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1.
J Extra Corpor Technol ; 53(1): 46-49, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33814605

RESUMO

Antiphospholipid syndrome (APS) is an acquired autoimmune condition characterized by the presence of antiphospholipid antibodies (lupus anticoagulant, anticardiolipin antibody, and anti-ß2 glycoprotein-I antibody) which leads to clinical thrombosis via a multifactorial mechanism of action. Despite the propensity to form clot in vivo, these antibodies interfere with the assembly of the prothrombinase complex on phospholipids in in vitro assays, leading to prolongation of activated clotting time and activated partial thromboplastin time. This disconnect between what occurs in vivo and in vitro makes monitoring anticoagulation during cardiac surgery particularly complex. We present a patient with APS undergoing coronary artery bypass grafting with cardiopulmonary bypass. We delineate our strategy for managing anticoagulation in the presence of this syndrome using the Hepcon Hemostasis Management System Plus (Medtronic, Inc. Minneapolis, MN) device by targeting whole blood heparin concentration to monitor anticoagulation.


Assuntos
Síndrome Antifosfolipídica , Anticoagulantes/farmacologia , Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/diagnóstico , Coagulação Sanguínea , Ponte Cardiopulmonar , Ponte de Artéria Coronária , Humanos
3.
Zhonghua Xue Ye Xue Za Zhi ; 42(1): 33-38, 2021 Jan 14.
Artigo em Chinês | MEDLINE | ID: mdl-33677866

RESUMO

Objectives: To cross-sectionally analyze the clinical characteristics of primary antiphospholipid syndrome (PAPS) patients with thrombocytopenia, risk factors associated with thrombocytopenia, and risk of symptom recurrence in these patients. Methods: The inpatients with PAPS were retrospectively analyzed in Peking Union Medical College Hospital from 2009 to 2019. Using the collected clinical and laboratory data, the clinical characteristics and risk of symptom recurrence in the PAPS patients with thrombocytopenia were compared with those in the PAPS patients with normal platelet counts. Univariate and multivariate logistic regression analyses were performed to screen the risk factors for thrombocytopenia. Results: In this study, 127 patients with PAPS were enrolled, of which 36 (28.3% ) had thrombocytopenia, with a median age of 38 years, and 63.9% were female. In the thrombocytopenia group, the average platelet count was (58.9±27.0) ×10(9)/L, and the prevalence of thrombosis and morbid pregnancy was not significantly different from that in the normal platelet group. However, the thrombocytopenia group had higher incidence rate of autoimmune hemolytic anemia (19.4% vs 3.3% ) , livedo reticularis (16.7% vs 3.3% ) , chronic kidney disease (25% vs 8.8% ) and antiphospholipid antibodies triple positiveness (61.1% vs 37.4% ) , lower complement levels (C3 of 0.87 g/L vs 1.07 g/L, C4 of 0.12 g/L vs 0.18 g/L, P<0.05) , and higher adjusted Global APS Score (median score of 13 vs 9, P=0.037) than the normal platelet group. In multivariate logistic regression analysis, hypocomplementemia (OR value 5.032, 95% CI 3.118-22.095) is an independent risk factor for thrombocytopenia. Conclusions: In patients with PAPS, thrombocytopenia is mostly mild to moderate. Hypocomplementemia may be the independent risk factor for thrombocytopenia in PAPS patients. The PAPS patients with thrombocytopenia may have a higher risk of symptom recurrence.


Assuntos
Síndrome Antifosfolipídica , Trombocitopenia , Adulto , Anticorpos Antifosfolipídeos , Síndrome Antifosfolipídica/complicações , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Trombocitopenia/epidemiologia
4.
Rev Med Suisse ; 17(729): 487-490, 2021 Mar 10.
Artigo em Francês | MEDLINE | ID: mdl-33689245

RESUMO

This article synthesizes the main aspects of the management of systemic lupus erythematosus patients in the context of the COVID-19 pandemic based on published literature. We will therefore develop on topics such as the risk of getting infected, the differences in COVID-19 clinical course and severity compared to general population, the role of antiphospholipid antibodies in thrombotic complications, and treatment strategies.


