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1.
Clinics (Sao Paulo) ; 80: 100573, 2025.
Artigo em Inglês | MEDLINE | ID: mdl-39764924

RESUMO

OBJECTIVE: Acute Pulmonary Embolism (APE) is a disease with increasing incidence worldwide. Antithrombotics are the cornerstone of the treatment. Bleeding is an adverse event related to this therapy. The objective was to evaluate the prevalence of bleeding in a sample of Brazilian patients hospitalized with APE and the impact of this complication on mortality. Additionally, the performance of some bleeding predictive scores was evaluated in this sample. METHODS: A retrospective cohort study was carried out on patients hospitalized with APE from January 2009 through August 2017. The medical records of these patients were reviewed, and the bleeding recorded during hospital stay was classified according to the "Thrombolysis in Myocardial Infarction (TIMI) bleeding risk." Five different predictive scores for bleeding after APE (RIETE, PE-SARD, VTE-BLEED, Kuijer, and ATRIA) were applied. Overall mortality at 30 days and one year were assessed. RESULTS: One hundred fifty-nine patients were included. The prevalence of any bleeding was 36/159 (23 %), major bleeding was 10/159 (06 %), minor bleeding was 11/159 (07 %), and bleeding requiring attention was 15/159 (10 %). Only major bleeding was associated with higher mortality at one-year follow-up with a Relative Risk (RR) of 2.00 (95 % CI 1.16-3.57; p = 0.044). All bleeding predictive scores evaluated showed low accuracy in identifying patients at higher risk of bleeding. CONCLUSION: Patients hospitalized with APE in Brazil had a high prevalence of bleeding. The major bleeding increased the one-year mortality. The bleeding predictive scores assessed showed limited accuracy in identifying patients at high risk of bleeding.


Assuntos
Hemorragia , Hospitalização , Embolia Pulmonar , Humanos , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/mortalidade , Masculino , Feminino , Estudos Retrospectivos , Brasil/epidemiologia , Pessoa de Meia-Idade , Hemorragia/etiologia , Hemorragia/epidemiologia , Hemorragia/mortalidade , Idoso , Doença Aguda , Fatores de Risco , Hospitalização/estatística & dados numéricos , Medição de Risco , Prevalência , Idoso de 80 Anos ou mais , Adulto
2.
Medicina (B Aires) ; 84(6): 1257-1261, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39666422

RESUMO

Hemorrhagic cholecystitis, a rare complication of acute cholecystitis, poses diagnostic challenges due to its varied clinical presentation and relative infrequency. This case involves a 59-year-old male with untreated diabetes and obesity, who presented with nonspecific abdominal pain. Initial results were inconclusive, leading to a delayed diagnosis. The patient presented again with worsening symptoms, now including melena, prompting a repeat contrast-enhanced computed tomography (CT) scan that revealed a collapsed gallbladder and signs of intra-abdominal bleeding. Urgent exploratory laparoscopy exposed a gangrenous, perforated gallbladder with active bleeding. He required intensive care postoperatively and recovered without complications. Teaching points include the importance of considering hemorrhagic cholecystitis as a possible diagnosis in patients presenting with upper gastrointestinal bleeding. The case emphasizes the role of imaging, particularly contrast-enhanced CT scans, in diagnosis. Surgical intervention remains the gold standard, highlighting the significance of timely management.


La colecistitis hemorrágica, una complicación rara de la colecistitis aguda, plantea desafíos diagnósticos debido a su presentación clínica variada y a su relativa infrecuencia. Este reporte presenta el caso de un hombre de 59 años con diabetes no tratada y obesidad, que consultó por dolor abdominal inespecífico por guardia externa. Los resultados iniciales fueron inconclusos, lo que provocó un retraso en el diagnóstico. El paciente consultó nuevamente con síntomas agravados, que incluían melena. Esto llevó a la realización de una nueva tomografía computada (TC) con contraste, que reveló una vesícula biliar colapsada y signos de hemorragia intraabdominal. Una laparoscopia exploradora de urgencia reveló una vesícula biliar gangrenosa y perforada con sangrado activo. Cursó postoperatorio en unidad de cuidados intensivos y se recuperó sin complicaciones. Los puntos de aprendizaje incluyen la importancia de considerar la colecistitis hemorrágica como un posible diagnóstico en pacientes que se presentan con hemorragia digestiva alta. El caso enfatiza el papel de las imágenes, especialmente las TC con contraste, en el diagnóstico. La intervención quirúrgica sigue siendo el gold standard, destacando la importancia del tratamiento temprano.


Assuntos
Tomografia Computadorizada por Raios X , Humanos , Masculino , Pessoa de Meia-Idade , Diagnóstico Diferencial , Colecistite Aguda/diagnóstico , Colecistite Aguda/cirurgia , Hemorragia/etiologia , Hemorragia/diagnóstico por imagem , Colecistite/diagnóstico , Colecistite/cirurgia , Colecistite/diagnóstico por imagem , Colecistite/complicações , Vesícula Biliar/diagnóstico por imagem
3.
Einstein (Sao Paulo) ; 22: eRC1008, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39699407

RESUMO

We report a case of computed tomography-guided percutaneous radiofrequency ablation of a bleeding renal angiomyolipoma. Radiofrequency ablation was performed as an alternative to partial nephrectomy and super-selective renal artery embolization for ruptured renal angiomyolipoma with slow persistent bleeding in a patient with elevated serum creatinine levels and other comorbidities. Computed tomography-guided radiofrequency ablation successfully stopped the active hemorrhage and did not affect long-term renal function during the 3-year follow period. No complications were associated with the procedure. Radiofrequency ablation of a bleeding renal angiomyolipoma may be considered a more invasive surrogate procedure in an urgent setting; however, further studies are necessary to evaluate the long-term benefits of this approach and its overall impact on renal function compared to traditional methods.


Assuntos
Angiomiolipoma , Neoplasias Renais , Ablação por Radiofrequência , Tomografia Computadorizada por Raios X , Humanos , Angiomiolipoma/cirurgia , Angiomiolipoma/complicações , Angiomiolipoma/diagnóstico por imagem , Neoplasias Renais/cirurgia , Neoplasias Renais/complicações , Ablação por Radiofrequência/métodos , Resultado do Tratamento , Feminino , Hemorragia/etiologia , Hemorragia/cirurgia , Hemorragia/diagnóstico por imagem , Pessoa de Meia-Idade , Ablação por Cateter/métodos
4.
Clinics (Sao Paulo) ; 79: 100525, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39504616

RESUMO

OBJECTIVE: The authors hypothesized that ventilation and hyperoxia may harm the cochlea vasculature in an experimental model of Congenital Diaphragmatic Hernia (CDH) performed in rabbits. METHODS: New Zealand rabbits underwent CDH creation at 25 days of gestation (term = 30 days). CDH was created in fetuses (n = 15) and compared with Controls (n = 15). Six groups were studied: Control, Control Ventilated 21% FiO2 (Control 21%), Control Ventilated 100% FiO2 (Control 100%), CDH, CDH Ventilated 21% FiO2 (CDH 21%) and CDH Ventilated 100% FiO2 (CDH 100%). Dynamic Compliance (CRS), dynamic Elastance (ERS), and dynamic Resistance (RRS) were measured. The cochleae were then removed, and the apical, middle, and basal slopes of the cochleae were evaluated. Samples were graded using a scoring system for the severity of bleeding: 0 (absent), 1 (mild), 2 (moderate), and 3 (severe). Statistical analysis was performed by contingence and ANOVA. RESULTS: There was no difference in the severity of cochlear bleeding between Controls and CDH without ventilation. Control 21% and 100% had average scores of 2 and 1.2 respectively; CDH 21% and 100% had average scores of 0.4 and 3.8 respectively; RR [CDH 100% / Control 100%] (95% CI) = 3.16 (p < 0.005). CONCLUSIONS: The severity of bleeding was 3.16 times worse with 100% oxygenation in CDH. This information may be helpful for future therapeutic strategies for decreasing SNHL in CDH patients.


Assuntos
Cóclea , Modelos Animais de Doenças , Hérnias Diafragmáticas Congênitas , Hiperóxia , Animais , Coelhos , Hérnias Diafragmáticas Congênitas/complicações , Hiperóxia/complicações , Respiração Artificial/efeitos adversos , Hemorragia/etiologia , Hérnia Diafragmática/complicações , Índice de Gravidade de Doença , Feminino
5.
Int J Mol Sci ; 25(18)2024 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-39337488

RESUMO

Platelets are small cell fragments that play a crucial role in hemostasis, requiring fast response times and fine signaling pathway regulation. For this regulation, platelets require a balance between two pathway types: the activatory and negative signaling pathways. Activatory signaling mediators are positive responses that enhance stimuli initiated by a receptor in the platelet membrane. Negative signaling regulates and controls the responses downstream of the same receptors to roll back or even avoid spontaneous thrombotic events. Several blood-related pathologies can be observed when these processes are unregulated, such as massive bleeding in activatory signaling inhibition or thrombotic events for negative signaling inhibition. The study of each protein and metabolite in isolation does not help to understand the role of the protein or how it can be contrasted; however, understanding the balance between active and negative signaling could help develop effective therapies to prevent thrombotic events and bleeding disorders.


Assuntos
Plaquetas , Hemorragia , Ativação Plaquetária , Transdução de Sinais , Trombose , Humanos , Trombose/metabolismo , Trombose/etiologia , Plaquetas/metabolismo , Hemorragia/metabolismo , Hemorragia/etiologia , Animais , Hemostasia
6.
Catheter Cardiovasc Interv ; 104(5): 1008-1011, 2024 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-39279204

RESUMO

Bleeding following a percutaneous renal biopsy is a complication that can be life-threatening. Embolization of the bleeding artery is a procedure that can limit the damage; however, embolization devices can be costly or not immediately available. This is why we present the case of a 25-year-old man with a history of multiple thromboses who underwent a renal biopsy due to suspected systemic lupus erythematosus. Five days after the procedure, he developed hypovolemic shock. A CT scan was performed due to suspected hemorrhage and showed active bleeding at the renal biopsy site. Since embolization devices were not immediately available, selective embolization of the bleeding artery was successfully performed using autologous fat. It is known that embolization with coils is the most frequently used interventional procedure to stop bleeding secondary to renal biopsies. However, embolization with autologous fat is a proven technique to stop bleeding in coronary perforations. In this case, we adapted this technique to treat an actively bleeding renal artery secondary to a renal biopsy. Based on this case, we consider that this technique may be an alternative when coil embolization is not available.


Assuntos
Embolização Terapêutica , Hemorragia , Rim , Artéria Renal , Humanos , Masculino , Adulto , Hemorragia/etiologia , Hemorragia/terapia , Resultado do Tratamento , Rim/patologia , Rim/irrigação sanguínea , Biópsia , Artéria Renal/diagnóstico por imagem , Tecido Adiposo
7.
Eur J Trauma Emerg Surg ; 50(6): 3109-3114, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-39110179

RESUMO

INTRODUCTION: Hemorrhage is a leading cause of death in trauma. Prehospital hemorrhage control techniques include tourniquet application for extremity wounds and direct compression; however, tourniquets are not effective in anatomic junctions, and direct compression is highly operator dependent. Balloon catheter compression has been employed previously in trauma care, but its use has been confined to the operating room and restricted to specific anatomic injuries. METHODS: In a single-center retrospective review, we describe a technique for balloon catheter compression for hemorrhage control that can be employed across the continuum of trauma care, from the prehospital setting to the trauma bay, the operating room, and postoperative period. RESULTS: Of 18,303 trauma patients in Venezuela, 45% of the 1757 patients with vascular injuries received Foley catheter compression for hemorrhage control. Of these catheters, the majority (75%) were placed in the emergency department, 5% in the prehospital setting, and 20% in the operating room. Over half (53.2%) of the balloon catheters were placed for hemorrhage control in non-compressible anatomic junctions. CONCLUSIONS: Foley catheter balloon compression is a useful addition to a provider's arsenal of hemorrhage control techniques, as it is effective in anatomic junctions, preserves collateral circulation through focused compression, and requires minimal active physical attention to maintain hemostasis.


Assuntos
Hemorragia , Torniquetes , Humanos , Estudos Retrospectivos , Hemorragia/terapia , Hemorragia/etiologia , Hemorragia/prevenção & controle , Masculino , Feminino , Adulto , Oclusão com Balão/métodos , Técnicas Hemostáticas/instrumentação , Pessoa de Meia-Idade , Ferimentos e Lesões/terapia , Ferimentos e Lesões/complicações , Serviços Médicos de Emergência , Lesões do Sistema Vascular/terapia
8.
Blood Transfus ; 22(5): 420-428, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39133623

RESUMO

BACKGROUND: In hospitalized patients undergoing therapeutic plasma exchange (TPE), it is not known how TPE-associated bleeding risk is impacted by a prior bleeding episode. Therefore, to assess the prevalence and predictors of bleeding recurrence, we analyzed data from the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III). MATERIALS AND METHODS: Using a retrospective cross-sectional analysis of REDS-III public use files, we identified hospitalized adults who had a major bleeding episode prior to their first TPE procedure. Patients were classified into two cohorts based on bleeding recurrence (no-recurrence vs recurrence). After identifying potential predictors, we used multiple imputation by chained equations to impute variables with <30% missing data. Variable selection was optimized using a 10-fold cross validated least absolute shrinkage and selection operator. Final predictors were identified by fitting a logistic regression model. RESULTS: In 310 patients with major bleeding prior to TPE initiation, bleeding recurred in 121 (39.0%). We identified the following seven unique predictors: 1) >10 TPE procedures (OR 2.23); 2) intensive care unit stay (OR 1.35); 3) thrombocytopenia (OR 1.26); 4) surgery (OR 1.22); 5) hepatic disease (OR 1.21); 6) 6-10 TPE procedures (OR 1.04); and 7) Asian race (OR 1.01). We also identified the following five interactions: 1) surgery and therapeutic anticoagulation (OR 1.50); 2) 6-10 TPE procedures and therapeutic anticoagulation (OR 1.05); 3) 6-10 TPE procedures and antiplatelets (OR 1.02); 4) >10 TPE procedures and antiplatelets (OR 1.00); and 5) albumin-only TPE and antiplatelets (OR 0.53). When assessed for adjusted performance, the prediction model had a C-statistic of 0.617 (95% CI 0.613-0.619) and Brier Score of 0.342 (95% CI 0.340-0.347). DISCUSSION: In this study assessing predictors of bleeding recurrence among hospitalized patients undergoing TPE, we identified seven variables and five interactions. These findings should be validated in future studies.


Assuntos
Hemorragia , Troca Plasmática , Recidiva , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Hemorragia/terapia , Hemorragia/etiologia , Hemorragia/epidemiologia , Estudos Transversais , Idoso , Adulto , Fatores de Risco , Hospitalização
11.
Sci Rep ; 14(1): 13395, 2024 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-38862533

RESUMO

The shock index (SI) has been associated with predicting transfusion needs in trauma patients. However, its utility in penetrating thoracic trauma (PTTrauma) for predicting the Critical Administration Threshold (CAT) has not been well-studied. This study aimed to evaluate the prognostic value of SI in predicting CAT in PTTrauma patients and compare its performance with the Assessment of Blood Consumption (ABC) and Revised Assessment of Bleeding and Transfusion (RABT) scores. We conducted a prognostic type 2, single-center retrospective observational cohort study on patients with PTTrauma and an Injury Severity Score (ISS) > 9. The primary exposure was SI at admission, and the primary outcome was CAT. Logistic regression and decision curve analysis were used to assess the predictive performance of SI and the PTTrauma score, a novel model incorporating clinical variables. Of the 620 participants, 53 (8.5%) had more than one CAT. An SI > 0.9 was associated with CAT (adjusted OR 4.89, 95% CI 1.64-14.60). The PTTrauma score outperformed SI, ABC, and RABT scores in predicting CAT (AUC 0.867, 95% CI 0.826-0.908). SI is a valuable predictor of CAT in PTTrauma patients. The novel PTTrauma score demonstrates superior performance compared to existing scores, highlighting the importance of developing targeted predictive models for specific injury patterns. These findings can guide clinical decision-making and resource allocation in the management of PTTrauma.


Assuntos
Transfusão de Sangue , Traumatismos Torácicos , Humanos , Masculino , Feminino , Transfusão de Sangue/métodos , Adulto , Estudos Retrospectivos , Traumatismos Torácicos/terapia , Pessoa de Meia-Idade , Prognóstico , Escala de Gravidade do Ferimento , Ferimentos Penetrantes/terapia , Hemorragia/terapia , Hemorragia/etiologia , Hemorragia/diagnóstico , Choque/terapia , Choque/etiologia , Choque/diagnóstico
12.
J Thromb Thrombolysis ; 57(6): 1031-1039, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38762708

RESUMO

Therapeutic anticoagulation showed inconsistent results in hospitalized patients with COVID-19 and selection of the best patients to use this strategy still a challenge balancing the risk of thrombotic and hemorrhagic outcomes. The present post-hoc analysis of the ACTION trial evaluated the variables independently associated with both bleeding events (major bleeding or clinically relevant non-major bleeding) and the composite outcomes thrombotic events (venous thromboembolism, myocardial infarction, stroke, systemic embolism, or major adverse limb events). Variables were assessed one by one with independent logistic regressions and final models were chosen based on Akaike information criteria. The model for bleeding events showed an area under the curve of 0.63 (95% confidence interval [CI] 0.53 to 0.73), while the model for thrombotic events had an area under the curve of 0.72 (95% CI 0.65 to 0.79). Non-invasive respiratory support was associated with thrombotic but not bleeding events, while invasive ventilation was associated with both outcomes (Odds Ratio of 7.03 [95 CI% 1.95 to 25.18] for thrombotic and 3.14 [95% CI 1.11 to 8.84] for bleeding events). Beyond respiratory support, creatinine level (Odds Ratio [OR] 1.01 95% CI 1.00 to 1.02 for every 1.0 mg/dL) and history of coronary disease (OR 3.67; 95% CI 1.32 to 10.29) were also independently associated to the risk of thrombotic events. Non-invasive respiratory support, history of coronary disease, and creatinine level may help to identify hospitalized COVID-19 patients at higher risk of thrombotic complications.ClinicalTrials.gov: NCT04394377.


Assuntos
COVID-19 , Produtos de Degradação da Fibrina e do Fibrinogênio , Hemorragia , Trombose , Humanos , COVID-19/sangue , COVID-19/complicações , COVID-19/diagnóstico , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Hemorragia/sangue , Hemorragia/diagnóstico , Hemorragia/etiologia , Hemorragia/induzido quimicamente , Masculino , Feminino , Trombose/sangue , Trombose/etiologia , Trombose/diagnóstico , Idoso , Pessoa de Meia-Idade , Hospitalização , Fatores de Risco , SARS-CoV-2 , Anticoagulantes/uso terapêutico , Anticoagulantes/efeitos adversos
13.
Rev. otorrinolaringol. cir. cabeza cuello ; 84(1): 58-62, mar. 2024. tab
Artigo em Espanhol | LILACS | ID: biblio-1565743

RESUMO

La hematoma amigdalino espontáneo, es un cuadro clínico raro con baja incidencia a nivel mundial, resultado de un proceso inflamatorio local secundario a la amigdalitis, donde el factor de riesgo más significativo es la amigdalitis a repetición. Desde el punto de vista clínico, su distinción del absceso periamigdalino, puede ser un desafío, lo cual es crucial debido a diferencias en el tratamiento y el pronóstico entre ambas. Al ser un cuadro de baja prevalencia es importante tener un alto nivel de sospecha diagnóstica para abordar adecuadamente esta entidad clínica y prevenir consecuencias potencialmente mortales.


Spontaneous tonsillar hematoma is a rare clinical condition with low incidence worldwide, resulting from a local inflammatory process secondary to tonsillitis, where the most significant risk factor is recurrent tonsillitis. From a clinical standpoint, its distinction from a peritonsillar abscess can be challenging, which is crucial due to differences in treatment and prognosis between the two. Given its low prevalence, maintaining a high level of diagnostic suspicion is important to address this clinical entity and prevent potentially life-threatening consequences appropriately.


Assuntos
Humanos , Masculino , Adulto , Tonsilite , Tomografia Computadorizada por Raios X/métodos , Abscesso Peritonsilar/diagnóstico por imagem , Tonsila Palatina , Hemorragia/etiologia , Hiperplasia
15.
Expert Rev Hematol ; 16(12): 1087-1097, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38066708

RESUMO

BACKGROUND: Emicizumab is a monoclonal antibody approved for prophylaxis against bleeds for people with hemophilia A (PwHA). A systematic review was conducted evaluating the efficacy/effectiveness and the safety of emicizumab as prophylaxis for PwHA compared to prophylaxis with factor VIII (FVIII) or bypassing agents (BPA), respectively in patients without and with inhibitors. RESEARCH DESIGN AND METHODS: Database-directed search strategies were performed in Aug/26/2022 and updated in Mar/16/2023. Studies evaluating the prophylaxis with emicizumab versus prophylaxis with FVIII or BPA in PwHA without or with inhibitors, respectively, were selected by two independent reviewers. Data were extracted by two independent reviewers. Annualized bleeding rates for total treated bleeding events (ABR-all) were evaluated by meta-analysis. The quality of studies and certainty of evidence were assessed. RESULTS: A total of 11 studies were included. The standard mean differences for ABR-all were -0.6 (95%CI -1.0 to -0.2, p-value = 0.0002), among PwHA without inhibitors, and -1.7 (95%CI -2.4 to -0.9, p-value <0.00001), among PwHA with inhibitors. However, there was moderate heterogeneity in both meta-analyses. The most frequent adverse event was injection site reaction. CONCLUSIONS: Emicizumab prophylaxis was superior in reducing the ABR-all when compared with prophylaxis with FVIII or BPA.


Assuntos
Anticorpos Biespecíficos , Hemofilia A , Hemostáticos , Humanos , Hemofilia A/complicações , Hemofilia A/tratamento farmacológico , Fator VIII/efeitos adversos , Hemorragia/etiologia , Hemorragia/prevenção & controle , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Biespecíficos/efeitos adversos , Hemostáticos/uso terapêutico
16.
Rev. cuba. cir ; 62(4)dic. 2023.
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1550844

RESUMO

Introducción: La hemorragia digestiva alta tiene una elevada morbimortalidad. La endoscopía digestiva alta es el estudio de elección para su diagnóstico y tratamiento. Objetivo: Describir la conducta ante la hemorragia digestiva alta. Métodos: Para la revisión bibliográfica se consultaron artículos científicos indexados en idioma español e inglés, relacionados con la hemorragia digestiva, publicados en las bases de datos PubMed, SciELO, Medline y Cochrane, pertenecientes a autores dedicados al estudio de este tema. Desarrollo: La hemorragia digestiva alta se clasifica, según la etiología de origen, en variceal y no variceal. La mayoría de los pacientes con hemorragia digestiva alta el sangrado se autolimita. La causa más habitual es la úlcera péptica, pero en caso de sangrado masivo la etiología más frecuente es la variceal. El empleo precoz de la terlipresina en los pacientes con hemorragia digestiva alta variceal mejora el control del sangrado y disminuye la mortalidad. Se debe hacer uso de escalas validadas de estratificación del riesgo: escala de riesgo de Rockall (tiene como propósito principal predecir la mortalidad y riesgo de resangrado del paciente) y la escala de Glasgow-Blatchford). Conclusiones: Sospechar la presencia de hemorragia digestiva alta, estratificar su riesgo e instaurar el manejo inicial y apropiado constituye una prioridad para el médico de urgencia(AU)


Introduction: Upper gastrointestinal bleeding presents high morbidity and mortality. Upper gastrointestinal endoscopy is the study of choice for its diagnosis and treatment. Objective: To describe the management of upper gastrointestinal bleeding. Methods: For the bibliographic review, the consultation was carried out of scientific articles indexed in Spanish and English, related to gastrointestinal bleeding, published in the databases PubMed, SciELO, Medline and Cochrane, belonging to authors dedicated to the study of this subject. Development: Upper gastrointestinal bleeding is classified, according to the etiology of origin, into variceal and nonvariceal. In most patients with upper gastrointestinal bleeding the bleeding as such is self-limiting. The most common cause is peptic ulcer; however, in the case of massive bleeding, the most frequent etiology is variceal. Early use of terlipressin in patients with variceal upper gastrointestinal bleeding improves bleeding control and decreases mortality. Validated risk stratification scales should be used: Rockall risk scale (its main purpose is to predict patient mortality and risk of bleeding recurrence) and the Glasgow-Blatchford scale. Conclusions: Suspecting the presence of upper gastrointestinal bleeding, stratifying its risk, as well as instituting initial and appropriate management, are a priority for the emergency physician(AU)


Assuntos
Humanos , Endoscopia Gastrointestinal/métodos , Terlipressina/uso terapêutico , Hemorragia/etiologia , Literatura de Revisão como Assunto , Bases de Dados Bibliográficas
17.
Expert Rev Hematol ; 16(12): 1143-1149, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37955142

RESUMO

BACKGROUND: Venous thromboembolism (VTE) and major bleeding (MB) are common in cancer patients. Reduced-doses of antithrombotics as secondary prophylaxis have limited data. This work aims to describe and to compare treatments and outcomes for cancer-associated VTE. RESEARCH DESIGN AND METHODS: Retrospective study. Adults with cancer-associated VTE were included. After 3-6 months of full-doses of anticoagulants, three strategies were considered: A) lowering the doses; B) maintaining full-doses; C) stopping treatment. The strategy and medication used were shown in a descriptive analysis and the rate of bleeding and VTE-recurrence between those in a comparative analysis. RESULTS: A total of 420 patients were included, 56.2% received DOACs, 43.8% enoxaparin. Strategy was defined in 257 patients: A (50.2%), B (46.3%), and C (3.5%). Forty-one (9.8%) had VTE-recurrence and 15 (3.6%) had MB or clinically relevant non-major bleeding (CRNMB).According to strategy, recurrent-VTE was 8.5% (A), 4.2% (B), and 11.1 (C) (p = 0.22), MB or CRNMB was 0.8% (A), 1.7% (B), and 0% (C) (p = 0.64). CONCLUSIONS: DOACs and strategy A were the most frequently used agent and strategy, respectively. There were no differences between medications or strategies used. The results must be interpreted with caution, and it is a retrospective single-center study, probably with information and selection bias.


Assuntos
Neoplasias , Tromboembolia Venosa , Adulto , Humanos , Heparina de Baixo Peso Molecular/efeitos adversos , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/complicações , Estudos Retrospectivos , Argentina/epidemiologia , Anticoagulantes/efeitos adversos , Hemorragia/etiologia , Neoplasias/complicações , Neoplasias/tratamento farmacológico
18.
PLoS One ; 18(11): e0286187, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38011251

RESUMO

INTRODUCTION: Hemophilia A and B are disorders associated with the deficit of coagulation factors VIII and IX. OBJECTIVE: Was to determine the incidence of complications in a cohort of patients diagnosed with moderate and severe hemophilia A or B under treatment in a specialized institution. METHODS: A retrospective study of a cohort of patients with replacement therapy for hemophilia A or B, evaluating treatment and complications between January/2012 and July/2019. Sociodemographic, clinical and disease management-related variables were extracted from the medical records. Time to inhibitor development and rate associated with bleeding and hospitalizations were evaluated. RESULTS: A total of 159 male patients were identified with hemophilia A (n = 140; 88.1%) and B (n = 19; 11.9%) with a mean follow-up of 5.9±2.3 years. The mean age was 23.6±16.1 years, hemophilia was reported as severe in 125 patients in hemophilia A (89.3%) and 13 patients in hemophilia B (68.4%). Primary prophylaxis was registered in 17.0% of patients, 44.7% secondary, and 38.3% tertiary, with recombinant factors (n = 84; 52.8%) followed by plasma derived factors (n = 75; 47.2%). The incidence of inhibitor development was 0.3 per 100 patients/year, with mean time to event of 509 days. The incidence of bleeding was 192 per 100 patients/year, especially at the joint (n = 99; 62.3%) and muscle (n = 25; 15.7%) level. The incidence of hospitalization was 3.7 per 100 patients/year. CONCLUSIONS: The most common complication was joint bleeding which was expected in this type of patients. Low proportion of patients developed factor inhibitors during the follow up.


Assuntos
Hemofilia A , Hemofilia B , Humanos , Masculino , Criança , Adolescente , Adulto Jovem , Adulto , Hemofilia A/complicações , Hemofilia A/tratamento farmacológico , Hemofilia A/epidemiologia , Hemofilia B/complicações , Hemofilia B/tratamento farmacológico , Hemofilia B/epidemiologia , Estudos Retrospectivos , Colômbia/epidemiologia , Fator VIII/uso terapêutico , Hemorragia/etiologia , Hemorragia/complicações
20.
J Clin Apher ; 38(6): 694-702, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37548357

RESUMO

BACKGROUND: Major bleeding in patients undergoing therapeutic plasma exchange (TPE) has been studied in large databases; but without standardizing bleeding definitions. Therefore, we used standardized definitions to evaluate major bleeding in hospitalized patients undergoing TPE using public use data files from the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III). STUDY DESIGN AND METHODS: In a retrospective cross-sectional analysis, we identified TPE-treated adults in a first inpatient encounter. We evaluated major bleeding prevalence using (1) International Classification of Diseases (ICD) or Current Procedural Terminology (CPT) codes, (2) packed red blood cell (PRBC) transfusion, or (3) hemoglobin (Hgb) decline. Patients with major bleeding prior to their first TPE were excluded from the analysis. RESULTS: Among 779 patients undergoing TPE, major bleeding by at least one of the three bleeding definitions occurred in 135 patients (17.3%). For each of the ICD/CPT, PRBC, and Hgb definitions, the prevalence of major bleeding was 2.8% (n = 31), 7.4% (n = 81), and 5.4% (n = 59), respectively. Only 3.7% of bleeds (5/135) were captured by all three definitions and 19.3% (26/135) exclusively by any two pairwise definitions. The addition of PRBC transfusion and Hgb decline to ICD/CPT code definitions increased bleeding prevalence threefold. CONCLUSION: Among hospitalized adults undergoing TPE in the REDS-III study, the prevalence of major bleeding was 17.3%. The addition of PRBC and Hgb decline to ICD codes increased bleeding prevalence threefold. Future studies are needed to develop validated models that identify patients at risk for major bleeding during TPE.


Assuntos
Hemorragia , Troca Plasmática , Adulto , Humanos , Troca Plasmática/efeitos adversos , Estudos Retrospectivos , Estudos Transversais , Prevalência , Hemorragia/epidemiologia , Hemorragia/etiologia , Hemorragia/terapia
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