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1.
Medicine (Baltimore) ; 99(6): e18984, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028408

RESUMO

RATIONALE: Autoimmune hemolytic AQ5 anemia (AIHA) is an immune disorder caused by antibodies directed against unmodified autologous red blood cells. In rare cases, AIHA is comorbid with other immunological disorders; for instance, when AIHA is complicated with immunologic thrombocytopenic purpura (ITP) it is called Evans Syndrome (ES). These multiple autoimmune mechanisms are referred to as "immunological tolerance loss," which is known as a characteristic autoimmunity specific for AIHA. And there are no estimation of the risk for thromboembolism in the "immunological tolerance loss" case. PATIENT CONCERNS: A 66-year-old man was diagnosed with ES after autologous stem cell transplantation for malignant lymphoma. His background immunological status was complicated because AIHA was mixed-type (warm and cold antibody type). The direct/indirect Coombs tests were positive. The anticomplement antibody was positive and his cold hemagglutinin level had increased. Anticardiolipin antibodies were negative: anticardiolipin ß2GPI antibody ≤1.2 U/mL (<3.5), anticardiolipin immunoglobulin G antibody ≤8 U/mL (<10), and anticardiolipin immunoglobulin M antibody ≤5 U/mL (<8). DIAGNOSES: ITP and mixed-type AIHA. INTERVENTIONS: The patient achieved complete response by initial prednisolone therapy; however, he did not respond to corticosteroid therapy after AIHA recurrence. He required the red blood cell transfusion due to the progression of hemolytic anemia. OUTCOMES: On the fourth day of refractory treatment following AIHA recurrence, the patient had acute respiratory failure with severe hypoxia and died. The cause of death was identified as pulmonary embolism (PE) based on the laboratory data and echocardiography findings, and a literature search suggested rapidly progressive hemolysis-induced PE. LESSONS: Although infrequent, comorbid thromboembolism to AIHA is well documented; however, a mixed-type AIHA case complicated with thromboembolism has not been previously reported. The combined pathophysiology of AIHA and thromboembolism should be considered in the clinical course of hemolysis. Our case suggested multiple immunological background, ITP, and mixed type AIHA, could be associated to a risk for thromboembolism (TE).


Assuntos
Anemia Hemolítica Autoimune/complicações , Embolia Pulmonar/etiologia , Idoso , Anemia Hemolítica Autoimune/diagnóstico , Evolução Fatal , Humanos , Masculino , Embolia Pulmonar/diagnóstico , Púrpura Trombocitopênica Idiopática/complicações , Púrpura Trombocitopênica Idiopática/diagnóstico , Trombocitopenia/complicações , Trombocitopenia/diagnóstico
2.
Medicine (Baltimore) ; 99(6): e18996, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028410

RESUMO

Upper extremity vein thrombosis (UE-VT) are more and more frequent pathologies and yet little studied. The aim is to describe the clinical and ultrasound features, UE-VT-related diseases, and the prevalence of pulmonary embolism (PE) and associated deaths.All UE-VT patients diagnosed by Doppler-ultrasound in Nantes University Hospital, from January 2015 to December 2017, were included retrospectively. UE-VT suspicion patterns, clinical features, UE-VT topography, and prevalence of PE and death were analyzed.Seven hundred and fifty-five UE-VT were analyzed, including 427 deep thrombosis (UE-DVT) and 328 superficial thrombosis (UE-SVT). In 86.2% (n = 651) UE-VT were related to endovascular devices. Among these thrombosis, one third is in connection with a PICC LINE and one quarter with a peripheral venous line. Forty nine percent (n = 370) of the patients had solid neoplasia or hematological malignancies. An inflammatory or systemic infectious context was found in 40.8% (n = 308) of the cases. The most frequently observed clinical sign at the UE-VT diagnosis was edema (28.6%). Among the UE-SVT it was the presence of an indurated cord (33.2%) and among the UE-DVT the indication of the Doppler-ultrasound was mainly a suspicion of infection on endovascular device (35.1%). In 10.6% (n = 80) of the cases the UE-VT were asymptomatic. The most frequently thrombosed veins were brachial basilic veins (16.7% of all thrombosed segments) followed by jugular (13%) and subclavian (12.3%) veins; 61.3% (n = 463) of UE-VT were in the right upper extremity; 63.3% (n = 478) UE-VT were occlusive. The occurrence of PE is 4% and the death rate is 10.2%, mainly related to the severe comorbidities of patients with UE-VT.UE-VT occurs in particular clinical contexts (hematological malignancies, solid cancers, systemic infections) and in the majority of endovascular devices (86.2%). The occurrence of PE is low.


Assuntos
Braço/irrigação sanguínea , Trombose/diagnóstico , Trombose Venosa/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/etiologia , Embolia Pulmonar/mortalidade , Estudos Retrospectivos , Trombose/complicações , Trombose/diagnóstico por imagem , Trombose/mortalidade , Ultrassonografia , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/mortalidade
3.
Zhonghua Er Ke Za Zhi ; 58(1): 25-29, 2020 Jan 02.
Artigo em Chinês | MEDLINE | ID: mdl-31905472

RESUMO

Objective: To improve the diagnosis and therapy of childhood pulmonary thromboembolism (PTE) by analyzing the clinical features of this rare condition. Methods: A total of 8 pediatric patients (4 males, 4 females) with PTE diagnosed in the Children's Hospital of Zhejiang University School of Medicine from March, 2014 to March, 2019 were enrolled. The clinical manifestation, laboratory results, imaging findings, diagnosis and treatment were summarized. Results: Among these 8 cases, aged from 9 hours to 14 years and 10 months. Fever was found in 4 cases, cough aggravation in 4, short of breath in 3, chest pain in 2, abdominal and back pain in one, hemoptysis in 2, cyanosis in 1, and edema of lower extremities in 2. Physical examination found decreased breath sound in 2 cases, phlegm rale in 3, and pleural friction rub in one. Pleural effusion was found in 5 cases by ultrasound. Plasma D-dimer increased in 6 cases (0.66-9.96 mg/L) and hypersensitive C-reactive protein elevated in 5 cases (10.78-78.00 mg/L). Chest enhanced CT showed pulmonary artery or venous filling defects, including pulmonary artery embolism in 7 cases and pulmonary vein embolism in one. The primary disease of these patients included Mycoplasma Pneumoniae pneumonia in 4 cases, nephritis in 2 and postoperative congenital heart disease in 2. Apart from one case who withdrew the treatment and was discharged, the other 7 patients received anticoagulant treatment had good outcome. Conclusions: For children with Mycoplasma pneumoniae pneumonia, immune disorders, long-term hormone therapy, cardiovascular invasive operation or other high-risk factors, PTE should be considered when fever, cough aggravation, short of breath, chest and back pain with pleural effusion are present. Chest enhanced CT scan should be performed as soon as possible, and anticoagulation should be started once the diagnosis is confirmed.


Assuntos
Pneumonia por Mycoplasma/complicações , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico , Adolescente , Dor no Peito/diagnóstico por imagem , Criança , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Masculino , Derrame Pleural , Pneumonia por Mycoplasma/diagnóstico , Embolia Pulmonar/complicações , Tomografia Computadorizada por Raios X , Resultado do Tratamento
4.
Br J Nurs ; 29(1): 22-26, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31917939

RESUMO

Pulmonary embolism (PE) is a condition characterised by an obstruction of the pulmonary arterial system by one or more emboli. Advanced clinical practitioners are often faced with ruling out a diagnosis of PE in patients with non-specific symptoms such as dyspnoea and pleuritic chest pain, which can be fairly mild and therefore a diagnosis of PE easily missed. PEs can be a challenge to diagnose, especially in elderly people, since it can be difficult to differentiate their symptoms from other less serious illnesses. Widely used scoring tools are helpful to calculate a patient's probability of having a PE. The Wells score is the most widely used pre-test clinical probability indicator of PE used in the UK, which scores the patient's probability of having a PE based on their risk factors. The D-dimer test is a relatively simple investigation to rule out venous thromboembolism (VTE) but can be raised for various reasons other than PE. Computed tomography pulmonary angiography (CTPA) is regarded as the gold standard imaging modality for investigation of acute PE but ventilation-perfusion (VQ) scans can be used as an alternative imaging technique for diagnosing PE in those where CTPA is contraindicated. Thrombolysis is underused in clinical practice due to the fear of adverse bleeding events. Patients without a massive or sub-massive PE are treated with anticoagulant therapy, usually commencing with subcutaneous low-molecular-weight heparin and switching over to a direct oral anticoagulant (DOAC). There has been a shift away from treatment with warfarin for the prevention and treatment of VTE over the past decade.