Assuntos
Síndrome Antifosfolipídica , Lúpus Eritematoso Sistêmico , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/terapia , Humanos , Pandemias
5.
Int Heart J ; 62(1): 181-185, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33518657

RESUMO

Libman-Sacks endocarditis, characterized by verrucous vegetations formation, is a typical cardiac manifestation of autoimmune diseases such as systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Although typically mild and asymptomatic, Libman-Sacks endocarditis can lead to serious complications, including thromboembolic events, superimposed bacterial endocarditis, and severe valvular regurgitation and/or stenosis, and valve surgery may be required. Here, we report a case of mitral valve repair for a large Libman-Sacks vegetation in a 29-year-old woman with a history of APS with cerebral infarction. Transesophageal echocardiography (TEE) demonstrated an isolated large mobile vegetation on the atrial side of posterior mitral valve leaflet, with severe mitral regurgitation. Next, we organized a multidisciplinary team meeting to better evaluate the case before performing the surgery. To prevent further thromboembolic events, and due to the insufficiency of the mitral valve, the patient was accepted for mitral valve surgery, and she was discharged uneventfully 10 days after successful surgery. She was managed with long-term anticoagulation medicine after surgery and followed up for 2 years with no complications. The present case showed mitral repair is feasible and effective in young female patients of child-bearing age, and the lesion only localized mitral valve abnormalities caused by Libman-Sacks endocarditis.


Assuntos
Síndrome Antifosfolipídica/complicações , Endocardite/cirurgia , Anuloplastia da Valva Mitral , Adulto , Ecocardiografia , Endocardite/diagnóstico por imagem , Endocardite/etiologia , Feminino , Humanos
6.
Med Clin North Am ; 105(2): 341-353, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33589107

RESUMO

Management of women with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and obstetric antiphospholipid syndrome (APS) during pregnancy presents unique clinical challenges. Women with both RA and SLE can have disease flares during pregnancy, leading to pregnancy complications, such as preeclampsia, small-for-gestational-age infants, and preterm delivery. Disease should be under control prior to conception. Women with obstetric APS need to be anticoagulated during pregnancy. Many but not all antirheumatic medications can be used during pregnancy and lactation.


Assuntos
Síndrome Antifosfolipídica , Artrite Reumatoide , Lúpus Eritematoso Sistêmico , Administração dos Cuidados ao Paciente/métodos , Complicações na Gravidez , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/terapia , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/terapia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/terapia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapia , Resultado da Gravidez , Gravidez de Alto Risco
7.
Hematology ; 26(1): 225-239, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33594951

RESUMO

OBJECTIVE: As COVID-19 is a new emerging disease, the hematological/immunological changes that develop in the infected patients remain unknown. This study aims to systematically review the hematologic autoimmune complications in these patients. METHOD: Data from three online databases including Medline (via PubMed), Scopus and Web of Science were searched on 19 December 2020, and after excluding duplicate, irrelevant and inappropriate records, eligible documents were identified. Afterwards, information such as patients' history, presentations, paraclinical data, treatment course and outcome were extracted from the records. RESULTS: A total of 58 documents were considered to be eligible for data extraction which described 94 patients with COVID-19 who developed hematologic autoimmune disorder in their course of infection. Of these patients with COVID-19, the most common hematologic autoimmune disorder was immune thrombocytopenic purpura (55 cases) followed by autoimmune hemolytic anemia (22 cases). Other hematologic autoimmune disorders include antiphospholipid syndrome, thrombotic thrombocytopenic purpura, Evans syndrome and autoimmune neutropenia. CONCLUSION: The current study would help us to always consider an autoimmune etiology for cases with abnormal hematologic finding which further lead to an appropriate treatment of the patients, especially when the symptoms present in about 1-2 weeks after the first manifestation of the infection symptoms. Maybe, at least in this pandemic, it should be recommended to evaluate patients with unexpected and unexplained decrease in their hemoglobulin or platelet count for COVID-19. Another challenging issue is the treatment options. Given the multiorgan involvement and multifaceted nature of the infection, an individualized approach should be taken for each patient.


Assuntos
Doenças Autoimunes/etiologia , Doenças Hematológicas/etiologia , Anemia Hemolítica Autoimune/sangue , Anemia Hemolítica Autoimune/etiologia , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/etiologia , Doenças Autoimunes/sangue , Doenças Hematológicas/sangue , Humanos , Neutropenia/sangue , Neutropenia/etiologia , Púrpura Trombocitopênica Idiopática/sangue , Púrpura Trombocitopênica Idiopática/etiologia , Púrpura Trombocitopênica Trombótica/sangue , Púrpura Trombocitopênica Trombótica/etiologia , Trombocitopenia/sangue , Trombocitopenia/etiologia
8.
BMC Neurol ; 21(1): 9, 2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413173

RESUMO

BACKGROUND: Antiphospholipid syndrome (APS) is associated with a high incidence of thrombotic events, either arterial thrombosis or venous thrombosis. However, APS-related non-thrombotic venous stenosis is rarely reported. CASE PRESENTATION: This study described two cases of young women with APS-related internal jugular vein stenosis (IJVS) and reviewed current literature on this issue, including clinical features, diagnosis, and treatment. CONCLUSIONS: IJVS is a rather rare complication of APS. Two cases were reported for the first time that high titer of antiphospholipid antibodies (aPL) might mediate direct vessel wall damage and further induce venous stenosis despite long-term standardized anticoagulation to prevent thrombus formation. Therefore, dynamic monitoring of autoantibodies and concomitant use of anticoagulants and corticosteroids may be necessary to the management of APS and its complications.


Assuntos
Síndrome Antifosfolipídica/complicações , Veias Jugulares/patologia , Trombose Venosa/etiologia , Adulto , Síndrome Antifosfolipídica/diagnóstico , Constrição Patológica/etiologia , Feminino , Humanos
9.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509859

RESUMO

A high functioning 74-year-old man with systemic lupus erythematosus presented to the emergency department with acute anxiety. He was found to have elevated cardiac enzymes and admitted to the cardiology service for investigation. In hospital, he developed an erythematous papular rash, and deteriorated to being somnolent and bedridden. He was found to have new multiterritory ischaemic strokes. It was eventually noted that he had persistent eosinophilia, present even on admission, which had been overlooked as the total leucocyte count was normal. Serology for antiphospholipid antibody syndrome (APS) was positive. He was diagnosed with hypereosinophilic syndrome (HES) secondary to new APS, and responded to high-dose steroids. This case highlights the importance of fully evaluating a leucocyte differential to make a diagnosis of HES. We discuss the definition, clinical manifestations, diagnostic approach and management of this important condition.


Assuntos
Síndrome Antifosfolipídica/diagnóstico , Cardiomiopatias/diagnóstico , Síndrome Hipereosinofílica/diagnóstico , Diagnóstico Ausente , Idoso , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/tratamento farmacológico , Síndrome Antifosfolipídica/fisiopatologia , Cardiomiopatias/sangue , Cardiomiopatias/tratamento farmacológico , Cardiomiopatias/etiologia , Creatina Quinase/sangue , Estado Terminal , Exantema/etiologia , Glucocorticoides/uso terapêutico , Humanos , Síndrome Hipereosinofílica/tratamento farmacológico , Síndrome Hipereosinofílica/etiologia , Síndrome Hipereosinofílica/fisiopatologia , Imunossupressores/uso terapêutico , Contagem de Leucócitos , Lúpus Eritematoso Sistêmico/complicações , Imagem por Ressonância Magnética , Masculino , Paresia/etiologia , Sonolência , Tomografia Computadorizada por Raios X , Troponina/sangue
10.
J Microbiol Immunol Infect ; 54(1): 37-45, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33500211

RESUMO

Although SARS-CoV-2 is considered a lung-tropic virus, severe COVID-19 is not just a viral pulmonary infection, clinically it is a multi-organ pathology with major coagulation abnormalities and thromboembolism events. Recently, antiphospholipid (aPL) antibodies were found increased in a large number of COVID-19 patients. Elevated aPL have been well documented in antiphospholipid syndrome (APS), a systemic autoimmune disorder characterized by recurrent venous or arterial thrombosis and/or obstetrical morbidity. Among treatment regimen of APS, hydroxychloroquine (HCQ) is one of the molecules proposed in the primary prevention of thrombosis and obstetrical morbidity in those patients. Due to its antithrombotic properties documented in APS therapy, HCQ could be considered a good candidate for the prevention of thrombotic events in COVID-19 patients in association with anticoagulant and its repurposing deserves further evaluation.


Assuntos
/tratamento farmacológico , Hidroxicloroquina/uso terapêutico , Trombose/prevenção & controle , Trombose/virologia , Anticorpos Antifosfolipídeos/sangue , Síndrome Antifosfolipídica/complicações , /virologia , Humanos , Morbidade , Trombose/sangue
11.
Rev. iberoam. fertil. reprod. hum ; 37(3/4): 0-0, jul.-dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-199278

RESUMO

INTRODUCCIÓN: La pérdida del embarazo que ocurre tras las veinte semanas de gestación, se denomina muerte fetal (MF); es un evento que causa un gran impacto psicoemocional en la pareja afectada. La literatura médica afirma que, en casi la mitad de estos casos, no hay una causa conocida. Las causas principales están relacionadas son: síndrome antifosfolípido obstétrico (SAF), otras alteraciones inmunológicas (OIA), otros factores que pueden causar infarto placentario por coagulación, rotura prematura de membranas, preeclampsia y trombosis en la circulación útero-placentaria. MÉTODOS: Revisamos cuidadosamente la historia clínica y los estudios inmunológicos de una cohorte de 38 pacientes que han sufrido MF. RESULTADOS: Treinta y ocho pacientes (edades 36-42 años) fueron estudiadas. En más de la mitad de los pacientes (57 %) se diagnosticó SAF. El hipotiroidismo autoinmune (26 %), el anticuerpo antinuclear (24 %) comprendió el grupo de OIA. Once de 38 pacientes mostraron diferentes mutaciones de trombofilias. La hiperhomocisteinemia estuvo presente en el 53 % de los pacientes. CONCLUSIÓN: Las alteraciones inmunológicas y la trombofilia se asociaron con una proporción significativa de nuestros casos de MF. El diagnóstico de las causas evitables es necesario para evitar complicaciones obstétricas en embarazos futuros


INTRODUCTION: Pregnancy loss that occurs after the twenty weeks of gestation, termed foetal death (FD), is a rare event of pregnancy causing great psycho-emotional impact on the affected couple. Medical literature states that in nearly half of these cases, there is no known cause. Leading, causes are related to obstetric antiphospholipid syndrome (APS), other immunological alterations (OIA), other factors that may cause clotting placental infarction, premature rupture of membranes, preeclampsia, and thrombosis in the utero-placental circulation with subsequent FD. METHODS: We carefully reviewed the complete medical records and immunological studies of a cohort of 38 patients that have suffered FD. RESULTS: Thirty-eight patients (ages 36 - 42 years) were studied. In more than half of the patients (57%) APS was diagnosed. Autoimmune hypothyroidism (26%), antinuclear antibody (24%) comprised the group of OIA. Eleven out of 38 patients showed different thrombophilia mutations. Hyperhomocysteinemia was present in 53% of patients. CONCLUSION: Immunological alterations and thrombophilia were associated with a significant proportion of our FD cases. Diagnosis of preventable causes of FD is necessary in order to avoid any obstetric complications in future pregnancies


Assuntos
Humanos , Masculino , Gravidez , Adulto , Morte Fetal/etiologia , Complicações na Gravidez/etiologia , Fatores de Risco , Síndrome Antifosfolipídica/complicações , Doenças do Sistema Imunitário/complicações , Trombose/complicações , Trombofilia/complicações , Estudos de Coortes
12.
Int J Mol Sci ; 21(24)2020 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-33333988

RESUMO

As in many autoimmune diseases, the pathogenesis of the antiphospholipid syndrome (APS) is the result of a complex interplay between predisposing genes and triggering environmental factors, leading to a loss of self-tolerance and immune-mediated tissue damage. While the first genetic studies in APS focused primarily on the human leukocytes antigen system (HLA) region, more recent data highlighted the role of other genes in APS susceptibility, including those involved in the immune response and in the hemostatic process. In order to join this intriguing debate, we analyzed the single-nucleotide polymorphisms (SNPs) derived from the whole exome sequencing (WES) of two siblings affected by APS and compared our findings with the available literature. We identified genes encoding proteins involved in the hemostatic process, the immune response, and the phospholipid metabolism (PLA2G6, HSPG2, BCL3, ZFAT, ATP2B2, CRTC3, and ADCY3) of potential interest when debating the pathogenesis of the syndrome. The study of the selected SNPs in a larger cohort of APS patients and the integration of WES results with the network-based approaches will help decipher the genetic risk factors involved in the diverse clinical features of APS.


Assuntos
Síndrome Antifosfolipídica/genética , Síndrome Antifosfolipídica/metabolismo , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Alelos , Anticorpos Antifosfolipídeos/genética , Anticorpos Antifosfolipídeos/imunologia , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/diagnóstico , Biologia Computacional/métodos , Feminino , Perfilação da Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Trombose/etiologia , Sequenciamento Completo do Exoma
14.
Cochrane Database Syst Rev ; 10: CD012169, 2020 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-33045766

RESUMO

BACKGROUND: Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by arterial or venous thrombosis (or both), and/or pregnancy morbidity in association with the presence of antiphospholipid antibodies. The prevalence of APS is estimated at 40 to 50 cases per 100,000 people. The most common sites of thrombosis are cerebral arteries and deep veins of the lower limbs. People with a definite APS diagnosis have an increased lifetime risk of recurrent thrombotic events. OBJECTIVES: To assess the effects of antiplatelet (AP) or anticoagulant agents, or both, for the secondary prevention of recurrent thrombosis, particularly ischemic stroke, in people with APS. SEARCH METHODS: We last searched the MEDLINE, Embase, CENTRAL, Cochrane Stroke Group Trials Register, and ongoing trials registers on 22 November 2019. We checked reference lists of included studies, systematic reviews, and practice guidelines. We also contacted experts in the field. SELECTION CRITERIA: We included randomized controlled trials (RCTs) that evaluated any anticoagulant or AP agent, or both, in the secondary prevention of thrombosis in people with APS, according to the criteria valid when the study took place. We did not include studies specifically addressing women with obstetrical APS. DATA COLLECTION AND ANALYSIS: Pairs of review authors independently worked on each step of the review, following Cochrane methods. We summarized the evidence using the GRADE approach. MAIN RESULTS: We identified eight studies including 811 participants that compared different AP or anticoagulant agents. NOAC (non-VKA oral anticoagulant: rivaroxaban 15 or 20 mg/d) versus standard-dose VKA (vitamin K antagonist: warfarin at moderate International Normalized Ratio [INR] - 2.5) or adjusted [INR 2.0-3.0] dose): In three studies there were no differences in any thromboembolic event (including death) and major bleeding (moderate-certainty evidence), but an increased risk of stroke (risk ratio [RR] 14.13, 95% confidence interval [CI] 1.87 to 106.8; moderate-certainty evidence). One of the studies reported a small benefit of rivaroxaban in terms of quality of life at 180 days measured as health state on Visual Analogue Scale (mean difference [MD] 7 mm, 95% CI 2.01 to 11.99; low-certainty evidence), but not measured as health utility on a scale from 0 to 1 (MD 0.04, 95% CI -0.02 to 0.10; low-certainty evidence). High-dose VKA (warfarin with a target INR of 3.1 to 4.0 [mean 3.3] or 3.5 [mean 3.2]) versus standard-dose VKA (warfarin with a target INR of 2.0 to 3.0 [mean 2.3] or 2.5 [mean 2.5]): In two studies there were no differences in the rates of thrombotic events and major bleeding (RR 2.22, 95% CI 0.79 to 6.23, low-certainty evidence), but an increased risk of minor bleeding in one study during a mean of 3.4 years (standard deviation [SD] 1.2) of follow-up (RR 2.55, 95% CI 1.07 to 6.07). In both trials there was evidence of a higher risk of any bleeding (hazard ratio [HR] 2.03 95% CI 1.12 to 3.68; low-certainty evidence) in the high-dose VKA group, and for this outcome (any bleeding) the incidence is not different, only the time to event is showing an effect. Standard-dose VKA plus a single AP agent (warfarin at a target INR of 2.0 to 3.0 plus aspirin 100 mg/d) versus standard-dose VKA (warfarin at a target INR of 2.0 to 3.0): One high-risk-of-bias study showed an increased risk of any thromboembolic event with combined treatment (RR 2.14, 95% CI 1.04 to 4.43; low-certainty evidence) and reported on major bleeding with five cases in the combined treatment group and one case in the standard-dose VKA treatment group, resulting in RR 7.42 (95% CI 0.91 to 60.7; low-certainty evidence) and no differences for secondary outcomes (very low- to low-certainty evidence). Single/dual AP agent and standard-dose VKA (pooled results): Two high-risk-of-bias studies compared a combination of AP and VKA (aspirin 100 mg/d plus warfarin or unspecified VKA at a target INR of 2.0 to 3.0 or 2.0 to 2.5) with a single AP agent (aspirin 100 mg/d), but did not provide any conclusive evidence regarding the effects of those drugs in people with APS (very low-certainty evidence). One of the above-mentioned studies was a three-armed study that compared a combination of AP and VKA (aspirin 100 mg/d plus warfarin at a target INR of 2.0 to 2.5) with dual AP therapy (aspirin 100 mg/d plus cilostazol 200 mg/d) and dual AP therapy (aspirin 100 mg/d plus cilostazol 200 mg/d) versus a single AP treatment (aspirin 100 mg/d). This study reported on stroke (very low-certainty evidence) but did not report on any thromboembolic events, major bleeding, or any secondary outcomes. We identified two ongoing studies and three studies are awaiting classification. AUTHORS' CONCLUSIONS: The evidence identified indicates that NOACs compared with standard-dose VKAs may increase the risk of stroke and do not appear to alter the risk of other outcomes (moderate-certainty evidence). Using high-dose VKA versus standard-dose VKA did not alter the risk of any thromboembolic event or major bleeding but may increase the risk of any form of bleeding (low-certainty evidence). Standard-dose VKA combined with an AP agent compared with standard-dose VKA alone may increase the risk of any thromboembolic event and does not appear to alter the risk of major bleeding or other outcomes (low-certainty evidence). The evidence is very uncertain about the benefit or harm of using standard-dose VKA plus AP agents versus single or dual AP therapy, or dual versus single AP therapy, for the secondary prevention of recurrent thrombosis in people with APS (very low-certainty evidence).


Assuntos
Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/complicações , Inibidores da Agregação de Plaquetas/uso terapêutico , Prevenção Secundária , Acidente Vascular Cerebral/prevenção & controle , Tromboembolia/prevenção & controle , Anticoagulantes/efeitos adversos , Causas de Morte , Inibidores do Fator Xa/uso terapêutico , Hemorragia/induzido quimicamente , Humanos , Inibidores da Agregação de Plaquetas/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Rivaroxabana/uso terapêutico , Acidente Vascular Cerebral/mortalidade , Tromboembolia/mortalidade , Varfarina/uso terapêutico
16.
J Am Heart Assoc ; 9(21): e017773, 2020 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-32972320

RESUMO

Background Recent literature reports a strong thrombotic tendency in patients hospitalized for a coronavirus disease 2019 (COVID-19) infection. This characteristic is unusual and seems specific to COVID-19 infections, especially in their severe form. Viral infections can trigger acquired thrombophilia, which can then lead to thrombotic complications. We investigate for the presence of acquired thrombophilia, which could participate in this phenomenon, and report its prevalence. We also wonder if these thrombophilias participate in the bad prognosis of severe COVID-19 infections. Methods and Results In 89 consecutive patients hospitalized for COVID-19 infection, we found a 20% prevalence of PS (protein S) deficiency and a high (ie, 72%) prevalence of antiphospholipid antibodies: mainly lupus anticoagulant. The presence of PS deficiency or antiphospholipid antibodies was not linked with a prolonged activated partial thromboplastin time nor with D-dimer, fibrinogen, or CRP (C-reactive protein) concentrations. These coagulation abnormalities are also not linked with thrombotic clinical events occurring during hospitalization nor with mortality. Conclusions We assess a high prevalence of positive tests detecting thrombophilia in COVID-19 infections. However, in our series, these acquired thrombophilias are not correlated with the severity of the disease nor with the occurrence of thrombotic events. Albeit the strong thrombotic tendency in COVID-19 infections, the presence of frequent acquired thrombophilia may be part of the inflammation storm of COVID-19 and should not systematically modify our strategy on prophylactic anticoagulant treatment, which is already revised upwards in this pathological condition. Registration URL: https://www.clini​caltr​ials.gov; Unique identifier: NCT04335162.


Assuntos
Síndrome Antifosfolipídica/epidemiologia , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Deficiência de Proteína S/epidemiologia , Trombose/epidemiologia , Idoso , Anticorpos Antifosfolipídeos/sangue , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/diagnóstico , Biomarcadores/sangue , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico , Prevalência , Prognóstico , Proteína S/análise , Deficiência de Proteína S/sangue , Deficiência de Proteína S/diagnóstico , Fatores de Risco , Índice de Gravidade de Doença , Trombose/sangue , Trombose/diagnóstico
17.
Kyobu Geka ; 73(8): 619-622, 2020 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-32879293

RESUMO

A 66-year-old woman with primary antiphospholipid antibody syndrome (APS) was admitted due to severe dyspnea. Eight months prior to admission, she underwent bioprosthetic mitral valve replacement for mitral valve stenosis and regurgitation. Transthoracic echocardiogram showed thickening bioprosthetic valve leaflets and severe valve stenosis. Emergency reoperation for artificial valve failure was performed. The explanted bioprosthetic valve showed massive thrombus formation. After the operation, she started strict anticoagulant and antiplatelet therapies and was discharged without recurrence of valve thrombosis.


Assuntos
Síndrome Antifosfolipídica , Bioprótese , Próteses Valvulares Cardíacas , Trombose , Idoso , Feminino , Humanos , Valva Mitral , Falha de Prótese , Reoperação
18.
Obstet Gynecol ; 136(4): 844-846, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925632

RESUMO

: With the current issue, the journal continues to bring new insights from Cochrane Systematic Reviews to the readers of Obstetrics & Gynecology. This month, we focus on potential interventions to improve pregnancy outcomes for women with recurrent pregnancy loss and antiphospholipid antibodies, the utility of pelvic floor muscle training in the perinatal period to prevent incontinence, and the use of adhesion barriers in gynecologic surgery. The summaries are published below, and the complete references with hyperlinks are listed in Box 1. BOX 1. ABSTRACTS DISCUSSED IN THIS SUMMARY.


Assuntos
Aborto Espontâneo , Incontinência Fecal , Procedimentos Cirúrgicos em Ginecologia , Assistência Perinatal , Aderências Teciduais , Incontinência Urinária , Aborto Espontâneo/etiologia , Aborto Espontâneo/prevenção & controle , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/tratamento farmacológico , Incontinência Fecal/etiologia , Incontinência Fecal/prevenção & controle , Feminino , Fibrinolíticos/farmacologia , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/normas , Humanos , Debilidade Muscular/etiologia , Debilidade Muscular/reabilitação , Diafragma da Pelve/fisiopatologia , Assistência Perinatal/métodos , Assistência Perinatal/normas , Gravidez , Resultado da Gravidez , Melhoria de Qualidade , Revisões Sistemáticas como Assunto , Aderências Teciduais/etiologia , Aderências Teciduais/prevenção & controle , Incontinência Urinária/etiologia , Incontinência Urinária/prevenção & controle
19.
Rev. argent. reumatolg. (En línea) ; 31(3): 51-54, set. 2020. ilus
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1149676

RESUMO

Las manifestaciones cutáneas en las enfermedades autoinmunes son frecuentes y heterogéneas. En algunas de ellas, como en el caso del lupus eritematoso sistémico, la dermatomiositis, la esclerosis sistémica y el síndrome antifosfolípidico son de tal importancia que se incluyen como criterios clasificatorios de la enfermedad. Los diagnósticos diferenciales varían en gravedad, pudiendo en ocasiones presentar riesgo vital, por lo cual se jerarquizan el diagnóstico y tratamiento oportunos. Se describe el caso de una paciente de 22 años con diagnóstico previo de lupus eritematoso sistémico y síndrome antifosfolípídico, que concurre a la consulta con cuadro agudo caracterizado por lesiones cutáneas dolorosas de aspecto necrótico acompañadas de fiebre y livedo reticularis.


Cutaneous involvement is frequent and heterogeneous in autoimmune diseases. In some of them, such as in systemic lupus erythematosus, dermatomyositis, systemic sclerosis and antiphospholipid syndrome, some manifestations are so relevant that are included in the classification criteria. Differential diagnosis ranges in severity. Since the disease may be life-threatening, a prompt diagnosis and treatment are mandatory. We describe a clinical case of a twenty-two-year-old woman with diagnosis of systemic lupus erythematosus and antiphospholipidic syndrome, presenting with acute, painful cutaneous lesions with necrotic aspect, fever and livedo reticularis.


Assuntos
Humanos , Feminino , Púrpura , Terapêutica , Síndrome Antifosfolipídica , Lúpus Eritematoso Sistêmico
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