are covered by national budgets because the absence of reimbursement remains an impediment to achieving universal coverage. Tackling cardiovascular disease with the aid of direct oral anticoagulants is an essential component of efforts to achieve the World Health Organization's target of reducing premature deaths due to noncommunicable disease by 25% by 2025.


Assuntos
Anticoagulantes/economia , Custos de Medicamentos , Medicamentos Essenciais/provisão & distribuição , Medicamentos Genéricos/provisão & distribuição , Acesso aos Serviços de Saúde/estatística & dados numéricos , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Custos e Análise de Custo , Medicamentos Essenciais/economia , Medicamentos Genéricos/economia , Custos de Cuidados de Saúde , Humanos
6.
Cardiovasc Diabetol ; 20(1): 176, 2021 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-34481513

RESUMO

BACKGROUND: It remains uncertain if prior use of oral anticoagulants (OACs) in COVID-19 outpatients with multimorbidity impacts prognosis, especially if cardiometabolic diseases are present. Clinical outcomes 30-days after COVID-19 diagnosis were compared between outpatients with cardiometabolic disease receiving vitamin K antagonist (VKA) or direct-acting OAC (DOAC) therapy at time of COVID-19 diagnosis. METHODS: A study was conducted using TriNetX, a global federated health research network. Adult outpatients with cardiometabolic disease (i.e. diabetes mellitus and any disease of the circulatory system) treated with VKAs or DOACs at time of COVID-19 diagnosis between 20-Jan-2020 and 15-Feb-2021 were included. Propensity score matching (PSM) was used to balance cohorts receiving VKAs and DOACs. The primary outcomes were all-cause mortality, intensive care unit (ICU) admission/mechanical ventilation (MV) necessity, intracranial haemorrhage (ICH)/gastrointestinal bleeding, and the composite of any arterial or venous thrombotic event(s) at 30-days after COVID-19 diagnosis. RESULTS: 2275 patients were included. After PSM, 1270 patients remained in the study (635 on VKAs; 635 on DOACs). VKA-treated patients had similar risks and 30-day event-free survival than patients on DOACs regarding all-cause mortality, ICU admission/MV necessity, and ICH/gastrointestinal bleeding. The risk of any arterial or venous thrombotic event was 43% higher in the VKA cohort (hazard ratio 1.43, 95% confidence interval 1.03-1.98; Log-Rank test p = 0.029). CONCLUSION: In COVID-19 outpatients with cardiometabolic diseases, prior use of DOAC therapy compared to VKA therapy at the time of COVID-19 diagnosis demonstrated lower risk of arterial or venous thrombotic outcomes, without increasing the risk of bleeding.


Assuntos
Assistência Ambulatorial/métodos , Anticoagulantes/administração & dosagem , COVID-19/tratamento farmacológico , Cardiopatias/tratamento farmacológico , Doenças Metabólicas/tratamento farmacológico , Vitamina K/antagonistas & inibidores , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , COVID-19/diagnóstico , COVID-19/mortalidade , Inibidores do Fator Xa/administração & dosagem , Feminino , Seguimentos , Cardiopatias/diagnóstico , Cardiopatias/mortalidade , Hemorragia/induzido quimicamente , Hemorragia/mortalidade , Humanos , Unidades de Terapia Intensiva/tendências , Masculino , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/mortalidade , Pessoa de Meia-Idade , Mortalidade/tendências , Resultado do Tratamento
7.
Zhen Ci Yan Jiu ; 46(8): 707-9, 2021 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-34472758

RESUMO

Acupuncture therapy is widely used in the treatment of various clinical problems, but has some contraindications which should be highly noted. For example, patients with potential hemorrhagic tendency owing to administration of necessary anticoagulants and antiplatelets should be paid more attention when acupuncture therapy was performed. Usually, anticoagulants and antiplatelets combined with nonsteroidal anti-inflammatory hormones, antibiotic agents and vasodilators significantly increased the risk of bleeding. Chinese herbal medicines for activating blood circulation to arrest pain, and improper medication including the dosage and frequency should be avoided. Patients with chronic liver diseases, acute and severe liver and kidney function impairment due to inability to secrete coagulation factor in time to initiate coagulation mechanism are also unsuitable for acupuncture the-rapy. For this reason, we put forward some necessary countermeasures: a) collecting the patient's medical history in detail, b) paying attention to the coagulation related tests, c) taking the patient's blood volume and platelet related parameters seriously, and d) enacting reasonable diagnosis and treatment ideas.


Assuntos
Terapia por Acupuntura , Anticoagulantes , Anticoagulantes/efeitos adversos , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Inibidores da Agregação Plaquetária
8.
Andes Pediatr ; 92(3): 395-405, 2021 Jun.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34479246

RESUMO

INTRODUCTION: In April 2020, the pediatric multisystem inflammatory syndrome temporarily associated with COVID-19 (MIS-C) was described for the first time. MIS-C could have a severe course and may require critical care support. OBJECTIVE: To describe the clinical, laboratory, and management characteristics of hospitalized children who meet MIS-C criteria with severe presentation in a pediatric critical pa tient unit. PATIENTS AND METHOD: Descriptive prospective study of children with severe MIS-C mana ged by treatment phases with immunoglobulin and methylprednisolone, according to their clinical response. Epidemiological, clinical, laboratory and imaging data were obtained. Phenotypes were classified into Kawasaki and not Kawasaki, comparing their findings. RESULTS: 20 patients were analy zed, the median age was 6 years, 60% were female, and 40% presented comorbidity. SARS-CoV-2 was detected in 90% of the patients. They presented fever as the first symptom, followed by brief and early gastrointestinal symptoms (70%). 75% presented the Kawasaki phenotype. They evolved with lymphopenia, hypoalbuminemia, coagulation alterations, and elevated systemic and cardiac in flammatory parameters. 80% of the cases presented echocardiographic alterations and 90% shock that required critical care support. All the patients had a short and favorable evolution. All patients responded to the established therapy, but 40% required a second phase of treatment. There were no differences when comparing phenotypes. No deaths were reported. CONCLUSION: MIS-C is a new childhood disease whose presentation could be life-threatening. It requires early suspicion, immuno modulatory management, critical care support, and a multidisciplinary approach to obtain the best results and optimize its prognosis.


Assuntos
COVID-19 , SARS-CoV-2 , Síndrome de Resposta Inflamatória Sistêmica , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Transtornos da Coagulação Sanguínea/etiologia , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/terapia , Criança , Cuidados Críticos , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Hipoalbuminemia/etiologia , Imunoglobulinas Intravenosas/administração & dosagem , Fatores Imunológicos/administração & dosagem , Unidades de Terapia Intensiva Pediátrica , Linfopenia/etiologia , Masculino , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Estudos Prospectivos , SARS-CoV-2/isolamento & purificação , Choque/etiologia , Choque/terapia , Avaliação de Sintomas , Síndrome de Resposta Inflamatória Sistêmica/complicações , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/terapia
9.
Rev Med Suisse ; 17(749): 1495-1498, 2021 Sep 08.
Artigo em Francês | MEDLINE | ID: mdl-34495584

RESUMO

Coagulation disorders related to abnormalities in hepatic synthesis are well known as prognostic factors in hepatic cirrhosis. The risk of bleeding, mainly linked to portal hypertension, must be weighed against the risk of thrombosis, the most frequent manifestation of which is portal venous thrombosis. Conventional laboratory tests are not a reliable reflection of this delicate balance. The use of prophylactic anticoagulation in hospitalized patients with decompensated hepatic cirrhosis or therapeutic anticoagulation in venous thrombosis is recommended in most cases, in the absence of contraindications.


Assuntos
Transtornos da Coagulação Sanguínea , Trombose , Trombose Venosa , Anticoagulantes/uso terapêutico , Coagulação Sanguínea , Humanos , Cirrose Hepática/complicações
10.
Rinsho Ketsueki ; 62(8): 1236-1246, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34497212

RESUMO

In 2020, infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) rapidly spread across the world to become a global pandemic. Coronavirus disease-2019 (COVID-19) is associated with a high rate of coagulopathy and thrombotic complications. The underlying mechanisms involved in these processes are complex. In addition to the low physical activity, blood coagulation activation accompanied by excessive immune/inflammatory reactions and vascular endothelialitis associated with the presence of intracellular SARS-CoV-2 and disrupted cell membranes contribute substantially to the complexity of the mechanisms. The types of thrombosis that occur include arterial thrombosis and venous thromboembolism. Microthrombi in alveolar capillaries are observed in COVID-19 patients. Considering the possible involvement of thrombosis in the worsening of COVID-19, prophylactic anticoagulant therapy, such as low-molecular-weight heparin or unfractionated heparin, is essential for patients with moderate and severe infections. Even with prophylactic anticoagulant therapy, the incidence of thrombosis remains high. Consequently, control of the underlying inflammation and vascular endothelial protection may be required in combination with anticoagulant therapy.


Assuntos
Transtornos da Coagulação Sanguínea , COVID-19 , Anticoagulantes , Heparina , Humanos , Pandemias , SARS-CoV-2
11.
Isr Med Assoc J ; 23(9): 580-583, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34472234

RESUMO

BACKGROUND: Oral anticoagulants (OAC) reduce the risk for stroke and death from all causes in patients with non-valvular atrial fibrillation (NVAF). OBJECTIVES: To explore adherence rates of OAC among patients with NVAF in long-term use in a real-world setting and to examine patient characteristics associated with good adherence. METHODS: We conducted a population-based cohort study with members of Clalit Health Services, Israel. All patients aged ≥ 30 years with a diagnosis of NVAF before 2016 who were treated with OAC were included. We included patients who filled at least one prescription per year in the three consecutive years 2016-2018. We analyzed all prescriptions that were filled for the medications from 1 January 2017 to 31 December 2017. We considered purchasing of at least nine monthly prescriptions during 2017 as good medication adherence. RESULTS: We identified 26,029 patients with NVAF who were treated with OAC; 10,284 (39.5%) were treated with apixaban, 6321 (24.3%) with warfarin, 6290 (24.1%) with rivaroxaban, and 3134 (12.0%) with dabigatran. Rates of good medication adherence were 88.9% for rivaroxaban, 84.9% for apixaban, 83.6% for dabigatran, and 55.8% for warfarin (P < 0.0001). Advanced age was associated with higher adherence rates (P < 0.001). Socioeconomic status was not associated with medication adherence. Good adherence with OAC was associated with lower low density lipoprotein (LDL) cholesterol and glucose levels. CONCLUSIONS: Adherence rates to OAC in chronic use among patients with chronic NAVF are high. Investing in OAC adherence may have a wider health impact than expected.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Adesão à Medicação , Acidente Vascular Cerebral/prevenção & controle , Administração Oral , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Estudos de Coortes , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/etiologia
12.
Khirurgiia (Mosk) ; (9): 54-62, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34480456

RESUMO

OBJECTIVE: To analyze an effectiveness of algorithm for complex treatment of patients with surgical complications of prolonged warfarin therapy in a general surgical hospital. MATERIAL AND METHODS: The study included 138 patients with surgical complications of prolonged warfarin therapy. All patients received warfarin for at least 6 months (49.5% of patients - over 5 years). Warfarin therapy was indicated for deep vein thrombosis in 54 patients and various cardiac diseases in 84 patients. Examination included clinical and instrumental survey, laboratory tests and coagulation tests - thromboelastography (TEG) and thrombodynamics test (TT). RESULTS: Recurrent VTEC occurred in 24 out of 138 patients, hemorrhagic complications - in 114 patients. Therapeutic management was applied in 111 patients, 27 ones underwent surgery (emergency treatment - 25 patients, after two days - 2 patients). Ten patients underwent endoscopic hemostasis, two patients - ultrasound-assisted percutaneous drainage of hematoma. Recurrent VTECs were caused by inadequate laboratory control and violations of warfarin therapy. Most of these patients underwent therapeutic management (only 3 patients required surgery for life-threatening flotation in great veins). Treatment of 114 patients with hemorrhagic complications of prolonged warfarin therapy depended on features of bleeding and severity of warfarin-induced coagulopathy. Depending on these factors, warfarin was discontinued and intravenous administration of vitamin K / FFP / prothrombin complex concentrate was applied. This approach ensured successful therapeutic measures in 90 patients of this group. Twenty-four patients underwent surgery after correction of hemostatic disorders. TT was characterized by high efficiency in analysis of thrombotic predisposition and prediction of the risk of VTEC. TEG was valuable for assessment of warfarin-induced coagulopathy and treatment of patients with hemorrhagic complications of prolonged warfarin therapy. CONCLUSION: The developed clinical and diagnostic algorithm for management of hemorrhagic complications of prolonged warfarin therapy ensures positive clinical results even in a general surgical hospital.


Assuntos
Anticoagulantes , Varfarina , Anticoagulantes/efeitos adversos , Testes de Coagulação Sanguínea , Hemorragia , Hospitais , Humanos , Varfarina/efeitos adversos
13.
F1000Res ; 10: 469, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34394916

RESUMO

Background: COVID-19 disease is accompanied by derangement of coagulation with a risk of fatal thromboembolic formation. COVID-19 patients are among those indicative for heparin treatment. Increased heparin administration among COVID-19 patients increased heparin induced-thrombocytopenia's risk with/without thrombocytopenia. Case presentation: We present a 71-year-old male patient who came to the emergency department (ED) with a COVID-19 clinical manifestation that PCR nasopharyngeal swab confirmed. He was assessed to have acute respiratory distress syndrome (ARDS), as shown by rapid progression of hypoxemic respiratory failure and bilateral pulmonary infiltrate. He was then treated with moxifloxacin, remdesivir, dexamethasone, heparin pump, and multivitamins. During admission, his respiratory symptoms got worse, so he transferred to the ICU for NIV support. On the ninth day of admission, he had gross hematuria followed by a rapid fall of platelet count. We used two different scoring systems (4Ts and HEP scoring system) to confirm the diagnosis of heparin-induced thrombocytopenia (HIT). Following the discontinuation of heparin injection, the thrombocyte continued to rise, and hematuria disappeared. Conclusion: Heparin-induced thrombocytopenia is associated with an increased risk of severe disease and mortality among COVID-19 patients. The differential diagnosis of HIT could be difficult among COVID-19 patients as thrombocytopenia can also be caused by infection progression. We use two scoring systems, 4Ts and HEP scoring, that can help us to manage the patient. With good management, we can avoid patient morbidity and mortality.


Assuntos
COVID-19 , Sepse , Trombocitopenia , Idoso , Anticoagulantes/efeitos adversos , Surtos de Doenças , Heparina/efeitos adversos , Humanos , Masculino , SARS-CoV-2 , Sepse/diagnóstico , Trombocitopenia/induzido quimicamente , Trombocitopenia/diagnóstico
14.
Ann Rheum Dis ; 80(5): 605-609, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34380108

RESUMO

BACKGROUND: Identification of modifiable risk factors and treatments for osteoarthritis (OA) are needed. Warfarin, a vitamin K antagonist, causes fetal and animal model skeletal abnormalities. Vitamin K insufficiency has been associated with OA, but whether warfarin is also detrimental to OA is not known. METHODS: We conducted a nested case-control study using a UK general practitioner electronic medical records database. We identified cases of knee or hip replacement (KR or HR) from among adults with atrial fibrillation newly prescribed either warfarin or direct oral anticoagulants (DOACs). Cases were matched with four controls by age and sex. We assessed the relation of warfarin compared with DOAC use to risk of joint replacement using conditional logistic regression. We also evaluated different durations of warfarin use. RESULTS: We identified 857 subjects with KR or HR (cases), of whom 64.6% were warfarin users, and 3428 matched controls, of whom 56.1% were warfarin users (mean age 75, 47% female). Warfarin users had a 1.59 times higher risk of joint replacement than DOAC users (adjusted OR 1.59, 95% CI 1.31 to 1.92). Longer duration of warfarin use was associated with higher risk of joint replacement in comparison with <1 year of warfarin use. CONCLUSION: Warfarin, a vitamin K antagonist, was associated with greater risk of KR and HR (an indicator for end-stage knee OA) than DOAC use, supporting the importance of adequate vitamin K functioning in limiting OA progression.


Assuntos
Anticoagulantes/efeitos adversos , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/estatística & dados numéricos , Osteoartrite/cirurgia , Varfarina/efeitos adversos , Idoso , Estudos de Casos e Controles , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/induzido quimicamente , Fatores de Risco , Vitamina K/antagonistas & inibidores
16.
J Pak Med Assoc ; 71(8): 2014-2017, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34418022

RESUMO

OBJECTIVE: To compare peri-operative practices and complications in ovarian cancer patients undergoing upfront surgery for primary disease under enhanced recovery after surgery protocol and traditional practices. METHODS: The retrospective cross-sectional study was done at the gynaecology departments of St Georges Hospital, United Kingdom, and the Aga Khan Hospital, Pakistan, and comprised data of an equal number of ovarian cancer patients from each centre who underwent ovarian cancer surgery from January 2015 to December 2016. The former centre practiced the enhanced recovery after surgery protocol, while the latter centre followed traditional practices. Data was analysed using SPSS 19. RESULTS: Of the 100 patients, there were 50(50%) in each group. Baseline variables were comparable except for diabetes which was more prevalent in the local group (p=0.03). Mechanical bowel preparation was performed in 47(94%) of local patients compared to 1(2%) in the other group, while the duration for nil-per-mouth status as well as the use of nasogastric tube and peritoneal drain were significantly different (p<0.05). Epidural anaesthesia was used in 39(78%) of patients in Pakistan compared to 4(8%) in the United Kingdom. The duration of thromboprophylaxis was also significantly different (p<0.05). CONCLUSIONS: Implementation of enhanced recovery after surgery protocol was found to have the potential to improve postoperative outcomes and good functional recovery without compromising patient safety.


Assuntos
Recuperação Pós-Cirúrgica Melhorada , Neoplasias Ovarianas , Tromboembolia Venosa , Anticoagulantes , Estudos Transversais , Feminino , Humanos , Neoplasias Ovarianas/cirurgia , Paquistão , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Reino Unido
17.
BMC Musculoskelet Disord ; 22(1): 688, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34389016

RESUMO

BACKGROUND: The use of drains reportedly does not improve surgical outcomes after hip replacement. There is still a lack of strict recommendations for drain placement after primary hip replacement. This study aimed to assess the safety of not using suction drainage after primary hip replacement in a population of patients undergoing extended thromboprophylaxis. METHODS: In this prospective randomized study, all patients were qualified for primary hip replacement and were divided into two groups: with and without drainage. The inclusion criterion was idiopathic hip osteoarthritis. The exclusion criteria were secondary coxarthrosis, autoimmune disease, coagulopathy, venous/arterial thrombosis, hepatic/renal insufficiency, cement, or hybrid endoprostheses. We performed an intention-to-treat analysis. Clinical, laboratory, and radiographic parameters were measured for the first three days after surgery. Hematoma collection, due to extended thromboprophylaxis, in the joint and soft tissues was evaluated precisely. The patients underwent follow-up for 30 days. RESULTS: The final analysis included a total of 100 patients. We did not find any significant statistical differences between groups in terms of hip fluid collection (9.76 vs. 10.33 mm, with and without drainage, respectively; mean difference, 0.6 mm; 95 % confidence interval [CI] -2.8 to 3.9; p = 0.653), estimated blood loss (1126 vs. 1224 ml; mean difference, 97.1 ml; 95 % CI -84.1 to 278.2; p = 0.59), and hemoglobin levels on postoperative day 3 (11.05 vs. 10.85 g/dl; mean difference, 0.2; 95 % CI -2.1 to 2.5; p = 0.53). In addition, the other parameters did not show significant differences between groups. Notably, two cases of early infections were observed in the no-drainage group, whereas there were no such complications in the drainage group. CONCLUSIONS: We conclude that the use of closed suction drainage after primary hip replacement is a safe procedure in patients undergoing extended thromboprophylaxis. Further research is warranted to validate these findings. TRIAL REGISTRATION: The study was successfully registered retrospectively at Clinicaltrial.gov with the identification number NCT04333264  03 April 2020.


Assuntos
Artroplastia de Quadril , Tromboembolia Venosa , Anticoagulantes/efeitos adversos , Artroplastia de Quadril/efeitos adversos , Drenagem , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Estudos Retrospectivos , Sucção/efeitos adversos
19.
BMJ Case Rep ; 14(8)2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34389601

RESUMO

COVID-19 is caused by the SARS-CoV-2, and its presentation ranges from mild upper respiratory illness to critical disease including acute respiratory distress syndrome and multiorgan dysfunction. While it was initially believed to primarily target the respiratory system, numerous studies have demonstrated it to cause a hypercoagulable state that predisposes to arterial and venous thrombosis. We present a case where a patient with COVID-19 developed acute lower limb ischaemia due to arterial thrombosis in the setting of full-dose enoxaparin, followed by heparin infusion protocol. The patient developed recurrent ischaemia despite thrombolysis in addition to anticoagulation, and eventually required open thrombectomy before making a full recovery.


Assuntos
COVID-19 , Anticoagulantes/uso terapêutico , Humanos , Isquemia/tratamento farmacológico , Isquemia/etiologia , SARS-CoV-2 , Terapia Trombolítica
20.
BMJ Case Rep ; 14(8)2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404650

RESUMO

Retroperitoneal haemorrhage (RH) is not uncommon in patients with provoking events like trauma. However, spontaneous RH (SRH) is a rare and life-threatening complication described as the development of bleeding into the retroperitoneal cavity, appearing spontaneously and without a preceding history of trauma or other predisposing illness. We are reporting a case of an elderly patient with recurrent deep vein thrombosis who had developed SRH secondary to concurrent use of multiple anticoagulation agents, resulting from poor healthcare follow-up and lack of sufficient medication reconciliation. This article highlights the significance of recognising risk factors for SRH, as well as management strategies through literature review.


Assuntos
Hemorragia , Polimedicação , Idoso , Anticoagulantes/efeitos adversos , Coagulação Sanguínea , Hemorragia/induzido quimicamente , Hemorragia/tratamento farmacológico , Humanos , Espaço Retroperitoneal
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