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1.
BMC Pregnancy Childbirth ; 21(1): 108, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33546624

RESUMO

BACKGROUND: As pregnancy is a physiological prothrombotic state, pregnant women may be at increased risk of developing coagulopathic and/or thromboembolic complications associated with COVID-19. METHODS: Two biomedical databases were searched between September 2019 and June 2020 for case reports and series of pregnant women with a diagnosis of COVID-19 based either on a positive swab or high clinical suspicion where no swab had been performed. Additional registry cases known to the authors were included. Steps were taken to minimise duplicate patients. Information on coagulopathy based on abnormal coagulation test results or clinical evidence of disseminated intravascular coagulation (DIC), and on arterial or venous thrombosis, were extracted using a standard form. If available, detailed laboratory results and information on maternal outcomes were analysed. RESULTS: One thousand sixty-three women met the inclusion criteria, of which three (0.28, 95% CI 0.0 to 0.6) had arterial and/or venous thrombosis, seven (0.66, 95% CI 0.17 to 1.1) had DIC, and a further three (0.28, 95% CI 0.0 to 0.6) had coagulopathy without meeting the definition of DIC. Five hundred and thirty-seven women (56%) had been reported as having given birth and 426 (40%) as having an ongoing pregnancy. There were 17 (1.6, 95% CI 0.85 to 2.3) maternal deaths in which DIC was reported as a factor in two. CONCLUSIONS: Our data suggests that coagulopathy and thromboembolism are both increased in pregnancies affected by COVID-19. Detection of the former may be useful in the identification of women at risk of deterioration.


Assuntos
/epidemiologia , Coagulação Intravascular Disseminada/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Hematológicas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Tromboembolia/epidemiologia , Trombose Venosa/epidemiologia , /virologia , Comorbidade , Coagulação Intravascular Disseminada/virologia , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/virologia , Complicações Hematológicas na Gravidez/virologia , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez , Tromboembolia/virologia , Trombose Venosa/virologia
5.
Medicine (Baltimore) ; 100(4): e24479, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530264

RESUMO

ABSTRACT: Application of the Caprini risk assessment model was explored in patients with deep vein thrombosis (DVT) after laparoscopic colorectal cancer surgery.This study was a prospective study. The risk factors for DVT were assessed with a survey at baseline and on the morning of surgery, first day after surgery and sixth day by using repeated blood vessels on color Doppler ultrasound of the lower limbs, and the intraoperative and postoperative conditions were recorded.Among 148 surgical patients, 24.3% had asymptomatic DVT. According to the risk stratification, the incidence of DVT was related to the Caprini score (P < .001). The area under the curve of the Caprini model was 0.701 ±â€Š0.047 (95% CI: 0.609-0.793, P<.001). The Youden index was 0.368, while the critical point was 10.5 in the Caprini model, corresponding to a sensitivity of 0.806 and a specificity of 0.563. Age, cardiovascular disease, intraoperative blood loss, postoperative fever, preoperative preparation, and hospital stay were higher in DVT patients than in patients without DVT. Moreover, the incidence of DVT in patients with a lithotomy position was higher than that in patients with a scissors position. In binary logistic regression analysis, the independent risk factors for DVT development were age, intraoperative blood loss, and preoperative preparation time.The Caprini model can be used for the prediction of venous thromboembolism in laparoscopic colorectal cancer surgery patients. The thrombosis risk assessment model must be established in line with patients undergoing endoscopic malignant tumor surgery.


Assuntos
Neoplasias Colorretais/cirurgia , Laparoscopia/efeitos adversos , Trombose Venosa/epidemiologia , Adulto , Idoso , Neoplasias Colorretais/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Medição de Risco/métodos , Ultrassonografia Doppler em Cores , Trombose Venosa/diagnóstico por imagem
6.
Vasa ; 50(1): 30-37, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33393383

RESUMO

Background: Deep venous thrombosis (DVT) and in particular, iliofemoral thrombosis (IFT) can lead to recurrent thrombosis and postthrombotic syndrome (PTS). Data on the prevalence, predictors and outcome of IFT are scarce. Patients and methods: We retrospectively searched our database of outpatients who had presented with DVT and IFT including the iliac veins from 2014 until 2017. In addition, we performed a prospective registry in a subgroup of patients with IFT. These patients received duplex ultrasound, magnetic resonance venography and measurement of symptom-free walking distance using a standardized treadmill ergometry. The severity of PTS was analyzed using the Villalta-Scale (VS) and quality of life was assessed using the VEINES-QOL/Sym Questionnaire. Results: 847 patients were retrospectively identified with DVT and 19.7% (167/847) of these presented with IFT. 50.9% (85/167) of the IFT-patients agreed to participate in the prospective registry. The majority of these patients (76.5%: 65/85) presented with left-sided IFT. In 53.8% (35/65) May-Thurner syndrome was suspected. 27.1% (23/85) underwent invasive therapy. Moderate or severe PTS (VS ≥ 10) occurred in 10.6% (9/85). The severity of PTS is correlated with a reduced quality of life (ρ (CI 95%) = -0.63 (-0.76; -0.46); p < 0.01). None of the patients presented with a venous ulcer at any time. A high body mass index was a significant predictor (OR (CI 95%) = 1.18 (1.05; 1.33), p = 0.007) for the development of clinically relevant PTS (VS ≥ 10) and venous claudication. Conclusions: Every fifth patient with DVT presented with an IFT. The majority developed left sided IFT. Every 10th patient developed moderate or severe PTS (VS ≥ 10). A high body mass index was predictive for the development of PTS and venous claudication.


Assuntos
Veia Ilíaca/diagnóstico por imagem , Síndrome Pós-Trombótica/epidemiologia , Qualidade de Vida , Trombose Venosa/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Flebografia , Síndrome Pós-Trombótica/diagnóstico por imagem , Sistema de Registros , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Trombose Venosa/diagnóstico por imagem
7.
Vasa ; 50(1): 11-21, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33393384

RESUMO

Postthrombotic syndrome (PTS) remains one of the major late complications of deep vein thrombosis (DVT) with a reported prevalence from 10 to 50%. Many factors were found to be related with the development and severity of PTS such as ipsilateral recurrent DVT, advanced age, obesity, ilio-femoral DVT and primary chronic venous disease presence. Some PTS prediction models have been proposed based on risk factor weight. However, it is still difficult to predict which patient with DVT will develop PTS and thus, the clinical application of these models remains limited. Among the identified problems the heterogeneity of the DVT patient population together with the variety of PTS clinical presentations and difficulties concerning PTS severity assessment should be mentioned. Difficulties on the implementation of the specific and objective PTS identification method have also the significant influence on the research focusing on PTS prevention modalities including risk factor modification, compression treatment, anticoagulation and invasive DVT treatment. In this review, the current approach and knowledge on PTS prediction and prevention are presented, including the conservative and invasive DVT treatment possibilities.


Assuntos
Síndrome Pós-Trombótica/prevenção & controle , Trombose Venosa/prevenção & controle , Humanos , Perna (Membro)/irrigação sanguínea , Síndrome Pós-Trombótica/diagnóstico , Síndrome Pós-Trombótica/epidemiologia , Medição de Risco , Fatores de Risco , Trombose Venosa/diagnóstico , Trombose Venosa/epidemiologia
8.
Clin Appl Thromb Hemost ; 27: 1076029620978532, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33448877

RESUMO

The rare Gln534 (Factor V Leiden; FVL) allele (1:169,519,049 T>C) is associated with an increased risk of venous thrombosis. The purpose of this study was to measure the prevalence of Factor V Leiden mutation in thrombophilia patients with deep vein thrombosis. Also, we investigated the functional and structural characteristics of this mutation p.(Arg534Gln) to be examined the cumulative impact on venous thrombosis risk as well correlated with different populations by Genome Wide Association Studies (GWAS). A total of 108 patients with idiopathic deep vein thrombosis were examined for Factor V Leiden gene mutation. Our preliminary data show that about 10% of patients were detected with the heterozygous and homozygous form of the Factor V Leiden mutation. An association analysis confirmed that the Factor V SNP variant (rs6025) was highly associated (P-value 4.91 x10-^ -39) with an increased risk of venous thrombosis. Also, we found that the recognized SNP was important among HapMap populations. Our results indicated that among the 3 populations (Asian, African, and American) studied, this association was highest in the African population based on the r(2) significant threshold (P-value 5e-190). In addition, this mutation was located at the domain F5/8 type A 2, which can disturb this domain and abolish its function. Because of aspartic acid nearby wild type position as form in the salt bridge due to this discharge will disturb the ionic interaction made by the wild type residue Arg534. This residue was not found to be in contact with other domains of which the function was known. However, contact with other molecules or domains (THPH2: MIM: 188055) were still possible and might be affected by this mutation that may cause thrombophilia due to activated protein C resistance.


Assuntos
Resistência à Proteína C Ativada/epidemiologia , Resistência à Proteína C Ativada/genética , Fator V/genética , Fator V/química , Feminino , Frequência do Gene , Estudos de Associação Genética , Estudo de Associação Genômica Ampla , Heterozigoto , Homozigoto , Humanos , Masculino , Modelos Moleculares , Mutação Puntual , Polimorfismo de Nucleotídeo Único , Prevalência , Arábia Saudita/epidemiologia , Trombose Venosa/epidemiologia , Trombose Venosa/genética
9.
Thromb Res ; 198: 135-138, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33338976

RESUMO

BACKGROUND: Thrombosis and pulmonary embolism appear to be major causes of mortality in hospitalized coronavirus disease 2019 (COVID-19) patients. However, few studies have focused on the incidence of venous thromboembolism (VTE) after hospitalization for COVID-19. METHODS: In this multi-center study, we followed 1529 COVID-19 patients for at least 45 days after hospital discharge, who underwent routine telephone follow-up. In case of signs or symptoms of pulmonary embolism (PE) or deep vein thrombosis (DVT), they were invited for an in-hospital visit with a pulmonologist. The primary outcome was symptomatic VTE within 45 days of hospital discharge. RESULTS: Of 1529 COVID-19 patients discharged from hospital, a total of 228 (14.9%) reported potential signs or symptoms of PE or DVT and were seen for an in-hospital visit. Of these, 13 and 12 received Doppler ultrasounds or pulmonary CT angiography, respectively, of whom only one patient was diagnosed with symptomatic PE. Of 51 (3.3%) patients who died after discharge, two deaths were attributed to VTE corresponding to a 45-day cumulative rate of symptomatic VTE of 0.2% (95%CI 0.1%-0.6%; n = 3). There was no evidence of acute respiratory distress syndrome (ARDS) in these patients. Other deaths after hospital discharge included myocardial infarction (n = 13), heart failure (n = 9), and stroke (n = 9). CONCLUSIONS: We did not observe a high rate of symptomatic VTE in COVID-19 patients after hospital discharge. Routine extended thromboprophylaxis after hospitalization for COVID-19 may not have a net clinical benefit. Randomized trials may be warranted.


Assuntos
/epidemiologia , Alta do Paciente , Embolia Pulmonar/epidemiologia , Tromboembolia Venosa/epidemiologia , Trombose Venosa/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , /mortalidade , Feminino , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/mortalidade , Fatores de Risco , Fatores de Tempo , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/mortalidade , Trombose Venosa/diagnóstico , Trombose Venosa/mortalidade
10.
J Am Acad Orthop Surg ; 28(22): e1014-e1019, 2020 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-33156588

RESUMO

INTRODUCTION: Metastatic bone disease of the extremities is a notable cause of morbidity and mortality. Surgical management is not curative; therefore, risks and benefits of surgery must be carefully considered. Previous studies of surgical outcomes are limited by small sample sizes because of the rare incidence of these procedures. In this study, we aim to describe the rates of complications and mortality in the first 30 days after surgical treatment of metastatic bone disease of the femur and humerus. METHODS: A retrospective review of patients in the National Surgical Quality Improvement Program database who underwent surgery between 2005 and 2016 was performed. Demographics, comorbidities, preoperative factors, surgical parameters, and postoperative complications were extracted. The cohort was also partitioned by surgical site and surgical modality. RESULTS: One thousand one hundred fifty-four patients were identified, 13.1 percent of patients experienced one or more complications within 30 days of surgery. The most common complications were urinary tract infection (2.9%), deep vein thrombosis (2.5%), pneumonia (2.4%), pulmonary embolism (2.0%), and surgical site infections (1.9%). In addition, intraoperative or postoperative bleeding requiring transfusion occurred in 32.9% of cases. The rates of unplanned readmission and unplanned revision surgery were 12.7% and 4.1%, respectively. The 30-day mortality rate was 7.1%. Femur and arthroplasty cases were associated with a higher risk of bleeding requiring transfusion. Prophylactic stabilization was associated with a lower risk of unplanned revision surgery (P = 0.015) and a lower overall complication rate (P < 0.0001). CONCLUSION: Our study demonstrates a higher 30-day mortality rate than previously reported. In additon, prophylactic stabilization of impending pathologic fractures may be associated with a lower risk of complications and unplanned revision surgery. The National Surgical Quality Improvement Program or other large database reports can help surgeons counsel patients appropriately regarding the risks and benefits of surgery.


Assuntos
Neoplasias Ósseas/secundário , Neoplasias Ósseas/cirurgia , Extremidades , Fêmur/cirurgia , Úmero/cirurgia , Complicações Pós-Operatórias/epidemiologia , Neoplasias Ósseas/mortalidade , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos , Pneumonia/epidemiologia , Embolia Pulmonar/epidemiologia , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Medição de Risco , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Infecções Urinárias/epidemiologia , Trombose Venosa/epidemiologia
11.
Medicine (Baltimore) ; 99(45): e23091, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157980

RESUMO

BACKGROUND: Peripherally inserted central catheter (PICC) is closely related to venous thromboembolism (VTE). It is a common complication of hospitalized patients, and its etiology is complex. How to prevent the occurrence of VTE is the focus of clinical work. In order to provide basis for individual prevention and accurate treatment of VTE, the purpose of this study was to explore the relationship between ABO blood group and the risk of VTE in cancer patients associated with PICC through meta-analysis. METHODS: Electronic databases, including Embase, Cochrane Library, Pubmed, Chinese databases SinoMed, Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), and Wanfang Data, were searched for case-control studies of ABO blood group and PICC-related VTE in cancer patients. The languages were limited to Chinese and English. Two reviewers were responsible for the selection of the study, the extraction of data and the evaluation of the quality of the research. All statistical analyses were carried out with Review Manager 5.3 and Stata 14.0. RESULTS: The results of this meta-analysis would be published in peer-reviewed journals. CONCLUSION: This study provided evidence to support the relationship between ABO blood group and the risk of PICC-related VTE in cancer patients. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/6DPFG.


Assuntos
Sistema ABO de Grupos Sanguíneos , Cateteres Venosos Centrais/efeitos adversos , Metanálise como Assunto , Neoplasias/sangue , Neoplasias/tratamento farmacológico , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Trombose Venosa/epidemiologia , Trombose Venosa/etiologia , Cateterismo Venoso Central/métodos , Humanos , Medição de Risco
12.
Am J Ther ; 27(6): e599-e610, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33156016

RESUMO

BACKGROUND: Venous thromboembolism (VTE) is increasingly reported in seriously ill patients with COVID-19 infection. Incidence of VTE has been reported before and results varied widely in study cohorts. AREA OF UNCERTAINTY: Incidence of major VTE (segmental pulmonary embolism and above and proximal deep vein thrombosis) which is a contributor to mortality and morbidity is not known. Also, data is unclear on the optimal anticoagulation regimen to prevent VTE. DATA SOURCES: Multiple databases including PubMed were searched until May 12, 2020, to include studies reporting VTE in hospitalized COVID-19 adult patients. MOOSE guidelines were followed in selection, and 11 studies were included. We conducted a systematic review and meta-analysis to quantitatively assess the VTE burden in hospitalized COVID-19 patients and potential benefits of therapeutic dosing of anticoagulation compared with prophylaxis dosing for VTE prevention. THERAPEUTIC ADVANCES: Many societies and experts recommend routine prophylactic anticoagulation with heparin for VTE prevention in hospitalized COVID-19 patients. In this meta-analysis, the pooled rate of major VTE was 12.5% in hospitalized patients and 17.2% in intensive care unit patients. When therapeutic anticoagulation dosing was compared with prophylactic anticoagulation, the pooled odds ratio of VTE was 0.33 (95% confidence interval 0.14-0.75; P = 0.008, I = 0%) suggesting statistical significance with therapeutic dosing of anticoagulation for primary prevention of VTE in all hospitalized patients. However, this should be interpreted with caution as the bleeding events and safety profile could not be ascertained because of lack of adequate information. We recommend applying this finding to hospitalized COVID 19 patients only after carefully weighing individual bleeding risks and benefits. CONCLUSION: Major VTE events, especially pulmonary embolism, seem to be high in COVID-19 patients admitted to the intensive care unit. Therapeutic anticoagulation dosing seems to significantly benefit the odds of preventing any VTE when compared with prophylactic dosing in all hospitalized patients.


Assuntos
Anticoagulantes/administração & dosagem , Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Embolia Pulmonar/epidemiologia , Trombose Venosa/epidemiologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Relação Dose-Resposta a Droga , Humanos , Incidência , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/prevenção & controle , Embolia Pulmonar/virologia , Trombose Venosa/tratamento farmacológico , Trombose Venosa/prevenção & controle , Trombose Venosa/virologia
13.
J Cardiovasc Pharmacol ; 76(4): 369-371, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33027192

RESUMO

The use of heparin has been shown to decrease the mortality in hospitalized patients with severe COVID-19. The aim of our study was to evaluate the clinical impact of venous thromboembolism prophylaxis with fondaparinux versus enoxaparin among 100 hospitalized COVID-19 patients. The incidence of pulmonary embolism, deep venous thrombosis, major bleeding (MB), clinically relevant non-MB, acute respiratory distress syndrome, and in-hospital mortality was compared between patients on fondaparinux versus enoxaparin therapy. The 2 groups were homogeneous for demographic, laboratory, and clinical characteristics. In a median follow-up of 28 (IQR: 12-45) days, no statistically significant difference in venous thromboembolism (14.5% vs. 5.3%; P = 0.20), MB and clinically relevant non-MB (3.2% vs. 5.3%, P = 0.76), ARDS (17.7% vs. 15.8%; P = 0.83), and in-hospital mortality (9.7% vs. 10.5%; P = 0.97) has been shown between the enoxaparin group versus the fondaparinux group. Our preliminary results support the hypothesis of a safe and effective use of fondaparinux among patients with COVID-19 hospitalized in internal medicine units.


Assuntos
Antitrombinas/uso terapêutico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Inibidores do Fator Xa/uso terapêutico , Fondaparinux/uso terapêutico , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Trombose Venosa/etiologia , Trombose Venosa/prevenção & controle , Idoso , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Antitrombinas/efeitos adversos , Enoxaparina/efeitos adversos , Enoxaparina/uso terapêutico , Inibidores do Fator Xa/efeitos adversos , Feminino , Fondaparinux/efeitos adversos , Hemorragia/induzido quimicamente , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Embolia Pulmonar/complicações , Estudos Retrospectivos , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/prevenção & controle , Trombose Venosa/epidemiologia
14.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(4): 395-399, 2020 Apr 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-32879063

RESUMO

OBJECTIVES: To analyze the risk factors for postoperative deep vein thrombosis (DVT) in neurosurgical patients to provide the basis for the prevention of postoperative DVT. METHODS: A total of 141 patients underwent neurosurgery were enrolled. Thrombelastography (TEG) test was performed before and at the end of surgery. According to whether there was DVT formation after operation, the patients were divided into a thrombosis group and a non-thrombosis group. T-test and rank sum test were used to compare the general clinical characteristics of the 2 groups, such as age, gender, intraoperative blood loss, D-dimer, intraoperative crystal input, colloid input, blood product transfusion, operation duration, length of postoperative hospitalization. The application of chi-square test and rank-sum test were used to compared TEG main test indicators such as R and K values between the 2 groups. Logistic regression was used to analyze the possible risk factors for postoperative DVT in neurosurgical patients. RESULTS: There were significant differences in postoperative TEG index R, clotting factor function, intraoperative blood loss, hypertension or not, length of postoperative hospital stay, and postoperative absolute bed time (all P<0.05). Logistic regression analysis showed hypercoagulability, more intraoperative blood loss and longer postoperative absolute bed time were risk factors for DVT formation after craniotomy. CONCLUSIONS: Hypercoagulability in postoperative TEG test of patients is an important risk factor for the formation of postoperative DVT after neurosurgery, which can predict the occurrence of postoperative DVT to some extent.


Assuntos
Trombofilia , Trombose Venosa/epidemiologia , Trombose Venosa/etiologia , Craniotomia/efeitos adversos , Humanos , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Fatores de Risco
15.
Stroke ; 51(10): 3023-3029, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32883194

RESUMO

BACKGROUND AND PURPOSE: There are conflicting figures of the incidence of cerebral venous thrombosis (CVT). The incidence was previously estimated to around 0.5/100 000/y, but more recent studies have suggested 1 to 1.5/100 000/y. The purpose of this study was to explore the incidence and mortality of CVT in a Norwegian population. METHODS: A retrospective cross-sectional hospital population-based study conducted at Akershus University Hospital serving roughly 10% of the total Norwegian population. Patients were identified through chart reviews based on the relevant International Classification of Diseases(Tenth Revision) codes for new CVT cases in a 7-year period between January 1, 2011, and December 31, 2017. Only inhabitants living in the hospital's catchment area were included. RESULTS: Sixty-two patients aged 0 to 80 years were identified and included. The median age was 46 years and 53% were females. The overall incidence of CVT was 1.75 (95% CI, 1.36-2.23) per 100 000/y with no significant sex differences. The incidence for children and adolescents (<18 years, n=9) was lower than for adults (≥18 years, n=53); 1.08 (0.52-1.97) versus 1.96 (1.49-2.55) per 100 000/y per year, with the highest incidence for those >50 years with 2.10 (1.38-3.07)/100 000/y. Headache was the most prevalent symptom, reported in 83%, followed by nausea, motor deficits, and seizures observed in 45%, 32%, and 32% of the patients. Transverse sinuses and the jugular vein were the most frequent sites of thrombosis. In most patients (61%), thrombosis occurred in multiple sinuses/veins. Risk factors were found in 73% of the patients, and most of the patients had a combination of 2 or more risk factors. The 30-day and 1-year mortality rates were 3% and 6%. CONCLUSIONS: The incidence of CVT in this population was higher than previously reported. The mortality rate was similar to previous studies.


Assuntos
Trombose Intracraniana/epidemiologia , Trombose Venosa/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Trombose Intracraniana/mortalidade , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida , Trombose Venosa/mortalidade , Adulto Jovem
16.
Intern Emerg Med ; 15(8): 1425-1433, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32840805

RESUMO

The association between coronavirus disease 2019 (COVID-19) pneumonia and venous thrombotic disorders is still unclear. We assessed the association between COVID-19 infection-related pneumonia and proximal deep-vein thrombosis (DVT) in a cohort of patients admitted to our hospital during the European outbreak in the front line of Cremona, Lombardy. In a single-center cross-sectional study, all patients hospitalized for more than 5 days in Internal Medicine Department with confirmed COVID-19 pneumonia received 2-point compressive ultrasound assessment (CUS) of the leg vein system during a single day. Ninety-four percent of patients received enoxaparin as standard pharmacological prophylaxis for venous thromboembolism. The presence of DVT was defined as incompressibility of popliteal or common femoral vein. Out of 121 patients with COVID-19 pneumonia (mean age 71.8, 66.3% males) hospitalized on March 31st, 70 stayed in hospital for over 5 days and 66 of them underwent CUS of deep venous system of the legs. The presence of asymptomatic DVT was found in 9 patients (13.6%). No symptomatic DVT was found. Patients with DVT showed mean age = 75.7 years, mean D-dimer levels = 4.02 ng/ml and all of them received enoxaparin for thromboprophylaxis, except one. Computed tomography pulmonary angiogram confirmed pulmonary embolism in five patients. One every seven patients with COVID-19-related pneumonia, hospitalized for more than 5 days, had asymptomatic proximal DVT and half of them had confirmed PE despite standard pharmacological thromboprophylaxis. This observational study suggests the need of an active surveillance through CUS in patients hospitalized with acute SARS-COV-2 and underline the need of a more intense thromboprophylaxis.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Pneumonia/etiologia , Trombose Venosa/etiologia , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas/epidemiologia , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia/epidemiologia , Pneumonia Viral/epidemiologia , Prevalência , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Trombose Venosa/epidemiologia , Trombose Venosa/fisiopatologia
17.
Clin Appl Thromb Hemost ; 26: 1076029620948137, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32795186

RESUMO

The SARS-CoV-2 virus caused a global pandemic within weeks, causing hundreds of thousands of people infected. Many patients with severe COVID-19 present with coagulation abnormalities, including increase D-dimers and fibrinogen. This coagulopathy is associated with an increased risk of death. Furthermore, a substantial proportion of patients with severe COVID-19 develop sometimes unrecognized, venous, and arterial thromboembolic complications. A better understanding of COVID-19 pathophysiology, in particular hemostatic disorders, will help to choose appropriate treatment strategies. A rigorous thrombotic risk assessment and the implementation of a suitable anticoagulation strategy are required. We review here the characteristics of COVID-19 coagulation laboratory findings in affected patients, the incidence of thromboembolic events and their specificities, and potential therapeutic interventions.


Assuntos
Anticoagulantes/administração & dosagem , Transtornos da Coagulação Sanguínea/epidemiologia , Infecções por Coronavirus/epidemiologia , Mortalidade Hospitalar , Pneumonia Viral/epidemiologia , Embolia Pulmonar/epidemiologia , Trombose Venosa/epidemiologia , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/fisiopatologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Incidência , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/fisiopatologia , Medição de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Trombose Venosa/tratamento farmacológico , Trombose Venosa/fisiopatologia
18.
Arterioscler Thromb Vasc Biol ; 40(10): 2527-2538, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32757649

RESUMO

OBJECTIVE: Deep vein thrombosis and pulmonary embolism referred as venous thromboembolism (VTE) are a common cause of morbidity and mortality. Plasma from healthy controls or individuals who have experienced a VTE were analyzed using metabolomics to characterize biomarkers and metabolic systems of patients with VTE. Approach and Results: Polar metabolite and lipidomic profiles from plasma collected 3 months after an incident VTE were obtained using liquid chromatography mass spectrometry. Fasting-state plasma samples from 42 patients with VTE and 42 healthy controls were measured. Plasma metabolomic profiling identified 512 metabolites forming 62 biological clusters. Multivariate analysis revealed a panel of 21 metabolites altogether capable of predicting VTE status with an area under the curve of 0.92 (P=0.00174, selectivity=0.857, sensitivity=0.971). Multiblock systems analysis revealed 25 of the 62 functional biological groups as significantly affected in the VTE group (P<0.05 to control). Complementary correlation network analysis of the dysregulated functions highlighted a subset of the lipidome composed mainly of n-3 long-chain polyunsaturated fatty acids within the predominant triglycerides as a potential regulator of the post-VTE event biological response, possibly controlling oxidative and inflammatory defence systems, and metabolic disorder associated dysregulations. Of interest was microbiota metabolites including trimethylamine N-oxide that remained associated to post incident VTE patients, highlighting a possible involvement of gut microbiota on VTE risk and relapse. CONCLUSIONS: These findings show promise for the elucidation of underlying mechanisms and the design of a diagnostic test to assess the likely efficacy of clinical care in patients with VTE.


Assuntos
Metabolismo Energético , Lipídeos/sangue , Metabolômica , Embolia Pulmonar/sangue , Biologia de Sistemas , Tromboembolia Venosa/sangue , Trombose Venosa/sangue , Adulto , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Microbioma Gastrointestinal , Humanos , Incidência , Lipidômica , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/epidemiologia , Recidiva , Fatores de Tempo , Tromboembolia Venosa/diagnóstico por imagem , Tromboembolia Venosa/epidemiologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/epidemiologia
19.
Clin Appl Thromb Hemost ; 26: 1076029620953217, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32854513

RESUMO

Deep vein thrombosis (DVT) is prevalent in patients with coronavirus disease 2019 (COVID-19). However, the risk factors and incidence rate of DVT remains elusive. Here, we aimed to assess the incidence rate and risk factors of DVT. All patients diagnosed with COVID-19 and performed venous ultrasound by ultrasound deparment between December 2019 and April 2020 in Wuhan Jin Yin-tan hospital were enrolled. Demographic information and clinical features were retrospectively collected. Notably, a comparison between the DVT and the non-DVT groups was explored. The incidence rate of venous thrombosis was 35.2% (50 patients out of 142). Moreover, the location of thrombus at the proximal extremity veins was 5.6% (n = 8), while at distal extremity veins was 35.2% (n = 50) of the patients. We also noted that patients with DVT exhibited a high level of D-dimer (OR 10.9 (95% CI, 3.3-36.0), P < 0.001), were admitted to the intensive care unit (OR 6.5 (95% CI, 2.1-20.3), P = 0.001), a lower usage of the anticoagulant drugs (OR 3.0 (95% CI, 1.1-7.8), P < 0.001). Finally, this study revealed that a high number of patients with COVID-19 developed DVT. This was observed particularly in critically ill patients with high D-dimer levels who required no anticoagulant medication.


Assuntos
Anticoagulantes/uso terapêutico , Infecções por Coronavirus/epidemiologia , Mortalidade Hospitalar/tendências , Pneumonia Viral/epidemiologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/epidemiologia , Adulto , Idoso , China , Estudos de Coortes , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Feminino , Hospitalização , Humanos , Incidência , Unidades de Terapia Intensiva/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Cobertura de Condição Pré-Existente , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Ultrassonografia Doppler/métodos , Trombose Venosa/tratamento farmacológico
20.
Neurology ; 95(16): e2200-e2213, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-32847952

RESUMO

OBJECTIVE: To test the hypothesis that race-, age-, and sex-specific incidence of cerebral venous thrombosis (CVT) has increased in the United States over the last decade. METHODS: In this retrospective cohort study, validated ICD codes were used to identify all new cases of CVT (n = 5,567) in the State Inpatients Databases (SIDs) of New York and Florida (2006-2016). A new CVT case was defined as first hospitalization for CVT in the SID without prior CVT hospitalization. CVT counts were combined with annual Census data to compute incidence. Joinpoint regression was used to evaluate trends in incidence over time. RESULTS: From 2006 to 2016, annual age- and sex-standardized incidence of CVT in cases per 1 million population ranged from 13.9 to 20.2, but incidence varied significantly by sex (women 20.3-26.9, men 6.8-16.8) and by age/sex (women 18-44 years of age 24.0-32.6, men 18-44 years of age 5.3-12.8). Incidence also differed by race (Blacks: 18.6-27.2; Whites: 14.3-18.5; Asians: 5.1-13.8). On joinpoint regression, incidence increased across 2006 to 2016, but most of this increase was driven by an increase in all age groups of men (combined annualized percentage change [APC] 9.2%, p < 0.001), women 45 to 64 years of age (APC 7.8%, p < 0.001), and women ≥65 years of age (APC 7.4%, p < 0.001). Incidence in women 18 to 44 years of age remained unchanged over time. CONCLUSION: CVT incidence is disproportionately higher in Blacks compared to other races. New CVT hospitalizations increased significantly over the last decade mainly in men and older women. Further studies are needed to determine whether this increase represents a true increase from changing risk factors or an artifactual increase from improved detection.


Assuntos
Trombose Intracraniana/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Trombose Venosa/epidemiologia , Adulto , Veias Cerebrais/fisiopatologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Grupos Minoritários , Estados Unidos
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