Assuntos
Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Humanos , Fatores de Risco
5.
JAMA ; 323(2): 130-139, 2020 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-31935028

RESUMO

Importance: The efficacy of factor XIa inhibition for thromboprophylaxis is unknown. Osocimab is a long-acting, fully human monoclonal antibody that inhibits factor XIa. Objective: To compare different doses of osocimab with enoxaparin and apixaban for thromboprophylaxis in patients who have undergone knee arthroplasty. Design, Setting, and Participants: Randomized, open-label, adjudicator-blinded, phase 2 noninferiority trial with observer blinding for osocimab doses, conducted at 54 hospitals in 13 countries. Adult patients undergoing unilateral knee arthroplasty were randomized from October 2017 through August 2018 and followed up until January 2019. Interventions: Single intravenous osocimab postoperative doses of 0.3 mg/kg (n = 107), 0.6 mg/kg (n = 65), 1.2 mg/kg (n = 108), or 1.8 mg/kg (n = 106); preoperative doses of 0.3 mg/kg (n = 109) or 1.8 mg/kg (n = 108); or 40 mg of subcutaneous enoxaparin once daily (n = 105) or 2.5 mg of oral apixaban twice daily (n = 105) for at least 10 days or until venography. Main Outcomes and Measures: The primary outcome was venous thromboembolism incidence between 10 and 13 days postoperatively (assessed by mandatory bilateral venography performed 10 to 13 days after surgery or confirmed symptomatic deep vein thrombosis or pulmonary embolism). A 5% noninferiority margin compared with enoxaparin was chosen. The primary safety outcome of major or clinically relevant nonmajor bleeding was assessed until 10 to 13 days postoperatively. Results: Of 813 randomized participants (mean [SD] age, 66.5 years [8.2 years]; body mass index, 32.7 [5.7]; and 74.2% women), 600 were included in the per-protocol population used for the primary analysis. The primary outcome occurred in 18 patients (23.7%) receiving 0.3 mg/kg, 8 (15.7%) receiving 0.6 mg/kg, 13 (16.5%) receiving 1.2 mg/kg, and 14 (17.9%) receiving 1.8 mg/kg of osocimab postoperatively; 23 (29.9%) receiving 0.3 mg/kg and 9 (11.3%) receiving 1.8 mg/kg of osocimab preoperatively; 20 (26.3%) receiving enoxaparin; and 12 (14.5%) receiving apixaban. Osocimab given postoperatively met criteria for noninferiority compared with enoxaparin with risk differences (1-sided 95% CIs) of 10.6% (95% CI, -1.2% to ∞) at the 0.6-mg/kg dose; 9.9% (95% CI, -0.9% to ∞) at the 1.2-mg/kg dose, and 8.4% (95% CI, -2.6 to ∞) at the 1.8-mg/kg dose. The preoperative dose of 1.8 mg/kg of osocimab met criteria for superiority compared with enoxaparin with a risk difference of 15.1%; 2-sided 90% CI, 4.9% to 25.2%). Postoperative and preoperative doses of 0.3 mg/kg of osocimab did not meet the prespecified criteria for noninferiority, with risk differences (1-sided 95% CIs) of 2.6% (95% CI, -8.9% to ∞) and -3.6% (95% CI, -15.5% to ∞), respectively. Major or clinically relevant nonmajor bleeding was observed in up to 4.7% of those receiving osocimab, 5.9% receiving enoxaparin, and 2% receiving apixaban. Conclusions and Relevance: Among patients undergoing knee arthroplasty, postoperative osocimab 0.6 mg/kg, 1.2 mg/kg, and 1.8 mg/kg met criteria for noninferiority compared with enoxaparin, and the preoperative 1.8-mg/kg dose of osocimab met criteria for superiority compared with enoxaparin for the primary outcome of incidence of venous thromboembolism at 10 to 13 days postoperatively. Further studies are needed to establish efficacy and safety of osocimab relative to standard thromboprophylaxis. Trial Registration: ClinicalTrials.gov Identifier: NCT03276143.


Assuntos
Anticoagulantes/administração & dosagem , Artroplastia do Joelho , Inibidores do Fator Xa/administração & dosagem , Hemorragia/induzido quimicamente , Complicações Pós-Operatórias/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Idoso , Anticoagulantes/efeitos adversos , Relação Dose-Resposta a Droga , Enoxaparina/administração & dosagem , Enoxaparina/efeitos adversos , Inibidores do Fator Xa/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Embolia Pulmonar/prevenção & controle , Pirazóis/administração & dosagem , Pirazóis/efeitos adversos , Piridonas/administração & dosagem , Piridonas/efeitos adversos , Método Simples-Cego , Trombose Venosa/prevenção & controle
6.
Medicine (Baltimore) ; 99(2): e18692, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914069

RESUMO

RATIONALE: Allergic bronchopulmonary aspergillosis (ABPA) complicated with pulmonary thromboembolism (PTE) is rare. This report describes a patient who was diagnosed with ABPA and soon developed PTE. PATIENT CONCERNS: A 64-year-old man was diagnosed with ABPA in hospital for recurrent fever with cough. Two months later, the patient was readmitted to the hospital because of PTE. DIAGNOSES: ABPA was diagnosed during the first hospitalization, and laboratory tests showed an increase in serum IgE and Aspergillus fumigatus-specific IgG. Sputum culture suggested A. fumigatus and high-resolution computed tomography (HRCT) showed inflammation of both lungs and central bronchiectasis. During the second hospitalization, the patient's chest angiography showed PTE. INTERVENTIONS: The patient began treatment with antifungal drugs and corticosteroids, and was discharged from the hospital when his condition improved. Two months after discharge, the patient was treated with anticoagulant drugs due to PTE. OUTCOMES: The patient got better after taking anticoagulant drugs and was discharged from the hospital. The patient appears for regular follow-up visits in our outpatient clinic every 2 months and is currently in good condition. LESSONS: Patients with ABPA may be concurred with PTE. The risk of PTE in ABPA should be assessed in advance and preventive strategies also need to be taken beforehand. Pulmonary artery examination is necessary once it happened.


Assuntos
Aspergilose Broncopulmonar Alérgica/complicações , Embolia Pulmonar/etiologia , Anticoagulantes/uso terapêutico , Antifúngicos/uso terapêutico , Aspergilose Broncopulmonar Alérgica/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/tratamento farmacológico
7.
Vasc Endovascular Surg ; 54(2): 135-140, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31769352

RESUMO

PURPOSE: Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis (USAT) appears to provide promising results for the management of acute submassive pulmonary embolisms (ASMPEs) at tertiary care centers. This study assessed outcome measures at a community-based hospital systems and compared results to known studies. MATERIALS AND METHODS: This is a single-center, retrospective study assessing clinical outcomes of the EkoSonic Endovascular System intervention for ASMPEs performed by three surgical 3 subspecialties (interventional radiology, interventional cardiology, and vascular surgery) part of a pulmonary embolism response team (PERT). We reviewed 146 PERT activations from June 2013 to December 2017. Eighty-three patients with ASMPEs underwent USAT. RESULTS: Our study showed greater differences (P = .01) between baseline and follow-up pulmonary artery systolic pressures (20.9 ± 9.8 mm Hg [n = 14]) compared to the ULTIMA study (12.3 ± 10 mm Hg [n = 30]). Our length-of-stay measures were shorter (6.1 ± 5.1 [n = 83]; P = .0001) compared to the SEATTLE II study (8.8 ± 5.0 [n = 150]). Preprocedure transthoracic echocardiograms (TTEs) were performed for 54 (65%) of 83 patients. Postprocedure TTEs at 48 hours was performed for 52 (62%) of 83 patients. Use of TTEs before and after intervention did not change outcomes. Intracranial hemorrhage was not observed in our patient population. There was no difference in outcomes between the three subspecialties in our study. CONCLUSIONS: Use of USAT in a community-based hospital PERT has similar outcomes to tertiary care centers. Furthermore, similar outcomes were observed between the three subspecialties suggesting development of a comprehensive care team for management of ASMPEs.


Assuntos
Cateterismo Periférico , Fibrinolíticos/administração & dosagem , Hospitais Comunitários , Embolia Pulmonar/terapia , Terapia Trombolítica/métodos , Terapia por Ultrassom , Doença Aguda , Adulto , Idoso , Cardiologistas , Cateterismo Periférico/efeitos adversos , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Infusões Intra-Arteriais , Masculino , Michigan , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/fisiopatologia , Radiologistas , Estudos Retrospectivos , Especialização , Cirurgiões , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Terapia por Ultrassom/efeitos adversos
8.
Vasc Endovascular Surg ; 54(1): 58-64, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31500542

RESUMO

A retrospective review from July 2016 to April 2018 was performed of 23 patients with submassive pulmonary embolism (PE) who received catheter-directed thrombolysis (CDT). Five (22%) of the 23 patients were discharged the same day from the intensive care unit (ICU) following thrombolysis completion. Their presentation, hospital courses, complications, and follow-up are reviewed. All 5 patients were diagnosed using chest computed tomography (CT) demonstrating a clot in the pulmonary vasculature and right ventricle dysfunction based on abnormal right ventricle to left ventricle (RV/LV) ratio. Patients with severe right heart dysfunction (RV/LV ratio ≥1.4) were protocolized to receive CDT via EkoSonic catheters (EKOS Corporation). Postoperatively, patients were admitted to the ICU with continuous alteplase at 1 mg/h. Echocardiography was then performed after 24 hours of therapy to assess right ventricle function and removal of EkoSonic catheters. Patients with reversal of right heart dysfunction and symptomatic improvement received bedside removal of catheters. The mean patient age was 50.6 years and body mass index was 33.6. Mean RV/LV ratio on admission via CT imaging was 1.56, with a mean troponin of 0.44. Interval mean RV/LV ratio on echocardiography after thrombolysis therapy was 0.91. There was a 0% incidence of periprocedural complications. One (20%) patient out of 5 had an emergency department visit 10 days postdischarge for acute shortness of breath, with workup revealing no evidence of recurrent PE. No patient required hospital readmission within 30 days. At the 6-week follow-up, all patients had continued normal right ventricular function noted on echocardiography. This case series demonstrates that for a select population of patients with severe submassive PE, the use of CDT and echocardiography monitoring can facilitate same-day discharge from the ICU.


Assuntos
Fibrinolíticos/administração & dosagem , Unidades de Terapia Intensiva , Tempo de Internação , Alta do Paciente , Embolia Pulmonar/tratamento farmacológico , Terapia Trombolítica/métodos , Adulto , Ecocardiografia , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Sistema de Registros , Estudos Retrospectivos , Índice de Gravidade de Doença , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/instrumentação , Fatores de Tempo , Resultado do Tratamento , Dispositivos de Acesso Vascular
9.
Radiol Clin North Am ; 58(1): 93-103, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31731905

RESUMO

This article describes an approach to analyzing the distribution of intravenous contrast on chest computed tomography and illustrates the various pathologies and pitfalls that may be encountered by the imager, especially in the hospitalized patient. Understanding normal and abnormal distribution of intravenous contrast can be used as a clue to detect alterations in physiology and flow.


Assuntos
Meios de Contraste , Cardiopatias/diagnóstico por imagem , Pacientes Internados , Embolia Pulmonar/diagnóstico por imagem , Intensificação de Imagem Radiográfica , Tomografia Computadorizada por Raios X/métodos , Coração/diagnóstico por imagem , Hospitalização , Humanos , Pulmão/diagnóstico por imagem , Radiografia Torácica/métodos
10.
Internist (Berl) ; 61(1): 36-43, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31848646

RESUMO

Swelling of soft parts of the lower extremities, whether uni- or bilateral, is a common reason for consulting a general practitioner (GP). Complex interactions mean that GPs are faced with a wide range of differential diagnoses during clarification of such findings. Of enormous importance is the prevention of a dangerous course, e.g., by initiating weight-adapted calculated antibiotic treatment, antithrombotic therapy, or even initial inpatient treatment and acute diagnostic workup in case of impending compartment syndrome or extensive venous thrombosis of the leg with or without suspicion of pulmonary embolism. Sometimes an acute venous thrombosis of the leg unmasks malignant disease. A swollen leg/swollen legs are frequently a leading symptom of decompensating heart or renal failure. Another possible cause are drug side effects, which may be exacerbated in a warm environment. An endocrine cause must also be considered in some cases. The GP is the appropriate physician for patients to contact and to initiate and coordinate diagnostics and treatment. In addition to coordination of specialist examinations, it is not infrequent that nurses and physiotherapists have to be involved in treatment, to ensure successful outpatient care.


Assuntos
Edema/diagnóstico , Medicina Geral , Perna (Membro)/fisiopatologia , Embolia Pulmonar/complicações , Insuficiência Venosa/complicações , Trombose Venosa , Diagnóstico Diferencial , Edema/etiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Extremidade Inferior
11.
Tidsskr Nor Laegeforen ; 139(18)2019 Dec 10.
Artigo em Norueguês | MEDLINE | ID: mdl-31823570

RESUMO

BACKGROUND: Early discharge and home treatment for pulmonary embolism patients results in fewer hospital complications and may reduce treatment costs. We wished to investigate whether it is as safe and effective as hospital treatment, and if so, how best to select patients for home treatment. MATERIAL AND METHOD: We searched the databases Embase, Ovid MEDLINE, In-Process & Other Non-Indexed Citations and the Cochrane Library for clinical trials of acute, objectively verified pulmonary embolism, where outcomes for hospital treatment and home treatment were compared. RESULTS: For a selected group of patients with acute, symptomatic pulmonary embolism, home treatment is as safe and effective as hospital treatment. PESI (Pulmonary Embolism Severity Index) and Hestia criteria have the best documented clinical utility for selection of patients for home treatment. INTERPRETATION: The Hestia criteria represent a pragmatic approach to selection of patients who can be treated at home for pulmonary embolism, and they can be applied without taking other formal criteria into consideration.


Assuntos
Serviços de Assistência Domiciliar , Embolia Pulmonar , Doença Aguda , Assistência Ambulatorial , Humanos , Alta do Paciente , Embolia Pulmonar/terapia
12.
Zhonghua Yi Xue Za Zhi ; 99(44): 3456-3460, 2019 Nov 26.
Artigo em Chinês | MEDLINE | ID: mdl-31826561

RESUMO

Objective: To explore the possibility of using coagulation factor Ⅱ and Ⅹ (FⅡ and FⅩ) for warfarin monitoring among Chinese pulmonary embolism patients. Methods: Blood samples were collected from pulmonary embolism patients who were taking warfarin as anticoagulant and who were from Peking Union Medical Collaege Hospital during Mar 2016 and Oct 2018. Activity of coagulation factor Ⅱ/Ⅹ and International Normalized Ratio (INR) level were detected. Correction analysis was used to investigate the relationship between activity of coagulation factor Ⅱ/Ⅹ and INR. Receiver Operating Characteristic (ROC) curve was used to analyze the diagnostic ability of FⅡ and FⅩ. Results: A total of 157 blood samples were collected in this research. When 1.5≤INR≤3.0, FⅡ (r=-0.768, P<0.001) and FⅩ(r=-0.690, P<0.001) were in inverse correlations with INR. Area under ROC curve (AUC) for FⅡ and FⅩ was 0.961 and 0.965 (P<0.001) when we used INR<2.0 as the criteria of anticoagulant inadequacy. AUC of ROC for FⅡ and FⅩ was 0.885 and 0.890 (P<0.001) when we used INR≤3.0 as the criteria of not over-anticoagulation. Conclusion: FⅡ and FⅩ activity can be used as the therapeutic markers of warfarin in Chinese pulmonary embolism patients.


Assuntos
Anticoagulantes/uso terapêutico , Fator X/uso terapêutico , Protrombina/uso terapêutico , Embolia Pulmonar , Varfarina/uso terapêutico , Humanos , Coeficiente Internacional Normatizado , Embolia Pulmonar/tratamento farmacológico
13.
Zhonghua Yi Xue Za Zhi ; 99(44): 3461-3465, 2019 Nov 26.
Artigo em Chinês | MEDLINE | ID: mdl-31826562

RESUMO

Objective: To investigate the clinical characteristics of patients with chronic thromboembolic pulmonary hypertension (CTEPH). Methods: CTEPH cases consecutively admitted into China-Japan Friendship Hospital from September 2015 to June 2019 were enrolled with prospective data collection. The medical histories, clinical characteristics, laboratory tests, imaging manifestation and hemodynamic parameters were analyzed. Patients were divided into high pulmonary vascular resistance (PVR) group and low PVR group according to the PVR level>1 000 dyn·s·cm(-5) or not, and clinical characteristics were compared between these two groups. Results: In the 148 cases of CTEPH, right heart catheterization was performed in 103 cases with mPAP (45.1±11.0) mmHg and PVR of (992±430) dyn·s·cm(-5). At diagnosis, 88 (59.5%) cases were in WHO functional class Ⅲ and 27 (18.2%) in class Ⅳ. Most common presenting symptoms were dyspnea (147, 99.3%), chest tightness (68, 45.9%), hemoptysis (42, 28.3%), syncope (30, 20.3%), and most common signs were P2 accentuation (95, 64.9%), edema (65, 43.9%), cyanosis (47, 31.8%), systolic murmur (44, 29.7%) and jugular vein distention (35, 23.6%). In 103 cases with right heart catheterization, 52 were in the low PVR group and 51 in high PVR group. Compared to the low PVR group, high PVR group patients had higher WHO functional class and more jugular vein distention (both P<0.05). In all the 148 cases, previous venous thromboembolism (VTE) was confirmed in 105 (70.9%) patients, with a higher prevalence of previous VTE in low PVR group than that in high PVR group (P<0.001). 30 (20.3%) patients had varicose veins of the lower extremities, and 21 (14.2%) had other thrombophilic disorders including antiphospholipid syndrome, protein C and S deficiency and antithrombin Ⅲ deficiency. Conclusions: Dyspnea, P2 accentuation and edema are the most common clinical presentation of CTEPH. Previous history of VTE is common in CTEPH patients with thrombophilia in some cases.


Assuntos
Hipertensão Pulmonar , Embolia Pulmonar , China , Doença Crônica , Humanos , Estudos Prospectivos , Resistência Vascular
15.
Kardiologiia ; 59(12): 35-43, 2019 Dec 11.
Artigo em Russo | MEDLINE | ID: mdl-31849307

RESUMO

AIM: To study the distribution of the type of heart circulation (left- dominant, right- dominant, and mixed (balanced) in patients with pulmonary thromboembolism of fatal and non-fatal outcome. MATERIALS AND METHODS: More than 36,000 case histories, protocols and findings of post-mortem examinations of patients hospitalized in 2003-2012 were subjected to analysis. (ten year period). Statistical processing of the actual material was carried out using the SAS 9 and SPSS 21 software packages. The critical level of significance p for all used procedures of statistical analysis was assumed to be 0.05. Results of the study. The study included 893 cases of pulmonary embolism registered in the data of the case histories and materials of the pathoanatomical studies. Data on the type of heart circulation and a detailed description of the coronary artery atherosclerosis were present in 264 cases: in 171 patients with pulmonary embolism and fatal outcome, and in 93 patients with pulmonary embolism and non-fatal outcome. A clear predominance was found in the group with pulmonary embolism and non-fatal outcome of patients with the right type of heart circulation - 78.5% versus 7% in the group of people who died with pulmonary embolism (p<0.0001). Accordingly, persons with "non-right type of heart circulation" (left and balanced) predominantly prevailed among patients with pulmonary embolism and fatal outcome. At the same time, the dead with the right type of heart circulation in all cases had a stenosis of the right coronary artery (RCA) more than 60%. RCA dominance in the heart circulation with absence its significant stenosis creates more favorable hemodynamic conditions for survival in patients with pulmonary embolism. Owners of other types of organization of coronary blood flow ("non-right type of heart circulation") have a worse prognosis both in the absence of coronary atherosclerosis and, moreover, in its presence, especially in the case of significant atherosclerotic lesion of the RCA pool. At the same time, in patients with the right type of heart circulation and hemodynamically significant atherosclerosis RCA in conditions of pulmonary embolism the prognosis is also unfavorable. In view of the above, in patients with coronary atherosclerosis, timely restoration of blood flow in RCA (coronary artery stenting) is great importance in relation to the prognosis associated not only with coronary heart disease, but also with PE.


Assuntos
Circulação Coronária , Embolia Pulmonar , Vasos Coronários , Coração , Humanos , Prognóstico
16.
Gan To Kagaku Ryoho ; 46(12): 1883-1885, 2019 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-31879408

RESUMO

A woman in her 70s developed deep vein thromboembolism(DVT)and pulmonary embolism(PE)during chemotherapy for advanced transverse colon cancer. After the first treatment with heparin and warfarin, the anticoagulant was changed to edoxaban to reduce the risk of bleeding. She continued receiving chemotherapy for 4 years. We recommend edoxaban as the first choice of anticoagulant for patients with DVT and PE requiring chemotherapy with fluoropyrimidine-based antineoplastic agents.


Assuntos
Anticoagulantes/efeitos adversos , Neoplasias do Colo , Fluoruracila/uso terapêutico , Embolia Pulmonar , Piridinas/efeitos adversos , Tiazóis/efeitos adversos , Tromboembolia , Tromboembolia Venosa , Idoso , Neoplasias do Colo/tratamento farmacológico , Humanos , Embolia Pulmonar/induzido quimicamente , Tromboembolia Venosa/induzido quimicamente
17.
Angiol Sosud Khir ; 25(4): 139-145, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855211

RESUMO

Using the 'Korona' cava filter in a total of 1345 oncological patients revealed regularity of a change in the shape of the inferior vena cava at the level of implantation. This made it feasible to determine one of the causes of long-term complications following implantation of other models of cava filters. The absence of clinically significant complications in the remote period after using this model of cava filter made it possible to implant it for a longer period, which is of special importance in oncological patients.


Assuntos
Embolia/prevenção & controle , Neoplasias/complicações , Filtros de Veia Cava , Veia Cava Inferior/cirurgia , Embolia/etiologia , Humanos , Embolia Pulmonar/etiologia , Embolia Pulmonar/prevenção & controle
18.
Angiol Sosud Khir ; 25(4): 167-172, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855214

RESUMO

Pulmonary haemorrhage is one of the most severe complications of pulmonary endarterectomy. To the most effective methods of combating this potentially fatal complication belongs extracorporeal membrane oxygenation (ECMO). In this article we describe a clinical case report regarding intraoperative use of central veno-arterial ECMO for pulmonary haemorrhage following thromboendarterectomy from the pulmonary arteries. According to the data of some authors, long-term ECMO support (for more than 4 days) may lead to such severe consequences as rethrombosis of pulmonary arteries and impairment of cerebral circulation. In our case we managed to avoid such complications, taking into consideration that the duration of ECMO amounted to 21 days. Resulting from the carried out comprehensive therapeutic measures by the time of discharge from hospital, a significant decrease in pulmonary artery pressure was achieved, with events of residual pulmonary hypertension.


Assuntos
Endarterectomia/efeitos adversos , Oxigenação por Membrana Extracorpórea , Hemorragia/cirurgia , Pneumopatias/cirurgia , Embolia Pulmonar/cirurgia , Hemorragia/etiologia , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/terapia , Pneumopatias/etiologia
19.
Angiol Sosud Khir ; 25(4): 181-187, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855216

RESUMO

BACKGROUND: Acute thrombosis in the system of the inferior vena cava is one of the most common vascular diseases and is of serious danger as a potential source of one of the most severe complications. In order to assess efficacy of open thrombectomy for embologenic iliofemoral venous thromboses we carried out comparison of the results of open thrombectomy and implantation of cava filters in a total of 119 patients presenting with iliofemoral thrombosis. PATIENTS AND METHODS: Open thrombectomy was performed in a total of 59 patients. Of these, 12 patients with segmental thromboses underwent radical thrombectomy and 47 patients with disseminated forms of thrombosis were subjected to partial thrombectomy with plication of the femoral vein. In 5 patients, the operation was supplemented with applying an arteriovenous fistula. Efficacy of operations was assessed with the help of ultrasonographic duplex angioscanning and regression of clinical manifestations. In the remote period, the degree of manifestations of post-thrombotic disease was assessed by means of the Villalta scale. RESULTS: After radical thrombectomy, patency of the iliofemoral segment was preserved in all patients during the whole follow-up period. In the group of patients with partial thrombectomy, 5 (9.5%) patients developed rethrombosis above the placation site at terms from 8 to 12 months. Four-year patency of the iliofemoral segment in this group of patients amounted to 81.5%. In patients with implanted cava filters, neither femoral vein nor iliac segment were patent completely. During the first year, thrombosis of cava filter developed in 9 cases; after 2 years, occlusion of the cava filter was diagnosed in 7 patients. In clinical assessment of the remote results with the use of the Villalta scale in patients after open thrombectomy the symptoms of post-traumatic disease were absent or weakly pronounced. After implantation of the cava filter all patients demonstrated the clinical course of post-traumatic disease, corresponding to 10-15 points. CONCLUSION: Open thrombectomy for iliofemoral embologenic thromboses performed at specialized departments is a radical method of preventing thromboembolic complications and promotes restoration or improvement of venous blood flow in the extremity.


Assuntos
Veia Femoral/cirurgia , Veia Ilíaca/cirurgia , Embolia Pulmonar/prevenção & controle , Trombectomia/métodos , Trombose Venosa/cirurgia , Implante de Prótese Vascular , Humanos , Embolia Pulmonar/etiologia , Resultado do Tratamento , Filtros de Veia Cava , Trombose Venosa/complicações
20.
Medicine (Baltimore) ; 98(51): e18386, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861001

RESUMO

RATIONALE: Pulmonary embolisms (PEs) are caused by emboli, which mostly originate from deep venous thrombi that travel to and suddenly block the pulmonary arteries. The emboli are usually thrombi, and right atrial myxoma emboli are rare. PATIENT CONCERNS: A 55-year-old man presented with shortness of breath and syncope. We proceeded with computed tomography pulmonary angiography (CTPA) and transthoracic echocardiogram (TTE), the results of which suggested that the diagnosis was a right atrial mass. DIAGNOSIS: A definitive diagnosis compatible with a right atrial myxoma (RAM) with tumoral pulmonary emboli after surgical excision was made. INTERVENTION: Right atrial and pulmonary artery embolectomy. OUTCOMES: The patient followed an uneventful course during the 6 years of follow-up after surgery. According to a review of the literature, RAMs are often not diagnosed in a timely manner or even go completely undiagnosed. TTE, transesophageal echocardiography (TEE), CT, magnetic resonance imaging (MRI), and positron emission tomography/computed tomography may be helpful in the preoperative diagnosis. Surgical removal of the masses from the atrium and pulmonary arteries was relatively uneventful. LESSONS: RAMs should be considered unlikely reasons for fatal pulmonary embolisms.


Assuntos
Átrios do Coração/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Mixoma/diagnóstico por imagem , Embolia Pulmonar/etiologia , Angiografia por Tomografia Computadorizada , Ecocardiografia , Átrios do Coração/cirurgia , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Mixoma/patologia , Mixoma/cirurgia , Embolia Pulmonar/cirurgia
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