Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.721
Filtrar
1.
Heart Surg Forum ; 22(5): E360-E365, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31596712

RESUMO

BACKGROUND: The purpose of this study was to evaluate whether a relationship exists between baseline HEMORR2HAGES score and antithrombotic potency amongst patients presenting with bleeding complication. We hypothesized that the more antithrombotic regimen potency, the less HEMORR2HAGES score you have. METHODS: This is a retrospective observational study of patients admitted with a diagnosis of active bleeding between November 1, 2013 and August 31, 2015. The antithrombotic groups included patients on the following regimens: single antiplatelet therapy (SAP), single oral anticoagulant therapy (SOAC), dual antiplatelet therapy (DAPT), dual combination (SOAC+SAP), and triple antithrombotic therapy. The primary outcome was to review the mean HEMORR2HAGES score among the various groups. RESULTS: There were a total of 180 patients in the study. No significant difference was noted among the five groups in the HEMORR2HAGES score (P = .36). The highest HEMORR2HAGES score was in the SAP group (3.23 ± 1.1). The lowest HEMORR2HAGES score was in the DAPT group (2.59 ± 1.2). In the Sub Group analysis, we compared single versus dual versus triple therapy, and we found the lowest HEMORR2HAGES score in the triple therapy group (2.70 ± 1.6); (P = .29). CONCLUSIONS: Among patients admitted with active bleeding, the HEMORR2HAGES score did not differentiate antithrombotic potency amongst groups with various regimens. This study highlights the necessity to evaluate antithrombotic therapy according to benefits and harms.


Assuntos
Anticoagulantes/uso terapêutico , Hemorragia/tratamento farmacológico , Idoso , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Inibidores da Agregação de Plaquetas/efeitos adversos , Inibidores da Agregação de Plaquetas/uso terapêutico , Estudos Retrospectivos , Acidente Vascular Cerebral/prevenção & controle
2.
Hematology ; 24(1): 631-636, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31514689

RESUMO

Objectives: Acquired hemophilia A (AHA) is a rare disease resulting from autoantibodies against coagulation factor VIII that leads to spontaneous bleeding. This study reports the clinical characteristics and treatment outcomes of a relatively sizable cohort of patients with AHA. Methods: We retrospectively analyzed the characteristics and outcomes of 42 patients with AHA diagnosed in our center from January 2014 through December 2018. Results: The FVIII activity (FVIII: C) was significantly suppressed (median 1.5%; interquartile range [IQR]: 0.9-3.5) by FVIII inhibitor (median 8 BU/mL; IQR: 4.0-16.0). Bypassing agents, PCC or FVIIa, were used in 14 patients for bleeding control without any adverse reaction; and most patients (90.5%, 38/42) were placed on immunosuppressive regimen, corticosteroid alone or in combination with cyclophosphamide. Patients treated with corticosteroids alone had a lower median inhibitor titer (8 BU/mL) than those treated with combination corticosteroids of cyclophosphamide (16 BU/mL) (p < 0.001). 97.4% (37/38) patients achieved complete remission (CR) after immunosuppression therapy, and the median time to CR in patients treated with corticosteroids alone was shorter than those with combination corticosteroids of cyclophosphamide (median 40 days; IQR: 31-65 vs. 51 days; IQR: 38-83, p = 0.301). 10 (26.3%) patients relapsed thereafter and were placed on combined corticosteroid and cyclophosphamide treatment, which yielded second remission in 8 patients (80%). Two patients died, one from uncontrolled post-surgical retroperitoneal hemorrhage and one from sepsis complicating corticosteroid therapy. Conclusion: The corticosteroid achieves a satisfactory outcome, particularly with low inhibitors titers; and combination of cyclophosphamide will facilitate remission in sever patients with high titers of inhibitors.


Assuntos
Testes de Coagulação Sanguínea/métodos , Hemofilia A/terapia , Hemorragia/tratamento farmacológico , Adolescente , Adulto , Idoso , Criança , China , Feminino , Hemofilia A/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
3.
Toxicol Lett ; 316: 35-48, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31509773

RESUMO

Snake envenomation globally is attributed to an ever-increasing human population encroaching into snake territories. Responsible for many bites in Asia is the widespread genus Trimeresurus. While bites lead to haemorrhage, only a few species have had their venoms examined in detail. We found that Trimeresurus venom causes haemorrhaging by cleaving fibrinogen in a pseudo-procoagulation manner to produce weak, unstable, short-lived fibrin clots ultimately resulting in an overall anticoagulant effect due to fibrinogen depletion. The monovalent antivenom 'Thai Red Cross Green Pit Viper antivenin', varied in efficacy ranging from excellent neutralisation of T. albolabris venom through to T. gumprechti and T. mcgregori being poorly neutralised and T. hageni being unrecognised by the antivenom. While the results showing excellent neutralisation of some non-T. albolabris venoms (such as T. flavomaculaturs, T. fucatus, and T. macrops) needs to be confirmed with in vivo tests, conversely the antivenom failure T. hageni, and the very poor results against T. gumprechti and T. mcgregori, despite being conducted in the ideal scenario of preincubation of antivenom:venom, indicates that the likelihood of clinically relevant cross-reactivity for these species is low (T. gumprechti and T. mcgregori) to non-existent (T. hageni). These same latter three species were also not inhibited by the serine protease inhibitor AEBSF, suggesting that the toxins leading to a coagulotoxic effect in these species are non-serine proteases while in contrast T. albolabris coagulotoxicity was completely impeded by AEBSF, and thus driven by kallikrein-type serine proteases. There was a conspicuous lack of phylogenetic pattern in venom variation, with the most potent venoms (T. albolabris and T. hageni) being distant to each other on the organismal tree, and with the three most divergent and poorly neutralised venoms (T. gumprechti, T. hageni, and T. mcgregori) were also not each others closest relatives. This reinforces the paradigm that the fundamental dynamic evolution of venom results in organismal phylogeny being a poor predictor of venom potency or antivenom efficacy. This study provides a robust investigation on the differential venom effects from a wide range of Trimeresurus species on coagulation, highlighting differential fibrinogenolytic effects, while also investigating the relative antivenom neutralisation capabilities of the widely available Thai Red Cross Green Pit Viper antivenom. These results therefore have immediate, real-world implications for patients envenomed by Trimeresurus species.


Assuntos
Antídotos/farmacologia , Antivenenos/farmacologia , Coagulação Sanguínea/efeitos dos fármacos , Venenos de Crotalídeos/antagonistas & inibidores , Hemorragia/tratamento farmacológico , Mordeduras de Serpentes/tratamento farmacológico , Trimeresurus , Animais , Testes de Coagulação Sanguínea , Reações Cruzadas , Venenos de Crotalídeos/classificação , Venenos de Crotalídeos/imunologia , Venenos de Crotalídeos/metabolismo , Fibrinólise/efeitos dos fármacos , Hemorragia/sangue , Hemorragia/imunologia , Filogenia , Mordeduras de Serpentes/sangue , Mordeduras de Serpentes/imunologia , Trimeresurus/classificação
4.
Clin Appl Thromb Hemost ; 25: 1076029619873976, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31496264

RESUMO

Patients with von Willebrand disease (VWD) often require treatment with supplemental von Willebrand factor (VWF) prior to procedures or to treat bleeding. Commercial VWF concentrates and more recently recombinant human VWF (rVWF) have replaced cryoprecipitate as the mainstay of therapy. In comparison with cryoprecipitate, the VWF content and multimer distribution under current manufacturing processes of these commercial products has not been reported. We measured the factor VIII (FVIII:C), VWF antigen (VWF:Ag), VWF collagen-binding activity (VWF:CB), VWF platelet-binding activity by GPIbM enzyme-linked immunosorbent assay (VWF:GPIbM), and percentage of high-molecular-weight (HMWM) VWF in 3 pools of group A and O cryoprecipitate, 3 vials of VWF concentrate (Humate-P), and 1 lot of rVWF (Vonvendi). We found that both group O and group A cryoprecipitate have significantly higher ratios of VWF:GPIbM activity and FVIII:C activity relative to VWF:Ag and have better preservation of HMWM than Humate-P. Although not compared statistically, rVWF appears to have more HMWM VWF and a higher ratio of VWF:GPIbM to VWF:Ag than Humate-P and cryoprecipitate. The estimated acquisition cost for our hospital for treating one major bleeding episode was more than 4-fold higher with Humate-P and 7- to 10-fold higher with rVWF than with cryoprecipitate.


