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1.
Medicina (Kaunas) ; 57(6)2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34208175

RESUMO

Background and Objectives: Patients with AF are at increased risk for Coronary Artery Disease (CAD) owing to their shared etiologies and risk factors. This study aimed to assess the prevalence, cardiovascular risk factors, and used medications of CAD in AF patients. Materials and Methods: This retrospective, case-control study utilized data from the Jordanian Atrial Fibrillation (Jo-Fib) registry. Investigators collected clinical features, history of co-existing comorbidities, CHA2DS2-VASc, and HAS BLED scores for all AF patients aged >18 visiting 19 hospitals and 30 outpatient cardiology clinics. A multivariable binary logistic regression was used to asses for factors associated with higher odds of having CAD. Results: Out of 2000 patients with AF, 227 (11.35%) had CAD. Compared to the rest of the sample, those with CAD had significantly higher prevalence of hypertension (82.38%; p < 0.01), hypercholesterolemia (66.52%, p < 0.01), diabetes (56.83%, p < 0.01), and smoking (18.06%, p = 0.04). Patients with AF and CAD had higher use of anticoagulants/antiplatelet agents combination (p < 0.01) compared to the rest of the sample. Females had lower CAD risk than males (OR = 0.35, 95% CI: 0.24-0.50). AF Patients with dyslipidemia (OR = 2.5, 95% CI: 1.8-3.4), smoking (OR = 1.7, 95% CI: 1.1-2.6), higher CHA2DS2-VASc score (OR = 1.5, 95% CI: 1.4-1.7), and asymptomatic AF (OR = 1.9, 95% CI: 1.3-2.6) had higher risk for CAD. Conclusions: Owing to the increased prevalence of CAD in patients with AF, better control of cardiac risk factors is recommended for this special group. Future studies should investigate such interesting relationships to stratify CAD risk in AF patients. We believe that this study adds valuable information regarding the prevalence, epidemiological characteristics, and pharmacotherapy of CAD in patients with AF.


Assuntos
Fibrilação Atrial , Doença da Artéria Coronariana , Acidente Vascular Cerebral , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Estudos de Casos e Controles , Doença da Artéria Coronariana/tratamento farmacológico , Doença da Artéria Coronariana/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
2.
BMJ Open ; 11(5): e048839, 2021 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059516

RESUMO

OBJECTIVE: The study aimed to examine the association between socioeconomic factors (SEFs) and oral anticoagulation (OAC) therapy and whether it was influenced by changing guidelines. We hypothesised that inequities in initiation of OAC reduced over time as more detailed and explicit clinical guidelines were issued. DESIGN: Register-based observational study. SETTINGS: All Danish patients with an incident hospital diagnosis of atrial fibrillation (AF), aged ≥30 years old and with high risk of stroke from 1 May 1999 to 2 October 2015 were included. Absolute risk differences (RD) (95% CI) were used to measure the association. PARTICIPANTS: 154 448 patients (mean age 78.2 years, men 47.3%). EXPOSURE: Education, family income and cohabiting status were the SEFs used as exposure. OUTCOME: A prescription of OAC within -30 to +90 days of baseline (incident AF). RESULTS: During 2002-2007, the crude RD of initiation of OAC for men with high education was 14.9% (12.8 to 16.9). Inequality reduced when new guidelines were published, and in 2013-2016 the crude RD was 5.6% (3.5 to 7.7). After adjusting for age, the RD substantially reduced. The same pattern was seen for cohabiting status, while inequality was smaller and more constant for income. CONCLUSION: Patients with low income, low education and living alone were associated with lower chance of being initiated with OAC. For education and cohabiting status, the crude difference reduced around 2011, when more detailed clinical guidelines were implemented in Denmark. Our results indicate that new guidelines might reduce inequality in OAC initiation and that new, high-cost drugs increase inequality.


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Administração Oral , Adulto , Idoso , Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Humanos , Masculino , Fatores de Risco , Fatores Socioeconômicos , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle
5.
Med Hypotheses ; 152: 110621, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34116360

RESUMO

The inflammatory component of Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) creates a pro-thrombotic state that necessitates a thrombophylactic strategy for hospitalized patients. Such strategies are difficult to be standardized because certain individuals can have pro-thrombotic conditions, such as inherited thrombophilia, which pre-dispose them to an additional coagulative risk. Whether outside the hospital or when admitted, patients with inherited thrombophilia need special anticoagulant and antiplatelet attention. Identifying such patients, especially in susceptible populations like the eastern Mediterranean (EM) region, will aid primary providers in risk stratification for choosing the optimal anticoagulation or antiplatelet plan.


Assuntos
COVID-19 , Trombofilia , Trombose , Anticoagulantes/uso terapêutico , Humanos , SARS-CoV-2 , Trombofilia/complicações
7.
Medicine (Baltimore) ; 100(25): e26473, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160457

RESUMO

BACKGROUND: The optimal treatment strategy for patent foramen ovale (PFO) patients with cryptic stroke remains controversial. We performed this meta-analysis to evaluate the effect of PFO closure versus different types of medical therapy. METHODS: We searched PubMed, Embase, and Cochrane databases. The primary efficacy endpoints were the composite outcome of recurrent stroke and/or transient ischemic attack (TIA). Secondary efficacy endpoints included separate stroke and TIA. Safety endpoints included new-onset atrial fibrillation (AF)/atrial flutter and bleeding. RESULTS: Compared with antiplatelet therapy, PFO closure significantly reduced the risk of composite outcome (odds ratio [OR] 0.37, 95% confidence interval [CI] 0.27-0.51), stroke (OR 0.22, 95% CI 0.13-0.36], and TIA (OR 0.57, 95% CI 0.34-0.98); Compared with the mixed medical therapy group (consist of antiplatelet therapy, anticoagulant therapy, or both), PFO closure still showed some benefits, but the effect was not as significant as that of antiplatelet therapy (composite outcome: OR 0.53, 95% CI 0.41-0.69; stroke: OR 0.48, 95% CI 0.34-0.68; TIA: OR 0.69, 95% CI 0.50-0.96); Compared with anticoagulant therapy, PFO closure showed no benefit (composite outcome: OR 0.77, 95% CI 0.46-1.28; stroke: OR 0.59, 95% CI 0.28-1.25; TIA: OR 1.01, 95% CI 0.50-2.04). In terms of safe endpoints, compared with antiplatelet therapy and anticoagulant therapy, PFO closure increased the risk of AF/atrial flutter (OR 9.56, 95% CI 2.85-32.06; OR 18.96, 95% CI 1.11-323.8, respectively) and reduced the risk of bleeding (OR 0.50, 95% CI 0.24-1.05; OR 0.13, 95% CI 0.04-0.46, respectively); compared with mixed medical therapy, PFO closure increased the risk of AF/atrial flutter (OR 4.40,95% CI 2.24-8.67), but there was no difference in bleeding (OR 0.97, 95% CI 0.56-1.68). CONCLUSIONS: With the addition of anticoagulants, the benefit of PFO closure decreased gradually. Patient groups that adopt individualized medical therapy strategies may benefit more.


Assuntos
Anticoagulantes/uso terapêutico , Forame Oval Patente/cirurgia , Ataque Isquêmico Transitório/epidemiologia , AVC Isquêmico/epidemiologia , Inibidores da Agregação Plaquetária/uso terapêutico , Prevenção Secundária/métodos , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , Fibrilação Atrial/prevenção & controle , Flutter Atrial/epidemiologia , Flutter Atrial/etiologia , Flutter Atrial/prevenção & controle , Seguimentos , Forame Oval Patente/complicações , Humanos , Incidência , Ataque Isquêmico Transitório/etiologia , Ataque Isquêmico Transitório/prevenção & controle , AVC Isquêmico/etiologia , AVC Isquêmico/prevenção & controle , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Prevenção Secundária/estatística & dados numéricos , Resultado do Tratamento
8.
Sci Prog ; 104(2): 368504211025927, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34120531

RESUMO

With over 600 million coronavirus (COVID-19) vaccine doses administered globally, adverse events are constantly monitored. Recently however, reports of thrombosis and thrombocytopenia following vaccination with the ChAdOx1 nCoV-19 vaccine have emerged. This paper aims to review the available literature and guidelines pertaining to vaccine-induced immune thrombotic thrombocytopenia (VITT) and the proposed guidelines, while offering a potential approach that unifies the available evidence. While the risk of VITT remains extremely low and the benefits outweigh the risks, experimental studies are needed to clarify the pathophysiology behind VITT and possibly decrease the risk of thrombosis and other adverse events occurring. However, treatment should not be delayed in suspected cases, and IV immunoglobulin and non-heparin anticoagulation should be initiated.


Assuntos
Anticoagulantes/uso terapêutico , Vacinas contra COVID-19/efeitos adversos , COVID-19/prevenção & controle , Imunoglobulinas Intravenosas/uso terapêutico , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Trombose/tratamento farmacológico , Antitrombinas/uso terapêutico , Autoanticorpos/sangue , Biomarcadores/sangue , COVID-19/epidemiologia , COVID-19/imunologia , Inibidores do Fator Xa/uso terapêutico , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Fondaparinux/uso terapêutico , Heparina/efeitos adversos , Humanos , Guias de Prática Clínica como Assunto , Púrpura Trombocitopênica Idiopática/sangue , Púrpura Trombocitopênica Idiopática/induzido quimicamente , Púrpura Trombocitopênica Idiopática/patologia , SARS-CoV-2/imunologia , SARS-CoV-2/patogenicidade , Trombose/sangue , Trombose/induzido quimicamente , Trombose/patologia
9.
Sci Rep ; 11(1): 13325, 2021 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-34172793

RESUMO

COVID 19 is associated with a hypercoagulable state and frequent thromboembolic complications. For how long this acquired abnormality lasts potentially requiring preventive measures, such as anticoagulation remains to be delineated. We used viscoelastic rotational thrombelastometry (ROTEM) in a single center cohort of 13 critical ill patients and performed follow up examinations three months after discharge from ICU. We found clear signs of a hypercoagulable state due to severe hypofibrinolysis and a high rate of thromboembolic complications during the phase of acute illness. Three month follow up revealed normalization of the initial coagulation abnormality and no evidence of venous thrombosis in all thirteen patients. In our cohort the coagulation profile was completely normalized three months after COVID-19. Based on these findings, discontinuation of anticoagulation can be discussed in patients with complete venous reperfusion.


Assuntos
Anticoagulantes/uso terapêutico , Transtornos da Coagulação Sanguínea , COVID-19 , Tromboelastografia , Tromboembolia , Trombose Venosa , Idoso , Coagulação Sanguínea , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/patologia , COVID-19/sangue , COVID-19/tratamento farmacológico , COVID-19/patologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Tromboembolia/tratamento farmacológico , Tromboembolia/patologia , Trombose Venosa/tratamento farmacológico , Trombose Venosa/patologia
10.
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
11.
JAMA Netw Open ; 4(6): e2111788, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34115129

RESUMO

Importance: Venous thromboembolism (VTE) is a common complication of COVID-19. It is not well understood how hospitals have managed VTE prevention and the effect of prevention strategies on mortality. Objective: To characterize frequency, variation across hospitals, and change over time in VTE prophylaxis and treatment-dose anticoagulation in patients hospitalized for COVID-19, as well as the association of anticoagulation strategies with in-hospital and 60-day mortality. Design, Setting, and Participants: This cohort study of adults hospitalized with COVID-19 used a pseudorandom sample from 30 US hospitals in the state of Michigan participating in a collaborative quality initiative. Data analyzed were from patients hospitalized between March 7, 2020, and June 17, 2020. Data were analyzed through March 2021. Exposures: Nonadherence to VTE prophylaxis (defined as missing ≥2 days of VTE prophylaxis) and receipt of treatment-dose or prophylactic-dose anticoagulants vs no anticoagulation during hospitalization. Main Outcomes and Measures: The effect of nonadherence and anticoagulation strategies on in-hospital and 60-day mortality was assessed using multinomial logit models with inverse probability of treatment weighting. Results: Of a total 1351 patients with COVID-19 included (median [IQR] age, 64 [52-75] years; 47.7% women, 48.9% Black patients), only 18 (1.3%) had a confirmed VTE, and 219 (16.2%) received treatment-dose anticoagulation. Use of treatment-dose anticoagulation without imaging ranged from 0% to 29% across hospitals and increased over time (adjusted odds ratio [aOR], 1.46; 95% CI, 1.31-1.61 per week). Of 1127 patients who ever received anticoagulation, 392 (34.8%) missed 2 or more days of prophylaxis. Missed prophylaxis varied from 11% to 61% across hospitals and decreased markedly over time (aOR, 0.89; 95% CI, 0.82-0.97 per week). VTE nonadherence was associated with higher 60-day (adjusted hazard ratio [aHR], 1.31; 95% CI, 1.03-1.67) but not in-hospital mortality (aHR, 0.97; 95% CI, 0.91-1.03). Receiving any dose of anticoagulation (vs no anticoagulation) was associated with lower in-hospital mortality (only prophylactic dose: aHR, 0.36; 95% CI, 0.26-0.52; any treatment dose: aHR, 0.38; 95% CI, 0.25-0.58). However, only the prophylactic dose of anticoagulation remained associated with lower mortality at 60 days (prophylactic dose: aHR, 0.71; 95% CI, 0.51-0.90; treatment dose: aHR, 0.92; 95% CI, 0.63-1.35). Conclusions and Relevance: This large, multicenter cohort of patients hospitalized with COVID-19, found evidence of rapid dissemination and implementation of anticoagulation strategies, including use of treatment-dose anticoagulation. As only prophylactic-dose anticoagulation was associated with lower 60-day mortality, prophylactic dosing strategies may be optimal for patients hospitalized with COVID-19.


Assuntos
Anticoagulantes/uso terapêutico , COVID-19/complicações , Hospitalização/tendências , SARS-CoV-2 , Tromboembolia Venosa/prevenção & controle , Idoso , COVID-19/epidemiologia , Feminino , Mortalidade Hospitalar/tendências , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
12.
Medicine (Baltimore) ; 100(22): e26152, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087871

RESUMO

RATIONALE: Patients with cancer have elevated risk of both venous thromboembolism and bleeding compared with patients without cancer due to cancer- and patient-specific factors. Balancing the increased and competing risks of clotting and bleeding in these patients can be difficult because management of cancer-associated thrombosis requires anticoagulation despite its known increased risks for bleeding. The adjustment of blood transfusion or cessation of anticoagulants can be a challenge in surgical diagnosis or treatment of cancer patients with such an imbalanced coagulate status. PATIENT CONCERNS: A 45-year-old woman with no underlying disease was suspected of ovarian cancer and was awaiting diagnostic laparoscopic exploration surgery. DIAGNOSES: While waiting for the surgery, the patient developed chest pain and underwent stent insertion under diagnosis of myocardial infarction. Two weeks later, endocarditis developed, and replacement of the aortic valve and mitral valve was planned. In addition, the patient developed multiple thromboembolisms and was administered anticoagulants to eliminate vegetation of valves and multiple thromboses. Her blood test showed anemia (7.4 g/dL) and severe thrombocytopenia (24 × 109/L). INTERVENTIONS: The patient underwent double valve replacement. OUTCOMES: A color change of the left lower extremity was noted 5 hours after double valve replacement, and angiography was performed. Thrombectomy was performed under diagnosis of thrombosis in the left iliac artery. One month later, the patient underwent laparoscopic exploration surgery as scheduled. LESSONS: This case will help establish the criteria of blood coagulation for surgical treatment of cancer patients with imbalanced clotting and bleeding.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Neoplasias/complicações , Trombocitopenia/complicações , Tromboembolia/etiologia , Trombose/complicações , Anticoagulantes/uso terapêutico , Endocardite/complicações , Endocardite/cirurgia , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/cirurgia , Stents , Trombose/tratamento farmacológico
13.
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
15.
Artigo em Inglês | MEDLINE | ID: mdl-34073370

RESUMO

Introduction: The use of vitamin K antagonists (VKAs) in non-valvular atrial fibrillation (NVAF) is complicated due to the narrow therapeutic margin they present and their unpredictable dose-response relationship. Most studies are based on warfarin, with the results being extrapolated to acenocoumarol. However, studies comparing the two treatments in terms of the degree of anticoagulation control are scarce, justifying the present study. Main factors associated with poor control of time in therapeutic range (TTR) of anticoagulated patients are also studied. Methods: Cross-sectional study, with real-world data from patients treated in primary care (PC). Data were obtained from the System for the Improvement of Research in PC (SIDIAP) database, covering 60,978 NVAF-anticoagulated patients from 287 PC centres in 2018. Descriptive statistics were derived, and odds ratios were estimated by multivariate logistic regression. Results: 41,430 patients were considered: 93% were being treated with acenocoumarol and 7% with warfarin. There was no difference in poor control of TTR between the two types of VKA treatment, acenocoumarol and warfarin (38.9 vs. 38.4; p = 0.610). Poor anticoagulation control was mainly associated with advanced alcoholism (OR = 1.38), liver failure (OR = 1.37) and intracranial haemorrhage (OR = 1.35) as well as female sex, age < 60 years, cardiovascular history, diabetes mellitus and other variables. Conclusions: There is no association between poor anticoagulation control and the type of VKA treatment administered. Factors associated with poor control of TTR must be considered in clinical practice to improve control and decision-making.


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Acenocumarol/uso terapêutico , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Atenção Primária à Saúde , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Varfarina/uso terapêutico
17.
Sci Rep ; 11(1): 13325, 2021 06 25.
Artigo em Inglês | MEDLINE | ID: covidwho-1281739

RESUMO

COVID 19 is associated with a hypercoagulable state and frequent thromboembolic complications. For how long this acquired abnormality lasts potentially requiring preventive measures, such as anticoagulation remains to be delineated. We used viscoelastic rotational thrombelastometry (ROTEM) in a single center cohort of 13 critical ill patients and performed follow up examinations three months after discharge from ICU. We found clear signs of a hypercoagulable state due to severe hypofibrinolysis and a high rate of thromboembolic complications during the phase of acute illness. Three month follow up revealed normalization of the initial coagulation abnormality and no evidence of venous thrombosis in all thirteen patients. In our cohort the coagulation profile was completely normalized three months after COVID-19. Based on these findings, discontinuation of anticoagulation can be discussed in patients with complete venous reperfusion.


Assuntos
Anticoagulantes/uso terapêutico , Transtornos da Coagulação Sanguínea , COVID-19 , Tromboelastografia , Tromboembolia , Trombose Venosa , Idoso , Coagulação Sanguínea , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/patologia , COVID-19/sangue , COVID-19/tratamento farmacológico , COVID-19/patologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Tromboembolia/tratamento farmacológico , Tromboembolia/patologia , Trombose Venosa/tratamento farmacológico , Trombose Venosa/patologia
18.
BMC Nephrol ; 22(1): 224, 2021 06 16.
Artigo em Inglês | MEDLINE | ID: covidwho-1277921

RESUMO

BACKGROUND: Coronavirus-19 (COVID-19) has been declared a global pandemic by the World Health Organisation. Severe disease typically presents with respiratory failure but Acute Kidney Injury (AKI) and a hypercoagulable state can also occur. Early reports suggest that thrombosis may be linked with AKI. We studied the development of AKI and outcomes of patients with COVID-19 taking chronic anticoagulation therapy. METHODS: Electronic records were reviewed for all adult patients admitted to Manchester University Foundation Trust Hospitals between March 10 and April 302,020 with a diagnosis of COVID-19. Patients with end-stage kidney disease were excluded. AKI was classified as per KDIGO criteria. RESULTS: Of the 1032 patients with COVID-19 studied,164 (15.9%) were taking anticoagulant therapy prior to admission. There were similar rates of AKI between those on anticoagulants and those not anticoagulated (23.8% versus 19.7%) with no difference in the severity of AKI or requirement of renal replacement therapy between groups (1.2% versus 3.5%). Risk factors for AKI included hypertension, pre-existing renal disease and male sex. There was a higher mortality in those taking anticoagulant therapy (40.2% versus 30%). Patients taking anticoagulants were less likely to be admitted to the Intensive Care Unit (8.5% versus 17.4%) and to receive mechanical ventilation (42.9% versus 78.1%). CONCLUSION: Patients on chronic anticoagulant therapy did not have a reduced incidence or severity of AKI suggesting that AKI is unlikely to be thrombotic in nature. Therapeutic anticoagulation is currently still under investigation in randomised controlled studies to determine whether it has a potential role in COVID-19 treatment.


Assuntos
Injúria Renal Aguda , Anticoagulantes/uso terapêutico , COVID-19 , Unidades de Terapia Intensiva/estatística & dados numéricos , Trombofilia , Trombose/prevenção & controle , Injúria Renal Aguda/complicações , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/prevenção & controle , Injúria Renal Aguda/virologia , Idoso , COVID-19/sangue , COVID-19/epidemiologia , COVID-19/terapia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Cobertura de Condição Pré-Existente/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de Doença , Trombofilia/diagnóstico , Trombofilia/prevenção & controle , Trombofilia/virologia , Trombose/sangue , Trombose/etiologia , Reino Unido/epidemiologia
19.
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
20.
Semin Vasc Surg ; 34(2): 8-12, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-1240793

RESUMO

This literature review discusses the current evidence on acute limb ischemia (ALI) in patients with COVID-19. Throughout the pandemic, these patients have been at increased risk of arterial thrombotic events and subsequent mortality as a result of a hypercoagulable state. The exact mechanism of thrombosis is unknown; however arterial thrombosis may be due to invasion of endothelial cells via angiotensin-converting enzyme 2 (ACE2) receptors, endothelial injury from inflammation, or even free-floating aortic thrombus. Multiple studies have been performed evaluating the medical and surgical management of these patients; the decision to proceed with operative intervention is dependent on the patient's clinical status as it relates to COVID-19 and morbidity of that disease. The interventions afforded typically include anticoagulation in patients undergoing palliation; alternatively, thrombectomy (endovascular and open) is utilized in other patients. There is a high risk of rethrombosis, despite anticoagulation, given persistent endothelial injury from the virus. Postoperative mortality can be high in these patients.


Assuntos
COVID-19/complicações , Isquemia/terapia , Isquemia/virologia , Extremidade Inferior/irrigação sanguínea , Trombose/terapia , Trombose/virologia , Anticoagulantes/uso terapêutico , COVID-19/diagnóstico , COVID-19/terapia , Humanos , Isquemia/diagnóstico , Trombectomia , Trombose/diagnóstico
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