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1.
Medicine (Baltimore) ; 99(5): e19000, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000440

RESUMO

BACKGROUND: Patients with cancer are of a high level risk of venous thromboembolism (VTE). Low molecular weight heparin (LMWH) is recommended as the normal treatment for cancer-associated venous thrombosis. Recently, some studies suggest that patients with cancer-associated venous thrombosis can get a good efficacy and safety profile from treating with direct oral anticoagulants (DOACs) compared with other anticoagulants. However, when it comes to the efficacy of DAOCs in preventing VTE in patient with cancer, the data are limited. Thus, we performed such a meta-analysis to determine the efficacy and safety of DOACs in preventing VTE in patient with cancer compared with LMWHs. METHODS: Medline/PubMed and CENTRAL (The Cochrane Central Register of Controlled Trials) were systematically searched for relevant studies. For each trial, data on VTE, major bleeding, or bleeding were extracted by 2 reviewers independently. Pooled risk ratios (RRs) were calculated by using Review Manager 5.3 software and the significance was determined by the Z test. RESULTS: A total of 6 studies with 7185 patients were included in our meta-analysis. DOACs (RR = 0.55, 95% confidence interval [95%CI]: 0.34-0.90, I = 31%) had a similar prevention effect of VTE to LMWH (RR = 0.59, 95% CI: 0.37-0.95, I = 59%). DOACs (RR = 1.52, 95% CI: 0.99-2.33, I = 0%) yielded a similar bleeding occurrence rate compared with LMWH (RR = 1.35, 95% CI: 1.07-1.70, I = 35%). DOACs (RR = 1.95, 95% CI: 0.88-4.30, I = 0%) showed a sight higher major bleeding occurrence rate than LMWH (RR = 1.38, 95% CI: 0.88-2.14, I = 0%). CONCLUSION: DOACs show comparable efficacy to LMWH in cancer patients without VTE with a slightly higher major bleeding occurrence rate. DOACs are inclined to be an alternative thromboprophylaxis strategy in cancer patients as they have superiorities compared to traditional anticoagulation agents. Further studies are still demanded as exiting relevant researches are limited.


Assuntos
Anticoagulantes/administração & dosagem , Heparina de Baixo Peso Molecular/administração & dosagem , Neoplasias/complicações , Tromboembolia Venosa/prevenção & controle , Administração Oral , Hemorragia/induzido quimicamente , Humanos
2.
Rev Med Suisse ; 15(674): 2232-2235, 2019 Dec 04.
Artigo em Francês | MEDLINE | ID: mdl-31804034

RESUMO

The use of direct oral anticoagulants (DOACs) has been largely -implemented in the management of venous thromboembolic disease in non-cancer patients. In cancer-associated thrombosis, low molecular weight heparins (LMWHs) and especially dalteparin have long been the reference standard therapy. Following the publication of two randomised trials comparing edoxaban and rivaroxaban to -dalteparin, DOACs now represent an alternative with an interesting efficacy and safety profile. Moreover, they offer the comfort of an oral administration and a lower cost. In patients with gastrointestinal or genitourinary cancers however, a higher bleeding risk has been shown with DOACs. LMWHs thus remain the treatment of choice in this group of patients.


Assuntos
Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Neoplasias/complicações , Tromboembolia Venosa/complicações , Tromboembolia Venosa/tratamento farmacológico , Administração Oral , Dalteparina/administração & dosagem , Dalteparina/uso terapêutico , Heparina de Baixo Peso Molecular/administração & dosagem , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Piridinas/administração & dosagem , Piridinas/uso terapêutico , Rivaroxabana/administração & dosagem , Rivaroxabana/uso terapêutico , Tiazóis/administração & dosagem , Tiazóis/uso terapêutico
3.
Pan Afr Med J ; 34: 45, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762912

RESUMO

Hemocholecyst is defined as a hemorrhage into the gallbladder. It is a rare complication of anticoagulant therapies which can progress to spontaneous rupture of the gallbladder with hemorrhagic shock. We report the case of a 75-year old hypertensive, dyslipidemic man with hypertensive heart disease initially hospitalized for left hemiplegia. The patient received antiplatelet and anticoagulant therapy with low molecular weight heparin (LMWH) as prevention strategy. After 5 days of treatment the patient developed hemocholecyst and hemoperitoneum, confirmed by angio-abdominal computerized tomography scan in emergency assessment. The patient underwent cholecystectomy, hemostasis of the gallbladder fossa and evacuation of the hemoperitoneum.


