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2.
J Stroke Cerebrovasc Dis ; 29(2): 104446, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31837921

RESUMO

OBJECTIVE: In population-based studies asymptomatic retinal emboli occur in .32%-2.9% of people. Retinal artery occlusion (RAO) may occur concurrently with cerebral stroke but the frequency is unknown. No study has examined how commonly retinal emboli occur in the acute stroke population. We aimed to assess the prevalence of retinal emboli and RAO at the time of carotid territory ischemic stroke. METHODS: Patients were enrolled prospectively after onset of symptoms consistent with the diagnosis of carotid territory ischemic stroke. Every participant underwent pharmacologic dilation of both pupils and bedside funduscopic examination. Emboli were classified as cholesterol, calcific, platelet/fibrin, or other and categorized by the side of occurrence. Stroke was classified as atheroembolic, cardioembolic, embolic stroke of undetermined source, lacunar, or other. Acute RAO was diagnosed by direct visualization of ischemic retinal whitening. RESULTS: Sixty-five patients were enrolled with a mean age of 59.2 years; 23 were female (35.4%). Eleven of 65 subjects (16.9%) had retinal emboli visible on funduscopy; all were cholesterol emboli except a single platelet/fibrin embolus in a patient with atheroembolic source. Six patients (9%) had acute RAO and no RAO was seen in the lacunar or undetermined source subgroups. CONCLUSIONS: Retinal emboli occurred more than 10 times more frequently in the acute stroke patient than in large population-based studies. RAOs also occurred concurrently with ischemic stroke. Although emboli were seen in patients with atheroembolic and cardioembolic sources, all patients with carotid disease had emboli in the ipsilateral eye. Future studies are required to determine if the presence of retinal emboli or RAO may help elucidate an etiology in patients suffering from embolic stroke of undetermined source.


Assuntos
Isquemia Encefálica/epidemiologia , Embolia/epidemiologia , Oclusão da Artéria Retiniana/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Isquemia Encefálica/diagnóstico , Embolia/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oregon/epidemiologia , Projetos Piloto , Prevalência , Estudos Prospectivos , Oclusão da Artéria Retiniana/diagnóstico , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Adulto Jovem
3.
J Stroke Cerebrovasc Dis ; 28(12): 104449, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31668582

RESUMO

BACKGROUND: Visceral infarctions appear to be more common in patients with embolic stroke subtypes, but their relation to troponin elevation remains uncertain. METHODS: Among patients with acute ischemic stroke enrolled in the Cornell AcutE Stroke Academic Registry (CAESAR) from 2011 to 2016, we included those with troponin measured within 24 hours from stroke onset and a contrast-enhanced abdominal computed tomographic scan within 1 year of admission. A troponin elevation was defined as a value exceeding our laboratory's upper limit of normal (.04 ng/ mL) in the absence of a clinically recognized acute ST-segment elevation myocardial infarction. Visceral infarction was defined as a renal or splenic infarction as ascertained by a single radiologist blinded to patients' other characteristics. Multivariable logistic regression was used to evaluate the association between elevated troponin and visceral infarction. RESULTS: Among 2116 patients registered in CAESAR from 2011 to 2016, 153 patients had both a troponin assay and a contrast-enhanced abdominal computed tomographic scan, of whom 33 (21%) had an elevated troponin and 22 (14%) had a visceral infarction. The prevalence of visceral infarction was higher among patients with an elevated troponin (30%; 95% confidence interval [CI], 16%-49%) than among patients without an elevated troponin (10%; 95% CI, 5%-17%) (P = .003). After adjustment for demographics and comorbidities, we found a significant association between elevated troponin and visceral infarction (odds ratio, 3.9; 95% CI, 1.5-10.4). CONCLUSIONS: Among patients with acute ischemic stroke, elevated troponin was associated with visceral infarction. Our results demonstrate that poststroke troponin elevation may indicate the presence of underlying embolic sources.


Assuntos
Isquemia Encefálica/sangue , Embolia/sangue , Infarto/sangue , Rim/irrigação sanguínea , Baço/irrigação sanguínea , Acidente Vascular Cerebral/sangue , Troponina/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Embolia/diagnóstico , Embolia/epidemiologia , Feminino , Humanos , Infarto/diagnóstico , Infarto/epidemiologia , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Valor Preditivo dos Testes , Prevalência , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Regulação para Cima
5.
J Card Surg ; 34(10): 1130-1132, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31374581

RESUMO

A 46-year-old female presented with native tricuspid valve endocarditis complicated by a stroke with a hemorrhagic component. There was no evidence of intracardiac shunt nor left-sided valve involvement. Delayed surgery was planned to allow neurologic recovery, however, the patient developed an ST-elevation myocardial infarction and cardiac arrest from an occluded right posterior ventricular branch of the right coronary artery from a septic embolism. Repeat imaging demonstrated new aortic valve vegetation involving the right coronary cusp. This case highlights a unique sequence of events in a patient initially presenting with presumed isolated tricuspid valve vegetation.


Assuntos
Doença da Artéria Coronariana/etiologia , Embolia/etiologia , Endocardite Bacteriana/complicações , Infecções Estafilocócicas/complicações , Valva Tricúspide/diagnóstico por imagem , Antibacterianos/uso terapêutico , Procedimentos Cirúrgicos Cardíacos/métodos , Doença da Artéria Coronariana/diagnóstico , Ecocardiografia Transesofagiana , Embolia/diagnóstico , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/terapia , Staphylococcus aureus/isolamento & purificação , Valva Tricúspide/microbiologia , Valva Tricúspide/cirurgia
8.
Rev Cardiovasc Med ; 20(1): 35-39, 2019 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-31184094

RESUMO

Coronary artery septic embolization is a rare, but severe complication of infective endocarditis involving the leftside of the valves. The first case mentioned in the literature was a postmortem finding of a left anterior descending coronary artery occlusion by a vegetation fragment. Since this case, there have been several therapeutic strategies published with this clinical setting including medical treatment, percutaneous coronary angioplasty addressing coronary occlusion, surgical intervention for both the infected valve and coronary embolization, and hybrid procedures with transcatheter septic embolus aspiration followed by surgical valvular interventions. Out of the three interventions mentioned, the latter provided the best results and was in concordance with results observed in a case of mitral valve infected endocarditis complicated with acute occlusion of the left anterior descending coronary artery in patient whose comorbidities included hypertrophic obstructive cardiomyopathy. A transcatheter left anterior descending coronary artery embolus aspiration was performed , followed by a surgical mitral valve replacement and septal myectomy with an uneventful postoperative course. Although rare, this severe complication of infective endocarditis has a specific clinical course and therapeutic strategy, and in our opinion, it could be mentioned as a separate entity among embolic complications of infective endocarditis in future guidelines. Previously published cases suggest that the hybrid intervention might be the therapy of choice for this clinical setting; however, larger studies are necessary for confirmation.


Assuntos
Oclusão Coronária/microbiologia , Embolia/microbiologia , Endocardite Bacteriana/microbiologia , Valva Mitral/microbiologia , Infecções Estafilocócicas/microbiologia , Antibacterianos/uso terapêutico , Cateterismo Cardíaco , Oclusão Coronária/diagnóstico , Oclusão Coronária/terapia , Embolia/diagnóstico , Embolia/terapia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/cirurgia , Sucção , Resultado do Tratamento
9.
J Invasive Cardiol ; 31(6): E148-E153, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31158811

RESUMO

Treatment of acute coronary syndromes secondary to septic coronary valvular embolism in endocarditis patients remains unclear. Several revascularization strategies have been described, including thromboaspiration, stent implantation, balloon angioplasty, and surgical intervention. We herein present an illustration of an atypical case of an acute coronary syndrome related to a coronary bifurcation occlusion due to a septic embolism in a patient presenting with infective endocarditis. We also summarized previous similar cases and their management.


Assuntos
Síndrome Coronariana Aguda/etiologia , Embolia/complicações , Endocardite Bacteriana/complicações , Revascularização Miocárdica/métodos , Sepse/complicações , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/cirurgia , Angiografia Coronária , Ecocardiografia , Eletrocardiografia , Embolia/diagnóstico , Endocardite Bacteriana/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/normas , Sepse/diagnóstico
10.
Cardiol Young ; 29(6): 842-844, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169093

RESUMO

We describe two cases of spontaneous embolisation and successful retrieval of ceramic-coated patent arterial duct devices. In both, the device embolised to the descending aorta in the absence of pulmonary hypertension and despite optimum placement. We have discussed possible mechanisms for embolisation in these patients and suggested alternative methods for device retrieval. Based on this limited experience, we conclude that for tubular ducts, ceramic-coated devices should be oversized to form a tighter waist or alternate devices may be considered.


Assuntos
Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/cirurgia , Cateterismo Cardíaco/métodos , Cerâmica , Remoção de Dispositivo/métodos , Embolia/cirurgia , Dispositivo para Oclusão Septal/efeitos adversos , Doenças da Aorta/diagnóstico , Doenças da Aorta/etiologia , Aortografia , Materiais Revestidos Biocompatíveis , Permeabilidade do Canal Arterial/cirurgia , Embolia/diagnóstico , Feminino , Humanos , Lactente , Falha de Prótese
11.
Eur J Haematol ; 103(1): 67-69, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31069850

RESUMO

The management of anticoagulant therapy (OAT) in patients with factor VII (FVII) deficiency is a very challenging clinical issue, as warfarin further reduces FVII levels, thus potentially increasing bleeding risk. On the other hand, the International Normalized Ratio test is misleading in such patients, as they do not reflect the actual level of global inhibition of the coagulation system. We report here three cases of patients with a moderate FVII deficiency and receiving direct oral anticoagulants (DOAC) for prevention of cardioembolism in atrial fibrillation. Of note, two of them experienced a treatment failure while on warfarin, while DOAC treatment was not associated with thrombotic or hemorrhagic adverse events. DOAC are very attractive for the management of OAT in FVII deficient patients, because they do not require monitoring by tests affected by the inherited defect, and their mechanism of action is FVII-independent.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/complicações , Embolia/etiologia , Embolia/prevenção & controle , Deficiência do Fator VII/complicações , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Coagulação Sanguínea/efeitos dos fármacos , Embolia/sangue , Embolia/diagnóstico , Deficiência do Fator VII/diagnóstico , Evolução Fatal , Feminino , Humanos , Masculino , Inibidores da Agregação de Plaquetas/administração & dosagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
13.
Echocardiography ; 36(5): 837-843, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30934139

RESUMO

INTRODUCTION: Cardiac myxomas are the most common primary intracardiac tumors. Although myxomas are histologically benign, they are potentially dangerous due to potential risk of systemic and cerebral embolism. In this study, we aimed to investigate the potential predictors of embolism in patients with left atrial myxoma. METHODS: This single-center retrospective study enrolled 93 patients (mean age: 52.9 ± 15.3 years, female: 70 [75.3%]) with left atrial myxomas between 2014 and 2018. The patients were classified into two groups (embolic vs nonembolic) to investigate possible predictors of embolism. Demographic, laboratory, and echocardiographic parameters were recorded into a dataset and compared between patients with and without embolism. RESULTS: The study population was composed of 13 (14%) patients in embolic (11 cerebrovascular and 2 peripheral) and 80 (86%) patients in nonembolic group. Demographic and laboratory parameters were similar between the groups. Tumor sizes were significantly higher in the embolic group than in the nonembolic group (5.59 ± 1.08 vs 4.29 ± 0.61; P = 0.001). By multivariate analysis, increased tumor size, increased left atrial diameter, and the presence of atrial fibrillation and irregular tumor surface were identified as independent predictors of embolism. In ROC curve analyses, tumor size above 4.6 cm predicted embolism with a sensitivity of 77% and a specificity of 73% (AUC: 0.858; 95% CI: 0.752-0.964; P < 0.001). CONCLUSION: The presence of atrial fibrillation, irregular tumor surface, increased tumor size, and increased left atrial diameter is associated with increased risk of embolism in patients with left atrial myxoma. Early surgery should be scheduled for such patients due to increased potential for embolism.


Assuntos
Ecocardiografia/métodos , Embolia/diagnóstico , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Mixoma/complicações , Mixoma/diagnóstico por imagem , Adulto , Idoso , Fibrilação Atrial/complicações , Embolia/complicações , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Neoplasias Cardíacas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Mixoma/patologia , Estudos Retrospectivos , Fatores de Risco , Carga Tumoral
14.
Arch Cardiovasc Dis ; 112(6-7): 400-409, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31014991

RESUMO

BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs), including apixaban, are recommended for prevention of stroke and systemic embolism in non-valvular atrial fibrillation (NVAF). AIMS: To describe the characteristics of patients starting anticoagulant treatment, identify the characteristics associated with apixaban prescription, and describe apixaban use in France. METHODS: This was a non-interventional multicentre French study. Patients with NVAF (aged≥18 years) with anticoagulant treatment started in the preceding 3 months were evaluated in four groups (NOAC [apixaban, dabigatran or rivaroxaban] or vitamin K antagonist [VKA]). RESULTS: Data from 2027 patients were eligible for analysis. Mean age was 73.0±11.2 years, 56.6% were men and 80.2% were anticoagulant naïve. Stage≥4 chronic kidney disease was present in 2.2% of patients prescribed apixaban, none of those prescribed dabigatran or rivaroxaban, and 16.8% of those prescribed VKAs. The median CHA2DS2-VASc score was 3 for all three NOACs and 4 for VKAs; the median HAS-BLED score was≥3 for 2.5-5.9% of patients prescribed NOACs and 12.0% of those prescribed VKAs. Apixaban was more likely to be prescribed than other NOACs in older patients with higher bleeding risk and decreased renal function, and VKAs in patients with lower bleeding risk and better renal function. Patients received a reduced dose (5mg/day; 30.4% patients) or a full dose (10mg/day; 69.6% patients) of apixaban. Only 79.3% of patients prescribed apixaban had doses consistent with the summary of product characteristics; underdosing was more frequent than overdosing. Off-label use of apixaban was observed, mainly in elderly patients, despite normal renal function and weight. CONCLUSIONS: Initiation of apixaban versus NOACs was more common among patients with increased age, higher bleeding risk and decreased renal function, whereas initiation of apixaban versus VKAs was more common among patients with lower bleeding risk and better renal function.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Embolia/prevenção & controle , Inibidores do Fator Xa/administração & dosagem , Padrões de Prática Médica/tendências , Pirazóis/administração & dosagem , Piridonas/administração & dosagem , Acidente Vascular Cerebral/prevenção & controle , Administração Oral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Estudos Transversais , Uso de Medicamentos/tendências , Embolia/diagnóstico , Embolia/epidemiologia , Inibidores do Fator Xa/efeitos adversos , Feminino , França/epidemiologia , Fidelidade a Diretrizes/tendências , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Uso Off-Label , Guias de Prática Clínica como Assunto , Pirazóis/efeitos adversos , Piridonas/efeitos adversos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
15.
BMJ Case Rep ; 12(3)2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30898968

RESUMO

A 51-year-old, otherwise well woman, presented with progressive severe dyspnoea. CT pulmonary angiogram (CTPA) demonstrated a large filling defect within the right main pulmonary artery with evidence of right heart strain. She was anticoagulated and discharged home; however, was readmitted with progression of symptoms and hypotension within 1 month. Repeat CTPA demonstrated progression of the filling defect. Formal surgical thrombectomy was performed with removal of an unusual cream-coloured, rubber-like material. Histological analysis revealed intravenous leiomyomatosis (IVL). IVL is a rare benign neoplasm, characterised by smooth muscle cell proliferation in vascular structures that can act aggressively. This case describes the workup, recognition and management of IVL.


Assuntos
Leiomiomatose/patologia , Neoplasias Vasculares/patologia , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Embolia/diagnóstico , Feminino , Humanos , Leiomiomatose/diagnóstico por imagem , Leiomiomatose/cirurgia , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Trombectomia , Neoplasias Vasculares/diagnóstico por imagem , Neoplasias Vasculares/cirurgia
16.
Trials ; 20(1): 107, 2019 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-30736833

RESUMO

BACKGROUND: Inter-observer variability in stroke aetiological classification may have an effect on trial power and estimation of treatment effect. We modelled the effect of misclassification on required sample size in a hypothetical cardioembolic (CE) stroke trial. METHODS: We performed a systematic review to quantify the reliability (inter-observer variability) of various stroke aetiological classification systems. We then modelled the effect of this misclassification in a hypothetical trial of anticoagulant in CE stroke contaminated by patients with non-cardioembolic (non-CE) stroke aetiology. Rates of misclassification were based on the summary reliability estimates from our systematic review. We randomly sampled data from previous acute trials in CE and non-CE participants, using the Virtual International Stroke Trials Archive. We used bootstrapping to model the effect of varying misclassification rates on sample size required to detect a between-group treatment effect across 5000 permutations. We described outcomes in terms of survival and stroke recurrence censored at 90 days. RESULTS: From 4655 titles, we found 14 articles describing three stroke classification systems. The inter-observer reliability of the classification systems varied from 'fair' to 'very good' and suggested misclassification rates of 5% and 20% for our modelling. The hypothetical trial, with 80% power and alpha 0.05, was able to show a difference in survival between anticoagulant and antiplatelet in CE with a sample size of 198 in both trial arms. Contamination of both arms with 5% misclassified participants inflated the required sample size to 237 and with 20% misclassification inflated the required sample size to 352, for equivalent trial power. For an outcome of stroke recurrence using the same data, base-case estimated sample size for 80% power and alpha 0.05 was n = 502 in each arm, increasing to 605 at 5% contamination and 973 at 20% contamination. CONCLUSIONS: Stroke aetiological classification systems suffer from inter-observer variability, and the resulting misclassification may limit trial power. TRIAL REGISTRATION: Protocol available at reviewregistry540 .


Assuntos
Ensaios Clínicos como Assunto/métodos , Embolia/complicações , Cardiopatias/complicações , Modelos Estatísticos , Tamanho da Amostra , Acidente Vascular Cerebral/etiologia , Terminologia como Assunto , Anticoagulantes/uso terapêutico , Ensaios Clínicos como Assunto/estatística & dados numéricos , Interpretação Estatística de Dados , Embolia/diagnóstico , Embolia/tratamento farmacológico , Cardiopatias/diagnóstico , Cardiopatias/tratamento farmacológico , Humanos , Variações Dependentes do Observador , Inibidores da Agregação de Plaquetas/uso terapêutico , Fatores de Risco , Acidente Vascular Cerebral/classificação , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/tratamento farmacológico , Fatores de Tempo , Resultado do Tratamento
17.
G Ital Cardiol (Rome) ; 20(2): 117-119, 2019 Feb.
Artigo em Italiano | MEDLINE | ID: mdl-30747927

RESUMO

The majority of myxomas are located in the left atrium (75%) followed by the right atrium (20%). In rare cases, myxomas can be found in the ventricles, with 2.5% reported for myxomas in the left ventricle. Systemic emboli, mostly cerebral, occur in two thirds of such patients, while coronary emboli are rare. Here we report a case of left ventricular myxoma causing infero-postero-lateral myocardial infarction, successfully treated by intracoronary thromboaspiration of myxoma embolus.


Assuntos
Embolia/diagnóstico , Neoplasias Cardíacas/complicações , Infarto do Miocárdio/etiologia , Mixoma/complicações , Adulto , Embolia/complicações , Feminino , Neoplasias Cardíacas/diagnóstico , Ventrículos do Coração/patologia , Humanos , Mixoma/diagnóstico
18.
Am J Obstet Gynecol ; 220(4): 297-307, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30682365

RESUMO

Compared with adults who are admitted to general medical-surgical wards, women who are admitted to labor and delivery services are at much lower risk of experiencing unexpected critical illness. Nonetheless, critical illness and other complications that put either the mother or fetus at risk do occur. One potential approach to prevention is to use automated early warning systems, such as those used for nonpregnant adults. Predictive models that use data extracted in real time from electronic records constitute the cornerstone of such systems. This article addresses several issues that are involved in the development of such predictive models: specification of temporal characteristics, choice of denominator, selection of outcomes for model calibration, potential uses of existing adult severity of illness scores, approaches to data processing, statistical considerations, validation, and options for instantiation. These have not been addressed explicitly in the obstetrics literature, which has focused on the use of manually assigned scores. In addition, this article provides some results from work in progress to develop 2 obstetric predictive models with the use of data from 262,071 women who were admitted to a labor and delivery service at 15 Kaiser Permanente Northern California hospitals between 2010 and 2017.


Assuntos
Diagnóstico Precoce , Processamento Eletrônico de Dados/métodos , Registros Eletrônicos de Saúde , Complicações do Trabalho de Parto/epidemiologia , Transtornos Puerperais/epidemiologia , Automação , Cardiotocografia , Estado Terminal , Eclampsia/diagnóstico , Eclampsia/epidemiologia , Eclampsia/prevenção & controle , Embolia/diagnóstico , Embolia/epidemiologia , Embolia/prevenção & controle , Feminino , Morte Fetal , Humanos , Hipóxia-Isquemia Encefálica/diagnóstico , Hipóxia-Isquemia Encefálica/epidemiologia , Hipóxia-Isquemia Encefálica/prevenção & controle , Morte Materna , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/prevenção & controle , Obstetrícia , Hemorragia Pós-Parto/diagnóstico , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/prevenção & controle , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/prevenção & controle , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/prevenção & controle , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/prevenção & controle , Medição de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Hemorragia Uterina/diagnóstico , Hemorragia Uterina/epidemiologia , Hemorragia Uterina/prevenção & controle , Ruptura Uterina/diagnóstico , Ruptura Uterina/epidemiologia , Ruptura Uterina/prevenção & controle
20.
J Stroke Cerebrovasc Dis ; 28(2): 325-329, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30415920

RESUMO

BACKGROUND: Patients with intracerebral hemorrhage taking anticoagulants are increasingly common in Japan due to the aging population. The clinical benefit of restarting anticoagulants is established, but the optimal timing of resumption is controversial. Risk factors for hemorrhagic and cardioembolic events in the acute phase are also unknown. This study investigated hemorrhagic and cardioembolic events and risk factors in intracerebral hemorrhage patients taking anticoagulants. METHODS: The clinical data of 65 consecutive intracerebral hemorrhage patients taking anticoagulants were retrospectively reviewed. Hemorrhagic and cardioembolic complications and risk factors were analyzed. RESULTS: Lobar hemorrhage was the most frequent (21 of 65 cases, 32.3%). At discharge, 31 patients (47.7%) showed severe disability or had died. Eight (18.6%) of 43 patients who restarted anticoagulants after initial treatment developed hemorrhagic events, including recurrent intracerebral hemorrhage in 3. HAS-BLED score was 2-3 in these 3 patients. Six (15.8%) of 38 patients who took anticoagulants for cardiogenic factors suffered cardioembolism. Systemic inflammatory response syndrome was significantly more common in the cardioembolic group (66.7%) compared with the noncardioembolic group (21.9%, P < .05). CHA2DS2-VASc score was paradoxically high in the noncardioembolic group (3 versus 5, P < .05). CONCLUSION: HAS-BLED score and CHA2DS2-VASc score were not useful for risk assessment for hemorrhagic events, recurrent intracerebral hemorrhage, and cardioembolism in the acute phase. Inflammatory response might be important in the occurrence of cardioembolic events.


Assuntos
Anticoagulantes/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Hemorragia Cerebral/induzido quimicamente , Embolia/prevenção & controle , Fatores Etários , Idoso , Anticoagulantes/administração & dosagem , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/mortalidade , Hemorragia Cerebral/terapia , Tomada de Decisão Clínica , Técnicas de Apoio para a Decisão , Avaliação da Deficiência , Esquema de Medicação , Embolia/diagnóstico , Embolia/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Japão/epidemiologia , Masculino , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
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