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2.
Medicine (Baltimore) ; 100(26): e26360, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190153

RESUMO

BACKGROUND: To describe the outcome of the patients with cerebral venous sinus thrombosis (CVST) during pregnancy and postpartum treated with anticoagulant therapy. METHODS: This is a retrospective cohort study and patients with CVST were collected from October 2009 to March 2018. Patients were divided into pregnancy-related (occurred during pregnancy and postpartum) group and non-pregnancy-related. Recovery rate at 12 months after anticoagulant therapy, adverse events, characteristics of patients with poor outcomes were statistically analyzed. RESULTS: Fifty-eight pregnancy-related CVST patients (17 pregnancy and 41 postpartum) as study group and 76 non-pregnancy-related CVST women as control group were enrolled. Study group was statistically different to control group in several baseline variables. More pregnancy-related patients had modified rankin scale (mRS) = 5 (15.5% vs 11.8%, P = 8.1×10-3) before anticoagulant therapy. At 12 months heparinization, difference in recovery rate was not statistically significant (80% vs 87.5%, P = .29) between 2 groups. No differences were found of adverse events between 2 groups. Patients with poor outcomes had less sigmoid sinus thrombosis (16.7% vs 61.5%, P = .14), more coma (41.2% vs 17.2%, P = 5.2×10-7), more mRS = 4 (33.3% vs 19.2%, P = 1.63 × 10-4), more mRS = 5 (66.7% vs 9.6%, P = 1.63 × 10-4) before treatment. CONCLUSION: Pregnancy-related CVST patients had severer condition before treatment, but can achieve comparable recovery rate at 12 months after anticoagulant therapy with non-pregnancy-related women. Pregnancy-related patients with poor prognosis had less sinus sigmoid occlusion, more coma, high mRS at admission.


Assuntos
Anticoagulantes/uso terapêutico , Complicações Hematológicas na Gravidez/tratamento farmacológico , Transtornos Puerperais/tratamento farmacológico , Trombose dos Seios Intracranianos/tratamento farmacológico , Anticoagulantes/efeitos adversos , Feminino , Heparina de Baixo Peso Molecular/efeitos adversos , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Resultado do Tratamento
3.
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
4.
BMJ Case Rep ; 14(6)2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34116998

RESUMO

A 61-year-old obese man who had recently tested positive for COVID-19 presented to the emergency department following an unwitnessed collapse, with a brief period of unresponsiveness. CT pulmonary angiography confirmed the presence of extensive bilateral pulmonary embolism despite the patient reporting full compliance with long-term dabigatran. The patient was initially anticoagulated with low-molecular-weight heparin and was treated with non-invasive ventilation and dexamethasone for COVID-19 pneumonia. He made a full recovery and was discharged on oral rivaroxaban. His case highlighted some of the common problems encountered when selecting an anticoagulation strategy for obese patients, as well as the lack of definitive evidence to guide treatment decisions. These challenges were further complicated by our incomplete understanding of the underlying mechanisms of COVID-19 coagulopathy, with limited data available regarding the optimal management of thromboembolic complications.


Assuntos
COVID-19 , Embolia Pulmonar , Tromboembolia Venosa , Anticoagulantes/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Embolia Pulmonar/complicações , Embolia Pulmonar/tratamento farmacológico , SARS-CoV-2 , Tromboembolia Venosa/complicações , Tromboembolia Venosa/tratamento farmacológico
5.
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.
BMJ Case Rep ; 14(6)2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: covidwho-1266369

RESUMO

A 61-year-old obese man who had recently tested positive for COVID-19 presented to the emergency department following an unwitnessed collapse, with a brief period of unresponsiveness. CT pulmonary angiography confirmed the presence of extensive bilateral pulmonary embolism despite the patient reporting full compliance with long-term dabigatran. The patient was initially anticoagulated with low-molecular-weight heparin and was treated with non-invasive ventilation and dexamethasone for COVID-19 pneumonia. He made a full recovery and was discharged on oral rivaroxaban. His case highlighted some of the common problems encountered when selecting an anticoagulation strategy for obese patients, as well as the lack of definitive evidence to guide treatment decisions. These challenges were further complicated by our incomplete understanding of the underlying mechanisms of COVID-19 coagulopathy, with limited data available regarding the optimal management of thromboembolic complications.


Assuntos
COVID-19 , Embolia Pulmonar , Tromboembolia Venosa , Anticoagulantes/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Embolia Pulmonar/complicações , Embolia Pulmonar/tratamento farmacológico , SARS-CoV-2 , Tromboembolia Venosa/complicações , Tromboembolia Venosa/tratamento farmacológico
10.
BMJ Case Rep ; 14(6)2021 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-34162622

RESUMO

Gastrointestinal (GI) bleeding is a serious complication encountered commonly in patients on chronic anticoagulation and/or antiplatelet agents. There is a lack of guidelines on how to manage antiplatelet/anticoagulant therapy in patients with thrombocytopenia and GI bleeding. This poses a clinical dilemma when a clinician encounters serious GI bleeding in clinical practice. We present a patient with paroxysmal atrial fibrillation and chronic thrombocytopenia who suffered severe GI bleeding less than 2 weeks after a percutaneous coronary intervention while being treated with dual antiplatelet therapy and oral anticoagulation.


Assuntos
Fibrilação Atrial , Intervenção Coronária Percutânea , Púrpura Trombocitopênica Idiopática , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Quimioterapia Combinada , Hemorragia Gastrointestinal/tratamento farmacológico , Hemorragia Gastrointestinal/terapia , Humanos , Inibidores da Agregação Plaquetária/efeitos adversos , Púrpura Trombocitopênica Idiopática/complicações , Púrpura Trombocitopênica Idiopática/tratamento farmacológico
11.
Spine (Phila Pa 1976) ; 46(13): 901-906, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34100843

RESUMO

STUDY DESIGN: Retrospective cohort study with propensity matched cohorts. OBJECTIVE: The purpose of this study was to evaluate the association of anticoagulation with VTE and hematoma complications after spine surgery. SUMMARY OF BACKGROUND DATA: One of the major complications of surgery is VTE which can range in presentation. Spine surgery is an especially complex balance between minimizing the risk of a VTE event and also the increased risk of a hematoma which can lead to devastating neurological outcomes. METHODS: The elective spine surgery cases at a single academic center between 2015 and 2017 were identified. A total of 3790 patients were initially identified. Two hundred sixty patients were excluded. The cohort was then matched using a propensity score. This matched a single patient who did not receive anticoagulation to a single patient who did within the institution. This left a total of 1776 patients with 888 patients in each arm. RESULTS: The incidence of VTE, PE, and unplanned reoperation for hematoma in this cohort was 0.96%, 0.34%, and 1.13%, respectively. Predicted odds of VTE and PE were not significantly different; however, the odds of an unplanned reoperation for hematoma (odds ratio [OR] = 7.535, 95% confidence interval [CI]: 2.004-28.340, P = 0.002) were greater for those who received pharmacological anticoagulation in our institutional cohort. CONCLUSION: In this study, anticoagulation does not lead to lower rates of VTE events, but it increases the risk of symptomatic hematomas which require a return trip to the OR. While this was not a randomized controlled trial, we attempted to correct for this with propensity matching. Future randomized control trials would be needed.Level of Evidence: 3.


Assuntos
Anticoagulantes , Procedimentos Cirúrgicos Eletivos , Hematoma , Procedimentos Ortopédicos , Coluna Vertebral/cirurgia , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Hematoma/epidemiologia , Hematoma/etiologia , Humanos , Incidência , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Reoperação , Estudos Retrospectivos
12.
Ann Palliat Med ; 10(5): 5400-5406, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34107695

RESUMO

BACKGROUND: To study the various factors affecting the anticoagulant effect of warfarin, and to promote the rational use of warfarin. METHODS: We collected the medical records of 125 hospitalized patients who used warfarin from January 2018 to December 2019. Statistical analysis was performed on characteristics such as gender, age, treatment, diabetes, hyperlipidemia, hyperthyroidism, hypothyroidism, hepatitis, renal insufficiency, and nephritis; along with other pathological factors, such as aspirin, clopidogrel, spironolactone, amiodarone, amlodipine, trimetazidine, bisoprolol, isosorbide, atorvastatin, furosemide, digoxin, metoprolol, acarbose, levamlodipine, enoxaparin, moxifloxacin, levofloxacin, other drug interactions, and comorbidities. RESULTS: Gender and age did not have a significant effect on the efficacy of warfarin. Infection and bleeding extended the number of days of warfarin administration. Acarbose, enoxaparin, and moxifloxacin had a likely effect on warfarin treatment-related indicators. CONCLUSIONS: Warfarin anticoagulation is affected by many factors. Therefore, medical personnel should pay close attention to the impact of these factors on the anticoagulant effect of warfarin. This study found that warfarin-related bleeding adverse drug reactions and anticoagulant effects have a significant association. Bleeding not only affected the total number of days hospitalized, but also extended the number of days of warfarin administration. However, in terms of patients' pathological states, international normalized ratio values combined with drugs used were not associated with disease and may only be a reference for bleeding risk.


Assuntos
Anticoagulantes , Varfarina , Anticoagulantes/efeitos adversos , Interações Medicamentosas , Hemorragia , Humanos , Coeficiente Internacional Normatizado , Varfarina/efeitos adversos
14.
J Coll Physicians Surg Pak ; 30(6): 633-637, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34102772

RESUMO

OBJECTIVE: To evaluate the risk factors for developing rectus sheath hematoma (RSH). STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Department of General Surgery, Hitit University School of Medicine, Erol Olcok Training and Research Hospital, Turkey; from January 2018 to April 2020. METHODOLOGY: Patients with RSH were studied. Those with other pathologies in rectus sheath, and repeat studies, were excluded. Demographic data, presenting symptoms, comorbidities, medications administered containing anticoagulant drugs, imaging results, laboratory findings, coagulation parameters, length of hospital stay, treatments administered, type of RSH, morbidity, mortality and risk factors of increased bleeding diathesis, were recorded. RESULTS: Of the 61 studied patients, 56 (91.8%) had at least one chronic disease, and 77% were receiving anticoagulation therapy. RSH size was significantly larger for patients taking acetylsalicylic acid than for patients taking other anticoagulants, and an RSH area less than 1,924 mm2 was associated with increased length of hospital stay. Binary logistic regression analysis showed that a unit increase in gender was associated with a 1.5-fold increase in the risk of greater RSH size, and that female gender was associated with a 45.3-fold risk of increase in the risk of RSH. Notably, if up to 4 units of erythrocyte suspension replacement is not applied for conservative treatment of RSH, RSH size may increase by 23.5 times. CONCLUSION: Risk factors of RSH include chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease, atrial fibrillation, asthma, hypertension, diabetes mellitus, chronic renal failure, prior abdominal surgery, female sex, older age, anticoagulant drug use and cancer-related immunosuppression. Key Words: Rectus sheath hematoma, Conservative treatment, Anticoagulant treatment.


Assuntos
Hematoma , Reto do Abdome , Idoso , Anticoagulantes/efeitos adversos , Feminino , Hematoma/epidemiologia , Hematoma/etiologia , Humanos , Reto do Abdome/diagnóstico por imagem , Fatores de Risco , Turquia
15.
Clin Lab ; 67(6)2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34107617

RESUMO

BACKGROUND: Anticoagulation of pregnant woman with mechanical prosthetic heart valves is associated with significant maternal and fetal risks. METHODS: We describe a case of dorsal midline dysplasia in a fetus at 11 weeks' gestation. The mother was receiving warfarin therapy at a dose of 7.5 mg daily following a mechanical mitral valve replacement for rheumatic heart disease. RESULTS: Histological assessment revealed a meningocele with hemorrhage. No cerebellar or cerebral tissue was present in the skull confirming anencephaly. CONCLUSIONS: A multidisciplinary approach in pregnant women with mechanical prosthetic heart valves is essential in order to improve fetal outcomes.


Assuntos
Malformações do Sistema Nervoso , Complicações Cardiovasculares na Gravidez , Anticoagulantes/efeitos adversos , Feminino , Feto , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Varfarina/efeitos adversos
16.
Clin Lab ; 67(6)2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34107626

RESUMO

BACKGROUND: To explore the application of SF-Cube 2.0 technology in platelet count in patients with EDTA-dependent pseudothrombocytopenia (EDTA-PTCP). METHODS: Twenty-two out-patients and in-patients with EDTA-PTCP in our hospital were selected from February 1, 2020, to August 31, 2020. With the permission of each patient, blood samples of EDTA and sodium citrate anticoagulant tubes were collected. EDTA anticoagulant samples were tested by using the "complete blood cell count and white blood cell differential count"(CD) mode, and "complete blood cell count, white blood cell differential count, and reticulocyte count" (CDR) mode of the Mindray BC-6800Plus automated hematology analyzer, and the platelet counts were compared with the sample of sodium citrate anticoagulant from this patient. RESULTS: As SF-Cube 2.0 technology (implemented by using the CDR mode of the Mindray BC-6800Plus) was used, the platelet count of EDTA-PTCP sample was consistent with that of sodium citrate anticoagulant, which was significantly higher than that of CD detection mode. CONCLUSIONS: SF-Cube 2.0 technology can effectively correct the platelet counts in people with known or suspected EDTA-PTCP.


Assuntos
Agregação Plaquetária , Trombocitopenia , Anticoagulantes/efeitos adversos , Ácido Edético/farmacologia , Humanos , Contagem de Plaquetas , Tecnologia , Trombocitopenia/induzido quimicamente , Trombocitopenia/diagnóstico
19.
Medicine (Baltimore) ; 100(19): e25875, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106641

RESUMO

ABSTRACT: Available classification tools and risk factors predicting bleeding events in elderly patients after mechanical valve replacement may not be suitable in Asian populations. Thus, we aimed to identify an accurate model for predicting bleeding in elderly patients receiving warfarin after mechanical valve replacement in a Korean population. In this retrospective cohort study, a random forest model was used to determine factors predicting bleeding events among 598 participants. Twenty-two descriptors were selected as predictors for bleeding. Steroid use was the most important predictor of bleeding events, followed by labile international normalized ratio, history of stroke, history of myocardial infarction, and cancer. The random forest model was sensitive (80.77%), specific (87.67%), and accurate (85.86%), with an area under the curve of 0.87, suggesting fair prediction. In the elderly, drug interactions with steroids and overall physical condition had a significant effect on bleeding. Elderly patients taking warfarin for life require lifelong management.


Assuntos
Anticoagulantes/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Hemorragia/induzido quimicamente , Aprendizado de Máquina , Varfarina/efeitos adversos , Corticosteroides/administração & dosagem , Idoso , Humanos , Infarto do Miocárdio/epidemiologia , Neoplasias/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
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