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1.
J Am Acad Orthop Surg ; 28(22): e1014-e1019, 2020 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-33156588

RESUMO

INTRODUCTION: Metastatic bone disease of the extremities is a notable cause of morbidity and mortality. Surgical management is not curative; therefore, risks and benefits of surgery must be carefully considered. Previous studies of surgical outcomes are limited by small sample sizes because of the rare incidence of these procedures. In this study, we aim to describe the rates of complications and mortality in the first 30 days after surgical treatment of metastatic bone disease of the femur and humerus. METHODS: A retrospective review of patients in the National Surgical Quality Improvement Program database who underwent surgery between 2005 and 2016 was performed. Demographics, comorbidities, preoperative factors, surgical parameters, and postoperative complications were extracted. The cohort was also partitioned by surgical site and surgical modality. RESULTS: One thousand one hundred fifty-four patients were identified, 13.1 percent of patients experienced one or more complications within 30 days of surgery. The most common complications were urinary tract infection (2.9%), deep vein thrombosis (2.5%), pneumonia (2.4%), pulmonary embolism (2.0%), and surgical site infections (1.9%). In addition, intraoperative or postoperative bleeding requiring transfusion occurred in 32.9% of cases. The rates of unplanned readmission and unplanned revision surgery were 12.7% and 4.1%, respectively. The 30-day mortality rate was 7.1%. Femur and arthroplasty cases were associated with a higher risk of bleeding requiring transfusion. Prophylactic stabilization was associated with a lower risk of unplanned revision surgery (P = 0.015) and a lower overall complication rate (P < 0.0001). CONCLUSION: Our study demonstrates a higher 30-day mortality rate than previously reported. In additon, prophylactic stabilization of impending pathologic fractures may be associated with a lower risk of complications and unplanned revision surgery. The National Surgical Quality Improvement Program or other large database reports can help surgeons counsel patients appropriately regarding the risks and benefits of surgery.


Assuntos
Neoplasias Ósseas/secundário , Neoplasias Ósseas/cirurgia , Extremidades , Fêmur/cirurgia , Úmero/cirurgia , Complicações Pós-Operatórias/epidemiologia , Neoplasias Ósseas/mortalidade , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos , Pneumonia/epidemiologia , Embolia Pulmonar/epidemiologia , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Medição de Risco , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Infecções Urinárias/epidemiologia , Trombose Venosa/epidemiologia
2.
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
6.
Br J Radiol ; 93(1113): 20200407, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32735448

RESUMO

OBJECTIVES: To present a single-centre experience on CT pulmonary angiography (CTPA) for the assessment of hospitalised COVID-19 patients with moderate-to-high risk of pulmonary thromboembolism (PTE). METHODS: We analysed consecutive COVID-19 patients (RT-PCR confirmed) undergoing CTPA in March 2020 for PTE clinical suspicion. Clinical data were retrieved. Two experienced radiologists reviewed CTPAs to assess pulmonary parenchyma and vascular findings. RESULTS: Among 34 patients who underwent CTPA, 26 had PTE (76%, 20 males, median age 61 years, interquartile range 54-70), 20/26 (77%) with comorbidities (mainly hypertension, 44%), and 8 (31%) subsequently dying. Eight PTE patients were under thromboprophylaxis with low-molecular-weight heparin, four PTE patients had lower-limbs deep vein thrombosis at ultrasound examination (performed in 33/34 patients). Bilateral PTE characterised 19/26 cases, with main branches involved in 10/26 cases. Twelve patients had a parenchymal involvement >75%, the predominant pneumonia pattern being consolidation in 10/26 patients, ground glass opacities in 9/26, crazy paving in 5/26, and both ground glass opacities and consolidation in 2/26. CONCLUSION: COVID-19 patients are prone to PTE. ADVANCES IN KNOWLEDGE: PTE, potentially attributable to an underlying thrombophilic status, may be more frequent than expected in COVID-19 patients. Extension of prophylaxis and adaptation of diagnostic criteria should be considered.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pacientes Internados/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Embolia Pulmonar/epidemiologia , Idoso , Comorbidade , Angiografia por Tomografia Computadorizada/métodos , Feminino , Hospitalização , Humanos , Itália/epidemiologia , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Risco
7.
Adv Biol Regul ; 77: 100744, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32773104
8.
Am J Cardiol ; 133: 148-153, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-32800295

RESUMO

Pulmonary embolisms (PEs) in coronavirus disease 2019 (COVID-19) have increasingly been reported in observational studies. However, limited information describing their clinical characteristics and outcomes exists. Our study aims to describe clinical features and risk stratification strategies of hospitalized COVID-19 patients with PE. We retrospectively analyzed 101 hospitalized patients with COVID-19 infection and acute PE. Clinical outcomes measured were intensive care unit admission, mechanical ventilation, bleeding and transfusion events, acute kidney injury (AKI) and mortality. Pulmonary severity index (PESI) scores were used for risk stratification. The most common comorbidities were hypertension (50%), obesity (27%) and hyperlipidemia (32%) among this cohort. Baseline D-dimer abnormalities (4,647.0 ± 8,281.8) were noted on admission with a 3-fold increase at the time of PE diagnosis (13,288.4 ± 14,917.9; p <0.05). Five (5%) patients required systemic thrombolysis and 12 (12%) patients experienced moderate to severe bleeding. Thirty-one (31%) patients developed AKI and 1 (1%) patient required renal replacement therapy. Twenty-three (23%) patients were admitted to intensive care unit, of which 20 (20%) patients received mechanical ventilation. The mortality rate was 20%. Most patients (65%) had Intermediate to high risk PESI scores (>85), which portended a worse prognosis with higher mortality rate and length of stay. In conclusion, this study provides characteristics and early outcomes for hospitalized patients with COVID-19 and acute pulmonary embolism. PESI scores were utilized for risk stratifying clinical outcomes. Our results should serve to alert the medical community to heighted vigilance of this VTE complication associated with COVID-19 infection.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Unidades de Terapia Intensiva/estatística & dados numéricos , Pneumonia Viral/complicações , Embolia Pulmonar/etiologia , Doença Aguda , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Prognóstico , Embolia Pulmonar/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências
9.
Clin Appl Thromb Hemost ; 26: 1076029620948137, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32795186

RESUMO

The SARS-CoV-2 virus caused a global pandemic within weeks, causing hundreds of thousands of people infected. Many patients with severe COVID-19 present with coagulation abnormalities, including increase D-dimers and fibrinogen. This coagulopathy is associated with an increased risk of death. Furthermore, a substantial proportion of patients with severe COVID-19 develop sometimes unrecognized, venous, and arterial thromboembolic complications. A better understanding of COVID-19 pathophysiology, in particular hemostatic disorders, will help to choose appropriate treatment strategies. A rigorous thrombotic risk assessment and the implementation of a suitable anticoagulation strategy are required. We review here the characteristics of COVID-19 coagulation laboratory findings in affected patients, the incidence of thromboembolic events and their specificities, and potential therapeutic interventions.


Assuntos
Anticoagulantes/administração & dosagem , Transtornos da Coagulação Sanguínea/epidemiologia , Infecções por Coronavirus/epidemiologia , Mortalidade Hospitalar , Pneumonia Viral/epidemiologia , Embolia Pulmonar/epidemiologia , Trombose Venosa/epidemiologia , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/fisiopatologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Incidência , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/fisiopatologia , Medição de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Trombose Venosa/tratamento farmacológico , Trombose Venosa/fisiopatologia
10.
Arterioscler Thromb Vasc Biol ; 40(10): 2527-2538, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32757649

RESUMO

OBJECTIVE: Deep vein thrombosis and pulmonary embolism referred as venous thromboembolism (VTE) are a common cause of morbidity and mortality. Plasma from healthy controls or individuals who have experienced a VTE were analyzed using metabolomics to characterize biomarkers and metabolic systems of patients with VTE. Approach and Results: Polar metabolite and lipidomic profiles from plasma collected 3 months after an incident VTE were obtained using liquid chromatography mass spectrometry. Fasting-state plasma samples from 42 patients with VTE and 42 healthy controls were measured. Plasma metabolomic profiling identified 512 metabolites forming 62 biological clusters. Multivariate analysis revealed a panel of 21 metabolites altogether capable of predicting VTE status with an area under the curve of 0.92 (P=0.00174, selectivity=0.857, sensitivity=0.971). Multiblock systems analysis revealed 25 of the 62 functional biological groups as significantly affected in the VTE group (P<0.05 to control). Complementary correlation network analysis of the dysregulated functions highlighted a subset of the lipidome composed mainly of n-3 long-chain polyunsaturated fatty acids within the predominant triglycerides as a potential regulator of the post-VTE event biological response, possibly controlling oxidative and inflammatory defence systems, and metabolic disorder associated dysregulations. Of interest was microbiota metabolites including trimethylamine N-oxide that remained associated to post incident VTE patients, highlighting a possible involvement of gut microbiota on VTE risk and relapse. CONCLUSIONS: These findings show promise for the elucidation of underlying mechanisms and the design of a diagnostic test to assess the likely efficacy of clinical care in patients with VTE.


Assuntos
Metabolismo Energético , Lipídeos/sangue , Metabolômica , Embolia Pulmonar/sangue , Biologia de Sistemas , Tromboembolia Venosa/sangue , Trombose Venosa/sangue , Adulto , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Microbioma Gastrointestinal , Humanos , Incidência , Lipidômica , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/epidemiologia , Recidiva , Fatores de Tempo , Tromboembolia Venosa/diagnóstico por imagem , Tromboembolia Venosa/epidemiologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/epidemiologia
11.
BMJ ; 370: m2177, 2020 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-32759284

RESUMO

Pulmonary embolism is a common and potentially fatal cardiovascular disorder that must be promptly diagnosed and treated. The diagnosis, risk assessment, and management of pulmonary embolism have evolved with a better understanding of efficient use of diagnostic and therapeutic options. The use of either clinical probability adjusted or age adjusted D-dimer interpretation has led to a reduction in diagnostic imaging to exclude pulmonary embolism. Direct oral anticoagulation therapies are safe, effective, and convenient treatments for most patients with acute venous thromboembolism, with a lower risk of bleeding than vitamin K antagonists. These oral therapeutic options have opened up opportunities for safe outpatient management of pulmonary embolism in selected patients. Recent clinical trials exploring the use of systemic thrombolysis in intermediate to high risk pulmonary embolism suggest that this therapy should be reserved for patients with evidence of hemodynamic compromise. The role of low dose systemic or catheter directed thrombolysis in other patient subgroups is uncertain. After a diagnosis of pulmonary embolism, all patients should be assessed for risk of recurrent venous thromboembolism to guide duration of anticoagulation. Patients with a venous thromboembolism associated with a strong, transient, provoking risk factor can safely discontinue anticoagulation after three months of treatment. Patients with an ongoing strong risk factor, such as cancer, or unprovoked events are at increased risk of recurrent events and should be considered for extended treatment. The use of a risk prediction score can help to identify patients with unprovoked venous thromboembolism who can benefit from extended duration therapy. Despite major advances in the management of pulmonary embolism, up to half of patients report chronic functional limitations. Such patients should be screened for chronic thromboembolic pulmonary hypertension, but only a small proportion will have this as the explanation of their symptoms. In the remaining patients, future studies are needed to understand the pathophysiology and explore interventions to improve quality of life.


Assuntos
Anticoagulantes/uso terapêutico , Neoplasias/complicações , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Administração Oral , Anticoagulantes/efeitos adversos , Angiografia por Tomografia Computadorizada , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Fibrinolíticos/uso terapêutico , Humanos , Imagem de Perfusão , Gravidez , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etiologia , Recidiva , Medição de Risco , Fatores de Risco , Filtros de Veia Cava , Tromboembolia Venosa/tratamento farmacológico
12.
Br J Radiol ; 93(1115): 20200591, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32816525

RESUMO

OBJECTIVES: We aimed to analyze the association between the onsets of PE and of progressive disease (PD) in CT scans of oncological patients undergoing clinical trials. METHODS: We retrospectively searched our oncological clinical trials database (1/2012 - 6/2017). We retrieved patients who underwent protocol baseline and follow-up CT scans. RECIST 1.1 categories of response were calculated for each scan at interpretation. The entire dataset was searched for reports with incidental PE.For patients with incidental PE, we collected all the scans conducted up to and including the scan with PE. For each scan, we retrieved the recorded RECIST 1.1 category. We excluded patients with PE at baseline.The frequency of incidental PE in oncological clinical trial patients was calculated. For patients with incidental PE, we evaluated the association between PE and PD. RESULTS: During the study period, 1,070 patients underwent 3,818 CTs. The total number of follow-up months was 7,292 months. 18 patients developed incidental PE during follow-up. Thus, the frequency of incidental PE in oncological clinical trial patients was 3% per year of follow-up. Patients with incidental PE underwent 60 scans up to development of PE. Of 42 non-baseline scans, 6/6 (100%) PD showed PE, and 5/36 (13.9%) non-PD showed PE, making PE onset associated with PD onset (p < 0.001). CONCLUSION: In oncological clinical trials, the frequency of incidental PE is 3% per year of follow-up. The onset of incidental PE is linked to the onset of PD. ADVANCES IN KNOWLEDGE: Incidental PE is associated with the onset of disease progression. Radiologists interpret oncological scans should be aware of the association between PE and PD.


Assuntos
Progressão da Doença , Achados Incidentais , Neoplasias/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Ensaios Clínicos como Assunto , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/epidemiologia , Critérios de Avaliação de Resposta em Tumores Sólidos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/estatística & dados numéricos
13.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 46(5): 339-346, jul.-ago. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-197321

RESUMO

OBJETIVO: Analizar la tendencia evolutiva de episodios tromboembólicos graves en la Comunidad Autónoma de Galicia desde el 1 de enero de 2006 hasta el 31 de diciembre de 2015. MATERIAL Y MÉTODOS: Estudio observacional descriptivo en el Servicio Galego de Saúde durante 10 años (2006-2015). Se incluyeron pacientes con diagnóstico principal al alta de tromboembolismo pulmonar (TEP), ictus o trombosis venosa profunda (TVP). Fuente de datos: Servizo de admisión e documentación clínica, Subdirección de Información e Servizos Tecnolóxicos e Instituto Galego de Estatística. Variables de medida: número de casos nuevos de tromboembolismos acontecidos en un año, incidencia acumulada (número de casos nuevos/100.000 habitantes y año), mortalidad durante el ingreso hospitalario y porcentaje anual del cambio (APC). RESULTADOS: Se identificaron 50.611 eventos tromboembólicos. La mayor incidencia de tromboembolismo se encontró para ictus en hombres de 80 o más años con 940,84 casos nuevos por 100.000 habitantes/año. Todos los tromboembolismos fueron más frecuentes en hombres a excepción del TEP en mujeres jóvenes y las de mayor edad. El total de eventos tromboembólicos mostró un incremento continuo del 2,20% anual. La evolución temporal de la incidencia acumulada del TEP fue más pronunciada para mujeres entre 2006 y 2011 con un incremento anual del 10,65% y un aumento de menor magnitud a partir de 2011. La evolución de la incidencia acumulada del ictus mostró un APC de 1,56% en mujeres. CONCLUSIÓN: Este estudio pone de manifiesto un incremento en la tendencia evolutiva de los ingresos por TEP e ictus durante el periodo 2006-2015 en Galicia


OBJECTIVE: To analyse the trend of serious thromboembolic episodes in Galicia from 2006 to 2015. METHODS: A retrospective observational study was performed using the public network of the Galician Health Service over the 10 year period (2006-2015). It included patients with a primary diagnosis in their discharge report of pulmonary thromboembolism (PTE), stroke, or deep vein thrombosis (DVT). Data source: Servizo de admisión e documentación clínica, Subdirección de Información e Servizos Tecnolóxicos e Instituto Galego de Estatística. Measurement variables: the number of new cases of thromboembolism occurred in one year, cumulative incidence (number of new cases/ 100,000 persons years), mortality during hospital admission, and annual percentage change (APC). RESULTS: A total of 50,611 hospital admissions due to a venous thromboembolic event were identified. The highest incidence was found for stroke in men aged 80 years or older, with 940.84 new cases per 100,000 population per year. All thromboembolic events were more common in men, with the exception of PTE in young and older women. A continued increased was identified in all the thromboembolic events with an APC of 2.20%. The temporal evolution of the cumulative incidence for PTE was split into two segments, with an annual increase of 10.65% from 2006 to 2011, and a smaller increase since 2011. The cumulative incidence trend showed an APC for stroke of 1.56%. CONCLUSION: This study reveals an increase in the evolutionary trend of hospital admissions for PTE and stroke during the period 2006-2015 in Galicia


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Tromboembolia Venosa/epidemiologia , Estatísticas Hospitalares , Acidente Vascular Cerebral/epidemiologia , Embolia Pulmonar/epidemiologia , Espanha/epidemiologia , Epidemiologia Descritiva , Incidência , Estudos Retrospectivos
17.
Eur Heart J ; 41(32): 3058-3068, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32656565

RESUMO

AIMS: While pulmonary embolism (PE) appears to be a major issue in COVID-19, data remain sparse. We aimed to describe the risk factors and baseline characteristics of patients with PE in a cohort of COVID-19 patients. METHODS AND RESULTS: In a retrospective multicentre observational study, we included consecutive patients hospitalized for COVID-19. Patients without computed tomography pulmonary angiography (CTPA)-proven PE diagnosis and those who were directly admitted to an intensive care unit (ICU) were excluded. Among 1240 patients (58.1% men, mean age 64 ± 17 years), 103 (8.3%) patients had PE confirmed by CTPA. The ICU transfer and mechanical ventilation were significantly higher in the PE group (for both P < 0.001). In an univariable analysis, traditional venous thrombo-embolic risk factors were not associated with PE (P > 0.05), while patients under therapeutic dose anticoagulation before hospitalization or prophylactic dose anticoagulation introduced during hospitalization had lower PE occurrence [odds ratio (OR) 0.40, 95% confidence interval (CI) 0.14-0.91, P = 0.04; and OR 0.11, 95% CI 0.06-0.18, P < 0.001, respectively]. In a multivariable analysis, the following variables, also statistically significant in univariable analysis, were associated with PE: male gender (OR 1.03, 95% CI 1.003-1.069, P = 0.04), anticoagulation with a prophylactic dose (OR 0.83, 95% CI 0.79-0.85, P < 0.001) or a therapeutic dose (OR 0.87, 95% CI 0.82-0.92, P < 0.001), C-reactive protein (OR 1.03, 95% CI 1.01-1.04, P = 0.001), and time from symptom onset to hospitalization (OR 1.02, 95% CI 1.006-1.038, P = 0.002). CONCLUSION: PE risk factors in the COVID-19 context do not include traditional thrombo-embolic risk factors but rather independent clinical and biological findings at admission, including a major contribution to inflammation.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Hospitalização/tendências , Pandemias , Pneumonia Viral/complicações , Embolia Pulmonar/etiologia , Angiografia por Tomografia Computadorizada/métodos , Infecções por Coronavirus/epidemiologia , Feminino , França/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências
18.
Med Glas (Zenica) ; 17(2): 275-278, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32662615

RESUMO

Aim The outbreak of the COVID-19 pandemic has had a major impact on the delivery of elective, as well as emergency surgery on a world-wide scale. Up to date few studies have actually assessed the impact of COVID-19 on the postoperative morbidity and mortality following emergency gastrointestinal surgery. Herein, we present our relevant experience over a 3-month period of uninterrupted provision of emergency general surgery services in George Eliot Hospital NHS Trust, the United Kingdom. Methods We performed a retrospective analysis of a prospective institutional database, which included the operation types, paraclinical investigations and postoperative complications of all patients undergoing emergency general surgery operations between March - May 2020. Results The occurrence of a 5% overall respiratory complication rate postoperatively, with 3% infection rate for COVID-19 was found; no patient had unplanned return to intensive care for ventilator support and there was no mortality related to COVID-19 infection. Conclusion When indicated, emergency surgery should not be delayed in favour of expectant/conservative management in fear of COVID-19-related morbidity or mortality risks.


Assuntos
Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos do Sistema Digestório , Emergências , Mortalidade , Pneumonia Viral/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Insuficiência Respiratória/epidemiologia , Infecções Respiratórias/epidemiologia , Abscesso/cirurgia , Síndrome Coronariana Aguda/tratamento farmacológico , Síndrome Coronariana Aguda/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicectomia , Betacoronavirus , Colecistectomia Laparoscópica , Comorbidade , Infecções por Coronavirus/terapia , Surtos de Doenças , Drenagem , Feminino , Herniorrafia , Humanos , Laparoscopia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/terapia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/epidemiologia , Insuficiência Respiratória/terapia , Infecções Respiratórias/terapia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/epidemiologia , Reino Unido/epidemiologia , Adulto Jovem
19.
Swiss Med Wkly ; 150: w20301, 2020 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-32640479

RESUMO

AIMS OF THE STUDY: Many centres have noticed a high number of venous thromboembolism (VTE) events among critically ill inpatients with COVID-19 pneumonia. The aims of this study were (1) to summarise the reported risk of VTE associated with COVID-19 infections and (2) to summarise guidance documents on thromboprophylaxis in COVID-19 patients, in a systematic review. METHODS: We systematically searched for peer-reviewed evidence on the risk of VTE in patients with COVID-19, in PubMed, Embase and Twitter, and for guidelines or guidance documents for thromboprophylaxis, from international or national societies relevant to the field of thrombosis and haemostasis, up to April 30 2020. RESULTS: We found 11 studies (1 clinical trial, 7 retrospective cohorts and 3 prospective cohorts), which included a range of 16 to 388 in patients with COVID-19 (total of 1369 inpatients). The diagnoses of COVID-19 and VTE were of high quality, but the follow-up was often unclear. Most studies reported universal in-hospital thromboprophylaxis. Among all inpatients and among intensive care unit (ICU) inpatients with COVID-19, reported risks of VTE were 4.4–8.2% (three studies) and 0–35.3% (six studies), respectively. Two studies at least partially screened for VTE in ICU inpatients with COVID-19, and found risks of 24.7–53.8%. We found 12 guidelines for thromboprophylaxis of COVID-19 patients. The majority suggested universal pharmacological thromboprophylaxis in all COVID-19 inpatients, but there was heterogeneity in the suggested intensity of thromboprophylaxis: seven advised considering intensified doses of heparin according to the clinical or biological severity of the disease, especially in the ICU setting. CONCLUSIONS: Venous thromboembolism very commonly complicates the clinical course of inpatients with COVID-19, despite thromboprophylaxis. The risk appears highest among critically ill inpatients. We found no estimates of risks among outpatients. Many questions remain unresolved, as delineated by the heterogeneity of national and international guidelines. This situation calls for fast randomised clinical trials, comparing different schemes of thromboprophylaxis in COVID-19 inpatients.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Embolia Pulmonar/epidemiologia , Tromboembolia Venosa/epidemiologia , Trombose Venosa/epidemiologia , Anticoagulantes/uso terapêutico , Betacoronavirus , Fondaparinux/uso terapêutico , Heparina/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Pandemias , Guias de Prática Clínica como Assunto , Embolia Pulmonar/prevenção & controle , Risco , Tromboembolia Venosa/prevenção & controle , Trombose Venosa/prevenção & controle
20.
J Thromb Thrombolysis ; 50(3): 558-566, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32617807

RESUMO

COVID-19 is associated with a variety of clinical complications including coagulopathy, which frequently results in venous thromboembolism (VTE). Retrospective analyses reported a markedly increased rate of VTEs in COVID-19. However, most recent studies on coagulopathy in COVID-19 were only focused on critically ill patients, and without suitable control groups. We aimed to evaluate the rate of VTEs in an all-comers cohort with suspected COVID-19 during a 30-days follow-up period. We also studied the level of D-dimers and their association with the course of disease. In our prospective single-center study (DRKS00021206, 03/30/2020), we analyzed 190 patients with suspected COVID-19 admitted to the emergency department between March and April 2020. Forty-nine patients were SARS-CoV-2 positive (25.8%). The 141 SARS-CoV-2-negative patients served as control group. After completion of a 30-days follow-up, VTE was diagnosed in 3 patients of the SARS-CoV-2-positive group (6.1%, amongst these 2 ICU cases) versus 5 patients in the SARS-CoV-2-negative group (3.5%), however the difference was not statistically significant (p = 0.427). 30-days mortality was similar in both groups (6.1% vs. 5%, p = 0.720). Disease severity correlated with the maximum level of D-dimers during follow-up in COVID-19. The rate of VTE was numerically higher in SARS-CoV-2 positive all-comers presenting with suspected COVID-19 as compared to well-matched controls suffering from similar symptoms. VTEs in the COVID-19 group predominantly occurred in ICU courses. The maximum level of D-dimers during follow-up was associated with disease severity in COVID-19, whereas the level of D-dimers at admission was not.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Embolia Pulmonar/epidemiologia , Tromboembolia Venosa/epidemiologia , Trombose Venosa/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/patogenicidade , Biomarcadores/sangue , Estudos de Casos e Controles , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Alemanha/epidemiologia , Interações Hospedeiro-Patógeno , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Estudos Prospectivos , Embolia Pulmonar/sangue , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/virologia , Sistema de Registros , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Tromboembolia Venosa/sangue , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/virologia , Trombose Venosa/sangue , Trombose Venosa/diagnóstico , Trombose Venosa/virologia
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