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1.
J Surg Res ; 245: 500-509, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31446192

RESUMO

BACKGROUND: Abdominal surgery may increase the risk of splanchnic vein thrombosis (SVT). We determined the incidence of SVT after abdominal surgery and identified groups at highest risk. MATERIALS AND METHODS: MEDLINE and Embase were searched for clinical studies evaluating the incidence of postoperative SVT after abdominopelvic surgery. Study selection, data abstraction, and risk of bias assessment were carried out independently by two reviewers. Clinical heterogeneity was explored by subgroup analyses (i.e., type of intra-abdominal procedure and organ group). RESULTS: Of 5549 abstracts screened, 48 were analyzed. Pooled incidence of SVT (n = 50,267) was 2.68% [95% confidence interval (CI), 2.24 to 3.11] (1347 events), I2 = 96%. Pooled incidence of SVT in high-risk procedures were splenectomy with devascularization (24%), hepatectomy in patients with cirrhosis (9%), and pancreatectomy with venous resection (5%). Pooled incidence of symptomatic and asymptomatic SVT was 1.02% (95% CI: 0.97% to 1.07%) and 0.98% (95% CI 0.88% to 1.07%), respectively. Most common causes of SVT-related mortality were irreversible thrombosis, bowel ischemia, liver failure, and gastrointestinal bleed. Most studies included were at a high risk of bias due to lack of prospective data collection and lack of SVT screening for all participants. CONCLUSIONS: Incidence of SVT after abdominal surgery is low but remains a relevant complication. Patients undergoing procedures involving surgical manipulation of the venous system and splenectomy are at the highest risk. Given the life-threatening risks associated with SVT, there is a need for larger prospective studies on the incidence and impact of SVT after abdominal surgery.


Assuntos
Cavidade Abdominal/cirurgia , Complicações Pós-Operatórias/epidemiologia , Circulação Esplâncnica , Trombose Venosa/epidemiologia , Hepatectomia/efeitos adversos , Humanos , Incidência , Pancreatectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Esplenectomia/efeitos adversos , Trombose Venosa/etiologia
2.
Am Surg ; 85(11): 1288-1293, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775973

RESUMO

Portal vein system thrombosis (PVST) is a form of venous thrombosis, which behaves as a common and potentially life-threatening complication after splenectomy. Numerous studies have been made to investigate the mechanism and the risk factors of PVST. However, the research on the prevention and treatment of PVST associated with platelet's (PLT) rule of change is rare. This work mainly investigates the PLT's rule of change and its correlativity with the formation of PVST after splenectomy. The retrospective study included 117 patients who underwent splenectomy from August 2014 to June 2018 and monitored by blood routine, D-dimer (D-D), and portal vein system ultrasound routinely after splenectomy. The changes of PLT and D-D were recorded and compared before and after each operation. We analyzed the changes of PLT and D-D as well as the incidence of PVST postoperatively. Most of the patients' PLT increased significantly after splenectomy. On the first day after operation, there were 80 patients' (68.38%) PLT recovered to normal or above normal. The proportion of patients with abnormally high PLT value on the seventh and fourteenth day were 60.68 per cent and 81.20 per cent, respectively. Thereinto, there were 67 patients' (57.26%) PLT beyond 500 × 109/L on the 14th day. The D-D of all patients exceeded the normal range on the first, seventh, and fourteenth day after operation, and the difference was statistically significant (P < 0.05), which behaved similar like PLT. Meanwhile, our color Doppler ultrasonography showed that the incidence of PVST was 70.79 per cent. Among the patients with PVST, 82 (100%) patients' PLT was increased after operation. The PLT of patients increased obviously after splenectomy. The increased blood viscosity caused by the consecutive elevation of PLT may result in a higher PVST incidence. Early intervention and treatment are needed clinically for PVST after splenectomy.


Assuntos
Sistema Porta , Complicações Pós-Operatórias/sangue , Esplenectomia/efeitos adversos , Trombose Venosa/sangue , Adolescente , Adulto , Idoso , Viscosidade Sanguínea , Criança , Ecocardiografia Doppler em Cores , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Hiperesplenismo/diagnóstico , Hipertensão Portal/diagnóstico , Incidência , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas/estatística & dados numéricos , Sistema Porta/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Ultrassonografia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/epidemiologia , Trombose Venosa/etiologia , Adulto Jovem
3.
Vasc Health Risk Manag ; 15: 449-461, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31695400

RESUMO

Splanchnic vein thrombosis (SVT) including portal, mesenteric, splenic vein thrombosis and the Budd-Chiari syndrome, is a manifestation of unusual site venous thromboembolism. SVT presents with a lower incidence than deep vein thrombosis of the lower limbs and pulmonary embolism, with portal vein thrombosis and Budd-Chiari syndrome being respectively the most and the least common presentations of SVT. SVT is classified as provoked if secondary to a local or systemic risk factor, or unprovoked if the causative trigger cannot be identified. Diagnostic evaluation is often affected by the lack of specificity of clinical manifestations: the presence of one or more risk factors in a patient with a high clinical suspicion may suggest the execution of diagnostic tests. Doppler ultrasonography represents the first line diagnostic tool because of its accuracy and wide availability. Further investigations, such as computed tomography and magnetic resonance angiography, should be executed in case of suspected thrombosis of the mesenteric veins, suspicion of SVT-related complications, or to complete information after Doppler ultrasonography. Once SVT diagnosis is established, a careful patient evaluation should be performed in order to assess the risks and benefits of the anticoagulant therapy and to drive the optimal treatment intensity. Due to the low quality and large heterogeneity of published data, guidance documents and expert opinion could direct therapeutic decision, suggesting which patients to treat, which anticoagulant to use and the duration of treatment.


Assuntos
Veias Mesentéricas , Veia Porta , Veia Esplênica , Trombose Venosa , Anticoagulantes/uso terapêutico , Humanos , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/fisiopatologia , Veia Porta/diagnóstico por imagem , Veia Porta/fisiopatologia , Valor Preditivo dos Testes , Fatores de Risco , Circulação Esplâncnica , Veia Esplênica/diagnóstico por imagem , Veia Esplênica/fisiopatologia , Resultado do Tratamento , Ultrassonografia Doppler , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico , Trombose Venosa/epidemiologia , Trombose Venosa/fisiopatologia
4.
Hosp Pract (1995) ; 47(4): 181-185, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31580732

RESUMO

Purpose: There is limited clinical data evaluating anticoagulation with the direct oral anticoagulants (DOACs) in morbidly obese patients. We sought to examine the efficacy in preventing stroke or other systemic embolic events and safety of apixaban, dabigatran, and rivaroxaban, in comparison to warfarin in patients with either a body-mass index (BMI) over 40 kg/m2 and/or a weight over 120 kg.Methods: After approval from IRB, we collected retrospective data from our institution's records on 180 patients. We analyzed the rates of stroke and systemic embolic events as defined as ischemic stroke, pulmonary embolism (PE), deep vein thrombosis (DVT), and myocardial infarction (MI) as well as major bleeding in morbidly obese patients receiving apixaban, dabigatran, or rivaroxaban in comparison to warfarin for anticoagulation due to nonvalvular atrial fibrillation, postoperative thrombus prophylaxis, or DVT/PE treatment and/or reduction in risk for recurrence.Results: The final analysis included 90 patients in both arms. Fifty-two percent (n = 41) of patients in the DOAC group were on apixaban therapy, 12% (n = 11) on dabigatran, and 37% (n = 33) on rivaroxaban. The average BMI and weight in the DOAC group were 46.7 kg/m2 and 139.3 kg, respectively. In the warfarin group, average BMI and weight were 45.8 kg/m2 and 135.9 kg, respectively. There were 11 patients who developed a stroke or thromboembolic event in the DOAC group and 10 in the warfarin group (OR 1.11, 95% confidence interval [CI] 0.45-2.78; p = 0.82). The events in the DOAC group consisted of three patients who developed ischemic stroke, three patients who developed DVTs, one who developed a PE, and four patients who developed MIs. There were two major bleeding events in the DOAC group and three events in the warfarin group (p = 0.65).Conclusions: Anticoagulation therapy with DOACs in morbidly obese patients may be a safe and effective alternative to warfarin for prevention of stroke or systemic embolic events. However, additional studies are necessary to confirm these findings.


Assuntos
Anticoagulantes/administração & dosagem , Anticoagulantes/classificação , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Obesidade Mórbida/epidemiologia , Varfarina/administração & dosagem , Administração Oral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Índice de Massa Corporal , Dabigatrana/administração & dosagem , Feminino , Hemorragia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Embolia Pulmonar/epidemiologia , Pirazóis/administração & dosagem , Piridonas/administração & dosagem , Estudos Retrospectivos , Rivaroxabana/administração & dosagem , Acidente Vascular Cerebral/prevenção & controle , Trombose Venosa/epidemiologia , Varfarina/uso terapêutico , Adulto Jovem
5.
Medicine (Baltimore) ; 98(39): e16774, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574793

RESUMO

BACKGROUND: Total hip arthroplasty (THA) relieves pain and restores function in patients with severe rheumatoid arthritis and osteoarthritis. Over the past few decades, several authors have attempted to assess the efficacy and safety of simultaneous bilateral THA compared with staged bilateral THA. The purpose of this meta-analysis is to compare the mortalities and complications between simultaneous bilateral THA and staged bilateral THA. METHODS: A literature search to identify eligible studies was undertaken to identify all relevant articles published until August 2018. We included studies that compared simultaneous bilateral THA and staged bilateral THA and their effects on mortality and complications. The outcomes included mortality, the occurrence of deep venous thrombosis (DVT), the occurrence of pulmonary embolism (PE), respiratory complications, cardiovascular complications, digestive system complications and the occurrence of dislocation. Stata 12.0 was used for the meta-analysis. RESULTS: Nineteen studies involving 59,257 patients were identified; among them, 16,758 patients were selected for treatment with simultaneous bilateral THA, and 42,499 patients were chosen for the purpose of staged bilateral THA. The meta-analysis results demonstrated that there was no significant difference between simultaneous bilateral THA and staged bilateral THA in terms of mortality (risk ratio [RR] = 1.15, 95% CI = 0.76, 1.74; P = .520). Compared with staged bilateral THA, simultaneous bilateral THA was associated with a reduction in the occurrence of DVT, PE and respiratory complications (P < .05). There were no significant differences in the cardiovascular complications, digestive system complications or the occurrence of dislocation and infection (P = .057). CONCLUSIONS: We observed that the prevalence of DVT, PE and respiratory complications was considerably lower with the use of simultaneous bilateral THA than with the use of staged bilateral THA. Thus, simultaneous bilateral THA is a considerably safer procedure than staged bilateral THA in selected THA patients.


Assuntos
Artrite Reumatoide/cirurgia , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Osteoartrite do Quadril/cirurgia , Complicações Pós-Operatórias/epidemiologia , Artroplastia de Quadril/mortalidade , Doenças do Sistema Digestório/epidemiologia , Cardiopatias/epidemiologia , Humanos , Luxações Articulares/epidemiologia , Prevalência , Embolia Pulmonar/epidemiologia , Transtornos Respiratórios/epidemiologia , Trombose Venosa/epidemiologia
6.
Br J Nurs ; 28(19): S10-S18, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31647744

RESUMO

Central vascular access device (CVAD)-related sheaths, sometimes described as 'fibrin sheaths', may result in minor or significant sequelae, from persistent withdrawal occlusion (PWO) to infective sheaths associated with increased morbidity and mortality. The authors studied 179 patients who underwent isotope scans, where isotope was infused via the CVAD. Isotope was found to bind to the sheaths around the catheters of some patients. The amount of uptake was taken to be an extent to which a sheath had developed around the CVAD. The degree of uptake of isotope was categorised into three groups: low uptake, moderate uptake and high uptake. Patients were then followed up from the date the CVAD was inserted to 12 months after the date of the isotope scan, until the device was removed or to the date the patient died, to identify incidence of infection, thrombosis and PWO. PWO incidence in all levels of uptake was around 5-7%. Bloodstream infection (BSI) incidence for low uptake was 7% (9/130), moderate uptake 10% (3/30) and for patients with significant uptake 16% (3/19). Thrombosis for no uptake was less than 1% (1/130), moderate uptake 7% (2/30), and significant uptake had no incidence of thrombosis. Total complications: no uptake 15%, moderate uptake 23% and significant uptake 21%. This single-centre study showed that patients with isotope-highlighted sheaths experienced higher incidence of infective, thrombotic and total complications.


Assuntos
Infecções Relacionadas a Cateter/epidemiologia , Cateteres Venosos Centrais/efeitos adversos , Fibrina , Trombose Venosa/epidemiologia , Humanos , Incidência
7.
Medicine (Baltimore) ; 98(37): e17103, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517841

RESUMO

BACKGROUND: To assess whether the ultrasound (US) is a reliable approach in detecting lower-limb deep-vein thrombosis (DVT) in patients without symptoms of DVT. METHODS: The research team performed a systematic search in PubMed, Ovid, Cochrane, and Web of Science without language or date restrictions. Full-text reports on prospective diagnostic studies involve the detection of lower-limb proximal and distal DVT in patients without symptoms of DVT using US and venography. A meta-analysis was performed using Meta-DiSc (version 1.4), providing the pooled sensitivity, specificity, positive (LR+) and negative (LR-) likelihood ratios of the detection accuracy of US. There were 4 different classes of subgroup analysis-the class of patients stratified by location of US exam (proximal, distal, whole leg), the class stratified by technique (color/doppler, compression, both modalities), the class stratified by kind of surgery (orthopedic, otherwise hospitalized) and the class stratified by era of publishing (1980s, 1990s, 2000s). The study quality and the risk of bias were evaluated using QUADAS-2, with heterogeneity was assessed and quantified by the Q score and I statistics, respectively. RESULTS: The meta-analysis included 26 articles containing 41 individual studies with a total of 3951 patients without symptoms of DVT. Using venography as the gold standard, US for proximal DVT had a pooled sensitivity of 59% (95% confidence interval (CI) = 51%-66%) and a pooled specificity of 98% (95% CI = 97%-98%), US for distal DVT had a poor sensitivity of 43% (95% CI = 38%-48%) and a pooled specificity of 95% (95% CI = 94%-96%), US for whole-leg DVT had a pooled sensitivity of 59% (95% CI = 54%-64%) and a pooled specificity of 95% (95% CI = 94%-96%), US for post-major orthopedic surgery patients had a pooled sensitivity of 52% (95% CI = 49%-55%), and US for other types of patients had a pooled sensitivity of 58% (95% CI = 43%-72%). Pure compression technique for DVT had a poor sensitivity of 43% (95% CI = 39%-48%), pure color/doppler technique for DVT had a pooled sensitivity of 58% (95% CI = 53%-63%), compression and color/doppler technique for DVT had a pooled sensitivity of 61% (95% CI = 48%-74%). CONCLUSION: US could be a useful tool for diagnosing DVT, but it has a lower positive rate and a higher false negative rate. The rate of missed diagnosis of lower-limb DVT by US amounts to 50% or so in the patients without symptoms of DVT. The negative results do not preclude the possibility of DVT and if appropriate heightened surveillance and continued monitoring or try a more accurate inspection method is warranted. The whole leg evaluation and color/doppler technique should be the preferred approach.


Assuntos
Diagnóstico Tardio , Extremidade Inferior/irrigação sanguínea , Ultrassonografia/normas , Trombose Venosa/diagnóstico , Humanos , Extremidade Inferior/fisiopatologia , Ultrassonografia/métodos , Ultrassonografia/estatística & dados numéricos , Trombose Venosa/epidemiologia
8.
Transplant Proc ; 51(6): 1880-1886, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31399172

RESUMO

BACKGROUND: Both hyponatremia and portal vein thrombosis (PVT) reflect the severity of liver dysfunction and are independently associated with increased morbidity in cirrhotic patients. In this study, we analyzed effects of hyponatremia on PVT development. METHODS: Data on adult liver transplants (LTs) in the Model for End-Stage Liver Disease era through September 2016 were obtained. Receiver operating curves and multivariable logistic regression models were constructed to evaluate the association between serum sodium level and PVT. Based on the receiver operating curves, hyponatremia was defined as a sodium level below 125 mEq/L. RESULTS: Of the 49,155 recipients included, 16% had hyponatremia (n = 7828) and 9% had PVT (n = 4414) at transplant. Subjects with hyponatremia had lower rates of PVT at the time of LT (4.4% vs 10.1%, P < .001), incidence of nonalcoholic steatohepatitis (10.8% vs 16.5%, P < .001), diabetes (19.7% vs 24.3%, P < .001), and need for dialysis (8.8% vs 16.0%, P < .001) as well as higher rates of chronic hepatitis C and B (37.6% vs 29.1%, P < .001 and 2.9% vs 1.7%, P < .001). Multivariable regression analysis confirmed that hyponatremia was independently associated with a decreased likelihood of PVT (odds ratio [OR], 0.44, P < .001). African American patients had a lower incidence of PVT (OR, 0.70; P < .001). Variables associated with a higher incidence of PVT were: nonalcoholic steatohepatitis (OR, 1.15; P = .005), moderate-to-severe ascites (OR, 1.10; P = .008), and Hispanic ethnicity (OR, 1.2; P < .001). CONCLUSION: Hyponatremia is associated with a lower rate of PVT independent of severity of liver disease and other thrombotic risk factors. This protective effect should be taken into consideration during the perioperative management of hyponatremia in patients undergoing LT.


Assuntos
Hiponatremia/etiologia , Transplante de Fígado/efeitos adversos , Veia Porta , Complicações Pós-Operatórias/etiologia , Trombose Venosa/etiologia , Adulto , Idoso , Feminino , Humanos , Hiponatremia/epidemiologia , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Complicações Pós-Operatórias/epidemiologia , Diálise Renal , Estudos Retrospectivos , Fatores de Risco , Trombose Venosa/epidemiologia
9.
BMC Pregnancy Childbirth ; 19(1): 294, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409379

RESUMO

BACKGROUND: The risk of venous thromboembolism (VTE) during pregnancy and puerperal periods is significantly higher than during the non-pregnant period and is one of the major causes of maternal mortality. Developed countries have promulgated guidelines for risk assessment and prevention of maternal VTE, and standardized management has led to a significant reduction in maternal mortality. However, there is a paucity of relevant research related to pregnancy and puerperal VTE in China. METHODS/DESIGN: We will perform a prospective cohort study and recruit 13,000 pregnant women from 2018 to 2020 in Beijing, China. VTE risk assessment will be conducted using the Royal College of Obstetricians and Gynaecologists (RCOG) pregnancy and puerperal VTE risk-assessment-scoring tool during early and late pregnancy, as well as during the puerperal period. Venous ultrasonography of lower extremities, routine blood tests, and coagulation parameters will be examined. These VTE risk assessments will be performed again if patients have VTE-related symptoms during their pregnancies, or if any of the following occur: (1) patients are hospitalized over 7 days due to any pregnancy complications; (2) patients are placed under strict bed rest for ≥ 3 days to prevent miscarriage. For patients with a confirmed diagnosis of VTE, treatment and follow-up plans will be decided jointly by the obstetricians, vascular surgeons, and pulmonologists. All patients in the study will be followed up by dedicated healthcare providers for up to 42 days postpartum. Statistical analyses will be performed to test the feasibility of the RCOG scoring tool for the Chinese population. The RCOG scoring tool will then be revised based upon the characteristics of the Chinese population, and the revised assessment scoring tool will then be tested in the cohort to evaluate its efficacy. Finally, a pregnancy and puerperal VTE risk-assessment tool will be proposed based on our study results. DISCUSSION: This study will establish a preliminary VTE risk-assessment tool that is applicable to pregnant and puerperal women in China and provide guidelines for further thrombophylactic interventions. Furthermore, we wish to draw increased attention to pregnancy-associated VTE to reduce VTE-related mortality. TRIAL REGISTRATION: Chi CTR1800015848 (04/24/2018).


Assuntos
Complicações Cardiovasculares na Gravidez/epidemiologia , Transtornos Puerperais/epidemiologia , Embolia Pulmonar/epidemiologia , Medição de Risco/métodos , Tromboembolia Venosa/epidemiologia , Trombose Venosa/epidemiologia , Repouso em Cama , China/epidemiologia , Estudos de Coortes , Feminino , Humanos , Tempo de Internação , Gravidez , Estudos Prospectivos
10.
J Orthop Surg Res ; 14(1): 235, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337430

RESUMO

BACKGROUND: Excessive blood loss caused by total joint arthroplasty (TJA) often increases the requirement for blood transfusion, which is associated with adverse outcomes. The purpose of this study was to determine the relationship between perioperative transfusion and postoperative DVT in TJA. METHODS: This retrospective study reviewed medical records of 715 patients, who consecutively underwent primary unilateral total knee arthroplasty (TKA) or total hip arthroplasty (THA) at our institution between September 2015 and March 2017. Demographic, clinical and surgical parameters were introduced into the univariate analysis to find risk factors for DVT within postoperative 30 days. In order to identify if allogenic blood transfusion was independently associated with DVT, a multivariate logistic regression analysis was conducted to adjust for gender, age, body mass index (BMI), diagnosis, and type of surgery. RESULTS: The incidence of perioperative allogenic blood transfusion was 12.4% (n = 89). Fifty-seven patients (8.0%) developed DVT after surgery. Univariate analysis demonstrated that there were differences between DVT group and non-DVT group in gender (P = 0.045), age (P < 0.001), BMI (P = 0.026), primary diagnosis (P = 0.001), type of surgery (P < 0.001), and transfusion rates (P = 0.040). After adjustment by using multivariate logistic regression analysis, transfusion appeared to be the independent risk factor for DVT in TJA (P = 0.001; OR = 3.9, 95%CI 1.8-8.4). CONCLUSION: We found that perioperative allogenic blood transfusion was significantly associated with DVT following TJA. In order to reduce the risk of DVT and other adverse outcomes, methods to decrease transfusion rates should be used in clinical practice.


Assuntos
Artroplastia de Quadril/tendências , Artroplastia do Joelho/tendências , Transfusão de Sangue/tendências , Assistência Perioperatória/tendências , Complicações Pós-Operatórias/epidemiologia , Trombose Venosa/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Trombose Venosa/diagnóstico , Adulto Jovem
11.
J Stroke Cerebrovasc Dis ; 28(10): 104247, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31350167

RESUMO

BACKGROUND/OBJECTIVE: Most of the studies and registries related to cerebral venous thrombosis (CVT) are reported from European countries and the United States. The objective of the present study is to identify risk factors, presentation, and outcome of CVT in Asian patients. METHODS: Asian CVT registry is a prospective multinational observational study that included patients (aged > 16 years) with symptomatic CVT. RESULTS: Eight hundred and twelve patients (59% women) from 20 centers in 9 Asian countries were included. Mean age of the patients was 31 years. Motor weakness in limbs was present in 325 (40%) patients. One hundred and eighty (22.1%) patients had a normal Glasgow coma scale (GCS) at presentation, and another 529 patients (65%) had GCS between 11 and 14. The rest (103; 13%) had a GCS of less than 10 at presentation. Permanent risk factors were present in 264 (33%) patients, transient in 342 (42%) patients, both in 43 (5%) patients and no risk factors were found in 163 (20%) patients. Anemia was present in 51%, use of oral contraceptive pills (OCP) was present in 12% women and a hypercoaguable state was present in more than 40% of those tested. One hundred and forty-three cases (18%) were in women who were either pregnant (18; 2%) or in the puerperium (up to 6 weeks postpartum; N = 125; 15%). A total of 86 (10.5%) patients were diagnosed with infection in any part of the body. The most common MRI finding was local brain edema or ischemia (53.3%) followed by hemorrhage (26.7%). Twenty-seven patients (3.3%) died during hospital stay. The mRS score at discharge was available for 661 (81%) patients. Of these, 577 (87.3%) had good functional outcome at discharge. Motor weakness at presentation, GCS of 9 or less and mental status disorder were the strongest independent predictors of mortality at last follow-up among patients with CVT. CONCLUSIONS: Important differences were identified as compared to western data including younger age, high frequency of anemia, low use of OCP, and high frequency of hypercoaguable states. Functional outcome at discharge was good.


Assuntos
Trombose Intracraniana/epidemiologia , Trombose Venosa/epidemiologia , Adolescente , Adulto , Fatores Etários , Anemia/epidemiologia , Ásia/epidemiologia , Anticoncepcionais Orais Hormonais/efeitos adversos , Feminino , Escala de Coma de Glasgow , Mortalidade Hospitalar , Humanos , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/mortalidade , Trombose Intracraniana/terapia , Masculino , Gravidez , Estudos Prospectivos , Recuperação de Função Fisiológica , Sistema de Registros , Fatores de Risco , Trombofilia/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/mortalidade , Trombose Venosa/terapia , Adulto Jovem
12.
Ren Fail ; 41(1): 623-628, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31269849

RESUMO

Objective: The aim of this study is to investigate the role of prophylactic anticoagulation regimens based on low molecular weight heparin (LMWH) or aspirin in thromboembolic events in patients with primary membranous nephropathy (PMN). Methods: A total of 717 patients with PMN were consecutively enrolled in this retrospective study. The propensity score matching method was utilized to adjust for the selection bias inherent in an analysis of outcomes, which was stratified by the anticoagulation prophylaxis regimen. Results: According to the anticoagulation prophylaxis regimen, patients were assigned into three groups: only LMWH therapy (L + A-, n = 53), only aspirin therapy (L - A+, n = 97), and no therapy of LMWH or aspirin (L - A-, n = 567). After performing 1:1 match, 37 patients were selected in the L + A - group and the L - A- group, respectively, and 94 patients were selected in the L - A+ group and the L - A- group, respectively. It showed that the prophylactic use of LMWH had no protective effects on arterial thromboembolic events (ATEs) (10.8% vs. 21.6%, p = .21) or venous thromboembolic events (VTEs) (8.1% vs. 10.8%, p = .69). The incidence of VTEs in the L - A+ group was lower than the L - A- group (2.1% vs. 10.6%, p = .02), while there were no significant differences in the incidences of ATEs between the L - A+ group and the L - A- group (5.3% vs. 7.4%, p = .55). Conclusions: The prophylactic use of LMWH showed no benefits on the incidence of ATEs or VTEs in patients with PMN. Aspirin effectively decreased the incidence of VTEs, without effects on the occurrence of ATEs.


Assuntos
Aspirina/uso terapêutico , Glomerulonefrite Membranosa/epidemiologia , Heparina de Baixo Peso Molecular/uso terapêutico , Tromboembolia Venosa/epidemiologia , Trombose Venosa/epidemiologia , Adulto , Idoso , Pequim/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Fatores de Risco , Tromboembolia Venosa/prevenção & controle , Trombose Venosa/prevenção & controle
13.
Medicine (Baltimore) ; 98(30): e16514, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348262

RESUMO

ABSTRCT: The purpose of this study was to evaluate the efficacy and safety of rivaroxaban for the treatment of cancer-associated venous thromboembolism (VTE).We performed a retrospective chart review of cancer patients with a pulmonary embolism, deep vein thrombosis, or both. Our analysis included all patients who received rivaroxaban from March 2013 to June 2016 at the Hemato-Oncology Division at the Pusan National University Hospital in Korea.Preliminary results identified 123 patients with a history of cancer that were treated with rivaroxaban. The average duration of rivaroxaban therapy was 95.25 days. While 35 patients had resolved VTE after the initiation of rivaroxaban, only one patient had it recur on rivaroxaban treatment. Major bleeding was observed in 6 (4.9%) patients and minor bleeding in 12 (9.8%) patients. The majority of bleeding events occurred spontaneously and most incidences of bleeding could be treated conservatively. Recurrence and major bleeding events on rivaroxaban were relatively low despite the fact that many patients had metastatic disease. Among 52 patient deaths (42.3%), none were due to VTE or bleeding complications; the cause of death in the majority of cases was cancer progression.Rivaroxaban is effective and safe for the treatment of cancer-associated VTE.


Assuntos
Neoplasias/epidemiologia , Rivaroxabana/administração & dosagem , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/prevenção & controle , República da Coreia/epidemiologia , Estudos Retrospectivos , Trombose Venosa/epidemiologia , Trombose Venosa/prevenção & controle , Adulto Jovem
14.
Br J Anaesth ; 123(3): 316-324, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31176448

RESUMO

BACKGROUND: Venous thrombosis (VT) in children is often associated with a central venous catheter (CVC). We aimed to determine the incidence of VT associated with percutaneous non-tunnelled CVCs in a general paediatric population, and to identify risk factors for VT in this cohort. METHODS: Observational, prospective study enrolling consecutive patients at a tertiary multi-disciplinary paediatric hospital. A total of 211 percutaneous, non-tunnelled CVCs were analysed. Data regarding potential risk factors for CVC-related VT were collected. Compression ultrasonography with colour Doppler was used to diagnose VT. RESULTS: Overall, 30.3% of children developed CVC-related VT, with an incidence rate of 29.6 (confidence interval, 22.5-36.9) cases/1000 CVC days. Upper body CVC location, multiple lumen CVCs, and male gender were independent risk factors for VT in multivariate analysis. All upper body VTs were in the internal jugular vein (IJV). The occurrence of CVC-related VT did not affect length of paediatric ICU or hospital stay. In patients with VT, femoral CVCs, young age, paediatric ICU admission, and a ratio of CVC/vein diameter >0.33 were associated with VT being symptomatic, occlusive, or both. IJV VT was often asymptomatic and non-occlusive. CONCLUSIONS: Paediatric non-tunnelled CVCs are frequently complicated by VT. Avoiding IJV CVCs and multiple lumen catheters could potentially reduce the overall risk of VT. However, IJV VT was more likely to be smaller and asymptomatic compared with femoral vein VT. More data are needed on the risk of complications from smaller, asymptomatic VT compared with the group of VT with symptoms or vein occlusion. Femoral vein CVCs and CVC/vein diameter >0.33 could be modifiable risk factors for VT with larger thrombotic mass. CLINICAL TRIAL REGISTRATION: ACTRN12615000442505.


Assuntos
Cateteres Venosos Centrais/efeitos adversos , Trombose Venosa/etiologia , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Criança , Pré-Escolar , Feminino , Veia Femoral/diagnóstico por imagem , Humanos , Incidência , Lactente , Veias Jugulares/diagnóstico por imagem , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Suécia/epidemiologia , Ultrassonografia Doppler em Cores , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/epidemiologia
15.
Emergencias (Sant Vicenç dels Horts) ; 31(3): 167-172, jun. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182726

RESUMO

Objetivos: Evaluar la precisión, la seguridad y la eficiencia de la ecografía realizada por urgenciólogos para el diagnóstico de la trombosis venosa profunda (TVP). Métodos: Estudio prospectivo multicéntrico de cohortes que incluyó pacientes con sospecha de TVP asignados a un grupo intervención (evaluados ecográficamente por el urgenciólogo y posteriormente por el radiólogo) y a un grupo control (evaluados únicamente por el radiólogo). Se analizaron las variables relacionadas con el paciente, el urgenciólogo, el episodio, el resultado de la prueba y los tiempos de estancia y acontecimientos a 30 días. Se calcularon la sensibilidad, la especificidad, las razones de verosimilitud positiva y negativa, y el índice kappa. Resultados: Se incluyeron 304 pacientes (95 control, 209 intervención). Ambos grupos fueron comparables. La prevalencia de TVP en la cohorte global fue de 35,5% (IC 95% 30,3-41,0). La sensibilidad de la ecografía realizada por urgenciólogos fue superior según la experiencia-curso vs meses vs uso habitual: 71,4 (IC 95% 50,0-86,0) vs 75,0 (IC 95% 80,0-95,4) vs 94,7 (IC 95% 82,7-98,5), así como la especificidad 83,3 (IC 95% 55,2-95,2) vs 100 (IC 95% 83,0100) vs 96,6 (IC 95% 88,4-99,0). Las razones de verosimilitud positiva y negativa para la ecografía realizada por urgenciólogos fueron del 27,94 y del 0,054, respectivamente. El índice de kappa fue de 0,80. El tiempo hasta la realización de la ecografía por el urgenciólogo fue de 1,81 (DE 1,46) frente a 4,39 (DE 1,81) horas del radiólogo (p = 0,007). Durante el seguimiento a 30 días, se registraron 3 muertes, ninguna de ellas por recurrencia o hemorragia. Conclusión: La ecografía realizada por urgenciólogos para el diagnóstico de TVP es precisa, segura y podría resultar eficiente. Sin embargo, se requiere de experiencia basada en el uso habitual de esta técnica


Objective: To assess the accuracy, safety, and efficiency of ultrasound images obtained by emergency physician to diagnose deep vein thrombosis (DVT). Methods: Prospective multicenter cohort study. We assigned patients suspected of having DVT to an intervention or control group. Emergency physicians took ultrasound images that were later evaluated by a radiologist in the intervention group. In the control group, images were evaluated only by the radiologist. We analyzed patient, physician, and episode variables. Test results, times until imaging, and 30-day adverse events were also analyzed. Sensitivity, specificity, positive and negative likelihood ratios, and agreement between physicians and radiologists ( Kappa statistic) were calculated. Results: A total of 304 patients (209 in the intervention group and 95 controls) were included. The groups were comparable. The overall prevalence of DVT was 35.5% (95% CI, 30.3-41.0). The sensitivity of ultrasound images obtained by emergency physicians was superior in relation to experience: 71.4 (95% CI, 50.0-86.0) for those in a training course, 75.0 (95% CI, 80.0-95.4) for those with at least 2 months' practical experience, and 94.7 (95% CI, 82.7-98.5) for routine users. Specificity statistics for the 3 levels of physician experience were 83.3 (95% CI 55.2- 95.2), 100 (95% CI 83.0-100), and 96.6 (95% CI 88.4-99.0), respectively. The positive and negative likelihood ratios for ultrasound imaging by physicians were 27.94 and 0.054, respectively. The Kappa statistic was 0.80. Mean (SD) time until a physician took ultrasound images was 1.81 (1.46) hours versus 4.39 (1.81) hours until a radiologist obtained images (P = .007). Three deaths occurred within 30 days. They were not attributable to recurrence or bleeding. Conclusions: Ultrasound images taken by emergency physicians to diagnose DVT are accurate and safe and may be efficient. However, routine experience with ultrasound is necessary


Assuntos
Humanos , Trombose Venosa/diagnóstico por imagem , Serviços Médicos de Emergência/estatística & dados numéricos , Ultrassonografia/métodos , Eficiência , Fatores de Risco , Trombose Venosa/epidemiologia , Sensibilidade e Especificidade , Tempo de Internação
16.
Semin Thromb Hemost ; 45(4): 326-333, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31041798

RESUMO

Arterial and venous thromboses are common in glioma patients, both in the perioperative period and throughout the course of the disease. High-grade glioma patients harbor underlying hypercoagulability, which predisposes these high-risk patients with prolonged immobility and neurologic deficits to thrombotic events. Despite the high incidence and recurrent nature of these complications, there is no standardized approach to the management of glioma patients, and many challenges remain. Historically, the perceived risk of intracranial and intratumoral hemorrhage limited the use of anticoagulation, favoring nonpharmacological prophylaxis and treatment. Multiple studies have demonstrated the safety and efficacy of anticoagulation when indicated, with low molecular weight heparin as the preferred short- or long-term treatment. This review will discuss the epidemiology, risk factors, and therapeutic management of both venous and arterial thrombotic complications in glioma.


Assuntos
Glioma/epidemiologia , Trombose/epidemiologia , Tromboembolia Venosa/epidemiologia , Trombose Venosa/epidemiologia , Anticoagulantes/uso terapêutico , Comorbidade , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Prognóstico , Fatores de Risco , Trombose/tratamento farmacológico , Tromboembolia Venosa/tratamento farmacológico , Trombose Venosa/tratamento farmacológico
17.
Semin Thromb Hemost ; 45(4): 321-325, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31041801

RESUMO

The incidence of venous thromboembolism (VTE) is known to be higher in patients with malignancy as compared with the general population. It is important to understand and review the epidemiology of VTE in cancer patients because it has implications regarding treatment and prognosis. Multiple studies have shown that cancer patients who develop VTE are at higher risk for mortality. This article will focus on an update regarding the epidemiology of cancer-associated thrombosis (CT). The authors will describe factors associated with CT risk including cancer type and stage at the time of diagnosis, race and ethnicity, and cancer-directed therapy. In addition, recurrent thrombosis and the effect of thromboembolism on survival in cancer patients will also be addressed.


Assuntos
Neoplasias/epidemiologia , Medição de Risco/métodos , Tromboembolia Venosa/epidemiologia , Trombose Venosa/epidemiologia , Comorbidade , Humanos , Neoplasias/mortalidade , Neoplasias/terapia , Prognóstico , Recidiva , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Taxa de Sobrevida , Tromboembolia Venosa/mortalidade , Tromboembolia Venosa/terapia , Trombose Venosa/mortalidade , Trombose Venosa/terapia
18.
Dan Med J ; 66(5)2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31066352

RESUMO

INTRODUCTION: A venous thromboembolism (VTE), i.e. deep vein thrombosis (DVT) or pulmonary embolism (PE), is a potentially lethal complication to surgical procedures. The aim of this study was to evaluate the incidence of symptomatic VTEs in a large consecutive Danish cohort treated surgically for degenerative spinal disease. METHODS: This was a retrospective, consecutive, one-centre cohort study of patients treated surgically for either cervical or lumbar degenerative disease. According to the local treatment protocol, patients with an increased risk of VTE received rivaroxaban as thrombosis prophylaxis. VTE events within six months from the surgical procedure were identified via the Danish National Patient Register and confirmed by patient chart review. RESULTS: A total of 6,145 surgical procedures were included - 808 cervical and 5,337 lumbar procedures. Twelve patients (0.2%) were examined on suspicion of symptomatic VTE, ten for DVT and two for PE. VTE was confirmed in eight patients (0.1%), seven DVT and one PE. One patient died within six months, producing a mortality rate of 0.01%. CONCLUSIONS: VTEs are an uncommon but potentially lethal complication in patients who undergo surgery for a degenerative spinal disease. Incidence and mortality were low in a consecutive cohort where rivaroxaban was used as thrombosis prophylaxis in patients with an increased preoperative risk of VTE. FUNDING: none. TRIAL REGISTRATION: not relevant.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Doenças da Coluna Vertebral/cirurgia , Tromboembolia Venosa/epidemiologia , Trombose Venosa/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/epidemiologia , Estudos Retrospectivos , Doenças da Coluna Vertebral/complicações
19.
Ann Vasc Surg ; 60: 45-51, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31075462

RESUMO

BACKGROUND: The objectives of the study were to investigate and compare the incidence of perioperative pulmonary embolism (PE) in trauma patients with below-knee deep vein thrombosis (BKDVT) and above-knee DVT (AKDVT) who need major orthopedic surgery and evaluate the usage of inferior vena cava (IVC) filters in these cases with BKDVT. METHODS: Between January 2003 and December 2017, patients with pelvic and/or lower extremity fracture diagnosed with DVT by duplex ultrasound were eligible for the study. A reduced-dose anticoagulation therapy was administered in patients without absolute contraindication to anticoagulation therapy during the perioperative period. Patients who did not undergo filter insertion with BKDVT were classified as the BKDVT group, and cases with thrombosis involving the popliteal or more proximal veins were classified as the AKDVT group; the incidence of PE was analyzed. Among patients with BKDVT, cases with or without filter deployment were placed in the filter group and control group, respectively, to evaluate the value of IVC filter in these patients. RESULTS: A total of 3295 patients with pelvic and/or lower extremity fracture were diagnosed as having DVT, among which, 2070 cases did not undergo filter insertion. The incidence of PE in the BKDVT group and AKDVT group was 2.08% (24/1154) and 3.17% (29/916), respectively. A total of 366 patients with BKDVT underwent filter placement and no PE occurred. The incidence of PE in the filter group was lower than the control group. In patients without filter placement, the cases received anticoagulation therapy and those who did not, the incidence of PE was 2.21% and 1.94%, respectively, and there was no difference between the two subgroups. CONCLUSIONS: There was no difference in incidence of PE between the AKDVT and BKDVT groups. Reduced-dose anticoagulation therapy does not affect the rates of PE in trauma patients with BKDVT who require ongoing orthopedics operations. For these patients, placement of the retrievable filter may be considered.


Assuntos
Fixação de Fratura , Fraturas Ósseas/cirurgia , Traumatismos da Perna/cirurgia , Ossos Pélvicos/cirurgia , Embolia Pulmonar/prevenção & controle , Trombose Venosa/terapia , Adulto , Idoso , Anticoagulantes/administração & dosagem , China/epidemiologia , Feminino , Fixação de Fratura/efeitos adversos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/epidemiologia , Humanos , Incidência , Traumatismos da Perna/diagnóstico por imagem , Traumatismos da Perna/epidemiologia , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/lesões , Período Perioperatório , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Filtros de Veia Cava , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/epidemiologia
20.
Ter Arkh ; 91(2): 73-81, 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-31094175

RESUMO

AIM: To build a predictive model for PVT in cirrhotic patients. MATERIALS AND METHODS: A single centre case-control study was carried out. From the database of 1512 cirrhotic patients 94 with newly diagnosed PVT based on contrast-enhanced computed tomography were referred to the Case group. Malignant PVT was an exclusion criterion. Patients without PVT were stratified and matched according to sex, age and etiology of cirrhosis; case-control ratio was 1 : 3-4. The prevalence of PVT in the database, clinical, laboratory, instrumental parameters of the groups were evaluated. Logistic regression model was used to estimate association between variables and PVT. RESULTS: The overall prevalence of PVT was 6.2% with the highest rates among the patients with HBV infection - 16.7%, nonalcoholic steatohepatitis - 15.6%, alcohol abuse in combination with HCV infection - 11.7%. The best predictive model included variables: Child-Pugh classes B-C (coefficient of regression ß=1.853, р=0.001), ascites (ß=0.460, р=0.003), hepatocellular carcinoma without vascular invasion (ß=2.126, р=0.0001), endoscopic band ligation (ß=0.774, р=0.003), azygoportal disconnection (ß=2.734, р=0.001), portal hypertensive gastropathy (ß=0.793, р=0.017), portal vein diameter (ß=0.203, р=0.004), and local factors - ulcerative colitis flare, Clostridium difficile enterocolitis, spontaneous bacterial peritonitis, colorectal cancer, splenectomy, cholecystectomy (ß=2.075, р=0.017). The model had accuracy 85.8% (95% CI 81.7-89.4%), sensitivity - 55.1% (95% CI 43.4-66.4%), specificity - 95% (95% CI 91.6-97.3%), and AUC - 0.871 (95% CI 0.826-0.916). CONCLUSION: Child-Pugh classes B-C, severe portal hypertension, hepatocellular carcinoma without vascular invasion, and local factors were estimated as risk factors of PVT in cirrhotic patients.


Assuntos
Cirrose Hepática/complicações , Cirrose Hepática/fisiopatologia , Veia Porta/diagnóstico por imagem , Veia Porta/patologia , Trombose Venosa/etiologia , Trombose Venosa/fisiopatologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Hipertensão Portal/epidemiologia , Cirrose Hepática/epidemiologia , Neoplasias Hepáticas/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Tomografia Computadorizada por Raios X , Trombose Venosa/complicações , Trombose Venosa/epidemiologia
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