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1.
G Ital Cardiol (Rome) ; 21(7): 483-488, 2020 Jul.
Artigo em Italiano | MEDLINE | ID: mdl-32555563

RESUMO

On March 11, 2020, just after 2 months from the first cases of coronavirus disease 2019 (COVID-19) in China, the Director-General of the World Health Organization stated that COVID-19 has to be considered as a pandemic. Italian doctors were the first protagonists, after the Chinese ones, in the management of this disease. Clinical observations showed that, in addition to the respiratory infection, a systemic inflammatory response occurs, which leads to coagulation disorders and consequent venous thromboembolism as well as other thrombotic complications. We here review the available literature on this issue to better understand the pathophysiological mechanisms of coagulopathy useful to draw future clinical and therapeutic conclusions.


Assuntos
Transtornos da Coagulação Sanguínea/epidemiologia , Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Tromboembolia Venosa/epidemiologia , Viremia/epidemiologia , Anticoagulantes/uso terapêutico , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/fisiopatologia , Causas de Morte , Comorbidade , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Incidência , Itália , Masculino , Pneumonia Viral/diagnóstico , Medição de Risco , Análise de Sobrevida , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/tratamento farmacológico , Viremia/diagnóstico , Organização Mundial da Saúde
4.
J Hand Surg Am ; 45(6): 518-522, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32387155

RESUMO

As coronavirus 2019 (COVID-19) continues to cause an immense burden on the global health care systems, it is crucial to understand the breadth of this disease process. Recent reports identified hypercoagulability in a subset of critically ill patients and extremity ischemia in an even smaller cohort. Because abnormal coagulation parameters and extremity ischemia have been shown to correlate with poor disease prognosis, understanding how to treat these patients is crucial. To better describe the identification and management of this phenomenon, we present 2 cases of critically ill patients with COVID-19 who developed fingertip ischemia while in the intensive care unit.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Dedos/irrigação sanguínea , Isquemia/tratamento farmacológico , Isquemia/etiologia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Adulto , Idoso , Betacoronavirus , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/fisiopatologia , Terapia Combinada , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Estado Terminal/terapia , Progressão da Doença , Evolução Fatal , Feminino , Seguimentos , Humanos , Unidades de Terapia Intensiva , Isquemia/fisiopatologia , Masculino , Pandemias , Alta do Paciente , Doenças Vasculares Periféricas/diagnóstico , Doenças Vasculares Periféricas/tratamento farmacológico , Doenças Vasculares Periféricas/etiologia , Pneumonia Viral/terapia , Medição de Risco , Amostragem
6.
Mil Med Res ; 7(1): 19, 2020 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-32307014

RESUMO

Since December 2019, a novel type of coronavirus disease (COVID-19) in Wuhan led to an outbreak throughout China and the rest of the world. To date, there have been more than 1,260,000 COVID-19 patients, with a mortality rate of approximately 5.44%. Studies have shown that coagulation dysfunction is a major cause of death in patients with severe COVID-19. Therefore, the People's Liberation Army Professional Committee of Critical Care Medicine and Chinese Society on Thrombosis and Hemostasis grouped experts from the frontline of the Wuhan epidemic to come together and develop an expert consensus on diagnosis and treatment of coagulation dysfunction associated with a severe COVID-19 infection. This consensus includes an overview of COVID-19-related coagulation dysfunction, tests for coagulation, anticoagulation therapy, replacement therapy, supportive therapy and prevention. The consensus produced 18 recommendations which are being used to guide clinical work.


Assuntos
Betacoronavirus , Transtornos da Coagulação Sanguínea/diagnóstico , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Idoso , Anticoagulantes/uso terapêutico , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/virologia , China , Consenso , Humanos , Pessoa de Meia-Idade , Pandemias
7.
Thromb Haemost ; 120(6): 937-948, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32316065

RESUMO

Coronavirus disease 2019 (COVID-19) has caused a global pandemic in just a few months, causing millions infected. Nearly 20% of COVID-19 patients present severe coagulation abnormalities, which may occur in almost all of the severe and critical ill COVID-19 cases. Concomitant venous thromboembolism (VTE), a potential cause of unexplained deaths, has been frequently reported in COVID-19 cases, but its management is still challenging due to the complexity between antithrombotic therapy and coagulation disorders. Based on frontline practical experience and comprehensive literature review, here a panel of experts and physicians from China and Europe developed an evidence and opinion-based consensus on the prophylaxis and management of VTE associated with COVID-19. This statement aims for clinicians treating COVID-19 and provides practical recommendations in detailed situations, for example, how to choose thromboprophylactic measures for patients with diverse severity of disease and bleeding risk, or which kind of anticoagulant should be prescribed. With limited experience on COVID19-associated VTE, this expert consensus statement should be helpful for clinicians worldwide with specific suggestions.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Tromboembolia Venosa/prevenção & controle , Tromboembolia Venosa/terapia , Anticoagulantes/uso terapêutico , Betacoronavirus , Transtornos da Coagulação Sanguínea/tratamento farmacológico , China/epidemiologia , Consenso , Infecções por Coronavirus/sangue , Infecções por Coronavirus/terapia , Estado Terminal , Europa (Continente)/epidemiologia , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hemorragia/prevenção & controle , Humanos , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/terapia , Embolia Pulmonar/complicações , Embolia Pulmonar/prevenção & controle , Sistema de Registros , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Tromboembolia Venosa/complicações , Trombose Venosa/complicações , Trombose Venosa/prevenção & controle
8.
Toxicon ; 180: 39-42, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32289355

RESUMO

Bothrops venezuelensis is a venomous snake of the Viperidae family. It is associated with a high snakebite-related morbidity and mortality in Venezuela, although clinical case descriptions are scarce. Bites by other Bothrops sp. can result in coagulopathy and acute kidney injury. We describe a bite by a captive juvenile B. venezuelensis that caused local swelling, severe pain, endothelial damage, excessive fibrinolysis (INR >12, aPTT 136s, fibrinogen 0.3g/l) and incoagulable blood within 1.5 hours after the bite. The patient was treated with prothrombin complex factors concentrate, fibrinogen and antivenom (Antivipmyn®, Instituto Bioclon, Mexico) 4.5 h after the bite, which improved coagulation parameters progressively. Subsequently signs of compensated disseminated intravascular coagulation manifested and the patient received fresh frozen plasma and erythrocyte concentrate. The patient developed acute kidney injury with macroscopic hematuria. Fluid overload resulted in pulmonary edema requiring intermittent ventilation and diuretic treatment with furosemide. He was discharged with moderately elevated creatinine 16 days after hospitalization. Creatinine level normalized within another week. This case displays the life-threatening toxicity even after juvenile B. venezuelensis bites and the comparability to bites by other Bothrops sp.


Assuntos
Bothrops , Mordeduras de Serpentes/diagnóstico , Lesão Renal Aguda , Adolescente , Animais , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Venenos de Crotalídeos , Coagulação Intravascular Disseminada/tratamento farmacológico , Edema , Humanos , Masculino , Dor , Plasma , Mordeduras de Serpentes/tratamento farmacológico , Venezuela
9.
Einstein (Sao Paulo) ; 18: eRC4819, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31994611

RESUMO

We describe a patient with tertiary hyperparathyroidism with history of three episodes of deep vein thrombosis and on rivaroxaban. The patient underwent a subtotal parathyroidectomy, developing cervical hematoma with airway compression. Therefore, emergency surgical decompression was necessary. Later, on the ninth postoperative day, the serum ionized calcium levels were low. Medical team knowledge about preexisting diseases and their implication in the coagulation state are essential conditions to reduce morbidity and mortality of surgeries. However, no reports were found in literature about the association of hypocalcemia with the use of the new class of anticoagulants, which act as factor X inhibitors (Stuart-Prower factor), predisposing to increased bleeding in the immediate postoperative period.


Assuntos
Transtornos da Coagulação Sanguínea/tratamento farmacológico , Inibidores do Fator Xa/efeitos adversos , Hipocalcemia/induzido quimicamente , Rivaroxabana/efeitos adversos , Cálcio/sangue , Humanos , Hiperparatireoidismo/etiologia , Hiperparatireoidismo/cirurgia , Hipocalcemia/cirurgia , Masculino , Pessoa de Meia-Idade , Paratireoidectomia/efeitos adversos , Paratireoidectomia/métodos , Insuficiência Renal Crônica/complicações , Fatores de Risco
10.
Rev. esp. cardiol. (Ed. impr.) ; 73: 0-0, 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-187648

RESUMO

La pandemia producida por la infección del nuevo coronavirus SARS-CoV-2, que da lugar a una enfermedad altamente contagiosa (COVID-19), ha producido un colapso de los sistemas sanitarios de todo el mundo. Se ha descrito que estos pacientes sufren un estado inflamatorio que condiciona un alto riesgo trombótico. Sin embargo, apenas hay información sobre cómo abordar el riesgo trombótico, la coagulopatía y el tratamiento anticoagulante de estos pacientes. Por otra parte, incluso los pacientes no infectados por COVID-19 sufren una tremenda influencia en su abordaje habitual por la situación sanitaria actual. El objetivo del presente documento, elaborado por el Grupo de Trabajo de Trombosis Cardiovascular de la Sociedad Española de Cardiología, es presentar la información disponible y dar unas pautas sencillas de tratamiento con fármacos antitrombóticos


The new coronavirus SARS-CoV-2, which gives rise to the highly contagious COVID-19 disease, has caused a pandemic that is overwhelming health care systems worldwide. Affected patients have been reported to have a heightened inflammatory state that increases their thrombotic risk. However, there is very scarce information on the management of thrombotic risk, coagulation disorders, and anticoagulant therapy. In addition, the situation has also greatly influenced usual care in patients not infected with COVID-19. This article by the Working Group on Cardiovascular Thrombosis of the Spanish Society of Cardiology aims to summarize the available information and to provide a practical approach to the management of antithrombotic therapy


Assuntos
Humanos , Fibrinolíticos/administração & dosagem , Infecções por Coronavirus/tratamento farmacológico , Vírus da SARS/patogenicidade , Trombose/tratamento farmacológico , Síndrome Respiratória Aguda Grave/tratamento farmacológico , Tromboembolia Venosa/tratamento farmacológico , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Inibidores da Agregação de Plaquetas/administração & dosagem , Trombose/prevenção & controle , Anticoagulantes/administração & dosagem , Heparina de Baixo Peso Molecular/administração & dosagem , Vitamina K/antagonistas & inibidores , Pandemias , Pneumonia Viral/tratamento farmacológico , Transtornos da Coagulação Sanguínea/fisiopatologia , Interações Medicamentosas
11.
Artigo em Russo | MEDLINE | ID: mdl-31793543

RESUMO

AIM: To detect plasma procoagulant activity in patients with schizophrenia at admission to the hospital in a state of exacerbation before (point 1) and after (point 2) pharmacotherapy and evaluate plasma and platelet hemostasis abnormalities. MATERIAL AND METHODS: The study included 80 women, aged from 16 to 57 years, median age 28 years, with schizophrenia with continuous, paroxysmal-progressive or paroxysmal course (F20.00, F20.01, F20.02 according to ICD-10). In 42 of 80 patients, depressive disorders in the structure of schizophrenia were observed. The thrombodynamic test (TD) was performed on T-2 Trombodynamis device according to the manufacturer's instructions (Hemacore LLC, Moscow, Russia). Blood for the TD test was taken in admission to the hospital (point 1) and on discharge (point 2). All patients received standard pharmacotherapy according to their condition. RESULTS: For the first time, it was established that in the whole group of patients (n=46) thrombodynamic indicators of the rate of growth of the clot: initial velocity (Vin), stationary velocity (Vst) and adjusted for spontaneous clots velocity (V) and the amount of clot for 30 minutes test TD (ClotSize, CS) were significantly higher compared to normal values. The mean time of occurrence of spontaneous thrombosis (Tsp) was significantly less than 30 min (p<0.0001), indicating rapid, spontaneous thrombosis. Other parameters of TD did not differ significantly from the norm. As a result of treatment, the initial growth rate of the clot from the activator (Vi) decreased from 58,5 µm/min to 54,5 µm/min; V speed from 37,4 µm/min to 33,5 µm/min; CS clot size from 1249 µm to 1219 µm; clot density - from 24 874 units up to 23 658 units. All these changes are significant. Such dynamics of plasma hemostasis clearly indicates a significant decrease in the coagulation activity of the blood plasma of patients as a result of treatment. An increase in the time of appearance of spontaneous clots after treatment (from 23.5 minutes to 30.5 minutes) indicates a decrease in the procoagulant activity of platelet microparticles after treatment, i.e. the reduction of platelet activation as a result of treatment. CONCLUSION: Our studies have shown for the first time that treatment of patients with antidepressants and antipsychotics reduces the generation of spontaneous clots. The treatment of patients with schizophrenia is accompanied by a decrease in the activity of plasma and platelet hemostasis. This is of great practical importance, since hypercoagulation of spontaneous clots in schizophrenic patients aggravates their chronic inflammatory disorders and affects their resistance to treatment.


Assuntos
Transtornos da Coagulação Sanguínea , Coagulação Sanguínea , Esquizofrenia , Adolescente , Adulto , Antipsicóticos/efeitos adversos , Coagulação Sanguínea/efeitos dos fármacos , Transtornos da Coagulação Sanguínea/induzido quimicamente , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Feminino , Hemostasia , Humanos , Pessoa de Meia-Idade , Esquizofrenia/tratamento farmacológico , Adulto Jovem
12.
BMJ Case Rep ; 12(10)2019 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-31676504

RESUMO

Spontaneous hepatic rupture is an uncommon cause of haemorrhagic shock and very rarely happens due to amyloidosis. This report describes one such case in which a middle-aged man presented in extremis. He was managed initially with massive transfusion, interventional radiology embolisation and decompressive laparotomy for abdominal compartment syndrome. Subsequent coagulopathy was treated with activated factor VII due to deficient native activity. Serum protein electrophoresis and liver biopsy during his hospital course yielded a diagnosis of amyloidosis, which was treated palliatively with steroids and bortezomib. Despite supportive care, he died 10 days after presentation. This case illustrates the importance of considering an uncommon pathology when a patient presents with a condition in an uncommon way.


Assuntos
Amiloidose/complicações , Hepatopatias/patologia , Ruptura Espontânea/etiologia , Choque Hemorrágico/diagnóstico , Amiloidose/tratamento farmacológico , Amiloidose/patologia , Antineoplásicos/uso terapêutico , Biópsia , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Eletroforese das Proteínas Sanguíneas/métodos , Bortezomib/uso terapêutico , Embolização Terapêutica/métodos , Fator VII/uso terapêutico , Evolução Fatal , Humanos , Hipertensão Intra-Abdominal/cirurgia , Laparotomia/métodos , Fígado/patologia , Hepatopatias/terapia , Masculino , Pessoa de Meia-Idade , Choque Hemorrágico/etiologia , Esteroides/uso terapêutico
13.
PLoS One ; 14(10): e0223406, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31581265

RESUMO

Trauma and hemorrhagic shock can lead to acute traumatic coagulopathy (ATC) that is not fully reversed by prehospital resuscitation as simulated with a limited volume of fresh whole blood (FWB) in a rat model. Tranexamic Acid (TXA) is used as an anti-fibrinolytic agent to reduce surgical bleeding if administered prior to or during surgery, and to improve survival in trauma if given early after trauma. It is not clear from the existing clinical literature whether TXA has the same mechanism of action in both settings. This study sought to explore the molecular mechanisms of TXA activity in trauma and determine whether administration of TXA as a supplement to FWB resuscitation could attenuate the established ATC in a rat model simulating prehospital resuscitation of polytrauma and hemorrhagic shock. In a parallel in-vitro study, the effects on clotting assays of adding plasmin at varying doses along with either simultaneous addition of TXA or pre-incubation with TXA were measured, and the results suggested that maximum anti-fibrinolytic effect of TXA on plasmin-induced fibrinolysis required pre-incubation of TXA and plasmin prior to clot initiation. In the rat model, ATC was induced by polytrauma followed by 40% hemorrhage. One hour after trauma, the rats were resuscitated with FWB collected from donor rats. Vehicle or TXA (10mg/kg) was given as bolus either before trauma (TXA-BT), or 45min after trauma prior to resuscitation (TXA-AT). The TXA-BT group was included to contrast the coagulation effects of TXA when used as it is in elective surgery vs. what is actually feasible in real trauma patients (TXA-AT group). A single dose of TXA prior to trauma significantly delayed the onset of ATC from 30min to 120min after trauma as measured by a rise in prothrombin time (PT). The plasma d-dimer as well as plasminogen/fibrinogen ratio in traumatized liver of TXA-BT were significantly lower as compared to vehicle and TXA-AT. Wet/dry weight ratio and leukocytes infiltration of lungs were significantly decreased only if TXA was administrated later, prior to resuscitation (TXA-AT). In conclusion: Limited prehospital trauma resuscitation that includes FWB and TXA may not correct established systemic ATC, but rather may improve overall outcomes of resuscitation by attenuation of acute lung injury. By contrast, TXA given prior to trauma reduced levels of fibrinolysis at the site of tissue injury and circulatory d-dimer, and delayed development of coagulopathy independent of reduction of fibrinogen levels following trauma. These findings highlight the importance of early administration of TXA in trauma, and suggest that further optimization of dosing protocols in trauma to exploit TXA's various sites and modes of action may further improve patient outcomes.


Assuntos
Antifibrinolíticos/administração & dosagem , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/etiologia , Coagulação Sanguínea/efeitos dos fármacos , Hemorragia/sangue , Hemorragia/etiologia , Traumatismo Múltiplo/complicações , Ácido Tranexâmico/administração & dosagem , Animais , Biomarcadores , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/fisiopatologia , Modelos Animais de Doenças , Hemodinâmica/efeitos dos fármacos , Hemorragia/tratamento farmacológico , Hemorragia/fisiopatologia , Humanos , Imuno-Histoquímica , Masculino , Traumatismo Múltiplo/etiologia , Ratos
14.
PLoS Negl Trop Dis ; 13(10): e0007338, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31644526

RESUMO

BACKGROUND: Daboia siamensis (Eastern Russell's viper) is a medically important snake species found widely distributed across Southeast Asia. Envenomings by this species can result in systemic coagulopathy, local tissue injury and/or renal failure. While administration of specific antivenom is an effective treatment for Russell's viper envenomings, the availability of, and access to, geographically-appropriate antivenom remains problematic in many rural areas. In this study, we determined the binding and neutralizing capability of antivenoms manufactured by the Thai Red Cross in Thailand against D. siamensis venoms from four geographical locales: Myanmar, Taiwan, China and Thailand. METHODOLOGY/PRINCIPLE FINDINGS: The D. siamensis monovalent antivenom displayed extensive recognition and binding to proteins found in D. siamensis venom, irrespective of the geographical origin of those venoms. Similar immunological characteristics were observed with the Hemato Polyvalent antivenom, which also uses D. siamensis venom as an immunogen, but binding levels were dramatically reduced when using comparator monovalent antivenoms manufactured against different snake species. A similar pattern was observed when investigating neutralization of coagulopathy, with the procoagulant action of all four geographical venom variants neutralized by both the D. siamensis monovalent and the Hemato Polyvalent antivenoms, while the comparator monovalent antivenoms were ineffective. These in vitro findings translated into therapeutic efficacy in vivo, as the D. siamensis monovalent antivenom was found to effectively protect against the lethal effects of all four geographical venom variants preclinically. Assessments of in vivo nephrotoxicity revealed that D. siamensis venom (700 µg/kg) significantly increased plasma creatinine and blood urea nitrogen levels in anaesthetised rats. The intravenous administration of D. siamensis monovalent antivenom at three times higher than the recommended scaled therapeutic dose, prior to and 1 h after the injection of venom, resulted in reduced levels of markers of nephrotoxicity and prevented renal morphological changes, although lower doses had no therapeutic effect. CONCLUSIONS/SIGNIFICANCE: This study highlights the potential broad geographical utility of the Thai D. siamensis monovalent antivenom for treating envenomings by the Eastern Russell's viper. However, only the early delivery of high antivenom doses appears to be capable of preventing venom-induced nephrotoxicity.


