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1.
BMC Prim Care ; 23(1): 147, 2022 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-35676639

RESUMO

BACKGROUND: The risk of thromboembolic events and COVID-19 complications in anticoagulated patients once hospitalized has been widely analyzed. We aim to assess these outcomes in primary health care (PHC) patients chronically treated with oral anticoagulants (OAC) in comparison with non-treated. METHODS: Cohort study including adults with COVID-19 diagnosis in the PHC records in Catalonia, Spain; from March to June 2020. Patients were matched between exposed and non-exposed to OAC based on age and gender in a 1:2 design. Data source is the Information System for Research in Primary Care (SIDIAP). RESULTS: We included 311,542 individuals with COVID-19. After propensity score matching, we obtained a cohort of 20,360 people, 10,180 exposed and 10,180 non-exposed to OAC. Their mean age was 79.9 and 52.1% were women. Patients exposed to OAC had a higher frequency of comorbidities than non-exposed. Anticoagulated patients had a higher risk of hospital admission (IRR 1.16, 95% CI 1.03-1.29), and of stroke and pulmonary embolism than non-anticoagulated (IRR 1,80, 95% CI 1.06-3.06). The risk of pneumonia was not different between groups (IRR 1.04, 95% CI 0.84-1.30). We found a lower risk of death in patients exposed to OAC (IRR 0.60, 95% CI 0.55-0.65). CONCLUSIONS: OAC users in our study had more comorbidities and were older than non-users, well known risks for hospitalization being confirmed with our results. We also found in our study that OAC exposure was not associated to an increased risk in the mortality rate, and it was associated with higher risks of hospital admission and thromboembolic events, although we cannot assess the effect of the interventions applied during hospital admission on the outcomes studied, as our database is a PHC database. TRIAL REGISTRATION: EUPAS register: EUPAS37205 .


Assuntos
COVID-19 , Trombose , Adulto , Anticoagulantes/efeitos adversos , COVID-19/complicações , Teste para COVID-19 , Estudos de Coortes , Feminino , