Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.926
Filtrar
1.
Vasc Health Risk Manag ; 16: 53-56, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32021228

RESUMO

Introduction: Factor V Leiden (G1691A), prothrombin (G20210A) and MTHFR (C677T) gene mutations were investigated in many studies for their association with Deep Venous Thrombosis. Case Presentation: A North Lebanese family has been examined, from an index case, a 40-year-old woman, who had a history of venous thrombosis with unexplained recurrent miscarriage. The index case was found to be heterozygous for factor V Leiden G1691A, prothrombin G20210A, and methylenetetrahydrofolate reductase C677T gene variants. Her family members were heterozygous for at least two of the three-point mutations, and multiple risk factors associated with thrombophilia were identified. Conclusion: Our findings emphasize the need for clarifying the utility and futility of thrombophilia testing in the era of molecular diagnostics.


Assuntos
Aborto Habitual/etiologia , Resistência à Proteína C Ativada/genética , Coagulação Sanguínea/genética , Fator V/genética , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Mutação , Protrombina/genética , Trombofilia/genética , Trombose Venosa/etiologia , Aborto Habitual/sangue , Aborto Habitual/diagnóstico , Resistência à Proteína C Ativada/sangue , Resistência à Proteína C Ativada/complicações , Resistência à Proteína C Ativada/diagnóstico , Adulto , Feminino , Predisposição Genética para Doença , Hereditariedade , Humanos , Líbano , Linhagem , Fenótipo , Gravidez , Fatores de Risco , Trombofilia/sangue , Trombofilia/complicações , Trombofilia/diagnóstico , Trombose Venosa/sangue , Trombose Venosa/diagnóstico
2.
Plast Reconstr Surg ; 145(2): 392-401, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985629

RESUMO

BACKGROUND: Sequential compression devices are often considered a mainstay of prophylaxis against deep venous thromboses in surgical patients. The devices are believed to produce a milking action on the deep veins to prevent venous stasis. A systemic fibrinolytic effect has also been proposed, adding a second mechanism of action. The plasma levels of tissue plasminogen activator and plasminogen activator inhibitor-1 reflect fibrinolytic activity. METHODS: A randomized trial was conducted among 50 consecutive plastic surgery outpatients undergoing cosmetic surgery performed by the author under total intravenous anesthesia and without paralysis. Patients were randomized to receive calf-length sequential compression devices or no sequential compression devices during surgery. Blood samples were obtained from the upper extremity preoperatively and at hourly intervals until the patient was discharged from the postanesthesia care unit. Tissue plasminogen activator and plasminogen activator inhibitor-1 levels were measured. Ultrasound surveillance was used in all patients. There was no outside funding for the study. RESULTS: All patients agreed to participate (inclusion rate, 100 percent). No patient developed clinical signs or ultrasound evidence of a deep venous thrombosis. There were no significant changes in tissue plasminogen activator levels or plasminogen activator inhibitor-1 levels from the preoperative measurements at any hourly interval and no differences in levels comparing patients treated with or without sequential compression devices. CONCLUSIONS: No significant change in systemic fibrinolytic activity occurs during outpatient plastic surgery under total intravenous anesthesia. Sequential compression devices do not affect tissue plasminogen activator or plasminogen activator inhibitor-1 levels, suggesting no fibrinolytic benefit. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.


Assuntos
Fibrinólise/fisiologia , Dispositivos de Compressão Pneumática Intermitente , Adulto , Idoso , Técnicas Cosméticas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Inativadores de Plasminogênio/metabolismo , Estudos Prospectivos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Ativador de Plasminogênio Tecidual/metabolismo , Trombose Venosa/sangue , Trombose Venosa/prevenção & controle , Adulto Jovem
3.
World Neurosurg ; 133: e774-e783, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605841

RESUMO

BACKGROUND: The use of venous duplex ultrasonography (VDU) for confirmation of deep venous thrombosis in neurosurgical patients is costly and requires experienced personnel. We evaluated a protocol using D-dimer levels to screen for venous thromboembolism (VTE), defined as deep venous thrombosis and asymptomatic pulmonary embolism. METHODS: We used a retrospective bioinformatics analysis to identify neurosurgical inpatients who had undergone a protocol assessing the serum D-dimer levels and had undergone a VDU study to evaluate for the presence of VTE from March 2008 through July 2017. The clinical risk factors and D-dimer levels were evaluated for the prediction of VTE. RESULTS: In the 1918 patient encounters identified, the overall VTE detection rate was 28.7%. Using a receiver operating characteristic curve, an area under the curve of 0.58 was identified for all D-dimer values (P = 0.0001). A D-dimer level of ≥2.5 µg/mL on admission conferred a 30% greater relative risk of VTE (sensitivity, 0.43; specificity, 0.67; positive predictive value, 0.27; negative predictive value, 0.8). A D-dimer value of ≥3.5 µg/mL during hospitalization yielded a 28% greater relative risk of VTE (sensitivity, 0.73; specificity, 0.32; positive predictive value, 0.24; negative predictive value, 0.81). Multivariable logistic regression showed that age, male sex, length of stay, tumor or other neurological disease diagnosis, and D-dimer level ≥3.5 µg/mL during hospitalization were independent predictors of VTE. CONCLUSIONS: The D-dimer protocol was beneficial in identifying VTE in a heterogeneous group of neurosurgical patients by prompting VDU evaluation for patients with a D-dimer values of ≥3.5 µg/mL during hospitalization. Refinement of this screening model is necessary to improve the identification of VTE in a practical and cost-effective manner.