Assuntos
Doenças de von Willebrand/tratamento farmacológico , Fator de von Willebrand/análise , Ensaio de Imunoadsorção Enzimática/métodos , Fator VIII/análise , Fibrinogênio/análise , Hemorragia/tratamento farmacológico , Hemorragia/economia , Humanos , Proteínas Recombinantes/análise , Doenças de von Willebrand/economia
5.
J Clin Pharm Ther ; 44(5): 809-812, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31486123

RESUMO

WHAT IS KNOWN AND OBJECTIVE: The off-label use of fondaparinux in patients with heparin-induced thrombocytopenia with thrombosis (HITT) has historically been controversial. We present a case of successful fondaparinux use to treat HITT confirmed by the serotonin-release assay in the setting of other significant clotting and bleeding risk factors. CASE SUMMARY: We report a 19-year-old male with a history of Factor V Leiden and recent neurosurgery treated with fondaparinux after developing HITT confirmed by the serotonin-release assay (SRA). The patient achieved full platelet recovery on fondaparinux and was successfully transitioned to warfarin therapy without further thrombotic nor bleeding complications. WHAT IS NEW AND CONCLUSION: This case demonstrates a clear example of success of fondaparinux use to treat SRA-confirmed HITT in the setting of complicating factors and adds to the existing literature supporting the use of fondaparinux for HIT.


Assuntos
Fator V/metabolismo , Inibidores do Fator Xa/uso terapêutico , Fondaparinux/uso terapêutico , Serotonina/metabolismo , Trombocitopenia/tratamento farmacológico , Trombose/tratamento farmacológico , Adulto , Anticoagulantes/uso terapêutico , Coagulação Sanguínea/efeitos dos fármacos , Hemorragia/tratamento farmacológico , Hemorragia/metabolismo , Heparina/efeitos adversos , Humanos , Masculino , Trombocitopenia/induzido quimicamente , Trombocitopenia/metabolismo , Trombose/metabolismo , Adulto Jovem
6.
Curr Top Med Chem ; 19(22): 1990-2002, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31339072

RESUMO

BACKGROUND: In Brazil, the Bothrops genus accounts for 87% of registered snakebites, which are characterized by hemorrhage, tissue necrosis, hemostatic disturbances, and death. The treatment recommended by governments is the administration of specific antivenoms. Although antivenom efficiently prevents venom-induced lethality, it has limited efficacy in terms of preventing local tissue damage. Thus, researchers are seeking alternative therapies able to inhibit the main toxic effects of venoms, without compromising safety. OBJECTIVE: The study aimed to test the ability of aqueous extracts of leaves, stems, and fruits of the plant Clusia fluminensis to neutralize some toxic effects induced by the venoms of Bothrops jararaca and Bothrops jararacussu. METHODS: The plant extracts were incubated with venoms for 30 min. at 25 °C, and then in vitro (coagulant and proteolytic) and in vivo (hemorrhagic, myotoxic, and edematogenic) activities were evaluated. In addition, the extracts were administered to animals (by oral, intravenous or subcutaneous routes) before or after the injection of venom samples, and then hemorrhage and edema assays were performed. In addition, a gel solution of the fruit extract was produced and tested in terms of reducing hemorrhage effects. A chemical prospection was performed to identify the main classes of compounds present in the extracts. RESULTS: All the extracts inhibited the activities of the two venoms, regardless of the experimental protocol or route of administration of the extracts. Moreover, the gel of the fruit extract inhibited the venom-induced-hemorrhage. The extracts comprised of tannins, flavonoids, saponins, steroids, and terpenoids. CONCLUSION: Antivenom properties of C. fluminensis extracts deserve further investigation in order to gain detailed knowledge regarding the neutralization profile of these extracts.


Assuntos
Antivenenos/farmacologia , Clusia/química , Extratos Vegetais/farmacologia , Venenos de Serpentes/antagonistas & inibidores , Animais , Antivenenos/química , Antivenenos/isolamento & purificação , Bothrops , Brasil , Frutas/química , Hemorragia/tratamento farmacológico , Camundongos , Extratos Vegetais/química , Extratos Vegetais/isolamento & purificação , Folhas de Planta/química , Caules de Planta/química , Venenos de Serpentes/toxicidade
7.
Rozhl Chir ; 98(6): 245-247, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31331180

RESUMO

INTRODUCTION: Bleeding from epidural blood vessels may be an unpleasant complication during surgery of the lumbar spine, which is often difficult to manage with electrocoagulation. The use of local hemostatic agents is a possible solution. This paper presents the first experience with an agent of oxidized non-regenerated cellulose. METHODS: The agent of oxidized non-regenerated cellulose was used in 21 patients (12 women and 9 men) to stop bleeding from the ventral epidural lumbar venous plexus. It was always removed before the end of the operation. RESULTS: In all cases, bleeding was stopped within 2 minutes. Bleeding did not recur until the end of surgery (even after removal of the agent). No early or other complications were observed in the patients studied. CONCLUSION: The agent of oxidized non-regenerated cellulose appears to be a rational and effective solution for bleeding from epidural veins in the lumbar spine.


