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1.
Vasc Health Risk Manag ; 15: 253-258, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31496715

RESUMO

Antiphospholipid syndrome (APS) is an autoantibody-mediated acquired thrombophilia characterized by venous and/or arterial thromboses, pregnancy morbidity (predominantly repeated fetal losses), and the presence of phospholipid antibodies. The estimated annual incidence of APS is 5 new cases per 100,000 people. The most common thrombotic events in patients with APS in order of frequency are stroke, transient ischemic attack, deep vein thrombosis, and pulmonary embolism. Patients with APS may develop an intracardiac thrombus, which is a life-threatening complication with a high risk of increased morbidity and mortality; however, it is treatable by surgical removal, extensive anticoagulant administration, and prevention of other complications. Catastrophic APS, which is a rare and severe condition diagnosed based on rapidly progressive thromboembolic events involving three or more organs, systems, or tissues, occurs in less than 1% of all patients with APS. We herein report an autopsy case of catastrophic APS in a 12-year-old Thai boy with multiple thromboembolic events including intracardiac thrombus formation with a positive lupus anticoagulant test result. To the best of our knowledge, this is the youngest reported patient with APS to date.


Assuntos
Síndrome Antifosfolipídica/complicações , Cardiopatias/etiologia , Tromboembolia/etiologia , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/terapia , Autopsia , Biomarcadores/sangue , Doença Catastrófica , Criança , Evolução Fatal , Cardiopatias/sangue , Cardiopatias/diagnóstico , Cardiopatias/terapia , Humanos , Inibidor de Coagulação do Lúpus/sangue , Masculino , Tromboembolia/sangue , Tromboembolia/diagnóstico , Tromboembolia/terapia
2.
Ann Hematol ; 98(10): 2273-2281, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31256219

RESUMO

Although renal dysfunction at the time of diagnosis of paroxysmal nocturnal hemoglobinuria (PNH) is a risk factor for mortality, subsequent renal events can occur. The objective of this study was to identify clinical implication of renal dysfunction occurring during the disease course in PNH patients. One hundred one patients with a granulocyte clone size of > 10% were enrolled. Renal events were observed in 55 (54.5%) patients during a median follow-up of 94.2 months. Median time to first renal event from diagnosis of PNH was 79.3 months. Thromboembolism (TE) event and recurrent TE events were observed in 25 (24.8%) and 8 (7.9%) patients, respectively. The rate of recurrent TE was significantly higher in patients with renal events ≥ 2 compared with that in patients with renal event ≤ 1 (18.8% vs. 2.9%; P = 0.012). The rate of recurrent TE was significantly higher in patients with chronic kidney disease (CKD) + acute kidney disease (AKD) compared with the rest of the patients (27.3% vs. 5.6%; P = 0.040). CKD+AKD was the only independent risk factor for OS in multivariate analysis (hazard ratio 7.95, 95% CI 1.24-51.15, P = 0.029). Therefore, close monitoring of renal events in PNH patients during the entire clinical course is essential.


Assuntos
Lesão Renal Aguda , Hemoglobinúria Paroxística , Insuficiência Renal Crônica , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Seguimentos , Hemoglobinúria Paroxística/complicações , Hemoglobinúria Paroxística/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia , Tromboembolia/epidemiologia , Tromboembolia/etiologia
3.
Khirurgiia (Mosk) ; (7): 52-57, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31355815

