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1.
Medicine (Baltimore) ; 98(37): e17181, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517875

RESUMO

In this single-center, retrospective study, we aimed to report the clinical outcomes, among Asian comorbid cancer patients with venous thromboembolism (VTE), and compare them with those of VTE patients without cancer.Between January 2013 and December 2017, a total of 322 consecutive patients-diagnosed with acute VTE involving the leg, pelvis, or lung-were screened for inclusion. Comorbid cancer patients with VTE (n = 135, 41.9%) were included in this study and analyzed in comparison with VTE patients without cancer (n = 187, 58.1%). The study outcomes were the composite incidence of symptomatic and radiologically confirmed recurrence of VTE, or any-cause mortality.The study outcome incidence was 62.2% (n = 84) during a mean follow-up period of 10 months: VTE recurrence in 7 patients and any-cause mortality in 83. Upon multivariate analysis, higher body mass index, diabetes mellitus, cancer stage IV, and radiotherapy were independently associated with study outcome incidence. VTE involving the inferior vena cava (hazard ratio [HR], 12.1; 95% confidence interval [CI], 1.20-120.80; P = .034), lung cancer (HR, 16.5; 95% CI, 2.32-117.50; P = .005), and use of vitamin K antagonists (HR, 36.4; 95% CI, 3.00-442.70; P = .005) were independent predictors of VTE recurrence. Compared with VTE patients without cancer, the study outcome incidence was significantly higher among comorbid cancer patients with VTE (62.2% vs 7.5%, P < .001), although there was no significant difference in VTE recurrence between the 2 groups (5.2% in patients with cancer vs 3.7% in patients without cancer, P = .531).We found that various cancer-related and patient-related factors were associated with outcomes among comorbid cancer patients with VTE. The composite incidence of VTE recurrence or any-cause mortality was significantly higher among cancer patients with VTE than among VTE patients without cancer.


Assuntos
Neoplasias/complicações , Neoplasias/terapia , Tromboembolia Venosa/complicações , Tromboembolia Venosa/terapia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico por imagem , Neoplasias/epidemiologia , Recidiva , República da Coreia , Estudos Retrospectivos , Tromboembolia Venosa/diagnóstico por imagem , Tromboembolia Venosa/epidemiologia
2.
Bone Joint J ; 101-B(6): 691-694, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31154840

RESUMO

AIMS: To our knowledge, there is currently no information available about the rate of venous thromboembolism (VTE) or recommendations regarding chemoprophylaxis for patients whose lower limb is immobilized in a plaster cast. We report a retrospective case series assessing the rate of symptomatic VTE in patients treated with a lower limb cast. Given the complex, heterogeneous nature of this group of patients, with many risk factors for VTE, we hypothesized that the rate of VTE would be higher than in the general population. PATIENTS AND METHODS: Patients treated with a lower limb cast between 2006 and 2018 were identified using plaster room records. Their electronic records and radiological reports were reviewed for details about their cast, past medical history, and any VTE recorded in our hospital within a year of casting. RESULTS: There were 136 episodes of casting in 100 patients. The mean age was 55 years (22 to 91). The mean time in a cast was 45 days (five days to eight months). A total of 76 patients had neuropathy secondary to diabetes. No patient received chemical thromboprophylaxis while in a cast. One VTE (0.7% of casting episodes) was documented. This was confirmed by Doppler scan nine days after removing the cast. CONCLUSION: The frequency of VTE was higher than that of the general population (0.05%); this is most likely attributable to our patients' apparent increase in VTE risk as suggested by The National Institute for Health and Care Excellence (NICE). These findings suggest that thromboprophylaxis is not routinely indicated in patients who undergo immobilization of the lower limb in a cast, although the risks of VTE should be assessed. While the cast itself does not pose an increased risk, other pathologies, such as active cancer, mean that each individual case needs to be considered on their merit. Cite this article: Bone Joint J 2019;101-B:691-694.


Assuntos
Moldes Cirúrgicos/efeitos adversos , Imobilização/efeitos adversos , Extremidade Inferior/irrigação sanguínea , Tromboembolia Venosa/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tromboembolia Venosa/diagnóstico por imagem
7.
PLoS One ; 14(3): e0210800, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30835735

RESUMO

BACKGROUND: There have been many efforts to find modifiable risk factors for venous thromboembolism (VTE) in the perioperative period of total knee arthroplasty (TKA), while no study has investigated the relationship between the muscle mass and deep vein thrombosis (DVT) or pulmonary embolism frequency following TKA. This study aimed to evaluate the relationship between muscle volume and the prevalence of symptomatic and radiologically confirmed venous thromboembolism (VTE) after total knee arthroplasty (TKA). METHODS: A total of 261 consecutive patients who underwent primary TKA between 2013 and 2015 were enrolled. Computed tomographic venography with pulmonary angiography (CTVPA) was performed between the 5th and 7th postoperative days to assess the presence of VTE. Four parameters of muscle volume at three levels were evaluated on CTVPA: (i) the cross-sectional area of all skeletal muscles (skeletal muscle index) and total psoas area at the level of the third lumbar vertebrae; (ii) the vastus lateralis muscle at the thigh level; and (iii) the posterior crural muscle at the lower leg level. The relationship between the muscle volume at each level and the prevalence of VTE after TKA was evaluated with multivariate adjusted logistic regression models. RESULTS: The CTVPA scan showed no proximal DVT, and all thrombi were located in muscular, peroneal, and posterior tibial veins. In unilateral TKA, patients with lower muscle volume of the vastus lateralis at the thigh level in the nonoperated limb had significantly higher prevalence of distal DVT in the operated limb (adjusted OR: 2.97 at subclinical DVT revealed by CTVPA and adjusted OR: 2.68 at symptomatic DVT). This finding was also discovered in patients who underwent simultaneous bilateral TKA (adjusted OR: 1.73-2.97 at subclinical DVT and adjusted OR:1.76-1.86 at symptomatic DVT). CONCLUSIONS: The relative muscle volume of the vastus lateralis at the thigh level was negatively associated with the prevalence of symptomatic and radiologically confirmed DVT, suggesting that low thigh muscle mass is an independent risk factor for VTE in the postoperative period of TKA.


Assuntos
Artroplastia do Joelho/efeitos adversos , Músculo Esquelético/diagnóstico por imagem , Embolia Pulmonar/epidemiologia , Tromboembolia Venosa/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Embolia Pulmonar/diagnóstico por imagem , Tromboembolia Venosa/diagnóstico por imagem
8.
Br J Radiol ; 92(1098): 20180478, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30844299

RESUMO

Radiologists routinely evaluate for tumor thrombus in the portal and hepatic veins in patients with hepatocellular carcinoma and in the renal vein and inferior vena cava in patients with renal cell carcinoma. However, tumor thrombus occurs in association with numerous other tumor types, e.g. colorectal carcinoma and pancreatic neuroendocrine tumor. Furthermore tumor thrombi are not limited to the primary tumor but also seen with local recurrence and metastatic disease. While less recognized, these thrombi nevertheless affect patterns of recurrence and prognosis. Their detection is critical for accurate local staging and early detection of local recurrence and metastatic disease. The purpose of this pictorial review is to draw the attention of radiologists to the less familiar manifestations of tumor thrombus, review the imaging findings and illustrate the clinical significance of these thrombi.


Assuntos
Neoplasias/irrigação sanguínea , Trombose Venosa/diagnóstico por imagem , Adolescente , Adulto , Idoso , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia/irrigação sanguínea , Recidiva Local de Neoplasia/diagnóstico por imagem , Neoplasias/diagnóstico por imagem , Veias Renais/diagnóstico por imagem , Veia Cava Inferior/diagnóstico por imagem , Tromboembolia Venosa/diagnóstico por imagem
10.
Br J Radiol ; 92(1095): 20180695, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30629460

RESUMO

OBJECTIVE:: We aimed to determine the diagnostic performance of the contrast-enhanced and unenhanced combined pulmonary arterial MRI and magnetic resonance venography techniques in the diagnosis of venous thromboembolism (VTE). METHODS:: 44 patients who underwent CT pulmonary angiography (CTPA) for suspected PE constituted the study population. Patients underwent combined pulmonary and lower extremity MRI, and Doppler ultrasonography within 72 h after CTPA. Combined MRI included two sequences: unenhanced steady-state free precession (SSFP) and contrast-enhanced three-dimensional (3D) gradient echo (GRE). The presence of emboli in pulmonary arteries and thrombi in lower extremity veins on 3D-GRE and SSFP sequences was recorded. RESULTS:: CTPA showed a total of 244 emboli in 33 (75%) patients whereas contrast-enhanced 3D-GRE MRI showed deep vein thrombosis (DVT) in 34 (77%) subjects. Sensitivities for SSFP vs 3D-GRE MRI respectively in PE detection were 87.9 vs 100% on a per-patient basis, and 53.7 vs 73% on a per-embolus basis. Of 34 patients with established DVT, 31 (91%) were detected by Doppler ultrasound and 29 (85%) were detected by SSFP technique respectively. CONCLUSION:: Both contrast-enhanced and unenhanced combined MRI of acute PE and DVT are feasible one-stop-shopping techniques in patients with suspected thromboembolism. ADVANCES IN KNOWLEDGE:: Pulmonary VTE is a common disease with high mortality. Non-invasive techniques withhigh accuracy are required for the assessment of VTE. CT-related radiation and contrast material risks cause concerns. MRI is a radiation-free technique evaluating the vessels with and without contrast. Combined contrast enhancedor unenhanced pulmonary and lower extremity MRI is feasible in patients with suspected thromboembolism.


Assuntos
Angiografia por Ressonância Magnética/métodos , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia por Tomografia Computadorizada/métodos , Meios de Contraste , Feminino , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Ultrassonografia Doppler/métodos , Tromboembolia Venosa/diagnóstico por imagem , Adulto Jovem
11.
BMJ Case Rep ; 12(1)2019 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-30635311

RESUMO

Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterised by thromboembolic events including venous thromboembolism (VTE) in association with the presence of antiphospholipid antibodies. The standard treatment of VTE historically consists of anticoagulation therapy with warfarin, a vitamin K antagonist. Recently, direct oral anticoagulants, including rivaroxaban have become available for the treatment of VTE. However, the choice of anticoagulant, and the duration of anticoagulation in patients with APS has not been determined yet due to lack of evidence. Here, we report a case of recurrent venous thrombosis after discontinuation of rivaroxaban therapy and avoiding sedentary lifestyle in a patient with APS. We suggest that indefinite anticoagulation therapy might be needed even in low-risk APS cases.


Assuntos
Síndrome Antifosfolipídica/complicações , Rivaroxabana/uso terapêutico , Tromboembolia Venosa/etiologia , Trombose Venosa/etiologia , Assistência ao Convalescente , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/patologia , Inibidores do Fator Xa/uso terapêutico , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/etiologia , Recidiva , Rivaroxabana/administração & dosagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tromboembolia Venosa/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico
12.
Eur J Radiol ; 110: 256-259, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30599869

RESUMO

BACKGROUND: Previous authors have reported an increased incidence of acute pulmonary embolism (PE) in patients with sickle cell disease (SCD) based on retrospective analysis of ICD codes. It is unknown whether patients with SCD have higher rates of positive CT pulmonary angiogram (CTPA) in the emergency department (ED). METHODS: The institutional review board (IRB) approved this retrospective study; informed consent was waived. Between January 1, 2005 and May 31, 2015, 28 patients with SCD underwent a total of 78 CTPA studies in the ED. A control group of 75 non-SCD patients matched for age, gender and race underwent 78 consecutive CTPA studies in the emergency department. Modified Wells' (mWells') scores were calculated for each CTPA study performed. The studies for both groups were blind read by two fellowship trained body radiologists. Descriptive statistics were performed, with significance considered if p < 0.05. RESULTS: The rate of positive CT pulmonary angiogram in patients with SCD was 6.4% (5/78), compared with 12.8% (10/78) in non-SCD matched controls. There was no significant difference in the rate of positive CTPA (p = 0.277). There was also no difference in the mean mWells' score between the two groups (2.44 for SCD vs. 1.95 for controls, p = 0.120). CONCLUSION: SCD patients did not have a significantly different rate of acute PE when compared with matched controls undergoing CTPA in the ED.


Assuntos
Anemia Falciforme/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Serviço Hospitalar de Emergência , Artéria Pulmonar/diagnóstico por imagem , Tromboembolia Venosa/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , Embolia Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Sensibilidade e Especificidade
14.
Ann Vasc Surg ; 56: 24-28, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30500652

RESUMO

BACKGROUND: The aim of this study is to describe the timing of venous thromboembolism (VTE) diagnosis in patients with cerebral or spinal trauma and stroke and describe the relationships between VTE prophylaxis and timing of VTE diagnosis at a community hospital. METHODS: Retrospective cohort observational study over a span of 10 years from 2006 to 2016 was conducted. RESULTS: Lower extremity ultrasound surveillance identified 138 patients who developed VTE during their hospital stay (mean age 62 years, 61.6% males). Mechanical prophylaxis was used in 79.7% and pharmacologic prophylaxis in 78.3% of patients. The average time of admission to administration of mechanical prophylaxis was 1.92 and 7.7 days for pharmacologic prophylaxis. In patients who received pharmacologic prophylaxis within 2 days, 51.5% of all VTE events occurred during the first week, 73.5% by the second week, and 91.2% by the third week of the hospital stay. In patients who started pharmacologic prophylaxis after 2 days in the hospital, 85% of all VTE events occurred within the first week and 90% within 10 days of the hospital stay (P < 0.001). The timing of initiation of mechanical prophylaxis did not influence the timing of VTE events. CONCLUSIONS: In immobilized patients with stroke, traumatic brain injury, or spinal cord injury, VTE screening should be performed at different schedules based on the timing of initiation of pharmacologic prophylaxis. In patients who did not start prophylaxis during the first 2 days of admission to the hospital, the majority of the VTE events occurred during the first 10 days.


Assuntos
Repouso em Cama/efeitos adversos , Lesões Encefálicas/terapia , Admissão do Paciente , Traumatismos da Coluna Vertebral/terapia , Acidente Vascular Cerebral/terapia , Tempo para o Tratamento , Tromboembolia Venosa/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas/complicações , Lesões Encefálicas/diagnóstico , Feminino , Hospitais Comunitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Traumatismos da Coluna Vertebral/complicações , Traumatismos da Coluna Vertebral/diagnóstico , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia , Tromboembolia Venosa/diagnóstico por imagem , Tromboembolia Venosa/etiologia , Adulto Jovem
15.
J Thromb Thrombolysis ; 47(2): 209-215, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30392138

RESUMO

Routine screening of high-risk asymptomatic trauma or surgical patients for venous thromboembolism (VTE) is controversial. Studies suggest against screening while others recognize that some patients at high risk may benefit. The purpose of this pilot study is to evaluate the benefit of routine screening using doppler ultrasonography for the early detection of deep venous thrombosis (DVT) in post-operative neurosurgical patients. This was a quasi-experimental study at a major academic tertiary care medical center. A total of 157 adults underwent cranial or spinal surgical interventions from March through August 2017 and received either standard screening (n = 104) versus routine ultrasonography screening (n = 53). There was no significant difference in incidence of DVT between the two groups: 11 (11%) in the standard screening group versus 5 (9%) in the routine screening group, p = 0.823. Upper and lower extremity ultrasonography was performed in 43 (41%) of the standard screening group versus 53 (100%) in the routine screening group, p < 0.001. DVT was identified in nearly one of every 6 ultrasonography screenings in the standard screening group versus 27 ultrasonography screenings required to identify one DVT in the routine screening group. There were the same number of screenings for upper extremity ultrasonography, but they did not yield or detect DVT; instead only superficial, untreatable, DVTs were reported. Total cost to diagnose one DVT, including screening and labor, averaged $13,664 in the standard group versus $56,525 in the routine group. Routine screening in neurosurgical patients who received VTE prophylaxis was not associated with lower incidence of VTE and mortality attributed to PE. Thus, routine screening may not be cost effective to prevent complications from DVT incidence.


Assuntos
Procedimentos Neurocirúrgicos/efeitos adversos , Embolia Pulmonar/diagnóstico , Ultrassonografia Doppler , Tromboembolia Venosa/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Adulto , Idoso , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/mortalidade , Projetos Piloto , Valor Preditivo dos Testes , Embolia Pulmonar/economia , Embolia Pulmonar/mortalidade , Fatores de Risco , Texas/epidemiologia , Tromboembolia Venosa/economia , Tromboembolia Venosa/mortalidade , Trombose Venosa/economia , Trombose Venosa/mortalidade
16.
J Stroke Cerebrovasc Dis ; 28(1): 232-233, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30352753

