Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 18.693
Filtrar
1.
Tuberk Toraks ; 69(2): 269-278, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34256519

RESUMO

COVID-19 emerged in Wuhan, China in late December 2019, and WHO declared it a pandemic on March 11, 2020. The disease has a wide spectrum ranging from asymptomatic or mild disease to ARDS and death. There have been over 83.9 million cases with 1.8 million deaths worldwide. COVIDassociated coagulopathy appears to be an entity responsible for deaths. Thromboprophylaxis is recommended in patients with COVID-19 to prevent arterial and venous thromboembolism. Low molecular weight heparin such as enoxaparin is often recommended. However, there is still no consensus regarding the treatment dose and duration. The purpose of this review was to observe the pathogenesis of thromboembolic events in COVID-19, current thromboprophylaxis regimens, treatment dosage and duration with guidelines of international scientific institutions.


Assuntos
Anticoagulantes/administração & dosagem , COVID-19/complicações , Gerenciamento Clínico , Pandemias , SARS-CoV-2 , Tromboembolia Venosa/prevenção & controle , COVID-19/epidemiologia , Humanos , Turquia/epidemiologia , Tromboembolia Venosa/etiologia
2.
Medicine (Baltimore) ; 100(23): e26313, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115042

RESUMO

RATIONALE: In coronavirus disease 2019 (COVID-19) patients with acute respiratory distress syndrome refractory to optimal conventional management, we should consider the indication for veno-venous extracorporeal membrane oxygenation (V-V ECMO). Growing evidence indicates that COVID-19 frequently causes coagulopathy, presenting as hypercoagulation and incidental thrombosis. For these reasons, a multifactorial approach with several anticoagulant markers should be considered in the management of anticoagulation using heparin in COVID-19 patients on V-V ECMO. PATIENT CONCERNS: A 48-year-old man was infected with COVID-19 with a worsening condition manifesting as acute respiratory distress syndrome. DIAGNOSES: He was refractory to conventional therapy, thus we decided to introduce V-V ECMO. We used heparin as an anticoagulant therapy for V-V ECMO and adjusted the doses of heparin by careful monitoring of the activated clotting time (ACT) and activated partial thromboplastin time (APTT) to avoid both hemorrhagic and thrombotic complications. We controlled the doses of heparin in the therapeutic ranges of ACT and APTT, but clinical hemorrhaging and profound elevation of coagulant marker became apparent. INTERVENTIONS: Using thromboelastography (TEG; Haemonetics) in addition to ACT and APTT, we were able to clearly detect not only sufficient coagulability of COVID19 on V-V ECMO (citrated rapid thromboelastography-R 0.5 min, angle 75.5°, MA 64.0 mm, citrated functional fibrinogen-MA 20.7 mm) but also an excessive effect of heparin (citrated kaolin -R 42.7 min, citrated kaolin with heparinase 11.7 min). OUTCOMES: Given the TEG findings indicating an excessive heparin effect, the early withdrawal of ECMO was considered. After an evaluation of the patient's respiratory capacity, withdrawal from V-V ECMO was achieved and then anticoagulation was stopped. The hemorrhagic complications and elevated thrombotic marker levels dramatically decreased. LESSONS: TEG monitoring might be a useful option for managing anticoagulation in COVID-19 patients on V-V ECMO frequently showing a hypercoagulative state and requiring massive doses of heparin, to reduce both hemorrhagic and thrombotic complications.


Assuntos
Anticoagulantes/administração & dosagem , COVID-19/complicações , Oxigenação por Membrana Extracorpórea , Heparina/administração & dosagem , Síndrome do Desconforto Respiratório/terapia , Tromboelastografia , Hemorragia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome do Desconforto Respiratório/virologia
3.
Medicine (Baltimore) ; 100(25): e26264, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160390

RESUMO

BACKGROUND: Antiphospholipid antibody syndrome (APS) is a systemic, autoimmune, prothrombotic disease characterized by persistent antiphospholipid antibodies, thrombosis, recurrent abortion, complications during pregnancy, and occasionally thrombocytopenia. At present, there is no consensus on the treatment of this disease. Long-term anticoagulation is recommended in most cases in patients with thrombotic APS. This study aimed to evaluate whether aspirin combined with low-molecular-weight heparin (LMWH) can improve the live birth rate in antiphospholipid syndrome and its correlation with D-dimer. METHODS: The data were retrieved from the WanFang Data, CBM, VIP, CNKI, the Cochrane Library, PubMed, EMBASE, OVID, and Web of Science databases. We collected data on randomized controlled trials of aspirin combined with LMWH in the treatment of pregnant women with APS. The "Risk of Bias Assessment" tool and the "Jadad Scale" provided by the Cochrane Collaboration were used to evaluate the risk of bias and quality of the collected literature. The risk ratio (RR) and its 95% confidence interval (CI) were determined using Statase-64 software. RESULTS: In this study, a total of 11 studies were included, comprising a total of 2101 patients. The live birth rate in pregnant women with APS was higher on administration of aspirin combined with LMWH than with aspirin alone (RR = 1.29, 95% CI = 1.22-1.35, P < .001). d-dimer concentration in plasma predicted the live birth rate, which was higher below the baseline than above it (RR = 1.16, 95% CI = 1.09-1.23, P < .001). The subgroup analysis of the live birth rate was carried out based on the course of treatment, and the results were consistent with the overall results. Begg funnel plot test revealed no publication bias. Sensitivity analysis showed that deleting any study did not affect the results. CONCLUSION: Aspirin combined with LMWH for APS may improve live birth rate, and detection of d-dimer levels in APS pregnant women may predict pregnancy complications and guide the use of anticoagulants.


Assuntos
Aborto Habitual/prevenção & controle , Anticoagulantes/administração & dosagem , Síndrome Antifosfolipídica/tratamento farmacológico , Complicações Hematológicas na Gravidez/tratamento farmacológico , Trombose/tratamento farmacológico , Aborto Habitual/sangue , Aborto Habitual/imunologia , Anticorpos Antifosfolipídeos/sangue , Anticorpos Antifosfolipídeos/imunologia , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/imunologia , Aspirina/administração & dosagem , Biomarcadores/sangue , Coeficiente de Natalidade , Quimioterapia Combinada/métodos , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Nascido Vivo , Gravidez , Complicações Hematológicas na Gravidez/sangue , Complicações Hematológicas na Gravidez/diagnóstico , Complicações Hematológicas na Gravidez/imunologia , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Trombose/sangue , Trombose/complicações , Trombose/imunologia , Resultado do Tratamento
4.
Clin Appl Thromb Hemost ; 27: 10760296211021495, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34142564

RESUMO

The treatment process of patients using warfarin is expected to be hindered during the COVID-19 pandemic. Therefore we investigated whether the time in therapeutic range (TTR) and bleeding complications were affected during the COVID-19 pandemic. 355 patients using warfarin were included between March 2019 to March 2021. Demographic parameters, INR (international normalized ratio), and bleeding rates were recorded retrospectively. The TTR value was calculated using Rosendaal's method. The mean age of the patients was 61 ± 12 years and 55% of them were female. The mean TTR value during the COVID-19 pandemic was lower than the pre-COVID-19 period (56 ± 21 vs 68 ± 21, P < 0.001). Among the patients, 41% had a lack of outpatient INR control. During the COVID-19 pandemic, 71 (20%) patients using VKA suffered bleeding. Among patients with bleeding, approximately 60% did not seek medical help and 6% of patients performed self-reduction of the VKA dose. During the COVID-19 pandemic, TTR values have decreased with the lack of monitoring. Furthermore, the majority of patients did not seek medical help even in case of bleeding.


Assuntos
Anticoagulantes/farmacologia , Tempo de Sangramento , Coagulação Sanguínea/efeitos dos fármacos , COVID-19/sangue , Hemorragia/induzido quimicamente , Coeficiente Internacional Normatizado , Pandemias , SARS-CoV-2 , Trombofilia/sangue , Varfarina/farmacologia , Idoso , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , COVID-19/complicações , Relação Dose-Resposta a Droga , Feminino , Próteses Valvulares Cardíacas/efeitos adversos , Hemorragia/psicologia , Humanos , Hipertensão/complicações , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Embolia Pulmonar/tratamento farmacológico , Estudos Retrospectivos , Automedicação , Trombofilia/tratamento farmacológico , Trombofilia/etiologia , Varfarina/administração & dosagem , Varfarina/efeitos adversos , Varfarina/uso terapêutico
5.
Ther Adv Cardiovasc Dis ; 15: 17539447211012803, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34120532

RESUMO

BACKGROUND: Rates of obesity continue to rise worldwide as evidenced in the 2017 Centers for Disease Control and Prevention (CDC) report that indicated over 35% of United States (US) citizens are obese, with Louisiana ranked as the fifth most obese state in America. Since large clinical trials tend to exclude obese patients, health care providers are faced with concerns of under- or overdosing these patients on warfarin. METHODS: This retrospective chart review evaluated patients who reported to a community anticoagulation clinic for warfarin management between 1 June 2017 and 30 September 2017. Along with baseline demographics, chronic use of drugs that have clinically significant interactions with warfarin, social activity such as tobacco use and alcohol consumption, were collected. Body mass indexes (BMI) were collected and categorized according to the World Health Organization definitions as follows: Normal (BMI 18-24.9 kg/m2), Overweight (25-29.9 kg/m2), Obesity Class I (30-34.9 kg/m2), Obesity Class II (35-39.9 kg/m2), Obesity Class III (⩾40 kg/m2). The primary outcome was the mean 90-day warfarin dose required to maintain "intermediate control" or "good control" of international normalized ratio (INR), stratified by BMI classifications. The secondary outcome was the time in therapeutic range (TTR) stratified by BMI classifications. RESULTS: A total of 433 patient encounters were included in this study. There was a total of 43 encounters in the Normal BMI category, 111 Overweight encounters, 135 Obesity Class I encounters, 45 Obesity Class II encounters, and 99 Obesity Class III encounters. Approximately 63% of the study population were male, and over 90% the patients were African American. The Obesity Class I and Obesity Class II class required an average of 11.47 mg and 17.10 mg more warfarin, respectively, to maintain a therapeutic INR when compared with the Normal BMI category. These findings were statistically significant with p values of 0.007 and <0.001, respectively. Additionally, upon comparing the Overweight BMI category with the Obesity Class II category, there was a mean warfarin dose difference of 11.22 mg (p = 0.010) more in Obesity Class II encounters to maintain a therapeutic INR. In the secondary analysis of TTR, Overweight category encounters had the highest TTR, whereas encounters in the Normal BMI category had the lowest TTR. CONCLUSION: As BMI increases, there is an increased chronic warfarin requirement to maintain "intermediate control" or "good control" of INR between 2 and 3 in an ambulatory care setting.


Assuntos
Anticoagulantes/administração & dosagem , Coagulação Sanguínea/efeitos dos fármacos , Índice de Massa Corporal , Obesidade/diagnóstico , Varfarina/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/sangue , Cálculos da Dosagem de Medicamento , Interações Medicamentosas , Monitoramento de Medicamentos , Feminino , Humanos , Coeficiente Internacional Normatizado , Masculino , Registros Médicos , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/fisiopatologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Tempo , Varfarina/sangue
6.
Clin Appl Thromb Hemost ; 27: 10760296211021495, 2021.
Artigo em Inglês | MEDLINE | ID: covidwho-1277870

RESUMO

The treatment process of patients using warfarin is expected to be hindered during the COVID-19 pandemic. Therefore we investigated whether the time in therapeutic range (TTR) and bleeding complications were affected during the COVID-19 pandemic. 355 patients using warfarin were included between March 2019 to March 2021. Demographic parameters, INR (international normalized ratio), and bleeding rates were recorded retrospectively. The TTR value was calculated using Rosendaal's method. The mean age of the patients was 61 ± 12 years and 55% of them were female. The mean TTR value during the COVID-19 pandemic was lower than the pre-COVID-19 period (56 ± 21 vs 68 ± 21, P < 0.001). Among the patients, 41% had a lack of outpatient INR control. During the COVID-19 pandemic, 71 (20%) patients using VKA suffered bleeding. Among patients with bleeding, approximately 60% did not seek medical help and 6% of patients performed self-reduction of the VKA dose. During the COVID-19 pandemic, TTR values have decreased with the lack of monitoring. Furthermore, the majority of patients did not seek medical help even in case of bleeding.


Assuntos
Anticoagulantes/farmacologia , Tempo de Sangramento , Coagulação Sanguínea/efeitos dos fármacos , COVID-19/sangue , Hemorragia/induzido quimicamente , Coeficiente Internacional Normatizado , Pandemias , SARS-CoV-2 , Trombofilia/sangue , Varfarina/farmacologia , Idoso , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , COVID-19/complicações , Relação Dose-Resposta a Droga , Feminino , Próteses Valvulares Cardíacas/efeitos adversos , Hemorragia/psicologia , Humanos , Hipertensão/complicações , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Embolia Pulmonar/tratamento farmacológico , Estudos Retrospectivos , Automedicação , Trombofilia/tratamento farmacológico , Trombofilia/etiologia , Varfarina/administração & dosagem , Varfarina/efeitos adversos , Varfarina/uso terapêutico
7.
Medicine (Baltimore) ; 100(23): e26313, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: covidwho-1266224

RESUMO

RATIONALE: In coronavirus disease 2019 (COVID-19) patients with acute respiratory distress syndrome refractory to optimal conventional management, we should consider the indication for veno-venous extracorporeal membrane oxygenation (V-V ECMO). Growing evidence indicates that COVID-19 frequently causes coagulopathy, presenting as hypercoagulation and incidental thrombosis. For these reasons, a multifactorial approach with several anticoagulant markers should be considered in the management of anticoagulation using heparin in COVID-19 patients on V-V ECMO. PATIENT CONCERNS: A 48-year-old man was infected with COVID-19 with a worsening condition manifesting as acute respiratory distress syndrome. DIAGNOSES: He was refractory to conventional therapy, thus we decided to introduce V-V ECMO. We used heparin as an anticoagulant therapy for V-V ECMO and adjusted the doses of heparin by careful monitoring of the activated clotting time (ACT) and activated partial thromboplastin time (APTT) to avoid both hemorrhagic and thrombotic complications. We controlled the doses of heparin in the therapeutic ranges of ACT and APTT, but clinical hemorrhaging and profound elevation of coagulant marker became apparent. INTERVENTIONS: Using thromboelastography (TEG; Haemonetics) in addition to ACT and APTT, we were able to clearly detect not only sufficient coagulability of COVID19 on V-V ECMO (citrated rapid thromboelastography-R 0.5 min, angle 75.5°, MA 64.0 mm, citrated functional fibrinogen-MA 20.7 mm) but also an excessive effect of heparin (citrated kaolin -R 42.7 min, citrated kaolin with heparinase 11.7 min). OUTCOMES: Given the TEG findings indicating an excessive heparin effect, the early withdrawal of ECMO was considered. After an evaluation of the patient's respiratory capacity, withdrawal from V-V ECMO was achieved and then anticoagulation was stopped. The hemorrhagic complications and elevated thrombotic marker levels dramatically decreased. LESSONS: TEG monitoring might be a useful option for managing anticoagulation in COVID-19 patients on V-V ECMO frequently showing a hypercoagulative state and requiring massive doses of heparin, to reduce both hemorrhagic and thrombotic complications.


Assuntos
Anticoagulantes/administração & dosagem , COVID-19/complicações , Oxigenação por Membrana Extracorpórea , Heparina/administração & dosagem , Síndrome do Desconforto Respiratório/terapia , Tromboelastografia , Hemorragia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome do Desconforto Respiratório/virologia
9.
J Clin Neurosci ; 89: 106-112, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34119252

