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2.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462030

RESUMO

This case represents a rare fulminant course of fried-rice associated food poisoning in an immunocompetent person due to pre-formed exotoxin produced by Bacillus cereus, with severe manifestations of sepsis, including multi-organ (hepatic, renal, cardiac, respiratory and neurological) failure, shock, metabolic acidosis, rhabdomyolysis and coagulopathy. Despite maximal supportive measures (continuous renal replacement therapy, plasmapheresis, N-acetylcysteine infusion and blood products, and broad-spectrum antimicrobials) and input from a multidisciplinary team (consisting of infectious diseases, intensive care, gastroenterology, surgery, toxicology, immunology and haematology), mortality resulted. This case is the first to use whole genome sequencing techniques to confirm the toxigenic potential of B. cereus It has important implications for food preparation and storage, particularly given its occurrence in home isolation during the COVID-19 pandemic.


Assuntos
Bacillus cereus/genética , Exotoxinas/genética , Doenças Transmitidas por Alimentos/diagnóstico , Acetilcisteína/uso terapêutico , Acidose/fisiopatologia , Acidose/terapia , Adulto , Antiarrítmicos/uso terapêutico , Antibacterianos/uso terapêutico , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Bacillus cereus/isolamento & purificação , Transtornos da Coagulação Sanguínea/fisiopatologia , Transtornos da Coagulação Sanguínea/terapia , Transfusão de Sangue , Encefalopatias , Terapia de Substituição Renal Contínua , Evolução Fatal , Feminino , Doenças Transmitidas por Alimentos/microbiologia , Doenças Transmitidas por Alimentos/fisiopatologia , Doenças Transmitidas por Alimentos/terapia , Depuradores de Radicais Livres/uso terapêutico , Humanos , Imunocompetência , Falência Hepática/fisiopatologia , Falência Hepática/terapia , Insuficiência de Múltiplos Órgãos/fisiopatologia , Insuficiência de Múltiplos Órgãos/terapia , Plasmaferese , Insuficiência Renal/fisiopatologia , Insuficiência Renal/terapia , Rabdomiólise/fisiopatologia , Rabdomiólise/terapia , Sepse/fisiopatologia , Sepse/terapia , Choque/fisiopatologia , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Sequenciamento Completo do Genoma
3.
Phytomedicine ; 81: 153433, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33373925

RESUMO

OBJECTIVE: Previous studies mainly reported the clinical characteristics of novel coronavirus 2019 (COVID-19) infections, but the research on clinical characteristics and treatment outcomes of COVID-19 patients with stroke is still rare. METHODS: A multi-center retrospective study was conducted at 11 hospitals in 4 provinces of China, and COVID-19 patients with stroke were enrolled from February 24 to May 4, 2020. We analyzed epidemiological, demographic, and clinical characteristics of cases as well as the laboratory test results, treatment regimens and outcomes, and the clinical characteristics and therapeutic outcomes were compared between severe and nonsevere patients, and by age group, respectively. RESULTS: A total of 27 patients [mean age: 66.41 (SD 12.1) years] were enrolled. Among them, 9 (33.3%) were severe patients and 18 (66.7%) were nonsevere patients; 17 (63.0%) were female; 19 (70.4%) were aged 60 years and above. The most common symptoms were fever [19 (70.4%)], fatigue [12 (44.4%)] and cough [11 (40.7%)], respectively. Abnormal laboratory findings of COVID-19 patients with stroke included high levels of C-reactive protein [19 (73.1%)], D-dimer [14 (58.3%)], blood glucose [14 (53.8%)], fibrinogen [13 (50.0%)], and decreased lymphocytes [12 (44.4%)]. Comparing to nonsevere cases with stroke, severe patients with stroke were likely to be older, susceptible to receiving oxygen inhalation, and had more complications (p < 0.05). In addition, there were significant differences in lymphocytes, neutrophils, lactate dehydrogenase, C-reactive protein, creatine kinase between the severe cases and nonsevere cases (p < 0.05). The older patients had a decreased platelet count and elevated fibrinogen, compared with the younger (p < 0.05). All patients (100%) received antiviral treatment, 12 (44.4%) received antibiotics treatment, 26 (96.3%) received Traditional Chinese Medicine (Lung cleansing & detoxifying decoction), and oxygen inhalation was in 18 (66.7%). The median duration of hospitalization was 16 days. By May 4, 2020, a total of 26 (96.3%) patients were cured and discharged, and 1 (3.7%) patients died. CONCLUSION: COVID-19 patients with stroke had poor indicators of coagulation system, and severe and older patients might have a higher risk of complications and unfavorable coagulation system. However, the overall treatment outcome is favorable.


Assuntos
/complicações , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , Transtornos da Coagulação Sanguínea/complicações , Transtornos da Coagulação Sanguínea/terapia , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oxigenoterapia , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento
4.
Int J Mol Sci ; 22(1)2020 Dec 25.
Artigo em Inglês | MEDLINE | ID: mdl-33375718

RESUMO

Red blood cells (RBCs) release extracellular vesicles (EVs) including both endosome-derived exosomes and plasma-membrane-derived microvesicles (MVs). RBC-derived EVs (RBCEVs) are secreted during erythropoiesis, physiological cellular aging, disease conditions, and in response to environmental stressors. RBCEVs are enriched in various bioactive molecules that facilitate cell to cell communication and can act as markers of disease. RBCEVs contribute towards physiological adaptive responses to hypoxia as well as pathophysiological progression of diabetes and genetic non-malignant hematologic disease. Moreover, a considerable number of studies focus on the role of EVs from stored RBCs and have evaluated post transfusion consequences associated with their exposure. Interestingly, RBCEVs are important contributors toward coagulopathy in hematological disorders, thus representing a unique evolving area of study that can provide insights into molecular mechanisms that contribute toward dysregulated hemostasis associated with several disease conditions. Relevant work to this point provides a foundation on which to build further studies focused on unraveling the potential roles of RBCEVs in health and disease. In this review, we provide an analysis and summary of RBCEVs biogenesis, composition, and their biological function with a special emphasis on RBCEV pathophysiological contribution to coagulopathy. Further, we consider potential therapeutic applications of RBCEVs.


Assuntos
Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/metabolismo , Eritrócitos/metabolismo , Vesículas Extracelulares/metabolismo , Homeostase , Transporte Biológico , Biomarcadores/metabolismo , Transtornos da Coagulação Sanguínea/terapia , Comunicação Celular , Micropartículas Derivadas de Células/metabolismo , Gerenciamento Clínico , Suscetibilidade a Doenças , Perfilação da Expressão Gênica , Humanos , Óxido Nítrico/metabolismo , Oxirredução
6.
Anatol J Cardiol ; 24(4): 224-234, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33001051

RESUMO

Coronavirus disease 2019 (COVID-19) caused by 'Severe Acute Respiratory Syndrome Coronavirus-2' (SARS-CoV-2) infection emerged in Wuhan, a city of China, and spread to the entire planet in early 2020. The virus enters the respiratory tract cells and other tissues via ACE2 receptors. Approximately 20% of infected subjects develop severe or critical disease. A cytokine storm leads to over inflammation and thrombotic events. The most common clinical presentation in COVID-19 is pneumonia, typically characterized by bilateral, peripheral, and patchy infiltrations in the lungs. However multi-systemic involvement including peripheral thromboembolic skin lesions, central nervous, gastrointestinal, circulatory, and urinary systems are reported. The disease has a higher mortality compared to other viral agents causing pneumonia and unfortunately, no approved specific therapy, nor vaccine has yet been discovered. Several clinical trials are ongoing with hydroxychloroquine, remdesivir, favipiravir, and low molecular weight heparins. This comprehensive review aimed to summarize coagulation abnormalities reported in COVID-19, discuss the thrombosis, and inflammation-driven background of the disease, emphasize the impact of thrombotic and inflammatory processes on the progression and prognosis of COVID-19, and to provide evidence-based therapeutic guidance, especially from antithrombotic and anti-inflammatory perspectives.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Inflamação/virologia , Pneumonia Viral/complicações , Trombose/virologia , Transtornos da Coagulação Sanguínea/terapia , Transtornos da Coagulação Sanguínea/virologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Citocinas/metabolismo , Transtornos Hemostáticos/virologia , Humanos , Imunomodulação/fisiologia , Inflamação/terapia , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Prognóstico , Trombose/terapia
7.
Crit Care ; 24(1): 559, 2020 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938471

RESUMO

Critically ill patients with COVID-19 are at increased risk for thrombotic complications which has led to an intense debate surrounding their anticoagulation management. In the absence of data from randomized controlled clinical trials, a number of consensus guidelines and recommendations have been published to facilitate clinical decision-making on this issue. However, substantive differences exist between these guidelines which can be difficult for clinicians. This review briefly summarizes the major societal guidelines and compares their similarities and differences. A common theme in all of the recommendations is to take an individualized approach to patient management and a call for prospective randomized clinical trials to address important anticoagulation issues in this population.


Assuntos
Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/terapia , Infecções por Coronavirus/complicações , Estado Terminal , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto , Trombose/etiologia , Trombose/terapia , Betacoronavirus , Humanos , Pandemias
8.
Orv Hetil ; 161(37): 1599-1605, 2020 09.
Artigo em Húngaro | MEDLINE | ID: mdl-32894740

RESUMO

Major trauma is a frequent cause of death, and is the leading cause of death in the younger agegroups. Severe bleeding is often responsible for early mortality. The background of the latter is the trauma-induced coagulopathy (TIC), which - often very early - develops after the onset of bleeding. The high amount of blood products, i.e., massive transfusion administered during the management of traumatic bleeding can result in severe, even fatal complications. Modern, aggressive management of masssive traumatic bleeding is effective in reducing exsanguination and mortality or late complications. This method also fits into the concept of Patient Blood Management. This review deals with the up-to-date, goal-directed, preventive management of traumatic bleeding and coagulopathy, with emphasis on theoretical grounds. The aim is to present the essence of this management method also to those who are not directly involved in this activity. Orv Hetil. 2020; 161(37): 1599-1605.


Assuntos
Transtornos da Coagulação Sanguínea , Hemorragia , Ferimentos e Lesões , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/terapia , Transfusão de Sangue , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Ferimentos e Lesões/complicações
9.
Einstein (Sao Paulo) ; 18: eAO5032, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32876090

RESUMO

Objective To describe the implementation of a care protocol based on rapid response teams, for management and resolution of bleeding. Methods A hospital protocol called Hemorrhage Code (Code H) was devised and developed. In a flow line, a multidisciplinary team provides comprehensive, fast and effective care to the patient with a severe hemorrhagic condition. In another flow line, professionals based at the hospital pharmacy focus on identifying patients at risk of bleeding, to avoid this event. Several hospital professionals and sectors were trained, each with specific roles, ensuring full support to the medical and nursing staffs. Results After implementing this protocol, we were able to significantly reduce the number of catastrophic events related to failure in bleeding management. Conclusion Code H is an example of a value-based medicine and precision medicine project by delivering comprehensive and multidisciplinary care, in addition to point-of-care testing introduced in clinical practice, optimizing patient safety and care practices at the hospital. Furthermore, it will be possible to minimize the risk of lawsuits for the hospital and physicians, as well as rationalizing resources with benefits for administrators and payers.


Assuntos
Transtornos da Coagulação Sanguínea/terapia , Transfusão de Sangue , Hemorragia/terapia , Assistência ao Paciente/normas , Segurança do Paciente , Guias de Prática Clínica como Assunto , Choque Hemorrágico/terapia , Brasil , Hemorragia/prevenção & controle , Humanos , Estudos Retrospectivos
10.
Medicine (Baltimore) ; 99(33): e21143, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871982

RESUMO

BACKGROUND: The impact of vitamin K in ameliorating diabetes-associated complications, especially those linked with platelet activation and coagulation remains unclear. The current study aims to systematically explore and discuss the available evidence on the impact of vitamin K on the diabetes-cardiovascular disease (CVD)-associated complications. METHODS: A systematic review of studies published on the MEDLINE (PubMed), EMBASE, and Google Scholar electronic database will be conducted. The review will include studies published from inception until May 25, 2020, reporting on the effect of vitamin K on CVD-related markers, especially coagulation factors and platelet activation in type 2 diabetes mellitus. Before the full-text screening, all studies will be screened by title, abstract, and keywords. The Downs and Black checklist will be used to assess the quality of the studies. Additionally, the Cochrane collaboration tool will also be used to evaluate the risk of bias across the included studies. Kappa Cohen's calculator will be used to assess the level of agreement between the authors. DISCUSSIONS: This systematic review will not require ethical approval, and the results will be distributed through conference and peer-reviewed publications. Our results will assist current and future research scientists on the potential use of vitamin K as a protective therapy against CVD-related complications. SYSTEMATIC REVIEW REGISTRATION: This protocol is registered on the International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42020151667.


Assuntos
Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/terapia , Diabetes Mellitus Tipo 2/complicações , Metanálise como Assunto , Revisões Sistemáticas como Assunto , Vitamina K/uso terapêutico , Diabetes Mellitus Tipo 2/terapia , Suplementos Nutricionais , Humanos
11.
An Sist Sanit Navar ; 43(2): 245-249, 2020 Aug 31.
Artigo em Espanhol | MEDLINE | ID: mdl-32814926

RESUMO

One of the most significant negative prognostic factors in patients suffering from the disease caused by SARS-CoV-2 (COVID-19) is the development of coagulopathy, associated with abnormal laboratory findings, such as increased D-dimer, and venous thromboembolic complications, requiring thromboprophylactic strategies. The main clinical characteristics of COVID-19 patients are revised here as compared to other coronavirus infections, such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), emphasizing clinical, diagnostic and therapeutic aspects.


Assuntos
Betacoronavirus , Transtornos da Coagulação Sanguínea/virologia , Infecções por Coronavirus/diagnóstico , Coronavírus da Síndrome Respiratória do Oriente Médio , Vírus da SARS , Trombose/virologia , Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos da Coagulação Sanguínea/terapia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Fibrinolíticos/uso terapêutico , Humanos , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Prognóstico , Síndrome Respiratória Aguda Grave/complicações , Síndrome Respiratória Aguda Grave/diagnóstico , Síndrome Respiratória Aguda Grave/fisiopatologia , Síndrome Respiratória Aguda Grave/terapia , Trombose/diagnóstico , Trombose/terapia
13.
Rev Assoc Med Bras (1992) ; 66(6): 842-848, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32696883

RESUMO

INTRODUCTION Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly described virus responsible for the outbreak of the coronavirus disease 2019 (Covid-19), named by the World Health Organization (WHO) in February/2020. Patients with Covid-19 have an incidence of acute respiratory distress syndrome (ARDS) of 15.9-29% and sepsis is observed in all deceased patients. Moreover, disseminated intravascular coagulation (DIC) is one of the major underlying causes of death among these patients. In patients with DIC, there is a decrease in fibrinogen and an increase in D-dimer levels. Some studies have shown that fibrinogen and one of its end products, D-dimer, might have a predictive value for mortality in patients with non-Covid sepsis secondary to complications of DIC. Therefore, anticoagulation, considering its mortality benefits in cases of non-Covid sepsis, may also have an important role in the treatment of Covid-19. METHODS We reviewed the literature of all studies published by April 2020 on patients infected with Covid-19. Our review was limited to D-dimer and fibrinogen changes and anticoagulation recommendations. RESULTS Anticoagulation therapy can be started following the DIC diagnosis in Covid-19 patients despite the bleeding risks. In addition, the current evidence suggests a routine use of anticoagulation, particularly in patients with higher D-dimer levels (> 3.0 µg/mL). CONCLUSION Covid-19 is a systemic, hypercoagulable disease requiring more studies concerning treatment. Aanticoagulation is still an issue to be studied, but D-dimer rise and disease severity are the indicative factors to start treatment as soon as possible.


Assuntos
Anticoagulantes , Transtornos da Coagulação Sanguínea , Infecções por Coronavirus , Coronavirus , Fibrinogênio , Pandemias , Pneumonia Viral , Anticoagulantes/uso terapêutico , Betacoronavirus , Biomarcadores/análise , Transtornos da Coagulação Sanguínea/terapia , Transtornos da Coagulação Sanguínea/virologia , Infecções por Coronavirus/complicações , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Fibrinogênio/análise , Humanos , Pneumonia Viral/complicações
14.
Lancet Haematol ; 7(10): e756-e764, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32628911

RESUMO

The COVID-19 pandemic has major implications for blood transfusion. There are uncertain patterns of demand, and transfusion institutions need to plan for reductions in donations and loss of crucial staff because of sickness and public health restrictions. We systematically searched for relevant studies addressing the transfusion chain-from donor, through collection and processing, to patients-to provide a synthesis of the published literature and guidance during times of potential or actual shortage. A reduction in donor numbers has largely been matched by reductions in demand for transfusion. Contingency planning includes prioritisation policies for patients in the event of predicted shortage. A range of strategies maintain ongoing equitable access to blood for transfusion during the pandemic, in addition to providing new therapies such as convalescent plasma. Sharing experience and developing expert consensus on the basis of evolving publications will help transfusion services and hospitals in countries at different stages in the pandemic.


Assuntos
Betacoronavirus , Bancos de Sangue/estatística & dados numéricos , Doadores de Sangue/provisão & distribução , Transfusão de Sangue , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Anticorpos Antivirais/uso terapêutico , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/terapia , Preservação de Sangue , Segurança do Sangue , Transfusão de Sangue/estatística & dados numéricos , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Seleção do Doador , Procedimentos Cirúrgicos Eletivos , Alocação de Recursos para a Atenção à Saúde , Política de Saúde , Necessidades e Demandas de Serviços de Saúde , Hemoglobinopatias/complicações , Hemoglobinopatias/terapia , Humanos , Imunização Passiva , Pandemias/prevenção & controle , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
Indian Pediatr ; 57(9): 827-833, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32583809

RESUMO

CONTEXT: Preliminary data on coexistence of secondary hemophagocytic lymphohistiocytosis syndrome (HLH) and disseminated intravascular coagulation (DIC) in critically ill children with novel coronavirus disease (COVID-19) are emerging. Herein, we summarize the available literature and fill-in the gaps in this regard. EVIDENCE ACQUISITION: We have performed a literature search for articles in PubMed, EMBASE and Google Scholar databases till May 12, 2020, with following keywords: "COVID-19", "SARS-CoV-2", "HLH", "HScore", "coagulopathy", "D-dimer", "cytokine storm", "children" and "pediatrics" with interposition of Boolean operator "AND". RESULTS: Children presenting with moderate-severe COVID-19 and Kawasaki disease shock-like syndrome exhibit peripheral blood picture analogous to HLH. HScore, a validated tool to diagnose HLH, has been suggested to screen severe COVID-19 patients for cytokine storm. However, HScore faces certain limitations in this scenario. It may be more pragmatic to use 'high D-dimer' (> 3 µg/mL) instead of 'low fibrinogen' to facilitate early detection of cytokine storm. COVID-19 associated coagulopathy resembles hypercoagulable form of DIC with bleeding being rarely reported. Although the International Society on Thrombosis and Haemostasis (ISTH) interim guidance recommends low molecular weight heparin in all hospitalized patients, data is lacking in population below 14 years of age. However, in the presence of life-threatening thromboembolic event or symptomatic acro-ischemia, unfractionated heparin (UFH) should be used with caution. CONCLUSIONS: HScore can be used as a complement to clinical decision for initiating immunosuppression. Children with moderate-to-severe COVID-19, especially those with documented thrombocytopenia or chilblains, should be regularly monitored for coagulopathy.


Assuntos
Betacoronavirus , Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos da Coagulação Sanguínea/virologia , Infecções por Coronavirus/complicações , Linfo-Histiocitose Hemofagocítica/diagnóstico , Linfo-Histiocitose Hemofagocítica/virologia , Pneumonia Viral/complicações , Transtornos da Coagulação Sanguínea/terapia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Humanos , Linfo-Histiocitose Hemofagocítica/terapia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia
16.
Vasc Med ; 25(5): 471-478, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32558620

RESUMO

An ongoing global pandemic of viral pneumonia (coronavirus disease [COVID-19]), due to the virus SARS-CoV-2, has infected millions of people and remains a threat to many more. Most critically ill patients have respiratory failure and there is an international effort to understand mechanisms and predictors of disease severity. Coagulopathy, characterized by elevations in D-dimer and fibrin(ogen) degradation products (FDPs), is associated with critical illness and mortality in patients with COVID-19. Furthermore, increasing reports of microvascular and macrovascular thrombi suggest that hemostatic imbalances may contribute to the pathophysiology of SARS-CoV-2 infection. We review the laboratory and clinical findings of patients with COVID-19-associated coagulopathy, and prior studies of hemostasis in other viral infections and acute respiratory distress syndrome. We hypothesize that an imbalance between coagulation and inflammation may result in a hypercoagulable state. Although thrombosis initiated by the innate immune system is hypothesized to limit SARS-CoV-2 dissemination, aberrant activation of this system can cause endothelial injury resulting in loss of thromboprotective mechanisms, excess thrombin generation, and dysregulation of fibrinolysis and thrombosis. The role various components including neutrophils, neutrophil extracellular traps, activated platelets, microparticles, clotting factors, inflammatory cytokines, and complement play in this process remains an area of active investigation and ongoing clinical trials target these different pathways in COVID-19.


Assuntos
Betacoronavirus , Transtornos da Coagulação Sanguínea/virologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos da Coagulação Sanguínea/terapia , Infecções por Coronavirus/patologia , Infecções por Coronavirus/terapia , Humanos , Pandemias , Pneumonia Viral/patologia , Pneumonia Viral/terapia
17.
Rev. Assoc. Med. Bras. (1992) ; 66(6): 842-848, June 2020. tab, graf
Artigo em Inglês | LILACS, Sec. Est. Saúde SP | ID: biblio-1136295

RESUMO

SUMMARY INTRODUCTION Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly described virus responsible for the outbreak of the coronavirus disease 2019 (Covid-19), named by the World Health Organization (WHO) in February/2020. Patients with Covid-19 have an incidence of acute respiratory distress syndrome (ARDS) of 15.9-29% and sepsis is observed in all deceased patients. Moreover, disseminated intravascular coagulation (DIC) is one of the major underlying causes of death among these patients. In patients with DIC, there is a decrease in fibrinogen and an increase in D-dimer levels. Some studies have shown that fibrinogen and one of its end products, D-dimer, might have a predictive value for mortality in patients with non-Covid sepsis secondary to complications of DIC. Therefore, anticoagulation, considering its mortality benefits in cases of non-Covid sepsis, may also have an important role in the treatment of Covid-19. METHODS We reviewed the literature of all studies published by April 2020 on patients infected with Covid-19. Our review was limited to D-dimer and fibrinogen changes and anticoagulation recommendations. RESULTS Anticoagulation therapy can be started following the DIC diagnosis in Covid-19 patients despite the bleeding risks. In addition, the current evidence suggests a routine use of anticoagulation, particularly in patients with higher D-dimer levels (> 3.0 μg/mL). CONCLUSION Covid-19 is a systemic, hypercoagulable disease requiring more studies concerning treatment. Aanticoagulation is still an issue to be studied, but D-dimer rise and disease severity are the indicative factors to start treatment as soon as possible.


RESUMO INTRODUÇÃO O coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2) é o vírus responsável pelo surto recentemente batizado de doença pelo coronavirus 2019 (Covid-19) pela Organização Mundial de Saúde (OMS) em fevereiro/2020. Os doentes com Covid-19 têm uma incidência de síndrome de dificuldade respiratória aguda (SDRA) de 15,9-29% e sepse é observada em todos os pacientes que vêm a óbito. Além disso, a coagulação intravascular disseminada (DIC) é uma das principais causas subjacentes de morte entre esses pacientes. Em pacientes com DIC, ocorre com uma diminuição do fibrinogênio e um aumento dos níveis de dímero D. Alguns estudos mostraram que o fibrinogênio e um dos seus produtos finais, o dímero D, podem ter um valor preditivo para a mortalidade em pacientes com sepse não relacionada à Covid-19 decorrente de complicações da DIC. Portanto, a anticoagulação, considerando seus benefícios quanto à mortalidade na sepse não relacionada à Covid-19, pode também ter um papel importante no tratamento da Covid-19. MÉTODOS Realizamos uma revisão de todos os estudos publicados até abril de 2020 sobre pacientes infectados com Covid-19. A nossa revisão limitou-se a alterações no dímero D, nos fibrinogênios e recomendações de anticoagulantes. RESULTADOS A terapêutica anticoagulante pode ser iniciada após o diagnóstico de DIC em pacientes com Covid-19 apesar dos riscos de hemorragia. Além disso, a evidência atual sugere o uso rotineiro da anticoagulação, principalmente em pacientes com níveis mais elevados de dímero D (> 3, 0 µg/mL). CONCLUSÃO A Covid-19 é uma doença sistêmica e hipercoagulável que requer mais estudos em relação ao tratamento. A anticoagulação ainda é uma questão a ser estudada, mas o aumento de dímeros D e a gravidade da doença são os fatores indicativos para o início do tratamento o mais rápido possível.


Assuntos
Humanos , Pneumonia Viral/complicações , Transtornos da Coagulação Sanguínea/terapia , Transtornos da Coagulação Sanguínea/virologia , Fibrinogênio/análise , Infecções por Coronavirus/complicações , Coronavirus , Pandemias , Anticoagulantes/uso terapêutico , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Biomarcadores/análise , Infecções por Coronavirus , Betacoronavirus
18.
Cleve Clin J Med ; 87(8): 461-468, 2020 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-32409435

RESUMO

Severe COVID-19 illness is associated with intense inflammation, leading to high rates of thrombotic complications that increase morbidity and mortality. Markedly elevated levels of D-dimer with normal fibrinogen levels are the hallmark laboratory findings of severe COVID-19- associated coagulopathy. Prophylaxis against venous thromboembolism is paramount for all hospitalized patients, with more aggressive prophylaxis and screening recommended for patients with D-dimer levels above 3.0 µg/mL. Point-of-care ultrasonography is the imaging method of choice for patients at high risk, as it entails minimal risk of exposing providers to the virus.


Assuntos
Anticoagulantes/farmacologia , Betacoronavirus , Transtornos da Coagulação Sanguínea , Infecções por Coronavirus , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Monitorização Fisiológica/métodos , Pandemias , Pneumonia Viral , Betacoronavirus/patogenicidade , Betacoronavirus/fisiologia , Coagulação Sanguínea/efeitos dos fármacos , Coagulação Sanguínea/fisiologia , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/terapia , Testes de Coagulação Sanguínea/métodos , Quimioprevenção/métodos , Infecções por Coronavirus/sangue , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Humanos , Pneumonia Viral/sangue , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Trombose/etiologia , Trombose/prevenção & controle
20.
Sci Rep ; 10(1): 7784, 2020 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-32385325

RESUMO

BACKGROUND: Markedly elevated D-dimer levels can occur in emergency patients with various clinical situations, and is likely to indicate the presence of coagulopathy, rapid differential diagnosis was crucial for them. METHODS: D-dimer was detected in consecutive 813 patients entering the emergency department of our hospital, for the patients with D-dimer levels above 5.0 µg/mL, the final diagnoses and 28-day mortality were confirmed, and the levels of thrombomodulin (TM), thrombin-antithrombin complex (TAT) and plasmin-antiplasmin complex (PAP) on admission were detected. RESULTS: There were 148 emergency patients with D-dimer levels higher than 5.0 µg/mL mainly due to sepsis, malignancy, trauma, venous thromboembolism (VTE), cerebrovascular accident, and so on. Both of the TM and TAT levels among these diagnoses were significantly different (p < 0.001). The elevated TM (>13.3 TU/mL) had a predictive value of 96.0% for excluding VTE, and the normal TM had a predictive value of 90.4% for excluding sepsis. The overall 28-day mortality of these patients with D-dimer >5.0 ug/mL was 14.2%, the TAT level on admission was independently associated with 28-day mortality (odds ratio 1.014, 95% CI 1.001-1.027, P = 0.030). CONCLUSIONS: The medical emergencies associated with markedly elevated D-dimer levels were revealed, specific markers of endothelial dysfunction and thrombin generation measured by automatic analyzer have the potential to distinguish diagnoses and predict outcomes in these patients.


Assuntos
Biomarcadores , Transtornos da Coagulação Sanguínea/sangue , Emergências , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/terapia , Criança , Suscetibilidade a Doenças , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
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