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1.
Medicine (Baltimore) ; 98(38): e17309, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568016

RESUMO

Pregnancy and inflammatory bowel disease (IBD) are independent risk factors for venous thromboembolism (VTE). Nevertheless, the optimal VTE prevention strategy for women with IBD in pregnancy and postpartum period has not been established yet. We assessed VTE risks during pregnancy and the postpartum period in women with IBD through systematic review and meta-analysis.Systematic searches were conducted in MEDLINE (Ovid), Embase (Ovid), CENTRAL (Ovid), and Web of Science (Tomson Reuters) from the database inception till May 2017 to identify relevant studies reporting the risk of VTE during pregnancy and/or the postpartum period in women with IBD. Random effect meta-analyses were performed to compare VTE-related outcomes between women with IBD and without IBD. Our protocol was registered: CRD 42017060199 in the PROSPERO International prospective register of systematic reviews.In the analysis of 5 studies reviewed, IBD population (n = 17,636) had a significantly increased risk of VTE during pregnancy (pooled risk ratio (RR) 2.13, 95% confidence interval (CI) 1.66-2.73) and postpartum (RR 2.61, 95% CI 1.84-3.69), comparing to the non-IBD population (n = 11,251,778). According to the location of VTE, the risk of deep vein thrombosis increased significantly by RR of 2.74 (95% CI 1.73-4.36) during pregnancy, whilst risk increase of pulmonary embolism was not statistically significant. In the subgroup analysis, the degree of VTE risk was higher in both periods in the UC group than in the CD group, as compared to that in the non-IBD population (UC group, during pregnancy: RR 2.24, 95% CI 1.6-3.11; postpartum period: RR 2.85, 95% CI 1.79-4.52).Significantly increased risks of VTE during pregnancy were found in the women with IBD, according to the periods and type of IBD, which might support a detailed strategy regarding administration of prophylactic anticoagulants to women with IBD.


Assuntos
Doenças Inflamatórias Intestinais/complicações , Período Pós-Parto , Complicações na Gravidez/epidemiologia , Tromboembolia Venosa/etiologia , Feminino , Humanos , Gravidez , Fatores de Risco
2.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(9): 694-699, 2019 Sep 12.
Artigo em Chinês | MEDLINE | ID: mdl-31484244

RESUMO

Objective: To investigate the incidence of venous thromboembolism (VTE) in lung transplant (LT) recipients. Methods: The clinical data on 124 consecutive patients who underwent lung transplant at Lung Transplantation Center of China-Japan Friendship Hospital from March 2017 to September 2018 were retrospectively collected. Deep venous thrombosis (DVT) was ascertained by vascular ultrasound. Pulmonary embolism (PE) was diagnosed by either chest computed tomography pulmonary angiogram or ventilation/perfusion scan. The risk factors in those patients with postoperative VTE were studied. Results: A total of 124 lung transplant recipients including 78 single lung transplant recipients (62.9%) and 46 bilateral lung transplant recipients(37.1%) were enrolled. Preoperative and postoperative prophylactic anticoagulant was used in 52 patients(52/124, 41.9%) and 69 patients(69/124, 55.6%) respectively. Thirty-two patients developed postoperative VTE among 124 consecutive patients. The overall incidence rate of VTE among 124 LT recipients was 25.8%. The median time to VTE episode following lung transplant was 22.5 days (range 4-295 days). The percentage of DVT in VTE was 93.8%(30/32), involving 1-8 (2.83±1.86) veins. And 60.0% of DVT was from lower extremities and 56.7% located in upper extremities (P>0.05). Four patients (4/32,12.5%) had PE episodes, and half of them suffered from only PE without DVT. The use of extracorporeal membrane oxygenation (ECMO) in 32 patients with VTE was 90.6% (29/32), which was significantly higher than that without VTE (64/92,69.6%, P=0.033). However, there was no difference in the use of peripherally inserted central catheter (PICC) between two groups (96.9% vs 81.5%, P=0.067). Resolution of VTE was successfully accomplished by anticoagulant therapy with long-term use of low molecular weight heparin in 30 patients (93.7%) and followed by oral warfarin in 2 patients (6.3%). Three months follow-up data after anticoagulant therapy showed that total and partial vascular recanalization rate was 65.6%(21/32) and 34.4%(11/32), respectively. Despite anticoagulation-related bleeding complications in three patients, no serious consequences occurred. Conclusions: VTE was frequent in LT recipients. It was speculated that ECMO utilization may be a major risk factor for high incidence of VTE in LT recipients. Aggressive VTE screening/treatment protocols were suggested to be implemented in LT recipients.


Assuntos
Transplante de Pulmão/efeitos adversos , Complicações Pós-Operatórias , Tromboembolia Venosa/epidemiologia , Adulto , Anticoagulantes/administração & dosagem , China/epidemiologia , Humanos , Incidência , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/etiologia
3.
Unfallchirurg ; 122(8): 633-645, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31367841

RESUMO

As the population gets older the prevalence of atrial fibrillation and venous thromboembolism also increases. Therefore, more patients require anticoagulation and currently direct oral anticoagulants (DOAC), such as dabigatran etexilate, apixaban, rivaroxaban and edoxaban are preferred to vitamin K antagonists (VKA), mainly because of the more favorable risk-benefit profile with respect to bleeding. Older patients in particular frequently present at the accident and emergency department due to falls and an increased risk of fractures. The perioperative management of these patients who are treated with DOACs is a challenge in the clinical routine and needs special consideration. This article discusses these issues in an interdisciplinary approach and develops strategies for the perioperative management of patients treated with DOACs and undergoing trauma or orthopedic surgery.


Assuntos
Antitrombinas/administração & dosagem , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Tromboembolia Venosa/prevenção & controle , Ferimentos e Lesões/cirurgia , Administração Oral , Fibrilação Atrial/complicações , Humanos , Assistência Perioperatória , Tromboembolia Venosa/etiologia , Ferimentos e Lesões/complicações
4.
Gynecol Oncol ; 155(1): 112-118, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31378374

RESUMO

OBJECTIVES: We aimed to clarify if endometrial cancer patients are at higher risk of venous thromboembolism (VTE) following hysterectomy, compared to patients undergoing hysterectomy for benign gynecological disease. METHODS: In a nationwide registry-based cohort study, patients undergoing hysterectomy for endometrial cancer or benign disease were followed 30 days after surgery. The Danish Gynecological Cancer Database (DGCD) and the Danish National Patient Register (DNPR) were linked with four other administrative registries to describe the population and retrieve data on venous thromboembolism and mortality. Multivariable logistic regression models were used to estimate odds ratios (ORs) for 30-day postoperative VTE. RESULTS: We identified 5513 patients with endometrial cancer, and 45,825 patients with benign disease undergoing hysterectomy in the period 2005-2014. The overall incidence of 30-day VTE following hysterectomy was 0.2% (103/51,338). Thirty (0.5%) patients with endometrial cancer and 73 (0.16%) patients with benign disease developed VTE. In a multivariable logistic regression analysis, significant predictors of 30-day OR for VTE were open surgery (minimally invasive surgery vs. open: OR = 0.46; 95% CI, 0.30-0.71; p < 0.001), lymphadenectomy (OR = 4.00; 95% CI, 1.89-8.46; p < 0.001), BMI > 40 (OR = 2.34;95% CI, 1.10-5.01; p = 0.03) and previous VTE (OR = 34; 95% CI, 22.7-51.3; p < 0.001). There was no statistically significant difference in the 30-day OR for VTE in endometrial cancer compared to benign disease (OR = 1.47; 95% CI, 0.74-2.91; p = 0.27). CONCLUSIONS: This study did not identify endometrial cancer to be an independent risk factor for VTE following hysterectomy compared to benign disease. We identified open surgery, lymphadenectomy, BMI above 40 and previous VTE as independent risk factors for 30-day postoperative VTE.


Assuntos
Neoplasias do Endométrio/epidemiologia , Neoplasias do Endométrio/cirurgia , Histerectomia/estatística & dados numéricos , Tromboembolia Venosa/epidemiologia , Adulto , Estudos de Coortes , Dinamarca/epidemiologia , Neoplasias do Endométrio/patologia , Feminino , Humanos , Histerectomia/efeitos adversos , Incidência , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Sistema de Registros , Tromboembolia Venosa/etiologia
5.
J Orthop Traumatol ; 20(1): 28, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31321578

RESUMO

INTRODUCTION: Total knee arthroplasty (TKA) surgery can be associated with significant blood loss. Among the problems associated with such blood loss is the need for transfusions of banked blood [1]. Transfusions not only have a financial consequence but also carry a small risk of disease transmission to the patient. Antifibrinolytics have been successfully used to reduce transfusion requirements in elective arthroplasty patients. The objective of this meta-analysis is to determine which of tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA) is more effective for reducing peri-operative blood loss, and lessening the need for blood transfusion following knee arthroplasty surgery. MATERIALS AND METHODS: MEDLINE, Embase and CINAHL databases were searched for relevant articles published between January 1980 to January 2018 for the purpose of identifying studies comparing TXA and EACA for TKA surgery. A double-extraction technique was used, and included studies were assessed regarding their methodological quality prior to analysis. Outcomes analysed included blood loss, pre- and post-operative haemoglobin, number of patients requiring transfusion, number of units transfused, operative and tourniquet time, and complications associated with antifibrinolytics. RESULTS: Three studies contributed to the quantitative analysis of 1691 patients, with 743 patients included in the TXA group and 948 in the EACA group. Estimated blood loss was similar between the two groups [95% confidence interval (CI) -0.50, 0.04; Z = 1.69; P = 0.09]. There were no differences between the two groups regarding the percentage of patients requiring transfusion (95% CI 0.14, 4.13; Z = 0.31; P = 0.76). There was no difference in the pre- and post-operative haemoglobin difference between the two groups (95% CI -0.36, 0.24; Z = 0.38; P = 0.70). There was no difference in the average number of transfused units (95% CI -0.53, 0.25; Z = 0.71; P = 0.48). There was no difference in the operative (95% CI -0.35, 0.36; Z = 0.04; P = 0.97) or tourniquet time (95% CI -0.16, 0.34; Z = 0.72; P = 0.47). Similarly, there was no difference in the percentage of venous thromboembolism between the two groups (95% CI 0.17, 2.80; Z = 0.51; P = 0.61). CONCLUSIONS: This study did not demonstrate TXA to be superior to EACA. In fact, both antifibrinolytic therapies demonstrated similar efficacy in terms of intra-operative blood loss, transfusion requirements and complication rates. Currently EACA has a lower cost, which makes it an appealing alternative to TXA for TKA surgery. LEVEL OF EVIDENCE: 3.


Assuntos
Ácido Aminocaproico/uso terapêutico , Antifibrinolíticos/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Perda Sanguínea Cirúrgica/prevenção & controle , Hemorragia Pós-Operatória/prevenção & controle , Ácido Tranexâmico/uso terapêutico , Antifibrinolíticos/efeitos adversos , Transfusão de Sangue , Feminino , Humanos , Masculino , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/terapia , Tromboembolia Venosa/etiologia
6.
Zhonghua Yi Xue Za Zhi ; 99(24): 1848-1852, 2019 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-31269578

RESUMO

Objective: To analyze the incidence and influencing factors of venous thromboembolism (VTE) after lung transplantation. Methods: This study retrospectively analyzed the clinical data of 375 lung transplant patients from January 2015 to December 2017 in Wuxi People's Hospital. Every patient was classified into the VTE group or the non-VTE group according to whether the patient had VTE or not. Basic information like age, type of surgical procedure etc. was compared between two groups. The prevention and treatment of VTE between two groups were also compared. Furthermore, multivariate Logistic regression analysis was used to analyze the influence of related factors on the occurrence of postoperative VTE. Deep venous thrombosis (DVT) was diagnosed with vascular ultrasonography, and pulmonary thromboembolism (PTE) was diagnosed with CT pulmonary angiogram, nuclear ventilation/perfusion scanning, or pulmonary angiography. Results: This study included 316 lung transplant patients. VTE occurred in 19 patients (6.0%) during perioperative and follow-up period. The age of the VTE group was significantly higher than that of the non-VTE group (63.4±11.9 vs 54.3±13.0, P=0.003). The proportion of single lung transplantation in the VTE group was significantly higher than that in the non-VTE group (78.9% vs 48.5%, P=0.010). The incidence of VTE in patients without prevention was significantly higher than that in patients with prevention (15.0% vs 1.9%, P<0.001). Single lung transplantation (OR=4.425, P=0.018), duration in intensive care unit (ICU) (OR=1.396, P=0.001) and age (OR=1.080, P=0.005) were independent risk factors for VTE after lung transplantation. Conclusions: The incidence of VTE after lung transplantation is high. Single lung transplantation, prolonged duration of ICU stay and advanced age increase the risk of VTE after lung transplantation.


Assuntos
Transplante de Pulmão , Embolia Pulmonar , Tromboembolia Venosa , Humanos , Incidência , Transplante de Pulmão/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Tromboembolia Venosa/etiologia
7.
Ther Adv Cardiovasc Dis ; 13: 1753944719860676, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31319783

RESUMO

BACKGROUND: The role of cancer-specific factors for ischemic stroke and mortality in patients with cancer and atrial fibrillation (AF) is unknown. We evaluated the utility of a previously validated risk tool for venous thromboembolism (VTE) in cancer outpatients [Khorana score (KS)] in predicting stroke and mortality in cancer patients with AF. METHODS: We conducted a retrospective cohort study of patients with cancer and AF at the Cleveland Clinic from 2008 to 2014. Outcomes, CHADS2, CHA2DS2-VASc, and KS scores were calculated from date of cancer diagnosis. Prognostic factors were identified with Fine and Gray regression (for stroke) or Cox proportional hazards analysis (for mortality). RESULTS: The study population comprised 1181 patients. Genitourinary (19%), lung (18%), and gastrointestinal (13%) were the most frequent cancers. Overall, 67% had CHADS2 ⩾ 2, 57% had an intermediate KS (1-2), and 7% high KS (⩾3). Median follow up was 26.5 months (range 0.03-76). At a median of 8.2 months (range 0-61), 45 patients (3.8%) developed a stroke and 418 (35%) died. In multivariable analysis a high KS (HR 4.5, 95% CI 3.2-6.3, p < 0.001) was associated with a quadruple risk of death and every point increase in CHADS2 score had a 20% increased risk of death (HR 1.19, 95% CI 1.1-1.2, p < 0.001). The addition of KS did not improve risk stratification for ischemic stroke to CHADS2. CONCLUSION: In patients with cancer and AF, CHADS2 and CHA2DS2-VASc but not KS were predictive of ischemic stroke. A high KS represented a unique predictor of mortality beyond traditional risk scores.


Assuntos
Fibrilação Atrial/complicações , Isquemia Encefálica/etiologia , Técnicas de Apoio para a Decisão , Neoplasias/complicações , Acidente Vascular Cerebral/etiologia , Tromboembolia Venosa/etiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidade , Registros Eletrônicos de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Neoplasias/mortalidade , Ohio , Valor Preditivo dos Testes , Prognóstico , Sistema de Registros , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/mortalidade
8.
Cancer Treat Res ; 179: 55-68, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317480

RESUMO

Cancer and its treatments are commonly complicated by venous thromboembolism (VTE), but there is a substantial variation in risk between individual cancer patients. The risk of VTE in cancer patients is influenced by multiple risk factors including primary site of cancer, stage, comorbidities, use of specific antineoplastic agents. Several biomarkers have been associated with subsequent VTE including D-dimer and tissue factor, although no single risk factor or biomarker accurately is predictive of VTE on its own. The risk of VTE is best predicted by a validated risk assessment score. Cancer patients at risk of VTE benefit from thromboprophylaxis, supported by evidence in the setting of hospitalization for acute medical illness and surgery, and emerging data from two large randomized trials in the outpatient setting. This chapter focuses on approaches to identifying risk of VTE and approaches to reducing this risk with appropriate thromboprophylaxis.


Assuntos
Neoplasias/complicações , Tromboembolia Venosa/prevenção & controle , Anticoagulantes/uso terapêutico , Quimioprevenção , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Trombose/etiologia , Trombose/prevenção & controle , Tromboembolia Venosa/etiologia
9.
Cancer Treat Res ; 179: 87-101, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317482

RESUMO

Cancer patients have an increased risk of thrombosis. The development of cancer thrombosis is dependent on a number of factors including cancer type, stage, various biologic markers, and the use of central venous catheters. In addition, cancer treatment itself may increase thrombotic risk. Tamoxifen increases the risk of venous thromboembolism (VTE) by two- to sevenfold, while an impact on risk of arterial thrombosis is uncertain. Immunomodulatory imide drugs (IMiDs) such as thalidomide and lenalidomide increase the risk of VTE in patients with multiple myeloma (MM) by about 10-40% when given in combination with glucocorticoids or other chemotherapy agents; the risk of VTE in MM patients treated with IMiD-containing regimens necessitates that such patients receive thromboprophylaxis with aspirin, low-molecular-weight heparin, or warfarin. Among cytotoxic chemotherapy agents, cisplatin, and to a lesser extent fluorouracil, has been described in association with thrombosis. L-asparaginase in treatment of acute lymphoblastic leukemia is significantly associated with increased thrombosis particularly affecting the CNS, which may be due to acquired antithrombin deficiency; at some centers, plasma infusions or antithrombin replacement is used to mitigate this. Bevacizumab, an inhibitor of vascular endothelial growth factor, increases arterial and possibly venous thrombotic risk, although the literature is conflicting about the latter. Supportive care agents in cancer care, such as erythropoiesis-stimulating agents, granulocyte colony stimulating factor, and steroids, also have some impact on thrombosis. This review summarizes the mechanisms by which these and other therapies modulate thrombotic risks and how such risks may be managed.


Assuntos
Antineoplásicos/efeitos adversos , Neoplasias/tratamento farmacológico , Trombose/tratamento farmacológico , Anticoagulantes/uso terapêutico , Antineoplásicos/uso terapêutico , Humanos , Neoplasias/complicações , Fatores de Risco , Trombose/etiologia , Trombose/prevenção & controle , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle
10.
Cancer Treat Res ; 179: 69-85, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317481

RESUMO

Venous thromboembolism is known to be associated with an increase in morbidity and mortality in patients with malignancy. Predictive laboratory biomarkers of venous thromboembolism (VTE) have long been sought after to improve outcomes and help guide clinical decision making. Previously studied biomarkers include C reactive protein (CRP), tissue factor expressing microparticles (TF MP), D-dimer, soluble P-selectin (sP-selectin), plasminogen activator inhibitor 1 (PAI-1), factor VIII, platelet count, and leukocyte counts. This chapter will focus on these possible biomarkers for cancer-associated thrombosis (CAT) with particular emphasis on the pathophysiology behind thrombosis formation as well as data from clinical studies in patients with malignancy. The incorporation of the above biomarkers into risk assessment tools to predict CAT will also be reviewed, as will risk factors for recurrent VTE in patients with malignancy. Further studies are ongoing to develop readily available biomarkers that can be incorporated into future risk assessment models with the goal of reducing morbidity and mortality due to cancer-associated thrombosis.


Assuntos
Biomarcadores/análise , Neoplasias/complicações , Tromboembolia Venosa/sangue , Biomarcadores/sangue , Humanos , Neoplasias/sangue , Neoplasias/fisiopatologia , Medição de Risco , Fatores de Risco , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/fisiopatologia
11.
Cancer Treat Res ; 179: 103-115, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317483

RESUMO

The management of cancer-associated thrombosis (CAT) is complex, and treatment strategies have been evolving over the past 15 years. It is well recognized that oral vitamin K antagonists are difficult to use in cancer patients, with higher rates of treatment failure and bleeding complications than in non-cancer patients. Low-molecular-weight-heparin (LMWH) became the widely accepted standard of care for treatment of cancer-associated thrombosis, following the CLOT study comparing dalteparin with warfarin in 2003. LMWH remains widely used for the treatment of CAT. However, in the past two years, several studies have served to validate direct oral anticoagulants as a safe and effective alternative to LMWH. Two randomized clinical trials comparing edoxaban and rivaroxaban with dalteparin, and several retrospective studies have shown the efficacy of edoxaban and rivaroxaban for the treatment of CAT. However, there is an evidence of increased bleeding with the DOACs, particularly gastrointestinal or urinary tract bleeding in patients with lesions within the gastrointestinal or urinary tracts. This chapter discusses the ongoing development of optimal treatment strategies for cancer-associated thrombosis.


Assuntos
Anticoagulantes/administração & dosagem , Inibidores do Fator Xa/administração & dosagem , Heparina de Baixo Peso Molecular/administração & dosagem , Neoplasias/complicações , Tromboembolia Venosa/tratamento farmacológico , Administração Oral , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Inibidores do Fator Xa/efeitos adversos , Inibidores do Fator Xa/uso terapêutico , Hemorragia/induzido quimicamente , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Tromboembolia Venosa/etiologia
12.
Cancer Treat Res ; 179: 179-189, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317488

RESUMO

Venous thromboembolism is commonly diagnosed in patients with primary and secondary brain tumors. Anticoagulation management in the setting of brain tumors is complicated by the high background rate of spontaneous intracranial hemorrhage. Until recently, there was limited evidence to support the decision to administer therapeutic anticoagulation in the setting of brain metastases or primary brain tumors. The current evidence suggests that the safety profile of therapeutic low molecular weight heparin for the treatment of venous thromboembolism is contingent on whether the origin of brain tumor is primary (i.e., glioma) versus secondary. In patients with brain metastases, the rate of intracranial hemorrhage often exceeds 20% but is not influenced by the administration of low molecular weight heparin. In contrast, in primary brain tumors such as glioma, therapeutic anticoagulation is associated with an increased risk of intracranial hemorrhage that can negatively impact survival. This chapter reviews the underlying mechanisms contributing to thrombosis and hemorrhage in brain tumors and summarizes the current evidence and approaches in anticoagulation to treat venous thromboembolism.


Assuntos
Anticoagulantes/uso terapêutico , Neoplasias Encefálicas/complicações , Hemorragias Intracranianas/etiologia , Tromboembolia Venosa/tratamento farmacológico , Anticoagulantes/efeitos adversos , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/secundário , Humanos , Hemorragias Intracranianas/induzido quimicamente , Tromboembolia Venosa/etiologia
14.
Ceska Gynekol ; 84(2): 145-148, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31238685

RESUMO

OBJECTIVE: To present a case of a patient with embolic event in the puerperium at the surgery for residual trophoblastic tissue. DESIGN: Case report. SETTING: Department of Obstertics and Gynaecology, Hospital Rakovník. CASE REPORT: We present the 33-year-old second-graders case of three weeks of labor at 40th weeks, which was operated at our workplace for residual trophoblastic tissue. The gynecological surgery took place without complications, however, after the operation, breathing and circulation arrest. Thrombolysis was given for suspicion of embolization etiology. In spite of an intense urgent CPR and multidisciplinary collaboration, there is a failure in the life and death of the patient. CONCLUSION: In presenting this serious case of an embolic event, the author want to emphasize the need for proper diagnosis, an indication of the surgical performance or the conservative procedure for placental remnants in the puerperium.


Assuntos
Placenta Retida/cirurgia , Período Pós-Parto , Tromboembolia Venosa/etiologia , Adulto , Evolução Fatal , Feminino , Humanos , Gravidez
15.
Medicine (Baltimore) ; 98(23): e15833, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169685

RESUMO

Few prospective studies have reported the cumulative incidence of venous thromboembolism (VTE) in the intensive care unit (ICU), especially for patients receiving guideline-recommended VTE prophylaxis. We aimed to design a prospective observational study to investigate the cumulative incidence and risk factors of ICU-acquired VTE for those populations.We prospectively studied 281 consecutively included patients in the ICU at a single center. All patients provided informed consent. Patients received ultrasound evaluation and were followed for VTE before ICU discharge or within 28 days of ICU stay. The type of VTE thromboprophylaxis was also recorded for all patients. Variables from univariate analyses that were associated with VTE were included in the binary logistic regression analysis to determine VTE predictors. The cumulative VTE incidence with 95% confidence interval (CI) was estimated using Kaplan-Meier methods.Patients had a median age of 60 years (range, 18-89) and an acute physiology and chronic health evaluation II score of 17 (range, 4-36). Despite all patients receiving guideline-recommended thromboprophylaxis, the cumulative incidence of VTE at 7, 14, 21, and 28 days was 4.45% (95% CI 2.55-7.71), 7.14% (95% CI 4.61-10.97), 7.53% (95% CI 4.92-11.43), and 9.55% (95% CI 6.55-13.81), respectively. Central venous catheter use (P = .002, odds ratio [OR] = 4.50), Caprini score (P = .012, OR = 1.20), and ICU length of stay (P = .006, OR = 1.08) were independent risk factors related to the incidence of VTE for patients admitted to the ICU.Our prospective observational study found that the 28-day cumulative incidence of VTE was relatively high for patients admitted to the ICU, despite the use of guideline-recommended thromboprophylaxis. Patients with femoral central venous catheter, prolonged ICU length of stay, or a high Caprini score may have an increased risk of developing VTE.


Assuntos
Anticoagulantes/uso terapêutico , Cuidados Críticos/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tromboembolia Venosa/epidemiologia , APACHE , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/normas , Cuidados Críticos/métodos , Cuidados Críticos/normas , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Fatores de Risco , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle , Adulto Jovem
16.
Anticancer Res ; 39(5): 2615-2625, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31092460

RESUMO

BACKGROUND/AIM: This study aimed to assess whether low-molecular-weight heparin (LMWH) is effective and safe in preventing postoperative venous thromboembolism (VTE) in patients undergoing esophageal cancer surgery. PATIENTS AND METHODS: In this single-institution, prospective, randomized trial, 73 patients with esophageal cancer undergoing esophagectomy were randomly divided into the enoxaparin group (E group) and intermittent pneumatic compression group (I group). The primary endpoint was efficacy of enoxaparin, and secondary endpoints were evidence of bleeding and serum anti-Xa activity in the E group. RESULTS: The E group comprised 42 patients and the I group comprised 31 patients. Deep vein thrombosis was observed in 0 (0%) patients in the E group and 7 (22.6%) patients in the I group (p=0.002). Soluble fibrin monomer complex was significantly lower in the E versus I group on day 8 (p<0.001). D-dimer was significantly lower in the E versus I group on days 2, 8, and 15 (p=0.008, p<0.001, p<0.001, respectively). CONCLUSION: VTE was significantly reduced by using enoxaparin.


Assuntos
Enoxaparina/administração & dosagem , Neoplasias Esofágicas/complicações , Esofagectomia/efeitos adversos , Tromboembolia Venosa/tratamento farmacológico , Idoso , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Feminino , Hemorragia/tratamento farmacológico , Hemorragia/etiologia , Hemorragia/patologia , Heparina de Baixo Peso Molecular , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Complicações Pós-Operatórias , Tromboembolia Venosa/etiologia , Trombose Venosa/diagnóstico , Trombose Venosa/patologia , Trombose Venosa/prevenção & controle
17.
Rev Col Bras Cir ; 46(2): e2075, 2019 May 09.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31090863

RESUMO

Total knee arthroplasty is an elective procedure performed on relatively healthy individuals. However, due to the inherent risk of venous thromboembolism, drugs are used for its prophylaxis. The objective of the present study was to conduct a systematic review of the literature to compare the efficacy of enoxaparin and rivaroxaban in preventing this complication and the risk of intraoperative bleeding. We reviewed the SciELO, Pubmed and Cochrane databases with the descriptors knee arthroplasty, rivaroxaban and enoxaparin through the PICO search strategy. Inclusion criteria were the articles during the study period comparing both drugs in knee arthroplasty. Relevant criteria to study eligibility were articles published since 2010 and with a sample of more than 20 patients; studies obtained in their entirety; and studies with follow-up of more than 12 months. The variables used to compare the articles were the most common postoperative complications of knee arthroplasties: venous thromboembolism and bleeding. We used the Review Man software, version 5.3, for structuring the review. In the studies analyzed, considering symptomatic venous thromboembolism, rivaroxaban resulted in higher benefits when compared to enoxaparin.


Assuntos
Anticoagulantes/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Enoxaparina/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Rivaroxabana/uso terapêutico , Tromboembolia Venosa/prevenção & controle , Perda Sanguínea Cirúrgica , Humanos , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Operatória/induzido quimicamente , Fatores de Risco , Resultado do Tratamento , Tromboembolia Venosa/etiologia
18.
World Neurosurg ; 122: e619-e626, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-31108078

RESUMO

BACKGROUND: Traumatic subdural hematomas (tSDHs) have high morbidity and mortality and often require neurosurgical intervention. The risk of venous thromboembolism (VTE) after tSDH ranges from 1%-20%, yet a consensus chemoprophylaxis protocol does not exist. An increased understanding of VTE risk factors following tSDH may inform development of prophylaxis guidelines. METHODS: Retrospective analysis of a prospective, single-institution Level I trauma center database identified the incidence and risk factors for deep venous thrombosis (DVT) and pulmonary embolism (PE) in consecutive tSDH patients from 1990-2015. Univariate and multivariate analyses were used. RESULTS: Of 3024 tSDH patients, 682 (22.6%) required neurosurgical intervention in the form of an intracranial pressure monitor, external ventricular drain (EVD), or craniotomy/craniectomy. Overall, 129 (4.3%) and 20 (0.7%) patients were diagnosed with a DVT or PE. Risk factors for DVT included age =60 (odds ratio [OR]=1.5, P=0.039), preexisting endocrine disorder (OR=4.1, P=0.001), hospital length of stay =7 days (OR=4.7, P < 0.001), intensive care unit length of stay =7 days (OR=3.6, P < 0.001), and lower extremity fracture (OR=2.1, P=0.004); GCS >3 was associated with a reduced DVT risk (OR=0.6, P=0.020). Risk factors for PE included intensive care unit length of stay =7 days (OR=9.7, P < 0.001) and lower extremity fracture (OR=4.7, P=0.002). Neurosurgical intervention did not independently increase VTE risk but was associated with increased hospital length of stay (P < 0.001). CONCLUSIONS: While overall VTE risk is low following tSDH, elderly patients and those with severe injuries requiring prolonged hospitalizations have increased thrombotic risk. Development of tiered VTE prophylaxis regimens based on early postinjury thrombotic risk profiles warrants future study.