Assuntos
Biomarcadores/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Tromboembolia Venosa/sangue , Tromboembolia Venosa/diagnóstico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Trombose Venosa/sangue
4.
J Clin Pathol ; 73(1): 7-13, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31422373

RESUMO

AIMS: Hereditary protein S (PS) deficiency is one of the natural anticoagulant deficiencies causing thrombophilia. We herein described a young male with recurrent deep venous thrombosis, who was diagnosed as type I PS deficiency with compound heterozygous mutations of PROS1 gene. We aimed to analyse the relationship between the genotype and phenotype detection and investigate the pathological mechanisms of PROS1 mutations causing PS deficiency. METHODS: Genetic analysis of PROS1 gene was carried out by direct sequencing. Thrombin generation potential and the inhibition function of thrombin generation by plasma PS were detected by thrombin generation test (TGT). The mRNA transcription level of mutant PS in vitro was measured by real-time PCR, while the protein level was evaluated by western blot and ELISA. Cellular distribution of the protein was further analysed by immunofluorescence. RESULTS: Compound heterozygous mutations (PROS1 c.1551_1552delinsG, p.Thr518Argfs*39 and PROS1 c.1681C>T, p.Arg561Trp) were identified in the propositus, and the former one was a novel small indel mutation. TGT results showed impaired inhibition of thrombin generation with the addition of activated protein C in his parents with certain heterozygous mutations. In vitro expression study, p.Thr518Argfs*39 mutant produced truncated protein retained in the cytoplasm, while p.Arg561Trp mutant partially affected the secretion of PS. Both mutations are located in C-terminal sex hormone-binding globulin (SHBG)-like domain of PS. CONCLUSIONS: Compound heterozygous mutations identified in the study have strong detrimental effect, causing severe type I PS deficiency in the propositus. SHBG-like domain of PS might play an important role in PS secretion system.


Assuntos
Coagulação Sanguínea/genética , Proteínas Sanguíneas/genética , Heterozigoto , Mutação , Deficiência de Proteína S/genética , Trombose Venosa/genética , Adulto , Proteínas Sanguíneas/metabolismo , Feminino , Predisposição Genética para Doença , Células HEK293 , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Deficiência de Proteína S/sangue , Deficiência de Proteína S/diagnóstico , Recidiva , Via Secretória , Índice de Gravidade de Doença , Trombina/metabolismo , Trombose Venosa/sangue , Trombose Venosa/diagnóstico
5.
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
6.
PLoS Med ; 16(10): e1002883, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31603898

RESUMO

BACKGROUND: Recurrent venous thromboembolism (VTE) is common. Current guidelines suggest that patients with unprovoked VTE should continue anticoagulants unless they have a high bleeding risk, whereas all others can stop. Prediction models may refine this dichotomous distinction, but existing models apply only to patients with unprovoked first thrombosis. We aimed to develop a prediction model for all patients with first VTE, either provoked or unprovoked. METHODS AND FINDINGS: Data were used from two population-based cohorts of patients with first VTE from the Netherlands (Multiple Environment and Genetic Assessment of Risk Factors for Venous Thrombosis [MEGA] follow-up study, performed from 1994 to 2009; model derivation; n = 3,750) and from Norway (Tromsø study, performed from 1999 to 2016; model validation; n = 663). Four versions of a VTE prediction model were developed: model A (clinical, laboratory, and genetic variables), model B (clinical variables and fewer laboratory markers), model C (clinical and genetic factors), and model D (clinical variables only). The outcome measure was recurrent VTE. To determine the discriminatory power, Harrell's C-statistic was calculated. A prognostic score was assessed for each patient. Kaplan-Meier plots for the observed recurrence risks were created in quintiles of the prognostic scores. For each patient, the 2-year predicted recurrence risk was calculated. Models C and D were validated in the Tromsø study. During 19,201 person-years of follow-up (median duration 5.7 years) in the MEGA study, 507 recurrences occurred. Model A had the highest predictive capability, with a C-statistic of 0.73 (95% CI 0.71-0.76). The discriminative performance was somewhat lower in the other models, with C-statistics of 0.72 for model B, 0.70 for model C, and 0.69 for model D. Internal validation showed a minimal degree of optimism bias. Models C and D were externally validated, with C-statistics of 0.64 (95% CI 0.62-0.66) and 0.65 (95% CI 0.63-0.66), respectively. According to model C, in 2,592 patients with provoked first events, 367 (15%) patients had a predicted 2-year risk of >10%, whereas in 1,082 patients whose first event was unprovoked, 484 (45%) had a predicted 2-year risk of <10%. A limitation of both cohorts is that laboratory measurements were missing in a substantial proportion of patients, which therefore were imputed. CONCLUSIONS: The prediction model we propose applies to patients with provoked or unprovoked first VTE-except for patients with (a history of) cancer-allows refined risk stratification, and is easily usable. For optimal individualized treatment, a management study in which bleeding risks are also taken into account is necessary.


Assuntos
Medição de Risco/métodos , Trombose Venosa/sangue , Trombose Venosa/diagnóstico , Adolescente , Adulto , Idoso , Algoritmos , Anticoagulantes/uso terapêutico , Estudos de Casos e Controles , Feminino , Seguimentos , Hemorragia/diagnóstico , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Países Baixos , Noruega , Polimorfismo de Nucleotídeo Único , Probabilidade , Prognóstico , Recidiva , Fatores de Risco , Trombose Venosa/genética , Adulto Jovem
7.
J Stroke Cerebrovasc Dis ; 28(11): 104364, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31521516

RESUMO

A 48-year-old woman was admitted to our hospital because of headache and fever. She was diagnosed with aseptic meningitis. Five days later, she had a seizure and developed left hemiparesis. Magnetic resonance imaging showed hyperintensity in the right parietal area on fluid attenuated inversion recovery imaging. She was diagnosed as having cerebral venous thrombosis (CVT) because the suprasagittal sinus was invisible on the venographic studies. Moreover, deep venous thrombosis (DVT) was detected in her left lower extremity. Laboratory findings showed hyperthyroidism and markedly increased factor VIII activity. This is a rare case of concomitant CVT and DVT induced by high factor VIII activity due to hyperthyroidism under the presence of meningitis, an additional risk factor for thrombosis.


Assuntos
Coagulação Sanguínea , Fator VIII/análise , Hipertireoidismo/complicações , Trombose do Seio Sagital/etiologia , Trombose Venosa/etiologia , Anticoagulantes/uso terapêutico , Feminino , Humanos , Hipertireoidismo/sangue , Hipertireoidismo/diagnóstico , Hipertireoidismo/tratamento farmacológico , Iodetos/uso terapêutico , Meningite Asséptica/sangue , Meningite Asséptica/complicações , Pessoa de Meia-Idade , Trombose do Seio Sagital/sangue , Trombose do Seio Sagital/diagnóstico por imagem , Trombose do Seio Sagital/tratamento farmacológico , Resultado do Tratamento , Regulação para Cima , Trombose Venosa/sangue , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico
8.
Blood ; 134(12): 970-978, 2019 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-31395599

RESUMO

Stasis of venous blood triggers deep vein thrombosis by activating coagulation, yet its effects on the fibrinolytic system are not fully understood. We examined the relationship between stasis, fibrinolysis, and the development of experimental venous thrombosis. Effects of stasis-induced deep vein thrombosis and fibrinolysis on thrombosis were examined by inferior vena cava ligation in congenic mice with and without α2-antiplasmin (α2AP), the primary inhibitor of plasmin. Venous thrombus weights were measured and thrombus composition was determined by Martius scarlet blue and immunofluorescence staining. Venous thrombi from α2AP+/+ mice contained plasminogen activators, plasminogen activator inhibitor-1, plasminogen, and α2AP, which changed with thrombus age. Normal, α2AP+/+ mice developed large, occlusive thrombi within 5 hours after ligation; thrombi were even larger in plasminogen-deficient mice (P < .001). No significant thrombus formation was seen in α2AP-/- mice (P < .0001) or in α2AP+/+ mice treated with an α2AP-inactivating antibody (P < .001). Venous stasis activated fibrinolysis, measured by D-dimer levels, in α2AP-/- mice vs α2AP+/+ mice (P < .05). Inhibition of fibrinolysis by the indirect plasmin inhibitor ε-aminocaproic acid or by α2AP restored thrombosis in α2AP-/- mice. In addition to its effects on acute thrombosis, thrombus formation was also markedly suppressed in α2AP-/- mice vs α2AP+/+ mice (P < .0001) 1, 7, and 14 days after ligation. We conclude that experimental venous stasis activates the fibrinolytic system to block the development of venous thrombosis. Suppression of fibrinolysis by α2AP appears essential for stasis-induced thrombus development, which suggests that targeting α2AP may prove useful for preventing venous thrombosis.


Assuntos
Fibrinólise/fisiologia , Síndrome Pós-Trombótica/complicações , Trombose Venosa/prevenção & controle , alfa 2-Antiplasmina/fisiologia , Animais , Modelos Animais de Doenças , Feminino , Fibrinólise/genética , Ligadura , Masculino , Camundongos , Camundongos Congênicos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Síndrome Pós-Trombótica/sangue , Síndrome Pós-Trombótica/genética , Síndrome Pós-Trombótica/fisiopatologia , Veia Cava Inferior/patologia , Veia Cava Inferior/cirurgia , Trombose Venosa/sangue , Trombose Venosa/genética , Trombose Venosa/fisiopatologia , alfa 2-Antiplasmina/genética
9.
Clin Adv Hematol Oncol ; 17(7): 396-404, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31449506

RESUMO

Venous thromboembolism (VTE), which comprises deep vein thrombosis and pulmonary embolism, is one of the leading causes of non-obstetric maternal death in the United States. Physiologic and anatomic changes associated with pregnancy set the stage for a hypercoagulable state. In addition, other risk factors-including those associated with certain fetal characteristics such as low birth weight or stillbirth-have been correlated with an increased risk for VTE. Women with a personal or strong family history of VTE, as well as documented thrombophilia, represent a unique group in whom antepartum and/or postpartum prophylaxis can be considered. The choice of anticoagulant therapy for either treatment or prophylaxis in most cases is heparin, most commonly low-molecular-weight heparin. This is owing to the fact that vitamin K antagonists and the direct oral anticoagulants are contraindicated in pregnancy because of potential teratogenicity. With careful management and vigilant monitoring, appropriate anticoagulation can be used safely and effectively to improve patient outcomes.


