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1.
Clin Biochem ; 74: 54-59, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31669512

RESUMO

BACKGROUND: In order to manage risks of bleeding and thrombosis after some surgical procedures, platelet function is often measured repeatedly over days or weeks using laboratory tests of platelet function. To interpret test results in the perioperative period, it is necessary to understand analytical, biological and between-person variation. METHODS: We collected three separate blood specimens from 16 healthy volunteers on the first study day, and one additional specimen from each volunteer 1, 2, and 3 months later. Arachidonic acid-induced and adenosine diphosphate (ADP)-induced platelet function were measured in duplicate by whole blood impedance aggregometry using Multiplate (ASPI/ADP tests) and VerifyNow (Aspirin Reaction Units [ARU] and P2Y12 Reaction Units [PRU]). The analytical variation (CVA), within-subject variation (CVI), between-subject variation (CVG), index of individuality (II), and reference change values (RCV) were calculated. RESULTS: VerifyNow ARU demonstrated the smallest short-term and long-term variability (CVA, CVI, and CVG ~1%), resulting in short- and long-term RCV values <5%. II was also higher (1.92) for VerifyNow ARU than other platelet function tests. Multiplate ASPI and ADP tests had the highest RCV both short-(19.0% and 25.2%, respectively) and long-term (32.1% and 39.6%, respectively) due to increased CVA (>5%) and CVI (3.9-13.1%). VerifyNow PRU had a lower RCV than Multiplate ADP; but was the only test with II <0.6. CONCLUSIONS: VerifyNow ARU results can be interpreted relative to a fixed cut-off or population-based reference interval; or relative to small changes in an individual's previous values. VerifyNow PRU and Multiplate ASPI and ADP tests should only be interpreted based upon relative change; and can only distinguish relatively large (>23%) changes over several weeks.


Assuntos
Variação Biológica da População/fisiologia , Testes de Função Plaquetária , Difosfato de Adenosina/farmacologia , Ácido Araquidônico/farmacologia , Aspirina/farmacologia , Feminino , Seguimentos , Hemorragia/prevenção & controle , Humanos , Masculino , Distribuição Normal , Agregação Plaquetária/efeitos dos fármacos , Inibidores da Agregação de Plaquetas/farmacologia , Valores de Referência , Trombose/prevenção & controle
3.
Expert Opin Drug Saf ; 18(12): 1171-1189, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31623473

RESUMO

Introduction: Potent platelet inhibition reduces the risk of thrombotic complications including myocardial infarction and death in patients with acute coronary syndrome (ACS). Targeting different pathways involved in thrombotic processes have synergistic effects and more effectively counteract thrombosis both in the acute and long-term following an ACS. Unavoidably, more potent platelet inhibition increases the risk of bleeding. In light of the adverse prognostic implications associated with bleeding, including increased mortality, safety aspects with antiplatelet therapy have gained increased importance.Areas covered: This review aims at describing the safety of different antiplatelet agents, particularly with regards to the risk of bleeding complications, used in the management of ACS patients. New bleeding reduction strategies to enhance the safety of antiplatelet therapy are also reviewed.Expert opinion: The final goal of a well-structured antiplatelet treatment strategy is that of tackling the spectrum of ischemic risk without compromising patient safety. A simple mnemonic rule for guiding therapeutic decisions in this complex clinical scenario can be summarized with the acronym 'ABC', meaning the sequential process of assessing, balancing and customizing treatment strategies in individual patients on the tradeoff between bleeding and ischemic risk. This approach is recommended for maximizing the ischemic benefits, while preserving safety, with the use of antiplatelet therapy.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Hemorragia/induzido quimicamente , Inibidores da Agregação de Plaquetas/efeitos adversos , Síndrome Coronariana Aguda/complicações , Hemorragia/epidemiologia , Hemorragia/prevenção & controle , Humanos , Inibidores da Agregação de Plaquetas/administração & dosagem , Trombose/etiologia , Trombose/prevenção & controle
5.
Urologiia ; (4): 38-43, 2019 Sep.
Artigo em Russo | MEDLINE | ID: mdl-31535803