RESUMO

BACKGROUND: Mutation of protein S K196E (PS K196E) is a genetic risk factor for venous thromboembolism; however, there are few reports on cerebral venous thrombosis (CVT) with this mutation. We report a case of CVT that was diagnosed as having PS K196E mutation at the initial thrombotic event. METHODS: A 54-year-old man suddenly developed generalized seizures after headache and nausea. Brain magnetic resonance imaging showed cerebral edema, and angiography revealed CVT. Blood examination revealed that protein S activity was low (44%) despite normal free protein S antigen levels (81%). Sequence analysis revealed a heterozygous PS K196E mutation. We treated him with warfarin with the international normalized ratio maintained at 2.0-3.0. After 1 month, he was discharged without any neurological sequelae. RESULTS: Early identification of the causes of thrombophilia is important for the long-term management of CVT. However, detection of PS K196E mutation is difficult because its only feature is a moderate decrease in the activity of protein S, which is influenced by environmental factors. CONCLUSIONS: The possibility of PS K196E mutation should be considered if other causes of CVT are ruled out and if protein S activity is decreased.


Assuntos
Trombose Intracraniana/genética , Mutação , Proteína S/genética , Tromboembolia Venosa/genética , Diagnóstico Diferencial , Predisposição Genética para Doença , Humanos , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Tromboembolia Venosa/diagnóstico por imagem , Tromboembolia Venosa/tratamento farmacológico
17.
Cochrane Database Syst Rev ; 11: CD010837, 2018 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-30407621

RESUMO

BACKGROUND: Venous thromboembolism (VTE) is a collective term for two conditions: deep vein thrombosis (DVT) and pulmonary embolism (PE). A proportion of people with VTE have no underlying or immediately predisposing risk factors and the VTE is referred to as unprovoked. Unprovoked VTE can often be the first clinical manifestation of an underlying malignancy. This has raised the question of whether people with an unprovoked VTE should be investigated for an underlying cancer. Treatment for VTE is different in cancer and non-cancer patients and a correct diagnosis would ensure that people received the optimal treatment for VTE to prevent recurrence and further morbidity. Furthermore, an appropriate cancer diagnosis at an earlier stage could avoid the risk of cancer progression and lead to improvements in cancer-related mortality and morbidity. This is an update of a review first published in 2015. OBJECTIVES: To determine whether testing for undiagnosed cancer in people with a first episode of unprovoked VTE (DVT of the lower limb or PE) is effective in reducing cancer or VTE-related mortality and morbidity and to determine which tests for cancer are best at identifying treatable cancers early. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 11 July 2018. We also undertook reference checking to identify additional studies. SELECTION CRITERIA: Randomised and quasi-randomised trials in which people with an unprovoked VTE were allocated to receive specific tests for identifying cancer or clinically indicated tests only were eligible for inclusion. Primary outcomes included all-cause mortality, cancer-related mortality and VTE-related mortality. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, assessed risk of bias and extracted data. We resolved any disagreements by discussion. MAIN RESULTS: No new studies were identified for this 2018 update. In total, four studies with 1644 participants are included. Two studies assessed the effect of extensive tests including computed tomography (CT) scanning versus tests at the physician's discretion, while the other two studies assessed the effect of standard testing plus positron emission tomography (PET)/CT scanning versus standard testing alone. For extensive tests including CT versus tests at the physician's discretion, the quality of the evidence, as assessed according to GRADE, was low due to risk of bias (early termination of the studies). When comparing standard testing plus PET/CT scanning versus standard testing alone, the quality of evidence was moderate due to a risk of detection bias. The quality of the evidence was downgraded further as detection bias was present in one study with a low number of events.When comparing extensive tests including CT versus tests at the physician's discretion, pooled analysis on two studies showed that testing for cancer was consistent with either benefit or no benefit on cancer-related mortality (odds ratio (OR) 0.49, 95% confidence interval (CI) 0.15 to 1.67; 396 participants; 2 studies; P = 0.26; low-quality evidence). One study (201 participants) showed that, overall, malignancies were less advanced at diagnosis in extensively tested participants than in participants in the control group. In total, 9/13 participants diagnosed with cancer in the extensively tested group had a T1 or T2 stage malignancy compared to 2/10 participants diagnosed with cancer in the control group (OR 5.00, 95% CI 1.05 to 23.76; P = 0.04; low-quality evidence). There was no clear difference in detection of advanced stages between extensive tests versus tests at the physician's discretion: one participant in the extensively tested group had stage T3 compared with four participants in the control group (OR 0.25, 95% CI 0.03 to 2.28; P = 0.22; low-quality evidence). In addition, extensively tested participants were diagnosed earlier than control group (mean: 1 month with extensive tests versus 11.6 months with tests at physician's discretion to cancer diagnosis from the time of diagnosis of VTE). Extensive testing did not increase the frequency of an underlying cancer diagnosis (OR 1.32, 95% CI 0.59 to 2.93; 396 participants; 2 studies; P = 0.50; low-quality evidence). Neither study measured all-cause mortality, VTE-related morbidity and mortality, complications of anticoagulation, adverse effects of cancer tests, participant satisfaction or quality of life.When comparing standard testing plus PET/CT screening versus standard testing alone, standard testing plus PET/CT screening was consistent with either benefit or no benefit on all-cause mortality (OR 1.22, 95% CI 0.49 to 3.04; 1248 participants; 2 studies; P = 0.66; moderate-quality evidence), cancer-related mortality (OR 0.55, 95% CI 0.20 to 1.52; 1248 participants; 2 studies; P = 0.25; moderate-quality evidence) or VTE-related morbidity (OR 1.02, 95% CI 0.48 to 2.17; 854 participants; 1 study; P = 0.96; moderate-quality evidence). Regarding stage of cancer, there was no clear difference for detection of early (OR 1.78, 95% 0.51 to 6.17; 394 participants; 1 study; P = 0.37; low-quality evidence) or advanced (OR 1.00, 95% CI 0.14 to 7.17; 394 participants; 1 study; P = 1.00; low-quality evidence) stages of cancer. There was also no clear difference in the frequency of an underlying cancer diagnosis (OR 1.71, 95% CI 0.91 to 3.20; 1248 participants; 2 studies; P = 0.09; moderate-quality evidence). Time to cancer diagnosis was 4.2 months in the standard testing group and 4.0 months in the standard testing plus PET/CT group (P = 0.88). Neither study measured VTE-related mortality, complications of anticoagulation, adverse effects of cancer tests, participant satisfaction or quality of life. AUTHORS' CONCLUSIONS: Specific testing for cancer in people with unprovoked VTE may lead to earlier diagnosis of cancer at an earlier stage of the disease. However, there is currently insufficient evidence to draw definitive conclusions concerning the effectiveness of testing for undiagnosed cancer in people with a first episode of unprovoked VTE (DVT or PE) in reducing cancer- or VTE-related morbidity and mortality. The results could be consistent with either benefit or no benefit. Further good-quality large-scale randomised controlled trials are required before firm conclusions can be made.


Assuntos
Neoplasias/complicações , Neoplasias/diagnóstico , Embolia Pulmonar/etiologia , Tromboembolia Venosa/etiologia , Trombose Venosa/etiologia , Causas de Morte , Detecção Precoce de Câncer , Humanos , Neoplasias/diagnóstico por imagem , Neoplasias/mortalidade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Tromboembolia Venosa/diagnóstico por imagem , Tromboembolia Venosa/mortalidade , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/mortalidade
18.
Clin Neurol Neurosurg ; 175: 68-73, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30384119

RESUMO

OBJECTIVES: Venous thromboembolism (VTE) is a serious complication following severe traumatic brain injury (TBI), however, anticoagulant prophylaxis remains controversial due to concerns of intracranial hemorrhage (ICH) progression. We examined anticoagulant prophylaxis practice patterns at a major trauma centre and determined risk estimates for VTE and ICH progression classified by timing of anticoagulant initiation. PATIENTS AND METHODS: A 1-year prospective analysis of consecutive patients with severe TBI admitted to a Level-I trauma centre was conducted. In addition, we systematically reviewed the literature to identify studies on VTE and anticoagulant prophylaxis after severe TBI. RESULTS: 64 severe TBI patients were included. 83% of patients received anticoagulant prophylaxis, initiated ≥3d post-TBI in 67%. The in-hospital VTE incidence was 16% and there was no significant difference between patients who received early (<3d) versus late (≥3d) prophylaxis (10% vs. 16%). Rates of ICH progression (0% vs. 7%) were similar between groups. Our systematic review identified 5 studies with VTE rates ranging from 5 to 10% with prophylaxis, to 11-30% without prophylaxis. The effect of timing of anticoagulant prophylaxis initiation on ICH progression was not reported in any study. CONCLUSION: VTE is a common complication after severe TBI. Anticoagulant prophylaxis is often started late (≥3d) post-injury. Randomized trials are justifiable and necessary to provide practice guidance with regards to optimal timing of anticoagulant prophylaxis.


Assuntos
Anticoagulantes/administração & dosagem , Lesões Encefálicas Traumáticas/tratamento farmacológico , Profilaxia Pós-Exposição/métodos , Índice de Gravidade de Doença , Tromboembolia Venosa/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Tromboembolia Venosa/diagnóstico por imagem , Tromboembolia Venosa/mortalidade , Adulto Jovem
19.
Clin Respir J ; 12(11): 2573-2580, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30207643

RESUMO

INTRODUCTION: Venous thromboembolism (VTE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is not rare, which would affect the patient's prognosis. OBJECTIVES: To examine the prevalence, risk factors and clinical characteristics of AECOPD patients with VTE. METHODS: We performed this multi-center, prospective, observational study that involved 16 hospitals in China. Patients admitted to hospital due to AECOPD were consecutively enrolled. Baseline characteristics, VTE risk factors, symptoms, signs and auxiliary examination results were collected. Lower limb venous ultrasound and computed tomography pulmonary angiography were examined. RESULTS: Between June 2009 and October 2010, a total of 1144 AECOPD patients (the average age 72.0 ± 9.1 years, 761 males) were enrolled in this study. Seventy-eight (6.8%) were diagnosed with VTE, including 24 PE, 64 DVT, 10 combined PE and DVT. VTE patients were older than non-VTE patients. History of venous thromboembolism and lower extremity varicose vein, and presence of longer immobility (≥3 days), lower limbs problems of swelling, pain and walking difficulties, diuretics use, fever, syncope, higher d-dimer and lower hemoglobin were more common in VTE patients than in non-VTE patients. After adjusting the covariates, venous thrombosis history, prolonged immobility (≥3 days), lower limb pain before hospitalization, higher d-dimer independently associated with VTE development. Regular glucocorticoid use was not associated with increased risk of VTE in this set of patients. CONCLUSION: VTE is relatively common among hospitalized AECOPD patients. Conventional prophylactic anticoagulant therapy may be considered for those hospitalized AECOPD patients with risk factors.


Assuntos
Extremidade Inferior/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Tromboembolia Venosa/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , China/epidemiologia , Angiografia por Tomografia Computadorizada/métodos , Progressão da Doença , Feminino , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/mortalidade , Fatores de Risco , Ultrassonografia/métodos , Tromboembolia Venosa/complicações , Tromboembolia Venosa/diagnóstico por imagem , Tromboembolia Venosa/prevenção & controle
20.
J Int Med Res ; 46(10): 4332-4337, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30088430

RESUMO

Objective A patent foramen ovale (PFO) is detected frequently by echocardiography. However, a thrombus trapped in a PFO is relatively rare. We herein describe a rare case of a 51-year-old patient with pulmonary embolism in which a large thrombus-in-transit through a PFO was found by echocardiography and disappeared after treatment. Methods A 51-year-old woman presented with a 1-week history of chest tightness, unspecified chest pain, and shortness of breath. Echocardiography revealed a large thrombus trapped in a PFO with increased pulmonary artery pressure, which is a very rare and critical condition. Results The patient was treated with thrombolysis and anticoagulation and discharged from the hospital with an uneventful recovery. Conclusion Our treatment of the present patient achieved a satisfactory result, but it may not be applicable to every patient. Echocardiography is a readily available and safe tool for demonstrating the size, location, and extent of a thrombus, and it plays an important role in the early diagnosis and treatment evaluation for patients with a thrombus trapped in a PFO with concurrent pulmonary embolism.


Assuntos
Forame Oval Patente/complicações , Embolia Pulmonar/etiologia , Trombose/diagnóstico por imagem , Anticoagulantes/uso terapêutico , Angiografia por Tomografia Computadorizada , Ecocardiografia Transesofagiana , Feminino , Fibrinolíticos/uso terapêutico , Forame Oval Patente/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Terapia Trombolítica , Trombose/complicações , Trombose/tratamento farmacológico , Tromboembolia Venosa/complicações , Tromboembolia Venosa/diagnóstico por imagem , Tromboembolia Venosa/tratamento farmacológico
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