Assuntos
Antivenenos/farmacologia , Antivenenos/uso terapêutico , Insuficiência Renal/induzido quimicamente , Insuficiência Renal/prevenção & controle , Venenos de Víboras/toxicidade , Animais , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Nitrogênio da Ureia Sanguínea , China , Creatinina/sangue , Rim/patologia , Dose Letal Mediana , Masculino , Mianmar , Ratos , Ratos Sprague-Dawley , Insuficiência Renal/patologia , Víbora de Russell , Mordeduras de Serpentes/terapia , Taiwan , Tailândia , Peçonhas , Venenos de Víboras/antagonistas & inibidores , Venenos de Víboras/imunologia
15.
Medicine (Baltimore) ; 98(36): e17015, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490385

RESUMO

Synthetic cannabinoids have become increasingly popular drugs of abuse due to low cost and inability to detect these substances on routine drug screenings. In the United States, incidence of synthetic cannabinoid contamination with long-acting anticoagulant rodenticides (LAARs) resulting in coagulopathy and bleeding complications has been described.We sought to describe the natural history, management approach, and outcomes of bleeding secondary to synthetic cannabinoid-associated LAAR toxicity in an observational case series of patients evaluated at an urban academic medical system.We conducted an observational study of patients with suspected exposure to LAAR-contaminated synthetic cannabinoids and associated bleeding treated within the Johns Hopkins Health System.In this 16 subject cohort, hematuria was the most common bleeding symptom at presentation. The majority of the cohort (75%) had international normalized ratio (INR) > 9.6 at presentation. Of the 13 patients with brodifacoum testing, 12/13 (92%) were positive. Twelve patients (75%) had at least 1 INR value below 2 within 24 hours of the first INR measurement. Of this cohort, 1/16 (6%) died in hospital. The median length of hospital stay was 4 days, (interquartile range = 3-6). The average cost of pharmacological treatment for coagulopathy during inpatient hospitalization was $5300 (range, $2241-$8086).In patients presenting with unexplained coagulopathy it is important for emergency department providers to consider LAAR intoxication and consider formal testing for brodifacoum to assist with treatment planning. Use of a standardized management algorithm including intravenous/oral vitamin K, judicious use of blood products and close laboratory monitoring is essential to optimizing outcomes.


Assuntos
Transtornos da Coagulação Sanguínea/tratamento farmacológico , Rodenticidas/envenenamento , Vitamina K/uso terapêutico , Adulto , Algoritmos , Transtornos da Coagulação Sanguínea/induzido quimicamente , Canabinoides , Contaminação de Medicamentos , Feminino , Humanos , Drogas Ilícitas , Masculino , Estudos Retrospectivos
16.
Am J Surg ; 218(6): 1065-1073, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31540685

RESUMO

INTRODUCTION: The optimal time to initiate venous thromboembolism (VTE) chemoprophylaxis in blunt solid organ injury (BSOI) patients is debated. We hypothesize that 1) BSOI patients are hypercoagulable within 12 h of injury and 2) hypercoagulability dominates in patients who develop clot complications (CC). MATERIAL AND METHODS: This is a prospective study of BSOI patients admitted to two Level-1 Trauma Centers' trauma intensive care units (ICU). Serial kaolin thrombelastography (TEG) and tissue plasminogen activator (tPA)-challenge TEGs were performed. CC included VTE and cerebrovascular accidents. RESULTS: On ICU admission, all patients (n = 95) were hypercoagulable, 58% were in fibrinolysis shutdown, and 50% of patients were tPA-resistant. Twelve patients (13%) developed CC. Compared to those without CC, they demonstrated decreased fibrinolysis at 12 h and higher clot strength at 48 h CONCLUSIONS: BSOI patients are universally hypercoagulable upon ICU admission. VTE chemoprophylaxis should be started immediately in BSOI patients with hypercoagulability on TEG.


Assuntos
Anticoagulantes/uso terapêutico , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/etiologia , Tromboembolia Venosa/prevenção & controle , Ferimentos não Penetrantes/complicações , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tromboelastografia , Tempo para o Tratamento , Centros de Traumatologia
17.
Drug Saf ; 42(12): 1409-1422, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31552603

RESUMO

Direct oral anticoagulants are now recommended by major guidelines as first-choice agents for both stroke prevention in non-valvular atrial fibrillation and treatment/prevention of venous thromboembolism in non-cancer patients. Although there are no published head-to-head trials comparing different direct oral anticoagulants, a growing body of evidence from indirect comparisons and observational studies is suggesting that each direct oral anticoagulant may have a specific risk profile. This review aims to (1) synthesize and critically assess the latest evidence in comparative effectiveness and safety research in the aforementioned consolidated therapeutic uses, by performing an overview of systematic reviews and (2) highlight current challenges, namely underexplored areas, where research should be directed, also considering ongoing unpublished studies. The evidence gathered so far on the risk-benefit profile of direct oral anticoagulants is appraised in the light of existing guidelines to discuss whether further implementation should be proposed.


Assuntos
Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Administração Oral , Transtornos da Coagulação Sanguínea/sangue , Pesquisa Comparativa da Efetividade , Humanos , Resultado do Tratamento
18.
Rev. esp. anestesiol. reanim ; 66(7): 394-404, ago.-sept. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-187554

RESUMO

El shock hemorrágico es una de las principales causas de muerte en los pacientes politraumáticos graves. Para aumentar la supervivencia de estos pacientes se ha desarrollado una estrategia combinada de tratamiento conocida como Control de Daños. Los objetivos de este artículo son analizar el concepto actual de la Reanimación de Control de Daños y sus tres niveles de tratamiento, describir la mejor estrategia transfusional y abordar la coagulopatía aguda del paciente traumático como entidad propia. Se describen también los potenciales cambios que podrían producirse en los próximos años en esta estrategia de tratamiento


Haemorrhagic shock is one of the main causes of mortality in severe polytrauma patients. To increase the survival rates, a combined strategy of treatment known as Damage Control has been developed. The aims of this article are to analyse the actual concept of Damage Control Resuscitation and its three treatment levels, describe the best transfusion strategy, and approach the acute coagulopathy of the traumatic patient as an entity. The potential changes of this therapeutic strategy over the coming years are also described


Assuntos
Humanos , Traumatismo Múltiplo/cirurgia , Choque Hemorrágico/terapia , Recuperação Demorada da Anestesia/terapia , Perda Sanguínea Cirúrgica/prevenção & controle , Hidratação/métodos , Traumatismo Múltiplo/complicações , Sala de Recuperação/organização & administração , Ácido Tranexâmico/uso terapêutico , Transfusão de Sangue/métodos , Transtornos da Coagulação Sanguínea/tratamento farmacológico
19.
Biomed Res Int ; 2019: 1345923, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31467868

RESUMO

Snakebite envenoming is a neglected public health issue in many tropical and subtropical countries. To diagnosis and treat snakebites may be challenging to health care personnel since sufficient information has not been yet provided. This review presents the clinical, therapeutic, and laboratory aspects of Crotalus durissus (South American rattlesnakes) victims. The clinical setting may show local effects such as little or no pain, mild edema, and recurrent erythema. In contrast, the systemic effects may be quite remarkable, such as changes due to neurological damage, intense rhabdomyolysis, incoagulability of the blood, and variations in the peripheral blood elements. The main complication is acute kidney injury. The appropriate treatment depends mainly on the correct recognition of the aggressor snake and the symptoms expressed by the victim. Rattlesnake venom can cause irreparable damage and lead to death. Therefore, a prompt diagnosis allows the immediate onset of proper serotherapy.


Assuntos
Lesão Renal Aguda/diagnóstico , Antivenenos/uso terapêutico , Crotalus , Mordeduras de Serpentes/diagnóstico , Lesão Renal Aguda/tratamento farmacológico , Lesão Renal Aguda/patologia , Lesão Renal Aguda/prevenção & controle , Animais , Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/patologia , Venenos de Crotalídeos/efeitos adversos , Humanos , Imunização Passiva , Rabdomiólise/diagnóstico , Rabdomiólise/tratamento farmacológico , Rabdomiólise/patologia , Mordeduras de Serpentes/tratamento farmacológico , Mordeduras de Serpentes/patologia , Mordeduras de Serpentes/prevenção & controle
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