RESUMO

BACKGROUND: Stroke severity can be mitigated by preceding anticoagulant administration in acute ischemic stroke patients with atrial fibrillation (AF). We investigated if such mitigative effects are different between warfarin and direct oral anticoagulants (DOACs). MATERIAL AND METHODS: We collected data from a regional multicenter stroke registry. Ischemic stroke or transient ischemic attack patients with AF were included. Background characteristics, National Institutes of Health Stroke Scale (NIHSS) score on admission, lesion characteristics, and in-hospital death were analyzed according to preceding antithrombotic agents at onset. RESULTS: A total of 2173 patients had AF; 628 were prescribed warfarin, 272 DOACs, 429 antiplatelets alone, and 844 no antithrombotics. The NIHSS score on admission was lowest in the DOACs group compared to the other groups. In neuroimaging analysis, small ischemic lesions were observed more frequently in the DOACs group, while large ischemic lesions were less frequent in this group. When the no antithrombotics group was used as a reference, the adjusted odds ratio for moderate to severe stroke was 0.56 (95% confidence interval, 0.40-0.78) in the DOACs group, while it was 0.98 (0.77-1.24) in the warfarin group and 0.94 (0.72-1.22) in the antiplatelets group. In-hospital mortality was lowest in the DOACs group compared to the other groups. CONCLUSION: Preceding DOAC administration might mitigate the severity of stroke in AF patients more strongly than other antithrombotics, possibly leading to a better outcome in patients with stroke.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/complicações , Fibrinolíticos/administração & dosagem , AVC Isquêmico/tratamento farmacológico , Varfarina/administração & dosagem , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Fibrinolíticos/uso terapêutico , Humanos , AVC Isquêmico/etiologia , AVC Isquêmico/prevenção & controle , Pessoa de Meia-Idade , Varfarina/uso terapêutico
10.
J Clin Neurosci ; 89: 389-396, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34088580

RESUMO

BACKGROUND: The decision to resume antithrombotic therapy after surgical evacuation of chronic subdural hematoma (CSDH) requires judicious weighing of the risk of bleeding against that of thromboembolism. This study aimed to investigate the impact of time to resumption of antithrombotic therapy on outcomes of patients after CSDH drainage. METHODS: Data were obtained retrospectively from three tertiary hospitals in Singapore from 2010 to 2017. Outcome measures analyzed were CSDH recurrence and any thromboembolic events. Logistic and Cox regression tests were used to identify associations between time to resumption and outcomes. RESULTS: A total of 621 patients underwent 761 CSDH surgeries. Preoperative antithrombotic therapy was used in 139 patients. 110 (79.1%) were on antiplatelets and 35 (25.2%) were on anticoagulants, with six patients (4.3%) being on both antiplatelet and anticoagulant therapy. Antithrombotic therapy was resumed in 84 patients (60.4%) after the surgery. Median time to resumption was 71 days (IQR 29 - 201). Recurrence requiring reoperation occurred in 15 patients (10.8%), of which 12 had recurrence before and three after resumption. Median time to recurrence was 35 days (IQR 27 - 47, range 4 - 82 days). Recurrence rates were similar between patients that were restarted on antithrombotic therapy before and after 14, 21, 28, 42, 56, 70 and 84 days, respectively. Thromboembolic events occurred in 12 patients (8.6%), of which five had the event prior to restarting antithrombosis. CONCLUSIONS: Time to antithrombotic resumption did not significantly affect CSDH recurrence. Early resumption of antithrombotic therapy can be safe for patients with a high thromboembolic risk.


Assuntos
Anticoagulantes/administração & dosagem , Drenagem/métodos , Fibrinolíticos/administração & dosagem , Hematoma Subdural Crônico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/etiologia , Tromboembolia/epidemiologia , Adulto , Idoso , Anticoagulantes/uso terapêutico , Estudos de Coortes , Drenagem/efeitos adversos , Fibrinolíticos/uso terapêutico , Hematoma Subdural Crônico/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Tromboembolia/tratamento farmacológico
11.
BMJ ; 373: n1205, 2021 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-34108229

RESUMO

OBJECTIVE: To determine the efficacy and safety of dalteparin postoperative bridging treatment versus placebo for patients with atrial fibrillation or mechanical heart valves when warfarin is temporarily interrupted for a planned procedure. DESIGN: Prospective, double blind, randomised controlled trial. SETTING: 10 thrombosis research sites in Canada and India between February 2007 and March 2016. PARTICIPANTS: 1471 patients aged 18 years or older with atrial fibrillation or mechanical heart valves who required temporary interruption of warfarin for a procedure. INTERVENTION: Random assignment to dalteparin (n=821; one patient withdrew consent immediately after randomisation) or placebo (n=650) after the procedure. MAIN OUTCOME MEASURES: Major thromboembolism (stroke, transient ischaemic attack, proximal deep vein thrombosis, pulmonary embolism, myocardial infarction, peripheral embolism, or vascular death) and major bleeding according to the International Society on Thrombosis and Haemostasis criteria within 90 days of the procedure. RESULTS: The rate of major thromboembolism within 90 days was 1.2% (eight events in 650 patients) for placebo and 1.0% (eight events in 820 patients) for dalteparin (P=0.64, risk difference -0.3%, 95% confidence interval -1.3 to 0.8). The rate of major bleeding was 2.0% (13 events in 650 patients) for placebo and 1.3% (11 events in 820 patients) for dalteparin (P=0.32, risk difference -0.7, 95% confidence interval -2.0 to 0.7). The results were consistent for the atrial fibrillation and mechanical heart valves groups. CONCLUSIONS: In patients with atrial fibrillation or mechanical heart valves who had warfarin interrupted for a procedure, no significant benefit was found for postoperative dalteparin bridging to prevent major thromboembolism. TRIAL REGISTRATION: Clinicaltrials.gov NCT00432796.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/complicações , Dalteparina/administração & dosagem , Próteses Valvulares Cardíacas/efeitos adversos , Procedimentos Cirúrgicos Operatórios , Tromboembolia/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Tromboembolia/etiologia , Varfarina/administração & dosagem
12.
Medicine (Baltimore) ; 100(20): e25456, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: covidwho-1236275

RESUMO

INTRODUCTION: Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired, life-threatening hemopoietic stem cell disorder characterized by the triad of hemolytic anemia, thrombosis, and impaired bone marrow function. Evidence suggests that severe outcomes in COVID19 infection are attributed to the excessive activation of the complement cascade leading to acute lung injury and associated is with an increased prothrombotic state. PATIENT CONCERNS: A 27-year-old Caucasian man with PNH presented to the Emergency Department of our hospital with acute onset shortness of breath, cough and blood in urine. DIAGNOSIS: The patient was diagnosed with acute hemolytic exacerbation of PNH complicated with moderate COVID19 pneumonia. OUTCOMES: The patient was initiated with an anticoagulant unfractionated heparin, dexamethasone, and cefuroxime injection. His symptoms quickly resolved, and he was discharged after 5 days. CONCLUSION: The complement system activation is a critical component in the sequalae of COVID19 infection. Evidence suggests that severe outcomes in COVID19 infection are attributed to the excessive activation of the complement cascade leading to acute lung injury and associated is with an increased prothrombotic state. Notably, C5a concentration was noted to be higher in patients with COVID19 infection. The use of complement inhibitors to attenuate immune mediated damage in COVID19 nevertheless represents a very interesting theoretical approach. However, careful consideration as to which patients may benefit will be required and the outcome of clinical trials needed.


Assuntos
Anticoagulantes/administração & dosagem , COVID-19/tratamento farmacológico , Inativadores do Complemento/administração & dosagem , Hemoglobinúria Paroxística/complicações , Trombose/prevenção & controle , Adulto , COVID-19/diagnóstico , COVID-19/imunologia , COVID-19/virologia , Teste Sorológico para COVID-19 , Ativação do Complemento/efeitos dos fármacos , Hemoglobinúria Paroxística/sangue , Hemoglobinúria Paroxística/tratamento farmacológico , Hemoglobinúria Paroxística/imunologia , Humanos , Masculino , SARS-CoV-2/imunologia , SARS-CoV-2/isolamento & purificação , Exacerbação dos Sintomas , Trombose/imunologia , Resultado do Tratamento
13.
Pediatr Blood Cancer ; 68(7): e29049, 2021 07.
Artigo em Inglês | MEDLINE | ID: covidwho-1217408

RESUMO

Thrombosis within the microvasculature and medium to large vessels is a serious and common complication among critically ill individuals with coronavirus disease 2019 (COVID-19). While children are markedly less likely to develop severe disease than adults, they remain at risk for thrombosis during acute infection and with the post-acute inflammatory illness termed multisystem inflammatory syndrome in children. Significant knowledge deficits in understanding COVID-19-associated coagulopathy and thrombotic risk pose clinical challenges for pediatric providers who must incorporate expert opinion and personal experience to manage individual patients. We discuss clinical scenarios to provide framework for characterizing thrombosis risk and thromboprophylaxis in children with COVID-19.


Assuntos
Anticoagulantes/administração & dosagem , COVID-19 , SARS-CoV-2/metabolismo , Síndrome de Resposta Inflamatória Sistêmica , Trombose , Adolescente , COVID-19/sangue , COVID-19/tratamento farmacológico , Criança , Feminino , Humanos , Masculino , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Trombose/sangue , Trombose/tratamento farmacológico
15.
Pan Afr Med J ; 38: 226, 2021.
Artigo em Inglês | MEDLINE | ID: covidwho-1175757

RESUMO

The global pandemic caused by the SARS-CoV-2 has resulted in an increased incidence of venous thromboembolism among hospitalized COVID-19-patients, especially those who required intensive care, despite thromboprophylaxis. This has resulted in the use of higher doses of thromboprophylaxis or therapeutic anticoagulation therapy even in the absence of thrombotic events. However, after their hospital discharge, authors and current guidelines are not unanimous about extended anticoagulant therapy in patients with COVID-19. Here, we report two pulmonary embolism cases following hospitalization for COVID-19, despite intermediate doses of thromboprophylaxis. These rare cases suggest that there may be a residual thrombotic risk following hospitalization for COVID-19 and highlight questions about extended prophylactic-anticoagulation therapy after hospital discharge of patients with COVID-19.


Assuntos
Anticoagulantes/administração & dosagem , COVID-19/complicações , Embolia Pulmonar/virologia , Idoso , Relação Dose-Resposta a Droga , Hospitalização , Humanos , Masculino , Fatores de Tempo , Tromboembolia Venosa/prevenção & controle
16.
Pan Afr Med J ; 38: 226, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34046131

RESUMO

The global pandemic caused by the SARS-CoV-2 has resulted in an increased incidence of venous thromboembolism among hospitalized COVID-19-patients, especially those who required intensive care, despite thromboprophylaxis. This has resulted in the use of higher doses of thromboprophylaxis or therapeutic anticoagulation therapy even in the absence of thrombotic events. However, after their hospital discharge, authors and current guidelines are not unanimous about extended anticoagulant therapy in patients with COVID-19. Here, we report two pulmonary embolism cases following hospitalization for COVID-19, despite intermediate doses of thromboprophylaxis. These rare cases suggest that there may be a residual thrombotic risk following hospitalization for COVID-19 and highlight questions about extended prophylactic-anticoagulation therapy after hospital discharge of patients with COVID-19.


Assuntos
Anticoagulantes/administração & dosagem , COVID-19/complicações , Embolia Pulmonar/virologia , Idoso , Relação Dose-Resposta a Droga , Hospitalização , Humanos , Masculino , Fatores de Tempo , Tromboembolia Venosa/prevenção & controle
17.
Nursing ; 51(6): 54-64, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34014879

RESUMO

ABSTRACT: The rise in direct oral anticoagulant (DOAC) use means nurses must understand the reversal of these agents in case of bleeding. Depending on bleed severity, as well as other criteria, pharmacologic reversal can be considered in place of supportive care alone. Knowledge of literature surrounding DOAC reversal is crucial.


Assuntos
Anticoagulantes/efeitos adversos , Hemorragia/induzido quimicamente , Hemorragia/enfermagem , Administração Oral , Anticoagulantes/administração & dosagem , Hemorragia/tratamento farmacológico , Humanos
18.
Medicine (Baltimore) ; 100(20): e25456, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011023

RESUMO

INTRODUCTION: Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired, life-threatening hemopoietic stem cell disorder characterized by the triad of hemolytic anemia, thrombosis, and impaired bone marrow function. Evidence suggests that severe outcomes in COVID19 infection are attributed to the excessive activation of the complement cascade leading to acute lung injury and associated is with an increased prothrombotic state. PATIENT CONCERNS: A 27-year-old Caucasian man with PNH presented to the Emergency Department of our hospital with acute onset shortness of breath, cough and blood in urine. DIAGNOSIS: The patient was diagnosed with acute hemolytic exacerbation of PNH complicated with moderate COVID19 pneumonia. OUTCOMES: The patient was initiated with an anticoagulant unfractionated heparin, dexamethasone, and cefuroxime injection. His symptoms quickly resolved, and he was discharged after 5 days. CONCLUSION: The complement system activation is a critical component in the sequalae of COVID19 infection. Evidence suggests that severe outcomes in COVID19 infection are attributed to the excessive activation of the complement cascade leading to acute lung injury and associated is with an increased prothrombotic state. Notably, C5a concentration was noted to be higher in patients with COVID19 infection. The use of complement inhibitors to attenuate immune mediated damage in COVID19 nevertheless represents a very interesting theoretical approach. However, careful consideration as to which patients may benefit will be required and the outcome of clinical trials needed.