RESUMO

OBJECTIVE: To compare incidence of thromboembolic and hemorrhagic complications in patients with atrial fibrillation (AF) undergoing elective surgery on different schemes of perioperative anticoagulant therapy (ACT). MATERIAL AND METHODS: There were 86 patients (56 (65.1%) men and 30 (34.9%) women, mean age was 69 (64; 78) years) with non-valvular AF who underwent elective interventions. Forty (46.5%) patients underwent abdominal surgery, 34 (39.5%) - cardiovascular procedures, 12 (14.0%) patients underwent surgery for malignant diseases. We have analyzed incidence of thromboembolic and hemorrhagic events and compliance of perioperative ACT modes with current international guidelines. RESULTS: Thromboembolic and hemorrhagic events developed in 14 (16.3%) patients. Thromboembolic complications were noted in 6 (7.0%) patients, hemorrhagic events - in 8 (9.3%) cases. Maximum complication rate was observed in case of bridge-therapy (n=12, 20.0%). Cancellation of ACT was followed by 2 (9.5%) complications, bridge-therapy - by 4 (6.7%) thromboembolic complications. Hemorrhagic events were 2 times more common in case of this therapy (n=8, 13.3%). It was found that ESC guidelines for perioperative ACT were applied in less than half of patients (41, 47.7% patients with AF undergoing elective surgery). Half of complications (8 out of 16) occurred if unapproved modes of ACT were used (including 7 cases of bridge-therapy was not necessary). The causes of these complications were inadequate assessment of perioperative risk of thromboembolic and hemorrhagic events; unreasonable administration of bridge therapy. CONCLUSION: An unambiguous clinical effect of bridge therapy has not been confirmed in patients with high risk of thromboembolic complications. Cancer patients have higher risk of complications compared with others. These events occur mainly due to non-compliance with clinical guidelines and insufficient prevention of thromboembolic events.


Assuntos
Anticoagulantes/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Hemorragia/prevenção & controle , Tromboembolia/prevenção & controle , Idoso , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Feminino , Fidelidade a Diretrizes , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tromboembolia/etiologia
4.
Ceska Gynekol ; 84(3): 229-232, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31324115

RESUMO

OBJECTIVE: Summary of available literature concerning recommendation of antithrombotic prophylaxis in the infertility treatment by in vitro fertilization (IVF) and in pregnancies after IVF. DESIGN: Review article. SETTINGS: Department of Obstetrics and Gynecology, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký University Olomouc; Institute of Medical Genetics, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký University Olomouc. METHODS: Analysis of literary sources and databases Medline, Web of Science, Scholar Google, 2010-2018. CONCLUSION: The incidence of thromboembolism in the first trimester of pregnancy after IVF is 0.2% e. g. 10-times higher compared to normal pregnant population. Pregnancies after IVF are complicated in 6-7% by ovarian hyperstimulation syndrome (OHSS), they then have the risk of venous thromboembolism (VTE) 1.7% in the first trimester, what is 100-times higher as compared to the general population. Women after IVF without OHSS have a 5-times higher risk of VTE compared to the general population. To lower the risk of thromboembolism during treatment, use of low dose gonadotrophin (mild) stimulation protocols, prioritization of antagonistic stimulation protocols, avoidance of OHSS using GnRH agonists instead of hCG, cryo embryotransfer in natural cycles, reduction of incidence of multiple pregnancy by single embryo transfer, use of prophylactic and therapeutic low molecular weight heparin (LMWH) is recommended. These strategies can reduce the risk of thromboembolism. The LMWH application is suitable in pregnant women in the first trimester of pregnancy after IVF where OHSS was present.


Assuntos
Fertilização In Vitro/efeitos adversos , Fibrinolíticos/administração & dosagem , Heparina de Baixo Peso Molecular/administração & dosagem , Síndrome de Hiperestimulação Ovariana/complicações , Complicações Hematológicas na Gravidez/etiologia , Tromboembolia/prevenção & controle , Transferência Embrionária , Feminino , Humanos , Indução da Ovulação , Gravidez , Complicações Hematológicas na Gravidez/tratamento farmacológico , Taxa de Gravidez , Tromboembolia/tratamento farmacológico , Tromboembolia/etiologia
6.
Blood Coagul Fibrinolysis ; 30(4): 149-155, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31090597

RESUMO

OBJECTIVES: Thromboembolism is one of the most common complications during induction therapy of pediatric acute lymphoblastic leukemia (ALL). Procoagulant microparticles in the circulation may cause thromboembolic events. The aim of our study was to determine the levels of apoptotic, platelet-derived, endothelial-derived, and tissue factor-positive microparticles of children with ALL at diagnosis and during induction therapy. METHODS: Sixteen precursor B-cell ALL cases and 30 healthy children between 1 and 18 years of age were included. Microparticle levels were analyzed from peripheral blood samples at initial diagnosis, on days 12 and 13 (before and after the first L-asparaginase administration), and on day 33 of ALL-BFM 2000 treatment protocol. Microparticle levels were analyzed by using flow cytometry. RESULTS: At initial diagnosis, platelet, endothelial-derived, and tissue factor-positive microparticle levels were significantly high in children with ALL. They increased significantly after prednisone and L-asparaginase administration. Apoptotic microparticle levels were not elevated at diagnosis, but remained high during all induction therapy period. None of the patients had evidence of thromboembolism during induction therapy. CONCLUSION: Our study demonstrated that children with ALL have increased levels of apoptotic, platelet-derived, endothelial-derived, and tissue factor-positive microprticles during induction therapy. Further studies are needed in larger groups of patients in order to evaluate the risk of elevated microprticles for development of thromboembolism during induction therapy period in children with ALL.


Assuntos
Micropartículas Derivadas de Células/química , Micropartículas Derivadas de Células/patologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia , Indução de Remissão/métodos , Adolescente , Apoptose , Asparaginase/administração & dosagem , Plaquetas , Criança , Pré-Escolar , Células Endoteliais , Feminino , Humanos , Lactente , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Prednisona/administração & dosagem , Tromboembolia/etiologia , Tromboplastina
7.
Semin Thromb Hemost ; 45(4): 354-372, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31108555

RESUMO

The relationship between malignancy and coagulopathy is one that is well documented yet incompletely understood. Clinicians have attempted to quantify the hypercoagulable state produced in various malignancies using common coagulation tests such as prothrombin time, activated partial thromboplastin time, and platelet count; however, due to these tests' focus on individual aspects of coagulation during one specific time point, they have failed to provide clinicians the complete picture of malignancy-associated coagulopathy (MAC). Viscoelastic tests (VETs), such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM), are whole blood analyses that have the advantage of providing information related to the cumulative effects of plasma clotting factors, platelets, leukocytes, and red cells during all stages of the coagulation and fibrinolytic processes. VETs have gained popularity in the care of trauma patients to objectively measure trauma-induced coagulopathy (TIC), but the utility of VETs remains yet unrealized in many other medical specialties. The authors discuss the similarities and differences between TIC and MAC, and propose a mechanism for the hypercoagulable state of MAC that revolves around the thrombomodulin-thrombin complex as it switches between activating the protein C anticoagulation pathway or the thrombin activatable fibrinolysis inhibitor coagulation pathway. Additionally, they review the current literature on the use of TEG and ROTEM in patients with various malignancies. Although limited research is currently available, early results demonstrate the utility of both TEG and ROTEM in the prediction of hypercoagulable states and thromboembolic complications in oncologic patients.


Assuntos
Transtornos da Coagulação Sanguínea/diagnóstico , Testes de Coagulação Sanguínea/métodos , Neoplasias/complicações , Trombose/diagnóstico , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/complicações , Humanos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Tromboelastografia/métodos , Tromboembolia/sangue , Tromboembolia/diagnóstico , Tromboembolia/etiologia , Trombose/sangue , Trombose/complicações
8.
J Stroke Cerebrovasc Dis ; 28(7): e92-e94, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31097325

RESUMO

Amaurosis fugax (AmF) is defined as transient monocular visual loss secondary to retinal ischemia. In most patients presenting with AmF, the attack of visual loss occurs in the same eye. A 64-year-old woman experienced transient visual loss in her right eye. Three days after that, an attack happened on the left side. In total, she had 5 episodes of AmF in 2 months. AmF occurred on both sides at different times, and so may be referred to as "Alternating AmF". Diffusion-weighted magnetic resonance imaging showed high-intensity lesions in various parts of brain, and laboratory examination revealed elevated D-dimer and ovarian tumor marker. We suspected Trousseau syndrome and found a giant ovary tumor. After removal of the tumor, no recurrence was observed. When a patient with alternating AmF is encountered, screening for malignancy is essential.


Assuntos
Adenocarcinoma de Células Claras/complicações , Amaurose Fugaz/etiologia , Neoplasias Ovarianas/complicações , Tromboembolia/etiologia , Trombofilia/etiologia , Adenocarcinoma de Células Claras/sangue , Adenocarcinoma de Células Claras/diagnóstico , Adenocarcinoma de Células Claras/terapia , Amaurose Fugaz/diagnóstico por imagem , Biomarcadores Tumorais/sangue , Coagulação Sanguínea , Angiografia Cerebral/métodos , Imagem de Difusão por Ressonância Magnética , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias Ovarianas/sangue , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/terapia , Recidiva , Síndrome , Tromboembolia/sangue , Tromboembolia/diagnóstico por imagem , Trombofilia/sangue , Trombofilia/diagnóstico , Resultado do Tratamento
10.
Acta Haematol ; 141(4): 245-253, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30965330

RESUMO

BACKGROUND: The incidence of venous thromboembolism (VTE) in haematological malignancies varies according to the type and grade of the disease and clinical variables, and there is a need to develop a tool to predict the occurrence of VTE in cancer patients at diagnosis to tailor prophylactic anticoagulation use during treatment. OBJECTIVE: To study the incidence of VTE in haematological malignancies and clarify whether vascular and inflammatory biomarkers could be used as predictors of VTE in those patients. METHODS: This was a prospective observational cohort study. Hypercoagulability and inflammatory biomarkers were assayed in a group of 171 patients with haematological malignancies at diagnosis. These markers included (1) coagulation and fibrinolysis activation markers (D-dimer, fibrinogen, antithrombin, plasminogen activator inhibitor 1), (2) endothelial and platelet activation markers (von Willebrand factor and soluble P-selectin), and (3) inflammatory markers (tumour necrosis factor αand interleukin 6). The end point was mortality or symptomatic VTE. RESULTS/CONCLUSION: The incidence of symptomatic VTE was 7%. None of the tested biomarkers showed statistical significance as predictors for the occurrence of VTE in haematological malignancies. However, there were statistically significant associations between the occurrence of VTE and central venous access device insertion, the prothrombin time, and the erythrocyte sedimentation rate. An ESR above 106.5 mm/h is associated with increased VTE occurrence.


Assuntos
Fibrinólise , Neoplasias Hematológicas/sangue , Ativação Plaquetária , Tromboembolia/sangue , Biomarcadores/sangue , Feminino , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/epidemiologia , Humanos , Incidência , Inflamação/sangue , Inflamação/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tromboembolia/epidemiologia , Tromboembolia/etiologia
11.
J Cancer Res Ther ; 15(2): 305-311, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30964102

RESUMO

Background: Hepatocellular carcinoma (HCC) with tumor thrombus extending to the inferior vena cava (IVC) and right atrium (RA) is rare, which is generally associated with serial syndromes and poor prognosis. The results of earlier observations revealed that the median survival was 1-5 months after diagnosis for untreated patients. The prognosis was poor with surgery, radiotherapy, transarterial chemoembolization (TACE), and chemotherapy. Methods: A total of 1850 patients received TACE for advanced HCC at our institution from October 2011 to September 2016. Among them, 18 cases presented tumor thrombus extended from hepatic vein to IVC and RA. TACE was performed to deal with the tumor thrombus inside the RA, and angiography was performed for characterizing. The successful rate, survival, safety, and clinical adverse events were retrospectively studied. Results: A total of 56 interventional procedures were conducted for the 18 cases of tumor thrombus extending to IVC and RA. TACE were successfully performed in all patients without significant complications. One case died of pneumonia, and no severe adverse effect was observed in the other 17 cases. The 1- and 3-year overall survival rates were 50% and 16.7%, respectively. The average survival from diagnosis of right atrial tumor thrombus (RATT) was 15.2 months. The blood supply was rich for all RATT. There were seven cases with single-feeding artery and 11 cases with two or three feeding arteries that originated from intra- or extra-hepatic arteries. The extrahepatic artery played a critical role in the blood supply of RATT, including right inferior phrenic artery (8/18), left inferior phrenic artery (1/18), and the left gastric artery (2/18). Conclusion: For HCC with tumor thrombus in the IVC and RA, TACE could safely improve the prognosis of these patients. Searching for multiple feeding arteries are essential for ensuring efficacy. In addition, careful examination and appropriate embolization technique are essential for safety and efficacy. Lipiodol was a safe and ideal agent for the embolization in RATT.


Assuntos
Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Átrios do Coração/patologia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/terapia , Tromboembolia/diagnóstico , Tromboembolia/etiologia , Adulto , Idoso , Angiografia/métodos , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/mortalidade , Quimioembolização Terapêutica/métodos , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Tromboembolia/mortalidade , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
12.
Blood Rev ; 35: 59-67, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30928168

RESUMO

An increasing body of evidence suggests an association between cancer and atrial fibrillation (AF). The exact magnitude and underlying mechanism of this association are however unclear. Cancer-related inflammation, anti-cancer treatment and other cancer-related comorbidities are proposed to affect atrial remodelling, increasing the susceptibility of cancer patients for developing AF. Moreover, cancer is assumed to modify the risk of thromboembolisms and bleeding. A thorough and adequate understanding of these risks is however lacking, as current literature is scarce and show ambiguous results in AF patients. The standardized risk-models that normally aid the clinician in the decision of initiating anticoagulant therapy do not take the presence of malignancy into account. Other factors that complicate risk assessment in AF patients with cancer include drug-drug interactions and other cancer-related comorbidities such as renal impairment. In this review, we highlight the available literature regarding epidemiological association, risk assessment and anticoagulation therapy in AF patients with cancer.


Assuntos
Fibrilação Atrial/etiologia , Neoplasias/complicações , Animais , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Hemorragia/tratamento farmacológico , Hemorragia/etiologia , Humanos , Morbidade , Mortalidade , Neoplasias/sangue , Neoplasias/epidemiologia , Medição de Risco , Fatores de Risco , Tromboembolia/epidemiologia , Tromboembolia/etiologia , Trombofilia
14.
APMIS ; 127(7): 515-528, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31009118

RESUMO

The aim of this study was to examine the changes in hemostasis parameters in endocarditis and thromboembolic events in nonfatal methicillin-sensitive Staphylococcus aureus bacteremia (MS-SAB) - a topic not evaluated previously. In total, 155 patients were recruited and were categorized according to the presence of endocarditis or thromboembolic events with gender-age adjusted controls. Patients who deceased within 90 days or patients not chosen as controls were excluded. SAB management was supervised by an infectious disease specialist. Patients with endocarditis (N = 21), compared to controls (N = 21), presented lower antithrombin III at day 4 (p < 0.05), elevated antithrombin III at day 90 (p < 0.01), prolonged activated partial thromboplastin time at days 4 and 10 (p < 0.05), and enhanced thrombin-antithrombin complex at day 4 (p < 0.01). Thromboembolic events (N = 8), compared to controls (N = 34), significantly increased thrombin-antithrombin complex at day 4 (p < 0.05). In receiver operating characteristic analysis, the changes in these hemostasis parameters at day 4 predicted endocarditis and thromboembolic events (p < 0.05). No differences in hemoglobin, thrombocyte, prothrombin fragment, thrombin time, factor VIII, D-dimer or fibrinogen levels were observed between cases and controls. The results suggest that nonfatal MS-SAB patients present marginal hemostasis parameter changes that, however, may have predictability for endocarditis or thromboembolic events. Larger studies are needed to further assess the connection of hemostasis to complications in SAB.


Assuntos
Bacteriemia/complicações , Endocardite Bacteriana/etiologia , Hemostasia/fisiologia , Infecções Estafilocócicas/complicações , Tromboembolia/etiologia , Antitrombina III/metabolismo , Bacteriemia/metabolismo , Plaquetas/metabolismo , Plaquetas/fisiologia , Fator VIII/metabolismo , Feminino , Hemoglobinas/metabolismo , Humanos , Masculino , Meticilina/farmacologia , Pessoa de Meia-Idade , Fragmentos de Peptídeos/metabolismo , Peptídeo Hidrolases/metabolismo , Estudos Prospectivos , Infecções Estafilocócicas/metabolismo , Staphylococcus aureus/patogenicidade , Tempo de Trombina/métodos , Tromboembolia/metabolismo
15.
J Stroke Cerebrovasc Dis ; 28(6): e64-e65, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30935806

RESUMO

Ischaemic stroke secondary to isolated internal carotid artery thrombus without risk factors is uncommon. A 55-year-old woman presented to the acute stroke unit with acute right middle cerebral artery territory infarction secondary to right internal carotid artery occlusion. There were no risk factors for cerebrovascular disease, but mediastinal imaging showed the presence of a large retrosternal goitre which was displacing the mediastinal structures including the brachiocephalic and common carotid artery. Intraluminal thrombus is visible in the displaced innominate artery and is the underlying cause for the stroke in our patient. This case highlights the importance of appropriate imaging of the mediastinum in cases with thyroid goitre.


Assuntos
Artéria Carótida Interna , Estenose das Carótidas/etiologia , Bócio/complicações , Infarto da Artéria Cerebral Média/etiologia , Tromboembolia/etiologia , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/terapia , Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada , Tratamento Conservador , Feminino , Bócio/diagnóstico por imagem , Bócio/terapia , Humanos , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/terapia , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/administração & dosagem , Tromboembolia/diagnóstico por imagem , Tromboembolia/terapia , Resultado do Tratamento
16.
Medicine (Baltimore) ; 98(8): e14549, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813164

RESUMO

The risk of thromboembolism in patients with CHA2DS2-VASc score of 0 to 1 was low, and the anticoagulant therapy was not recommended. Although the CHA2DS2-VASc score was low, there were still many patients suffered from thrombotic events and stroke. We aim to investigate the risk factors of thrombotic events in nonvalvular atrial fibrillation (NVAF) patients with low CHA2DS2-VASc score.We retrospectively enrolled 595 consecutive NVAF patients with low CHA2DS2-VASc score (male: CHA2DS2-VASc = 0, female: CHA2DS2-VASc = 1). The general clinical data, blood biochemical data, and echocardiography results of the 595 patients were collected. Multivariate logistic regression models were used to evaluate risk factors of thrombosis. Receiver operating characteristic curve was used to identify the optimal cut-off value of the independent risk factors. A P value of <.05 (2-sided) was considered to be statistically significant.In multivariate analysis, lipoprotein (a) (Lp(a)) plasma level and left atrium diameter (LAD) were positively related to thromboembolism in NVAF patients with CHA2DS2-VASc score of 0 to 1 after adjustment for age, gender, and other variables (odds ratio [OR] = 1.02, 95% confidence interval [CI]: 1.01-1.03; OR = 1.13, 95% CI: 1.06-1.18). Lp(a) exerted a significant predictive value with area under the curve (AUC) of 0.62 (95% CI: 0.55-0.68, P < .01). The optimal cut-off value for Lp(a) predicting thrombotic events was 27.2 mg/dL (sensitivity 45.7%, specificity 73.4%). LAD showed a significant predictive value with AUC of 0.71 (95% CI: 0.64-0.78, P < .01). The optimal cut-off point for LAD predicting thrombotic events was 43.5 mm (sensitivity 47.1%, specificity 85.8%).High Lp(a) plasma level and left atrial dilatation might be independent risk factors of thrombotic events for NVAF patients with low CHA2DS2-VASc score.


Assuntos
Fibrilação Atrial/complicações , Medição de Risco/métodos , Tromboembolia/etiologia , Idoso , Área Sob a Curva , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Fatores de Risco
17.
Ann Hematol ; 98(5): 1071-1082, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30848334

RESUMO

Thromboembolic events and cardiovascular disease are the most prevalent complications in patients with polycythemia vera (PV) compared with other myeloproliferative disorders and are the major cause of morbidity and mortality in this population. Moreover, a vascular complication such as arterial or venous thrombosis often leads to the diagnosis of PV. The highest rates of thrombosis typically occur shortly before or at diagnosis and decrease over time, probably due to the effects of treatment. Important risk factors include age (≥ 60 years old) and a history of thrombosis; elevated hematocrit and leukocytosis are also associated with an increased risk of thrombosis. The goal of therapy is to reduce the risk of thrombosis by controlling hematocrit to < 45%, a target associated with reduced rates of cardiovascular death and major thrombosis. Low-risk patients (< 60 years old with no history of thrombosis) are managed with phlebotomy and low-dose aspirin, whereas high-risk patients (≥ 60 years old and/or with a history of thrombosis) should be treated with cytoreductive agents. Interferon and ruxolitinib are considered second-line therapies for patients who are intolerant of or have an inadequate response to hydroxyurea, which is typically used as first-line therapy. In this review, we discuss factors associated with thrombosis and recent data on current treatments, including anticoagulation, highlighting the need for more controlled studies to determine the most effective cytoreductive therapies for reducing the risk of thrombosis in patients with PV.


Assuntos
Policitemia Vera , Tromboembolia , Fatores Etários , Anticoagulantes/uso terapêutico , Aspirina/uso terapêutico , Humanos , Hidroxiureia/efeitos adversos , Hidroxiureia/uso terapêutico , Interferons/uso terapêutico , Flebotomia , Policitemia Vera/complicações , Policitemia Vera/diagnóstico , Policitemia Vera/terapia , Pirazóis/uso terapêutico , Fatores de Risco , Tromboembolia/diagnóstico , Tromboembolia/etiologia , Tromboembolia/terapia , Trombose/diagnóstico , Trombose/etiologia , Trombose/terapia
18.
Medicine (Baltimore) ; 98(11): e14833, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30882670

RESUMO

Although the new oral P2Y12 inhibitors, prasugrel/ticagrelor have shown greater efficacy than clopidogrel in patients with the acute coronary syndrome, but they have not shown better efficacy in Korean patients. So we evaluated the efficacy of the prasugrel/ticagrelor in patients with myocardial infarction (MI) and diabetes, a more high-risk patients group.From the Korea Acute Myocardial Infarction Registry-National Institute of Health, 3985 patients with MI and diabetes who underwent PCI were enrolled between November 2011 and December 2015. The patients were divided into 2 groups: clopidogrel (n = 2985) and prasugrel/ticagrelor (n = 1000).After propensity score matching, prasugrel/ticagrelor group showed a no significant difference in risk of the composite of cardiac death (CD), recurrent MI or stroke (hazard ratio [HR], 0.705; 95% confidence interval [CI], 0.474-1.048; P = .084). However, the risk of major bleeding was significantly higher in the prasugrel/ticagrelor group. (HR; 2.114, 95% CI; [1.027-4.353], P = .042). In subgroup analysis, major bleeding was significantly increased in the subgroup of creatinine clearance <60 ml/min/1.73 m, hypertension, underwent a trans-femoral approach and diagnosed as NSTEMI among the prasugrel/ticagrelor group.The use of prasugrel/ticagrelor did not improve the composite of CD, recurrent MI or stroke, however, significantly increased major bleeding events in Korean patients with MI and diabetes undergoing PCI.


Assuntos
Clopidogrel , Diabetes Mellitus , Infarto do Miocárdio , Intervenção Coronária Percutânea , Complicações Pós-Operatórias/prevenção & controle , Cloridrato de Prasugrel , Tromboembolia , Ticagrelor , Idoso , Clopidogrel/administração & dosagem , Clopidogrel/efeitos adversos , Estudos de Coortes , Comorbidade , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Avaliação de Processos e Resultados (Cuidados de Saúde) , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Inibidores da Agregação de Plaquetas/administração & dosagem , Inibidores da Agregação de Plaquetas/efeitos adversos , Período Pós-Operatório , Cloridrato de Prasugrel/administração & dosagem , Cloridrato de Prasugrel/efeitos adversos , República da Coreia/epidemiologia , Tromboembolia/etiologia , Tromboembolia/prevenção & controle , Ticagrelor/administração & dosagem , Ticagrelor/efeitos adversos
20.
Presse Med ; 48(3 Pt 2): e175-e185, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30878334

RESUMO

Palliative and supportive care holds a major place in pancreatic ductal adenocarcinoma (PDAC) management. It aims to prevent and reduce symptoms and hospital admissions, while ensuring optimal health-related quality of life (HRQoL), which has been reported to be correlated with overall survival in PDAC. Best supportive care includes non-specific treatment of pain, anxiety and depression, chemotherapy-related toxicities, as well as thromboembolic disease treatment and prevention in high-risk patients. Moreover, nutrition and physical activity interventions are receiving increasing attention as they are crucial to optimize treatment tolerance and efficacy. Of note, they require adaptation to the specificities of PDAC setting and stage of the disease. In this review, we propose an overview of palliative and supportive care interventions in PDAC, with a highlight on nutritional and physical activity management.


Assuntos
Carcinoma Ductal Pancreático/complicações , Carcinoma Ductal Pancreático/psicologia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/psicologia , Ansiedade/etiologia , Ansiedade/terapia , Caquexia/etiologia , Caquexia/terapia , Dor do Câncer/terapia , Depressão/etiologia , Depressão/terapia , Exercício , Humanos , Desnutrição/etiologia , Desnutrição/terapia , Apoio Nutricional , Cuidados Paliativos , Assistência Perioperatória , Tromboembolia/etiologia , Tromboembolia/terapia
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