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1.
Khirurgiia (Mosk) ; (10): 75-81, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31626243

RESUMO

Postoperative complications in vascular surgery may be partly provoked by suture material. Analysis of the mechanisms of these complications may be useful for their prevention. Mechanisms of suture-induced thrombosis and neointimal hyperplasia, possible strategies for prevention of postoperative complications including those allowing drug deliveries directly to the vascular anastomosis area are discussed in the article. According to the literature data, heparin is the most optimal drug for modifying suture material and prevention of thrombosis and neointimal hyperplasia. Heparin delivery to the vascular anastomosis site will reduce the risk of thrombosis by inhibiting the activity of thrombin. Complex of heparin and antithrombin III increases inhibitory effect of antithrombin against thrombin. In addition, heparin is able to reduce proliferation of vascular smooth muscle cells through inhibition of the synthesis of extracellular matrix proteases involved in migration and proliferation of cells. Thus, heparin delivery to the vascular injury site may be used to prevent thrombosis and myoproliferative response. Moreover, this strategy prevents complications associated with systemic administration of anticoagulants.


Assuntos
Suturas/efeitos adversos , Trombose/prevenção & controle , Doenças Vasculares/prevenção & controle , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Anticoagulantes/administração & dosagem , Heparina/administração & dosagem , Humanos , Hiperplasia/etiologia , Hiperplasia/patologia , Hiperplasia/prevenção & controle , Neointima/patologia , Trombose/etiologia , Doenças Vasculares/etiologia
2.
J Clin Neurosci ; 66: 275-277, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31101584

RESUMO

We report the case of a 59 year old woman who presented with a six week history of worsening bifrontal headache. On CT brain the only abnormal finding was a partially empty sella potentially indicative of increased intracranial pressure. MRI found a large cerebral venous sinus thrombosis in the superior sagittal sinus. Blood tests and a bone marrow biopsy revealed a diagnosis of JAK2 positive primary polycythaemia rubra vera. The lack of sensitivity and specificity of CT in the diagnosis of CVST should engender a low threshold for MRI in patients with risk factors and/or non-diagnostic abnormalities on initial CT. Management of this dual pathology involves both the immediate treatment of the thrombus with heparin bridging to warfarin and the long treatment for polycythaemia involving repeat venesections and cytoreductive therapy.


Assuntos
Síndrome da Sela Vazia/complicações , Síndrome da Sela Vazia/diagnóstico por imagem , Policitemia Vera/complicações , Policitemia Vera/diagnóstico por imagem , Trombose dos Seios Intracranianos/complicações , Trombose dos Seios Intracranianos/diagnóstico por imagem , Diagnóstico Diferencial , Síndrome da Sela Vazia/terapia , Feminino , Cefaleia/complicações , Cefaleia/diagnóstico por imagem , Cefaleia/terapia , Heparina/administração & dosagem , Humanos , Pessoa de Meia-Idade , Policitemia Vera/terapia , Sela Túrcica/diagnóstico por imagem , Trombose dos Seios Intracranianos/terapia , Varfarina/administração & dosagem
3.
A A Pract ; 12(9): 305-307, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31048599

RESUMO

We report a 31-year-old woman with sickle beta thalassemia zero who presented at 21 weeks gestational age with multiple bilateral pulmonary emboli and no hemodynamic instability. Acquired antithrombin deficiency was suspected due to a refractory response to therapeutic anticoagulation with enoxaparin, unfractionated heparin, and fondaparinux, and a reduced antithrombin antigen level. At 26 4/7 weeks, she developed signs concerning for increased pulmonary clot burden. To avoid the use of alternative anticoagulants that may cross the placenta and impact the fetus, a planned cesarean delivery was performed without complication at 27 weeks gestation. Both mother and child experienced successful long-term outcomes.