Assuntos
Anticoagulantes/administração & dosagem , COVID-19/tratamento farmacológico , Inativadores do Complemento/administração & dosagem , Hemoglobinúria Paroxística/complicações , Trombose/prevenção & controle , Adulto , COVID-19/diagnóstico , COVID-19/imunologia , COVID-19/virologia , Teste Sorológico para COVID-19 , Ativação do Complemento/efeitos dos fármacos , Hemoglobinúria Paroxística/sangue , Hemoglobinúria Paroxística/tratamento farmacológico , Hemoglobinúria Paroxística/imunologia , Humanos , Masculino , SARS-CoV-2/imunologia , SARS-CoV-2/isolamento & purificação , Exacerbação dos Sintomas , Trombose/imunologia , Resultado do Tratamento
19.
Nat Commun ; 12(1): 3187, 2021 05 27.
Artigo em Inglês | MEDLINE | ID: mdl-34045459

RESUMO

Failure of conventional clinical therapies such as tumor resection and chemotherapy are mainly due to the ineffective control of tumor metastasis. Metastasis consists of three steps: (i) tumor cells extravasate from the primary sites into the circulation system via epithelial-mesenchymal transition (EMT), (ii) the circulating tumor cells (CTCs) form "micro-thrombi" with platelets to evade the immune surveillance in circulation, and (iii) the CTCs colonize in the pre-metastatic niche. Here, we design a systemic metastasis-targeted nanotherapeutic (H@CaPP) composed of an anti-inflammatory agent, piceatannol, and an anti-thrombotic agent, low molecular weight heparin, to hinder the multiple steps of tumor metastasis. H@CaPP is found efficiently impeded EMT, inhibited the formation of "micro-thrombi", and prevented the development of pre-metastatic niche. When combined with surgical resection or chemotherapy, H@CaPP efficiently inhibits tumor metastasis and prolonged overall survival of tumor-bearing mice. Collectively, we provide a simple and effective systemic metastasis-targeted nanotherapeutic for combating tumor metastasis.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Portadores de Fármacos/química , Neoplasias Mamárias Experimentais/terapia , Metástase Neoplásica/terapia , Nanomedicina Teranóstica/métodos , Animais , Anti-Inflamatórios/administração & dosagem , Anticoagulantes/administração & dosagem , Linhagem Celular Tumoral/transplante , Quimioterapia Adjuvante/métodos , Modelos Animais de Doenças , Transição Epitelial-Mesenquimal/efeitos dos fármacos , Feminino , Heparina de Baixo Peso Molecular/administração & dosagem , Células Endoteliais da Veia Umbilical Humana , Humanos , Masculino , Glândulas Mamárias Animais/patologia , Glândulas Mamárias Animais/cirurgia , Neoplasias Mamárias Experimentais/patologia , Camundongos , Nanopartículas/química , Células Neoplásicas Circulantes/efeitos dos fármacos , Paclitaxel/administração & dosagem , Estudo de Prova de Conceito , Ratos , Estilbenos/administração & dosagem
20.
Pediatr Blood Cancer ; 68(7): e29049, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33955167

RESUMO

Thrombosis within the microvasculature and medium to large vessels is a serious and common complication among critically ill individuals with coronavirus disease 2019 (COVID-19). While children are markedly less likely to develop severe disease than adults, they remain at risk for thrombosis during acute infection and with the post-acute inflammatory illness termed multisystem inflammatory syndrome in children. Significant knowledge deficits in understanding COVID-19-associated coagulopathy and thrombotic risk pose clinical challenges for pediatric providers who must incorporate expert opinion and personal experience to manage individual patients. We discuss clinical scenarios to provide framework for characterizing thrombosis risk and thromboprophylaxis in children with COVID-19.


Assuntos
Anticoagulantes/administração & dosagem , COVID-19 , SARS-CoV-2/metabolismo , Síndrome de Resposta Inflamatória Sistêmica , Trombose , Adolescente , COVID-19/sangue , COVID-19/tratamento farmacológico , Criança , Feminino , Humanos , Masculino , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Trombose/sangue , Trombose/tratamento farmacológico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...