Assuntos
Anticoagulantes/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Complicações Hematológicas na Gravidez/tratamento farmacológico , Embolia Pulmonar/tratamento farmacológico , Tromboembolia Venosa/tratamento farmacológico , Trombose Venosa/tratamento farmacológico , Administração Oral , Feminino , Humanos , Gravidez , Complicações Hematológicas na Gravidez/sangue , Embolia Pulmonar/sangue , Fatores de Risco , Trombofilia/sangue , Trombofilia/tratamento farmacológico , Tromboembolia Venosa/sangue , Trombose Venosa/sangue
10.
Plast Reconstr Surg ; 144(3): 409e-418e, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31461018

RESUMO

BACKGROUND: Flap blood glucose decreases when flap congestion occurs. The hypothesis that flap blood glucose works as an indicator for venous congestion was tested experimentally, and flap congestion was reproduced in rodent models. METHODS: Blood glucose levels of a rat abdominal skin flap, with or without its vein pedicle clamped, were checked before and every 10 minutes after flap elevation. In rats whose pedicle vein was shut off, it was further followed up every 5 minutes after declamping. To examine the effect of systemic blood glucose on flap blood glucose, in some rats, glucose solution was administered intraperitoneally before the experiment to artificially produce hyperglycemia. Forty-two rats were divided into four groups, with (n = 24) or without (n = 18) venous blockage and with (n = 20) or without (n = 22) glucose preloading. RESULTS: Flap blood glucose decreased rapidly to off-scale low (<20 mg/dl) within 40 minutes only when the vein pedicle was shut off in normoglycemic (40 ± 8.2 minutes, mean ± SD) and hyperglycemic (40 ± 9.9 minutes) rat groups (p < 0.01). There was no significant difference in the time taken for the flap blood glucose to decrease to off-scale low after venous blockage between both groups (p = 0.379). When the vein was declamped, flap blood glucose again rapidly returned to the systemic level in 15 minutes or earlier in both groups (p = 0.0283). CONCLUSIONS: Flap blood glucose sensitively and specifically reflects the state of vein occlusion, whether the systemic blood glucose is normal or high. The authors' results indicate that flap blood glucose works as a reliable indicator for the venous system.


Assuntos
Glicemia/análise , Complicações Pós-Operatórias/diagnóstico , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Retalhos Cirúrgicos/patologia , Trombose Venosa/diagnóstico , Animais , Modelos Animais de Doenças , Humanos , Masculino , Modelos Animais , Necrose/etiologia , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Ratos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fluxo Sanguíneo Regional , Sensibilidade e Especificidade , Pele/irrigação sanguínea , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/transplante , Veias , Trombose Venosa/sangue , Trombose Venosa/etiologia
11.
Transfus Apher Sci ; 58(4): 525-528, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31327731

RESUMO

We present important laboratory testing and clinical management strategies used to safely discharge home a 69-year old woman with heparin-induced thrombocytopenia (HIT) from the hospital. She was admitted for a coronary artery bypass graft procedure for which she was anticoagulated with heparin. Shortly after the procedure she developed thrombocytopenia and was diagnosed with HIT using the 4Ts scoring system, a latex-enhanced immunoassay (LEI) screen and confirmatory serotonin release assay. Her anticoagulation was switched from heparin to argatroban, and response to treatment was monitored in the laboratory using LEI. Unfortunately, she also received platelet transfusions and subsequently developed multifocal deep vein thrombosis with worsening platelet counts with nadir less than 10 x 10^3/µL. After five therapeutic plasma exchange procedures we noted an improvement in platelet counts, which plateaued into the 50s x 10^3/µL. Furthermore, the LEI remained positive. At this juncture we decided to transition from argatroban to fondaparinux so that she could leave the hospital in stable condition. Upon follow-up with hematology she exhibited no worsening clinical signs or symptoms of disease, and platelet counts markedly improved to within normal limits of detection. In this report we examine the utility of LEI in monitoring patients with HIT, therapeutic plasma exchange in the management of severe HIT (with thrombosis), and the use of subcutaneous fondaparinux in managing HIT in the outpatient setting.


Assuntos
Heparina/efeitos adversos , Trombocitopenia , Idoso , Ponte de Artéria Coronária , Feminino , Fondaparinux/administração & dosagem , Heparina/administração & dosagem , Humanos , Ácidos Pipecólicos/administração & dosagem , Contagem de Plaquetas , Transfusão de Plaquetas , Trombocitopenia/sangue , Trombocitopenia/induzido quimicamente , Trombocitopenia/terapia , Trombose Venosa/sangue , Trombose Venosa/induzido quimicamente , Trombose Venosa/terapia
12.
Med J Aust ; 210(11): 516-524, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31155730

RESUMO

Diagnosis of deep vein thrombosis (DVT) requires a multifaceted approach that includes clinical assessment, evaluation of pre-test probability, and objective diagnostic testing. Common symptoms and signs of DVT are pain, swelling, erythema and dilated veins in the affected limb. The pre-test probability of DVT can be assessed using a clinical decision rule that stratifies DVT into "unlikely" or "likely". If DVT is "unlikely", refer for D-dimer test. If the D-dimer level is normal, DVT can be excluded; if the D-dimer level is increased, refer for compression ultrasound. If DVT is "likely", refer for compression ultrasound. When DVT is confirmed, anticoagulation is indicated to control symptoms, prevent progression and reduce the risk of post-thrombotic syndrome and pulmonary embolism. Anticoagulation may consist of a parenteral anticoagulant overlapped by warfarin or followed by a direct oral anticoagulant (DOAC) (dabigatran or edoxaban), or of a DOAC (apixaban or rivaroxaban) without initial parenteral therapy. DOACs are the preferred treatment for DVT because they are at least as effective, safer and more convenient than warfarin. DOACs may require dose reduction or avoidance in patients with renal dysfunction, and should be avoided in pregnancy. Recent evidence shows that DVT in patients with cancer may be treated with edoxaban (after discontinuation of 5 days of initial heparin or low molecular weight heparin [LMWH]) or rivaroxaban if patients prefer not to have daily injections of LMWH, but the risk of gastrointestinal bleeding is higher with DOACs than with LMWH in patients with gastrointestinal cancer.


Assuntos
Anticoagulantes/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Trombose Venosa/diagnóstico , Trombose Venosa/terapia , Administração Oral , Anticoagulantes/efeitos adversos , Progressão da Doença , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hemorragia Gastrointestinal/induzido quimicamente , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Neoplasias/complicações , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Trombose Venosa/sangue
13.
Blood Coagul Fibrinolysis ; 30(5): 188-192, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31157680

RESUMO

: Multiple studies have shown that in approximately half of individuals with pulmonary embolism (PE), the deep venous thrombosis (DVT) is not evident at the moment of PE diagnosis. The underlying factors and the origin of PE in these patients are not completely understood: missed DVT, embolization of DVT in its entirety, or de-novo PE being possible explanations. The aim of this study was to evaluate the differences in PE patient with or without co-existing DVT. Sixty-three consecutive PE patients were included. Whole leg bilateral Doppler compression ultrasound was performed to all patients. The PE location and extension, C-reactive protein, platelet count, hemostatic markers FV, FVIII, FXIIIa, Fibrinogen, von Willebrand factor antigen, thrombomodulin were assessed. Thorough clinical assessment including echocardiography and pulmonary function tests were performed upon arrival and seven months later. The mean age of the patients was 57 years (SD 17.3) and 33 (52%) were women. Thirty-one patients (49.2%) had co-existing DVT. The presence of DVT was associated with the proximal location of the PE (100%), whereas none of the patients (n = 10) with exclusively peripheral PE had co-existing DVT. The PE extension, the measured hemostatic and inflammatory markers or the patient characteristics did not statistically differ between patients with isolated PE and PE with co-existing DVT. In roughly half of the PE patients no DVT could be detected. The location of the PE was associated with the presence of co-existing DVT. There were no differences in the PE extension, hemostatic markers or in the patient characteristic between patients with isolated PE or PE with co-existing DVT.


Assuntos
Embolia Pulmonar/complicações , Trombose Venosa/complicações , Adulto , Idoso , Feminino , Hemostasia , Humanos , Perna (Membro)/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Embolia Pulmonar/sangue , Embolia Pulmonar/diagnóstico por imagem , Ultrassonografia Doppler , Trombose Venosa/sangue , Trombose Venosa/diagnóstico por imagem
14.
Hum Immunol ; 80(10): 883-889, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31078335

RESUMO

Deep vein thrombosis (DVT) is characterized by high acute fatality rate due to pulmonary embolism and by serious long-term complications. The risk of DVT development is increased in many medical conditions, such as trauma, cancer, and surgery. However, DVT can also occur as an idiopathic disease without clearly identifiable causes. To investigate the pathogenesis of idiopathic DVT, the involvement of circulating monocytes and macrophages was examined. Data showed that circulating monocytes and monocyte-derived macrophages from DVT patients presented significantly elevated M1-polarization, characterized by higher IL-6 and higher TNF-α than corresponding cells from controls. Macrophages from DVT patients were more potent at stimulating endothelial cell-mediated expression of adhesion molecules, including SELE, ICAM1, and VCAM1, than macrophages from controls. M1-polarization, but not M2-polarization, could profoundly upregulate the expression of adhesion molecules. This upregulation was dependent on direct cell-to-cell contact, as well as on contact-independent TNF-α expression. IL-10 expression, on the other hand, significantly reduced the upregulation of adhesion molecules. Together, this study demonstrated that circulating monocytes and macrophages could contribute to the pathogenesis of idiopathic DVT.


Assuntos
Moléculas de Adesão Celular/genética , Polaridade Celular/genética , Macrófagos/metabolismo , Regulação para Cima/genética , Trombose Venosa/sangue , Trombose Venosa/imunologia , Adulto , Idoso , Comunicação Celular/genética , Células Cultivadas , Feminino , Expressão Gênica , Células Endoteliais da Veia Umbilical Humana , Humanos , Interleucina-10/genética , Interleucina-10/metabolismo , Interleucina-6/genética , Interleucina-6/metabolismo , Ativação de Macrófagos/imunologia , Masculino , Pessoa de Meia-Idade , Monócitos/metabolismo , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/metabolismo
15.
Rev Med Chil ; 147(2): 145-152, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31095161

RESUMO

BACKGROUND: Mean platelet volume (MPV) is a risk factor for cardiovascular and inflammatory diseases. AIM: To evaluate the association between high MPV and 90-day mortality after an episode of venous thromboembolism (VTE). MATERIAL AND METHODS: Retrospective cohort of 594 patients with a median age of 73 years (58% women) with a first episode VTE, included in an institutional Thromboembolic Disease registry between 2014 and 2015. MPV values were obtained from the automated blood cell count measured at the moment of VTE diagnosis. Volumes ≥ 11 fL were classified as high. All patients were followed for 90 days to assess survival. RESULTS: The main comorbidities were cancer in 221 patients (37%), sepsis in 172 (29%) and coronary artery disease in 107 (18%). Median MPV was 8 fl (8-9), brain natriuretic peptide 2,000 pg/ml (1,025-3,900) and troponin 40 pg/ml (19.5-75). Overall mortality was 20% (121/594) during the 90 days of follow-up. Thirty three deaths occurred within 7 days and 43 within the first month. The loss of patients from follow-up was 5% (28/594) at 90 days. Mortality among patients with high MP was 36% (23/63). The crude mortality hazard ratio (HR) for high MPV was 2.2 (95% confidence intervals (CI) 1.4-3.5). When adjusted for sepsis, oncological disease, heart disease, kidney failure and surgery, the mortality HR of high MPV was 2.4 (CI95% 1.5-3.9) in the VTE group, 2.3 (CI95% 1.5-4.4) in the deep venous thrombosis group, and 2.9 (CI95% 1.6 -5.6) in the pulmonary embolism group. CONCLUSIONS: High MPV is an independent risk factor for mortality following an episode of VTE.


Assuntos
Volume Plaquetário Médio , Tromboembolia Venosa/mortalidade , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Plaquetas , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Neoplasias/complicações , Fragmentos de Peptídeos/sangue , Prognóstico , Embolia Pulmonar/sangue , Embolia Pulmonar/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Sepse/complicações , Análise de Sobrevida , Troponina/sangue , Tromboembolia Venosa/sangue , Tromboembolia Venosa/complicações , Trombose Venosa/sangue , Trombose Venosa/mortalidade
16.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(2): 248-251, 2019 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-31106547

RESUMO

OBJECTIVE: To explore the association of plasma high density lipoprotein-cholesterol (HDL-C) and deep vein thrombosis (DVT) in traumatic fracture patients. METHODS: We performed a retrospective study in 1 054 traumatic fracture patients admitted between April 2012 and December 2014. 188 cases were divided into DVT and others (n=866) into control group based on ultrasound results. The relationship between HDL-C and DVT was determined by univariate and multivariate logistic regression analyses. RESULTS: Compared with control group, patients in DVT group had significantly lower HDL-C level, and low level of plasma HDL-C was associated with the occurrence of DVT. Deceased HDL-C, inceased age, inceased immobilization, inceasd anticoagulant-free days, fracture sites, and blood transfusion were risk factors for the occurrence of DVT in traumatic fracture patients. Patients with surgery had significantly lower level of HDL-C in both groups compared with patients without surgery respectively. CONCLUSION: Low level of plasma HDL-C was independently associated with the occurrence of DVT in traumatic fracture patients.


Assuntos
HDL-Colesterol/sangue , Fraturas Ósseas/sangue , Trombose Venosa/sangue , Fraturas Ósseas/complicações , Humanos , Estudos Retrospectivos , Fatores de Risco
17.
Arthritis Rheumatol ; 71(9): 1545-1552, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30957430

RESUMO

OBJECTIVE: To estimate the annual incidence and prevalence of and frequency of mortality associated with antiphospholipid syndrome (APS). METHODS: An inception cohort of patients with incident APS in 2000-2015 from a geographically well-defined population was identified based on comprehensive individual medical records review. All cases met the 2006 Sydney criteria for APS (primary definition) or had a diagnosis of APS confirmed by physician consensus (secondary definition). Levels of lupus anticoagulant, IgM and IgG anticardiolipin antibodies, and anti-ß2-glycoprotein I antibodies were tested in a centralized laboratory. Incidence rates were age- and sex-adjusted to the 2010 US white population. Prevalence estimates were obtained from the incidence rates, assuming that there was no increased mortality associated with APS and that migration in or out of the area was independent of disease status. RESULTS: Among this cohort in 2000-2015, 33 cases of incident APS, as defined by the Sydney criteria, were identified (mean age of patients 54.2 years; 55% female, 97% white). The annual incidence of APS in adults ages ≥18 years was 2.1 (95% confidence interval [95% CI] 1.4-2.8) per 100,000 population. Incidence rates were similar in both sexes. The estimated prevalence of APS was 50 (95% CI 42-58) per 100,000 population, and was similar in both sexes. Six patients (18%) had a concurrent diagnosis of systemic lupus erythematosus. The most frequent clinical manifestation was deep vein thrombosis. The overall frequency of mortality among patients with APS was not significantly different from that in the general population (standardized mortality ratio 1.61, 95% CI 0.74-3.05). CONCLUSION: APS occurred in ~2 persons per 100,000 population per year. The estimated prevalence was 50 per 100,000 population. Overall mortality was not notably different from that observed in the general population.


Assuntos
Síndrome Antifosfolipídica/epidemiologia , Adulto , Anticorpos Anticardiolipina/sangue , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/imunologia , Austrália/epidemiologia , Autoanticorpos/sangue , Feminino , Humanos , Imunoglobulina M/sangue , Incidência , Inibidor de Coagulação do Lúpus/sangue , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/imunologia , Masculino , Prevalência , Trombose Venosa/sangue , Trombose Venosa/epidemiologia , Trombose Venosa/imunologia , Adulto Jovem , beta 2-Glicoproteína I/imunologia
18.
Orv Hetil ; 160(15): 585-592, 2019 Apr.
Artigo em Húngaro | MEDLINE | ID: mdl-30957536

RESUMO

INTRODUCTION: The objective of the D-dimer tests is to exclude venous thromboembolic disorders. The characteristics of various D-dimer tests differ significantly and consequently, their results are difficult to compare. AIM: Our goal was to compare three D-dimer tests, analyse their correlation and harmonise their sensitivity and specificity through the optimisation of cut-off values. METHOD: At Semmelweis University, the D-dimer level was determined with three different reagents in 158 plasma samples, suspected with venous thromboembolism. INNOVANCE D-Dimer was selected as the referent, and in the case of the two other tests (STA-Liatest D-Di; Dia-D-Dimer), the cut-off values were changed between 0.2-1 µg/ml (fibrinogen-equivalent unit - FEU). The optimal cut-off values were estimated by diagnostic parameters and chi-square test. The correlation of the different tests was calculated by regression analysis. RESULTS: Based on the chi-square statistics, there is no significant difference between STA-Liatest D-Di and INNOVANCE D-Dimer tests using the cut-off values 0.3-1 µg/ml (FEU) (STA-Liatest D-Di). In the case of Dia-D-DIMER, there is a significant difference using 0.2-0.3 µg/ml (FEU) cut-off values, 0.4 µg/ml (FEU) is a border-line value and using 0.5-1 µg/ml (FEU) cut-off values, there is no significant difference. The sensitivity of STA-Liatest D-Di changed between 82.7-100% using 0.2-1 µg/ml (FEU) cut-off values, while the sensitivity of Dia-D-DIMER was 92.3-100%. Their specificities ranged between 50-96.3% and 35.2-87%. The optimal cut-off values were estimated as 0.5-0.6 µg/ml (FEU) for the STA-Liatest D-Di test and 0.7 µg/ml (FEU) for the Dia-D-DIMER test. CONCLUSION: Each diagnostic laboratory should determine the optimal cut-off value of the D-dimer test in use, considering the examined population of the area. Orv Hetil. 2019; 160(15): 585-592.


Assuntos
Testes de Coagulação Sanguínea/instrumentação , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Tromboembolia Venosa/diagnóstico , Trombose Venosa/diagnóstico , Testes de Coagulação Sanguínea/normas , Humanos , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Tromboembolia Venosa/sangue , Trombose Venosa/sangue
19.
Lipids Health Dis ; 18(1): 79, 2019 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-30927926

RESUMO

BACKGROUND: Lipid profiles disorders frequently occur in patients with chronic liver diseases, and the mortality of cirrhosis complicated with portal vein thrombosis (PVT) remains high. Research identifying simple and objective prognosis indicators for cirrhotic PVT has been limited. The aim of the present study was to investigate the association between lipid profiles and liver function, which may help predict the 1-year mortality in non-malignant cirrhosis with PVT. METHODS: A retrospective cohort of 117 subjects with non-malignant cirrhotic PVT was conducted. The primary indicators of lipid profiles included triglyceride, cholesterol, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol. Correlations of lipid profiles with liver function tests, the Child-Turcotte-Pugh (CTP) score and the model for end-stage liver disease (MELD) score were investigated. The relationship between lipid profiles and 1-year mortality was assessed using the area under the receiver operating characteristic curves (AUROC). Logistic regression models were established to confirm the association between HDL-C and mortality. RESULTS: The level of HDL-C was significantly decreased in non-survivors (p < 0.01) and patients with more severe liver damage stages (CTP p < 0.001; MELD p < 0.001). There was no significant difference in the HDL-C level among patients with different severities of PVT (p = 0.498). The level of HDL-C was positively correlated with albumin (p < 0.001, R = 0.438) and platelet (p = 0.022, R = 0.212) levels. The level of HDL-C was negatively correlated with bilirubin (p < 0.001, R = - 0.319), C-reactive protein (p < 0.001, R = - 0.342), the aspartate aminotransferase to alanine aminotransferase ratio (p < 0.0.1, R = - 0.237), the CTP score (p < 0.001, R = - 0.397) and the MELD score (p < 0.001, R = - 0.406). The 1-year mortality rate was 12.8%. The AUROC of HDL-C for the prediction of 1-year mortality in this population was 0.744 (p < 0.01, 95%CI 0.609-0.879). The level of HDL-C was independently associated with mortality by multivariate logistic regression models. CONCLUSIONS: The HDL-C level significantly decreases with the deterioration of liver function, which may serve as a potential indicator for the prognosis of non-malignant cirrhotic patients with PVT.


Assuntos
HDL-Colesterol/sangue , Cirrose Hepática/sangue , Prognóstico , Trombose Venosa/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Plaquetas/metabolismo , Proteína C-Reativa/metabolismo , Feminino , Humanos , Fígado/lesões , Fígado/patologia , Cirrose Hepática/complicações , Cirrose Hepática/mortalidade , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Veia Porta/patologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Trombose Venosa/complicações , Trombose Venosa/mortalidade , Trombose Venosa/patologia
20.
Gastroenterology ; 157(1): 34-43.e1, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30986390

RESUMO

DESCRIPTION: This expert review was commissioned and approved by the AGA Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership. The intent is to evaluate the current data on mechanism of altered coagulation in patients with cirrhosis, provide guidance on the use of currently available testing of the coagulation cascade, and help practitioners use anticoagulation and pro-coagulants appropriately in patients with cirrhosis. METHODS: This review is framed around the best practice points, which were derived from the most impactful publications in the area of coagulation in cirrhosis and agreed to by all authors. BEST PRACTICE ADVICE 1: Global tests of clot formation, such as rotational thromboelastometry, thromboelastography, sonorheometry, and thrombin generation, may eventually have a role in the evaluation of clotting in patients with cirrhosis, but currently lack validated target levels. BEST PRACTICE ADVICE 2: In general, clinicians should not routinely correct thrombocytopenia and coagulopathy before low-risk therapeutic paracentesis, thoracentesis, and routine upper endoscopy for variceal ligation in patients with hepatic synthetic dysfunction-induced coagulation abnormalities. BEST PRACTICE ADVICE 3: Blood products should be used sparingly because they increase portal pressure and carry a risk of transfusion-associated circulatory overload, transfusion-related acute lung injury, infection transmission, alloimmunization, and/or transfusion reactions. BEST PRACTICE ADVICE 4: The following transfusion thresholds for management of active bleeding or high-risk procedures may optimize clot formation in advanced liver disease: hematocrit ≥25%, platelet count >50,000, and fibrinogen >120 mg/dL. Commonly utilized thresholds for international normalized ratio correction are not supported by evidence. BEST PRACTICE ADVICE 5: Thrombopoietin agonists are a good alternative to platelet transfusion, but require time (about 10 days) to elevate platelet levels. BEST PRACTICE ADVICE 6: The large volume of fresh frozen plasma required to reach an arbitrary international normalized ratio target, limitations of the usual target, minimal effect on thrombin generation, and adverse effects on portal pressure limit the utility of this agent significantly. BEST PRACTICE ADVICE 7: The 4-factor prothrombin complex concentrate contains both pro- and anticoagulant factors that offer an attractive low-volume therapeutic to rebalance a disturbed hemostatic system. However, dosage is, in part, based on international normalized ratio, which is problematic in cirrhosis, and published experience in liver disease is limited. BEST PRACTICE ADVICE 8: Anti-fibrinolytic therapy may be considered in patients with persistent bleeding from mucosal oozing or puncture wound bleeding consistent with impaired clot integrity. Both ε-aminocaproic acid and tranexamic acid inhibit clot dissolution. Neither is believed to generate a hypercoagulable state, although both may exacerbate pre-existing thrombi. BEST PRACTICE ADVICE 9: Desmopressin releases von Willebrand factor as its primary hemostatic mechanism. As this factor is usually elevated in cirrhosis, the agent lacks a sound evidence-based foundation, but may be useful in patients with concomitant renal failure. BEST PRACTICE ADVICE 10: Systemic heparin infusion is recommended for symptomatic deep vein thrombosis and portal and mesenteric vein thrombosis, but there are unresolved issues regarding monitoring with both the anti-Xa assay and the partial thromboplastin time due to cirrhosis-related antithrombin deficiency (heparin cofactor). BEST PRACTICE ADVICE 11: Treatment of incidental portal and mesenteric vein thrombosis depends on estimated impact on transplantation surgical complexity vs risks of bleeding and falls. Therapy with low-molecular-weight heparin, vitamin K antagonists, and direct-acting anticoagulants improve portal vein repermeation vs observation alone. BEST PRACTICE ADVICE 12: Direct-acting anticoagulants, such as the factor Xa and thrombin inhibitors, are relatively safe and effective in stable cirrhotic patients, but are in need of further study in patients with more advanced liver disease.


Assuntos
Transtornos da Coagulação Sanguínea/terapia , Transfusão de Sangue/métodos , Cirrose Hepática/sangue , Trombofilia/terapia , Trombose Venosa/terapia , Anticoagulantes/uso terapêutico , Antifibrinolíticos/uso terapêutico , Antitrombinas/uso terapêutico , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/complicações , Fatores de Coagulação Sanguínea/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Fibrinogênio/metabolismo , Hematócrito , Heparina/uso terapêutico , Humanos , Coeficiente Internacional Normatizado , Cirrose Hepática/complicações , Plasma , Contagem de Plaquetas , Veia Porta , Tromboelastografia , Trombocitopenia , Trombofilia/sangue , Trombofilia/complicações , Trombopoetina/agonistas , Reação Transfusional , Trombose Venosa/sangue , Trombose Venosa/complicações
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA