Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 66.875
Filtrar
1.
BMJ Open ; 11(9): e051003, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479938

RESUMO

INTRODUCTION: Acute traumatic coagulopathy (ATC) in bleeding trauma patients increase in-hospital mortality. Fibrinogen concentrate (FC) and prothrombin complex concentrate (PCC) are two purified concentrates of clotting factors that have been used to treat ATC. However, there is a knowledge gap on their use compared with the standard of care, the transfusion of plasma. METHODS AND ANALYSIS: The factors in the initial resuscitation of severe trauma 2 trial is a multicentre, randomised, parallel-control, single-blinded, phase IV superiority trial. The study aims to address efficacy and safety of the early use of FC and PCC compared with a plasma-based resuscitation. Adult trauma patients requiring massive haemorrhage protocol activation on hospital arrival will receive FC 4 g and PCC 2000 IU or plasma 4 U, based on random allocation. The primary outcome is a composite of the cumulative number of all units of red cells, plasma and platelets transfused within 24 hours following admission. Secondary outcomes include measures of efficacy and safety of the intervention. Enrolment of 350 patients will provide an initial power >80% to demonstrate superiority for the primary outcome. After enrolment of 120 patients, a preplanned adaptive interim analysis will be conducted to reassess assumptions, check for early superiority demonstration or reassess the sample size for remainder of the study. ETHICS AND DISSEMINATION: The study has been approved by local and provincial research ethics boards and will be conducted according to the Declaration of Helsinki, Good Clinical Practice guidelines and regulatory requirements. As per the Tri-Council Policy Statement, patient consent will be deferred due to the emergency nature of the interventions. If superiority is established, results will have a major impact on clinical practice by reducing exposure to non-virally inactivated blood products, shortening the time for administration of clotting factors, correct coagulopathy more efficaciously and reduce the reliance on AB plasma. TRIAL REGISTRATION NUMBER: NCT04534751, pre results.


Assuntos
Transtornos da Coagulação Sanguínea , Hemostáticos , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transfusão de Sangue , Fibrinogênio , Hemorragia/tratamento farmacológico , Humanos , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
2.
J Trauma Nurs ; 28(5): 332-338, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34491952

RESUMO

OBJECTIVE: Early assessment of the clinical status of trauma patients is crucial for guiding the treatment strategy, and it requires a rapid and systematic approach. The aim of this report is to critically review the assessment parameters currently used in the prehospital setting to quantify blood loss in trauma. DATA SOURCES: Studies regarding hemorrhagic shock in trauma were pooled from PubMed, EMBASE, and Cochrane databases using key words such as "hemorrhagic shock," "vital signs evaluation," "trauma," "blood loss," and "emergency medical service," alone or combined. STUDY SELECTION: Articles published since 2009 in English and Italian were considered eligible if containing data on assessment parameters in blood loss in adults. DATA EXTRACTION: Sixteen articles matching the inclusion criteria were considered in our study. DATA SYNTHESIS: Current prehospital assessment measures lack precise correlation with blood loss. CONCLUSIONS: Traditional assessment parameters such as heart rate, systolic blood pressure, shock index, and Glasgow Coma Scale score often lag in providing accurate blood loss assessment. The current literature supports the need for a noninvasive, continuously monitored assessment parameter to identify early shock in the prehospital setting.


Assuntos
Serviços Médicos de Emergência , Choque Hemorrágico , Ferimentos e Lesões , Adulto , Escala de Coma de Glasgow , Hemorragia/diagnóstico , Hemorragia/terapia , Humanos , Monitorização Fisiológica , Choque Hemorrágico/diagnóstico , Choque Hemorrágico/terapia , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia
3.
Khirurgiia (Mosk) ; (9): 54-62, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34480456

RESUMO

OBJECTIVE: To analyze an effectiveness of algorithm for complex treatment of patients with surgical complications of prolonged warfarin therapy in a general surgical hospital. MATERIAL AND METHODS: The study included 138 patients with surgical complications of prolonged warfarin therapy. All patients received warfarin for at least 6 months (49.5% of patients - over 5 years). Warfarin therapy was indicated for deep vein thrombosis in 54 patients and various cardiac diseases in 84 patients. Examination included clinical and instrumental survey, laboratory tests and coagulation tests - thromboelastography (TEG) and thrombodynamics test (TT). RESULTS: Recurrent VTEC occurred in 24 out of 138 patients, hemorrhagic complications - in 114 patients. Therapeutic management was applied in 111 patients, 27 ones underwent surgery (emergency treatment - 25 patients, after two days - 2 patients). Ten patients underwent endoscopic hemostasis, two patients - ultrasound-assisted percutaneous drainage of hematoma. Recurrent VTECs were caused by inadequate laboratory control and violations of warfarin therapy. Most of these patients underwent therapeutic management (only 3 patients required surgery for life-threatening flotation in great veins). Treatment of 114 patients with hemorrhagic complications of prolonged warfarin therapy depended on features of bleeding and severity of warfarin-induced coagulopathy. Depending on these factors, warfarin was discontinued and intravenous administration of vitamin K / FFP / prothrombin complex concentrate was applied. This approach ensured successful therapeutic measures in 90 patients of this group. Twenty-four patients underwent surgery after correction of hemostatic disorders. TT was characterized by high efficiency in analysis of thrombotic predisposition and prediction of the risk of VTEC. TEG was valuable for assessment of warfarin-induced coagulopathy and treatment of patients with hemorrhagic complications of prolonged warfarin therapy. CONCLUSION: The developed clinical and diagnostic algorithm for management of hemorrhagic complications of prolonged warfarin therapy ensures positive clinical results even in a general surgical hospital.


Assuntos
Anticoagulantes , Varfarina , Anticoagulantes/efeitos adversos , Testes de Coagulação Sanguínea , Hemorragia , Hospitais , Humanos , Varfarina/efeitos adversos
4.
Rinsho Ketsueki ; 62(8): 1050-1059, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34497191

RESUMO

Essential thrombocythemia (ET) and polycythemia vera (PV) are myeloproliferative neoplasms (MPN), wherein JAK2 V617F mutation exists as a common driver mutation, and the JAK-STAT pathway is constitutively activated. The treatment goal for ET and PV is the prevention of thrombosis and bleeding. The treatment strategy for ET is careful observation or antiplatelet therapy with or without cytoreductive therapy based on the thrombotic risk. The treatment strategy for all PV patients is phlebotomy with a target hematocrit of <45% in addition to antiplatelet therapy. Moreover, for patients at a high risk of thrombosis, additional cytoreductive therapy is considered beneficial. In this session, we discuss important points for ET diagnosis, thrombotic risk stratification, and the details of treatment strategy and current practice with evidence from clinical trials in ET. Furthermore, current topics in the treatment of ET and PV will be introduced with a focus on clinical data about interferon-α, which is reported to induce not only hematologic response but also molecular and histopathologic response in MPN.


Assuntos
Transtornos Mieloproliferativos , Policitemia Vera , Trombocitemia Essencial , Trombose , Hemorragia , Humanos , Janus Quinase 2/genética , Policitemia Vera/diagnóstico , Policitemia Vera/terapia , Trombocitemia Essencial/diagnóstico , Trombocitemia Essencial/genética , Trombocitemia Essencial/terapia , Trombose/etiologia , Trombose/prevenção & controle
5.
Rinsho Ketsueki ; 62(8): 1205-1212, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34497208

RESUMO

Von Willebrand disease (VWD) is a congenital bleeding disorder caused by quantitative and qualitative abnormalities in von Willebrand factor (VWF). VWD was first reported in 1926 by Dr. Erik von Willebrand, a Swedish physician, who reported a bleeding disorder in a family. VWD manifests as bleeding from the skin and mucous membranes (abnormal primary hemostasis). The symptoms are less severe than those of hemophilia and may be undiagnosed in many cases. Evidence-based guidelines are required for selection and patient management. Since ristocetin cofactor activity (vWF:RCo) and VWF antigen levels (vWF:Ag) are not routinely measured in clinical laboratories, the actual diagnosis is often determined by a mild prolongation of the activated partial thromboplastic time (APTT) associated with a relative decrease in factor VIII activity. Particularly, it is desirable to provide standard treatment measures on how to introduce the recently proposed bleeding score (BS; clinically scored for various bleeding symptoms of VWD) and how to deal with gynecological symptoms, such as excessive menstruation and irregular vaginal bleeding. In terms of treatment options, recombinant vWF concentrates were introduced in 2020, which has led to the expansion in the range of treatment options for patients.


Assuntos
Doenças de von Willebrand , Feminino , Hemorragia/diagnóstico , Hemorragia/terapia , Humanos , Doenças de von Willebrand/diagnóstico , Doenças de von Willebrand/tratamento farmacológico , Fator de von Willebrand
6.
Acta Biomed ; 92(S5): e2021405, 2021 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-34505844

RESUMO

BACKGROUND AND AIM: Intraabdominal hemorrhage secondary to liver and kidney injury is a major cause of morbidity and mortality. Endovascular arterial embolization is an established interventional radiology technique used to treat active bleeding, and its role in managing abdominal hemorrhages is growing, given the increasing trend for conservative treatment. Our study aims to retrospectively evaluate the technical and clinical results and the possible complications of arterial embolization procedures performed in emergency, in post-traumatic, iatrogenic, and pathological hepatic and renal bleedings. METHODS: We performed a ten-year, single-center retrospective survey (from January 2010 to December 2019) of all patients treated in emergency by intra-arterial embolization of liver and kidney bleeding. Preliminary CT angiography studies were evaluated, as well as the angiographic findings. Materials used, procedural data, and clinical outcomes, including complications, were recorded. RESULTS: The diagnostic angiography showed a single source of bleeding in 20 cases (66.7%), two bleeding vessels in 4 cases (13.3%), and multiple hemorrhagic sources in 6 cases (20%). All bleeding sources were successfully embolized; in 12 patients (40%), complete embolization was achieved with coils and 18 patients (60%) with hemostatic sponges. In one case, a second embolization procedure was performed for the persistence of hemodynamic instability. No major post-procedural complications were recorded. The mean procedure duration was 65.1 minutes. CONCLUSIONS: Based on our experience and literature data, the treatment of endovascular embolization in acute abdominal bleeding of hepatic and renal origin represents the treatment of choice, as it can provide complete therapeutic success in hemodynamically stable patients. (www.actabiomedica.it).


Assuntos
Embolização Terapêutica , Radiologia Intervencionista , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Fígado , Estudos Retrospectivos , Resultado do Tratamento
7.
J Spec Oper Med ; 21(3): 23-29, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34529800

RESUMO

BACKGROUND: Compared with those of tourniquet application, tourniquet conversion concepts are underdeveloped. The purpose of this project was to develop tourniquet conversion concepts and generate hypotheses. METHODS: One person performed 100 tests of tourniquet application and conversion. Testing varied by conversion types, materials, and assessments. Conversions were from improvised or Combat Application Tourniquets (C-A-T) to another C-A-T, a new site (with initial C-A-T only), a pneumatic Emergency and Military Tourniquet (EMT), or a pressure dressing (compression bandage or a roll gauze and an elastic wrap). Simulated limbs were created using plastic bottle-based manikins, pool noodle-based manikins, plastic pipes, glass bottles, a rain downspout, and a cardboard poster tube. RESULTS: Tourniquet application, conversion, and total times averaged 105, 132, and 237 seconds, respectively. Improvised tourniquet time was longer than that of C-A-T (p ≤ .05, all three). By initial tourniquet site, the 2-3 inches site had longer conversion and total time (p ≤ .02, both) compared with highest site. By whether initial tourniquets placed were also used in conversion, total time was shorter if yes (p = .05). Conversion to a pressure dressing was longer in conversion and total time (p ≤ .02, both) compared with conversion to a tourniquet. One wrap was short; we switched to those longer to cover limbs better. Limb types varied for indentation. Conversion communications improved when we used abbreviations and symbols. CONCLUSIONS: This preliminary project simulated tourniquet conversion to develop clinical concepts and research hypotheses to build a better basis for later research.


Assuntos
Militares , Torniquetes , Bandagens , Hemorragia/terapia , Humanos , Manequins
8.
Isr Med Assoc J ; 23(9): 595-600, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34472236

RESUMO

BACKGROUND: Limited data exist regarding the safety of ultrasound-guided femoral nerve blockade (US-FNB) in patients with hip fractures treated with anti-Xa direct oral anticoagulants (DOAC). OBJECTIVES: To compare the safety outcomes of US-FNB to conventional analgesia in patients with hip fractures treated with anti-Xa DOAC. METHODS: This observational exploratory prospective study included 69 patients who presented to our emergency department (ED) in 3 years with hip fracture and who were treated with apixaban or rivaroxaban. Patients received either a US-FNB (n=19) or conventional analgesics (n=50) based on their preference and, and the presence of a trained ED physician qualified in performing US-FNB. Patients were observed for major bleeding events during and 30 days after hospitalization. The degree of preoperative pain and opioid use were also observed. RESULTS: We found no significant difference in the number of major bleeding events between groups (47.4% vs. 54.0%, P = 0.84). Degree of pain measured 3 and 12 hours after presentation was found to be lower in the US-FNB group (median visual analog scale of pain improvement from baseline of -5 vs. -3 (P = 0.002) and -5 vs.-4 (P = 0.023), respectively. Opioid administration pre-surgery was found to be more than three times more common in the conventional analgesia group (26.3% vs.80%, P < 0.0001). CONCLUSIONS: Regarding patients treated with Anti-Xa DOAC, US-FNB was not associated with an increase in major bleeding events compared to conventional analgesia, although it was an effective means of pain alleviation. Larger scale randomized controlled trials are required to determine long-term safety and efficacy.


Assuntos
Inibidores do Fator Xa/administração & dosagem , Fraturas do Quadril/cirurgia , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Analgésicos/administração & dosagem , Analgésicos Opioides/administração & dosagem , Estudos de Coortes , Serviço Hospitalar de Emergência , Inibidores do Fator Xa/efeitos adversos , Feminino , Nervo Femoral/diagnóstico por imagem , Hemorragia/epidemiologia , Hemorragia/etiologia , Humanos , Masculino , Bloqueio Nervoso/efeitos adversos , Medição da Dor , Projetos Piloto , Estudos Prospectivos , Pirazóis/administração & dosagem , Pirazóis/efeitos adversos , Piridonas/administração & dosagem , Piridonas/efeitos adversos , Rivaroxabana/administração & dosagem , Rivaroxabana/efeitos adversos , Ultrassonografia de Intervenção
9.
Rev Assoc Med Bras (1992) ; 67(3): 426-430, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34468609

RESUMO

OBJECTIVE: To determine if there is a difference between uterine incision techniques (vertical vs. transversal) in terms of clinical results. METHODS: All women with leiomyomas who underwent open abdominal myomectomy (n=61) between March and August 2016 at the Gynecology and Obstetrics Clinic at the Women's Health Research and Training Hospital Zekai Tahir Burak were included, and the clinical results were included and prospectively reviewed. RESULTS: The estimated blood loss during myomectomy increased in the transversal group compared with the vertical group (809.33±483.34 versus 405.32±180.95 mL, p<0.001). The average operation duration was 60 min, and the patients got discharged on the second day after surgery. No intergroup statistical differences were observed in the surgical procedure. CONCLUSIONS: Surgeons should give preference to the most viable incision depending on the size and location of the leiomyoma.


Assuntos
Laparoscopia , Leiomioma , Miomectomia Uterina , Neoplasias Uterinas , Perda Sanguínea Cirúrgica/prevenção & controle , Feminino , Hemorragia , Humanos , Histerectomia , Leiomioma/cirurgia , Gravidez , Miomectomia Uterina/efeitos adversos , Neoplasias Uterinas/cirurgia
10.
Zhen Ci Yan Jiu ; 46(8): 707-9, 2021 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-34472758

RESUMO

Acupuncture therapy is widely used in the treatment of various clinical problems, but has some contraindications which should be highly noted. For example, patients with potential hemorrhagic tendency owing to administration of necessary anticoagulants and antiplatelets should be paid more attention when acupuncture therapy was performed. Usually, anticoagulants and antiplatelets combined with nonsteroidal anti-inflammatory hormones, antibiotic agents and vasodilators significantly increased the risk of bleeding. Chinese herbal medicines for activating blood circulation to arrest pain, and improper medication including the dosage and frequency should be avoided. Patients with chronic liver diseases, acute and severe liver and kidney function impairment due to inability to secrete coagulation factor in time to initiate coagulation mechanism are also unsuitable for acupuncture the-rapy. For this reason, we put forward some necessary countermeasures: a) collecting the patient's medical history in detail, b) paying attention to the coagulation related tests, c) taking the patient's blood volume and platelet related parameters seriously, and d) enacting reasonable diagnosis and treatment ideas.


Assuntos
Terapia por Acupuntura , Anticoagulantes , Anticoagulantes/efeitos adversos , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Inibidores da Agregação Plaquetária
11.
Ann Palliat Med ; 10(8): 9002-9014, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34488387

RESUMO

BACKGROUND: Erbium-doped yttrium aluminum garnet (ER:YAG) lasers have been used to treat peri-implant, but there are some disputes. To dispel these negative views, our study aims to compare the efficacy and safety of Er:YAG lasers versus conventional mechanical debridement in the treatment of peri-implantitis. METHODS: Seven databases were used to search for relevant studies and full-text articles which evaluate the comparisons of Er:YAG lasers and mechanical debridement for patients with peri-implantitis. Review Manager 5.4 was employed to assess the effects of the results among the selected studies. Forest plots, subgroup analyses, and on the included articles were also completed. Cochrane risk of bias assessment tool was used to assess the risk of bias. RESULTS: Our study focused on 10 previously conducted studies which included 294 patients with peri-implantitis and a total of 461 implants. No significant differences in clinical attachment level (CAL) (MD =0.17, P=0.25, at 6 months; MD =0.23, P=0.15, at 12 months), reduction in bleeding on probing (BOP) (MD =9.54%, P=0.18, at 6 months; MD =11.28%, P=0.24, at 12 months), or plaque index (PI) (MD =-0.02, P=0.75, at 6 months; MD =-0.07, P=0.66, at 12 months) were observed between the Er:YAG laser group and the mechanical debridement group. However, in reducing probing depth (PD) (MD =0.28, P=0.03, at 6 months; MD =0.35, P=0.002, at 12 months) and gingival recession (GR) changes (MD =-0.12, P=0.04, at 6 months; MD =-0.16, P=0.03, at 12 months), the Er:YAG laser group showed some advantages at 6-month and 12-month intervals following treatment. No significant publication bias existed in our meta-analysis by using funnel plot and Egger's test (PD: P=0.65; CAL: P=0.73). DISCUSSION: Our research supported the premise that Er:YAG lasers offer health benefits to patients with peri-implantitis and can effectively reduce PD and GR. Due to the limitations of the included studies, further studies should be carried out to validate our findings.


Assuntos
Terapia a Laser , Lasers de Estado Sólido , Peri-Implantite , Hemorragia , Humanos , Lasers de Estado Sólido/uso terapêutico , Peri-Implantite/cirurgia , Resultado do Tratamento
12.
Cardiovasc Diabetol ; 20(1): 176, 2021 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-34481513

RESUMO

BACKGROUND: It remains uncertain if prior use of oral anticoagulants (OACs) in COVID-19 outpatients with multimorbidity impacts prognosis, especially if cardiometabolic diseases are present. Clinical outcomes 30-days after COVID-19 diagnosis were compared between outpatients with cardiometabolic disease receiving vitamin K antagonist (VKA) or direct-acting OAC (DOAC) therapy at time of COVID-19 diagnosis. METHODS: A study was conducted using TriNetX, a global federated health research network. Adult outpatients with cardiometabolic disease (i.e. diabetes mellitus and any disease of the circulatory system) treated with VKAs or DOACs at time of COVID-19 diagnosis between 20-Jan-2020 and 15-Feb-2021 were included. Propensity score matching (PSM) was used to balance cohorts receiving VKAs and DOACs. The primary outcomes were all-cause mortality, intensive care unit (ICU) admission/mechanical ventilation (MV) necessity, intracranial haemorrhage (ICH)/gastrointestinal bleeding, and the composite of any arterial or venous thrombotic event(s) at 30-days after COVID-19 diagnosis. RESULTS: 2275 patients were included. After PSM, 1270 patients remained in the study (635 on VKAs; 635 on DOACs). VKA-treated patients had similar risks and 30-day event-free survival than patients on DOACs regarding all-cause mortality, ICU admission/MV necessity, and ICH/gastrointestinal bleeding. The risk of any arterial or venous thrombotic event was 43% higher in the VKA cohort (hazard ratio 1.43, 95% confidence interval 1.03-1.98; Log-Rank test p = 0.029). CONCLUSION: In COVID-19 outpatients with cardiometabolic diseases, prior use of DOAC therapy compared to VKA therapy at the time of COVID-19 diagnosis demonstrated lower risk of arterial or venous thrombotic outcomes, without increasing the risk of bleeding.


Assuntos
Assistência Ambulatorial/métodos , Anticoagulantes/administração & dosagem , COVID-19/tratamento farmacológico , Cardiopatias/tratamento farmacológico , Doenças Metabólicas/tratamento farmacológico , Vitamina K/antagonistas & inibidores , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , COVID-19/diagnóstico , COVID-19/mortalidade , Inibidores do Fator Xa/administração & dosagem , Feminino , Seguimentos , Cardiopatias/diagnóstico , Cardiopatias/mortalidade , Hemorragia/induzido quimicamente , Hemorragia/mortalidade , Humanos , Unidades de Terapia Intensiva/tendências , Masculino , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/mortalidade , Pessoa de Meia-Idade , Mortalidade/tendências , Resultado do Tratamento
13.
Blood Adv ; 5(17): 3333-3343, 2021 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-34477814

RESUMO

Orthologous proteins contain sequence disparity guided by natural selection. In certain cases, species-specific protein functionality predicts pharmacological enhancement, such as greater specific activity or stability. However, immunological barriers generally preclude use of nonhuman proteins as therapeutics, and difficulty exists in the identification of individual sequence determinants among the overall sequence disparity. Ancestral sequence reconstruction (ASR) represents a platform for the prediction and resurrection of ancient gene and protein sequences. Recently, we demonstrated that ASR can be used as a platform to facilitate the identification of therapeutic protein variants with enhanced properties. Specifically, we identified coagulation factor VIII (FVIII) variants with improved specific activity, biosynthesis, stability, and resistance to anti-human FVIII antibody-based inhibition. In the current study, we resurrected a panel of ancient mammalian coagulation factor IX (FIX) variants with the goal of identifying improved pharmaceutical candidates. One variant (An96) demonstrated 12-fold greater FIX activity production than human FIX. Addition of the R338L Padua substitution further increased An96 activity, suggesting independent but additive mechanisms. after adeno-associated virus 2 (AAV2)/8-FIX gene therapy, 10-fold greater plasma FIX activity was observed in hemophilia B mice administered AAV2/8-An96-Padua as compared with AAV2/8-human FIX-Padua. Furthermore, phenotypic correction conferred by the ancestral variant was confirmed using a saphenous vein bleeding challenge and thromboelastography. Collectively, these findings validate the ASR drug discovery platform as well as identify an ancient FIX candidate for pharmaceutical development.


Assuntos
Fator IX , Hemofilia B , Animais , Testes de Coagulação Sanguínea , Fator IX/genética , Terapia Genética , Hemofilia B/genética , Hemofilia B/terapia , Hemorragia , Camundongos
15.
Ann Ital Chir ; 92: 361-364, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34524110

RESUMO

Spontaneous liver hemorrhage (SLH) is a serious, extremely rare, and life-threatening occurrence requiring a multidisciplinary approach. Since diagnosis might be difficult, a high mortality rate is reported. Survival depends on a prompt diagnosis followed by an appropriate management. If left untreated, SLH progresses, in fact, to a hemorrhagic shock and death. SLH is rarely idiopathic, whereas more commonly is secondary to severe preeclampsia and HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count) syndrome, hepatocellular carcinoma (HCC), adenoma, focal nodular hyperplasia or hemangioma, and connective tissue diseases. We report two patients presenting with an idiopathic SLH successfully treated with angioembolization, and the results of an extensive literature review. KEY WORDS: Intrahepatic hematoma, Spontaneous liver hemorrhage, Spontaneous liver rupture.


Assuntos
Carcinoma Hepatocelular , Síndrome HELLP , Hepatopatias , Neoplasias Hepáticas , Feminino , Síndrome HELLP/diagnóstico , Síndrome HELLP/terapia , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Fígado , Hepatopatias/diagnóstico , Hepatopatias/terapia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/terapia , Gravidez , Ruptura Espontânea
16.
Angiol Sosud Khir ; 27(3): 153-158, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34528600

RESUMO

Presented herein is a clinical case report demonstrating uncontrolled development of fatal complications in a young parturient woman with vascular Ehlers-Danlos syndrome. The disease had not been known previously. In the third period of natural term delivery we revealed a complete linear vertical uterine rupture with a clinical picture of haemorrhagic shock. After hysterectomy we encountered sequential ruptures of the iliac veins, arteries, abdominal portion of the aorta and inferior vena cava. Attempts at restoring the integrity of vessels followed by ligation thereof, terminating in cutting of vascular walls, with the appearance of new sources of bleeding. The diagnosis was later on verified by the findings of autopsy and genetic typing.


Assuntos
Síndrome de Ehlers-Danlos , Síndrome de Ehlers-Danlos/complicações , Síndrome de Ehlers-Danlos/diagnóstico , Feminino , Hemorragia , Humanos , Artéria Ilíaca , Gravidez , Ruptura Espontânea , Útero
17.
N Engl J Med ; 385(10): 885-895, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34469646

RESUMO

BACKGROUND: Immune thrombocytopenia is a rare autoimmune disorder with associated bleeding risk and fatigue. Recommended first-line treatment for immune thrombocytopenia is high-dose glucocorticoids, but side effects, variable responses, and high relapse rates are serious drawbacks. METHODS: In this multicenter, open-label, randomized, controlled trial conducted in the United Kingdom, we assigned adult patients with immune thrombocytopenia, in a 1:1 ratio, to first-line treatment with a glucocorticoid only (standard care) or combined glucocorticoid and mycophenolate mofetil. The primary efficacy outcome was treatment failure, defined as a platelet count of less than 30×109 per liter and initiation of a second-line treatment, assessed in a time-to-event analysis. Secondary outcomes were response rates, side effects, occurrence of bleeding, patient-reported quality-of-life measures, and serious adverse events. RESULTS: A total of 120 patients with immune thrombocytopenia underwent randomization (52.4% male; mean age, 54 years [range 17 to 87]; mean platelet level, 7×109 per liter) and were followed for up to 2 years after beginning trial treatment. The mycophenolate mofetil group had fewer treatment failures than the glucocorticoid-only group (22% [13 of 59 patients] vs. 44% [27 of 61 patients]; hazard ratio, 0.41; range, 0.21 to 0.80; P = 0.008) and greater response (91.5% of patients having platelet counts greater than 100×109 per liter vs. 63.9%; P<0.001). We found no evidence of a difference between the groups in the occurrence of bleeding, rescue treatments, or treatment side effects, including infection. However, patients in the mycophenolate mofetil group reported worse quality-of-life outcomes regarding physical function and fatigue than those in the glucocorticoid-only group. CONCLUSIONS: The addition of mycophenolate mofetil to a glucocorticoid for first-line treatment of immune thrombocytopenia resulted in greater response and a lower risk of refractory or relapsed immune thrombocytopenia, but with somewhat decreased quality of life. (Funded by the U.K. National Institute for Health Research; FLIGHT ClinicalTrials.gov number, NCT03156452; EudraCT number, 2017-001171-23.).


Assuntos
Glucocorticoides/uso terapêutico , Imunossupressores/uso terapêutico , Ácido Micofenólico/uso terapêutico , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Adolescente , Adulto , Idoso , Quimioterapia Combinada , Fadiga/induzido quimicamente , Feminino , Glucocorticoides/efeitos adversos , Hemorragia/etiologia , Hemorragia/prevenção & controle , Humanos , Imunossupressores/efeitos adversos , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/efeitos adversos , Contagem de Plaquetas , Púrpura Trombocitopênica Idiopática/complicações , Qualidade de Vida , Adulto Jovem
18.
BMJ Case Rep ; 14(8)2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34373244

RESUMO

Diffuse alveolar haemorrhage (DAH) has been reported as a rare complication of clopidogrel use and is usually a diagnosis of exclusion. We describe the case of an 88-year-old Native American woman who presented with acute hypoxic respiratory failure with CT scan of the chest showing diffuse bilateral ground-glass opacities. She had been on clopidogrel for 6 months for a carotid artery stent. Bronchoscopy with bronchoalveolar lavage and transbronchial biopsies revealed DAH. Infectious and autoimmune work-up were all negative. Clopidogrel was stopped and high-dose steroids were started. Her symptoms gradually improved until she was discharged from the hospital. The differential DAH is broad. Anticoagulant-induced DAH should be part of the differential diagnosis, and is usually a diagnosis of exclusion.


Assuntos
Pneumopatias , Idoso de 80 Anos ou mais , Lavagem Broncoalveolar , Broncoscopia , Clopidogrel/efeitos adversos , Feminino , Hemorragia/induzido quimicamente , Humanos , Pneumopatias/diagnóstico , Pneumopatias/diagnóstico por imagem
19.
Lancet Haematol ; 8(9): e627-e636, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34363769

RESUMO

BACKGROUND: Current guidelines recommend a risk-adjusted treatment strategy for the management of acute pulmonary embolism. This is a particular patient category for whom optimal treatment (anticoagulant treatment, reperfusion strategies, and duration of hospitalisation) is currently unknown. We investigated whether treatment of acute intermediate-risk pulmonary embolism with parenteral anticoagulation for a short period of 72 h, followed by a switch to a direct oral anticoagulant (dabigatran), is effective and safe. METHODS: We did a multinational, multicentre, single-arm, phase 4 trial at 42 hospitals in Austria, Belgium, France, Germany, Italy, Netherlands, Romania, Slovenia, and Spain. Adult patients (aged ≥18 years) with symptomatic intermediate-risk pulmonary embolism, with or without deep-vein thrombosis, were enrolled. Patients received parenteral low-molecular-weight or unfractionated heparin for 72 h after diagnosis of pulmonary embolism before switching to oral dabigatran 150 mg twice per day following a standard clinical assessment. The primary outcome was recurrent symptomatic venous thromboembolism or pulmonary embolism-related death within 6 months. The primary and safety outcomes were assessed in the intention-to-treat population. The study was terminated early, as advised by the data safety and monitoring board, following sample size adaptation after the predefined interim analysis on Dec 18, 2018. This trial is registered with the EU Clinical Trials Register (EudraCT 2015-001830-12) and ClinicalTrials.gov (NCT02596555). FINDINGS: Between Jan 1, 2016, and July 31, 2019, 1418 patients with pulmonary embolism were screened, of whom 402 were enrolled and were included in the intention-to-treat analysis (median age was 69·5 years [IQR 60·0-78·0); 192 [48%] were women and 210 [52%] were men). Median follow-up was 217 days (IQR 210-224) and 370 (92%) patients adhered to the protocol. The primary outcome occurred in seven (2% [upper bound of right-sided 95% CI 3]; p<0·0001 for rejecting the null hypothesis) patients, with all events occurring in those with intermediate-high-risk pulmonary embolism (seven [3%; upper bound of right-sided 95% CI 5] of 283). At 6 months, 11 (3% [95% CI 1-5]) of 402 patients had at least one major bleeding event and 16 (4% [2-6]) had at least one clinically relevant non-major bleeding event; the only fatal haemorrhage occurred in one (<1%) patient before the switch to dabigatran. INTERPRETATION: A strategy of early switch from heparin to dabigatran following standard clinical assessment was effective and safe in patients with intermediate-risk pulmonary embolism. Our results can help to refine guideline recommendations for the initial treatment of acute intermediate-risk pulmonary embolism, optimising the use of resources and avoiding extended hospitalisation. FUNDING: German Federal Ministry of Education and Research, University Medical Center Mainz, and Boehringer Ingelheim.


Assuntos
Anticoagulantes/uso terapêutico , Dabigatrana/uso terapêutico , Embolia Pulmonar/tratamento farmacológico , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Dabigatrana/efeitos adversos , Esquema de Medicação , Feminino , Seguimentos , Hemorragia/etiologia , Heparina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/complicações , Fatores de Risco , Resultado do Tratamento , Tromboembolia Venosa/complicações
20.
Curr Opin Cardiol ; 36(5): 597-608, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34397466

RESUMO

PURPOSE OF REVIEW: Coronary artery disease (CAD) is a common comorbidity in patients with cancer. We review shared risk factors between the two diseases and cancer treatments that increase the risk of CAD. We also discuss outcomes and management considerations of patients with cancer who develop CAD. RECENT FINDINGS: Several traditional and novel risk factors promote the development of both CAD and cancer. Several cancer treatments further increase the risk of CAD. The presence of cancer is associated with a higher burden of comorbidities and thrombocytopenia, which predisposes patients to higher bleeding risks. Patients with cancer who develop acute coronary syndromes are less likely to receive timely revascularization or appropriate medical therapy, despite evidence showing that receipt of these interventions is associated with substantial benefit. Accordingly, a cancer diagnosis is associated with worse outcomes in patients with CAD. The risk-benefit balance of revascularization is becoming more favorable due to the improving prognosis of many cancers and safer revascularization strategies, including shorter requirements for dual antiplatelet therapy after revascularization. SUMMARY: Several factors increase the complexity of managing CAD in patients with cancer. A multidisciplinary approach is recommended to guide treatment decisions in this high-risk and growing patient group.


Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Neoplasias , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/terapia , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/terapia , Hemorragia , Humanos , Revascularização Miocárdica , Neoplasias/complicações , Neoplasias/epidemiologia , Neoplasias/terapia , Medição de Risco , Fatores de Risco , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...