Assuntos
Hematoma Subdural/complicações , Hematoma Subdural/terapia , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia , Feminino , Hematoma Subdural/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Centros de Traumatologia , Tromboembolia Venosa/terapia
19.
Clin Appl Thromb Hemost ; 25: 1076029619853629, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31132874

RESUMO

Efficacy and safety of direct oral anticoagulants (DOACs) for preventing primary and recurrent venous thromboembolism (VTE) in patients with cancer remain unclear. In this study, we conducted a systematic review to summarize the most up-to-date evidence from randomized controlled trials (RCTs). Our primary outcomes included the benefit outcome (VTE) and safety outcome (major bleeding). A random-effects model was used to pool the relative risks (RRs) for data syntheses. The Grading of Recommendations Assessment, Development and Evaluation tool was used to evaluate the quality of the entire body of evidence across studies. We included 11 RCTs with a total of 3741 patients with cancer for analyses. The DOACs were significantly related with a reduced risk of VTE when compared with non-DOACs: RR = 0.77, 95% confidence interval [CI]: 0.61-0.99, P = .04. Nonsignificant trend towards a higher risk of major bleeding was found in DOACs: RR = 1.28 95% CI: 0.81-2.02, P = .29. The quality of the entire body of evidence was graded as moderate for risk of VTE, and low for risk of major bleeding. To summarize, DOACs were found to have a favorable effect on risk of VTE but a nonsignificant higher risk of major bleeding compared with non-DOACs in patients with cancer. The safety effect of DOACs in patients with cancer requires further evaluation in adequately powered and designed studies.


Assuntos
Anticoagulantes/uso terapêutico , Neoplasias/tratamento farmacológico , Tromboembolia Venosa/prevenção & controle , Administração Oral , Anticoagulantes/efeitos adversos , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Humanos , Neoplasias/complicações , Neoplasias/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
20.
Semin Thromb Hemost ; 45(4): 334-341, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31041803

RESUMO

Venous thromboembolism (VTE) is a common complication in patients with primary brain tumors, with up to 20% of patients per year having a VTE event. Clinical risk factors for VTE include glioblastoma subtype, paresis, or surgery. Furthermore, specific factors playing a role in tumor biology were recently identified to predispose to prothrombotic risk. For instance, mutations in the isocitrate dehydrogenase 1 (IDH1) gene, which occurs in a subgroup of glioma, correlate with risk of VTE, with low incidence in patients with presence of an IDH1 mutation compared with those with IDH1 wild-type status. In addition, expression of the glycoprotein podoplanin on brain tumors was associated with both intratumoral thrombi and high risk of VTE. As podoplanin has the ability to activate platelets, a mechanistic role of podoplanin-mediated platelet activation in VTE development has been suggested. From a clinical point of view, the management of patients with primary brain tumors and VTE is challenging. Anticoagulation is required to treat patients; however, it is associated with increased risk of intracranial hemorrhage. This review focuses on describing the epidemiology, risk factors, and mechanisms of brain tumor-associated thrombosis and discusses clinical challenges in the prevention and treatment of VTE in patients with brain tumors.


Assuntos
Anticoagulantes/uso terapêutico , Neoplasias Encefálicas/complicações , Glioblastoma/complicações , Trombose/tratamento farmacológico , Tromboembolia Venosa/tratamento farmacológico , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/metabolismo , Glioblastoma/genética , Glioblastoma/metabolismo , Humanos , Isocitrato Desidrogenase/genética , Isocitrato Desidrogenase/metabolismo , Glicoproteínas de Membrana/genética , Glicoproteínas de Membrana/metabolismo , Mutação , Ativação Plaquetária , Trombose/diagnóstico , Trombose/etiologia , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/etiologia
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