Assuntos
Anemia Falciforme/complicações , Resistência a Medicamentos , Embolia Pulmonar/complicações , Trombofilia/complicações , Adulto , Cesárea , Gerenciamento Clínico , Feminino , Heparina/administração & dosagem , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/etiologia , Segundo Trimestre da Gravidez
4.
Chin Med Sci J ; 34(1): 60-64, 2019 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-30961783

RESUMO

Heparin-induced thrombocytopenia (HIT) is a relatively infrequent complication of heparin administration. HIT can cause devastating thrombosis, making it one of the most serious adverse drug reactions encountered in clinical practice. We successfully treated a case of severe HIT presenting with thrombosis and life-threatening bleeding complications with intravenous immunoglobulin (IVIG), platelet transfusion and oral anticoagulant Rivaroxaban. In this case, we considered that IVIG played the most important role by preventing further thrombosis, increasing the platelet count, and ensuring the efficacy of Rivaroxaban. We therefore suggest that IVIG might be the optimal treatment for patients with this urgent condition.


Assuntos
Heparina/efeitos adversos , Imunoglobulinas Intravenosas/administração & dosagem , Transfusão de Plaquetas , Rivaroxabana/administração & dosagem , Trombocitopenia/induzido quimicamente , Trombocitopenia/terapia , Idoso de 80 Anos ou mais , Feminino , Heparina/administração & dosagem , Humanos
5.
Vasc Endovascular Surg ; 53(5): 395-400, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31018828

RESUMO

PURPOSE: To evaluate the feasibility and safety of a novel balloon-expandable, heparin-bonded endoprosthesis (Viabahn VBX, W. L. Gore and Associates) when used as a bridging stent graft (BSG) with fenestrated and branched endovascular aneurysm repair (FB-EVAR). FB-EVAR and BSGs increase repair complexity with the potential for endoleak formation, stenosis, thrombosis, and graft migration. The mechanical construction of the Viabahn VBX and its antithrombogenic properties may provide an advantage for FB-EVAR over existing BSGs. The efficacy, safety, and clinical outcomes were assessed. MATERIALS AND METHODS: Research ethics board approved, prospective, single arm cohort, pilot study of patients undergoing FB-EVAR between February 2017 and January 2018. Fenestrated and branched endovascular aneurysm repair was performed per the standard institutional protocol by a team composed of vascular surgeons and interventional radiologists. Viabahn VBX endografts were used for all intended visceral branches as long as appropriately sized devices were available (Under Investigational Testing Authorization from Health Canada). Patient characteristics, procedural details, and technical and clinical outcomes were reviewed and summarized. RESULTS: FB-EVAR was performed in 13 patients (9 male and 4 female) mean age of 74 (range: 61-83) with a total of 41 Viabahn VBXs stents implanted. Mean maximum aneurysm size was 6.7 cm (range: 5.5-9.0 cm) and included 5 juxtarenal abdominal aortic aneurysms and 8 thoracoabdominal; 3 type V, 3 type IV, and 2 type III (Crawford Classification). The Viabahn VBX was successfully deployed in 40 (98%) of 41 of cases. At median follow-up of 223 days (range: 2-462), there was a (40/40) 100% Viabahn VBX patency rate. Seven endoleaks were identified intra- or post procedurally in 6 (46%) of 13 cases, including 1 type IB, 3 type II, 2 type III, and 1 unclassified. Nine complications occurred in 6 patients. CONCLUSION: The Viabahn VBX stent is a safe and effective BSG for FB-EVAR with no early stent thrombosis. Further evaluation is required to determine longer term stent efficacy.


Assuntos
Anticoagulantes/administração & dosagem , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Materiais Revestidos Biocompatíveis , Procedimentos Endovasculares/instrumentação , Heparina/administração & dosagem , Stents , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/fisiopatologia , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Estudos de Viabilidade , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/prevenção & controle , Heparina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Desenho de Prótese , Fatores de Risco , Trombose/etiologia , Trombose/fisiopatologia , Trombose/prevenção & controle , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular/efeitos dos fármacos
6.
Nursing ; 49(5): 66-69, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31022035

RESUMO

PURPOSE: This study assessed the impact of process standard work, a quality improvement tool, on staff adherence to nurse-driven unfractionated heparin (UFH) protocols in adult patients at a community teaching hospital. METHODS: This was a retrospective quality improvement project, and statistical analysis was performed by a senior research specialist at the facility. RESULTS: In total, 109 venous thromboembolism or cardiac UFH anticoagulant protocols were included in the final analysis, accounting for 445 activated partial thromboplastin time results. CONCLUSION: There was no change in adherence to a nurse-driven UFH protocol among adult patients after the implementation of process standard work.


Assuntos
Protocolos Clínicos , Heparina/administração & dosagem , Adesão à Medicação/estatística & dados numéricos , Padrões de Prática em Enfermagem , Melhoria de Qualidade , Adulto , Hospitais Comunitários , Hospitais de Ensino , Humanos , Pesquisa em Avaliação de Enfermagem , Estudos Retrospectivos
7.
J Stroke Cerebrovasc Dis ; 28(6): 1500-1508, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30935810

RESUMO

OBJECTIVE: The role of heparin in acute ischemic stroke is controversial. We investigated the effect of heparin on ischemic lesion growth. METHODS: Data were analyzed on nonthrombolyzed ischemic stroke patients in whom diffusion-weighted imaging (DWI)/perfusion-weighted imaging (PWI) MRI was performed less than 12 hours of last known well and showed a PWI-DWI lesion mismatch, and who underwent follow-up neuroimaging at least 4 days after admission. Lesion growth was assessed by (1) absolute lesion growth and (2) percentage mismatch lost (PML). Univariate and multivariate regression analysis, and propensity score matching, were used to determine the effects of heparin on ischemic lesion growth. RESULTS: Of the 113 patients meeting study criteria, 59 received heparin within 24 hours. Heparin use was associated with ∼5-fold reductions in PML (3.5% versus 19.2%, P = .002) and absolute lesion growth (4.7 versus 20.5 mL, P = .009). In multivariate regression models, heparin independently predicted reduced PML (P = .04) and absolute lesion growth (P = .04) in the entire cohort, and in multiple subgroups (patients with and without proximal artery occlusion; DWI volume greater than 5 mL; cardio-embolic mechanism; DEFUSE-3 target mismatch). In propensity score matching analysis where patients were matched by admission NIHSS, DWI volume and proximal artery occlusion, heparin remained an independent predictor of PML (P = .048) and tended to predict absolute lesion growth (P = .06). Heparin treatment did not predict functional outcome at discharge or 90 days. CONCLUSION: Early heparin treatment in acute ischemic stroke patients with PWI-DWI mismatch attenuates ischemic lesion growth. Clinical trials with careful patient selection are warranted to investigate the potential ischemic protective effects of heparin.


Assuntos
Anticoagulantes/administração & dosagem , Isquemia Encefálica/tratamento farmacológico , Heparina/administração & dosagem , Fármacos Neuroprotetores/administração & dosagem , Acidente Vascular Cerebral/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Plast Reconstr Surg ; 143(6): 1224e-1232e, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30907817

RESUMO

BACKGROUND: The purpose of this study was to clarify the appropriate use of unfractionated heparin as an anticoagulation agent after digital replantation. METHODS: This study was a prospective, randomized, single-blind, blinded-endpoint method, three-arm, parallel-group, controlled clinical trial conducted at a single institution. A total of 88 patients (101 fingers) following digital amputation and subsequent repair by anastomosis of both arteries and veins were randomly allocated into three groups: (1) control group (no heparin dose), (2) low-dose heparin group (10,000 IU/day), and (3) high-dose heparin group (start at 15,000 IU/day, then adjust the dose to achieve an activated partial thromboplastin time of 1.5 to 2.5 times the baseline). The outcomes were assessed regarding the proportion of success at 2 weeks after replantation of amputated digits, total or partial necrosis, and occurrence of complications. RESULTS: No significant differences were found among the three groups, except for complications of congestion. The odds ratio of the heparin group compared with the control group for a success proportion was 5.40 (95 percent CI, 0.85 to 34.20; p = 0.027) in subjects aged 50 years or older. Significant elevations of activated partial thromboplastin time, aspartate transaminase, and alanine aminotransferase occurred in high-dose heparin groups on day 7. CONCLUSION: Unfractionated heparin administration is considered effective for patients aged 50 years or older, although the routine use of unfractionated heparin is not necessary after digital replantation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Anticoagulantes/administração & dosagem , Dedos/cirurgia , Heparina/administração & dosagem , Reimplante/métodos , Adolescente , Adulto , Idoso , Amputação Traumática/cirurgia , Criança , Feminino , Traumatismos dos Dedos/cirurgia , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Prospectivos , Método Simples-Cego , Resultado do Tratamento , Adulto Jovem
9.
Clin Appl Thromb Hemost ; 25: 1076029619833480, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30841720

RESUMO

Unfractionated heparin dosing is unpredictable and subject to numerous pharmacokinetic changes including distribution and metabolic changes associated with obesity and age. Weight-based dosing is commonly used to better predict the dose for a patient when targeting a therapeutic range. A dosing equation that adjusts weight-based doses for age and body mass index may improve therapeutic dose prediction. We conducted a 2-phase observational study with a derivation and validation period to develop an equation to adjust weight-based unfractionated heparin for age and body mass index to target a therapeutic activated partial thromboplastin time of 60 to 80 seconds. The first phase retrospectively identified patients who acheived therapeutic anticoagulation and utilized linear regression to determine a predictive equation for weight-based dosing that adjusts for age and body mass index. The second phase prospectively identified patients in an observational manner and compared the dose of unfractionated heparin on which they became therapeutic against both the weight-based dose and the predicted dose adjusted for age and body mass index. The correlation between predictive age and body mass index adjusted dose and actual therapeutic dose was 0.703 compared to the correlation between the empiric weight-based dose and actual therapeutic dose which was 0.532 ( P = .05). Age and body mass index adjusted weight-based dosing significantly improved therapeutic dose prediction for unfractionated heparin. Further study in a prospective, randomized trial is warranted for validation of this approach in a real world setting.


Assuntos
Anticoagulantes/uso terapêutico , Heparina/uso terapêutico , Tromboembolia Venosa/tratamento farmacológico , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Anticoagulantes/farmacologia , Índice de Massa Corporal , Peso Corporal , Feminino , Heparina/administração & dosagem , Heparina/farmacologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tromboembolia Venosa/patologia
10.
Int J Pharm ; 562: 162-171, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30902709

RESUMO

Artesunate-heparin conjugate (ART-HEP) based nanocapsules as drug delivery vehicle was developed for intracellular release of ART in malaria therapy. Owing both hydrophobic and hydrophilic moieties, the conjugate was successfully self-assembled into artesunate-heparin nanocapsules (ART-HEP-NCPs) with lower critical micelle concentration (CMC) of about 20 µg/mL. Dynamic light scattering (DLS) and transmission electron microscopy (TEM) revealed that ART-HEP-NCPs has an average hydrodynamic diameter of 112.1 nm with a negatively charged surface (-11.2 mV) and typical micellar nanostructure, respectively. Interestingly, such modification achieved high drug loading efficiency (DLE) of ART (29.3 wt%), which is significantly higher than already reported conventional ART-loaded nanoparticles. The nanocapsules demonstrated lower in vitro ART release under neutral physiological environment (33.81%) but higher release rate was observed in simulated acidic microenvironment (92.74%) in 70 h test. This behavior of ART-HEP-NCPs will facilitate the intracellular release of ART under slightly acidic parasitic food vacuole for effective antimalarial effect. Storage stability and hemolytic studies exhibited that ART-HEP based nanocapsules were stable and safe for intravenous (i.v) injection. Notably, ART-HEP-NCPs has promising internalization into Plasmodium infected red blood cells (iRBCs) and also displayed in vitro inhibitory effect against P. falciparum 3D7 with half-maximal inhibitory concentration (IC50) of 10.16 nM, which was slightly higher than free ART (IC50 6.27 nM). This expected slightly lower inhibitory effect of polymeric prodrug could be ascribed to the gradual release of ART from the polymer chain over time. More importantly, the in vivo pharmacokinetics study indicated that the nanoscale characteristic of nanocapsules substantially contributed to the extended circulation of ART in blood. In conclusion, such multifunctional ART-HEP-NCPs with higher ART loading and extended half-life could be a promising platform for targeted antimalarial drug delivery.


Assuntos
Antimaláricos , Artesunato , Heparina , Nanocápsulas , Animais , Antimaláricos/administração & dosagem , Antimaláricos/química , Antimaláricos/farmacocinética , Artesunato/administração & dosagem , Artesunato/química , Artesunato/farmacocinética , Sistemas de Liberação de Medicamentos , Liberação Controlada de Fármacos , Eritrócitos/efeitos dos fármacos , Feminino , Hemólise , Heparina/administração & dosagem , Heparina/química , Heparina/farmacocinética , Humanos , Malária/tratamento farmacológico , Camundongos Endogâmicos BALB C , Nanocápsulas/administração & dosagem , Nanocápsulas/química , Plasmodium falciparum/efeitos dos fármacos
11.
Carbohydr Polym ; 211: 370-379, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30824101

RESUMO

Heparin as negative polysaccharide is a universal building block to form polyion complex with different cationic counterparts. In this paper, three different cations, including chitosan, benzyldodecyldimethyl ammonium bromide and doxorubicin hydrochloride, were used to prepare heparin-based polyion complexes (HPICs). Their morphologies could be tuned by heparin content in HPIC, and they also showed pH-sensitive decomposition. Doxorubicin was further encapsulated into micelle and vesicle carrier made from heparin-benzyldodecyl dimethyl ammonium bromide PIC, whereas heparin-doxorubicin PIC could be directly used as drug carrier. In vitro drug release proved the drug carriers exhibit obvious pH sensitive release behaviour. Cytotoxicity indicated the drug carrier possessed significant cytotoxicity to tumor cells. The cell uptake observed by CLSM showed the carrier was able to deliver antitumor drug into tumor cell's nucleus. Consequently, these results showed the promising potential of HPIC in drug carrier application.


Assuntos
Portadores de Fármacos , Heparina , Antibióticos Antineoplásicos/administração & dosagem , Antibióticos Antineoplásicos/química , Compostos de Benzalcônio/administração & dosagem , Compostos de Benzalcônio/química , Transporte Biológico , Linhagem Celular Tumoral , Sobrevivência Celular/efeitos dos fármacos , Quitosana/administração & dosagem , Quitosana/química , Doxorrubicina/administração & dosagem , Doxorrubicina/química , Portadores de Fármacos/administração & dosagem , Portadores de Fármacos/química , Liberação Controlada de Fármacos , Heparina/administração & dosagem , Heparina/química , Humanos , Concentração de Íons de Hidrogênio , Micelas
12.
Ann Vasc Surg ; 58: 115-121, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30769063

RESUMO

BACKGROUND: Although autogenous venous grafts are preferable for below-the-knee bypass surgery in patients with critical limb ischemia, some 20% of patients will have no suitable vein for grafting, compelling a resort to artificial graft materials. Retrospective subgroup analyses within published studies comparing heparin-bonded polytetrafluoroethylene (PTFE) with crude PFTE graft in below-the-knee bypass suggest that heparin-bonded graft offers superior long-term patency rates, but this has not been prospectively verified in patients with critical limb ischemia. METHODS: A single-blind randomized controlled trial in 20 French centers has been designed. Patients assessed as having no suitable autologous vein for bypass grafting for critical lower limb ischemia will be randomized to receive either a heparin-bonded PTFE graft or a crude PTFE graft. A literature review suggested expected 1-year patency rates of 53% for the crude ePTFE arm and 74% for the heparin-bonded PTFE arm. On analyzing 1-year patency rate as a binary variable, for a significance level α = 0.05 and a randomization ratio of 1:1, a total of 176 patients (88 in each arm) will be required to obtain approximately 80% power to reject the null hypothesis. Assuming 10% dropout at 1 year and 20% mortality, 228 patients will be randomized (114 patients in each arm). RESULTS: The primary outcome variable will be patency at 1 year assessed by duplex ultrasound color-flow scan. Any intervention to open up or prevent a graft occlusion before 1 year will be classified as loss of patency. Technical success, deaths, complications, major adverse cardiovascular and limb events, length of hospitalization, and quality of life will also be recorded and analyzed as secondary outcome variables. Cost-utility and cost-effectiveness analyses based on standard tariffs in the French health insurance system will be performed. CONCLUSIONS: The REPLACE trial is the first randomized controlled trial designed to determine if heparin-bonded PTFE graft is superior to crude PTFE graft in below-the-knee bypass surgery for critical limb ischemia.


Assuntos
Anticoagulantes/administração & dosagem , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Materiais Revestidos Biocompatíveis , Heparina/administração & dosagem , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Politetrafluoretileno , Anticoagulantes/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , França , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Heparina/efeitos adversos , Humanos , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Estudos Multicêntricos como Assunto , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Desenho de Prótese , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
13.
J Cardiothorac Surg ; 14(1): 39, 2019 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-30808385

RESUMO

BACKGROUND: Heparinized solution (HS) use for the maintenance of arterial cannulas has been associated with coagulation disorders and has not been conclusively shown to confer additional benefits over normal saline (NS) alone. We tested the hypothesis that in adult patients admitted to the cardiac ICU (T0) after cardiac surgery, HS arterial cannulas might be independently associated with increased heparin-induced coagulation disorders and might not be superior to NS arterial cannulas in reducing arterial cannula occlusion. METHODS: In this cohort study, 170 patients who received NS arterial cannulas during the period from T0 to ICU discharge were included in this study from June 1, 2017, to May 1, 2018 (NS group). There were 2930 patients who used HS (2.5 U/ml) arterial cannulas from January 1, 2015, to December 31, 2016 (heparin group). To address indicated biases, we derived a propensity score that predicted the functions of NS and HS in the patency of arterial cannulas. RESULTS: There were 296 patients (148 in the NS group and 148 in the heparin group) with similar risk profiles in the propensity-score matched cohorts. In the propensity-matched patients, the duration of arterial cannulas (P = 0.4) and arterial cannula occlusion (P = 0.5) showed no differences between the NS and heparin groups. However, the heparin group had a significantly increased activated clotting time (P < 0.05), activated partial thromboplastin time (P = 0.01) and allogeneic red blood cell utilization (3.4% vs 10.8%, P < 0.05). Compared with the NS group, the heparin group had more drainage from chest tubes from T0 to T48 (10.6 ± 9.4 ml/kg vs 13.0 ± 7.22 ml/kg, P < 0.05) and had more allogeneic red blood cells transfused (0.1 ± 0.4 U vs 0.4 ± 1.1 U, P < 0.05). CONCLUSION: Based on the results of our study, the addition of heparin to normal saline for flushing arterial pressure monitoring cannulae did not reduce the incidence of catheter thrombosis and result in a very small but statically significant in increase in activated clotting time and activated partial thromboplastin time.


Assuntos
Anticoagulantes/administração & dosagem , Procedimentos Cirúrgicos Cardíacos , Heparina/administração & dosagem , Solução Salina/administração & dosagem , Trombose/prevenção & controle , Idoso , Pressão Arterial , Transtornos da Coagulação Sanguínea/induzido quimicamente , Transtornos da Coagulação Sanguínea/prevenção & controle , Testes de Coagulação Sanguínea , Determinação da Pressão Arterial/efeitos adversos , Determinação da Pressão Arterial/instrumentação , Cânula/efeitos adversos , Cateterismo/efeitos adversos , Cateterismo Periférico/instrumentação , Estudos de Coortes , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Irrigação Terapêutica/efeitos adversos , Irrigação Terapêutica/métodos , Trombose/etiologia
15.
J Card Surg ; 34(3): 131-133, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30625246

RESUMO

A small percentage of ascending aortic surgical procedures require temporary mechanical circulatory support, of which veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is the most established technique. We present a surgical technique for minimally invasive central V-A ECMO management, avoiding resternotomy or ventricular compression, while maintaining antegrade blood flow and permitting sternal closure following ascending aortic surgery.


Assuntos
Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/métodos , Oxigenação por Membrana Extracorpórea/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Anticoagulantes/administração & dosagem , Aorta Torácica/cirurgia , Procedimentos Cirúrgicos Eletivos , Heparina/administração & dosagem , Humanos , Tempo de Tromboplastina Parcial , Fatores de Tempo
17.
J Vet Emerg Crit Care (San Antonio) ; 29(1): 88-97, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30654425

RESUMO

OBJECTIVES: To systematically evaluate the evidence supporting the timing and mechanisms of permanent or temporary discontinuation of antiplatelet or anticoagulant medications in small animals DESIGN: Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality (poor, fair, or good), and development of consensus on conclusions via a Delphi-style survey for application of the concepts to clinical practice. SETTINGS: Academic and referral veterinary medical centers. RESULTS: Databases searched included Medline via PubMed and CAB abstracts. Two specific courses of inquiry were pursued, one focused on appropriate approaches to use for small animal patients receiving antiplatelet or anticoagulant drugs and requiring temporary discontinuation of this therapy for the purposes of invasive procedures (eg, surgery), and the other aimed at decision-making for the complete discontinuation of anticoagulant medications. In addition, the most appropriate methodology for discontinuation of heparins was addressed. CONCLUSIONS: To better define specific patient groups, a risk stratification characterization was developed. It is recommended to continue anticoagulant therapy through invasive procedures in patients at high risk for thrombosis that are receiving anticoagulant therapy, while consideration for discontinuation in patients with low to moderate risk of thrombosis is reasonable. In patients with thrombosis in whom the underlying cause for thrombosis has resolved, indefinite treatment with anticoagulant medication is not recommended. If the underlying cause is unknown or untreatable, anticoagulant medication should be continued indefinitely. Unfractionated heparin therapy should be slowly tapered rather than discontinued abruptly.


Assuntos
Doenças do Gato/tratamento farmacológico , Doenças do Cão/tratamento farmacológico , Fibrinolíticos/uso terapêutico , Medicina Veterinária/normas , Animais , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Gatos , Cuidados Críticos , Cães , Esquema de Medicação/veterinária , Fibrinolíticos/administração & dosagem , Heparina/administração & dosagem , Heparina/uso terapêutico , Padrões de Prática Médica/normas , Suspensão de Tratamento
18.
J Neurointerv Surg ; 11(7): 694-698, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30552166

RESUMO

BACKGROUND: The Pipeline Embolisation Device with Shield technology (PED-Shield) is suggested to have reduced thrombogenicity. This reduced thrombogenicity may make it possible to use safely in the acute treatment of aneurysmal subarachnoid haemorrhage (aSAH) on single antiplatelet therapy (SAPT). OBJECTIVE: To evaluate the safety and efficacy of the off-label use of PED-Shield with SAPT for the acute treatment of aSAH. METHODS: Patients who underwent acute treatment of ruptured intracranial aneurysms with the PED-Shield with SAPT were retrospectively identified from prospectively maintained databases at three Australian neurointerventional centres. Patient demographics, aneurysm characteristics, clinical and imaging outcomes were reviewed. RESULTS: Fourteen patients were identified (12 women), median age 64 (IQR 21.5) years. Aneurysm morphology was saccular in seven, fusiform in five, and blister in two. Aneurysms arose from the anterior circulation in eight patients (57.1%). Six (42.9%) patients were poor grade (World Federation of Neurological Societies grade ≥IV) SAH. Median time to treatment was 1 (IQR 0.5) day. Complete or near complete aneurysm occlusion (Raymond-Roy <3) was achieved in 12 (85.7%) patients at the end of early-acute follow-up (median day 7 after SAH). Permanent, treatment-related morbidity occurred in one (7.1%) patient and one (7.1%) treatment-related death occurred. The use of a postoperative heparin infusion (n=5) was associated with a higher rate of all complications (80.0% vs 11.1%, p=0.023) and symptomatic complications (60% vs 0.0%, p=0.028). No symptomatic ischaemic or haemorrhagic complications were observed in the patients who did not receive a post-operative heparin infusion. Nine (64.3%) patients were functionally independent on discharge from the treatment centre. CONCLUSION: The PED-Shield may be safe to use in the acute treatment of ruptured intracranial aneurysms with SAPT. Further investigation with a formal treatment registry is needed.


Assuntos
Aneurisma Roto/terapia , Prótese Vascular/tendências , Aneurisma Intracraniano/terapia , Inibidores da Agregação de Plaquetas/administração & dosagem , Hemorragia Subaracnóidea/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/epidemiologia , Austrália/epidemiologia , Prótese Vascular/efeitos adversos , Embolização Terapêutica/métodos , Embolização Terapêutica/tendências , Feminino , Heparina/administração & dosagem , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/epidemiologia , Resultado do Tratamento , Adulto Jovem
19.
World Neurosurg ; 123: e25-e30, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30528524

RESUMO

OBJECTIVE: Anticoagulant therapy (ACT) after traumatic intracranial hemorrhage may lead to progression of hemorrhage, but in the presence of thromboembolic events, the clinician must decide if the benefits outweigh the risks. Currently, no data exist to guide therapy in the acute setting. METHODS: We retrospectively identified all patients admitted to our institution with traumatic intracranial hemorrhage that received intravenous heparin, full-dose enoxaparin, or warfarin during their initial hospitalization over a 3-year period. We reviewed their demographics, hospital course, clinical indication and timing for initiation of ACT, and complications. RESULTS: A total of 112 patients were identified. The median age and Glasgow Coma Scale score of these patients was 50.5 years and 9.5, respectively. Twenty-two patients required neurosurgical procedures for their presenting injury, including intracranial pressure monitors and/or open surgeries. Fifty-four patients had deep vein thrombosis or pulmonary embolism prior to initiation, and the remaining 20 patients had preexisting conditions or other indications for initiating ACT. The median time from injury to starting ACT was 8 days. Immediate complications occurred in 6 patients; however, none of these patients required a neurosurgical intervention. Delayed complications included progression of acute to chronic subdural hematoma that required intervention in 2 patients. One patient died from delayed hemorrhage. CONCLUSIONS: For this patient population, the risk of immediate and delayed intracranial hemorrhages from initiating ACT therapy in intracranial injury must be weighed against the morbidity of delaying treatment. Although further studies are needed, our review provides the first rates of complications for this patient population.


Assuntos
Anticoagulantes/administração & dosagem , Hemorragia Intracraniana Traumática/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Enoxaparina/administração & dosagem , Feminino , Heparina/administração & dosagem , Humanos , Hemorragia Intracraniana Traumática/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Varfarina/administração & dosagem , Adulto Jovem
20.
Eur J Cancer Care (Engl) ; 28(2): e12978, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30536872

RESUMO

Port-a-cath (PAC) system is one of the most frequently employed venous accesses for administration of chemotherapy and supportive care. To prevent late complications, the latest guidelines recommend flushing/locking procedures every four weeks. In this retrospective study, we evaluate the frequencies of late complications with a eight-week flushing/locking procedure compared to the standard one. This study retrospectively compares the frequency of complications occurred using standard versus delayed flushing schedules. We performed a systematic review of the published studies about PAC complications associated with longer flushing intervals. Three hundred and ninety fully available patients were enrolled. One hundred and six patients had their PAC flushed/locked every month, 347 patients performed the flushing/locking procedures every eight weeks, 63 patients switched from the four to the eight-week schedule. No difference was seen in the number of occlusions, infections and mechanical dysfunctions between the two patient groups. The systematic literature review confirmed, in a total of 1,347 patients, the absence of an increased proportion of complications with delayed schedules. PAC flushing and locking every eight weeks are feasible and safe. This delayed schedule may improve patients' quality of life and decrease both nursing workload and costs for the national health system.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Controle de Infecções/métodos , Neoplasias/tratamento farmacológico , Dispositivos de Acesso Vascular , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Descontaminação/métodos , Remoção de Dispositivo , Feminino , Heparina/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Solução Salina/administração & dosagem , Fatores de Tempo , Adulto Jovem
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