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2.
Einstein (Sao Paulo) ; 18: eAO5425, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32935827

RESUMO

OBJECTIVE: To develop an informative manual on venous thromboembolism prevention for the lay population and to estimate evidences of content and face validity. METHODS: A methodological study conducted in three stages. The first stage was the preparation of the manual, followed by content validation with cardiovascular specialists who judged clarity, theoretical relevance and practical pertinence on a 4-point Likert scale. Items with a content validity index ≤0.75 were revised and re-evaluated. The last stage was the face validation by lay people, who were interviewed regarding item understanding and visual appearance. Items with more than 80.0% positive opinions were considered adequate. RESULTS: The manual was developed containing nine illustrations, definition of the disease, risk factors, signs and symptoms, and preventive measures. In the first assessment round, the validity index was 1.0 for the text of all sections, with suggestions for language adjustments. As to the illustrations, the validity indexes ranged from 0.67 to 1.0. In the second round, the validity index reached 1.0 for all items. A total of 40 lay people participated in the face validation, and all considered the paper type and font size appropriate, as well as the font used as readable; 97.5% were able to understand the information contained in the manual; 98.0% considered it esthetically beautiful; and 90.0% considered the reading not tiresome. CONCLUSION: The informative manual on venous thromboembolism prevention was prepared, its content validated by experts, and considered appropriate by the lay population. These results suggest that the manual may be used as a preventive educational strategy for venous thromboembolism.


Assuntos
Manuais como Assunto , Educação de Pacientes como Assunto , Tromboembolia Venosa/terapia , Humanos , Idioma , Reprodutibilidade dos Testes
3.
PLoS One ; 15(8): e0237342, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760163

RESUMO

OBJECTIVES: To explore how to integrate the "best" practice into nursing of venous thromboembolism (VTE) based on the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. METHODS: A mixed-methods design was used. A steering group for clinical evidence implementation (EI) was established to conduct pre-implementation baseline surveys, a thorough analysis of the evidence, and an analysis of the survey results. The hindering and enabling factors associated with the clinical implementation of the evidence were analysed based on the three core elements of i-PARIHS, to formulate the clinical implementation plan for VTE nursing evidence. On-site expert reviews and focus group interviews were used to evaluate the feasibility of the draft plan, make adjustments, and finalize the evidence-based practice plan, which was then put into practice and evaluated. RESULTS: A new nursing process, a health education manual and a nursing quality checklist on VTE has been established and proved to be appropriate through the implementation. Compliance with evidence related to VTE nursing increased significantly in the two units, with better compliance in unit B than unit A. The knowledge, attitude and behaviour scores for VTE nursing increased substantially in both nurses and patients. CONCLUSION: The EI programme of incorporating the "best" evidence on VTE nursing into clinical practice using the i-PARIHS framework demonstrated feasibility, appropriateness and effectiveness and could serve as a reference.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Enfermagem Baseada em Evidências/organização & administração , Implementação de Plano de Saúde/organização & administração , Unidades de Terapia Intensiva/organização & administração , Tromboembolia Venosa/terapia , Adulto , Prestação Integrada de Cuidados de Saúde/métodos , Enfermagem Baseada em Evidências/métodos , Estudos de Viabilidade , Feminino , Grupos Focais , Educação em Saúde/métodos , Educação em Saúde/organização & administração , Pesquisa sobre Serviços de Saúde , Médicos Hospitalares/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos
6.
Lancet Haematol ; 7(8): e583-e593, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32735837

RESUMO

BACKGROUND: Venous thromboembolism is associated with increased mortality risk in some populations, but how frequently it is a direct cause of death is unclear. We used data from venous thromboembolism prevention trials to evaluate the causal effect of venous thromboembolism reduction on mortality. METHODS: We did a systematic review and meta-analysis of randomised controlled trials (RCTs) evaluating venous thromboembolism prevention. We searched MEDLINE, Embase, PubMed, and Web of Science starting from Jan 1, 1993, to March 19, 2018. We included studies of patients who were at elevated risk of venous thromboembolism and were randomly assigned to either anticoagulant or antiplatelet therapy versus placebo or no treatment. We excluded studies with an active control agent (which might mitigate the lethality of venous thromboembolism) and those for which mortality data were unavailable. We modelled heterogeneity in a Bayesian framework, taking overall mortality as a primary endpoint, and pulmonary embolism, fatal pulmonary embolism, and major bleeding as secondary endpoints. We focused our analyses on studies reporting statistically significant effects of prevention on venous thromboembolism endpoints. We report treatment effects as median risk ratios (RRs), wherein a null effect equals 1, with 95% credible intervals (CrIs). This meta-analysis was registered with PROSPERO, CRD42018089697. FINDINGS: From 4229 studies screened, we identified 86 eligible RCTs; 52, with data from over 70 000 patients, were positive, with significantly increased venous thromboembolism risk in patients in control groups versus treatment groups (RR 2·74, 95% CrI 2·32-3·31, p<0·0001). The meta-analysis established that the causal effect of venous thromboembolism prevention on mortality was null (control group mortality was 3391 [9·8%] of 34 537 patients; treatment group mortality was 3498 [9·8%] of 35 795 patients [RR 1·01, 95% CrI 0·97-1·06; p=0·58]) with low heterogeneity (τ 0·02, 95% CrI 0·00-0·07, p=0·89). Patients in control groups had more pulmonary embolism (RR 2·22, 95% CrI 1·78-2·89, p<0·0001) and fatal pulmonary embolism (1·58, 1·14-2·19, p=0·01), but less major bleeding (0·60, 0·47-0·75, p<0·0001) than those in treatment groups. A meta-analysis with the additional 34 negative studies yielded similar results for all endpoints except fatal pulmonary embolism, where evidence of an effect was weaker (1·42, 1·05-1·91, p=0·02). INTERPRETATION: The perception that venous thromboembolism is a common cause of mortality should be revised considering the null effect of venous thromboembolism prevention on mortality. Our findings call into question the use of composite endpoints in venous thromboembolism-prevention trials and provide rationale for de-escalation trials. FUNDING: None.


Assuntos
Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Tromboembolia Venosa/mortalidade , Teorema de Bayes , Humanos , Prognóstico , Fatores de Risco , Taxa de Sobrevida , Tromboembolia Venosa/terapia
7.
Adv Biol Regul ; 77: 100742, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32773103

RESUMO

The rapid onset and worldwide spread of the COVID-19 epidemic (caused by SARS-CoV-2 coronavirus) has been associated with a profound impact in clinical practice also in the hematologic setting. First of all, given the immunosuppressive effect of many therapies that are normally administered to patients with hematological diseases, with a consequent increased risk of contracting a more severe viral infection, it has been necessary to reconsider in each individual patient the urgency and priority of the treatments foreseen by the normal standards of care. In particular, as regards allogeneic (and to a lesser extent autologous) hematopoietic cell transplantation and CAR T-cell therapy, specific recommendations have been issued by the transplant community on the criteria to be used to decide whether or not to postpone these procedures and on the clinical management of recipients and donors exposed to COVID-19. As to cytotoxic chemotherapy and other antineoplastic therapies, criteria have been proposed to decide, in the various clinical situations, which treatments were not deferrable and which instead could be postponed or replaced by less aggressive therapies. In the outpatient clinics, various organizational solutions for telemedicine have been adopted, resorting to telephone interviews and/or Information Technology, with the aim of reducing the influx of patients while maintaining an adequate control of their clinical condition. The collection of blood by the transfusion centers has been the subject of organizational measures, in order to avoid the transmission of COVID 19 while maintaining a sufficient blood collection for clinical needs. Finally, some hematologic laboratory alterations have been identified, such as thrombocytopenia, lymphopenia and coagulation abnormalities, useful for the prognostic evaluation of infected patients.


Assuntos
Anticoagulantes/uso terapêutico , Antineoplásicos/uso terapêutico , Antivirais/uso terapêutico , Infecções por Coronavirus/terapia , Doenças Hematológicas/terapia , Pandemias , Pneumonia Viral/terapia , Tromboembolia Venosa/terapia , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/imunologia , Betacoronavirus/patogenicidade , Transfusão de Sangue/ética , Tomada de Decisão Clínica/ética , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Gerenciamento Clínico , Doenças Hematológicas/epidemiologia , Doenças Hematológicas/imunologia , Doenças Hematológicas/virologia , Transplante de Células-Tronco Hematopoéticas/ética , Humanos , Pacientes Ambulatoriais , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Telemedicina/métodos , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/imunologia , Tromboembolia Venosa/virologia
8.
Med Clin North Am ; 104(4): 631-646, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32505257

RESUMO

"Acute venous thromboembolism is a common disease seen by nearly all hospitalists. The advent of low molecular weight heparin (LMWH) several decades ago ushered in the era of early hospital discharge and home treatment. More recently, the direct oral anticoagulants (DOACs) have further simplified outpatient treatment and some offer treatment without parenteral therapy. Use of DOACs for cancer-associated venous thromboembolism is emerging and is a welcome evolution of care to spare oncologic patients the burden of daily LMWH injections."


Assuntos
Anticoagulantes/uso terapêutico , Tromboembolia Venosa/terapia , Trombose Venosa/terapia , Administração Oral , Anticoagulantes/efeitos adversos , Hemorragia/induzido quimicamente , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Neoplasias/complicações , Embolia Pulmonar/terapia , Medição de Risco , Procedimentos Cirúrgicos Operatórios , Tromboembolia Venosa/etiologia , Trombose Venosa/etiologia , Vitamina K/antagonistas & inibidores
9.
PLoS One ; 15(6): e0234957, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32579570

RESUMO

INTRODUCTION: To summarize and compare the effectiveness of pharmacological thromboprophylaxis to pneumatic compression devices (PCD) for the prevention of venous thromboembolism in patients with acute intracerebral hemorrhage. METHODS: MEDLINE, PUBMED, EMBASE, and CENTRAL were systematically searched to identify randomized and non-randomized studies that compared each intervention directly to each other or against a common control (hydration, anti-platelet agents, stockings) in adults with acute spontaneous intracerebral hemorrhage. Two investigators independently screened the studies, extracted data, and appraised risk of bias. Studies with a high risk of bias were excluded from our final analysis. The primary outcome was the occurrence of venous thromboembolism (proximal deep vein thrombosis or pulmonary embolism) in the first 30 days. RESULTS: 8,739 articles were screened; four articles, all randomized control trials, met eligibility criteria. Bayesian network meta-analysis was performed to calculate risk estimates using both fixed and random effects analyses. 607 patients were included in the network analysis. PCD were associated with a significant decrease in venous thromboembolism compared to control (OR: 0.43, 95% Credible Limits [CrI]: 0.23-0.80). We did not find evidence of statistically significant differences between pharmacological thromboprophylaxis and control (OR: 0.93, 95% CrI: 0.19-4.37) or between PCD and pharmacological thromboprophylaxis (OR: 0.47, 95% CrI: 0.09-2.54). CONCLUSION: PCDs are superior to control interventions, but meaningful comparisons with pharmacotherapy are not possible due to a lack of data. This requires further exploration via large pragmatic clinical trials. TRIAL REGISTRATION: PROSPERO: CRD42018090960.


Assuntos
Hemorragia Cerebral/complicações , Tromboembolia Venosa/prevenção & controle , Humanos , Metanálise em Rede , Viés de Publicação , Risco , Tromboembolia Venosa/terapia
10.
Medicine (Baltimore) ; 99(21): e20127, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481281

RESUMO

BACKGROUND: Venous thromboembolism (VTE) is a serious, sometimes life-threatening complication that can occur following spine surgery. The incidence of VTE, and the optimal type and timing of thromboprophylaxis for this complication in elective spine surgery is a matter of debate. OBJECTIVE: To perform a systematic review with the aim of clarifying the efficacy and adverse effects of mechanical and chemical prophylaxis for preventing thromboembolic complications in elective spine surgery for conditions other than trauma and malignant disease. METHODS/DESIGN: A search strategy of related articles up to March 2018 was designed and executed in Medline and Embase. PATIENTS: adolescents (>10 years) and adults undergoing elective surgery for spinal deformity or degenerative disease (from C1 to S1). INTERVENTION: Perioperative mechanical and chemical thromboprophylaxis. Studies could be randomized controlled trials or observational studies that reported data on any relevant clinical outcomes. RESULTS: In total, 2451 uniquecitations were identified and 35 studies were ultimately included in the systematic review. The overall mean incidence of complications was 3.7% for deep venous thrombosis, 0.0% for pulmonary embolism, and 3.7% for bleeding in chemoprophylaxis group; 2.9% for deep venous thrombosis, 0.4% for pulmonary embolism and 0.0% for bleeding in mechanoprophylaxis; and 0.7% for deep venous thrombosis, 0.1% for pulmonary embolism and 0.2% for bleeding in mixed prophylaxis group with no specific data on these rates for the type of patient and type and location of surgery. None of the articles retrieved provided information on the adolescent population. DISCUSSION AND CONCLUSIONS: The poor design and high variability among the studies regarding characteristics of study population, details of interventions, and definitions of outcomes, determines a low quality of the available evidence and limits the interpretation of the results. We were unable to identify a clear advantage of one type of thromboprophylaxis over the other, although there was an increased risk of bleeding with chemoprophylaxis, which could favor the use of mechanoprophylaxis in this scenario.


Assuntos
Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Coluna Vertebral/cirurgia , Tromboembolia Venosa/prevenção & controle , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Humanos , Metanálise como Assunto , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Revisões Sistemáticas como Assunto , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/terapia
11.
Int J Cardiol ; 313: 129-131, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: covidwho-259358

RESUMO

There is some evidence that Covid 19 pneumonia is associated with prothrombotic status and increased risk of venous thromboembolic events (deep venous thrombosis and pulmonary embolism). Over a two-week period we admitted in our Unit 25 patients with Covid-19 pneumonia, of these pulmonary embolism was diagnosed using computed tomography angiography in 7. We report on clinical and biochemical features of these patients. They were all males, with a mean age of 70.3 years (range 58-84); traditional risk factors for venous thromboembolism were identified in the majority of patients with pulmonary embolism, however not differently from those without pulmonary embolism. Clinical presentation of pulmonary embolism patients was usually characterized by persistence or worsening of respiratory symptoms, with increasing oxygen requirement. D-dimer levels were several fold higher than the upper threshold of normal; in patients in whom PE was recognized during hospital stay, a rapid and relevant increase of D-dimer levels was observed. Computed tomographic findings ranged from massive acute pulmonary embolism to a segmental or sub-segmental pattern; furthermore, thrombosis of sub-segmental pulmonary arteries within lung infiltrates were occasionally seen, suggesting local mechanisms. Six out of 7 patients were treated with unfractionated or low molecular weight heparin with clinical benefit within few days; one patient needed systemic thrombolysis (death from hemorrhagic complication).


Assuntos
Infecções por Coronavirus , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Heparina/administração & dosagem , Pandemias , Pneumonia Viral , Embolia Pulmonar , Tromboembolia Venosa , Idoso , Anticoagulantes/administração & dosagem , Betacoronavirus/isolamento & purificação , Comorbidade , Angiografia por Tomografia Computadorizada/métodos , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Feminino , Humanos , Incidência , Itália/epidemiologia , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Oxigênio/sangue , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etiologia , Embolia Pulmonar/fisiopatologia , Embolia Pulmonar/terapia , Fatores Sexuais , Tromboembolia Venosa/complicações , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/terapia
12.
Int J Cardiol ; 313: 129-131, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32471650

RESUMO

There is some evidence that Covid 19 pneumonia is associated with prothrombotic status and increased risk of venous thromboembolic events (deep venous thrombosis and pulmonary embolism). Over a two-week period we admitted in our Unit 25 patients with Covid-19 pneumonia, of these pulmonary embolism was diagnosed using computed tomography angiography in 7. We report on clinical and biochemical features of these patients. They were all males, with a mean age of 70.3 years (range 58-84); traditional risk factors for venous thromboembolism were identified in the majority of patients with pulmonary embolism, however not differently from those without pulmonary embolism. Clinical presentation of pulmonary embolism patients was usually characterized by persistence or worsening of respiratory symptoms, with increasing oxygen requirement. D-dimer levels were several fold higher than the upper threshold of normal; in patients in whom PE was recognized during hospital stay, a rapid and relevant increase of D-dimer levels was observed. Computed tomographic findings ranged from massive acute pulmonary embolism to a segmental or sub-segmental pattern; furthermore, thrombosis of sub-segmental pulmonary arteries within lung infiltrates were occasionally seen, suggesting local mechanisms. Six out of 7 patients were treated with unfractionated or low molecular weight heparin with clinical benefit within few days; one patient needed systemic thrombolysis (death from hemorrhagic complication).


Assuntos
Infecções por Coronavirus , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Heparina/administração & dosagem , Pandemias , Pneumonia Viral , Embolia Pulmonar , Tromboembolia Venosa , Idoso , Anticoagulantes/administração & dosagem , Betacoronavirus/isolamento & purificação , Comorbidade , Angiografia por Tomografia Computadorizada/métodos , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Feminino , Humanos , Incidência , Itália/epidemiologia , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Oxigênio/sangue , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etiologia , Embolia Pulmonar/fisiopatologia , Embolia Pulmonar/terapia , Fatores Sexuais , Tromboembolia Venosa/complicações , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/terapia
13.
Medicine (Baltimore) ; 99(20): e20114, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443321

RESUMO

INTRODUCTION: Venous thromboembolism (VTE) in children not only imposes a heavy burden on the medical resources and economy of the society, but also seriously affects the growth and development of children, even threaten children's lives. A large number of publications have been performed in this field in recent years. In this bibliometric analysis, publications on VTE in children were examined and analyzed to explain the present research hotspots. METHODS: Articles related to VTE in children published in the PubMed database from 1988 to June 18, 2019 were selected as the research sample. BICOMB software was used to retrieve the annual publications, journals, journal source countries and the high-frequency major medical subject headings (MeSH) terms on the articles. Then, the co-word matrix was constructed by BICOMB using the selected high-frequency MeSH terms. Next, gCLUTO software was used to analyze the matrix by double clustering and visual analysis in a strategy of hotspot identification. In addition, CiteSpace software was used to perform the knowledge map of co-authors to explore the core authors. RESULTS: One thousand seven hundred seventy-nine articles on VTE in children were obtained. Seven hundred ninety academic journals distributed in 58 countries have published articles on VTE in children, and the developed countries and the United States were the major force in the journal source countries. Nowak-Göttl U occupied an important position in this field. We constructed a co-word matrix composing of 37 high-frequency MeSH terms, generated visual matrix and visual hill, and classified the hot-spots into 5 aspects based on 8 categories. CONCLUSION: The results show that the research trend of children's VTE has been increasing gradually, and the sound achievement has been obtained in these hotspots in relation to the area of inherited thrombophilia, prevention and control, treatment, diagnosis, prevalence, risk factors, and complication study. However, there is a lack of communication and cooperation in this field, and the gap of national and regional research results is huge. To sum up, this study provides evidence and guidance for researchers, clinicians, and educators.


Assuntos
Bibliometria , Tromboembolia Venosa , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Comunicação Acadêmica/tendências , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/prevenção & controle , Tromboembolia Venosa/terapia
14.
J Thromb Haemost ; 18(8): 1859-1865, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32459046
16.
Thromb Haemost ; 120(6): 937-948, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-101973

RESUMO

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


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Tromboembolia Venosa/prevenção & controle , Tromboembolia Venosa/terapia , Anticoagulantes/uso terapêutico , Betacoronavirus , Transtornos da Coagulação Sanguínea/tratamento farmacológico , China/epidemiologia , Consenso , Infecções por Coronavirus/sangue , Infecções por Coronavirus/terapia , Estado Terminal , Europa (Continente)/epidemiologia , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hemorragia/prevenção & controle , Humanos , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/terapia , Embolia Pulmonar/complicações , Embolia Pulmonar/prevenção & controle , Sistema de Registros , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Tromboembolia Venosa/complicações , Trombose Venosa/complicações , Trombose Venosa/prevenção & controle
17.
Cochrane Database Syst Rev ; 4: CD013422, 2020 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-32271939

RESUMO

BACKGROUND: The treatment of distal (below the knee) deep vein thrombosis (DVT) is not clearly established. Distal DVT can either be treated with anticoagulation, or monitored with close follow-up to detect progression to the proximal veins (above the knee), which requires anticoagulation. Proponents of this monitoring strategy base their decision to withhold anticoagulation on the fact that progression is rare and most people can be spared from potential bleeding and other adverse effects of anticoagulation. OBJECTIVES: To assess the effects of different treatment interventions for people with distal (below the knee) deep vein thrombosis (DVT). SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 12 February 2019. We also undertook reference checking to identify additional studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) for the treatment of distal DVT. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials and extracted data. We resolved disagreements by discussion. Primary outcomes of interest were recurrence of venous thromboembolism (VTE), DVT and major bleeding and follow up ranged from three months to two years. We performed fixed-effect model meta-analyses with risk ratio (RRs) and 95% confidence intervals (CIs). We assessed the certainty of the evidence using GRADE. MAIN RESULTS: We identified eight RCTs reporting on 1239 participants. Five trials randomised participants to anticoagulation for up to three months versus no anticoagulation. Three trials compared anticoagulation treatment for different time periods. Anticoagulant compared to no intervention or placebo for distal DVT treatment Anticoagulation with a vitamin K antagonist (VKA) reduced the risk of recurrent VTE during follow-up compared with participants receiving no anticoagulation (RR 0.34, 95% CI 0.15 to 0.77; 5 studies, 496 participants; I2 = 3%; high-certainty evidence), and reduced the risk of recurrence of DVT (RR 0.25, 95% CI 0.10 to 0.67; 5 studies, 496 participants; I2 = 0%; high-certainty evidence). There was no clear effect on risk of pulmonary embolism (PE) (RR 0.81, 95% CI 0.18 to 3.59; 4 studies, 480 participants; I2 = 0%; low-certainty evidence). There was little to no difference in major bleeding with anticoagulation compared to placebo (RR 0.76, 95% CI 0.13 to 4.62; 4 studies, 480 participants; I2 = 26%; low-certainty evidence). There was an increase in clinically relevant non-major bleeding events in the group treated with anticoagulants (RR 3.34, 95% CI 1.07 to 10.46; 2 studies, 322 participants; I2 = 0%; high-certainty evidence). There was one death, not related to PE or major bleeding, in the anticoagulation group. Anticoagulation for three months or more compared to anticoagulation for six weeks for distal DVT treatment Three RCTs of 736 participants compared three or more months of anticoagulation with six weeks of anticoagulation. Anticoagulation with a VKA for three months or more reduced the incidence of recurrent VTE to 5.8% compared with 13.9% in participants treated for six weeks (RR 0.42, 95% CI 0.26 to 0.68; 3 studies, 736 participants; I2 = 50%; high-certainty evidence). The risk for recurrence of DVT was also reduced (RR 0.32, 95% CI 0.16 to 0.64; 2 studies, 389 participants; I2 = 48%; high-certainty evidence), but there was probably little or no difference in PE (RR 1.05, 95% CI 0.19 to 5.88; 2 studies, 389 participants; I2 = 0%; low-certainty evidence). There was no clear difference in major bleeding events (RR 3.42, 95% CI 0.36 to 32.35; 2 studies, 389 participants; I2 = 0%; low-certainty evidence) or clinically relevant non-major bleeding events (RR 1.76, 95% CI 0.90 to 3.42; 2 studies, 389 participants; I2 = 1%; low-certainty evidence) between three months or more of treatment and six weeks of treatment. There were no reports for overall mortality or PE and major bleeding-related deaths. AUTHORS' CONCLUSIONS: Our review found a benefit for people with distal DVT treated with anticoagulation therapy using VKA with little or no difference in major bleeding events although there was an increase in clinically relevant non-major bleeding when compared to no intervention or placebo. The small number of participants in this meta-analysis and strength of evidence prompts a call for more research regarding the treatment of distal DVT. RCTs comparing different treatments and different treatment periods with placebo or compression therapy, are required.


Assuntos
Anticoagulantes/uso terapêutico , Perna (Membro)/irrigação sanguínea , Tromboembolia Venosa/terapia , Anticoagulantes/efeitos adversos , Esquema de Medicação , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Humanos , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Prevenção Secundária , Fatores de Tempo , Tromboembolia Venosa/complicações
18.
Thromb Haemost ; 120(6): 937-948, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32316065

RESUMO

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


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Tromboembolia Venosa/prevenção & controle , Tromboembolia Venosa/terapia , Anticoagulantes/uso terapêutico , Betacoronavirus , Transtornos da Coagulação Sanguínea/tratamento farmacológico , China/epidemiologia , Consenso , Infecções por Coronavirus/sangue , Infecções por Coronavirus/terapia , Estado Terminal , Europa (Continente)/epidemiologia , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hemorragia/prevenção & controle , Humanos , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/terapia , Embolia Pulmonar/complicações , Embolia Pulmonar/prevenção & controle , Sistema de Registros , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Tromboembolia Venosa/complicações , Trombose Venosa/complicações , Trombose Venosa/prevenção & controle
19.
PLoS One ; 15(4): e0230859, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32282801

RESUMO

A recent study found that approximately 1 in every 6 patients hospitalized for the 1st episode of syncope had an underlying pulmonary embolism (PE). As current guidelines do not strongly emphasize evaluation for PE in the workup of syncope, we hypothesize that there might be a higher rate of 30-day readmission due to untreated venous thromboembolism (VTE). The objective of this study is to measure the 30-day readmission rate due to VTE and identify predictors of 30-day readmission with VTE among syncope patients. We identified patients admitted with syncope with ICD9 diagnoses code 780.2 in the Nationwide Readmission Database (NRD-2013), Healthcare Cost and Utilization Project (HCUP). The 30-day readmission rate was calculated using methods described by HCUP. Logistic-regression was used to identify predictors of 30-day readmission with VTE. Discharge weights provided by HCUP were used to generate national estimates. In 2013, NRD included 207,339 eligible patients admitted with syncope. The prevalence rates of PE and DVT were 1.1% and 1.4%, respectively. At least one syncope associated condition was present in 60.9% of the patients. Among the patients who were not diagnosed with VTE during index admission for syncope (N = 188,015), 30-day readmission rate with VTE was 0.5% (0.2% with PE and 0.4% with DVT). In conclusion, low prevalence of VTE in patients with syncope and extremely low 30-day readmission rate with VTE argues against missed diagnoses of VTE in index admission for syncope. These results warrant further studies to determine clinical impact of work up for PE in syncope patients without risk factors.


Assuntos
Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Síncope/complicações , Tromboembolia Venosa/complicações , Tromboembolia Venosa/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
20.
J Card Surg ; 35(3): 609-611, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32017181

RESUMO

BACKGROUND: Cancer inducing a hypercoagulable state, venous thromboembolism (VTE) remains a leading cause of morbidity and mortality globally. We assessed the impacts of cancer on the likelihood for readmission after a VTE-targeted procedure. METHODS: We created a new cohort using discharge-level data from all hospitalizations from State Inpatient Databases of geographically dispersed participating states (18-27 states). RESULTS: In those presenting with VTE during index-admission (619 241), 2.4% patients underwent catheter directed thrombolytic therapy (CDL) on index admission and among those 20.3% had cancer. Moreover, the 30-day readmission rate amongst CDL recipients (10 776 overall) was 14.3% in those with cancer compared to 8.8% in those with no cancer history (P < .0001). Additionally, in-hospital mortality (5.7% vs 1.1%; P = 0.009) and cost-of-care ($11 014 ± 914 vs $10 520 ± 534; P = .04) was significantly higher in cancer compared to noncancer. CONCLUSION: The use of CDL does not appear to reduce the risk of returning for a VTE-related admission in cancer.


Assuntos
Mortalidade Hospitalar , Trombólise Mecânica/efeitos adversos , Trombólise Mecânica/métodos , Neoplasias/complicações , Readmissão do Paciente/estatística & dados numéricos , Tromboembolia Venosa/mortalidade , Tromboembolia Venosa/terapia , Cateteres , Estudos de Coortes , Custos e Análise de Custo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Tromboembolia Venosa/economia
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