RESUMO

INTRODUCTION: Nephrostomy tube placed after percutaneous removal of kidney stones can cause pain and discomfort in the early postoperative period [1, 2]. A tubeless percutaneous nephrolithotomy (PCNL) is considered as alternative approach. However, the most serious complication after tubeless procedure is a development of active uncontrolled bleeding from percutaneous tract in the early postoperative period. AIM: To improve the results of surgical treatment of kidney stones by evaluation of efficiency of using hemostatic matrix during tubeless PCNL. MATERIALS AND METHODS: A total of 113 patients with large kidney stones undergone to the tubeless PCNL for the past 9 years in our clinic. The external or internal stent was put for the drainage of upper urinary tract for 2 and 14 days, respectively. All patients were divided into 2 groups, depending on severity of bleeding (group 1 - no bleeding vs. group 2 - mild bleeding). Each group was further divided into two subgroups based on the technique and type of drainage of upper urinary tract at the end of the surgery. In the main group (n=74) the hemostatic matrix based on lyophilized thrombin 2000 IU was injected in percutaneous tract at the end of the surgery. The control group included 39 patients who underwent mini-PCNL without using hemostatic matrix. The blood loss, intensity of urine leakage from percutaneous tract (duration, visual analog scale) and degree of fluid extravasation in pararenal fat estimated by US were evaluated. RESULTS: The mean operative time was 47.5+/-3.6 min (52, 58, 38 and 49 min in subgroup I, II, III and control group, respectively). Hemoglobin drop was 9.3+/-4.1, 12.1+/-7.5, 14.6+/-11.2 and 10.6+/-5.9 in subgroups I, II, III and in the control group, respectively, while duration of hematuria was 16.1, 20.3, 28.5 and 22.9 hours, respectively. Fluid extravasation in pararenal space was found in 1 out 7 patients in subgroup III and control group, respectively (p<0.05). The dilatation of collection system (after double-J) persisted in 18.1%, 20% 22.2% and 13.3% cases in subgroup I, II, III and control group, respectively. There were no significant differences in other evaluated parameters. In 1 case in the control group there was severe bleeding which required selective embolization of the renal artery. CONCLUSION: The use of hemostatic matrix is an additional important measure which allows to prevent active bleeding from the percutaneous tract in early postoperative period. Moreover, the hemostatic matrix contributes to the sealing of tract and reduces the risk of fluid extravasation in pararenal space after mini-PCNL.


Assuntos
Hemorragia/prevenção & controle , Nefrolitotomia Percutânea , Humanos , Cálculos Renais , Nefrostomia Percutânea
6.
J Biol Regul Homeost Agents ; 33(3 Suppl. 1): 1-9, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31538444

RESUMO

Blood contamination of the canal during preparation and obturation can be a problem in Endodontics; this may result in apical microleakage. The purpose of this investigation was to observe and evaluate the hemostatic properties of biofilm decontaminant material (sulfonic/sulphuric acid solution, HybenX, EPIEN Medical) used in teeth with necrotic pulp and unstoppable bleeding after root canal shaping. A prospective study was designed with 2 randomized parallel groups: decontaminant material (experimental group) and sodium hypochlorite 5% (control group). The analysis of the root canal bleeding was evaluated by the clinician before and after the application of the sulfonic/sulphuric solution or sodium hypochlorite 5%, by measuring the millimeters of blood on a sterile paper point introduced in the root canal. Sixty patients with necrotic pulp and unstoppable bleeding were enrolled in this study and randomly divided into 2 groups: decontaminant material in 30 patients (experimental group) or sodium hypochlorite 5% in 30 patients (control group). T-test showed that the percentage change in millimeters of blood detected in the root canal was statistically greater for experimental group [mean difference: 0.74 (IC: 0.66-0.82); p less than 0.0001]. The hemostatic properties were better in the experimental group than in the sodium hypochlorite 5% group (control). Further research may be needed to confirm the results of this study..


Assuntos
Cavidade Pulpar , Hemorragia/prevenção & controle , Hemostáticos/uso terapêutico , Irrigantes do Canal Radicular/uso terapêutico , Humanos , Estudos Prospectivos , Tratamento do Canal Radicular , Hipoclorito de Sódio/uso terapêutico
8.
J Spec Oper Med ; 19(3): 45-50, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31539433

RESUMO

BACKGROUND: We sought opportunities to develop learning practices of individual first aid providers. In this study, we simulated deliberate practice in placing limb tourniquets. METHODS: This study comprised tourniquet uses by two experienced persons. Their practice sessions focused on developing a motor skill with periodic coaching. The Combat Application Tourniquet is 1.5-inches wide and was used in a technique of loop passage around the end of the limb to place it 2-3 inches above the wound. The simulated limb was a Z-Medica Hemorrhage Control Trainer. Both users applied the tourniquet six times over 5 days to accrue 30 uses individually (N = 60 tourniquet applications for the study). RESULTS: When represented as summary parameters, differences were small. For example, average ease of use was the same for both users, but such parameters only took a snapshot of performance, yielding a general assessment. However, for a learning curve by use number, a surrogate of experience accrual, application time revealed spiral learning. The amount that users compressed a limb averaged -15% compared with its unsqueezed state. Placement accuracy was classified relative to gap widths between the tourniquet and the wound, and of 60 performances, 55 were satisfactory and five were unsatisfactory (i.e., placement was <2 inches from the wound). When a tourniquet only overlaid the 2-inch edge of the placement zone (i.e., tourniquet was 2-3.5 inches away from the wound), no error was made, but errors were made in crossing that 2-inch edge. These gauging errors led us to create a template for learners to see and to demonstrate what the meaning of 2-3 inches is. CONCLUSION: Each metric had value in assessing first aid, but turning attention to gauging wound-tourniquet gaps revealed placement errors. Analysis of such errors uncovered what 2-3 inches meant in operation. Spiral learning may inform the development of best readiness practices such as coaching deliberate-practice sessions.


Assuntos
Primeiros Socorros , Hemorragia/prevenção & controle , Medicina Militar/educação , Torniquetes , Extremidades , Humanos
9.
J Spec Oper Med ; 19(3): 52-63, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31539434

RESUMO

Tourniquet application to stop limb bleeding is conceptually simple, but optimal application technique matters, generally requires training, and is more likely with objective measures of correct application technique. Evidence of problems with application techniques, knowledge, and training can be ascertained from January 2007 to August 2018 PubMed peer-reviewed papers and in Stop The Bleed-related videos. Available data indicates optimal technique when not under fire involves application directly on skin. For nonelastic tourniquets, optimal application technique includes pulling the strap tangential to the limb at the redirect buckle (parallel to the limb-encircling strap entering the redirect buckle). Before engaging the mechanical advantage tightening system, the secured strap should exert at least 150mmHg inward, and skin indentation should be visible. For Combat Application Tourniquets, optimal technique includes the slot in the windlass rod parallel to the stabilization plate during the single 180° turn that should be sufficient for achieving arterial occlusion, which involves visible skin indentation and pressures of 250mmHg to 428mmHg on normotensive adult thighs. Appropriate pressures on manikins and isolated-limb simulations depend on how the under-tourniquet pressure response of each compares to the under-tourniquet pressure response of human limbs for matching tourniquet-force applications. Lack of such data is one of several concerns with manikin and isolated-limb simulation use. Regardless of model or human limb use, pictures and videos purporting to show proper tourniquet application techniques should show optimal tourniquet application techniques and properly applied, arterially occlusive limb tourniquets. Ideally, objective measures of correct tourniquet application technique would be included.


Assuntos
Hemorragia/prevenção & controle , Torniquetes , Humanos , Pressão , Coxa da Perna
10.
J Spec Oper Med ; 19(3): 123-127, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31539448

RESUMO

Tourniquets have become ubiquitous tools for controlling hemorrhage in the modern prehospital environment, and while commercial products are preferable, improvised tourniquets play an important role when commercial options are not available. A properly constructed improvised tourniquet can be highly effective provided the user adheres to certain principles. This review article identifies key skills in the construction and application of improvised tourniquets on an extremity. An improvised tourniquet design for an extremity should include three components: a strap, a rod, and a securing mechanism. The strap can be made from a variety of materials, but cravat- like fabric has been shown to work well. Optimal strap dimensions should be at least 2cm in width and a continuous segment long enough to extend around the extremity while still offering ends to accommodate and secure the rod. The rod should be constructed from a material that is hard, strong, and capable of withstanding the torque placed on it without bending or breaking. After torque is applied, the rod must be secured into position to maintain the constricting force and survive patient transport. Finally, the need for an improvised tourniquet is a contingency that all first responders should anticipate. Hands-on training should be conducted routinely in conjunction with other first responder tasks.


Assuntos
Competência Clínica , Socorristas , Hemorragia/prevenção & controle , Torniquetes , Extremidades , Humanos
11.
Crit Care Resusc ; 21(3): 171-178, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31462204

RESUMO

OBJECTIVE: Fibrinogen is one of the first coagulation factors to be depleted during traumatic haemorrhage, and evidence suggests hypofibrinogenaemia leads to poor outcomes. A number of fibrinogen replacement products are currently available, with no clear consensus on the ideal product to use in severe traumatic haemorrhage. We hypothesised that it will be possible to rapidly administer fibrinogen concentrate (FC) guided by rotational thromboelastometry (ROTEM) FIBTEM A5 in patients presenting with trauma haemorrhage. METHODS: We examined 36 consecutive patients with trauma admitted to a level 1 trauma centre in Australia who received FC as part of their initial resuscitation. ROTEM analysis was conducted at various time points from emergency department (ED) admission to 48 hours after admission. The primary outcome was time to administration of FC after identification of hypofibrinogenaemia using ROTEM FIBTEM A5. Data were collected on quantity and timing of product transfusion, demographics, Injury Severity Score and laboratory values of coagulation. Spearman rank order correlation was used to determine the correlation between FIBTEM A5 and Clauss fibrinogen (FibC). RESULTS: Thirty-six patients received FC as their initial form of fibrinogen replacement during the study. Patients were hypofibrinogenaemic by both FIBTEM A5 (6 mm) and FibC (1.7 g/L) on presentation to the ED. It took a median of 22 minutes (IQR, 17-30 minutes) from time of a FIBTEM A5 analysis to FC administration. Both parameters increased significantly (P < 0.05) by 24 hours after admission. CONCLUSION: This study suggests that administration of FC represents a rapid and feasible method to replace fibrinogen in severe traumatic haemorrhage. However, the optimal method for replacing fibrinogen in traumatic haemorrhage is controversial and large multicentre randomised controlled trials are needed to provide further evidence. This study provided baseline data to inform the design of further clinical trials investigating fibrinogen replacement in traumatic haemorrhage.


Assuntos
Coagulação Sanguínea/efeitos dos fármacos , Fibrinogênio/administração & dosagem , Hemorragia/prevenção & controle , Tromboelastografia/instrumentação , Ferimentos e Lesões/tratamento farmacológico , Austrália , Transfusão de Sangue , Fibrinogênio/uso terapêutico , Hemorragia/diagnóstico , Humanos
12.
Life Sci ; 233: 116711, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31374233

RESUMO

AIMS: Insulin is a central peptide hormone required for carbohydrate metabolism; however, its role in diabetes-associated pulmonary disease is unknown. Here, we investigated the preventative effect of insulin against hyperglycemia-induced pulmonary vascular leakage and its molecular mechanism of action in the lungs of diabetic mice. MAIN METHODS: Vascular endothelial growth factor (VEGF) activated transglutaminase 2 (TGase2) by sequentially elevating intracellular Ca2+ and reactive oxygen species (ROS) levels in primary human pulmonary microvascular endothelial cells (HPMVECs). KEY FINDINGS: Insulin inhibited VEGF-induced TGase2 activation, but did not affect intracellular Ca2+ elevation and ROS generation. Insulin prevented VEGF-induced vascular leakage by inhibiting TGase2-mediated c-Src phosphorylation, disassembly of VE-cadherin and ß-catenin, and stress fiber formation. Insulin replacement therapy prevented hyperglycemia-induced TGase2 activation, but not ROS generation, in the lungs of diabetic mice. Insulin also prevented vascular leakage and cancer metastasis in the diabetic lung. Notably, vascular leakage was not detectable in the lungs of TGase2-null (Tgm2-/-) diabetic mice. SIGNIFICANCE: These findings demonstrate that insulin prevents hyperglycemia-induced pulmonary vascular leakage in diabetic mice by inhibiting VEGF-induced TGase2 activation rather than ROS generation.


Assuntos
Diabetes Mellitus Experimental/fisiopatologia , Proteínas de Ligação ao GTP/antagonistas & inibidores , Hemorragia/prevenção & controle , Hipoglicemiantes/farmacologia , Insulina/farmacologia , Pneumopatias/prevenção & controle , Transglutaminases/antagonistas & inibidores , Animais , Proteínas de Ligação ao GTP/fisiologia , Hemorragia/etiologia , Hemorragia/patologia , Humanos , Pneumopatias/etiologia , Pneumopatias/patologia , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/prevenção & controle , Neoplasias Pulmonares/secundário , Masculino , Melanoma Experimental/metabolismo , Melanoma Experimental/patologia , Melanoma Experimental/prevenção & controle , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Transglutaminases/fisiologia , Células Tumorais Cultivadas
13.
Expert Rev Clin Pharmacol ; 12(9): 859-865, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31352834

RESUMO

Introduction: Thrombocytopenia is a common hematological abnormality in patients with chronic liver disease (CLD), occurring in 64%~84% of patients with cirrhosis or fibrosis. Due to the increased risk of bleeding, thrombocytopenia potentially affects management of CLD, such as surgery or liver biopsy. Avatrombopag is a new oral thrombopoietin (TPO) receptor agonist, activating TPO receptor and increasing megakaryocytic proliferation/differentiation and platelet production. Areas covered: This review summarizes the collected data concerning pharmacokinetics, clinical efficacy, safety and tolerability profiles of avatrombopag for the management of thrombocytopenia in patients with CLD. Expert opinion: Avatrombopag is recently approved by Food and Drug Administration (FDA) for the treatment of thrombocytopenia in patients with CLD who are scheduled to undergo a procedure. Based on the available clinical trials, avatrombopag is superior to placebo in reducing the need for platelet transfusions or rescue procedures for bleeding. Avatrombopag is also recommended as alternative to platelet transfusions.


Assuntos
Hepatopatias/complicações , Tiazóis/uso terapêutico , Tiofenos/uso terapêutico , Trombocitopenia/tratamento farmacológico , Doença Crônica , Hemorragia/etiologia , Hemorragia/prevenção & controle , Humanos , Cirrose Hepática/complicações , Hepatopatias/fisiopatologia , Transfusão de Plaquetas/métodos , Receptores de Trombopoetina/agonistas , Tiazóis/efeitos adversos , Tiazóis/farmacologia , Tiofenos/efeitos adversos , Tiofenos/farmacologia , Trombocitopenia/etiologia
14.
Khirurgiia (Mosk) ; (7): 52-57, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31355815

RESUMO

OBJECTIVE: To compare incidence of thromboembolic and hemorrhagic complications in patients with atrial fibrillation (AF) undergoing elective surgery on different schemes of perioperative anticoagulant therapy (ACT). MATERIAL AND METHODS: There were 86 patients (56 (65.1%) men and 30 (34.9%) women, mean age was 69 (64; 78) years) with non-valvular AF who underwent elective interventions. Forty (46.5%) patients underwent abdominal surgery, 34 (39.5%) - cardiovascular procedures, 12 (14.0%) patients underwent surgery for malignant diseases. We have analyzed incidence of thromboembolic and hemorrhagic events and compliance of perioperative ACT modes with current international guidelines. RESULTS: Thromboembolic and hemorrhagic events developed in 14 (16.3%) patients. Thromboembolic complications were noted in 6 (7.0%) patients, hemorrhagic events - in 8 (9.3%) cases. Maximum complication rate was observed in case of bridge-therapy (n=12, 20.0%). Cancellation of ACT was followed by 2 (9.5%) complications, bridge-therapy - by 4 (6.7%) thromboembolic complications. Hemorrhagic events were 2 times more common in case of this therapy (n=8, 13.3%). It was found that ESC guidelines for perioperative ACT were applied in less than half of patients (41, 47.7% patients with AF undergoing elective surgery). Half of complications (8 out of 16) occurred if unapproved modes of ACT were used (including 7 cases of bridge-therapy was not necessary). The causes of these complications were inadequate assessment of perioperative risk of thromboembolic and hemorrhagic events; unreasonable administration of bridge therapy. CONCLUSION: An unambiguous clinical effect of bridge therapy has not been confirmed in patients with high risk of thromboembolic complications. Cancer patients have higher risk of complications compared with others. These events occur mainly due to non-compliance with clinical guidelines and insufficient prevention of thromboembolic events.


Assuntos
Anticoagulantes/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Hemorragia/prevenção & controle , Tromboembolia/prevenção & controle , Idoso , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Feminino , Fidelidade a Diretrizes , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tromboembolia/etiologia
15.
Curr Pain Headache Rep ; 23(9): 67, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31359193

RESUMO

PURPOSE OF REVIEW: Anticoagulant use among patients is prevalent and increasing. It is important for anesthesiologists to be aware of patients on anticoagulants while performing regional anesthesia. RECENT FINDINGS: In recent years, the FDA has approved many new anticoagulants. With new drugs coming to the market, new side effect profiles should be considered when treating patients, especially when using regional anesthesia. Both ASRA and European agencies have laid out recommendations regarding anticoagulant use and neuraxial/regional techniques. Regarding newer anticoagulants, the guidelines for discontinuation prior to neuraxial injection are based on pharmacokinetics, including half-life duration for each drug. While each clinical scenario requires an individualized approach, general guidelines can serve as a starting point to help with anesthetic planning and potentially improve patient safety in this evolving field.


Assuntos
Anestesia por Condução/métodos , Anticoagulantes/administração & dosagem , Medicina Baseada em Evidências/métodos , Administração Oral , Anestesia por Condução/efeitos adversos , Anticoagulantes/efeitos adversos , Medicina Baseada em Evidências/tendências , Hemorragia/induzido quimicamente , Hemorragia/diagnóstico , Hemorragia/prevenção & controle , Humanos , Fatores de Risco
16.
Am Surg ; 85(6): 601-605, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267900

RESUMO

The Stop the Bleed (STB) course teaches trainees prehospital hemorrhage control with a focus on mass education. Identifying populations most likely to benefit can help save on the significant cost and limited resources. In this study, we attempted to identify those populations and performed a cost analysis. Trainees underwent STB education and completed a survey on completion to assess demographics and prior experiences where STB skills could have been useful. Five hundred seventy-one trainees categorized as first responders (14%), students (56%), and the working public (30%) completed the survey. Most trainees found the lecture and simulation helpful, 96 per cent and 98 per cent, respectively. There were significant differences among groups who had previously been in situations where the STB course would have been helpful (88% first responders versus 40% students versus 43% public workers) (P < 0.001). Teaching a class of 10 students costs approximately $455; the cost can be as high as $1246 for a class of 50 students. Most STB trainees found the course helpful. First responders are most likely to be exposed to situations where course information could be helpful. Focusing on specific high-yield groups rather than mass education might be a more efficient approach to STB education.


Assuntos
Serviços Médicos de Emergência/organização & administração , Socorristas/educação , Hemorragia/prevenção & controle , Incidentes com Feridos em Massa/prevenção & controle , Adulto , Distribuição de Qui-Quadrado , Educação Médica/organização & administração , Educação Profissionalizante/organização & administração , Tratamento de Emergência , Feminino , Pessoal de Saúde/educação , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Pública/educação , Melhoria de Qualidade , Medição de Risco , Inquéritos e Questionários , Taxa de Sobrevida , Estados Unidos
17.
Mayo Clin Proc ; 94(8): 1535-1541, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31303429

RESUMO

OBJECTIVE: To assess the risk of hemorrhagic complications in patients taking novel oral anticoagulants (NOACs) and/or clopidogrel who underwent an ultrasound-guided thoracentesis. PATIENTS AND METHODS: A retrospective analysis was performed of ultrasound-guided thoracenteses completed at an academic institution between January 1, 2016, and November 14, 2017. All patients who underwent a thoracentesis while actively receiving treatment with an NOAC and/or clopidogrel were included in the study. Primary endpoints are any significant post-procedure bleeding complication; defined as a hemoglobin decrease of greater than 2 g/dL in 48 hours, hemothorax, chest wall hematoma, and bleeding requiring transfusion, surgery, or chest tube placement. RESULTS: A total of 115 thoracenteses were performed in 103 patients actively taking an NOAC (n=43) and/or clopidogrel (n=69). All patients used either the NOAC or clopidogrel within 24 hours before the procedure and continued using it daily thereafter. There were no bleeding complications. CONCLUSION: The overall risk of significant hemorrhage in patients taking an NOAC and/or clopidogrel while undergoing ultrasound-guided thoracentesis is very low. Albeit the total number of procedures reviewed may be insufficient to prove definitive safety, it is sufficient to provide a measure of relative risk when assessing benefits of thoracentesis in these patients.


Assuntos
Anticoagulantes/uso terapêutico , Clopidogrel/uso terapêutico , Derrame Pleural/cirurgia , Cirurgia Assistida por Computador/métodos , Toracentese/métodos , Centros Médicos Acadêmicos , Administração Oral , Idoso , Anticoagulantes/efeitos adversos , Clopidogrel/efeitos adversos , Estudos de Coortes , Feminino , Seguimentos , Hemorragia/induzido quimicamente , Hemorragia/prevenção & controle , Hemotórax/induzido quimicamente , Hemotórax/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Derrame Pleural/diagnóstico por imagem , Estudos Retrospectivos , Medição de Risco , Cirurgia Assistida por Computador/mortalidade , Taxa de Sobrevida , Resultado do Tratamento , Ultrassonografia de Intervenção
18.
Gen Thorac Cardiovasc Surg ; 67(11): 1001-1005, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31152378

RESUMO

Cabrol shunt and several of its modifications have been used as adjunctive procedures to control inaccessible bleeding occurring after aortic root surgeries. Nevertheless, the hemostatic effect of the shunt is suboptimal when the reconstructive procedure extends to the aortic arch and coronary arteries. We propose a "Mantle-style" modified Cabrol shunt to facilitate hemostasis of the exsanguination from the neo-root after aortic root replacement with concomitant arch and coronary reconstruction.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Hemorragia/prevenção & controle , Hemostasia Cirúrgica/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Vasos Coronários/cirurgia , Humanos , Masculino
19.
Expert Rev Cardiovasc Ther ; 17(6): 435-447, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31213156

RESUMO

Introduction: The radial artery is currently the most widely used access site for PCI procedures both acute and stable patient settings. Thanks to advantages in pharmacological therapy as well as in interventional devices, the rate of ischemic complications following PCI has significantly decreased. Nevertheless, this has been counterbalanced by an increased risk of periprocedural and late bleeding event, that can occur both at access and non-access sites. Choice of access site for PCI is of paramount importance to reduce the risk of access-related bleeding events. Areas covered: The aim of this review is to provide an overview of the actual available evidence comparing the transradial versus transfemoral approach to reduce hemorrhagic events. The most robust evidence comes from large randomized trials, partly also from observational registries, which compared the transradial and transfemoral approach. Expert opinion: Results show that radial access has proved to be decisive in reducing the incidence of hemorrhagic events. Furthermore, it showed a significant reduction in mortality and AKI compared to transfemoral access. However, increased experience in the use of the radial approach has led to less practice in the use of the femoral approach, which may be useful in cases of emergency, complications or inability to use the radial artery.


Assuntos
Hemorragia/prevenção & controle , Intervenção Coronária Percutânea/métodos , Artéria Femoral , Hemorragia/epidemiologia , Hemorragia/etiologia , Humanos , Incidência , Artéria Radial , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Resultado do Tratamento
20.
Vasc Health Risk Manag ; 15: 139-142, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31213821

RESUMO

Idarucizumab (Praxbind) is a humanized antibody fragment, that reversibly and with high affinityties up dabigatran (Pradaxa). Anticoagulation reversal is achieved immediately, and with no procoagulant effect. It is administered intravenously and clearance is renal. The main clinical application of idarucizumab is to antagonize bleeding related to dabigatran, especially if it occurs at critical sites, such as nervous system (central or peripheral), intraocular, pericardial, retroperitoneal or pulmonary. Other indications are: i) dabigatran-induced anticoagulation reversal in the need for emergency surgery or procedures at high risk of bleeding; and ii) second-line treatment in bleedings that persist despite local hemostasis procedures. In this narrative review, we comprehensively address clinical indications for idarucizumab, summing up evidence derived from a systematic literature review, but also from case reports.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antitrombinas/efeitos adversos , Coagulação Sanguínea/efeitos dos fármacos , Coagulantes/uso terapêutico , Dabigatrana/efeitos adversos , Hemorragia/prevenção & controle , Anticorpos Monoclonais Humanizados/efeitos adversos , Coagulantes/efeitos adversos , Medicina Baseada em Evidências , Hemorragia/induzido quimicamente , Humanos , Resultado do Tratamento
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