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1.
Int Heart J ; 61(5): 905-912, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921660

RESUMO

There is little data on management and outcomes of atrial fibrillation (AF) patients on direct oral anticoagulants (DOAC) undergoing general surgery.We retrospectively assessed 98 surgeries in 85 nonvalvular AF patients aged 73 ± 8 (59 men) receiving DOACs. Cardiac, emergency, and minimally invasive surgeries were excluded.The CHA2DS2-VASc score ranged from 0 to 8. The DOACs being given were: dabigatran, 16; rivaroxaban, 25; apixaban, 28; and edoxaban, 16. While the DOACs were not suspended in 11 cases, they were interrupted for a median of 2.0 days before surgery and restarted at a median of 3.0 days after surgery. There were 9 complications (9.2%), 3 instances of thromboembolism and 6 bleeding. Thromboembolism occurred at a mean of 3.0 postoperative days, all of which occurred before resumption of DOACs, while bleeding events occurred at a mean of 4.0 postoperative days. Two of the 3 patients with thromboembolism went into cardiopulmonary arrest during the event, but were resuscitated. There were significantly more patients with congestive heart failure or combined antiplatelets in the patients with complications. The complication group had a significantly higher HAS-BLED score and lower preoperative hemoglobin level. There were no significant differences in the management of DOAC interruption between those with complications and without.The perioperative complication rate in nonvalvular AF patients undergoing elective surgery treating with DOACs was 9.2%. Patients with congestive heart failure, receiving combined therapy with antiplatelets, a higher HAS-BLED score, or lower preoperative hemoglobin level were at higher risk. Further studies evaluating the ideal perioperative DOAC protocol are warranted.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Doenças das Artérias Carótidas/epidemiologia , Infarto Cerebral/epidemiologia , Inibidores do Fator Xa/administração & dosagem , Infarto do Miocárdio/epidemiologia , Assistência Perioperatória/métodos , Hemorragia Pós-Operatória/epidemiologia , Tromboembolia/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Antitrombinas/administração & dosagem , Fibrilação Atrial/complicações , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Dabigatrana/administração & dosagem , Procedimentos Cirúrgicos do Sistema Digestório , Procedimentos Cirúrgicos Eletivos , Embolia/epidemiologia , Endoscopia , Feminino , Humanos , Masculino , Procedimentos Ortopédicos , Complicações Pós-Operatórias/epidemiologia , Pirazóis/administração & dosagem , Piridinas/administração & dosagem , Piridonas/administração & dosagem , Estudos Retrospectivos , Rivaroxabana/administração & dosagem , Tiazóis/administração & dosagem , Tromboembolia/etiologia , Procedimentos Cirúrgicos Urológicos , Procedimentos Cirúrgicos Vasculares
2.
An. sist. sanit. Navar ; 43(2): 251-254, mayo-ago. 2020.
Artigo em Espanhol | IBECS | ID: ibc-193479

RESUMO

La infección por SARS-CoV-2 (COVID-19) se relaciona con un aumento del riesgo de enfermedad tromboembólica. Algunos autores recomiendan la anticoagulación en dosis terapéuticas de, al menos, los pacientes más graves, práctica no exenta de riesgos, por lo que otros consensos solo recomiendan la profilaxis tromboembólica. La recomendación generalizada en pacientes previamente anticoagulados es el cambio del anticoagulante oral por heparina de bajo peso molecular (HBPM). Presentamos dos pacientes ingresados por COVID-19 sin datos de gravedad, en los que se sustituyó la anticoagulación (acenocumarol en un caso y rivaroxabán en el otro) por HBPM a dosis terapéuticas, presentando ambos sangrados abdominales. Estos sangrados son una complicación infrecuente en pacientes anticoagulados, pero la concurrencia de dos casos en un breve espacio de tiempo en el contexto de la pandemia por COVID-19 nos plantea que aún no se dispone de una evidencia clara sobre la anticoagulación terapéutica en la infección por SARS-CoV-2


Infection caused by SARS-CoV-2 (COVID-19) is associated with an increased risk of thromboembolic disease. Some authors recommend anticoagulation at therapeutic doses for, at least, the most severely ill patients; this practice is not free of risks, which is why only thromboembolic prophylaxis is recommended by other consensuses. In the case of previously anticoagulated patients, changing the oral anticoagulant for a low molecular weight heparin (LMWH) is generally recommended. We present the cases of two patients admitted due to COVID-19, without serious clinical data, in whom anticoagulation (acenocoumarol and rivaroxaban, respectively) was replaced by LMWH at therapeutic doses, both presenting abdominal bleeding. This type of bleeding is an infrequent complication in anticoagulated patients, but the concurrence of two cases in a short period of time in the context of the COVID-19 pandemic leads us to consider that there is not yet any clear evidence on therapeutic anticoagulation in SARS-CoV-2 infection


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , Anticoagulantes/uso terapêutico , Tromboembolia/prevenção & controle , Fibrilação Atrial/tratamento farmacológico , Pandemias/estatística & dados numéricos , Rivaroxabana/uso terapêutico , Acenocumarol/uso terapêutico , Reação em Cadeia da Polimerase/métodos , Enoxaparina/uso terapêutico
3.
Washington; Organización Panamericana de la Salud; ago 25, 2020. 28 p.
Não convencional em Espanhol | LILACS | ID: biblio-1117908

RESUMO

En el transcurso de la pandemia de COVID-19, numerosos países, de ingresos bajos, medianos y alto, han visto agotadas sus reservas de medicamentos esenciales necesarios para el manejo de los pacientes con COVID-19 en las unidades de cuidados intensivos (UCI). El plan de preparación para emergencias sanitarias de los países requiere incluir una lista de medicamentos esenciales y otros dispositivos médicos necesarios en las UCI para afrontar emergencias sanitarias. La lista de medicamentos esenciales para el manejo de pacientes que ingresan a unidades de cuidados intensivos con sospecha o diagnóstico confirmado de COVID-19 es un documento de orientación fundamental que ayuda a los sistemas de salud de los países a priorizar los medicamentos esenciales que deben estar ampliamente disponibles y ser asequibles para manejar los pacientes en las UCI durante las situaciones de emergencia sanitaria, en este caso con sospecha o diagnóstico confirmado de COVID-19. Está dirigida a las autoridades sanitaras y a los encargados del manejo del sistema de salud de los países. Esta lista incluye fundamentalmente los medicamentos considerados esenciales para el manejo de los cuadros clínicos que con se observan con mayor frecuencia en pacientes hospitalizados en UCI a causa de una infección por SARS-CoV-2. No se incluyen la mayoría de los medicamentos que comúnmente se encuentran en las UCI para el manejo de otras patologías, comorbilidades o la estabilización del paciente (p. ej., insulina o antihipertensivos), salvo aquellos que pueden requerirse para el tratamiento o apoyo (p. ej., bloqueantes neuromusculares o anestésicos) de las dolencias generadas por la infección. Tampoco se incluyen medicamentos específicos para el tratamiento de la infección por SARS-CoV-2, puesto que no existe, por el momento, evidencia científica de alta calidad que avale su uso, salvo en el contexto de ensayos clínicos controlados. Un equipo de expertos en el tema realizó una búsqueda de información sobre la atención de pacientes en UCI durante la pandemia de COVID-19, en Medline (a través de PubMed), Cochrane, Tripdatabase, Epistemonikos y en buscadores generales de internet (Google). Se identificaron también revisiones o guías generadas por ministerios de Salud de varios países de la Región de las Américas, la Organización Mundial de la Salud (OMS), la Organización Panamericana de la Salud (OPS), el Instituto Nacional de Salud y Excelencia Clínica (NICE) de Reino Unido, los Centros para el Control y la Prevención de Enfermedades (CDC) de Estados Unidos y los Institutos Nacionales de Salud (NIH) de Estados Unidos.


Assuntos
Humanos , Criança , Adulto , Pneumonia Viral/tratamento farmacológico , Succinilcolina/uso terapêutico , Antipsicóticos/uso terapêutico , Benzodiazepinas/uso terapêutico , Administração dos Cuidados ao Paciente/organização & administração , Dexametasona/uso terapêutico , Corticosteroides/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Medicamentos Essenciais/provisão & distribução , Dexmedetomidina/uso terapêutico , Síndrome Respiratória Aguda Grave/tratamento farmacológico , Antipiréticos/uso terapêutico , Pandemias/prevenção & controle , Betacoronavirus/efeitos dos fármacos , Haloperidol/uso terapêutico , Analgésicos Opioides/uso terapêutico , Unidades de Terapia Intensiva/organização & administração , Anti-Infecciosos/uso terapêutico , Pneumonia Viral/prevenção & controle , Respiração Artificial/enfermagem , Choque Séptico/prevenção & controle , Tromboembolia/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Medicina Baseada em Evidências , Intubação/enfermagem , Hipóxia/tratamento farmacológico
4.
Ann Afr Med ; 19(3): 153-163, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32820726

RESUMO

It is now known that thrombotic disorders such as venous thromboembolism, ischemic stroke, and myocardial infarction contribute significantly to global morbidity and mortality. Anticoagulation service must respond to this new development. Warfarin has continued to provide the backbone for anticoagulation service for decades but with considerable drawbacks. The introduction of nonVitamin K oral anticoagulants (NOACs) has created new challenges. This article seeks to discuss how the establishment of appropriate models of anticoagulation could contain the draw backs of the old anticoagulants and improve on the compliance, availability, affordability, and accessibility of newer anticoagulants. Successful anticoagulation has always been defined by a scientific balancing of the risk of thrombosis and the complication of hemorrhage. To be able to maintain such optimal anticoagulation requires rational drug prescription (physician factor), institutelization of monitoring of therapy (anticoagulation clinic factor) as well as active participation of patients receiving therapy (patient factor). New models of service can be created out of this triad in a bid to replace the old routine medical care model. New models of anticoagulation service should include appropriately trained professionals such as Physicians, Pharmacists, Clinical Pharmacologists, Nurses, and Laboratory Scientists who are knowledgeable in diagnostic, management, and monitoring of anticoagulation. The different models of anticoagulation service discussed in this article clearly demonstrate the need for restructuring of this life saving service particularly in the era of NOAC. Newer models of care that should provide safe, efficacious, and cost-effective services are needed.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Anticoagulantes/uso terapêutico , Prescrições de Medicamentos , Tromboembolia/prevenção & controle , Varfarina/uso terapêutico , Administração Oral , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Anticoagulantes/administração & dosagem , Humanos , Qualidade da Assistência à Saúde , Tromboembolia/tratamento farmacológico , Resultado do Tratamento
5.
Saudi Med J ; 41(8): 779-790, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32789417

RESUMO

[No Abstract Available]    Saudi Med J 2020; Vol. 41 (8): 779-790doi: 10.15537/smj.2020.8.25222 How to cite this article:Yaser A. Faden, Nadia A. Alghilan,  Samiha H. Alawami, Eman S. Alsulmi, Hythem A. Alsum, Yasir A. Katib, Yasser S. Sabr, Fadwah H. Tahir, Nabeel S. Bondagji. Saudi Society of Maternal-Fetal Medicine guidance on pregnancy and coronavirus disease 2019. Saudi Med J 2020; Vol. 41 (8): 779-790. doi: 10.15537/smj.2020.8.25222.


Assuntos
Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Complicações Infecciosas na Gravidez/terapia , Cuidado Pré-Natal/métodos , Anticoagulantes/uso terapêutico , Antivirais/uso terapêutico , Betacoronavirus , Anormalidades Congênitas/virologia , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/transmissão , Estado Terminal , Parto Obstétrico/métodos , Feminino , Heparina/uso terapêutico , Humanos , Hidroxicloroquina/uso terapêutico , Recém-Nascido , Transmissão Vertical de Doença Infecciosa , Sulfato de Magnésio/uso terapêutico , Pandemias , Perinatologia , Equipamento de Proteção Individual , Pneumonia Viral/transmissão , Cuidado Pós-Natal , Gravidez , Resultado da Gravidez , Arábia Saudita , Sociedades Médicas , Tromboembolia/prevenção & controle , Tocolíticos/uso terapêutico
6.
Plast Reconstr Surg ; 146(2): 238-245, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740567

RESUMO

BACKGROUND: Antifibrinolytic medications, such as tranexamic acid, have recently garnered increased attention. Despite its ability to mitigate intraoperative blood loss and need for blood transfusion, there remains a paucity of research in breast reconstruction. The authors investigate whether intravenous tranexamic acid safely reduces the risk of hematoma following implant-based breast reconstruction. METHODS: A single-center retrospective cohort study was performed to analyze all consecutive patients undergoing immediate two-stage implant-based breast reconstruction following mastectomy between 2015 and 2016. The incidence of postoperative hematomas and thromboembolic events among all patients was reviewed. The patients in the intervention group received 1000 mg of intravenous tranexamic acid before mastectomy incision and 1000 mg at the conclusion of the procedure. Fisher's exact test and the Mann-Whitney-Wilcoxon test were used. Multivariate logistic regression models were performed to study the impact of intravenous tranexamic acid after adjusting for possible confounders. RESULTS: A total of 868 consecutive breast reconstructions (499 women) were reviewed. Overall, 116 patients (217 breasts) received intravenous tranexamic acid, whereas 383 patients (651 breasts) did not. Patient characteristics and comorbidities were similar between the two the groups. Patients who received tranexamic acid were less likely to develop hematomas [n = 1 (0.46 percent)] than patients who did not [n = 19 (2.9 percent)] after controlling for age, hypertension, and type of reconstruction (prepectoral and subpectoral) (p = 0.018). Adverse effects of intravenous tranexamic acid, including thromboembolic phenomena were not observed. Multivariate analysis demonstrated that age and hypertension independently increase risk for hematoma. CONCLUSIONS: Intravenous tranexamic acid safely reduces risk of hematoma in implant-based breast reconstruction. Further prospective randomized studies are warranted to further corroborate these findings. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Implantes de Mama/efeitos adversos , Mama/irrigação sanguínea , Hematoma/prevenção & controle , Mamoplastia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Tromboembolia/prevenção & controle , Ácido Tranexâmico/administração & dosagem , Adulto , Antifibrinolíticos/administração & dosagem , Neoplasias da Mama/cirurgia , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Hematoma/etiologia , Humanos , Injeções Intravenosas , Mastectomia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tromboembolia/etiologia , Resultado do Tratamento
7.
Am Heart J ; 227: 91-99, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32693197

RESUMO

Vitamin K antagonists are the only approved oral anticoagulants for long-term prophylaxis against valve thrombosis and thromboembolism in patients with a mechanical heart valve. Despite the proven efficacy and safety of anticoagulation with the oral direct factor Xa inhibitor apixaban compared with warfarin in high-risk populations including subjects with atrial fibrillation or with venous thromboembolism, it remains unknown whether patients with a mechanical heart valve can be safely managed with apixaban. The On-X Aortic Heart Valve and On-X Ascending Aortic Prosthesis with the Vascutek Gelweave Valsalva Graft may have lower rates of valve thrombosis and thromboembolism than conventional bileaflet and tilting disc valves due its unique pyrolytic carbon composition and flared inlet design. DESIGN: PROACT Xa is a randomized, multicenter, open-label, active-controlled trial comparing apixaban with warfarin in patients with an On-X Aortic Heart Valve or On-X Ascending Aortic Prosthesis with the Vascutek Gelweave Valsalva Graft. The study will randomize approximately 1,000 patients from approximately 60 sites in North America who underwent aortic valve replacement at least 3 months prior. Patients will be randomized 1:1 to receiving apixaban 5 mg twice daily or warfarin with a target international normalized ratio of 2.0-3.0. The last randomized participant will be followed for at least 2 years. The primary efficacy outcome is the composite of valve thrombosis and valve-related thromboembolism, and the primary safety outcome is major bleeding. Assuming the primary outcome occurs in warfarin-anticoagulated patients at a rate of 1.75%/patient-year, the study has more than 90% power to assess noninferiority of apixaban treatment with an absolute noninferiority margin of 1.75%/patient-year. A second co-primary analysis is to compare the hazard rate for the apixaban arm to twice the objective performance criterion for thromboembolism and valve thrombosis, that is, 3.4%/patient-year. SUMMARY: PROACT Xa will determine whether patients with an On-X Aortic Heart Valve can be anticoagulated with apixaban as an alternative to warfarin.


Assuntos
Anticoagulantes/uso terapêutico , Valva Aórtica/cirurgia , Inibidores do Fator Xa/uso terapêutico , Próteses Valvulares Cardíacas , Complicações Pós-Operatórias/prevenção & controle , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Tromboembolia/prevenção & controle , Trombose/prevenção & controle , Varfarina/uso terapêutico , Anticoagulantes/efeitos adversos , Inibidores do Fator Xa/efeitos adversos , Humanos , Estudos Multicêntricos como Assunto , Desenho de Prótese , Pirazóis/efeitos adversos , Piridonas/efeitos adversos , Resultado do Tratamento , Varfarina/efeitos adversos
8.
Am J Med Sci ; 360(1): 50-54, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32620221

RESUMO

BACKGROUND: Numerous studies have demonstrated that patients with non-O blood groups have a higher risk for venous thromboembolism than those with the O blood group. However, the effect of ABO blood groups on warfarin dose requirements in patients receiving anticoagulation in the Chinese Han population remains unknown. This study aimed to investigate the influence of ABO blood groups on warfarin dose requirements in a Chinese Han population. MATERIAL AND METHODS: A retrospective study was conducted in the First Affiliated Hospital of Shantou University Medical College in South China. Three hundred and fifty-eight patients with a confirmed diagnosis of deep vein thrombosis or atrial fibrillation were included. The frequency of blood groups and warfarin dose requirements were determined. RESULTS: Of 358 patients with deep vein thrombosis or atrial fibrillation, 111 patients had blood group A (31.01%), 104 patients had blood group B (29.05%), 20 patients had blood group AB (5.59%) and 123 patients had blood group O (34.36%). The patients in the O blood group had lower warfarin dose requirements than those in the A, B and AB blood groups. CONCLUSIONS: Our study showed that patients with non-O blood groups require higher doses of warfarin.


Assuntos
Sistema ABO de Grupos Sanguíneos , Anticoagulantes/uso terapêutico , Tromboembolia/genética , Tromboembolia/prevenção & controle , Varfarina/uso terapêutico , Idoso , Grupo com Ancestrais do Continente Asiático , Feminino , Predisposição Genética para Doença , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
9.
Cardiovasc Ther ; 2020: 1743927, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32684980

RESUMO

Sex-specific differences have been definitively demonstrated in cardiovascular (CV) diseases. These differences can also impact on the effects of CV therapies. Female sex is recognized as an independent predictor of thromboembolic risk, particularly in older patients. Most of strokes are due to atrial fibrillation (AF). Women affected by AF have higher stroke risk compared to men. The introduction of novel oral anticoagulants (NOACs) for long-term anticoagulation completely changed the anticoagulant therapeutic approach and follow-up of patients affected by nonvalvular atrial fibrillation (NVAF). CHA2DS2-VASc stroke risk scoring in use in the current international guidelines attributes 1 point to "female sex". Besides, no anticoagulation is indicated for AF female patients without other risk factors. Interestingly, NOACs seem to normalize the differences between males and females both in terms of safety and efficacy, whereas residual higher stroke risk and systemic embolism persist in AF women treated with vitamin K antagonist anticoagulants VKA with optimal time in therapeutic range. Based on the CHA2DS2-VASc score, NOACs represent the preferred choice in NVAF patients. Moreover, complete evaluation of apparently lower risk factor along with concomitant clinical conditions in AF patients appears mandatory, particularly for female patients, in order to achieve the most appropriate anticoagulant treatment, either in male or in female patients. The present review was performed to review sex differences in AF-related thromboembolic risk reported in the literature and possibly highlight current knowledge gaps in prevention and management that need further research.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Coagulação Sanguínea/efeitos dos fármacos , Inibidores do Fator Xa/administração & dosagem , Acidente Vascular Cerebral/prevenção & controle , Tromboembolia/prevenção & controle , Administração Oral , Anticoagulantes/efeitos adversos , Fibrilação Atrial/sangue , Fibrilação Atrial/epidemiologia , Tomada de Decisão Clínica , Inibidores do Fator Xa/efeitos adversos , Feminino , Humanos , Masculino , Seleção de Pacientes , Medição de Risco , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/epidemiologia , Tromboembolia/sangue , Tromboembolia/epidemiologia , Resultado do Tratamento , Vitamina K/antagonistas & inibidores
10.
Reprod Biomed Online ; 41(3): 361-364, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32660814

RESUMO

The COVID-19 pandemic has significantly increased mortality in many countries, with the number of infected cases increasing exponentially worldwide. One of the main determining factors of the poor prognosis in these patients is the development of coagulopathy. Moreover, it is well known that assisted reproductive technology procedures confer a risk of thromboembolic complications. This commentary analyses specific aspects coexisting between the thrombotic risk described during virus infection and that reported in the context of assisted reproduction treatments. Based on known pathophysiological aspects of virus infection and of ovarian stimulation, there are common elements that deserve to be taken into account. In the present context, any risk of hyperstimulation should be avoided. Gonadotrophin-releasing hormone agonist triggering should be mandatory in high-responder patients and/or those with COVID-19 infection. In both cases, the cycle should be segmented. A proposal is made for the use of prophylactic low molecular weight heparin not only in those cases in which oocyte retrieval has been performed, but also in those in which cancellation has been decided. In addition, endometrial preparation for frozen-thawed embryo transfers should use the transdermal route in order to minimize the higher thrombotic risk associated with the oral route.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Técnicas de Reprodução Assistida/efeitos adversos , Tromboembolia/epidemiologia , Tromboembolia/virologia , Transferência Embrionária/métodos , Feminino , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Recuperação de Oócitos , Síndrome de Hiperestimulação Ovariana/complicações , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Síndrome de Hiperestimulação Ovariana/virologia , Indução da Ovulação/efeitos adversos , Pandemias , Gravidez , Fatores de Risco , Tromboembolia/prevenção & controle
11.
Medicina (B Aires) ; 80 Suppl 3: 65-66, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32658849

RESUMO

Although the incidence is uncertain, some case reports suggest that COVID 19 infection is associated with an increased risk of venous thromboembolism. We suggest starting prophylactic anticoagulant therapy for all patients hospitalized with a symptomatic infection with COVID-19, unless contraindicated, with enoxaparin 40 mg SC daily if creatinine clearance is greater than 30 ml/min.


Assuntos
Anticoagulantes/administração & dosagem , Coronavirus , Pacientes Internados , Tromboembolia/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Anticoagulantes/uso terapêutico , Argentina , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia
12.
Pan Afr Med J ; 35(Suppl 2): 10, 2020.
Artigo em Inglês | MEDLINE | ID: covidwho-595180

RESUMO

COVID-19 pandemic is an emergent cardiovascular risk factor and a major cause of mortality worldwide. Thromboembolism is highly suspected as a leading cause of death in these patients through vascular inflammation caused by SARS COV2. Until now there is no real treatment of COVID-19 and many proposed drugs are under clinical trials. Considering the high incidence of thromboembolic events in critically ill patients with COVID-19, prevention of this disorder should be essential in order to reduce mortality in these patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Tromboembolia/terapia , Infecções por Coronavirus/transmissão , Humanos , Incidência , Pneumonia Viral/transmissão , Tromboembolia/epidemiologia , Tromboembolia/etiologia , Tromboembolia/prevenção & controle
14.
Maturitas ; 137: 57-62, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: covidwho-186443

RESUMO

COVID-19 is associated with a systemic inflammatory response with activation of coagulation in symptomatic patients. The possibility of coagulopathies in peri- and postmenopausal women taking estrogen therapies makes it necessary to consider antithrombotic strategies, such as the use of low molecular weight heparins (LMWH) at specific prophylactic or treatment doses for each individual case, depending on the risk factors that each woman presents. For such reasons, a panel of experts from various Spanish scientific societies has met to develop usage recommendations for managing menopausal women taking menopausal hormone therapy (MHT) or combined hormonal contraception (CHC) during the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Terapia de Reposição de Estrogênios , Terapia de Reposição Hormonal , Menopausa , Pandemias , Pneumonia Viral , Tromboembolia , Anticoagulantes/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Contracepção Hormonal , Humanos , Pessoa de Meia-Idade , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Fatores de Risco , Tromboembolia/etiologia , Tromboembolia/prevenção & controle
15.
Maturitas ; 137: 57-62, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32498938

RESUMO

COVID-19 is associated with a systemic inflammatory response with activation of coagulation in symptomatic patients. The possibility of coagulopathies in peri- and postmenopausal women taking estrogen therapies makes it necessary to consider antithrombotic strategies, such as the use of low molecular weight heparins (LMWH) at specific prophylactic or treatment doses for each individual case, depending on the risk factors that each woman presents. For such reasons, a panel of experts from various Spanish scientific societies has met to develop usage recommendations for managing menopausal women taking menopausal hormone therapy (MHT) or combined hormonal contraception (CHC) during the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Terapia de Reposição de Estrogênios , Terapia de Reposição Hormonal , Menopausa , Pandemias , Pneumonia Viral , Tromboembolia , Anticoagulantes/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Contracepção Hormonal , Humanos , Pessoa de Meia-Idade , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Fatores de Risco , Tromboembolia/etiologia , Tromboembolia/prevenção & controle
16.
Rev Esp Anestesiol Reanim ; 67(7): 391-399, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32591185

RESUMO

The infection by the coronavirus SARS-CoV-2, which causes the disease called COVID-19, mainly causes alterations in the respiratory system. In severely ill patients, the disease often evolves into an acute respiratory distress syndrome that can predispose patients to a state of hypercoagulability, with thrombosis at both venous and arterial levels. This predisposition presents a multifactorial physiopathology, related to hypoxia as well as to the severe inflammatory process linked to this pathology, including the additional thrombotic factors present in many of the patients. In view of the need to optimise the management of hypercoagulability, the working groups of the Scientific Societies of Anaesthesiology-Resuscitation and Pain Therapy (SEDAR) and of Intensive, Critical Care Medicine and Coronary Units (SEMICYUC) have developed a consensus to establish guidelines for actions to be taken against alterations in haemostasis observed in severely ill patients with COVID-19. These recommendations include prophylaxis of venous thromboembolic disease in these patients, and in the peripartum, management of patients on long-term antiplatelet or anticoagulant treatment, bleeding complications in the course of the disease, and the interpretation of general alterations in haemostasis.


Assuntos
Anticoagulantes/uso terapêutico , Betacoronavirus , Transtornos da Coagulação Sanguínea/prevenção & controle , Infecções por Coronavirus/complicações , Inibidores da Agregação de Plaquetas/uso terapêutico , Pneumonia Viral/complicações , Anticoagulantes/administração & dosagem , Transtornos da Coagulação Sanguínea/etiologia , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Feminino , Hemorragia/terapia , Humanos , Pandemias , Inibidores da Agregação de Plaquetas/administração & dosagem , Pneumonia Viral/sangue , Pneumonia Viral/epidemiologia , Gravidez , Complicações Hematológicas na Gravidez/sangue , Complicações Hematológicas na Gravidez/etiologia , Complicações Hematológicas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/sangue , Complicações Infecciosas na Gravidez/etiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Tromboembolia/etiologia , Tromboembolia/prevenção & controle , Trombose/etiologia
17.
J Obstet Gynaecol Res ; 46(8): 1235-1245, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32500549

RESUMO

The data pertaining to the COVID-19 pandemic has been rapidly evolving since the first confirmed case in December 2019. This review article presents a comprehensive analysis of the current data in relation to COVID-19 and its effect on pregnant women, including symptoms, disease severity and the risk of vertical transmission. We also review the recommended management of pregnant women with suspected or confirmed COVID-19 and the various pharmacological agents that are being investigated and may have a role in the treatment of this disease. At present, it does not appear that pregnant women are at increased risk of severe infection than the general population, although there are vulnerable groups within both the pregnant and nonpregnant populations, and clinicians should be cognizant of these high-risk groups and manage them accordingly. Approximately 85% of women will experience mild disease, 10% more severe disease and 5% critical disease. The most common reported symptoms are fever, cough, shortness of breath and diarrhea. Neither vaginal delivery nor cesarean section confers additional risks, and there is minimal risk of vertical transmission to the neonate from either mode of delivery. We acknowledge that the true effect of the virus on both maternal and fetal morbidity and mortality will only be evident over time. We also discuss the impact of social isolation can have on the mental health and well-being of both patients and colleagues, and as clinicians, we must be mindful of this and offer support as necessary.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Complicações Infecciosas na Gravidez/terapia , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/transmissão , Efeitos Psicossociais da Doença , Feminino , Humanos , Recém-Nascido , Transmissão Vertical de Doença Infecciosa , Mortalidade Materna , Saúde Mental , Morbidade , Pandemias , Pneumonia Viral/psicologia , Pneumonia Viral/transmissão , Gravidez , Cuidado Pré-Natal , Tromboembolia/prevenção & controle
18.
Pan Afr Med J ; 35(Suppl 2): 10, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32528621

RESUMO

COVID-19 pandemic is an emergent cardiovascular risk factor and a major cause of mortality worldwide. Thromboembolism is highly suspected as a leading cause of death in these patients through vascular inflammation caused by SARS COV2. Until now there is no real treatment of COVID-19 and many proposed drugs are under clinical trials. Considering the high incidence of thromboembolic events in critically ill patients with COVID-19, prevention of this disorder should be essential in order to reduce mortality in these patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Tromboembolia/terapia , Infecções por Coronavirus/transmissão , Humanos , Incidência , Pneumonia Viral/transmissão , Tromboembolia/epidemiologia , Tromboembolia/etiologia , Tromboembolia/prevenção & controle
20.
Infez Med ; 28(suppl 1): 52-56, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32532939

RESUMO

In spite of many ongoing attempts to repurpose existing antivirals, no drugs have emerged yet with the desirable activity against SARS-CoV-2. Hydroxychloroquine, lopinavir/ritonavir, remdesivir, umifenovir, favipiravir, ribavirin and beta-interferon-1 gave rise to variable but still inconsistent proof of clinical efficacy in the treatment of COVID-19. Pathogenetic studies have shown significant differences between commonly defined viral pneumonia and COVID-19 pulmonary disease. In severe forms, immune/inflammatory alterations reminiscent of disease forms like Macrophage Activation Syndrome (MAS) have been described, and therapeutic options other than anti-infective have been proposed and implemented, such as anti-inflammatory and anticoagulative agents. The thrombotic phenomena described in the pulmonary vascular bed of patients with severe COVID-19 suggest the administration of low-molecular weight heparin (LMWH) as standard measure in hospitalized patients with COVID-19.


Assuntos
Anticoagulantes/uso terapêutico , Infecções por Coronavirus/complicações , Cuidados Críticos/métodos , Heparina de Baixo Peso Molecular/uso terapêutico , Pneumonia Viral/complicações , Trombofilia/tratamento farmacológico , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Alanina/análogos & derivados , Alanina/uso terapêutico , Anticoagulantes/administração & dosagem , Antivirais/administração & dosagem , Antivirais/uso terapêutico , Biomarcadores , Infecções por Coronavirus/sangue , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/fisiopatologia , Gerenciamento Clínico , Método Duplo-Cego , Combinação de Medicamentos , Quimioterapia Combinada , Embolia/epidemiologia , Embolia/prevenção & controle , Endotélio Vascular/fisiopatologia , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Hidroxicloroquina/uso terapêutico , Interferon beta-1b/uso terapêutico , Lopinavir/uso terapêutico , Ativação de Macrófagos , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/fisiopatologia , Fibrose Pulmonar/etiologia , Fibrose Pulmonar/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Ritonavir/uso terapêutico , Tromboembolia/epidemiologia , Tromboembolia/prevenção & controle , Trombofilia/sangue , Trombofilia/etiologia , Trombose/epidemiologia , Trombose/prevenção & controle
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