Assuntos
Celulose Oxidada , Hemorragia , Hemostáticos , Celulose Oxidada/uso terapêutico , Feminino , Hemorragia/tratamento farmacológico , Hemostáticos/uso terapêutico , Humanos , Vértebras Lombares , Masculino , Hemorragia Pós-Operatória
8.
Hosp Pract (1995) ; 47(3): 113-122, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31317796

RESUMO

Direct oral anticoagulants (DOACs) include dabigatran etexilate, a direct thrombin inhibitor, and specific inhibitors of activated coagulation factor X (FXa; e.g. apixaban, betrixaban, edoxaban, rivaroxaban). DOACs are associated with lower rates of major and fatal bleeding events compared with warfarin. Clinicians may need to achieve rapid reversal of anticoagulation effects of the DOACs in an emergency setting. Idarucizumab and andexanet alfa, which reverse the anticoagulant effects of dabigatran and FXa inhibitors, respectively, are DOAC reversal agents available in the US. Other reversal agents (e.g. ciraparantag for heparins, DOACs) are in development. Alternative nonspecific agents (e.g. fresh frozen plasma, prothrombin complex concentrate) are available. Nonspecific prohemostatic agents can counteract the anticoagulant action of DOACs in emergency situations, when specific reversal agents are unavailable. However, specific reversal agents are efficacious and safe and should be preferred when available. In this review, we discuss practical issues in the initiation of DOAC therapy, situations where reversal may be needed, coagulation assays, reversal agents, and post-reversal complications in the context of published evidence and guidelines.


Assuntos
Anticorpos Monoclonais Humanizados/farmacologia , Anticoagulantes/administração & dosagem , Antitrombinas/uso terapêutico , Dabigatrana/antagonistas & inibidores , Fator X/antagonistas & inibidores , Fator Xa/farmacologia , Pacientes Internados , Proteínas Recombinantes/farmacologia , Administração Oral , Coagulação Sanguínea/efeitos dos fármacos , Serviços Médicos de Emergência , Fator Xa/agonistas , Inibidores do Fator Xa/uso terapêutico , Hemorragia/tratamento farmacológico , Humanos , Corpo Clínico Hospitalar
9.
Chin J Integr Med ; 25(7): 483-489, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31278626

RESUMO

Chronic primary immune thrombocytopenia (CITP) is the most common acquired autoimmune disease that seriously threaten the physical and mental health of patients. Compared with Western medicine treatment, the intervention and treatment of Chinese medicine (CM) has shown certain therapeutic advantages. This paper reviewed the new pathogenesis progress on T cell immune abnormality in CITP, and CM studies on interferes effects of cellular immune regulation of CITP in recent years. Qi deficiency failing to control blood and internal obstruction of blood stasis are the two common types of CM syndromes in CITP patients, the corresponding treatments include invigorating Pi (Spleen), supplementing qi, activating blood, as well as tonifying qi and activating yang, regulating Gan (Liver) to invigorate Pi. The authors also mentioned the problems in the research field of CM for CTIP treatment, and put forward new ideas for the research in the future.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Imunidade Celular , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Púrpura Trombocitopênica Idiopática/imunologia , Pesquisa , Hemorragia/tratamento farmacológico , Humanos
10.
J Ethnopharmacol ; 242: 112046, 2019 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-31279070

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: In Colombia, the only authorized treatment to cure snakebite envenomation is with the use of antivenom. The antivenom neutralizes the systemic effects properly, but is not very effective at neutralizing local effects, thus several cases have lead to complications. On the other hand, rural communities turn to the use of plants that are easily accessible and available for basic health care. One of these plants is named Piper auritum (PA), which is traditionally highlighted in some indigenous communities of Antioquia and Chocó. AIM OF THE STUDY: The main objective of this work was to characterize the venom's toxicity by determining the Minimum Edema Dose (MED), the Minimum Coagulant Dose-Plasma (MCD-P), the Minimum Hemorrhagic Dose (MHD) and to determine the neutralizing power of the Total Ethanolic Extract (TEE) from leaves of PA on the localized and systemic effects caused by the Bothrops rhombeatus venom. MATERIALS AND METHODS: To begin, the minimum dose that causes edema-forming, coagulant and hemorrhagic activities was determined. The protocols investigated include coagulant and edematic activities caused by the venom of Bothrops rhombeatus which were neutralized by the TEE of PA. RESULTS: The MCD-P was found to be 0.206 ±â€¯0.026 µg, the MED is the same at 0.768 ±â€¯0.065 µg, and the MHD is 3.553 ±â€¯0.292 µg, which are different from the reports for Bothrops asper and Bothrops ayerbei. Next, a phytochemical screening was done to the TEE where mainly triterpenes, steroids, coumarins, saponins, and lignans were identified. Also present were 43,733 ±â€¯2106 mg AG/g ES of phenols, which are secondary metabolites that are probably responsible for the neutralization of coagulant and edematic activities at rates of 2363.870 µL and 1787.708 µL of extract/mg of venom, respectively. As a comparative parameter, the National Institute Health's (NHI) effective dose of the antivenom was used as a comparative parameter. In addition, we determined the toxicity of the TEE of PA on to Artemia salina, being moderately toxic at 6 and 24 h, while the essential oil of PA at the same observation hours is in the extremely toxic range. CONCLUSIONS: The results reflect that the extract of P. auritum has an anti-inflammatory effect similar to that of the NIH serum. It could be used as a complement of NIH antivenom, using them together so it contributes to effectively reduce inflammation and the socio-economic impact generated by the permanence of a patient victim of snakebite in health centers. CLASSIFICATIONS: Immunological products and vaccines.


