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1.
Emerg Med Clin North Am ; 37(2): 339-350, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30940376

RESUMO

Cardiovascular disease has overtaken all other causes of maternal death in the United States. The physiologic changes of pregnancy place a significant amount of stress on the cardiovascular system and put pregnant women at risk for potentially catastrophic complications, such as pulmonary embolism, aortic or coronary artery dissection, myocardial infarction, and peripartum cardiomyopathy. The diagnosis of these conditions is challenging because the symptoms can mimic those experienced in normal pregnancies. There are subtle differences in the diagnosis and treatment of cardiovascular emergencies in pregnant patients that clinicians must be aware of; however, the overall management goals are similar.


Assuntos
Serviço Hospitalar de Emergência , Complicações Cardiovasculares na Gravidez/diagnóstico , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/terapia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/terapia , Cardiomiopatias/complicações , Cardiomiopatias/diagnóstico , Cardiomiopatias/terapia , Feminino , Humanos , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Período Periparto , Gravidez , Complicações Cardiovasculares na Gravidez/terapia , Tromboembolia Venosa/complicações , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/terapia
2.
J Cancer Res Ther ; 15(2): 344-349, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30964109

RESUMO

Aims: The aim of this study is to analyze the clinical features and prognosis of cancer patients with venous thromboembolism (VTE). Subjects and Methods: This was a retrospective observational study that selected cancer patients with a new VTE event from January 2003 to 2013 using the hospital information system in Beijing Hospital. The patients were divided into three groups according to the site of thrombosis as follows: pulmonary thromboembolism (PTE), deep venous thrombosis (DVT), or PTE plus DVT. The clinical manifestations and prognosis among the three groups were compared. Results: Among the 18,531 patients diagnosed with a malignant tumor, 280 (1.51%) patients presented with VTE at first diagnosis or during the disease course; of these, 26 had incidental pulmonary embolism (IPE). Dyspnea was the most common symptom in the PTE group (51.65%), and lower limb swelling was found mostly in the DVT group (65.27%). Approximately 53.92% and 63.21% of patients had VTE events within the first 3 and 6 months after cancer diagnosis, respectively. The median survival time of all VTE patients was 24.0 ± 7.85 months, with the DVT group having the longest survival time among the three groups (P < 0.05). About 29.23% of the 130 patient deaths occurred within the first 30 days after VTE diagnosis, and 46.92% occurred within the first 3 months. Conclusions: The incidence of IPE in cancer patients was not rare. Most VTE events occurred within the first 6 months after the cancer diagnosis, and nearly half of the deaths occurred within the first 3 months of VTE diagnosis in cancer patients.


Assuntos
Neoplasias/complicações , Neoplasias/mortalidade , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/mortalidade , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons/métodos , Prognóstico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etiologia , Embolia Pulmonar/terapia , Análise de Sobrevida , Avaliação de Sintomas , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/terapia , Trombose Venosa/diagnóstico , Trombose Venosa/etiologia , Trombose Venosa/terapia
3.
Harefuah ; 158(3): 187-191, 2019 Mar.
Artigo em Hebraico | MEDLINE | ID: mdl-30916508

RESUMO

INTRODUCTION: Deep Venous Thrombosis (DVT) is rare among children, yet may yield high morbidity and mortality. Due to the limited data regarding pediatric DVT, its management has been adopted from adults' protocols. Recent research reported associations of DVT and strokes with genetic thrombophilia, especially in the presence of transient risk factors (e.g.: hospitalization, malignancy, central venous lines…). AIMS: To evaluate the influence of risk factors within our pediatric DVT cohort of a tertiary center upon treatment and prognosis. METHODS: Retrospective analysis of prospectively collected data at the Sheba Medical Center. RESULTS: During the period 2014-2017, 76 out of 150 cases of acute DVT diagnosed at our center were fully followed. Upper extremity DVT was most commonly observed. Malignancy and a central venous line (CVL) were the most abundant risk factors. Genetic thrombophilia was diagnosed in one third of the cases. The majority of patients were treated with low molecular weight heparin for at least 3 months and 13% continued prolonged anti-coagulation treatment. Neither thrombophilia nor cancer affected the outcome. DISCUSSION: Our results confirm previously published data indicating that malignancy and CVL are the most common risk factors associated with DVT in children, making the upper extremity the most common location of thrombosis. Neither the type of cancer nor genetic thrombophilia was found to be associated with treatment outcome, but they did influence the treatment duration. Risk factors influence the pathogenesis of DVT and influence the duration of treatment.


Assuntos
Trombofilia , Tromboembolia Venosa , Trombose Venosa , Criança , Estudos de Coortes , Humanos , Estudos Retrospectivos , Fatores de Risco , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/terapia
5.
Thromb Res ; 175: 84-89, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30731388

RESUMO

Venous thromboembolism (VTE) is both common and a potential contributor to symptom burden in patients receiving palliative and end-of-life care. Many of the VTE treatment and prophylaxis recommendations are drawn from data of clinical trials assessing conventional VTE and cancer-associated thrombosis that excluded patients receiving specialist palliative or hospice care. In this group, the epidemiology of VTE and associated outcomes, as well as the risks and benefits of treatment in keeping with a palliative approach are of growing clinical and research interest. This narrative review summarizes current knowledge and challenges in the management of thromboembolic disease in palliative care, highlighting the complexity of decisions surrounding VTE treatment and prophylaxis.


Assuntos
Cuidados Paliativos/métodos , Assistência Terminal/métodos , Humanos , Tromboembolia Venosa/terapia
7.
J Pediatr Orthop ; 39(3): 125-129, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30730416

RESUMO

BACKGROUND: The frequency of knee arthroscopy procedures is increasing in pediatric and adolescent patients. In general, complications after these procedures in adolescents are uncommon. The purposes of this study are to report the incidence of venous thromboembolism (VTE) in adolescent patients after knee arthroscopy procedures, as well identify risk factors in this patient population. METHODS: Medical records were reviewed in all pediatric and adolescent patients (≤19 y) who underwent an arthroscopic knee procedure from 2010 to 2014 and were diagnosed with a symptomatic VTE in the postoperative period. Demographic features were recorded, and included age, sex, body mass index, clinical characteristics (diagnosis, type of surgical intervention, tourniquet time), VTE risk factors [family history of VTE, obesity (body mass index >30), oral contraceptive use, and smoking use/exposure] and treatment (anticoagulation type/duration). RESULTS: Out of 2783 patients who underwent knee arthroscopy during the 5-year study period, 7 patients (3 males, 4 females, mean age, 16.9 y, range, 15 to 18) developed a symptomatic postoperative VTE (incidence, 0.25%, 95% confidence interval, 0.11%-0.54%). There were 6 unilateral deep venous thrombosis, and 1 bilateral deep venous thrombosis. Arthroscopic procedures performed in this cohort included anterior cruciate ligament reconstruction (3), isolated lateral release (1), meniscectomy (2), and patellar realignment with arthroscopic lateral release, open tibial tubercle osteotomy, and open proximal medial retinacular reefing (1). VTE was diagnosed an average of 9 days following surgery (range, 3 to 16). All patients were initially treated with low-molecular-weight heparin, and 2 were converted to warfarin. Mean duration of anticoagulation treatment was 64 days (range, 28 to 183). All patients had at least 1 identifiable medical or surgical risk factor, including oral contraceptive use (2), smoking (2), obesity (2), an arthroscopically assisted open procedure (4), or tourniquet time >60 minutes (3). CONCLUSIONS: VTE after adolescent knee arthroscopy has not been well described. The incidence is ∼0.25%. Previously established risk factors for VTE were present in 100% of the affected population. Low-molecular-weight heparin was used to successfully treat this complication. LEVEL OF EVIDENCE: Level IV.


Assuntos
Artroscopia , Heparina de Baixo Peso Molecular/uso terapêutico , Articulação do Joelho/cirurgia , Tromboembolia Venosa , Adolescente , Artroscopia/efeitos adversos , Artroscopia/classificação , Artroscopia/métodos , Índice de Massa Corporal , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Avaliação de Processos e Resultados (Cuidados de Saúde) , Complicações Pós-Operatórias/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Torniquetes , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/terapia
8.
Int J Gynaecol Obstet ; 144(3): 277-282, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30578681

RESUMO

OBJECTIVE: To determine whether a personalized iterative venous thromboembolism (VTE) risk score improved preventive prophylaxis during pregnancy and puerperium. METHODS: An observational retrospective comparative study was conducted at single French hospital. Women who gave birth from February 1 to April 30, 2012 (n=557) or from February 1 to April 30, 2015 (n=512) underwent VTE risk assessment. The VTE risk score comprised known risk factors for this condition. RESULTS: Use of the VTE risk score at the first consultation increased the likelihood of appropriate treatment (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.2-1.9; P=0.002) and reduced the risk of undertreatment (OR 0.5, 95% CI 0.4-0.7; P<0.001). During hospitalization and puerperium, the VTE risk score increased the likelihood of appropriate treatment. The ORs were 6.2 (95% CI 2.1-18.9; P<0.001) and 5.4 (95% CI 4.1-7.2; P<0.001), respectively. The risk of undertreatment was also reduced at these time points. CONCLUSION: Use of the VTE risk score increased the number of appropriately treated patients during pregnancy and puerperium.


Assuntos
Complicações Cardiovasculares na Gravidez/diagnóstico , Diagnóstico Pré-Natal/métodos , Transtornos Puerperais/diagnóstico , Tromboembolia Venosa/diagnóstico , Fatores Etários , Anticoagulantes/administração & dosagem , Feminino , Heparina/administração & dosagem , Humanos , Razão de Chances , Gravidez , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Transtornos Puerperais/terapia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Meias de Compressão , Tromboembolia Venosa/terapia
9.
Thromb Haemost ; 119(2): 319-327, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30593086

RESUMO

BACKGROUND: Management of venous thromboembolism (VTE), encompassing both deep vein thrombosis (DVT) and pulmonary embolism (PE), varies worldwide. METHODS: The Global Anticoagulant Registry in the FIELD - Venous Thromboembolism (GARFIELD-VTE) is a prospective, observational study of 10,685 patients with objectively diagnosed VTE recruited from May 2014 to January 2017 at 417 sites in 28 countries. All patients are followed for at least 3 years. We describe the baseline characteristics of the study population and their management within 30 days of diagnosis. RESULTS: The median age was 60.2 years; 50.4% were male; 61.7% had DVT and 38.3% had PE ± DVT; and 32.3% were obese (body mass index ≥ 30 kg/m2). The most common risk factors were surgery (12.5%), hospitalization (12.0%) and trauma to the lower limbs (7.8%). At the time of VTE diagnosis, 10.1% had active cancer and 5.7% were chronically immobilized. Treatment for VTE was anticoagulant (AC) therapy alone in 90.9% of patients; 5.1% received thrombolytic and/or surgical/mechanical therapy ± AC and 4.0% received no therapy. Pre-diagnosis, 12.8% received AC therapy alone and 0.2% received thrombolytic and/or surgical/mechanical therapy ± AC. After diagnosis, parenteral AC therapy alone was administered in 17.6% of patients, and it was followed by a direct oral AC (DOAC) in 16.4% or a vitamin K antagonist (VKA) in 26.8%. DOACs alone were prescribed to 32.3% of patients, while 5.9% received VKA alone. CONCLUSION: The initial findings from this global registry highlight the heterogeneity in characteristics and management of VTE patients. Prospective follow-up will reveal the impact of this heterogeneity on outcomes.


Assuntos
Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/terapia , Idoso , Anticoagulantes/uso terapêutico , Cardiologia/métodos , Comorbidade , Feminino , Saúde Global , Hospitalização , Humanos , Cooperação Internacional , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/terapia , Sistema de Registros , Trombose Venosa/epidemiologia , Trombose Venosa/terapia
10.
JAMA ; 320(15): 1583-1594, 2018 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-30326130

RESUMO

Importance: Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and potentially fatal disease. Objective: To summarize the advances in diagnosis and treatment of VTE of the past 5 years. Evidence Review: A systematic search was conducted in EMBASE Classic, EMBASE, Ovid MEDLINE, and other nonindexed citations using broad terms for diagnosis and treatment of VTE to find systematic reviews and meta-analyses, randomized trials, and prospective cohort studies published between January 1, 2013, and July 31, 2018. The 10th edition of the American College of Chest Physicians Antithrombotic Therapy Guidelines was screened to identify additional studies. Screening of titles, abstracts, and, subsequently, full-text articles was performed in duplicate, as well as data extraction and risk-of-bias assessment of the included articles. Findings: Thirty-two articles were included in this review. The application of an age-adjusted D-dimer threshold in patients with suspected PE has increased the number of patients in whom imaging can be withheld. The Pulmonary Embolism Rule-Out Criteria safely exclude PE when the pretest probability is low. The introduction of direct oral anticoagulants has allowed for a simplified treatment of VTE with a lower risk of bleeding regardless of etiology or extent of the VTE (except for massive PE) and has made extended secondary prevention more acceptable. Thrombolysis is best reserved for patients with massive PE or those with DVT and threatened limb loss. Insertion of inferior vena cava filters should be avoided unless anticoagulation is absolutely contraindicated in patients with recent acute VTE. Graduated compression stockings are no longer recommended to treat DVT but may be used when acute or chronic symptoms are present. Anticoagulation may no longer be indicated for patients with isolated distal DVT at low risk of recurrence. Conclusions and Relevance: Over the past 5 years, substantial progress has been made in VTE management, allowing for diagnostic and therapeutic strategies tailored to individual patient characteristics, preferences, and values.


Assuntos
Anticoagulantes/uso terapêutico , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/terapia , Administração Oral , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Trombólise Mecânica , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/terapia
11.
J. vasc. bras ; 17(4)out.-dez. 2018. graf, tab
Artigo em Português | LILACS | ID: biblio-969128

RESUMO

A number of limitations of standard therapy with warfarin for deep vein thrombosis (DVT) have been established. This overview of systematic reviews presents the baseline results for efficacy and safety of the new direct oral anticoagulants (DOACs) thrombin inhibitors, and activated factor X (Xa) inhibitors in patients with DVT. Searches were run on PubMed and the Cochrane Database of Systematic Reviews. Twenty-three studies were retrieved, and one systematic review was judged eligible. This review scored maximum according to AMSTAR criteria and included 7,596 patients for analysis of thrombin inhibitors and 16,356 patients for analysis of factor Xa inhibitors. The results of the meta-analysis indicate that DOACs are similar for DVT treatment when compared to standard treatment with warfarin. The incidence of major bleeding is somewhat lower in patients treated with factor Xa inhibitors and similar to standard therapy when treated with direct thrombin inhibitors


A terapia padrão com varfarina para a trombose venosa profunda (TVP) tem uma série de limitações já estabelecidas. Essa revisão de revisões sistemáticas elenca os principais resultados de eficácia e segurança dos anticoagulantes orais diretos (DOACs), inibidores da trombina e do fator X ativado (Xa), em pacientes com TVP. A pesquisa foi realizada nas bases PubMed e Cochrane Database of Systematic Reviews. Foram recuperados 23 estudos, e uma revisão sistemática foi considerada elegível. Essa revisão atingiu escore máximo no AMSTAR e incluiu 7.596 pacientes para análise dos inibidores da trombina e 16.356 pacientes para a análise dos inibidores do fator Xa. Os resultados da metanálise indicam que os DOACs apresentam eficácia similar à terapia padrão no tratamento da TVP. A incidência de sangramento maior é um pouco menor nos pacientes tratados com os inibidores do fator Xa e similar à terapia padrão no tratamento com inibidores diretos da trombina


Assuntos
Humanos , Masculino , Feminino , Revisão , Trombose Venosa/terapia , Anticoagulantes/uso terapêutico , Varfarina/uso terapêutico , Heparina/uso terapêutico , Trombina , Fatores de Risco , Interações de Medicamentos , Tromboembolia Venosa/terapia , Inibidores do Fator Xa/uso terapêutico , Rivaroxabana/uso terapêutico , Dabigatrana/uso terapêutico , Hemorragia
12.
J Thromb Thrombolysis ; 46(4): 551-558, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30196344

RESUMO

Knee arthroscopy is the most common orthopedic procedure worldwide. While incidence of post-arthroscopy venous thromboembolic events (VTE) is low, treatment patterns and patient outcomes have not been described. Patients from the "Registro Informatizado Enfermedad TromboEmbolica" who had confirmed post-arthroscopy VTE were compared to patients with provoked, post bone-fracture, and to patients with unprovoked VTE. Baseline characteristics, presenting signs and symptoms, treatment and outcomes including recurrent VTE, bleeds or death were compared. A total of 101 patients with post-arthroscopy VTE and 19,218 patients with unprovoked VTE were identified. Post-arthroscopy patients were younger (49.5 vs. 66 years, P < 0.0001) and had less history of VTE [5.9% vs. 20%, OR 0.26 (0.11-0.59)]. Among patients with isolated DVT, there were fewer proximal DVT in the post-arthroscopy group [40% vs. 86%, OR 0.11 (0.06-0.19)]. Treatment duration was shorter in the post-arthroscopy group (174 ± 140 vs. 311 ± 340 days, P < 0.0001) and more often with DOAC [OR 3.67 (1.95-6.89)]. Recurrent VTE occurred in 6.18 (1.96-14.9) and 11.9 (11.0-12.8) per 100 patient years [HR 0.52 (0.16-1.26)] after treatment in the post-arthroscopy and unprovoked groups, respectively. Recurrent VTE occurred in 5.17 (1.31-14.1) per 100 patient years in a separate post bone-fracture group (n = 147), also not statistically different than the post-arthroscopy recurrence rate. After anticoagulation cessation, some patients post-knee arthroscopy develop VTE. While our small sample size precludes drawing firm conclusions, this signal should warrant further research into the optimal treatment duration for these patients, as some patients may be at increased risk for long-term recurrence.


Assuntos
Artroscopia/efeitos adversos , Tromboembolia Venosa/etiologia , Idoso , Anticoagulantes/uso terapêutico , Feminino , Humanos , Incidência , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva , Sistema de Registros , Resultado do Tratamento , Tromboembolia Venosa/patologia , Tromboembolia Venosa/terapia , Trombose Venosa
13.
Crit Rev Oncol Hematol ; 130: 44-50, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30196911

RESUMO

BACKGROUND: Results from cohort studies evaluating the benefit in prevention of recurrent Venous Thromboembolism in cancer population are heterogeneous and controversial. OBJECTIVE: To determine the effectiveness and harms of vena cava filters alone or combined with anticoagulation to prevent the risk of recurrent venous thromboembolism in patients with cancer-related venous thromboembolism. MATERIALS AND METHODS: A search strategy was conducted in the MEDLINE, CENTRAL, EMBASE and LILACS databases. Searches were also conducted in other databases and unpublished literature. Clinical trials were included without language restrictions. The risk of bias was evaluated with the Cochrane Collaboration's tool and a modified version for cohort studies. An analysis of fixed effects was conducted. The primary outcome was recurrent venous thromboembolism. The secondary outcomes were overall survival and adverse effects. The measure of the effect was the risk ratio with a 95% confidence interval. RESULTS: Seven studies were included in the qualitative and quantitative analysis. 35,333 patients were found among the seven studies. A low risk of bias was shown for most of the study items. The overall risk ratio (RR) for recurrent venous thromboembolism was 2.53 95%CI (1.35-4.75) favoring anticoagulation compared with vena cava filter. CONCLUSION: Vena cava filter did not show benefits for recurrent venous thromboembolism prevention in the cancer-patients population.


Assuntos
Anticoagulantes/uso terapêutico , Neoplasias/complicações , Filtros de Veia Cava/estatística & dados numéricos , Tromboembolia Venosa/terapia , Terapia Combinada , Gerenciamento Clínico , Humanos , Metanálise como Assunto , Tromboembolia Venosa/etiologia
16.
J. vasc. bras ; 17(3)jul.-set. 2018. tab, graf
Artigo em Português | LILACS | ID: biblio-916048

RESUMO

Contexto: O tromboembolismo venoso (TEV) representa uma preocupação crescente nas instituições hospitalares, tem grande impacto sobre a morbimortalidade em pacientes clínicos e cirúrgicos, e é a principal causa de morte evitável hospitalar. Embora existam modelos de avaliação de risco para pacientes hospitalizados, a profilaxia ainda é subutilizada ou é feita de forma incorreta. Objetivos: Avaliar o perfil de risco para TEV de pacientes clínicos e cirúrgicos recém-internados, bem como as medidas tromboprofiláticas aplicadas nas primeiras 24 horas de internação. Métodos: Este estudo transversal foi realizado em um hospital geral de grande porte do interior do estado de São Paulo entre março e julho de 2015. Os escores de Pádua e Caprini foram utilizados para estratificação de risco dos pacientes clínicos e cirúrgicos, respectivamente, enquanto a análise das medidas tromboprofiláticas baseou-se nas recomendações do 8º e 9º Consenso do American College of Chest Physicians. Resultados: Foram analisados 592 pacientes (62% clínicos e 38% cirúrgicos). A estratificação de risco revelou necessidade de quimioprofilaxia em 42% dos pacientes clínicos e 81% dos cirúrgicos (51% de alto risco e 30% de moderado risco). Por outro lado, receberam profilaxia adequada nas primeiras 24 horas de internação 54% dos pacientes clínicos de alto risco, 85% dos cirúrgicos de alto risco e 4% dos cirúrgicos de moderado risco, todos sem contraindicação. Conclusões: Há necessidade de aprimoramento da segurança do paciente em relação ao TEV já nas primeiras horas de internação. Existe uma subutilização da quimioprofilaxia especialmente nos pacientes clínicos de alto risco e cirúrgicos de moderado risco


Background: Venous thromboembolism (VTE) is a cause for growing concern in hospitals, has great impact on morbidity and mortality in clinical and surgical patients, and is the leading cause of preventable hospital deaths. Although there are risk assessment models for hospital inpatients, prophylaxis is still underused or is administered incorrectly. Objectives: To assess the risk profile for VTE in recently hospitalized clinical and surgical patients and evaluate the thromboprophylactic measures implemented in the first 24 hours of hospitalization. Methods: Cross-sectional study conducted in a large general hospital in the state of São Paulo, Brazil, between March and July 2015. Padua and Caprini scores were used for risk stratification of clinical and surgical patients, respectively, while thromboprophylactic measures were analyzed for compliance with the recommendations contained in the 8th and 9th Consensus of the American College of Chest Physicians. Results: A total of 592 patients (62% clinical and 38% surgical) were assessed. Risk stratification revealed a need for chemoprophylaxis in 42% of clinical patients and 81% of surgical patients (51% high risk and 30% moderate risk). However, 54% of high-risk clinical patients, 85% of high-risk surgical patients, and 4% of moderate-risk surgical patients, who were free from contraindications, were actually given the correct prophylaxis in the first 24 hours of hospitalization. Conclusions: There is a need to improve patient safety in relation to VTE in the first hours of hospitalization, since there is underutilization of chemoprophylaxis, especially in high-risk clinical patients and moderate-risk surgical patients


Assuntos
Humanos , Masculino , Feminino , Prevenção de Doenças , Hospitais , Trombose Venosa/terapia , Quimioprevenção/métodos , Estudos Transversais , Heparina/uso terapêutico , Hospitalização , Indicadores de Morbimortalidade , Limitação da Mobilidade , Obesidade , Fatores de Risco , Terapêutica , Tromboembolia Venosa/complicações , Tromboembolia Venosa/terapia
17.
J. vasc. bras ; 17(3)jul.-set. 2018. tab
Artigo em Português | LILACS | ID: biblio-916069

RESUMO

A aviação civil vem apresentando aumento progressivo do número de voos regulares nos últimos 10 anos e, em função disso, mais passageiros estão sendo transportados em viagens aéreas (VAs). Associado a isso, há um aumento das doenças relacionadas às VAs, especialmente naquelas de longa duração. Uma das complicações mais temidas dos voos é o tromboembolismo venoso (TEV), mas a sua real incidência é de difícil mensuração devido à falta de consenso sobre, por exemplo, quanto tempo após o pouso podemos considerar que o TEV possa estar relacionado à VA realizada ou mesmo quanto tempo de voo pode ser considerado como de longa duração. Muito tem se discutido sobre os mecanismos fisiopatológicos do TEV relacionado às VAs, quais passageiros são os de maior risco e quais medidas profiláticas podemos adotar com segurança e eficácia. O objetivo desta revisão é esclarecer esses pontos e as condutas consensuais atuais


Civil aviation has seen a steady increase in the number of scheduled flights over the last ten years and, as a result, more passengers are traveling by air. This has been associated with an increase in flight-related diseases, especially on long-haul flights. One of the most feared complications during flights is venous thromboembolism (VTE), but its true incidence is difficult to measure because of a lack of consensus on elements such as the definition of how long after landing a VTE can be considered to be related to a flight and even how long a flight must last to be considered of long duration. There has been much discussion of the pathophysiological mechanisms of flight-related VTE, of which passengers are at greatest risk, and of what prophylactic measures can be adopted safely and effectively. The purpose of this review is to clarify these points and describe current consensual conduct


Assuntos
Humanos , Masculino , Feminino , Viagem Aérea/tendências , Prevenção de Doenças , Tromboembolia Venosa/terapia , Trombose Venosa/terapia , Medicina Aeroespacial/métodos , Anticoagulantes , Heparina , Hipóxia/complicações , Incidência , Inibidores da Agregação de Plaquetas , Prevalência , Embolia Pulmonar/complicações , Revisão , Fatores de Risco
19.
Cardiovasc Intervent Radiol ; 41(9): 1313-1317, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29946944

RESUMO

Venous thromboembolism (VTE) is a major public health issue; deep vein thrombosis (DVT) affects about 1/1000 patients. Each year, VTE kills more patients in Western Europe than breast cancer, prostate cancer, acquired immune deficiency syndrome (AIDS) and road traffic accidents combined and is responsible for the deaths of approximately 370,000 European citizens (Cohen et al. in Thromb Haemost 98:756-764, 2007; Belohlávek et al. in Exp Clin Cardiol 18(2):129-138, 2013). The recently published ATTRACT trial (Acute Venous Thrombosis Thrombus Removal with Adjunctive Catheter-directed Thrombolysis) (Vedantham et al. in N Engl J Med 377:2240-2252, 2017) concluded that the addition of catheter-directed thrombolysis to standard therapy with anticoagulation and compression stockings offers no significant clinical benefit over standard therapy in terms of reduction in the rate of post-thrombotic syndrome (PTS) at 2 years. It is the largest, prospective, multi-centre, randomised controlled trial (RCT) and represents the culmination over a decade of planning, execution and analysis. In this opinion article, we analyse why it was needed, what it demonstrated, some limitations, and the directions in which this important publication will take us.


Assuntos
Anticoagulantes/uso terapêutico , Terapia Trombolítica/métodos , Tromboembolia Venosa/terapia , Terapia Combinada , Europa (Continente) , Feminino , Humanos , Masculino
20.
Prog Cardiovasc Dis ; 60(6): 622-628, 2018 Mar - Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29804569

RESUMO

There continues to be controversy on the use of inferior vena cava (IVC) filters in patients with deep venous thrombosis, pulmonary embolism, and venous thromboembolism. In this state of the art review, the benefits and risks of IVC filters are discussed. Based on the current state of knowledge regarding the efficacy and risks of this therapy, guidelines are suggested regarding the patients who need and who do not need this expensive, risky, but potentially life-saving therapy.


Assuntos
Anticoagulantes/administração & dosagem , Embolia Pulmonar/terapia , Filtros de Veia Cava/estatística & dados numéricos , Terapia Combinada , Feminino , Humanos , Masculino , Prognóstico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Taxa de Sobrevida , Resultado do Tratamento , Filtros de Veia Cava/efeitos adversos , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/mortalidade , Tromboembolia Venosa/terapia
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