Assuntos
Anticoagulantes/efeitos adversos , Colecistectomia/métodos , Doenças da Vesícula Biliar/diagnóstico por imagem , Hemoperitônio/diagnóstico por imagem , Idoso , Anticoagulantes/administração & dosagem , Doenças da Vesícula Biliar/induzido quimicamente , Doenças da Vesícula Biliar/terapia , Hemoperitônio/induzido quimicamente , Hemoperitônio/terapia , Heparina de Baixo Peso Molecular/administração & dosagem , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Masculino , Ruptura Espontânea , Tomografia Computadorizada por Raios X
4.
Dtsch Med Wochenschr ; 144(18): 1286-1300, 2019 09.
Artigo em Alemão | MEDLINE | ID: mdl-31514220

RESUMO

Pulmonary embolism (PE) is a life-threatening disease and the third most frequent cardiovascular cause of death after stroke and myocardial infarction. The annual incidence is increasing. The individual risk for PE-related complications and death increases with the number of comorbidities and severity of right ventricular dysfunction. Using clinical, laboratory and imaging parameters, patients with PE can be stratified to four risk classes (high, intermediate-high, intermediate-low and low risk). This risk stratification has concrete therapeutic consequences ranging from out-of-hospital treatment of low-risk patients to reperfusion treatment of (intermediate-) high-risk patients. For haemodynamically unstable patients, a treatment decision should preferable be made in interdisciplinary "Pulmonary Embolism Response Teams" (PERT). Being comparably efficient and due to a preferable safety profile compared to vitamin-K antagonists (VKAs), non-vitamin K-dependent oral anticoagulants (NOACs) are increasingly considered to be the treatment of choice for initial and prolonged anticoagulation of patients with pulmonary embolism. The use of low molecular weight heparins (LMWHs) is recommended for PE patients with cancer; however, recent studies indicate that treatment with factor Xa-inhibitors may be effective and safe (in patients without gastrointestinal cancer). Only prolonged anticoagulation (in reduced dosage) will ensure reduction of VTE recurrence and thus should be considered for all patients with unprovoked events.


Assuntos
Embolia Pulmonar , Administração Oral , Adolescente , Adulto , Idoso , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Criança , Alemanha , Heparina de Baixo Peso Molecular/administração & dosagem , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Incidência , Pessoa de Meia-Idade , Neoplasias/complicações , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/terapia , Fatores de Risco , Adulto Jovem
5.
Ulus Travma Acil Cerrahi Derg ; 25(4): 410-416, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31297774

RESUMO

BACKGROUND: The aim of this study was to compare the clinical and radiological results of the proximal femoral nail antirotation (PFNA) with those of the dynamic hip screw (DHS) and percutaneous compression plate (PCCP) in the treatment of simple pertrochanteric fractures. METHODS: A total of 203 patients were included in the study. PFNA fixations were performed in 73 patients (PFNA group), DHS in 68 patients (DHS group), and PCCP in 62 patients (PCCP group). The main outcome measurements were perioperative properties, the Harris hip score, changes in the neck-shaft angle, and loss of the abductor muscle strength. Data were compared between the groups. RESULTS: The mean estimated total blood loss and the number of patients receiving the blood transfusion rate in the PFNA group were statistically significantly lower. The mean operation and fluoroscopy times in the PCCP group were statistically significantly higher. The mean loss of the abductor muscle strength and changes in the neck-shaft angle in the PFNA group were statistically significantly higher. The mean Harris hip scores were similar. CONCLUSION: Our findings demonstrated that although PFNA was superior with regard to the perioperative data, DHS and PCCP were superior in maintaining the reduction and the abductor muscle strenght. All three implants were similar and had satisfactory functional outcomes.


Assuntos
Pinos Ortopédicos , Placas Ósseas , Parafusos Ósseos , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Anticoagulantes/administração & dosagem , Pinos Ortopédicos/normas , Placas Ósseas/normas , Parafusos Ósseos/normas , Cefazolina/administração & dosagem , Exercício , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fluoroscopia , Fixação Interna de Fraturas/normas , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Masculino , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Radiografia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Trombose Venosa/prevenção & controle
6.
Ceska Gynekol ; 84(3): 229-232, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31324115

RESUMO

OBJECTIVE: Summary of available literature concerning recommendation of antithrombotic prophylaxis in the infertility treatment by in vitro fertilization (IVF) and in pregnancies after IVF. DESIGN: Review article. SETTINGS: Department of Obstetrics and Gynecology, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký University Olomouc; Institute of Medical Genetics, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký University Olomouc. METHODS: Analysis of literary sources and databases Medline, Web of Science, Scholar Google, 2010-2018. CONCLUSION: The incidence of thromboembolism in the first trimester of pregnancy after IVF is 0.2% e. g. 10-times higher compared to normal pregnant population. Pregnancies after IVF are complicated in 6-7% by ovarian hyperstimulation syndrome (OHSS), they then have the risk of venous thromboembolism (VTE) 1.7% in the first trimester, what is 100-times higher as compared to the general population. Women after IVF without OHSS have a 5-times higher risk of VTE compared to the general population. To lower the risk of thromboembolism during treatment, use of low dose gonadotrophin (mild) stimulation protocols, prioritization of antagonistic stimulation protocols, avoidance of OHSS using GnRH agonists instead of hCG, cryo embryotransfer in natural cycles, reduction of incidence of multiple pregnancy by single embryo transfer, use of prophylactic and therapeutic low molecular weight heparin (LMWH) is recommended. These strategies can reduce the risk of thromboembolism. The LMWH application is suitable in pregnant women in the first trimester of pregnancy after IVF where OHSS was present.


Assuntos
Fertilização In Vitro/efeitos adversos , Fibrinolíticos/administração & dosagem , Heparina de Baixo Peso Molecular/administração & dosagem , Síndrome de Hiperestimulação Ovariana/complicações , Complicações Hematológicas na Gravidez/etiologia , Tromboembolia/prevenção & controle , Transferência Embrionária , Feminino , Humanos , Indução da Ovulação , Gravidez , Complicações Hematológicas na Gravidez/tratamento farmacológico , Taxa de Gravidez , Tromboembolia/tratamento farmacológico , Tromboembolia/etiologia
7.
Cancer Treat Res ; 179: 103-115, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317483

RESUMO

The management of cancer-associated thrombosis (CAT) is complex, and treatment strategies have been evolving over the past 15 years. It is well recognized that oral vitamin K antagonists are difficult to use in cancer patients, with higher rates of treatment failure and bleeding complications than in non-cancer patients. Low-molecular-weight-heparin (LMWH) became the widely accepted standard of care for treatment of cancer-associated thrombosis, following the CLOT study comparing dalteparin with warfarin in 2003. LMWH remains widely used for the treatment of CAT. However, in the past two years, several studies have served to validate direct oral anticoagulants as a safe and effective alternative to LMWH. Two randomized clinical trials comparing edoxaban and rivaroxaban with dalteparin, and several retrospective studies have shown the efficacy of edoxaban and rivaroxaban for the treatment of CAT. However, there is an evidence of increased bleeding with the DOACs, particularly gastrointestinal or urinary tract bleeding in patients with lesions within the gastrointestinal or urinary tracts. This chapter discusses the ongoing development of optimal treatment strategies for cancer-associated thrombosis.


Assuntos
Anticoagulantes/administração & dosagem , Inibidores do Fator Xa/administração & dosagem , Heparina de Baixo Peso Molecular/administração & dosagem , Neoplasias/complicações , Tromboembolia Venosa/tratamento farmacológico , Administração Oral , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Inibidores do Fator Xa/efeitos adversos , Inibidores do Fator Xa/uso terapêutico , Hemorragia/induzido quimicamente , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Tromboembolia Venosa/etiologia
8.
Am J Health Syst Pharm ; 76(14): 1019-1027, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31361880

RESUMO

PURPOSE: This review summarizes the available evidence concerning direct oral anticoagulant (DOAC) use to treat venous thromboembolism (VTE) in patients with cancer as well as pertinent safety data on the use of DOACs in patients with both cancer and atrial fibrillation. SUMMARY: The introduction of DOACs into clinical practice changed the way thrombotic complications are managed and prevented in diverse patient populations, including VTE and atrial fibrillation. Low-molecular-weight heparins have been the standard of care for treating VTE in cancer patients due to superiority over vitamin K antagonists in preventing recurrent VTE. Therefore, widespread DOAC use for VTE in patients with active cancer has not been adopted. CONCLUSION: Recent randomized clinical trials (SELECT-D, Hokusai VTE Cancer) have provided evidence that DOACs may have a role in treating VTE in cancer patients.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Neoplasias/complicações , Tromboembolia Venosa/tratamento farmacológico , Administração Oral , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Padrão de Cuidado , Resultado do Tratamento , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle , Vitamina K/antagonistas & inibidores
9.
Saudi Med J ; 40(6): 610-613, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31219497

RESUMO

Diffuse alveolar hemorrhage is an uncommon and often fatal condition in children that is characterized by distinct histopathological etiologies. Herein, we discuss the case of an 11-year-old girl who presented with acute worsening of hypoxia and left-sided chest pain. The patient had lung biopsy-proven idiopathic pulmonary capillaritis and was being treated with prednisolone every alternate day, azathioprine, and hydroxychloroquine. A contrast-computed tomography (CT) scan of the chest showed an acute left lower-lobe pulmonary embolism. Negative results were obtained on a test for thrombophilia. In children, pulmonary embolism with anti-neutrophil cytoplasmic antibody-negative idiopathic pulmonary capillaritis is a rare clinical condition. The exact cause of thrombus formation in this case is unknown; however, obesity, immobility, and chronic systemic corticosteroid therapy probably played a role.


Assuntos
Capilares , Pulmão/irrigação sanguínea , Embolia Pulmonar/etiologia , Vasculite/complicações , Doença Aguda , Anticorpos Anticitoplasma de Neutrófilos , Dor no Peito/etiologia , Criança , Feminino , Hemorragia/etiologia , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Hidroxicloroquina/administração & dosagem , Hipóxia/etiologia , Pneumopatias/etiologia , Mercaptopurina/administração & dosagem , Mercaptopurina/análogos & derivados , Prednisolona/administração & dosagem , Alvéolos Pulmonares , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamento farmacológico , Resultado do Tratamento
10.
BMC Surg ; 18(Suppl 1): 82, 2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-31074394

RESUMO

BACKGROUND: Currently, there is no strong evidence on the effectiveness and safety of pharmacological antithrombotic prophylaxis in thyroid surgery. The aim of this study was to establish whether the prophylactic use of low-molecular-weight heparin (LMWH) could negatively affect the early outcomes of patients undergoing total thyroidectomy. METHODS: Data from patients submitted to total thyroidectomy between February 2013 and October 2017 were retrospectively collected and analysed. Only patients with indication to antithrombotic prophylaxis according to current guidelines were included in the study. Eligible cases were divided into two groups, which corresponded to two distinct periods of our surgical practice: Group A, which included 178 consecutive patients who were submitted to antithrombotic prophylaxis with LMWH, and Group B, which included 348 consecutive patients who did not receive prophylaxis. Primary endpoints were the incidence of post-operative cervical haematomas (POCH) and thromboembolic events. Secondary endpoint was the length of postoperative hospital stay. Statistical analysis was performed by using Student's t test for continuous variables and Chi-square test for categorical variables. A P value of less than 0.05 was considered statistically significant. RESULTS: The two groups of patients were comparable in terms of age, gender, thyroid disease, duration of surgery, and weight of the thyroid gland. Overall, no thromboembolic events were registered. The comparative analysis of the other outcome measures, showed no significant differences between the two groups (POCH: 2 cases (1.12%) in Group A vs 8 cases (2.30%) in Group B - p 0.349; Postoperative hospital stay: 2.90 ± 0.86 days in Group A vs 2.89 ± 0.99 days in Group B - p 0.908). CONCLUSIONS: Data from this study do not support or contraindicate the use of antithrombotic prophylaxis in thyroid surgery. However, since thyroidectomy is a closed-space procedure, and even modest bleeding may quickly result in airway compression and death by asphyxia, mechanical prophylaxis should be preferred to LMWH whenever possible. TRIAL REGISTRATION: ISRCTN ISRCTN12029395. Registered 05/02/2018 retrospectively registered.


Assuntos
Fibrinolíticos/administração & dosagem , Heparina de Baixo Peso Molecular/administração & dosagem , Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Idoso , Estudos de Coortes , Feminino , Hemorragia/epidemiologia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
Stroke ; 50(5): 1149-1155, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30943884

RESUMO

Background and Purpose- There are limited data on intravenous thrombolysis treatment in patients with ischemic stroke who have received prophylactic doses of low molecular weight heparins (LMWHs). We aimed to evaluate the safety and outcomes of intravenous thrombolysis treatment in stroke patients taking thromboprophylactic doses of LMWH. Methods- We analyzed 109 291patients treated with intravenous thrombolysis, recorded in the Safe Implementation of Treatments in Stroke International Thrombolysis Register between 2003 and 2017 not taking oral anticoagulants or therapeutic doses of heparin at stroke onset. One thousand four hundred eleven patients (1.3%) were on prophylactic LMWH for deep venous thrombosis prevention. Outcome measures were symptomatic intracerebral hemorrhage, parenchymal hematoma, death within 7 days and 3 months, and functional dependency at 3 months. Results- Patients on LMWH were older, had more severe strokes, more prestroke disability, and comorbidities than patients without LMWH. There was no significant increase in adjusted odds ratios (aOR) for symptomatic intracerebral hemorrhage (aOR, 1.02 [95% CI, 0.48-2.17] as per Safe Implementation of Treatments in Stroke -MOST, aOR, 0.95 [0.59-1.53] per ECASS II]), nor for 7-day mortality (aOR, 1.14 [0.82-1.59]), in the prophylactic LMWH group. The LMWH group had a higher aOR for 3-month mortality (aOR, 1.94 [1.49-2.53]) and functional dependency, aOR, 1.44 (1.10-1.90). Propensity score analysis matching patients on baseline characteristics removed differences between groups on all outcomes except 3-month mortality. Conclusions- Intravenous thrombolysis in patients with acute ischemic stroke on treatment with prophylactic doses of LMWH at stroke onset is not associated with an increased risk of symptomatic intracerebral hemorrhage or early death.


Assuntos
Anticoagulantes/administração & dosagem , Heparina de Baixo Peso Molecular/administração & dosagem , Profilaxia Pré-Exposição/métodos , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Administração Intravenosa , Idoso , Feminino , Humanos , Masculino , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Terapia Trombolítica/mortalidade , Terapia Trombolítica/tendências , Resultado do Tratamento
13.
Cochrane Database Syst Rev ; 3: CD004318, 2019 03 27.
Artigo em Inglês | MEDLINE | ID: mdl-30916777

RESUMO

BACKGROUND: This an update of the review first published in 2009.Major abdominal and pelvic surgery carries a high risk of venous thromboembolism (VTE). The efficacy of thromboprophylaxis with low molecular weight heparin (LMWH) administered during the in-hospital period is well-documented, but the optimal duration of prophylaxis after surgery remains controversial. Some studies suggest that patients undergoing major abdominopelvic surgery benefit from prolongation of the prophylaxis up to 28 days after surgery. OBJECTIVES: To evaluate the efficacy and safety of prolonged thromboprophylaxis with LMWH for at least 14 days after abdominal or pelvic surgery compared with thromboprophylaxis administered during the in-hospital period only in preventing late onset VTE. SEARCH METHODS: We performed electronic searches on 28 October 2017 in the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, LILACS and registered trials (Clinicaltrials.gov October 28, 2017 and World Health Organization International Clinical Trials Registry Platform (ICTRP) 28 October 2017). Abstract books from major congresses addressing thromboembolism were handsearched from 1976 to 28 October 2017, as were reference lists from relevant studies. SELECTION CRITERIA: We assessed randomized controlled clinical trials (RCTs) comparing prolonged thromboprophylaxis (≥ fourteen days) with any LMWH agent with placebo, or other methods, or both to thromboprophylaxis during the admission period only. The population consisted of persons undergoing abdominal or pelvic surgery for both benign and malignant pathology. The outcome measures included VTE (deep venous thrombosis (DVT) or pulmonary embolism (PE)) as assessed by objective means (venography, ultrasonography, pulmonary ventilation/perfusion scintigraphy, spiral computed tomography (CT) scan or autopsy). We excluded studies exclusively reporting on clinical diagnosis of VTE without objective confirmation. DATA COLLECTION AND ANALYSIS: Review authors identified studies and extracted data. Outcomes were VTE (DVT or PE) assessed by objective means. Safety outcomes were defined as bleeding complications and mortality within three months after surgery. Sensitivity analyses were also performed with unpublished studies excluded, and with study participants limited to those undergoing solely open and not laparoscopic surgery. We used a fixed-effect model for analysis. MAIN RESULTS: We identified seven RCTs (1728 participants) evaluating prolonged thromboprophylaxis with LMWH compared with control or placebo. The searches resulted in 1632 studies, of which we excluded 1528. One hundred and four abstracts, eligible for inclusion, were assessed of which seven studies met the inclusion criteria.For the primary outcome, the incidence of overall VTE after major abdominal or pelvic surgery was 13.2% in the control group compared to 5.3% in the patients receiving out-of-hospital LMWH (Mantel Haentzel (M-H) odds ratio (OR) 0.38, 95% confidence interval (CI) 0.26 to 0.54; I2 = 28%; moderate-quality evidence).For the secondary outcome of all DVT, seven studies, n = 1728, showed prolonged thromboprophylaxis with LMWH to be associated with a statistically significant reduction in the incidence of all DVT (M-H OR 0.39, 95% CI 0.27 to 0.55; I2 = 28%; moderate-quality evidence).We found a similar reduction when analysis was limited to incidence in proximal DVT (M-H OR 0.22, 95% CI 0.10 to 0.47; I2 = 0%; moderate-quality evidence).The incidence of symptomatic VTE was also reduced from 1.0% in the control group to 0.1% in patients receiving prolonged thromboprophylaxis (M-H OR 0.30, 95% CI 0.08 to 1.11; I2 = 0%; moderate-quality evidence).No difference in the incidence of bleeding between the control and LMWH group was found, 2.8% and 3.4%, respectively (M-H OR 1.10, 95% CI 0.67 to 1.81; I2 = 0%; moderate-quality evidence).No difference in mortality between the control and LMWH group was found, 3.8% and 3.9%, respectively (M-H OR 1.15, 95% CI 0.72 to 1.84; moderate-quality evidence).Estimates of heterogeneity ranged between 0% and 28% depending on the analysis, suggesting low or unimportant heterogeneity. AUTHORS' CONCLUSIONS: Prolonged thromboprophylaxis with LMWH significantly reduces the risk of VTE compared to thromboprophylaxis during hospital admittance only, without increasing bleeding complications or mortality after major abdominal or pelvic surgery. This finding also holds true for DVT alone, and for both proximal and symptomatic DVT. The quality of the evidence is moderate and provides moderate support for routine use of prolonged thromboprophylaxis. Given the low heterogeneity between studies and the consistent and moderate evidence of a decrease in risk for VTE, our findings suggest that additional studies may help refine the degree of risk reduction but would be unlikely to significantly influence these findings. This updated review provides additional evidence and supports the previous results reported in the 2009 review.


Assuntos
Anticoagulantes/administração & dosagem , Heparina de Baixo Peso Molecular/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle , Embolia Pulmonar/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Abdome/cirurgia , Esquema de Medicação , Hospitalização , Humanos , Pelve/cirurgia , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Embolia Pulmonar/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Tromboembolia Venosa/epidemiologia
15.
PLoS One ; 14(3): e0213940, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30897142

RESUMO

BACKGROUND: Low-molecular-weight heparin (LMWH) is usually recommended for the treatment of cancer-associated thrombosis (CAT) but this treatment requires burdensome daily injections. We did a systematic review to compare the efficacy and safety of direct oral anticoagulants (DOAC), vitamin K antagonists (VKA) and LMWH in patients with CAT. METHODS: We searched Pubmed, Embase and CENTRAL for randomised controlled trials comparing DOAC, VKA and LMWH in patients with CAT. Pairwise and network meta-analyses were computed for venous thromboembolism (VTE) recurrence and bleeding complications. RESULTS: We identified 14 studies, including 4,661 patients. In pairwise comparison, DOAC were superior to LMWH to prevent VTE recurrence (HR 0.63; 95% CI 0.42-0.96) and LMWH was superior to VKA (HR 0.53; 95% CI 0.40-0.70). The rate of major bleeding was higher with DOAC compared to LMWH (HR 1.78; 95% CI 1.11-2.87). In the network meta-analysis, DOAC had a lower, but non-significant, rate of VTE recurrence compared to LMWH (HR 0.74; 95% CI 0.54-1.01). Both DOAC (HR 0.42; 95% CI 0.29-0.61) and LMWH (HR 0.57; 95% CI 0.44-0.75) were associated with lower rates of recurrence compared to VKA. No significant difference in major bleeding rate was observed in the network meta-analysis. Inconsistency was observed between pairwise and network meta-analysis comparisons for major bleeding. CONCLUSIONS: DOAC are effective to prevent VTE recurrence in patients with CAT but are associated with an increased risk of bleeding compared to LMWH. The choice of anticoagulant should be personalised, taking into account the patient's bleeding risk, including cancer site, and patient's values and preferences.


Assuntos
Anticoagulantes/uso terapêutico , Neoplasias/complicações , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/etiologia , Doença Aguda , Administração Oral , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Inibidores do Fator Xa/administração & dosagem , Inibidores do Fator Xa/efeitos adversos , Inibidores do Fator Xa/uso terapêutico , Feminino , Hemorragia/etiologia , Heparina de Baixo Peso Molecular/administração & dosagem , Heparina de Baixo Peso Molecular/efeitos adversos , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Masculino , Meta-Análise em Rede , Recidiva , Fatores de Risco , Segurança , Prevenção Secundária , Tromboembolia Venosa/prevenção & controle , Vitamina K/antagonistas & inibidores
16.
J Thromb Thrombolysis ; 47(4): 505-511, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30903459

RESUMO

Autologous adoptive T cell immunotherapy has been recognized as an effective treatment for cancer patients. The initial qualified lymphocytes is the core element determining the immunotherapeutic outcomes clinically. Cell separator based apheresis procedure is an optimal procedure to collect adequate mono-nucleated lymphocytes to generate efficient ex vivo T cell expansions; however, potential catheter-associated femoral vein thrombosis at post-apheresis might rise an additional deteriorated morbidity for cancer patients. The emerging prophylactic medications are required at such circumstances. Therefore this study was designed to compare the prophylactic effects of rivaroxaban versus low molecular weight heparin (LMWH) in patients who had exposed during the femoral vein catheterization for apheresis. 74 Patients were randomized 1:1:1 into three groups: subcutaneous injection of LMWH, Fraxiparine (n = 23) (0.4 ml, 3800 IU/day) for 2 days, oral rivaroxaban 10 mg/d (n = 26), and oral rivaroxaban 20 mg/d (n = 25) for consecutive 2 days. The primary endpoint was to compare the venous thromboembolism (VTE) occurrence cases in one month post catheterization. There were 4 cases confirmed VTE occurrence in LMWH group with contrast to 1 case in rivaroxaban 10 mg administration group. None was seen in rivaroxaban 20 mg group (P = 0.02 as the comparison with LMWH). Meantime there was no bleeding events occurrence afterwards. Oral rivaroxaban 20 mg/day was recommendable to be considered which superior to LMWH. Although these limited data and patient volume reached the statistical difference which was able to provide the evidence proofed to compare the potency of those two anticoagulants, it could be regarded as the preliminary data provide the clinical results for cancer patients who were placed in the condition of apheresis and subsequently undergone adoptive T cell immunotherapy.Trial registration ClinicalTrials.gov identifier, NCT03282643. Registered 16 February 2016, http://www.ClinicalTrials.gov/ NCT03282643.


Assuntos
Transferência Adotiva , Remoção de Componentes Sanguíneos , Heparina de Baixo Peso Molecular/administração & dosagem , Neoplasias/terapia , Rivaroxabana/administração & dosagem , Trombose/prevenção & controle , Adulto , Idoso , Feminino , Seguimentos , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/sangue , Estudos Prospectivos , Rivaroxabana/efeitos adversos , Linfócitos T/metabolismo , Linfócitos T/patologia , Trombose/sangue
17.
Ir J Med Sci ; 188(4): 1191-1193, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30848445

RESUMO

BACKGROUND: In the European Liver Transplant Registry, there are 137,863 liver transplantations recorded. Forty-one percent of patients survived 20 years after liver transplantation in the European countries. From 1988, when the US database for liver transplantation was created, to 2006, there are more than 56,000 liver transplants. Almost 80% of the liver transplant recipients survived 5 years after transplantation. The incidence of deep vein thrombosis (DVT) in the European population is 70-140/100.000 person-years. Cancer, paresis, immobilization, thrombophilia, inflammatory bowel disease, replacement hormonal or contraceptive therapies are associated with an increased risk of occurrence DVT or complications. The incidence of DVT in long-term surveillance of liver transplant recipients is unknown. Immunosuppressive therapy, thrombophilia abnormalities, hepatitis C and hepatocellular carcinoma recurrence, renal insufficiency, malignant tumours, obesity and diabetes were associated with DVT in long-term post-liver transplantation. The reported maximum time between liver transplantation and DVT was 210 days. AIM: The aim of the study is to update existing data in the literature regarding the occurrence and management of deep vein thrombosis in liver transplant patients over the long-term surveillence period. CONCLUSIONS: There are no specific guideline recommendations regarding acute DVT treatment in long-term surveillance after liver transplantation. Low molecular weight heparin (LMWH), unfractionated heparin (UFH) and vitamin K antagonist (VKA) are the anticoagulants used in specific complications post-transplantation. The safety and the efficacy of direct anticoagulants in liver transplantation recipients need to be assessed in future trials. Given that long-term survival of liver transplantation is much improved, complications associated with transplantation and ageing require appropriate cardiovascular guidelines.


Assuntos
Anticoagulantes/administração & dosagem , Transplante de Fígado/estatística & dados numéricos , Trombose Venosa/epidemiologia , Europa (Continente) , Heparina/administração & dosagem , Heparina de Baixo Peso Molecular/administração & dosagem , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Trombofilia/epidemiologia
18.
Braz Dent J ; 30(1): 12-21, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30864641

RESUMO

This study aimed to assess the effects of low molecular weight heparin (LMWH) on alveolar bone loss (ABL), blood count, and counting of megakaryocytes and adipocytes in male Wistar rats. Forty male 60-day Wistar rats were randomly divided into four groups: Control (C), Periodontal Disease (PD), Heparin (Hp) and Heparin + Periodontal Disease (Hp+PD). LMWH was applied for 60 days at doses of 1 ml/kg/day. Blood samples were collected at baseline, 30 and 60. On day-49, PD and Hp+PD groups were subjected to ligature-induced periodontitis around second upper right molar. The left side was assessed as spontaneous alveolar bone loss. Mean ABL in the side with ligature showed significantly different between C (0.35±0.07 mm) and Hp+DP (0.49±0.09 mm) groups (p<0.001), between PD (0.55±0.11 mm) and Hp (0.32±0.06 mm) groups (p<0.001) and between Hp and Hp+DP groups (p<0.001). No significant differences were found among groups for ABL in the side without ligature. Animal weight, food intake, and water consumption showed no statistically significant difference among groups. Megakaryocytes and adipocytes were counted using optical microscopy and no statistically significant differences were found. Within-groups, there were an increase and a decrease, respectively, in the counting of lymphocytes (p=0.005 for C and p=0.009 for Hp+PD groups only) and leukocytes (p=0.003 for C, p=0.001 for PD, p=0.002 for Hp, and p<0.001 for Hp+PD groups). There was no decrease in the number of platelets in the three collection periods. LMWH was not able to affect ABL, but it may change the blood counting, especially increasing lymphocytes.


Assuntos
Perda do Osso Alveolar/prevenção & controle , Heparina de Baixo Peso Molecular/farmacologia , Adipócitos/citologia , Animais , Relação Dose-Resposta a Droga , Heparina de Baixo Peso Molecular/administração & dosagem , Masculino , Megacariócitos/citologia , Ratos , Ratos Wistar
19.
J Coll Physicians Surg Pak ; 29(2): 119-122, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30700348

RESUMO

OBJECTIVE: To investigate the effect of low molecular weight heparin sodium combined with magnesium sulfate in the treatment of patients with severe preeclampsia. STUDY DESIGN: An experimental study. PLACE AND DURATION OF STUDY: The Department of Obstetrics and Gynecology, The Affiliated Hospital, North China University of Science and Technology, from April 2016 to July 2017. METHODOLOGY: Patients with severe preeclampsia were randomly divided into observation group (52 cases) and control group (51 cases). In the control group, magnesium sulfate were used, but in observation group low molecular weight heparin sodium were added. After treatment of 7 days, serum TGF-ß1, VCAM-1, ES levels and endothelial function markers of NO and ET-1 changes were compared between the two groups.The delivery status after treatment was observed in both groups. RESULTS: After treatment of 7 days, serum TGF-ß1 and NO levels in the observation group were higher than those in control group (both p<0.001), and VCAM-1, ES, ET-1, ET-1/NO levels in observation group were lower than those in control group (all p<0.001). Among the patients who delivered live births, observation group had a longer delivery gestation age after treatment than that of control group (p=0.038); placental quality, body mass and 1 minute Apgar score of surviving newborns in observation group were all higher than those in control group (all p<0.001). CONCLUSION: Low molecular weight heparin sodium combined with magnesium sulfate may improve the.


Assuntos
Heparina de Baixo Peso Molecular/administração & dosagem , Sulfato de Magnésio/uso terapêutico , Pré-Eclâmpsia/tratamento farmacológico , Resultado da Gravidez , Adulto , Relação Dose-Resposta a Droga , Esquema de Medicação , Quimioterapia Combinada , Feminino , Humanos , Pré-Eclâmpsia/diagnóstico , Gravidez , Índice de Gravidade de Doença
20.
J Med Vasc ; 44(1): 79-85, 2019 Feb.
Artigo em Francês | MEDLINE | ID: mdl-30770086

RESUMO

Congenital agenesis of the inferior vena cava, although rare, is found preferentially in young patients with proximal deep venous thrombosis. Exact diagnosis can be made thanks to enhanced computed tomography scan and/or magnetic resonance imaging, while Doppler ultrasonography is insufficient to establish an inferior vena cava malformation. A consensus has not yet been established for the treatment but lifelong anticoagulation with elastic stocking support to prevent post-thrombotic syndrome is commonly considered in most cases. We report a case of an unprovoked deep venous thrombosis caused by a congenital agenesis of the inferior vena cava localized to the infrarenal segment, in a 24-year-old man. An anticoagulation with low molecular weight heparin was started and prolonged oral anticoagulation was prescribed. In the absence of the usual thrombotic risk factors, the presence of an inferior vena cava anomaly should be considered.


Assuntos
Malformações Vasculares/complicações , Veia Cava Inferior/anormalidades , Trombose Venosa/etiologia , Anticoagulantes/administração & dosagem , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Masculino , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/tratamento farmacológico , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico , Adulto Jovem
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