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2.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(10): 1236-1240, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-33198871

RESUMO

OBJECTIVE: To evaluate the clinical characteristics, diagnosis, treatment and outcome of elderly patients with acute pulmonary embolism (APE), in order to strengthen the awareness of diagnosis of APE and reduce missed diagnosis and misdiagnosis. METHODS: A retrospective analysis of clinical data of 40 elderly patients (age ≥ 60 years old) diagnosed with APE admitted to TEDA International Cardiovascular Hospital from January 2008 to December 2018, including risk factors, clinical features, symptoms and signs, laboratory tests, risk of pulmonary embolism (Wells score), simplified pulmonary embolism severity index (sPESI), radiological tests, treatment, and outcome, etc. were conducted. Receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic value of Wells score and spiral CT pulmonary angiography (CTPA) in APE. RESULTS: A total of 40 elderly patients with APE were enrolled, male was 52.5%, and the age was (69.6±8.2) years old. The most common risk factor was deep vein thrombosis (DVT, 52.5%), followed by hypertension (37.5%) and heart failure (35.0%). The main clinical symptoms were exertional dyspnea (87.5%) and chest tightness (80.0%). Only 10.0% of patients had the triad of dyspnea, chest pain and hemoptysis at the same time. In addition, palpitation (65.0%) and lower limb swelling and pain (42.5%) were also common symptoms. The main clinical signs were shortness of breath (respiratory rate > 25 bpm, 80.0%), lung moist rales (52.5%), and tachycardia (heart rate > 100 bpm, 50.0%). The Wells score showed that 95% of the patients Wells ≥ 2, including moderate (Wells 2-6, 62.5%) and severe (Wells ≥ 7, 32.5%). Laboratory examination showed that 80.0% of patients had D-dimer > 0.5 mg/L, 72.5% had arterial partial pressure of oxygen (PaO2) < 60 mmHg (1 mmHg = 0.133 kPa), and 75.0% had arterial partial pressure of carbon dioxide (PaCO2) < 35 mmHg, 67.5% had brain natriuretic peptide (BNP) > 500 ng/L or N-terminal pro-BNP (NT-proBNP) > 300 ng/L, and 47.5% had cardiac troponin I (cTnI) > 0.3 µg/L. The confirmed diagnosis rate of CTPA in APE was 88.6% (31/35); 5 cases were diagnosed by pulmonary ventilation/perfusion imaging in 6 cases; 4 cases were diagnosed by magnetic resonance pulmonary angiography (MRPA). The sPESI score showed that 36 patients were moderate-risk patients [26 patients with sPESI ≥ 1, and 10 patients with sPESI 0 but right ventricular dysfunction (RVD) and/or elevated cardiac biomarkers]. Thrombolytic therapy and anticoagulant therapy were performed on 17 of them: 8 were cured, 8 were improved, and 1 died; anticoagulant therapy was performed on 18 moderate-risk patients: 9 were cured, 7 were improved, 1 left the hospital without cure, and 1 died; the other 1 moderate-risk patient with PE caused by right atrial myxoma was treated by operation and ultimately died. Four low-risk patients were treated by anticoagulant therapy: 2 were cured and 2 improved. The area under the ROC curve (AUC) of Wells score combined with CTPA was 0.82 (95% confidence interval was 0.73-0.98, P < 0.01), the sensitivity was 74.2%, and the specificity was 90.0%. CONCLUSIONS: DVT and chronic diseases are the most common risk factors for APE in the elderly patients, often accompanied by dyspnea, chest tightness, and lower limb swelling and pain. Early anticoagulation therapy in elderly APE can make a good prognosis. Wells score has an important predictive value for the diagnosis of APE, while blood D-dimer is an important exclusion parameter. CTPA test is the main diagnostic method for APE. The sPESI score can suggest risk stratification and prognosis, and further guided treatment.


Assuntos
Embolia Pulmonar , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Curva ROC , Estudos Retrospectivos , Troponina I , Disfunção Ventricular Direita
3.
Medicine (Baltimore) ; 99(45): e23031, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157953

RESUMO

RATIONALE: The evidence for outpatient pulmonary embolism (PE) management apart from hospitalization is expanding. The availability and ease of direct oral anticoagulants have facilitated this transition. The literature, however, is sparse on the topic of comprehensive management of pulmonary embolism in the primary care clinic setting. As such, the role of the primary care physician in the complete diagnosis, risk stratification for outpatient eligibility, and initiation of treatment is unclear. CASE PRESENTATIONS: Case 1: A 33-year-old man with known heterozygous Factor V Leiden mutation and a remote history of deep vein thrombosis presented to his primary care physician's office with 2 days of mild pleuritic chest pain and a dry cough after a recent transcontinental flight. Case 2: A 48-year-old man with a complex medical history including recent transverse myelitis presented to his primary care family physician with dyspnea and pleuritic chest pain for 6 days. DIAGNOSIS: Case 1: Computed tomographic pulmonary angiography that same afternoon showed multiple bilateral segmental and subsegmental emboli as well as several small pulmonary infarcts. Case 2: The patient's D-dimer was elevated at 1148 ng/mL. His physician ordered a computed tomographic pulmonary angiography, performed that evening, which showed segmental and subsegmental PE. INTERVENTIONS: Both patients were contacted by their respective physicians shortly after their diagnoses and, in shared decision-making, opted for treatment at home with 5 days of enoxaparin followed by dabigatran. OUTCOMES: Neither patient developed recurrence nor complications in the subsequent 3 months. LESSONS: These cases, stratified as low risk using the American College of Chest Physicians criteria and the PE Severity Index, are among the first in the literature to illustrate comprehensive primary care-based outpatient PE management. Care was provided within an integrated delivery system with ready, timely access to laboratory, advanced radiology, and allied health services. This report sets the stage for investigating the public health implications of comprehensive primary care-based PE management, including cost-savings as well as enhanced patient follow-up and patient satisfaction.


Assuntos
Dor no Peito/etiologia , Dispneia/etiologia , Transferência de Pacientes/métodos , Médicos de Atenção Primária/normas , Embolia Pulmonar/tratamento farmacológico , Doença Aguda , Adulto , Assistência Ambulatorial , Anticoagulantes/uso terapêutico , Antitrombinas/uso terapêutico , Dor no Peito/diagnóstico , Angiografia por Tomografia Computadorizada/métodos , Dabigatrana/uso terapêutico , Tomada de Decisão Compartilhada , Dispneia/diagnóstico , Enoxaparina/uso terapêutico , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Mielite Transversa/complicações , Mielite Transversa/diagnóstico , Transferência de Pacientes/estatística & dados numéricos , Médicos de Atenção Primária/estatística & dados numéricos , Embolia Pulmonar/diagnóstico por imagem , Medição de Risco , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/diagnóstico
4.
Kardiologiia ; 60(7): 20-27, 2020 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-33155937

RESUMO

Aim      To study the right ventricular (RV) myocardial longitudinal systolic strain in patient with RV myocardial infarction (MI), and pulmonary embolism (PE) with and without McConnell' phenomenon.Material and methods  This study included 53 patients with PE (mean age, 59.0±15.1 years; men, 58.5 %) and 30 patients with RVMI (mean age, 61.8±10.9 years; men, 90 %). Longitudinal strain of basal, medial and apical segments of the RV free wall (RVFW) and the interventricular septum (IVS) was determined in the mode of two-dimensional speckle tracking. Ratio of the IVS apical strain to the RVFW strain (apical ratio) was calculated. Systolic excursion of the RVFW apical segment (apical excursion) was measured in the anatomical M-mode from the apical four-chamber view.Results The McConnell's sign was observed in 23 (43.4 %) of 53 patients with PE and in 16 (53.3 %) of 30 patients with RVMI (p>0.05). Irrespective of the cause for the RV damage, patients with the McConnell's sign had higher values of the apical ratio (1.69±0.50 vs. 0.95±0.22; p<0.001; cutoff point, 1.18) and apical excursion (7.9±1.7 vs. 2.6±1.4 mm; p<0.001; cutoff point, 5.0 mm). Apical excursion closely correlated with the value of apical ratio (r=0.65; p<0.001) but not with the RVFW apical segment strain (r= -0.07; p>0.05).Conclusion      Incidence of the McConnell's sign was similar in patients with PE and RVMI. McConnell's sign is based on a passive systolic shift of the RVFW apical segment, which develops during contraction of the IVS apical segment. The greater the ratio of IVS apical segment to RBFW global strain the greater the amplitude of this shift. With the ratio value of 1.18 or more, the systolic shift of RVFW apical segment was >5 mm, which was visually perceived as the McConnell's sign.


Assuntos
Infarto do Miocárdio , Embolia Pulmonar , Disfunção Ventricular Direita , Adulto , Idoso , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Sístole , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/etiologia , Função Ventricular Direita
5.
Kardiologiia ; 60(7): 86-90, 2020 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-33155945

RESUMO

Objective Thromboembolic events such as acute coronary syndrome related prosthetic heart valve thrombosis, pulmonary artery embolism and renal artery embolism are a rare condition but a major cause of morbidity and mortality. In this study we discussed low-dose thrombolytic therapy, in patients with thromboembolic events in the intensive care unit.Methods The study was performed on 12 consecutive patients [8 female; 50.3±16.0 (35-95) years] with acute thromboembolism including acute coronary syndrome related prosthetic heart valve thrombosis, acute pulmonary embolism and acute renal embolism who were treated with low-dose (25 mg) and slow infusion (6 hours) of t-PA. We evaluated mainly in-hospital safety and also effectiveness.Total treatment episodes was 1.66±0.88 (1-4) times.Results All thromboembolic events have been successfully treated with low-dose (25 mg) and slow infusion (6 hours) of t-PA. The success criteria were clinically improvement and radiologically lysis. None of the patients had ischemic stroke, intracranial hemorrhage, embolism (peripheral and recurrence of coronary artery embolism), bleeding requiring transfusion. The most frequent in-hospital complication was a gum bleeding without need for transfusion (two patients).Conclusions In our case series low-dose (25 mg) and slow infusion (6 hours) of t-PA have been performed successfully for thromboembolic events including acute coronary syndrome related prosthetic heart valve thrombosis, pulmonary embolism and renal embolism in patients with in the intensive care unit. Safety is promising and if efficacy will be proved; this method may be a valuable alternative to standard fibrinolytic regimen.


Assuntos
Embolia Pulmonar , Tromboembolia , Trombose , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Unidades de Terapia Intensiva , Embolia Pulmonar/tratamento farmacológico , Tromboembolia/tratamento farmacológico , Tromboembolia/etiologia , Terapia Trombolítica , Trombose/tratamento farmacológico , Ativador de Plasminogênio Tecidual/efeitos adversos
6.
Kardiologiia ; 60(8): 115-123, 2020 Sep 17.
Artigo em Russo | MEDLINE | ID: mdl-33155967

RESUMO

Chronic thromboembolic pulmonary hypertension (CTEPH) is a precapillary type of pulmonary hypertension with chronic obstruction of large and medium branches of pulmonary arteries along with secondary alterations in pulmonary microcirculation, which cause progressive increases in pulmonary vascular resistance and pulmonary arterial pressure and ensuing severe right heart dysfunction and heart failure. Pulmonary thromboendarterectomy (PTE) is the treatment of choice for CTEPH; however, this procedure is available not for all patients. Although the surgery performed in the conditions of centers with advanced experience generally shows good results, up to 40% of patients are technically inoperable or PTE is associated with a high risk of complications. At present, riociguat, the only officially approved drug from the class of soluble guanylate cyclase stimulators, is considered as a first-line treatment for inoperable and residual forms of STEPH. Introduction of riociguat to clinical practice can be called a real breakthrough in the treatment of patients with STEPH who cannot undergo PTE or those with relapse or persistent STEPH after the surgery.


Assuntos
Hipertensão Pulmonar , Embolia Pulmonar , Doença Crônica , Humanos , Hipertensão Pulmonar/tratamento farmacológico , Hipertensão Pulmonar/etiologia , Embolia Pulmonar/complicações , Embolia Pulmonar/tratamento farmacológico , Pirazóis , Pirimidinas , Guanilil Ciclase Solúvel
7.
Am J Ther ; 27(6): e599-e610, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33156016

RESUMO

BACKGROUND: Venous thromboembolism (VTE) is increasingly reported in seriously ill patients with COVID-19 infection. Incidence of VTE has been reported before and results varied widely in study cohorts. AREA OF UNCERTAINTY: Incidence of major VTE (segmental pulmonary embolism and above and proximal deep vein thrombosis) which is a contributor to mortality and morbidity is not known. Also, data is unclear on the optimal anticoagulation regimen to prevent VTE. DATA SOURCES: Multiple databases including PubMed were searched until May 12, 2020, to include studies reporting VTE in hospitalized COVID-19 adult patients. MOOSE guidelines were followed in selection, and 11 studies were included. We conducted a systematic review and meta-analysis to quantitatively assess the VTE burden in hospitalized COVID-19 patients and potential benefits of therapeutic dosing of anticoagulation compared with prophylaxis dosing for VTE prevention. THERAPEUTIC ADVANCES: Many societies and experts recommend routine prophylactic anticoagulation with heparin for VTE prevention in hospitalized COVID-19 patients. In this meta-analysis, the pooled rate of major VTE was 12.5% in hospitalized patients and 17.2% in intensive care unit patients. When therapeutic anticoagulation dosing was compared with prophylactic anticoagulation, the pooled odds ratio of VTE was 0.33 (95% confidence interval 0.14-0.75; P = 0.008, I = 0%) suggesting statistical significance with therapeutic dosing of anticoagulation for primary prevention of VTE in all hospitalized patients. However, this should be interpreted with caution as the bleeding events and safety profile could not be ascertained because of lack of adequate information. We recommend applying this finding to hospitalized COVID 19 patients only after carefully weighing individual bleeding risks and benefits. CONCLUSION: Major VTE events, especially pulmonary embolism, seem to be high in COVID-19 patients admitted to the intensive care unit. Therapeutic anticoagulation dosing seems to significantly benefit the odds of preventing any VTE when compared with prophylactic dosing in all hospitalized patients.


Assuntos
Anticoagulantes/administração & dosagem , Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Embolia Pulmonar/epidemiologia , Trombose Venosa/epidemiologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Relação Dose-Resposta a Droga , Humanos , Incidência , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/prevenção & controle , Embolia Pulmonar/virologia , Trombose Venosa/tratamento farmacológico , Trombose Venosa/prevenção & controle , Trombose Venosa/virologia
8.
Nihon Shokakibyo Gakkai Zasshi ; 117(11): 992-1000, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-33177262

RESUMO

A 20-year-old woman with ulcerative colitis flare was admitted to Fukui Red Cross Hospital. During treatment with granulocyte and monocyte apheresis (GMA), the patient complained of chest discomfort and was diagnosed with pulmonary thromboembolism with central intravenous catheter thrombosis. Apixaban, a direct oral anticoagulant (DOAC), was used as monotherapy for anticoagulation, and thromboembolism was resolved without complication. Among extraintestinal complications in patients with ulcerative colitis, pulmonary thromboembolism can be a life-threatening condition and requires prompt anticoagulant therapy. Although the effectiveness of conventional pharmacological anticoagulation using warfarin and heparin has been reported, the efficacy of DOAC monotherapy remains controversial. DOAC monotherapy may be considered and innovative therapeutic strategy for a thromboembolic condition in patients with ulcerative colitis.


Assuntos
Colite Ulcerativa , Embolia Pulmonar , Trombose , Anticoagulantes/uso terapêutico , Colite Ulcerativa/complicações , Colite Ulcerativa/tratamento farmacológico , Feminino , Humanos , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/etiologia , Pirazóis , Piridonas , Adulto Jovem
9.
J Card Surg ; 35(10): 2821-2824, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33043655

RESUMO

A patient with acute pulmonary embolism suffered cardiac arrest, received manual and mechanical cardiopulmonary resuscitation and tissue plasminogen activator before extracorporeal cardiopulmonary resuscitation was initiated. She suffered a type B aortic dissection and retroperitoneal hemorrhage secondary to resuscitation measures. This case report describes high-risk anticoagulation management for contradicting treatment goals in preparation for pulmonary embolectomy on cardiopulmonary bypass.


Assuntos
Aneurisma Dissecante/etiologia , Aneurisma Aórtico/etiologia , Reanimação Cardiopulmonar/efeitos adversos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Hemorragia/etiologia , Embolia Pulmonar/etiologia , Espaço Retroperitoneal , Ponte Cardiopulmonar/efeitos adversos , Reanimação Cardiopulmonar/métodos , Contraindicações , Embolectomia , Feminino , Parada Cardíaca/etiologia , Humanos , Pessoa de Meia-Idade , Ativadores de Plasminogênio/administração & dosagem , Ativadores de Plasminogênio/efeitos adversos
12.
Int Heart J ; 61(5): 999-1004, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32999197

RESUMO

This study aimed to clarify the usefulness of the Ikari-curve left (IL) guiding catheter for balloon pulmonary angioplasty (BPA).The current BPA strategy for chronic thromboembolic pulmonary hypertension is dilation of as many branches as possible to normalize hemodynamics and oxygenation. The shape of the guiding catheter is a major factor in achieving this. However, conventional guiding catheters are difficult to introduce into particular branches. The IL guiding catheter may be suitable; however, its utility remains unclear.We retrospectively analyzed 202 consecutive BPA sessions of 40 patients from November 2016 to October 2019 and divided these sessions into two groups: the IL group where the IL guiding catheter was used and the non-IL group where other catheters were utilized. The occurrence of lung injury was determined by the presence of bloody sputum. We compared the rates of successful introduction into target vessels and assessed for the occurrence of lung injury.The average age of enrolled patients was 60.3 ± 14.4 years, with females comprising 65%. There were 99 sessions in the IL group. The median treated branches per session differed between the 2 groups (IL group: 15 versus non-IL group: 10, P < 0.05). The occurrence of lung injury was lower in the IL group (4.0% versus 11.7%, P = 0.07). The IL group had more successful vessel insertions than the non-IL group (78.8% versus 42.7%, P < 0.01).The IL guiding catheter may be introduced into branches that cannot be accessed by conventional guiding catheters.


Assuntos
Angioplastia com Balão/métodos , Hipertensão Pulmonar/terapia , Embolia Pulmonar/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/estatística & dados numéricos , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
Zhonghua Xin Xue Guan Bing Za Zhi ; 48(10): 837-841, 2020 Oct 24.
Artigo em Chinês | MEDLINE | ID: mdl-33076620

RESUMO

Objective: To investigate the clinical characteristics of inpatients with the indication of cardiac implantable electronic devices (CIED) therapy and combined acute pulmonary thromboembolism (APTE). Methods: We retrospectively screened 8 641 inpatients who admitted with the indication of CIED implantation in Fuwai Hospital from January 2014 to May 2019. The clinical characteristics, management strategies and clinical outcome were analyzed for patients diagnosed as APTE. Results: APTE were identified in 45 (5‰) patients in this cohort, there were 18(40%) male patients, the average age was (73±8) years old and body mass index was (27±10) kg/m2.Thirty-two (70%) patients were at intermediate-risk and 13 (30%) at low-risk. Anti-coagulation therapy was initiated in 38(84%) patients, and 30 patients underwent CIED implantation (27 pacemaker, 2 CRT and 1 ICD). No postoperative bleeding or pocket hematoma were detected in the 23 patients taking anticoagulation medication before implantation. During an average of (30±7) months' follow up, thrombus was dissolved in 20 patients, hemorrhage complications were observed in 2 patients (1 cerebral hemorrhage and 1 hematuria), anticoagulation therapy was discontinued in these 2 patients. Among 15 patients without immediate CIED implantation and treated with anticoagulation therapy during hospitalization, 2 patients developed complete paroxysmal Ⅲ° atrioventricular block, and recovered after therapy during hospitalization. Seven patients were re-hospitalized for CIED implantation due to bradycardia. Five patients died during follow-up (3 sudden cardiac death, 1 APTE combined with cerebral infarction, and 1 pulmonary infection). Conclusion: APTE is not rare in patients with the indication of CIED implantation, CIED implantation and anti-coagulation therapy are safe for these patients, and transient atrioventricular block could be detected in APTE patients.


Assuntos
Desfibriladores Implantáveis , Marca-Passo Artificial , Embolia Pulmonar , Idoso , Idoso de 80 Anos ou mais , Morte Súbita Cardíaca , Feminino , Humanos , Masculino , Embolia Pulmonar/complicações , Estudos Retrospectivos
15.
J Cardiovasc Pharmacol ; 76(4): 369-371, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33027192

RESUMO

The use of heparin has been shown to decrease the mortality in hospitalized patients with severe COVID-19. The aim of our study was to evaluate the clinical impact of venous thromboembolism prophylaxis with fondaparinux versus enoxaparin among 100 hospitalized COVID-19 patients. The incidence of pulmonary embolism, deep venous thrombosis, major bleeding (MB), clinically relevant non-MB, acute respiratory distress syndrome, and in-hospital mortality was compared between patients on fondaparinux versus enoxaparin therapy. The 2 groups were homogeneous for demographic, laboratory, and clinical characteristics. In a median follow-up of 28 (IQR: 12-45) days, no statistically significant difference in venous thromboembolism (14.5% vs. 5.3%; P = 0.20), MB and clinically relevant non-MB (3.2% vs. 5.3%, P = 0.76), ARDS (17.7% vs. 15.8%; P = 0.83), and in-hospital mortality (9.7% vs. 10.5%; P = 0.97) has been shown between the enoxaparin group versus the fondaparinux group. Our preliminary results support the hypothesis of a safe and effective use of fondaparinux among patients with COVID-19 hospitalized in internal medicine units.


Assuntos
Antitrombinas/uso terapêutico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Inibidores do Fator Xa/uso terapêutico , Fondaparinux/uso terapêutico , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Trombose Venosa/etiologia , Trombose Venosa/prevenção & controle , Idoso , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Antitrombinas/efeitos adversos , Enoxaparina/efeitos adversos , Enoxaparina/uso terapêutico , Inibidores do Fator Xa/efeitos adversos , Feminino , Fondaparinux/efeitos adversos , Hemorragia/induzido quimicamente , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Embolia Pulmonar/complicações , Estudos Retrospectivos , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/prevenção & controle , Trombose Venosa/epidemiologia
17.
Anesth Analg ; 131(5): 1324-1333, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079850

RESUMO

Patients with coronavirus disease 2019 (COVID-19) frequently experience a coagulopathy associated with a high incidence of thrombotic events leading to poor outcomes. Here, biomarkers of coagulation (such as D-dimer, fibrinogen, platelet count), inflammation (such as interleukin-6), and immunity (such as lymphocyte count) as well as clinical scoring systems (such as sequential organ failure assessment [SOFA], International Society on Thrombosis and Hemostasis disseminated intravascular coagulation [ISTH DIC], and sepsis-induced coagulopathy [SIC] score) can be helpful in predicting clinical course, need for hospital resources (such as intensive care unit [ICU] beds, intubation and ventilator therapy, and extracorporeal membrane oxygenation [ECMO]) and patient's outcome in patients with COVID-19. However, therapeutic options are actually limited to unspecific supportive therapy. Whether viscoelastic testing can provide additional value in predicting clinical course, need for hospital resources and patient's outcome or in guiding anticoagulation in COVID-19-associated coagulopathy is still incompletely understood and currently under investigation (eg, in the rotational thromboelastometry analysis and standard coagulation tests in hospitalized patients with COVID-19 [ROHOCO] study). This article summarizes what we know already about COVID-19-associated coagulopathy and-perhaps even more importantly-characterizes important knowledge gaps.


Assuntos
Anti-Inflamatórios/uso terapêutico , Anticoagulantes/uso terapêutico , Betacoronavirus/patogenicidade , Coagulação Sanguínea/efeitos dos fármacos , Infecções por Coronavirus/terapia , Inflamação/terapia , Pneumonia Viral/terapia , Embolia Pulmonar/terapia , Tromboembolia Venosa/terapia , Trombose Venosa/terapia , Anti-Inflamatórios/efeitos adversos , Anticoagulantes/efeitos adversos , Biomarcadores/sangue , Infecções por Coronavirus/sangue , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Medicina Baseada em Evidências , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Mortalidade Hospitalar , Interações Hospedeiro-Patógeno , Humanos , Inflamação/sangue , Inflamação/mortalidade , Inflamação/virologia , Mediadores da Inflamação/sangue , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Prognóstico , Embolia Pulmonar/sangue , Embolia Pulmonar/mortalidade , Embolia Pulmonar/virologia , Fatores de Risco , Tromboembolia Venosa/sangue , Tromboembolia Venosa/mortalidade , Tromboembolia Venosa/virologia , Trombose Venosa/sangue , Trombose Venosa/mortalidade , Trombose Venosa/virologia
19.
Mol Med ; 26(1): 95, 2020 10 14.
Artigo em Inglês | MEDLINE | ID: mdl-33054759

RESUMO

Pulmonary fibrosis arises from the repeated epithelial mild injuries and insufficient repair lead to over activation of fibroblasts and excessive deposition of extracellular matrix, which result in a mechanical stretched niche. However, increasing mechanical stress likely exists before the establishment of fibrosis since early micro injuries increase local vascular permeability and prompt cytoskeletal remodeling which alter cellular mechanical forces. It is noteworthy that COVID-19 patients with severe hypoxemia will receive mechanical ventilation as supportive treatment and subsequent pathology studies indicate lung fibrosis pattern. At advanced stages, mechanical stress originates mainly from the stiff matrix since boundaries between stiff and compliant parts of the tissue could generate mechanical stress. Therefore, mechanical stress has a significant role in the whole development process of pulmonary fibrosis. The alveoli are covered by abundant capillaries and function as the main gas exchange unit. Constantly subject to variety of damages, the alveolar epithelium injuries were recently recognized to play a vital role in the onset and development of idiopathic pulmonary fibrosis. In this review, we summarize the literature regarding the effects of mechanical stress on the fundamental cells constituting the alveoli in the process of pulmonary fibrosis, particularly on epithelial cells, capillary endothelial cells, fibroblasts, mast cells, macrophages and stem cells. Finally, we briefly review this issue from a more comprehensive perspective: the metabolic and epigenetic regulation.


Assuntos
Infecções por Coronavirus/imunologia , Epigênese Genética/imunologia , Fibrose Pulmonar Idiopática/imunologia , Mecanotransdução Celular/imunologia , Pneumonia Viral/imunologia , Embolia Pulmonar/imunologia , Insuficiência Respiratória/imunologia , Células Epiteliais Alveolares/imunologia , Células Epiteliais Alveolares/patologia , Betacoronavirus/imunologia , Betacoronavirus/patogenicidade , Fenômenos Biomecânicos , Infecções por Coronavirus/genética , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Citocinas/genética , Citocinas/imunologia , Células Endoteliais/imunologia , Células Endoteliais/patologia , Fibroblastos/imunologia , Fibroblastos/patologia , Humanos , Fibrose Pulmonar Idiopática/genética , Fibrose Pulmonar Idiopática/patologia , Fibrose Pulmonar Idiopática/virologia , Pulmão/irrigação sanguínea , Pulmão/imunologia , Pulmão/patologia , Macrófagos/imunologia , Macrófagos/patologia , Mecanotransdução Celular/genética , Pandemias , Pneumonia Viral/genética , Pneumonia Viral/patologia , Pneumonia Viral/virologia , Embolia Pulmonar/genética , Embolia Pulmonar/patologia , Embolia Pulmonar/virologia , Insuficiência Respiratória/genética , Insuficiência Respiratória/patologia , Insuficiência Respiratória/virologia , Estresse Mecânico
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