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1.
Medicine (Baltimore) ; 99(45): e23031, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157953

RESUMO

RATIONALE: The evidence for outpatient pulmonary embolism (PE) management apart from hospitalization is expanding. The availability and ease of direct oral anticoagulants have facilitated this transition. The literature, however, is sparse on the topic of comprehensive management of pulmonary embolism in the primary care clinic setting. As such, the role of the primary care physician in the complete diagnosis, risk stratification for outpatient eligibility, and initiation of treatment is unclear. CASE PRESENTATIONS: Case 1: A 33-year-old man with known heterozygous Factor V Leiden mutation and a remote history of deep vein thrombosis presented to his primary care physician's office with 2 days of mild pleuritic chest pain and a dry cough after a recent transcontinental flight. Case 2: A 48-year-old man with a complex medical history including recent transverse myelitis presented to his primary care family physician with dyspnea and pleuritic chest pain for 6 days. DIAGNOSIS: Case 1: Computed tomographic pulmonary angiography that same afternoon showed multiple bilateral segmental and subsegmental emboli as well as several small pulmonary infarcts. Case 2: The patient's D-dimer was elevated at 1148 ng/mL. His physician ordered a computed tomographic pulmonary angiography, performed that evening, which showed segmental and subsegmental PE. INTERVENTIONS: Both patients were contacted by their respective physicians shortly after their diagnoses and, in shared decision-making, opted for treatment at home with 5 days of enoxaparin followed by dabigatran. OUTCOMES: Neither patient developed recurrence nor complications in the subsequent 3 months. LESSONS: These cases, stratified as low risk using the American College of Chest Physicians criteria and the PE Severity Index, are among the first in the literature to illustrate comprehensive primary care-based outpatient PE management. Care was provided within an integrated delivery system with ready, timely access to laboratory, advanced radiology, and allied health services. This report sets the stage for investigating the public health implications of comprehensive primary care-based PE management, including cost-savings as well as enhanced patient follow-up and patient satisfaction.


Assuntos
Dor no Peito/etiologia , Dispneia/etiologia , Transferência de Pacientes/métodos , Médicos de Atenção Primária/normas , Embolia Pulmonar/tratamento farmacológico , Doença Aguda , Adulto , Assistência Ambulatorial , Anticoagulantes/uso terapêutico , Antitrombinas/uso terapêutico , Dor no Peito/diagnóstico , Angiografia por Tomografia Computadorizada/métodos , Dabigatrana/uso terapêutico , Tomada de Decisão Compartilhada , Dispneia/diagnóstico , Enoxaparina/uso terapêutico , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Mielite Transversa/complicações , Mielite Transversa/diagnóstico , Transferência de Pacientes/estatística & dados numéricos , Médicos de Atenção Primária/estatística & dados numéricos , Embolia Pulmonar/diagnóstico por imagem , Medição de Risco , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/diagnóstico
2.
Zhonghua Wai Ke Za Zhi ; 58(11): 864-869, 2020 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-33120450

RESUMO

Objective: To examine the ultrasound features and clinical characteristics of the intestinal ischemia secondary to acute mesenteric venous thrombosis (AMVT). Methods: From January 2016 to June 2019, 11 patients were diagnosed as intestinal ischemia secondary to AMVT confirmed by surgical pathology or CT in Peking Union Medical College Hospital. The patients included 7 males and 4 females, aging of (52.8±11.9) years (range: 34 to 81 years).The clinical characters and ultrasound features were retrospectively reviewed. Results: Abdomen pain was the chief complaint of all patients. Other complaints include 2 cases of blood in the stool, 1 case of hematemesis, 2 cases of vomiting, 1 case of diarrhea. Six patients showed rebound pain on physical examination. All patients had elevated white blood cell account and D-Dimer. Nine patients had a thrombosis in the portal vein simultaneously. All 11 patients underwent the CT scan including 10 contrast-enhanced CT. Mesenteric venous thrombosis was detected in 10 cases who underwent contrast-enhanced CT imaging. On CT imaging, 11 patients demonstrated intestinal wall thicken, 5 patients showed intestinal dilation. Eight patients underwent superior mesenteric venous ultrasound examination. Of them, 7 patients were correctly diagnosed as AMVT. Of the 10 patients who underwent abdominal ultrasound, 5 patients showed intestinal lesions including intestinal wall thicken in 4 patients and intestinal dilation in 1 patient. Peritoneal fluid was detected in 10 patients by ultrasound, which was consistent with CT. Ten patients underwent surgical procedures while 1 patient received conservative treatment. Conclusion: Ultrasound is an accurate imaging method in diagnosing superior mesenteric vein thrombosis and can detect intestinal wall thickening, intestinal dilation, and peritoneal fluid.


Assuntos
Isquemia Mesentérica , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/etiologia , Veias Mesentéricas/diagnóstico por imagem , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Estudos Retrospectivos , Ultrassonografia , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem
3.
Cochrane Database Syst Rev ; 10: CD006212, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-33027844

RESUMO

BACKGROUND: Pulmonary emboli (PE), or blood clots in the lungs,can be potentially fatal. Anticoagulation is the first line therapy to prevent PE. In some instances anticoagulation fails to prevent more emboli, or cannot be given because the person has a high risk of bleeding. Inferior vena caval filters (VCFs) are metal alloy devices that mechanically trap fragmented emboli from the deep leg veins en route to the pulmonary circulation. Retrievable filters are designed to be introduced and removed percutaneously. Although their deployment seems of theoretical benefit, their clinical efficacy and adverse event profile is unclear. This is the third update of a Cochrane Review first published in 2007. OBJECTIVES: To assess the evidence for the effectiveness and safety of vena caval filters (VCFs) in preventing pulmonary embolism (PE). SEARCH METHODS: For this review update, the Cochrane Vascular Information Specialist (CIS) searched the Specialised Register (last searched 10 September 2019) and the Cochrane Register of Controlled Trials (CENTRAL) (2019, Issue 8) via the Cochrane Register of Studies Online. The CIS also searched MEDLINE Ovid, EMBASE Ovid, CINAHL, and AMED (1 January 2017 to 10 September 2019) and trials registries to 10 September 2019. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) that examined the efficacy of VCFs in preventing PE. DATA COLLECTION AND ANALYSIS: For this update, studies were assessed and data extracted independently. We assessed study quality with Cochrane's 'Risk of bias' tool and used the GRADE approach to assess the overall certainty of the evidence. The outcomes of interest were PE, mortality, lower limb venous thrombosis, filter-related complications and major bleeding. MAIN RESULTS: We identified four new studies for this update, bringing the total to six included studies involving 1388 participants. The six studies were clinically heterogeneous and we were unable to carry out meta-analysis. Only two studies were considered to be both applicable in current clinical settings and of good methodological quality. One was a randomised open-label trial studying the effect of a retrievable inferior vena caval filter plus anticoagulation versus anticoagulation alone on risk of recurrent pulmonary embolism (PE) in 399 participants over three months. There was no evidence of a difference in the rates of PE, death, lower extremity deep vein thrombosis (DVT), or bleeding at three and six months after the intervention (moderate-certainty evidence). A filter was inserted in 193 people, but could only be successfully retrieved from 153. Minor filter complications were noted at six months. The second clinically relevant study was a randomised open-label trial of 240 participants who had sustained multiple traumatic injuries, allocated to a filter or no filter, three days after injury, in conjunction with anticoagulation and intermittent pneumatic compression. Prophylactic anticoagulation was initiated in both groups when it was thought safe to do so. There was no evidence of a difference in symptomatic PE, death, or lower limb venous thrombosis rates (moderate-certainty evidence). The only major filter complication was that one person required surgical removal of the filter. We are unable to draw any conclusions from the remaining four included studies. One study showed an increased incidence of long-term lower extremity DVT at eight years. Three studies are no longer clinically applicable because they utilised permanent filters which are seldom used now, or they did not use routine prophylactic anticoagulation which is current standard practice. The fourth study compared two filter types and was terminated prematurely as one filter group had a higher rate of thrombosis compared to the other filter type. AUTHORS' CONCLUSIONS: Two of the six identified studies were relevant for current clinical settings. One showed no evidence of a benefit of retrievable filters in acute PE for the outcomes of PE, death, DVT and bleeding during the initial three months in people who can receive anticoagulation (moderate-certainty evidence). The other study did not show any benefit for prophylactic filter insertion in people who sustained multiple traumatic injuries, with respect to symptomatic PE, mortality, or lower extremity venous thrombosis (moderate-certainty evidence). We can draw no firm conclusions regarding filter efficacy in the prevention of PE from the remaining four RCTs identified in this review. Further trials are needed to assess vena caval filter effectiveness and safety, and clinical differences between various filter types.


Assuntos
Embolia Pulmonar/prevenção & controle , Filtros de Veia Cava , Anticoagulantes/uso terapêutico , Terapia Combinada/métodos , Humanos , Dispositivos de Compressão Pneumática Intermitente , Traumatismo Múltiplo/complicações , Embolia Pulmonar/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior , Trombose Venosa/complicações
4.
Eur Rev Med Pharmacol Sci ; 24(17): 9154-9160, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32965007

RESUMO

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, China, and has subsequently spread worldwide. An association between increased venous thromboembolism in patients with pneumonia-related to COVID-19 has not yet been well described. PATIENTS AND METHODS: We aimed to illustrate cases of pulmonary thromboembolism in patients with acute respiratory distress syndrome related to COVID-19 treated in our intensive care unit. The medical records of patients affected by COVID-19 with acute respiratory distress syndrome in our institute from 1/3/2020 to 31/3/2020 were retrospectively reviewed. RESULTS: Our center registered a high prevalence of thromboembolic events among 62 patients affected by acute respiratory distress syndrome related to COVID-19 despite a regular antithrombotic prophylaxis. Out of these, 32 patients were transferred to other hospitals, and 30 were treated in our center. Venous thromboembolism was registered in 12 (19.3%) cases. In particular, 11 diagnoses of pulmonary embolism and 1 diagnosis of deep vein thrombosis were formulated. We described a case series of venous thromboembolism in nine patients treated in our Intensive Care Unit (ICU). Main pulmonary arteries were always involved in these patients. None of them died. CONCLUSIONS: In conclusion, critically ill patients with ARDS related to COVID-19 may have an increased risk of VTE that could be a leading cause of mortality. These patients require a high index of clinical suspicion and an accurate diagnostic approach, in order to immediately start an appropriate anticoagulant treatment.


Assuntos
Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/complicações , Tromboembolia Venosa/diagnóstico , Idoso , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Estado Terminal , Feminino , Humanos , Unidades de Terapia Intensiva , Itália , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Tromboembolia Venosa/complicações , Trombose Venosa/complicações , Trombose Venosa/diagnóstico
5.
Semin Thromb Hemost ; 46(7): 763-771, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32882719

RESUMO

Coronavirus disease 2019 (COVID-19) may have a wide spectrum of clinical presentations, leading in some cases to a critical condition with poor long-term outcomes and residual disability requiring post-acute rehabilitation. A major concern in severe COVID-19 is represented by a concomitant prothrombotic state. However, contrasting data are available about the prevalence of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and/or pulmonary embolism (PE). A detailed search on the association of COVID-19 with thromboembolic complications was conducted in the main electronic databases (PubMed, Web of Science, and Scopus) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The weighted mean prevalence (WMP) with 95% confidence interval (95% CI) was calculated with the random-effects model. Twenty studies enrolling 1,988 COVID-19 patients were included. The WMP of VTE was 31.3% (95% CI: 24.3-39.2%). The WMP of DVT was 19.8% (95% CI: 10.5-34.0%), whereas the WMP of PE was 18.9% (95% CI: 14.4-24.3%). Similar results were obtained when specifically analyzing studies on patients admitted to intensive care units and those on patients under antithrombotic prophylaxis. Regression models showed that an increasing age was associated with a higher prevalence of VTE (Z-score: 3.11, p = 0.001), DVT (Z-score: 2.33, p = 0.002), and PE (Z-score: 3.03, p = 0.002), while an increasing body mass index was associated with an increasing prevalence of PE (Z-score = 2.01, p = 0.04). Male sex did not impact the evaluated outcomes. The rate of thromboembolic complications in COVID-19 patients is definitely high. Considering the risk of fatal and disabling complications, adequate screening procedures and antithrombotic strategies should be implemented.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Embolia Pulmonar/complicações , Tromboembolia Venosa/complicações , Trombose Venosa/complicações , Anticoagulantes/efeitos adversos , Betacoronavirus , Índice de Massa Corporal , Cuidados Críticos/métodos , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Unidades de Terapia Intensiva , Masculino , Pandemias , Prevalência , Prognóstico , Embolia Pulmonar/tratamento farmacológico , Análise de Regressão , Risco , Tromboembolia Venosa/tratamento farmacológico , Trombose Venosa/tratamento farmacológico
6.
Am J Case Rep ; 21: e926785, 2020 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-32970653

RESUMO

BACKGROUND In corona virus disease 2019 (COVID-19), which emerged in December 2019 and is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), most case presentations have been related to the respiratory tract. Several recent studies reveal that angiotensin-converting enzyme 2 (ACE2), which was found in the target cells of the virus, is highly expressed in the lungs, small bowel, and vasculature. CASE REPORT A 29-year-old male construction worker from India presented with left-sided colicky abdominal pain. He tested positive for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription-polymerase chain reaction (RT-PCR). Isolated superior mesenteric vein thrombosis was diagnosed by CT (computed tomography) scan. He was managed by anti-coagulants and clinically improved. CONCLUSIONS This case report indicates that isolated venous thrombosis of the abdominal vessels without concurrent arterial thrombosis can be a complication of the hyper-coagulability state in COVID-19 patients. Hence, early evaluation of abdominal vessels in covid-19 patients who present with any abdominal symptoms should be considered, especially when found to have an elevated D-dimer level, as early treatment of thrombosis with low-molecular-weight heparin can have a significant impact on the therapeutic outcome.


Assuntos
Anticoagulantes/administração & dosagem , Infecções por Coronavirus/complicações , Oclusão Vascular Mesentérica/diagnóstico por imagem , Pneumonia Viral/complicações , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Técnicas de Laboratório Clínico/métodos , Indústria da Construção , Infecções por Coronavirus/diagnóstico , Humanos , Índia , Masculino , Oclusão Vascular Mesentérica/tratamento farmacológico , Oclusão Vascular Mesentérica/virologia , Veias Mesentéricas , Pandemias , Pneumonia Viral/diagnóstico , Radiografia Torácica/métodos , Reação em Cadeia da Polimerase em Tempo Real/métodos , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Trombose Venosa/complicações
7.
Korean J Gastroenterol ; 76(3): 164-166, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32969365

RESUMO

The World Health Organization has declared novel coronavirus disease 2019 (COVID-19) a global public health emergency. Although respiratory symptoms predominate in COVID-19, thrombosis can occur in patients with COVID-19. This paper reports a case of an 82-year-old female with a prior medical history of hypertension, diabetes presenting with fever and cough, and was diagnosed with COVID-19. The patient subsequently developed progressively worsening of abdominal distention, tenderness, and underwent emergent laparotomy. She was found to have a gangrenous colon. This case adds to the limited literature regarding the extrapulmonary complications of COVID-19.


Assuntos
Colite/diagnóstico , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Trombose Venosa/diagnóstico , Abdome/diagnóstico por imagem , Abdome/cirurgia , Doença Aguda , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Betacoronavirus/isolamento & purificação , Colite/patologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Feminino , Heparina/uso terapêutico , Humanos , Laparotomia , Necrose , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Tomografia Computadorizada por Raios X , Trombose Venosa/complicações , Trombose Venosa/tratamento farmacológico
10.
Neurology ; 95(12): e1706-e1715, 2020 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-32759191

RESUMO

OBJECTIVE: To identify characteristics, predictors, and outcomes of acute symptomatic seizures (ASS) in cerebral venous thrombosis (CVT), we investigated 1,281 consecutive adult patients with CVT included from 12 hospitals within the International CVT Consortium. METHODS: We defined ASS as any seizure between symptom onset and 7 days after diagnosis of CVT. We stratified ASS into prediagnosis and solely postdiagnosis ASS. Status epilepticus (SE) was also analyzed separately. We analyzed predictors for ASS and the association between ASS and clinical outcome (modified Rankin Scale) with multivariable logistic regression. RESULTS: Of 1,281 eligible patients, 441 (34%) had ASS. Baseline predictors for ASS were intracerebral hemorrhage (ICH; adjusted odds ratio [aOR] 4.1, 95% confidence interval [CI] 3.0-5.5), cerebral edema/infarction without ICH (aOR 2.8, 95% CI 2.0-4.0), cortical vein thrombosis (aOR 2.1, 95% CI 1.5-2.9), superior sagittal sinus thrombosis (aOR 2.0, 95% CI 1.5-2.6), focal neurologic deficit (aOR 1.9, 95% CI 1.4-2.6), sulcal subarachnoid hemorrhage (aOR 1.6, 95% CI 1.1-2.5), and female-specific risk factors (aOR 1.5, 95% CI 1.1-2.1). Ninety-three (7%) patients had solely postdiagnosis ASS, best predicted by cortical vein thrombosis (positive/negative predictive value 22%/92%). Eighty (6%) patients had SE, independently predicted by ICH, focal neurologic deficits, and cerebral edema/infarction. Neither ASS nor SE was independently associated with outcome. CONCLUSION: ASS occurred in one-third of patients with CVT and was associated with brain parenchymal lesions and thrombosis of the superficial system. In the absence of prediagnosis ASS, no subgroup was identified with sufficient risk of postdiagnosis ASS to justify prophylactic antiepileptic drug treatment. We found no association between ASS and outcome.


Assuntos
Trombose Intracraniana/complicações , Convulsões/etiologia , Trombose Venosa/complicações , Adulto , Veias Cerebrais/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
11.
Neurology ; 95(12): e1716-e1723, 2020 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-32759195

RESUMO

OBJECTIVE: To examine the incidence, characteristics, treatment, and predictors of late seizures (LS) after cerebral venous thrombosis (CVT), we described these features in a registry of 1,127 patients with CVT. METHODS: We included consecutive adult patients from an international consortium of 12 hospital-based CVT registries. We excluded patients with a history of epilepsy or with <8 days of follow-up. We defined LS as seizures occurring >7 days after diagnosis of CVT. We used multivariable Cox regression to identify predictors of LS. RESULTS: We included 1,127 patients with CVT. During a median follow-up of 2.0 years (interquartile range [IQR] 1.0-6.3), 123 patients (11%) experienced ≥1 LS (incidence rate for first LS 30 per 1,000 person-years, 95% confidence interval [CI] 25-35). Median time to first LS was 5 months (IQR 1-16 months). Baseline predictors of LS included status epilepticus in the acute phase (hazard ratio [HR] 7.0, 95% CI 3.9-12.6), decompressive hemicraniectomy (HR 4.2, 95% CI 2.4-7.3), acute seizure(s) without status epilepticus (HR 4.1, 95% CI 2.5-6.5), subdural hematoma (HR 2.3, 95% CI 1.1-4.9), and intracerebral hemorrhage (HR 1.9, 95% CI 1.1-3.1). Eighty-five patients (70% of patients with LS) experienced a recurrent seizure during follow-up, despite the fact that 94% received antiepileptic drug treatment after the first LS. CONCLUSION: During a median follow-up of 2 years, ≈1 in 10 patients with CVT had LS. Patients with baseline intracranial bleeding, patients with acute symptomatic seizures, and those who underwent decompressive hemicraniectomy were at increased risk of developing LS. The high recurrence risk of LS justifies epilepsy diagnosis after a first LS.


Assuntos
Trombose Intracraniana/complicações , Convulsões/epidemiologia , Convulsões/etiologia , Trombose Venosa/complicações , Adulto , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Recidiva , Fatores de Risco
13.
Eur J Haematol ; 105(6): 741-750, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32749010

RESUMO

BACKGROUND: Abnormal coagulation parameters have been reported in COVID-19-infected patients. Although the underlying mechanism of COVID-19 coagulopathy remains unknown, it has been suggested to be a form of disseminated intravascular coagulation (DIC). OBJECTIVES: The aim of our study was to analyze the coagulation parameters of patients with COVID-19, determine whether coagulation factors consumption occurs and identify potential prognostic biomarkers of the disease. PATIENTS/METHODS: Blood samples from hospitalized patients with COVID-19 pneumonia were collected. We performed basic coagulation tests and quantification of coagulation factors and physiological inhibitor proteins. Laboratory data were compared with clinical data and outcomes. RESULTS: The study involved 206 patients (63.6% male). D-dimer was particularly elevated (median 450 ng/mL; IQR 222.5-957.3). Free protein S levels were below the normal range (median 56.6%; IQR: 43.6-68.9), and factor VIII showed an increasing trend (median 173.4%; IQR: 144.1-214.9). However, all coagulation factors were within normal limits. We found no correlation between abnormal coagulation parameters and thrombosis, except for higher D-dimer (HR 1.99; 95% CI 1.3-3.1; P = .002). CONCLUSIONS: COVID-19 is associated with coagulopathy that correlates with poor prognosis. However, we did not demonstrate a consumption of coagulation factors, as seen in DIC.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Síndrome da Liberação de Citocina/complicações , Coagulação Intravascular Disseminada/complicações , Fator VIII/metabolismo , Pneumonia Viral/complicações , Trombose Venosa/complicações , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Testes de Coagulação Sanguínea , Plaquetas/patologia , Plaquetas/virologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Síndrome da Liberação de Citocina/diagnóstico , Síndrome da Liberação de Citocina/mortalidade , Síndrome da Liberação de Citocina/virologia , Coagulação Intravascular Disseminada/diagnóstico , Coagulação Intravascular Disseminada/mortalidade , Coagulação Intravascular Disseminada/virologia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Pulmão/irrigação sanguínea , Pulmão/efeitos dos fármacos , Pulmão/patologia , Pulmão/virologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Prognóstico , Proteína S/metabolismo , Estudos Retrospectivos , Índice de Gravidade de Doença , Análise de Sobrevida , Trombose Venosa/diagnóstico , Trombose Venosa/mortalidade , Trombose Venosa/virologia
15.
Chirurg ; 91(7): 588-594, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32504106

RESUMO

BACKGROUND: The incidence of deep vein thrombosis (DVT) in CoViD-19 patients in intensive care units (ICU) has so far been investigated in only a few studies. Prospective comparative studies with non-CoViD-19 ICU patients are completely lacking. OBJECTIVE: Evaluation of the incidence of DVT in ICU patients with CoViD-19 compared to non-CoViD-19 ICU patients who were treated in the University Hospital Augsburg during the same period. In addition, the aim was to investigate what type of anticoagulation was present in CoViD-19 patients at the time the DVT occurred and to what extent DVT is associated with increased mortality in this patient population. MATERIAL AND METHODS: In this prospective single center study, which was conducted between 18 April 2020 and 30 April 2020, 20 SARS-CoV2 positive patients were compared with 20 non-CoVid-19 patients in the ICU with respect to the occurrence of DVT. For this purpose, demographic data, laboratory parameters, and clinical outcomes were recorded and evaluated. RESULTS: The rate of DVT in the investigated patient collective was markedly higher in patients with SARS-CoV2 (CoViD-19 patients 20% vs. non-CoViD-19 patients 5%). Both DVT and elevated D­dimer levels were associated with increased mortality in the present study. CONCLUSION: We recommend the determination of D­dimer levels and, in the case of elevated levels, the broad indication for compression sonography of the deep leg veins on admission of patients with suspected or confirmed SARS-CoV2. In this way DVT in the setting of CoViD-19 can be recognized early and therapeutic anticoagulation can be started. All inpatient CoViD-19 patients should receive thrombosis prophylaxis with low molecular weight heparin. Further studies on point of care methods (TEG®, ROTEM®) for the detection of hypercoagulability in SARS-CoV2 are necessary.


Assuntos
Infecções por Coronavirus , Unidades de Terapia Intensiva , Pandemias , Pneumonia Viral , Trombose Venosa , Betacoronavirus , Infecções por Coronavirus/complicações , Humanos , Pneumonia Viral/complicações , Dados Preliminares , Estudos Prospectivos , Fatores de Risco , Trombose Venosa/complicações , Trombose Venosa/epidemiologia
16.
PLoS One ; 15(6): e0235003, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555683

RESUMO

INTRODUCTION: Deep vein thrombosis (DVT) is a frequent burden and a post-thrombotic syndrome (PTS) can be a serious long-term consequence. Iliofemoral DVT should be associated with severe forms of PTS. Therefore an early thrombus removal has been recommended in specific conditions. The aim of this study was to find out both, the long-term results after surgical thrombectomy of iliofemoral DVT in respect of the development of PTS as well as the venous hemodynamics after surgery concerning venous reflux and venous obstruction. METHODS: Sixty-seven patients who underwent surgical thrombectomy between the years 2000 and 2014 were included in this study; iliofemoral DVT was present in 52 of these patients. 35 patients could be reinvestigated after a mean follow-up of 8.5 years. CEAP (Clinical-Etiological-Anatomical-Pathophysiological) and Villalta scores were recorded in order to describe and assess PTS. Follow-up examinations included a detailed duplex mapping. Venous hemodynamics were measured by digital photoplethysmography and venous occlusion plethysmography. RESULTS: The primary patency rate of the iliofemoral segment was 88% after 8.5 years. 48% of all patients showed reflux in deep vein segments. Mild or moderate PTS occurred in 57% of all patients. Notably, there was no patient with an active ulcer or severe PTS. The mean venous outflow volume of all patients in the treated legs was 66.1 ml/100ml/min and significantly less than in the controlled contralateral non-treated legs (p<0.05). The mean venous refilling time was 16.3 seconds, while the mean value of the non-treated contralateral legs was 25.6 seconds and therefore significantly higher (p<0.05). CONCLUSION: Even though venous hemodynamics are significantly inferior in the treated legs, this study demonstrates excellent patency rates and good clinical outcome after surgical thrombectomy of iliofemoral veins.


Assuntos
Veia Femoral/cirurgia , Trombectomia/métodos , Trombose Venosa/cirurgia , Feminino , Veia Femoral/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Pós-Trombótica/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Grau de Desobstrução Vascular , Trombose Venosa/complicações
17.
Neurology ; 95(10): 454-457, 2020 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-32586898

Assuntos
Infarto Cerebral/diagnóstico por imagem , Infecções por Coronavirus/diagnóstico por imagem , Globo Pálido/diagnóstico por imagem , Hipóxia/diagnóstico , Pneumonia Viral/diagnóstico por imagem , Betacoronavirus , Infarto Cerebral/complicações , Infarto Cerebral/metabolismo , Infarto Cerebral/fisiopatologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/metabolismo , Infecções por Coronavirus/fisiopatologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/metabolismo , Cetoacidose Diabética/complicações , Cetoacidose Diabética/metabolismo , Diagnóstico Diferencial , Feminino , Humanos , Coma Hiperglicêmico Hiperosmolar não Cetótico/complicações , Coma Hiperglicêmico Hiperosmolar não Cetótico/metabolismo , Hipertensão/complicações , Hipertensão/fisiopatologia , Hipóxia/complicações , Hipóxia/metabolismo , Hipóxia-Isquemia Encefálica/diagnóstico , Leucoencefalite Hemorrágica Aguda/diagnóstico , Pulmão/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/metabolismo , Pneumonia Viral/fisiopatologia , Insuficiência Respiratória/complicações , Insuficiência Respiratória/metabolismo , Insuficiência Respiratória/fisiopatologia , Choque/complicações , Choque/metabolismo , Choque/fisiopatologia , Veia Subclávia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem
18.
Circulation ; 142(2): 114-128, 2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32421381

RESUMO

BACKGROUND: To investigate deep vein thrombosis (DVT) in hospitalized patients with coronavirus disease 2019 (COVID-19), we performed a single institutional study to evaluate its prevalence, risk factors, prognosis, and potential thromboprophylaxis strategies in a large referral and treatment center. METHODS: We studied a total of 143 patients with COVID-19 from January 29, 2020 to February 29, 2020. Demographic and clinical data, laboratory data, including ultrasound scans of the lower extremities, and outcome variables were obtained, and comparisons were made between groups with and without DVT. RESULTS: Of the 143 patients hospitalized with COVID-19 (age 63±14 years, 74 [51.7%] men), 66 patients developed lower extremity DVT (46.1%: 23 [34.8%] with proximal DVT and 43 [65.2%] with distal DVT). Compared with patients who did not have DVT, patients with DVT were older and had a lower oxygenation index, a higher rate of cardiac injury, and worse prognosis, including an increased proportion of deaths (23 [34.8%] versus 9 [11.7%]; P=0.001) and a decreased proportion of patients discharged (32 [48.5%] versus 60 [77.9%]; P<0.001). Multivariant analysis showed an association only between CURB-65 (confusion status, urea, respiratory rate, and blood pressure) score 3 to 5 (odds ratio, 6.122; P=0.031), Padua prediction score ≥4 (odds ratio, 4.016; P=0.04), D-dimer >1.0 µg/mL (odds ratio, 5.818; P<0.014), and DVT in this cohort, respectively. The combination of a CURB-65 score 3 to 5, a Padua prediction score ≥4, and D-dimer >1.0 µg/mL has a sensitivity of 88.52% and a specificity of 61.43% for screening for DVT. In the subgroup of patients with a Padua prediction score ≥4 and whose ultrasound scans were performed >72 hours after admission, DVT was present in 18 (34.0%) patients in the subgroup receiving venous thromboembolism prophylaxis versus 35 (66.0%) patients in the nonprophylaxis group (P=0.010). CONCLUSIONS: The prevalence of DVT is high and is associated with adverse outcomes in hospitalized patients with COVID-19. Prophylaxis for venous thromboembolism may be protective in patients with a Padua protection score ≥4 after admission. Our data seem to suggest that COVID-19 is probably an additional risk factor for DVT in hospitalized patients.


Assuntos
Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Trombose Venosa/diagnóstico , Adulto , Idoso , Anticoagulantes/uso terapêutico , Betacoronavirus/isolamento & purificação , Pressão Sanguínea , China/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Estimativa de Kaplan-Meier , Extremidade Inferior/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Prevalência , Prognóstico , Taxa Respiratória , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/tratamento farmacológico , Trombose Venosa/epidemiologia
20.
Transl Res ; 225: 54-69, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32407789

RESUMO

Venous thrombosis within the hepatic vasculature is associated with a distinct array of risk factors, characteristics, and potential complication. As such, it entails unique management considerations and strategies relative to the more common categories of venous thromboembolic disease. Although broadly divided into thrombosis of the afferent vasculature (the portal venous system) and efferent vasculature (the hepatic venous system), presentations and management strategies within these groupings are heterogeneous. Management decisions are influenced by a variety of factors including the chronicity, extent, and etiology of thrombosis. In this review we examine both portal vein thrombosis and hepatic vein thrombosis (and the associated Budd-Chiari Syndrome). We consider those factors which most impact presentation and most influence treatment. In so doing, we see how the particulars of specific cases introduce nuance into clinical decisions. At the same time we attempt to organize our understanding of such cases to help facilitate a more systematic approach. Critically, we must recognize that although increasing evidence is emerging to help guide our management strategies, the available data remain limited and largely retrospective. Indeed, current paradigms are based largely on observational experiences and expert consensus. As new and more rigorous studies emerge, treatment strategies are likely to be continually refined, and paradigm shifts are sure to occur.


Assuntos
Hepatopatias/complicações , Trombose Venosa/terapia , Humanos , Veia Porta/patologia , Trombose Venosa/complicações
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