Assuntos
Anti-Inflamatórios/uso terapêutico , Anticoagulantes/uso terapêutico , Antivenenos/uso terapêutico , Venenos de Crotalídeos/toxicidade , Piper , Extratos Vegetais/uso terapêutico , Animais , Anti-Inflamatórios/química , Anti-Inflamatórios/farmacologia , Anticoagulantes/química , Anticoagulantes/farmacologia , Antivenenos/química , Antivenenos/farmacologia , Artemia/efeitos dos fármacos , Coagulação Sanguínea/efeitos dos fármacos , Bothrops , Edema/tratamento farmacológico , Etanol/química , Hemorragia/tratamento farmacológico , Camundongos Endogâmicos ICR , Compostos Fitoquímicos/análise , Compostos Fitoquímicos/farmacologia , Compostos Fitoquímicos/uso terapêutico , Extratos Vegetais/química , Extratos Vegetais/farmacologia , Mordeduras de Serpentes/tratamento farmacológico , Solventes/química
12.
Monaldi Arch Chest Dis ; 89(2)2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170777

RESUMO

It is uncommon for Systemic lupus erythematosus (SLE) to present with diffuse alveolar hemorrhage (DAH) as the initial presentation. To diagnose this in a young male with no renal involvement is further uncommon. We report a case of a 16-year-old boy, who presented with hemoptysis and was eventually diagnosed as DAH with underlying SLE. Treatment with steroids and immunosuppressant helped in rapid recovery from this potentially life-threatening condition. This case highlights the need of defining diagnostic criteria for SLE in patients presenting as DAH and formulating guidelines for treatment of the same, especially in absence of co-existing lupus nephritis.


Assuntos
Hemoptise/etiologia , Hemorragia/etiologia , Lúpus Eritematoso Sistêmico/complicações , Alvéolos Pulmonares/patologia , Adolescente , Glucocorticoides/administração & dosagem , Hemorragia/diagnóstico , Hemorragia/tratamento farmacológico , Humanos , Imunossupressores/administração & dosagem , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Masculino
13.
ACS Appl Mater Interfaces ; 11(27): 23848-23857, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31245992

RESUMO

Thermal release of zeolite is conducive in hemostasis, but losing control will cause serious burns. How to balance the advantages and disadvantages is a challenge. Herein, a zeolite/cross-linked graphene sponge (Z-CGS) was design to break through this challenge. The CGS managed the heat release of zeolite by thermal conduction of graphene. Infrared thermal imager demonstrated the mild exothermic process and good thermal conductivity of the optimized Z-CGS. It controlled wound temperature below 42 °C effectively, as compared to 70 °C of naked zeolite. Blood clotting index further confirmed the contribution of thermal stimulation in Z-CGS. On the synergy of thermal and charge stimulations of zeolite, as well as physical adsorption of CGS, Z-CGS achieved outstanding hemostatic performance. Bleeding was stopped within 69 s in rat artery injury model, faster than that of the Quikclot Combat Gauze. Additionally, cytotoxicity assay and pathological analysis highlighted its biocompatibility. Z-CGS, therefore, was an outstanding composite of combining advantages of zeolite and graphene, while getting rid of the shortcomings of the basic unit. The thermal conductibility of graphene renews an avenue for the safe and highly efficient use of zeolite in hemostasis.


Assuntos
Grafite , Transtornos de Estresse por Calor/prevenção & controle , Hemorragia/tratamento farmacológico , Hemostasia/efeitos dos fármacos , Hemostáticos , Condutividade Térmica , Zeolitas , Animais , Grafite/química , Grafite/farmacologia , Hemostáticos/química , Hemostáticos/farmacologia , Ratos , Ratos Sprague-Dawley , Zeolitas/química , Zeolitas/farmacologia
14.
Nagoya J Med Sci ; 81(2): 259-267, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31239595

RESUMO

The activity of fibrinogen has been reported to decrease soon after the onset of major bleeding and to be an important determinant of the final extent of bleeding and postoperative outcome. A device that measures the perioperative fibrinogen level using the dry hematology (DH) method has recently become available. The aim of this study was to compare perioperative fibrinogen levels measured by the DH method with those measured by the conventional Clauss method and to assess the effects of heparin on these measurements. The study included 206 samples from 36 patients undergoing major surgery who received high-dose heparin (HH group, 23 samples), low-dose heparin (LH group, 57 samples), or no heparin (C group, 126 control samples). Each sample was measured using the DH and Clauss methods. After excluding samples outside the effective measurement range, the three study groups (HH group, n=23; LH group, n=49; C group, n=115) were compared. The mean fibrinogen level measured by the DH method in the HH group (87.9 ± 3.1%) was significantly lower than that measured by the Clauss method. There were no significant differences between the fibrinogen measurements obtained by the two methods between the LH and C groups. In patients on high-dose heparin, the mean fibrinogen level measured by the DH method was significantly lower than that measured by the Clauss method. When hemorrhage requires emergency treatment, a method that can measure the fibrinogen level rapidly is important. The DH method may be useful for decision-making with regard to perioperative coagulation factor replacement.


Assuntos
Fibrinogênio/análise , Hematologia/métodos , Feminino , Hemorragia/tratamento farmacológico , Hemorragia/metabolismo , Heparina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade
15.
Biomarkers ; 24(6): 517-523, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31215825

RESUMO

To evaluate whether genotype-guided antiplatelet therapy reduces the rates of cardiovascular events and bleeding events in patients with acute coronary syndrome (ACS). We systematically searched Pubmed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) (searched in September 2018) for controlled studies evaluating genotype-guided antiplatelet therapy in ACS with percutaneous coronary intervention (PCI) or without PCI. The primary endpoint was a composite of death, myocardial infarction (MI), stroke, targeted vessel revascularization and/or major bleeding. A total of five studies involving 2900 patients were included. Compared with the conventional group, the genotype-guided group had a decreased risk of primary composite outcomes (RR= 0.54; 95% CI: 0.41-0.72; I2 = 30%), death (RR = 0.54; 95% CI: 0.32-0.94; I2 = 21%), MI (RR = 0.52; 95% CI: 0.31-0.88; I2 = 49%), targeted vessel revascularization (RR = 0.59; 95% CI: 0.35-0.98; I2 = 0%), but not for stroke (RR = 0.53; 95% CI: 0.22-1.24; I2 = 0%) and bleeding events (RR = 0.80; 95% CI: 0.51-1.25; I2 = 33%). Genotype-guided strategies could reduce the rates of cardiovascular events without increasing bleeding events compared with conventional treatment in ACS. Future multi-centre genotype-based randomized control trials are required to confirm these findings.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Citocromo P-450 CYP2C19/genética , Hemorragia/tratamento farmacológico , Infarto do Miocárdio/tratamento farmacológico , Inibidores da Agregação de Plaquetas/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Trombose/tratamento farmacológico , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/genética , Síndrome Coronariana Aguda/mortalidade , Aspirina/uso terapêutico , Plaquetas , Revascularização Cerebral/métodos , Clopidogrel/uso terapêutico , Expressão Gênica , Genótipo , Hemorragia/etiologia , Hemorragia/genética , Hemorragia/mortalidade , Humanos , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/genética , Infarto do Miocárdio/mortalidade , Intervenção Coronária Percutânea/métodos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/genética , Acidente Vascular Cerebral/mortalidade , Análise de Sobrevida , Trombose/complicações , Trombose/genética , Trombose/mortalidade
16.
Emerg Med J ; 36(7): 395-400, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31217180

RESUMO

INTRODUCTION: Tranexamic acid (TXA) reduces bleeding and mortality. Recent trials have demonstrated improved survival with shorter intervals to TXA administration. The aims of this service evaluation were to assess the interval from injury to TXA administration and describe the characteristics of patients who received TXA pre-hospital and in-hospital. METHODS: We reviewed Trauma and Audit Research Network records and local trauma registries to identify patients of any age that received TXA at all London Major Trauma Centres and Queen's Medical Centre, Nottingham, during 2017. We used the 2016 NICE Guidelines (NG39) which state that TXA should be given within 3 hours of injury. RESULTS: We identified 1018 patients who received TXA, of whom 661 (65%) had sufficient data to assess the time from injury to TXA administration. The median interval was 74 min (IQR: 47-116). 92% of patients received TXA within 3 hours from injury, and 59% within 1 hour. Half of the patients (54%) received prehospital TXA. The median time to TXA administration when given prehospital was 51 min (IQR: 39-72), and 112 min (IQR: 84-160) if given in-hospital (p<0.001). In-hospital TXA patients had less haemodynamic derangement and lower base deficit on admission compared with patients given prehospital TXA. CONCLUSION: Prehospital administration of TXA is associated with a shorter interval from injury to drug delivery. Identifying a proportion of patients at risk of haemorrhage remains a challenge. However, further reinforcement is needed to empower pre-hospital clinicians to administer TXA to trauma patients without overt signs of shock.


Assuntos
Tempo para o Tratamento/estatística & dados numéricos , Ácido Tranexâmico/administração & dosagem , Adulto , Antifibrinolíticos/administração & dosagem , Antifibrinolíticos/farmacologia , Antifibrinolíticos/uso terapêutico , Feminino , Hemorragia/tratamento farmacológico , Hemorragia/mortalidade , Humanos , Londres , Masculino , Pessoa de Meia-Idade , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Estatísticas não Paramétricas , Ácido Tranexâmico/farmacologia , Ácido Tranexâmico/uso terapêutico , Centros de Traumatologia/organização & administração , Centros de Traumatologia/estatística & dados numéricos
17.
Drugs ; 79(10): 1147-1156, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31218660

RESUMO

Damoctocog alfa pegol (Jivi®) is approved in the USA, EU, Japan and Canada for the treatment and prophylaxis of previously treated patients aged ≥ 12 years with haemophilia A. Formulated with a 60 kDa polyethylene glycol (PEG) moiety, damoctocog alfa pegol is an intravenously (IV) administered recombinant factor VIII (rFVIII) product with a longer terminal half-life than non-PEGylated FVIII and rFVIII products. In the multinational phase II/III PROTECT VIII trial, prophylaxis with damoctocog alfa pegol reduced the likelihood of bleeding in previously treated patients aged ≥ 12 years with severe haemophilia A, with dosing schedules ranging from twice weekly to once every 7 days. Interim data from the ongoing extension phase indicated that the reduced annualized bleeding rates (ABRs) were maintained for up to 5.2 years of prophylaxis with damoctocog alfa pegol. Damoctocog alfa pegol was also effective in treating bleeding episodes and in providing haemostatic control during surgery. Damoctocog alfa pegol was generally well tolerated in adult and adolescent patients with severe haemophilia A, with most adverse events considered to be unrelated to treatment. There were no new or confirmed cases of FVIII inhibitor development and anti-PEG antibodies, observed in some patients, were of low titre and transient. Damoctocog alfa pegol extends the available treatment options in previously treated adults and adolescents with haemophilia A, offering the possibility of up to once-weekly administration for suitable patients.


Assuntos
Fator VIII/química , Hemofilia A/tratamento farmacológico , Polietilenoglicóis/química , Proteínas Recombinantes/farmacologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá , Criança , Relação Dose-Resposta a Droga , Esquema de Medicação , Aprovação de Drogas , Europa (Continente) , Feminino , Hemorragia/tratamento farmacológico , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Proteínas Recombinantes/química , Resultado do Tratamento , Estados Unidos , United States Food and Drug Administration , Adulto Jovem
18.
Med. clín (Ed. impr.) ; 152(12): 482-487, jun. 2019. mapas, tab
Artigo em Espanhol | IBECS | ID: ibc-183318

RESUMO

Objetivo: Comparar la incidencia de hemorragias entre los anticoagulantes orales (ACO) y analizar los factores que influyen en la aparición de hemorragias. Material y métodos: Estudio observacional, retrospectivo unicéntrico. Tras estudiar la población total en tratamiento con ACO, se analizó a los pacientes en tratamiento con un ACO del sector II de Zaragoza que acudieron al Servicio de Urgencias de Hospital Universitario Miguel Servet de julio a diciembre de 2015 por presentar algún evento. Se registraron datos demográficos, variables clínicas y características del evento hemorrágico. Como factores independientes en la aparición de hemorragias se valoró la dosis, fármacos, el sexo y la edad. Resultados: Había 9.452 pacientes en tratamiento con ACO, de los cuales 371 presentaron un evento hemorrágico (3,9%). La frecuencia por ACO fue 4,1% (311) en pacientes tratados con antagonistas de la vitamina K (AVK), 3,8% (33) con rivaroxaban, 3,3% (19) con dabigatran y, por último, con apixaban 2,1% (8) (p<0,05). En el análisis multivariante solo obtuvieron una influencia estadísticamente significativa la selección del anticoagulante y el sexo, en concreto, la dosis de apixaban 2,5mg y ser mujer presentaban menor riesgo de hemorragia (OR=0,1; IC=0,014-0,71 y OR=0,688; IC=0,55-0,85, respectivamente). Conclusión: Según los datos obtenidos, las mujeres y los pacientes en tratamiento con apixaban presentaban menor riesgo hemorrágico, si bien existen dudas de si este mejor perfil de seguridad está relacionado con una infradosificación, que podría influir en su efectividad. Por lo tanto, estos resultados deben ser analizados con prudencia y se deben realizar más estudios para confirmar estos datos


Objective: To compare the occurrence of haemorrhages among the different oral anticoagulants (OAC) and to analyse factors that influence it. Material and methods: Single-centre, observational, retrospective study. After studying the total population treated with OAC, patients who were treated with an OAC from July 2015 to December 2015 in the II Sector of the Zaragoza Hospital, who consulted the Emergency Department of the Miguel Servet University Hospital and presented a haemorrhagic event, were analysed. Patients' demographic data, clinical variables and data on the haemorrhagic event characteristics were gathered. Results: There were 9,452 patients treated with an OAC, 371 (3.9%) of which presented a haemorrhagic event. The frequency per OAC was; 4.1% (311) in patients treated with vitamin K antagonists, 3.8% (33) with rivaroxaban, 3.3% (19) with dabigatran and 2.1% (8) with apixaban. In the multivariate analysis, only the choice of anticoagulant and sex had a statistically significant influence of a lower risk of haemorrhage, in particular the dose of apixaban at 2.5mg and being female. (OR=0.1, CI=0.014-0.71 and OR=0.688, CI=0.55-0.85, respectively). Conclusion: According to the results obtained, females and patients undergoing treatment with apixaban presented lower haemorrhagic risk, although there are doubts about whether this better safety profile is related to underdosing, which could influence its effectiveness. Therefore, these results should be analysed with caution and further studies are needed to confirm this data


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Masculino , Anticoagulantes/administração & dosagem , Hemorragia/epidemiologia , Resultado do Tratamento , Anticoagulantes/uso terapêutico , Hemorragia/tratamento farmacológico , Estudos Retrospectivos , Análise Multivariada , Rivaroxabana/administração & dosagem , Dabigatrana/administração & dosagem , Análise Estatística , Eficácia
20.
Int J Lab Hematol ; 41 Suppl 1: 40-48, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31069986

RESUMO

Vitamin K antagonists (VKAs) cannot be administered without regular monitoring in order to assure their efficacy and safety. Indeed, if well managed, the VKAs appear to be no less efficacious or safe than the newer direct oral anticoagulants (DOACs). Although it is claimed that no regular monitoring of the DOACs is needed, their levels are increasingly being measured under a variety of circumstances, for example, prior to surgery, in suspected overdose, to confirm effective reversal, in patients with malabsorption and to assess patient compliance. Although no therapeutic range has been identified for the DOACs, it has been demonstrated for dabigatran and edoxaban that their antithrombotic effect increases gradually with increasing concentrations and that the risk of major bleeding also gradually increases. Furthermore, it has been determined that almost all dabigatran-related thrombotic events occur in patients with the lowest quartile concentration of the drug. This suggests that to assure an ideal effect of DOACs in all patients taking them, some form of regular monitoring and dose tailoring should be performed. For the vitamin K antagonists, the best outcome is obtained using formal algorithms and centralized management. Furthermore, data suggest that replacing the standard prothrombin time as a monitoring test may increase the stability of VKA anticoagulation with consequent reduction in thromboembolism without an increase in bleeding. Thus, it is likely that the outcome of all current oral anticoagulants can be improved in the coming years by improving monitoring and tailoring their effect.


Assuntos
Anticoagulantes/farmacocinética , Fibrilação Atrial , Monitoramento de Medicamentos/métodos , Hemorragia , Tromboembolia Venosa , Vitamina K/antagonistas & inibidores , Administração Oral , Anticoagulantes/uso terapêutico , Fibrilação Atrial/sangue , Fibrilação Atrial/tratamento farmacológico , Hemorragia/sangue , Hemorragia/tratamento farmacológico , Humanos , Tromboembolia Venosa/sangue , Tromboembolia Venosa/tratamento farmacológico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA