Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.932
Filtrar
1.
BMC Cardiovasc Disord ; 21(1): 327, 2021 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-34217220

RESUMO

BACKGROUND: The relative association between cardiovascular (CV) risk factors, such as diabetes and hypertension, established CV disease (CVD), and susceptibility to CV complications or mortality in COVID-19 remains unclear. METHODS: We conducted a cohort study of consecutive adults hospitalised for severe COVID-19 between 1st March and 30th June 2020. Pre-existing CVD, CV risk factors and associations with mortality and CV complications were ascertained. RESULTS: Among 1721 patients (median age 71 years, 57% male), 349 (20.3%) had pre-existing CVD (CVD), 888 (51.6%) had CV risk factors without CVD (RF-CVD), 484 (28.1%) had neither. Patients with CVD were older with a higher burden of non-CV comorbidities. During follow-up, 438 (25.5%) patients died: 37% with CVD, 25.7% with RF-CVD and 16.5% with neither. CVD was independently associated with in-hospital mortality among patients < 70 years of age (adjusted HR 2.43 [95% CI 1.16-5.07]), but not in those ≥ 70 years (aHR 1.14 [95% CI 0.77-1.69]). RF-CVD were not independently associated with mortality in either age group (< 70 y aHR 1.21 [95% CI 0.72-2.01], ≥ 70 y aHR 1.07 [95% CI 0.76-1.52]). Most CV complications occurred in patients with CVD (66%) versus RF-CVD (17%) or neither (11%; p < 0.001). 213 [12.4%] patients developed venous thromboembolism (VTE). CVD was not an independent predictor of VTE. CONCLUSIONS: In patients hospitalised with COVID-19, pre-existing established CVD appears to be a more important contributor to mortality than CV risk factors in the absence of CVD. CVD-related hazard may be mediated, in part, by new CV complications. Optimal care and vigilance for destabilised CVD are essential in this patient group. Trial registration n/a.


Assuntos
COVID-19 , Doenças Cardiovasculares , Diabetes Mellitus/epidemiologia , Mortalidade Hospitalar , Hipertensão/epidemiologia , Tromboembolia Venosa , Fatores Etários , Idoso , COVID-19/mortalidade , COVID-19/fisiopatologia , COVID-19/terapia , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Masculino , Mortalidade , Avaliação de Processos e Resultados em Cuidados de Saúde , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , SARS-CoV-2/isolamento & purificação , Reino Unido/epidemiologia , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
2.
Tuberk Toraks ; 69(2): 269-278, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34256519

RESUMO

COVID-19 emerged in Wuhan, China in late December 2019, and WHO declared it a pandemic on March 11, 2020. The disease has a wide spectrum ranging from asymptomatic or mild disease to ARDS and death. There have been over 83.9 million cases with 1.8 million deaths worldwide. COVIDassociated coagulopathy appears to be an entity responsible for deaths. Thromboprophylaxis is recommended in patients with COVID-19 to prevent arterial and venous thromboembolism. Low molecular weight heparin such as enoxaparin is often recommended. However, there is still no consensus regarding the treatment dose and duration. The purpose of this review was to observe the pathogenesis of thromboembolic events in COVID-19, current thromboprophylaxis regimens, treatment dosage and duration with guidelines of international scientific institutions.


Assuntos
Anticoagulantes/administração & dosagem , COVID-19/complicações , Gerenciamento Clínico , Pandemias , SARS-CoV-2 , Tromboembolia Venosa/prevenção & controle , COVID-19/epidemiologia , Humanos , Turquia/epidemiologia , Tromboembolia Venosa/etiologia
3.
JAMA Netw Open ; 4(6): e2111788, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34115129

RESUMO

Importance: Venous thromboembolism (VTE) is a common complication of COVID-19. It is not well understood how hospitals have managed VTE prevention and the effect of prevention strategies on mortality. Objective: To characterize frequency, variation across hospitals, and change over time in VTE prophylaxis and treatment-dose anticoagulation in patients hospitalized for COVID-19, as well as the association of anticoagulation strategies with in-hospital and 60-day mortality. Design, Setting, and Participants: This cohort study of adults hospitalized with COVID-19 used a pseudorandom sample from 30 US hospitals in the state of Michigan participating in a collaborative quality initiative. Data analyzed were from patients hospitalized between March 7, 2020, and June 17, 2020. Data were analyzed through March 2021. Exposures: Nonadherence to VTE prophylaxis (defined as missing ≥2 days of VTE prophylaxis) and receipt of treatment-dose or prophylactic-dose anticoagulants vs no anticoagulation during hospitalization. Main Outcomes and Measures: The effect of nonadherence and anticoagulation strategies on in-hospital and 60-day mortality was assessed using multinomial logit models with inverse probability of treatment weighting. Results: Of a total 1351 patients with COVID-19 included (median [IQR] age, 64 [52-75] years; 47.7% women, 48.9% Black patients), only 18 (1.3%) had a confirmed VTE, and 219 (16.2%) received treatment-dose anticoagulation. Use of treatment-dose anticoagulation without imaging ranged from 0% to 29% across hospitals and increased over time (adjusted odds ratio [aOR], 1.46; 95% CI, 1.31-1.61 per week). Of 1127 patients who ever received anticoagulation, 392 (34.8%) missed 2 or more days of prophylaxis. Missed prophylaxis varied from 11% to 61% across hospitals and decreased markedly over time (aOR, 0.89; 95% CI, 0.82-0.97 per week). VTE nonadherence was associated with higher 60-day (adjusted hazard ratio [aHR], 1.31; 95% CI, 1.03-1.67) but not in-hospital mortality (aHR, 0.97; 95% CI, 0.91-1.03). Receiving any dose of anticoagulation (vs no anticoagulation) was associated with lower in-hospital mortality (only prophylactic dose: aHR, 0.36; 95% CI, 0.26-0.52; any treatment dose: aHR, 0.38; 95% CI, 0.25-0.58). However, only the prophylactic dose of anticoagulation remained associated with lower mortality at 60 days (prophylactic dose: aHR, 0.71; 95% CI, 0.51-0.90; treatment dose: aHR, 0.92; 95% CI, 0.63-1.35). Conclusions and Relevance: This large, multicenter cohort of patients hospitalized with COVID-19, found evidence of rapid dissemination and implementation of anticoagulation strategies, including use of treatment-dose anticoagulation. As only prophylactic-dose anticoagulation was associated with lower 60-day mortality, prophylactic dosing strategies may be optimal for patients hospitalized with COVID-19.


Assuntos
Anticoagulantes/uso terapêutico , COVID-19/complicações , Hospitalização/tendências , SARS-CoV-2 , Tromboembolia Venosa/prevenção & controle , Idoso , COVID-19/epidemiologia , Feminino , Mortalidade Hospitalar/tendências , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
4.
J Infect Dev Ctries ; 15(5): 639-345, 2021 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-34106886

RESUMO

Venous thromboembolism (VTE) represents an important clinical complication of patients with SARS-CoV-2 infection, and high plasma D-dimer levels could suggest a higher risk of hypercoagulability. We aimed to analyse if laboratory exams, risk assessment scores, comorbidity scores were useful in predicting the VTE in SARS-CoV-2 patients admitted in internal medicine (IM). We evaluated 49 older adults with suspected VTE analysing history and blood chemistry, besides we calculated the Padua Prediction Score, the modified early warning scoring (MEWS) and the modified Elixhauser index (mEI). All patients underwent venous color-doppler ultrasounds of the lower limbs. Out of the 49 patients enrolled (mean age 79.3±14 years), 10 (20.4%) had deep vein thrombosis (DVT), and they were more frequently female (80% vs 20%, p = 0.04). We could not find any association with the Padua Prediction Score, the MEWS, and the mEI. D-dimer plasma levels were also not associated with DVT. In elderly people hospitalized with SARS-CoV-2 infection hospitalized in IM, our data, although limited by the sample size, suggest that prediction and diagnosis of VTE is difficult, due to lack of precise biomarkers and scores.


Assuntos
COVID-19/complicações , Tromboembolia Venosa/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos de Casos e Controles , Escore de Alerta Precoce , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Extremidade Inferior/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , SARS-CoV-2 , Ultrassonografia Doppler em Cores , Tromboembolia Venosa/sangue , Tromboembolia Venosa/etiologia
5.
Ann Plast Surg ; 86(6S Suppl 5): S610-S614, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34100822

RESUMO

PURPOSE: Early ambulation and return to preoperative (baseline) ambulatory level is protective against postoperative venous thromboembolism. The duration of decreased physical activity after surgery is unknown for most procedures, as surgeons typically estimate physical recovery based on subjective patient reporting. This study aims to quantify the time it takes to return to baseline ambulatory status after breast reconstruction using actigraphy devices. METHODS: Actigraphy devices were used to evaluate preoperative and postoperative physical activity levels in patients undergoing autologous breast reconstruction at a single academic institution. Steps and resting heart rate (HR) were used as metrics of physical activity and physiological state. "Baseline" physical activity was defined by the average daily step count during the 14 days before surgery. "Return to baseline" occurred when the 7-day daily step average was greater than or equal to 95% of their baseline steps. Study participation was considered complete once a patient returned to baseline or surpassed 8 postoperative weeks. RESULTS: From May 2019 to April 2020, 17 patients were enrolled in the study before deep inferior epigastric perforator breast reconstruction. The mean age was 48.2 years and mean BMI was 27.6. This cohort averaged 7908 ± 3271 preoperative steps. Two patients returned to baseline activity by postoperative day 28. In total, 8 patients returned by postoperative week 8. Preoperative resting HR average was 73.5 ± 9.43 beats per minute. The average resting HR was elevated by 2.59%, 4.28%, and 2.31% at weeks 1, 2, and 3, respectively. The 7-day daily average resting HR had normalized by week 4. CONCLUSIONS: Return to baseline physical activity after surgery may take longer than previously perceived, particularly after physiologically demanding surgeries, such as free flap breast reconstruction. These findings indicate that surgeons may underestimate the impact of surgery on physical decline and, consequently, may undertreat with venous thromboembolism prophylaxis.


Assuntos
Neoplasias da Mama , Mamoplastia , Retalho Perfurante , Tromboembolia Venosa , Actigrafia , Artérias Epigástricas/cirurgia , Exercício Físico , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle
6.
JAMA Netw Open ; 4(6): e2111788, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: covidwho-1265353

RESUMO

Importance: Venous thromboembolism (VTE) is a common complication of COVID-19. It is not well understood how hospitals have managed VTE prevention and the effect of prevention strategies on mortality. Objective: To characterize frequency, variation across hospitals, and change over time in VTE prophylaxis and treatment-dose anticoagulation in patients hospitalized for COVID-19, as well as the association of anticoagulation strategies with in-hospital and 60-day mortality. Design, Setting, and Participants: This cohort study of adults hospitalized with COVID-19 used a pseudorandom sample from 30 US hospitals in the state of Michigan participating in a collaborative quality initiative. Data analyzed were from patients hospitalized between March 7, 2020, and June 17, 2020. Data were analyzed through March 2021. Exposures: Nonadherence to VTE prophylaxis (defined as missing ≥2 days of VTE prophylaxis) and receipt of treatment-dose or prophylactic-dose anticoagulants vs no anticoagulation during hospitalization. Main Outcomes and Measures: The effect of nonadherence and anticoagulation strategies on in-hospital and 60-day mortality was assessed using multinomial logit models with inverse probability of treatment weighting. Results: Of a total 1351 patients with COVID-19 included (median [IQR] age, 64 [52-75] years; 47.7% women, 48.9% Black patients), only 18 (1.3%) had a confirmed VTE, and 219 (16.2%) received treatment-dose anticoagulation. Use of treatment-dose anticoagulation without imaging ranged from 0% to 29% across hospitals and increased over time (adjusted odds ratio [aOR], 1.46; 95% CI, 1.31-1.61 per week). Of 1127 patients who ever received anticoagulation, 392 (34.8%) missed 2 or more days of prophylaxis. Missed prophylaxis varied from 11% to 61% across hospitals and decreased markedly over time (aOR, 0.89; 95% CI, 0.82-0.97 per week). VTE nonadherence was associated with higher 60-day (adjusted hazard ratio [aHR], 1.31; 95% CI, 1.03-1.67) but not in-hospital mortality (aHR, 0.97; 95% CI, 0.91-1.03). Receiving any dose of anticoagulation (vs no anticoagulation) was associated with lower in-hospital mortality (only prophylactic dose: aHR, 0.36; 95% CI, 0.26-0.52; any treatment dose: aHR, 0.38; 95% CI, 0.25-0.58). However, only the prophylactic dose of anticoagulation remained associated with lower mortality at 60 days (prophylactic dose: aHR, 0.71; 95% CI, 0.51-0.90; treatment dose: aHR, 0.92; 95% CI, 0.63-1.35). Conclusions and Relevance: This large, multicenter cohort of patients hospitalized with COVID-19, found evidence of rapid dissemination and implementation of anticoagulation strategies, including use of treatment-dose anticoagulation. As only prophylactic-dose anticoagulation was associated with lower 60-day mortality, prophylactic dosing strategies may be optimal for patients hospitalized with COVID-19.


Assuntos
Anticoagulantes/uso terapêutico , COVID-19/complicações , Hospitalização/tendências , SARS-CoV-2 , Tromboembolia Venosa/prevenção & controle , Idoso , COVID-19/epidemiologia , Feminino , Mortalidade Hospitalar/tendências , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
7.
J Infect Dev Ctries ; 15(5): 639-345, 2021 05 31.
Artigo em Inglês | MEDLINE | ID: covidwho-1262631

RESUMO

Venous thromboembolism (VTE) represents an important clinical complication of patients with SARS-CoV-2 infection, and high plasma D-dimer levels could suggest a higher risk of hypercoagulability. We aimed to analyse if laboratory exams, risk assessment scores, comorbidity scores were useful in predicting the VTE in SARS-CoV-2 patients admitted in internal medicine (IM). We evaluated 49 older adults with suspected VTE analysing history and blood chemistry, besides we calculated the Padua Prediction Score, the modified early warning scoring (MEWS) and the modified Elixhauser index (mEI). All patients underwent venous color-doppler ultrasounds of the lower limbs. Out of the 49 patients enrolled (mean age 79.3±14 years), 10 (20.4%) had deep vein thrombosis (DVT), and they were more frequently female (80% vs 20%, p = 0.04). We could not find any association with the Padua Prediction Score, the MEWS, and the mEI. D-dimer plasma levels were also not associated with DVT. In elderly people hospitalized with SARS-CoV-2 infection hospitalized in IM, our data, although limited by the sample size, suggest that prediction and diagnosis of VTE is difficult, due to lack of precise biomarkers and scores.


Assuntos
COVID-19/complicações , Tromboembolia Venosa/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos de Casos e Controles , Escore de Alerta Precoce , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Extremidade Inferior/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , SARS-CoV-2 , Ultrassonografia Doppler em Cores , Tromboembolia Venosa/sangue , Tromboembolia Venosa/etiologia
8.
Ann Palliat Med ; 10(6): 6957-6967, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34118860

RESUMO

OBJECTIVE: At present, there are several guidelines for cancer complicated with VTE, but there is no specific recommendation for the treatment of lung cancer complicated with VTE. Whether is necessary to explore treatment and prevention of VTE in lung cancer. BACKGROUND: Venous thromboembolism (VTE) is a common complication of severe lung cancer that can entail many adverse effects for patients. The incidence of VTE is higher in patients with lung cancer than in those with other kinds of solid tumors, and it is especially high among patients with lung adenocarcinoma, at advanced tumor-node-metastasis (TNM) stages, or with a history of central venous catheter (CVC) or chemotherapy. However, the clinical symptoms of VTE in patients with lung cancer are not typical and cannot be detected easily, and the clinical prevention rate is low. In the acute phase of VTE in lung cancer, the Eastern Cooperative Oncology Group (ECOG) performance status score of patients typically ranges from 2 to 4 points, leaving end-stage maintenance therapy as the only treatment option. METHODS: Here, we analyze the existing literature and discuss the current status (including epidemiology, clinical manifestations, and risk factors), risk assessment tools, and the treatment and prevention of VTE in severe lung cancer. We focus particularly on the use of low-molecular-weight heparin and new oral anticoagulants (including in the management of thrombocytopenia after antitumor therapy) in lung cancer patients with VTE. CONCLUSIONS: Large-scale prospective multicenter studies on the treatment and prevention of VTE in lung cancer are necessary.


Assuntos
Neoplasias Pulmonares , Neoplasias , Tromboembolia Venosa , Anticoagulantes/uso terapêutico , Humanos , Neoplasias Pulmonares/complicações , Estudos Prospectivos , Fatores de Risco , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle
9.
J Pediatr Orthop ; 41(Suppl 1): S64-S69, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34096540

RESUMO

INTRODUCTION: Adolescents undergoing pediatric orthopaedic surgery typically experience an uncomplicated postoperative course. However, adolescence represents a unique transition period from pediatric to adult physiology. As a result, the astute pediatric orthopaedic surgeon will be aware of unique medical and social scenarios which are relevant to adolescents during the perioperative course including the risk of venous thromboembolism (VTE), prevalence of mental health conditions, and rising use of electronic cigarettes or "vaping" to consume nicotine and cannibas. DISCUSSION: Adolescents are at a greater risk of VTE after pediatric orthopaedic surgery. In particular, adolescent females with a family history of blood clotting disorders and those with a change in mobility after surgery should be considered for prophylaxis. The prevalence of adolescent mental health conditions including anxiety, depression, and behavioral issues is increasing in the United States. Higher levels of preoperative anxiety and the presence of mental health pathology are associated with slower recovery, higher levels of postoperative pain, and the increased likelihood for chronic pain. Several quick screening instruments are available to assess adolescents for preoperative anxiety risk, including the Visual Analogue Scale for Anxiety or the Amsterdam Perioperative Anxiety Information Scale. Unfortunately, electronic cigarettes have become increasingly popular for the consumption of nicotine and cannabis among adolescents. Preoperative use of combustive cigarettes (nicotine/cannabis) represents perioperative risks for induction/anesthesia, postoperative pain, and analgesia requirements and issues with delayed wound and fracture healing. CONCLUSIONS: VTE, underlying mental health conditions, and usage of nicotine and cannabis are clear detriments to the recovery and healing of adolescent patients following orthopaedic surgery. Therefore, standardized screening for adolescents before orthopaedic surgery is indicated to identify perioperative risk factors which have negative impacts on functional outcomes.


Assuntos
Procedimentos Ortopédicos , Complicações Pós-Operatórias , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Vaping/epidemiologia , Tromboembolia Venosa , Adolescente , Humanos , Saúde Mental , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/psicologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Prevalência , Risco Ajustado , Fatores de Risco , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle
10.
Artigo em Russo | MEDLINE | ID: mdl-34156208

RESUMO

Venous thromboembolic events (VTE) can significantly complicate postoperative period in neurosurgical patients. It is known that patients with brain tumors are especially susceptible to VTE. OBJECTIVE: To determine the incidence and risk factors of VTE in patients with various brain tumors. MATERIAL AND METHODS: All patients with brain tumors underwent surgery in 2019 (n=610). They were divided into the groups depending on tumor type: sellar region, intracerebral, extracerebral neoplasms and metastases. All patients underwent screening and prevention of VTE in accordance with the protocol accepted in the hospital. We analyzed the incidence of VTE in each group and significance of various risk factors. RESULTS: Overall incidence of VTE was 14.9% (91 cases). Deep vein thrombosis (DVT) was the most common - 85 cases (93.4%). Less common events were DVT combined with pulmonary embolism (PE) (n=5, 5.5%) and PE alone (n=1; 1.1%). PE caused death in 2 cases (0.3%). In patients with sellar tumors, incidence was 21.7% [13.4%; 29.35%], among intracerebral tumors - 13.8% [9.04%; 18.62%], extracerebral neoplasms - 15.4% [11.02%; 19.69%], metastases - 7.9% [1.32%; 11.84%]. Univariate and multivariate analysis revealed some risk factors of VTEs such as gender, age, surgery time, length of ICU-stay over 12 hours, body mass index >30 kg/m2. Moreover, risk factors have different significance in patients with different types of tumors. CONCLUSION: In this study, we found a high incidence of VTE among patients with brain tumors. Incidence and risk factors of VTE depend on the type of tumor.


Assuntos
Neoplasias Encefálicas , Tromboembolia Venosa , Trombose Venosa , Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/cirurgia , Humanos , Incidência , Fatores de Risco , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
11.
BMC Surg ; 21(1): 247, 2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34011335

RESUMO

BACKGROUND: The incidence of postoperative venous thromboembolism (VTE) is high in patients with inflammatory bowel disease. We aimed to analyze the incidence and predictive factors of postoperative VTE in patients with ulcerative colitis. METHODS: Patients with ulcerative colitis who underwent colon and rectum surgery during 2010-2018 were included. We retrospectively investigated the incidence of postoperative VTE. RESULTS: A total of 140 colorectal surgery cases were included. Postoperative VTE was detected in 24 (17.1 %). Portal-mesenteric venous thrombosis was the most frequent VTE (18 cases; 75 %); of these, 15 patients underwent total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA). In univariate analysis, VTE occurred more frequently in patients with neoplasia than in those refractory to medications (27.2 % vs. 12.5 %; p < 0.031). TPC with IPAA was more often associated with VTE development (28 %) than total colectomy (10.5 %) or proctectomy (5.9 %). On logistic regression analysis, TPC with IPAA, total colectomy, long operation time (> 4 h), and high serum D-dimer level (> 5.3 µg/mL) on the day following surgery were identified as predictive risk factors. CONCLUSIONS: Postoperative VTE occurred frequently and asymptomatically, especially after TPC with IPAA. Serum D-dimer level on the day after surgery may be a useful predictor of VTE.


Assuntos
Colite Ulcerativa , Proctocolectomia Restauradora , Tromboembolia Venosa , Colite Ulcerativa/complicações , Colite Ulcerativa/cirurgia , Humanos , Incidência , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Proctocolectomia Restauradora/efeitos adversos , Estudos Retrospectivos , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
12.
BMC Surg ; 21(1): 250, 2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34011342

RESUMO

BACKGROUND: Venous thromboembolism remains a common but preventable complication for cancerous lung surgical patients. Current guidelines recommend thromboprophylaxis for lung patients at high risk of thrombosis, while a consensus about specific administration time is not reached. This study was designed to investigate the safety profile of preoperative administration of low-molecular-weight-heparin (LMWH) for lung cancer patients. METHODS: From July 2017 to June 2018, patients prepared to undergo lung cancer surgery were randomly divided into the preoperative LMWH-administration group (PRL) for 4000 IU per day and the postoperative LMWH-administration group (POL) with same dosage, all the patients received thromboprophylaxis until discharge. Baseline characteristics including demographics and preoperative coagulation parameters were analyzed, while the endpoints included postoperative coagulation parameters, postoperative drainage data, hematologic data, intraoperative bleeding volume and reoperation rate. RESULTS: A total of 246 patients were collected in this RCT, 34 patients were excluded according to exclusion criterion, 101 patients were assigned to PRL group and 111 patients belonged to POL group for analysis finally. The baseline characteristic and preoperative coagulation parameters were all comparable except the PRL group cost more operation time (p = 0.008) and preoperative administration duration was significantly longer (p < 0.001). The endpoints including postoperative day 1 coagulation parameters, mean and total drainage volume, drainage duration, intraoperative bleeding volume and reoperation rate were all similar between the two groups. Moreover, coagulation parameters for postoperative day 3 between the two groups demonstrated no difference. CONCLUSION: Preoperative administration of low-molecular-weight-heparin demonstrated safety and feasibility for lung cancer patients intended to receive minimally invasive surgery. TRIAL REGISTRATION: ChiCTR2000040547 ( www.chictr.org.cn ), 2020/12/1, retrospectively registered.


Assuntos
Neoplasias Pulmonares , Tromboembolia Venosa , Anticoagulantes/efeitos adversos , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Neoplasias Pulmonares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle
13.
World J Gastroenterol ; 27(19): 2325-2340, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34040325

RESUMO

Pancreatic cancer (PC) is a devastating malignancy with fewer than 10% of patients being alive at 5 years after diagnosis. Venous thromboembolism (VTE) occurs in approximatively 20% of patients with PC, resulting in increased morbidity, mortality and significant health care costs. The management of VTE is particularly challenging in these frail patients. Adequate selection of the most appropriate anticoagulant for each individual patient according to the current international guidelines is warranted for overcoming treatment challenges. The International Initiative on Thrombosis and Cancer multi-language web-based mobile application (downloadable for free at www.itaccme.com) has been developed to help clinicians in decision making in the most complex situations. In this narrative review, we will discuss the contemporary epidemiology and burden of VTE in PC patients, the performances and limitations of current risk assessment models to predict the risk of VTE, as well as evidence from recent clinical trials for the primary prophylaxis and treatment of cancer-associated VTE that support up-dated clinical practice guidelines.


Assuntos
Neoplasias Pancreáticas , Tromboembolia Venosa , Anticoagulantes/uso terapêutico , Heparina de Baixo Peso Molecular , Humanos , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/epidemiologia , Prevenção Primária , Medição de Risco , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
14.
BMJ ; 373: n1114, 2021 05 05.
Artigo em Inglês | MEDLINE | ID: covidwho-1218221

RESUMO

OBJECTIVE: To assess rates of cardiovascular and haemostatic events in the first 28 days after vaccination with the Oxford-AstraZeneca vaccine ChAdOx1-S in Denmark and Norway and to compare them with rates observed in the general populations. DESIGN: Population based cohort study. SETTING: Nationwide healthcare registers in Denmark and Norway. PARTICIPANTS: All people aged 18-65 years who received a first vaccination with ChAdOx1-S from 9 February 2021 to 11 March 2021. The general populations of Denmark (2016-18) and Norway (2018-19) served as comparator cohorts. MAIN OUTCOME MEASURES: Observed 28 day rates of hospital contacts for incident arterial events, venous thromboembolism, thrombocytopenia/coagulation disorders, and bleeding among vaccinated people compared with expected rates, based on national age and sex specific background rates from the general populations of the two countries. RESULTS: The vaccinated cohorts comprised 148 792 people in Denmark (median age 45 years, 80% women) and 132 472 in Norway (median age 44 years, 78% women), who received their first dose of ChAdOx1-S. Among 281 264 people who received ChAdOx1-S, the standardised morbidity ratio for arterial events was 0.97 (95% confidence interval 0.77 to 1.20). 59 venous thromboembolic events were observed in the vaccinated cohort compared with 30 expected based on the incidence rates in the general population, corresponding to a standardised morbidity ratio of 1.97 (1.50 to 2.54) and 11 (5.6 to 17.0) excess events per 100 000 vaccinations. A higher than expected rate of cerebral venous thrombosis was observed: standardised morbidity ratio 20.25 (8.14 to 41.73); an excess of 2.5 (0.9 to 5.2) events per 100 000 vaccinations. The standardised morbidity ratio for any thrombocytopenia/coagulation disorders was 1.52 (0.97 to 2.25) and for any bleeding was 1.23 (0.97 to 1.55). 15 deaths were observed in the vaccine cohort compared with 44 expected. CONCLUSIONS: Among recipients of ChAdOx1-S, increased rates of venous thromboembolic events, including cerebral venous thrombosis, were observed. For the remaining safety outcomes, results were largely reassuring, with slightly higher rates of thrombocytopenia/coagulation disorders and bleeding, which could be influenced by increased surveillance of vaccine recipients. The absolute risks of venous thromboembolic events were, however, small, and the findings should be interpreted in the light of the proven beneficial effects of the vaccine, the context of the given country, and the limitations to the generalisability of the study findings.


Assuntos
Vacinas contra COVID-19/efeitos adversos , Doenças Arteriais Cerebrais/etiologia , Hemorragia/etiologia , Trombocitopenia/etiologia , Tromboembolia Venosa/etiologia , Trombose Venosa/etiologia , Adolescente , Adulto , Idoso , Doenças Arteriais Cerebrais/diagnóstico , Doenças Arteriais Cerebrais/epidemiologia , Dinamarca/epidemiologia , Feminino , Seguimentos , Hemorragia/diagnóstico , Hemorragia/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Sistema de Registros , Trombocitopenia/diagnóstico , Trombocitopenia/epidemiologia , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiologia , Trombose Venosa/diagnóstico , Trombose Venosa/epidemiologia , Adulto Jovem
16.
Yonsei Med J ; 62(6): 520-527, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34027639

RESUMO

PURPOSE: Trauma increases the risk of venous thromboembolism (VTE) in hospitalized patients. However, the risk and incidence of VTE in Korean trauma patients are limited. Therefore, we aimed to evaluate the incidence and identify potential predictors of VTE occurrence in Korean trauma patients. Moreover, we assessed the validity of the Greenfield risk assessment profile (RAP) and the trauma embolic scoring system (TESS) in these patients. MATERIALS AND METHODS: This retrospective cohort study used the data of trauma patients who were admitted to a regional trauma center between 2010 and 2016 and were eligible for entry into the Korea Trauma Data Bank. Clinical data were collected from hospital medical records. The patient's baseline characteristics and clinical data were compared between VTE and non-VTE groups. RESULTS: We included 9472 patients. The overall VTE rate was 0.87% (n=82), with 56 (0.59%) events of deep vein thrombosis and 39 (0.41%) of pulmonary embolism. Multiple regression analysis revealed that variables, including VTE history, pelvic-bone fracture, ventilator use, and hospitalization period, were significant, potential predictors of VTE occurrence. This study showed that increased RAP and TESS scores were correlated with increased VTE rate, with rates of 1% and 1.5% for the RAP and TESS scores of 6, respectively. The optimal cut-off value for RAP and TESS scores was 6. CONCLUSION: RAP and TESS, which are well-known diagnostic tools, demonstrated potentials in predicting the VTE occurrence in Korean trauma patients. Additionally, patients with pelvic-bone fractures and long-term ventilator treatment should be carefully examined for possible VTE.


Assuntos
Embolia Pulmonar , Tromboembolia Venosa , Humanos , Incidência , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Centros de Traumatologia , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
18.
Medicine (Baltimore) ; 100(18): e25639, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950941

RESUMO

BACKGROUND: Salvianolate, a common drug for stabilizing heart disease and Angina Pectoris, is considered to be off-label for preventing venous thromboembolism (VTE) or anticoagulation at present. However, many clinical studies have showed that salvianolate can effectively inhibit the deep-vein thrombosis (DVT) incidence, and prevent VTE of perioperative patients in the real world in China. OBJECTIVE: This analysis aimed to evaluate the effectiveness and safety of salvianolate in preventing VTE in perioperative patients. METHODS: Databases of PubMed, Cochrane Library, Embase, CNKI, Wanfang and VIP were searched until July 2019. Literature retrieval, data extraction and quality assessment were independently completed by two researchers and checked with each other. Review Manager 5.2 software was applied for meta-analysis. RESULTS: A total of 429 studies were retrieved, including 11 randomized controlled trials (RCTs) with a total of 1149 subjects. Compared with low molecular weight heparin (LMWH) group alone, salvianolate combined LMWH group had lower DVT incidence in preventing perioperative thrombosis (2.75% and 14.23%, OR: 0.21, 95% CI:[0.08,0.53]; P = .0009). The incidence of adverse reactions of experimental group was similar to that of control group (1.79% and 2.31%, OR: 0.65, 95% CI:[0.18,2.35]. P = .51). Compared with the control group, D-dimer level (D-D), platelet count (PLT), fibrinogen (FIB), whole blood high shear viscosity (WBHSV), and whole blood low shear viscosity (WBLSV) were all significantly decreased (P < .01), and prothrombin time (PT) was significantly increased (P < .05). CONCLUSION: Salvianolate combined LMWH has better effectiveness and the same safety in preventing venous thromboembolism in perioperative patients. However, due to the small number of included literatures, large sample studies are still needed to further verify this conclusion.


Assuntos
Uso Off-Label , Extratos Vegetais/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Tromboembolia Venosa/epidemiologia , China/epidemiologia , Quimioterapia Combinada/efeitos adversos , Quimioterapia Combinada/métodos , Heparina de Baixo Peso Molecular/administração & dosagem , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Período Perioperatório/estatística & dados numéricos , Extratos Vegetais/administração & dosagem , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Tempo de Protrombina , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle
19.
BMJ ; 373: n1114, 2021 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-33952445

RESUMO

OBJECTIVE: To assess rates of cardiovascular and haemostatic events in the first 28 days after vaccination with the Oxford-AstraZeneca vaccine ChAdOx1-S in Denmark and Norway and to compare them with rates observed in the general populations. DESIGN: Population based cohort study. SETTING: Nationwide healthcare registers in Denmark and Norway. PARTICIPANTS: All people aged 18-65 years who received a first vaccination with ChAdOx1-S from 9 February 2021 to 11 March 2021. The general populations of Denmark (2016-18) and Norway (2018-19) served as comparator cohorts. MAIN OUTCOME MEASURES: Observed 28 day rates of hospital contacts for incident arterial events, venous thromboembolism, thrombocytopenia/coagulation disorders, and bleeding among vaccinated people compared with expected rates, based on national age and sex specific background rates from the general populations of the two countries. RESULTS: The vaccinated cohorts comprised 148 792 people in Denmark (median age 45 years, 80% women) and 132 472 in Norway (median age 44 years, 78% women), who received their first dose of ChAdOx1-S. Among 281 264 people who received ChAdOx1-S, the standardised morbidity ratio for arterial events was 0.97 (95% confidence interval 0.77 to 1.20). 59 venous thromboembolic events were observed in the vaccinated cohort compared with 30 expected based on the incidence rates in the general population, corresponding to a standardised morbidity ratio of 1.97 (1.50 to 2.54) and 11 (5.6 to 17.0) excess events per 100 000 vaccinations. A higher than expected rate of cerebral venous thrombosis was observed: standardised morbidity ratio 20.25 (8.14 to 41.73); an excess of 2.5 (0.9 to 5.2) events per 100 000 vaccinations. The standardised morbidity ratio for any thrombocytopenia/coagulation disorders was 1.52 (0.97 to 2.25) and for any bleeding was 1.23 (0.97 to 1.55). 15 deaths were observed in the vaccine cohort compared with 44 expected. CONCLUSIONS: Among recipients of ChAdOx1-S, increased rates of venous thromboembolic events, including cerebral venous thrombosis, were observed. For the remaining safety outcomes, results were largely reassuring, with slightly higher rates of thrombocytopenia/coagulation disorders and bleeding, which could be influenced by increased surveillance of vaccine recipients. The absolute risks of venous thromboembolic events were, however, small, and the findings should be interpreted in the light of the proven beneficial effects of the vaccine, the context of the given country, and the limitations to the generalisability of the study findings.


Assuntos
Vacinas contra COVID-19/efeitos adversos , Doenças Arteriais Cerebrais/etiologia , Hemorragia/etiologia , Trombocitopenia/etiologia , Tromboembolia Venosa/etiologia , Trombose Venosa/etiologia , Adolescente , Adulto , Idoso , Doenças Arteriais Cerebrais/diagnóstico , Doenças Arteriais Cerebrais/epidemiologia , Dinamarca/epidemiologia , Feminino , Seguimentos , Hemorragia/diagnóstico , Hemorragia/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Sistema de Registros , Trombocitopenia/diagnóstico , Trombocitopenia/epidemiologia , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiologia , Trombose Venosa/diagnóstico , Trombose Venosa/epidemiologia , Adulto Jovem
20.
BMJ Case Rep ; 14(5)2021 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-33975833

RESUMO

Venous thromboembolism (VTE) is a recognised complication of lower limb trauma in adult patients and classically presents with cardiopulmonary symptoms. However, the risk of VTE and its presenting signs and symptoms are less well documented in the paediatric population. We report the case of a child who presented to our emergency department with abdominal pain 2 weeks after lower limb fracture, who was subsequently found to have a pulmonary thromboembolism (PTE). This case report highlights the importance of having a high index of suspicion for VTE in the paediatric population if there are predisposing risk factors and to consider PTE as a differential cause of abdominal pain. To the authors' knowledge, no case has been described in which a child presenting with abdominal pain was consequently found to have a pulmonary embolism.


Assuntos
Embolia Pulmonar , Tromboembolia Venosa , Dor Abdominal/etiologia , Adulto , Criança , Serviço Hospitalar de Emergência , Humanos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/diagnóstico por imagem , Fatores de Risco , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/etiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...