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3.
Subcell Biochem ; 102: 343-363, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36600139

RESUMO

Higher access to medical care, advanced diagnostic tools, and overall public health improvements have favored increased humans lifespan. With a growing proportion of older adults, the associated costs to care for ageing-associated conditions will continue to grow. This chapter highlights recent cellular and clinical evidence of platelets at an older age, from the hyperreactive phenotype associated with thrombosis to the well-known hallmarks of ageing identifiable in platelets and their potential functional implications on platelets at an older age. Therefore, it is imperative to understand platelets' molecular and cellular mechanisms during ageing in health and disease. New knowledge will favor the development of new ways to prevent some of the age-associated complications where platelets are key players.


Assuntos
Plaquetas , Trombose , Humanos , Idoso , Trombose/genética , Envelhecimento
4.
BMC Cardiovasc Disord ; 23(1): 1, 2023 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-36600223

RESUMO

OBJECTIVE: This study aimed to investigate the clinical characteristics and long-term prognosis of mycoplasma pneumoniae pneumonia (MPP)-associated thrombosis and to gain a better understanding of the diagnosis and treatment of the disease. METHODS: The medical records of 14 children with MPP-associated thrombosis between January 2016 and April 2020 were retrospectively reviewed at the Tianjin Children's Hospital. RESULTS: The ages of the patients ranged from 3 to 12 years old. Among the 14 cases, there were five cases of pulmonary embolism, two cases of cerebral infarction, one case of splenic infarction, one case of cardiac embolism, two cases of cardiac embolism with comorbid pulmonary embolism, one case of internal carotid artery and pulmonary embolism, one case of combined internal carotid artery and the cerebral infarction, and one case combined cardiac embolism and lower limb artery embolism. All cases had elevated D-dimer levels. After thrombolysis and anticoagulation therapy, three cases with cerebral embolism still suffered from neurological sequelae. In contrast, the remaining cases did not develop complications. CONCLUSION: MPP-associated thrombosis can occur in any vessel of the body. Thrombosis-associated symptoms may be complex and non-specific. Elevated D-dimer levels in a child with refractory mycoplasma pneumoniae pneumonia should raise suspicion of thrombosis. The long-term prognosis of thrombosis was favorable after the timely administration of anticoagulant therapy.


Assuntos
Pneumonia por Mycoplasma , Embolia Pulmonar , Trombose , Criança , Humanos , Pré-Escolar , Estudos Retrospectivos , Mycoplasma pneumoniae , Pneumonia por Mycoplasma/complicações , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/tratamento farmacológico , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/tratamento farmacológico , Trombose/complicações
5.
In Vivo ; 37(1): 498-502, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36593053

RESUMO

BACKGROUND/AIM: Acute pulmonary embolism during cesarean section is extremely rare and only a limited number of cases have been reported in literature. The aim of this study was to report a case of acute high risk pulmonary embolism during elective cesarean section treated with systemic thrombolysis and discuss the multidisciplinary management in both early recognition and prompt treatment. CASE REPORT: A 39-year-old, G5P2, ASA II parturient presented for repeat cesarean section under general anesthesia. A sudden drop in end-tidal CO2 after placenta delivery combined with significant hemodynamic instability after an uneventful intraoperative course was strongly indicative of pulmonary embolism. Urgent transthoracic ultrasound revealed a sizable thrombus in the inferior vena cava and the right atrium. Thrombolysis was carried out intraoperatively using recombinant tissue plasminogen activator, which was administered under continuous US monitoring until thrombus resolution. This resulted in significant bleeding that was treated in a stepwise manner beginning with implementation of massive transfusion protocol, Bakri balloon placement, and rescue hysterectomy several hours after the event. Follow-up was uneventful and she was discharged on the 12th postoperative day. CONCLUSION: Though pregnancy is one of the major risk factors of the development of venous thromboembolism, acute intraoperative pulmonary embolism is extremely rare. Specific guidelines for the management of such cases are difficult to issue due to the paucity of relevant data. Thus, an individualized approach by a multidisciplinary team for diagnosis and intervention is mandated.


Assuntos
Embolia Pulmonar , Trombose , Gravidez , Humanos , Feminino , Adulto , Cesárea/efeitos adversos , Ativador de Plasminogênio Tecidual , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/etiologia , Histerectomia/efeitos adversos , Trombose/cirurgia , Terapia Trombolítica/efeitos adversos , Período Pós-Parto
6.
BMJ Open ; 13(1): e063645, 2023 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-36639216

RESUMO

OBJECTIVES: During COVID-19 vaccination programmes, new safety signals have emerged for vaccines, including extremely rare cases of thrombosis with thrombocytopaenia syndrome (TTS). Background event rates before and during the pandemic are essential for contextualisation of such infrequent events. In the literature, most studies do not report an overall TTS event rate. Rather, background rates are mainly reported for subtypes of thrombotic/thromboembolic diagnoses included in the TTS clinical definition mostly by anatomical location, with reported rates for TTS subtypes varying widely. The objective of this study was to report prepandemic TTS background event rates in the general population. METHODS: Prepandemic background TTS rates were generated via secondary data analysis using a cohort design in the IBM Truven MarketScan (now Merative MarketScan) US health insurance claims database, from 1 January 2019 to 31 December 2019. Two algorithms were applied: thrombocytopaenia occurring±7 days (algorithm 1) or occurring 1 day prior to ≤14 days after the thrombotic/thromboembolic event (algorithm 2). RESULTS: The study population derived from the MarketScan database analysis included approximately 9.8 million adults (aged ≥18 years; mean age 45 years, 52% females). Using this study population, prepandemic background TTS incidence was estimated as 9.8-11.1 per 100 000 person-years. Event rates were higher in males and increased with age. Similar patterns were observed with both algorithms. CONCLUSIONS: This study presents an estimate of aggregate prepandemic background TTS event rates including by type of thrombosis/thromboembolism and age group. The background event rates are dependent on the precision of capturing underlying TTS events in variable data sources, and the ability of electronic health records or insurance claims databases to reflect the TTS clinical definition. Differences between reported event rates demonstrate that estimating background event rates for rare, unprecedented safety events is methodologically challenging.


Assuntos
Anemia , Vacinas contra COVID-19 , COVID-19 , Trombocitopenia , Tromboembolia , Trombose , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anemia/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Pandemias , Trombocitopenia/epidemiologia , Trombocitopenia/etiologia , Tromboembolia/epidemiologia , Trombose/epidemiologia , Trombose/etiologia , Vacinação/efeitos adversos
7.
BMC Surg ; 23(1): 15, 2023 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-36658522

RESUMO

BACKGROUND: Ligasure hemorrhoidectomy for thrombosed external hemorrhoids in pregnancy has been rarely studied. OBJECTIVE: The purpose of this article is to study the efficacy and safety of Ligasure hemorrhoidectomy comparing with conservative treatment for thrombosed external hemorrhoids in pregnancy. DESIGN: This was a retrospective cohort study. SETTING: The patients were treated at a tertiary referral center in China. PATIENTS: 94 pregnant patients hospitalized for thrombosed external hemorrhoids from September 2020 to December 2021. INTERVENTIONS: Ligasure hemorrhoidectomy treatment or conservative treatment according to the patient's wishes. MAIN OUTCOME MEASURES: Symptom relief, recurrence and satisfaction of thrombosed external hemorrhoids in pregnancy with different interventions. RESULTS: There were no differences between groups in maternal age, gestational age, body mass index, parity, constipation and a prior history of thrombosed external hemorrhoids. The pain scores were less in surgical group than in conservative group in post-treatment days 1 and 7. Time to return to normal activities was shorter in surgical group than in conservative group (6.51 vs. 13.52 days, P < 0.001). Post-treatment complications were mild in surgical group and there were no significant differences concerning the rate of abortion, preterm birth, cesarean delivery and weight of fetus. Recurrence rate was significantly lower in surgical group (8.57% vs. 30.43%, P = 0.017). The patient satisfaction scores were significantly higher in surgical group than in conservative group (Z = - 2.979, P = 0.003). LIMITATIONS: This was a retrospective study with a limited number of patients, the data was obtained from only one center. CONCLUSIONS: Comparing with conservative treatment, Ligasure hemorrhoidectomy for TEH in pregnancy results in more rapid pain relief, shorter time to return to normal activities, lower incidence of recurrence, and better patient satisfaction. This type of surgery has low and mild postoperative complications, is not attended by any risk to the mother or her fetus.


Assuntos
Hemorroidectomia , Hemorroidas , Nascimento Prematuro , Trombose , Humanos , Recém-Nascido , Feminino , Hemorroidas/cirurgia , Estudos Retrospectivos , Tratamento Conservador , Ligadura , Dor Pós-Operatória , Resultado do Tratamento
8.
Int J Mol Sci ; 24(2)2023 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-36674847

RESUMO

Antiphospholipid syndrome (APS) is an acquired highly prothrombotic disorder in which thrombo-inflammatory antiphospholipid antibodies (aPL) cause thrombosis via multiple mechanisms, including endothelial damage and activation. Obstetric complications in APS are caused by placental thrombosis, inflammation and complement activation. Anticoagulation is poorly effective in some patients especially those with triple positive aPL who are at ~30% risk of thrombosis recurrence within 10 years. Increasing therapeutic anticoagulation intensity may be beneficial but leads to excess bleeding with serious complications, such as intracerebral haemorrhage. Nonetheless, anticoagulation is still the mainstay of treatment despite the autoimmune nature of APS. The antimalarial immunomodulatory drug hydroxychloroquine (HCQ) has been used for many years for the treatment of inflammatory rheumatic diseases. HCQ has complex pleiotropic mechanisms of action upon multiple cell types. The proposed biological processes that HCQ regulates support the hypothesis that it may be a successful adjunctive treatment in the prevention of recurrent thrombosis and pregnancy complications.


Assuntos
Antimaláricos , Síndrome Antifosfolipídica , Trombose , Humanos , Feminino , Gravidez , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/tratamento farmacológico , Hidroxicloroquina/farmacologia , Hidroxicloroquina/uso terapêutico , Fibrinolíticos/uso terapêutico , Placenta , Antimaláricos/uso terapêutico , Trombose/tratamento farmacológico , Trombose/etiologia , Trombose/prevenção & controle , Anticoagulantes/uso terapêutico
9.
Stroke ; 54(2): 448-456, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36689583

RESUMO

BACKGROUND: Distal embolization (DE) is a common complication of endovascular treatment (EVT). We investigated the association of radiological thrombus characteristics and treatment details with DE. METHODS: Patients with thin-slice (≤2.5 mm) baseline noncontrast computed tomography and computed tomography angiography from the ESCAPE-NA1 trial (Efficacy and Safety of Nerinetide for the Treatment of Acute Ischemic Stroke) were included. Thrombus annotation was performed manually on coregistered scans by experienced readers. We assessed thrombus location, distance from internal carotid artery terminus, length, perviousness, absolute attenuation, and hyperdense artery sign. In addition, we evaluated balloon guide catheter use during EVT, first-line EVT approach, the number of thrombectomy passes, and prior intravenous thrombolysis administration. DE was defined as the occurrence of emboli distal to the target artery or in new territories during EVT. The association between thrombus characteristics, treatment details, and DE was evaluated using descriptive statistics and multivariable mixed-effects logistic regression, resulting in adjusted odds ratios (aOR) with 95% CI. Interaction between IVT and radiological thrombus characteristics was assessed by adding interaction terms in separate models. RESULTS: In total, 496 out of 1105 (44.9%) ESCAPE-NA1 patients were included. DE was detected in 251 out of 496 patients (50.6%). Patients with DE had longer thrombi (median, 28.5 [interquartile range, 20.8-42.3] mm versus 24.4 [interquartile range, 17.1-32.4] mm; P<0.01). There were no statistically significant differences in the other thrombus characteristics. Factors associated with DE were thrombus length (aOR, 1.02 [95% CI, 1.01-1.04]), balloon guide catheter use (aOR, 0.49 [95% CI, 0.29-0.85]), and number of passes (aOR, 1.24 [95% CI, 1.04-1.47]). In patients with hyperdense artery sign, IVT was associated with reduced odds of DE (aOR, 0.55 [95% CI, 0.31-0.97]), P for interaction=0.04. CONCLUSIONS: DE was associated with longer thrombi, no balloon guide catheter use, and more EVT passes. IVT was associated with a reduced risk of DE in patients with hyperdense artery sign. These findings may support treatment decisions on IVT and EVT approaches.


Assuntos
Isquemia Encefálica , Procedimentos Endovasculares , AVC Isquêmico , Acidente Vascular Cerebral , Trombose , Humanos , Acidente Vascular Cerebral/terapia , Isquemia Encefálica/terapia , AVC Isquêmico/etiologia , Trombose/etiologia , Trombectomia , Terapia Trombolítica/métodos , Resultado do Tratamento , Procedimentos Endovasculares/efeitos adversos
10.
Int J Med Sci ; 20(1): 136-141, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36619223

RESUMO

Objectives: There are currently no appropriate markers and target for prophylaxis against COVID-19-related thrombosis, especially in the not-severe cases. We tested the hypothesis that inflammation is a suitable marker and target for prophylaxis against COVID-19-related thrombosis. Methods: Data of all 32 COVID-19 patients admitted to Saitama Medical Center between January 1 and March 30, 2021, were analyzed. Patients were divided into severe (requiring oxygen, n=12) and non-severe (no requirement for oxygen, n=20), and also those with high C-reactive protein (CRP) level (cutoff value: 30 mg/L, n=21) and low-CRP (n=11). We also compared the clinical and laboratory data of a 46-year-old post-liver transplant male patient, who was treated with a combination of immunosuppressants (methylprednisolone, fludrocortisone, cyclosporine, and everolimus) with those of other COVID-19 patients, using the Smirnoff-Grubbs and Box plots tests. Results: The levels of CRP, ferritin, lactate dehydrogenase, aspartate aminotransferase, and thrombin-antithrombin complex (TAT) were significantly higher in the high-severity group than the low-severity group; while other coagulation parameters were comparable. The time between onset of illness and blood levels of lactate dehydrogenase, fibrinogen, D-dimer, TAT, and plasmin alpha2-plasmin inhibitor complex (PIC) were significantly higher whereas lymphocyte count was significantly lower in the high-CRP group. Extremely low levels of TAT, PIC, and plasminogen activator inhibitor-1 (PAI-1) were recorded in the liver transplant patient treated with immunosuppressants. The TAT, PIC, and PAI-1 levels were deemed outliers. Conclusions: Inflammation is a potentially suitable marker and target for prophylaxis against COVID-19-related thrombosis.


Assuntos
COVID-19 , Trombose , Humanos , Masculino , Pessoa de Meia-Idade , COVID-19/complicações , Inibidor 1 de Ativador de Plasminogênio , Inflamação/tratamento farmacológico , Trombose/tratamento farmacológico , Trombose/etiologia , Trombose/prevenção & controle , Oxigênio , Imunossupressores , Lactato Desidrogenases
12.
13.
J Cardiovasc Pharmacol Ther ; 28: 10742484221145010, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36594404

RESUMO

Fondaparinux sodium is a chemically synthesized selective factor Xa inhibitor approved for the prevention and treatment of venous thromboembolic events, that is, deep vein thrombosis, pulmonary embolism, and superficial vein thrombosis, in acutely ill (including those affected by COVID-19 or cancer patients) and those undergoing surgeries. Since its approval in 2002, the efficacy and safety of fondaparinux is well demonstrated by many clinical studies, establishing the value of fondaparinux in clinical practice. Some of the advantages with fondaparinux are its chemical nature of synthesis, minimal risk of contamination, 100% absolute bioavailability subcutaneously, instant onset of action, a long half-life, direct renal excretion, fewer adverse reactions when compared with direct oral anticoagulants, and being an ideal alternative in conditions where oral anticoagulants are not approved for use or in patients intolerant to low molecular weight heparins (LMWH). In the last decade, the real-world use of fondaparinux has been explored in other conditions such as acute coronary syndromes, bariatric surgery, in patients developing vaccine-induced immune thrombotic thrombocytopenia (VITT) and in pregnant women with heparin-induced thrombocytopenia (HIT), or those intolerant to LMWH. The emerging data from these studies have culminated in recent updates in the guidelines that recommend the use of fondaparinux under various conditions. This paper aims to review the recent data and the subsequent updates in the recommendations of various guidelines on the use of fondaparinux sodium.


Assuntos
COVID-19 , Trombose , Trombose Venosa , Gravidez , Humanos , Feminino , Fondaparinux/efeitos adversos , Heparina de Baixo Peso Molecular/efeitos adversos , Polissacarídeos/efeitos adversos , Anticoagulantes/efeitos adversos , Trombose/tratamento farmacológico , Trombose/prevenção & controle , Trombose Venosa/tratamento farmacológico , Heparina
14.
Int J Cardiovasc Imaging ; 39(1): 35-42, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36598680

RESUMO

In patients with nonvalvular atrial fibrillation (NVAF), the impact of left ventricular diastolic function on the risk of left atrial appendage (LAA) thrombus has rarely been studied. This prospective study aimed to investigate the relationship between diastolic function and the risk of LAA thrombus in patients with NVAF. Seventy-six patients with NVAF admitted to receive radiofrequency catheter ablation were prospectively enrolled. All the patients underwent transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in 24 h before ablation. Diastolic function was estimated by TTE including left atrial volume index (LAVI) and E/e', as well as invasive left atrial pressure (LAP) measured during the ablation procedure. LAA peak emptying velocity (LAA-PEV) and the intensity of spontaneous echo contrast (SEC) were determined by TEE. Average E/e', LAVI and mean LAP had a significant positive correlation with the intensity of SEC, the coefficient of correlation were 0.344 (p = 0.002), 0.416 (p < 0.001) and 0.402 (p < 0.001), respectively. After adjustment for CHA2DS2-VASc score and type of AF, multivariate regression analysis revealed that increased LAP (OR 1.144, 95% CI 1.012-1.293, p = 0.031) independently correlated with the risk of LAA thrombus (SEC ≥ Grade 2). LAA-PEV showed a significantly inverse relationship with mean LAP in patients with AF (r = - 0.525, p < 0.001), and in the assessment of elevated LAP with TEE, the LAA-PEV cut-off of 0.40 m/s had a sensitivity of 80%, specificity of 81%. Left ventricular diastolic dysfunction may constitute a potential risk for LAA thrombus and stroke. Furthermore, evaluation of LAA emptying with use of TEE is helpful for assessing the LAP status of patients with AF.


Assuntos
Apêndice Atrial , Fibrilação Atrial , Cardiopatias , Trombose , Humanos , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Apêndice Atrial/diagnóstico por imagem , Estudos Prospectivos , Valor Preditivo dos Testes , Ecocardiografia Transesofagiana/métodos , Trombose/diagnóstico por imagem , Trombose/etiologia
15.
J Pediatr Hematol Oncol ; 45(1): 25-28, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36598960

RESUMO

PURPOSE: Central venous lines (CVL) in children with acute lymphoblastic leukemia (ALL) provide comfortable administration of intensive chemotherapy and blood sampling. The optimal time for the insertion of CVL in patients with ALL during induction therapy is controversial. This study aimed to investigate the frequency of CVL-related complications in children with ALL concerning the time of CVL insertion. PATIENTS AND METHODS: We reviewed the records of 52 pediatric ALL patients with CVL. CVL placement before or on treatment day 15 was defined as "early insertion", and after treatment day 15 was defined as "late insertion". Demographics, preoperative blood counts, type of central line, time of CVL placement, CVL-related complications, and blood counts during complications were all noted. All the data were collected from those with the first catheter use. RESULTS: CVL was placed ≤15 days in 26 patients (50%) and after 15 days in 26 patients (50%). Regarding the infection rates, no statistical difference was found between early and late CVL-inserted groups ( P =n.s.). Five patients developed thrombosis, and risk was found to be similar between early and late CVL-inserted groups ( P =n.s.). Catheter-related mechanical complications were recorded in 7 patients (3 in early and 4 in late CVL-inserted group, ( P =n.s.). CONCLUSION: The present study showed no relation between the timing of CVL placement during induction therapy and the occurrence of infection and thrombosis. Our results suggest that CVL can be placed safely at the time of diagnosis or early induction treatment to provide a comfortable administration of chemotherapy and decrease painful blood samplings.


Assuntos
Cateterismo Venoso Central , Cateteres Venosos Centrais , Leucemia-Linfoma Linfoblástico de Células Precursoras , Trombose , Humanos , Criança , Cateterismo Venoso Central/efeitos adversos , Trombose/etiologia , Cateteres Venosos Centrais/efeitos adversos , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Estudos Retrospectivos
18.
BMJ Open Qual ; 12(1)2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36631136

RESUMO

Left ventricular (LV) thrombus is an increasingly recognised complication following anterior myocardial infarction and non-ischaemic cardiomyopathy. Whilst vitamin K antagonists (VKA) remain the only approved therapeutic option to reduce the risk of systemic thromboembolism including stroke, the off-label use of direct oral anticoagulants (DOACs) is becoming an attractive alternative.We aimed to improve the diagnosis and management of LV thrombus at a tertiary cardiology centre using quality improvement methodology. Outcomes included increasing the use of DOACs from 25% to 70% over a period of 1 year and shorten length of time from diagnosis to repeat imaging to within 3-6 months as recommended by guidelines.During the first Plan-Do-Study-Action (PDSA) cycle, we identified 84 patients diagnosed with LV thrombus between 1 December 2012 and 30 June 2018. The majority (74%) were prescribed VKA. Repeat imaging occurred in 89% of patients, but only 55% using the same modality. The mean duration between diagnosis and repeat imaging was 233±251 days. There were no significant differences between VKA and DOAC in terms of thrombus resolution, systemic embolisation or clinically significant bleeding. We published trust-wide guidelines on the management of LV thrombus with recommendations supporting the use of DOACs and appropriate follow-up imaging. A second PDSA cycle undertaken between 1 October 2019 and 31 March 2020 identified a further 20 patients. DOAC use increased to 70% and 70% of patients underwent follow-up imaging following a mean duration of 140±61 days, although in only 36% using the same modality.Using quality improvement methodology, we confirmed safe and efficient use of DOAC in the setting of LV thrombus. We published trust guidelines supporting their use, which was associated with an increase in DOAC use and in earlier follow-up imaging in line with our recommendations.


Assuntos
Cardiologia , Trombose , Humanos , Melhoria de Qualidade , Anticoagulantes/uso terapêutico , Trombose/diagnóstico por imagem , Trombose/tratamento farmacológico , Trombose/induzido quimicamente , Hemorragia
19.
BMC Pharmacol Toxicol ; 24(1): 2, 2023 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-36639796

RESUMO

INTRODUCTION: The literature recommends against the use of fondaparinux in patients with kidney failure and dialysis as it may, with repeated dosing, accumulate and put patients at risk of bleeding. The management of patients with thrombosis in the presence of heparin-induced thrombocytopenia HIT requires the introduction of an alternative anticoagulant like bivalirudin or argatroban. When these drugs are not available, fondaparinux, remains the only alternative. In similar scenarios, there are few studies addressing how to administer it.  METHODS: We developed a protocol for fondaparinux in patients with renal failure where pharmacokinetic parameters are altered, and levels changed only after hemodialysis or in cases of residual renal activity. Patients received a full first dose except for high risk of bleeding. We targeted a peak anti-factor Xa activity level of 0.6-1.3 units/ml and changed the subsequent dose accordingly. Furthermore, we monitored the patients for signs of bleeding, a drop in hemoglobin level, or clinical signs of thrombosis.  DISCUSSION: We described 10 patients with kidney failure and suspected HIT taking fondaparinux. All the patients achieved therapeutic anti-factor Xa activity levels. However, one developed new-onset venous thromboembolism (VTE) despite therapeutic anti-factor Xa levels. Another patient experienced a bleeding episode. We believe that these two patients developed complications due to their medical conditions rather than the use of fondaparinux. CONCLUSION: Fondaparinux can be safely used in kidney failure using our protocol. However, despite its safety profile and relative success, this case series was small. More robust studies need to be conducted prior to drawing conclusions.


New Fondaparinux Protocol to Reduce the Risk of Blood Thickening and Blood Clots Formation in Adults with Kidney Disease and Heparin-induced Thrombocytopenia (drop in platelets after the use of heparin): A Test Study.Fondaparinux is a drug used to treat patients suffering from thrombosis (clot in blood) and prevent vessels occlusions. When patients have kidney disease, the ideal treatment for thrombosis would be heparin; and, in case of Heparin Induced Thrombocytopenia (HIT), an unexpected drop in platelets after the use of heparin, the ideal treatment would be argatroban or bivalirudin. Fondaparinux can be used for HIT. However, studies recommend against its use in kidney disease as it might accumulate and cause bleeding.We were put in a challenging situation where we had patients with life-threatening thrombosis, kidney disease, HIT and unavailability of both argatroban and bivalirudin. Our only option was fondaparinux. We had to devise a safe and efficient protocol. The starting dose was the one used had the patient had a normal kidney function. Then, anti-Factor Xa activity was regularly measured with the target level 0.6-1.3units/ml 4 h after a dose. The dose was individualized, changed based on the Factor Xa activity result, the risk of bleeding or thrombosis, the overall kidney function and the need for dialysis.Our protocol was tested on 10 patients. All our patients could reach the target and safe Factor Xa activity. We had 2 exceptions. The first had a clotting event despite having therapeutic Factor Xa activity and the second was a very sick cancer patient who was bleeding despite skipping many doses of fondaparinux. We consider that these 2 cases developed complications due to their medical conditions rather than the use of fondaparinux.We concluded that fondaparinux can be safely used in patients with kidney disease, granted that Factor Xa activity is measured, the risk of bleeding is weighed to the risk of thrombosis and the dose is individualized. However, our sample size is small and further studies with a larger number of patients are needed to draw a conclusion.


Assuntos
Anticoagulantes , Fondaparinux , Insuficiência Renal , Trombocitopenia , Trombose , Adulto , Humanos , Anticoagulantes/uso terapêutico , Fondaparinux/uso terapêutico , Hemorragia/induzido quimicamente , Heparina/efeitos adversos , Insuficiência Renal/tratamento farmacológico , Estudos Retrospectivos , Trombocitopenia/induzido quimicamente , Trombocitopenia/tratamento farmacológico , Trombose/tratamento farmacológico
20.
BMC Cardiovasc Disord ; 23(1): 9, 2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36624370

RESUMO

BACKGROUND: Inflammation has been implicated in the progressive exacerbation of valvular atrial fibrillation (VAF) and thrombogenesis. This study aimed to analyze the association of systemic inflammation as measured by six indices with left atrial thrombus (LAT) in patients with VAF. METHODS: This comparative cross-sectional analytical study included 434 patients with VAF. Logistic regression analysis was used to assess the predictive value of LAT using six inflammation indices: neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio (MLR), white blood cell-to-mean platelet volume ratio, neutrophil-to-mean platelet volume ratio, systemic immune inflammation index, and systemic inflammation response index. Receiver operating characteristic curves were plotted, and the area under these curves (AUC) were calculated to evaluate the discriminative ability of the indices. RESULTS: Transesophageal echocardiography revealed LAT in 143 (32.9%) patients. All six indices reflected a positive correlation with C-reactive protein levels. Multivariate logistic analysis revealed that these indices were independent predictors of LAT, and MLR appeared to perform best (odds ratio 12.006 [95% confidence interval (CI) 3.404-42.347]; P < 0.001; AUC 0.639 [95% CI 0.583-0.694]; P < 0.001). CONCLUSIONS: Selected inflammatory indices were significantly and independently associated with LAT among patients with VAF.


Assuntos
Fibrilação Atrial , Cardiopatias , Trombose , Humanos , Estudos Transversais , Fatores de Risco , Cardiopatias/complicações , Trombose/diagnóstico por imagem , Trombose/etiologia , Ecocardiografia Transesofagiana , Inflamação/diagnóstico , Inflamação/complicações
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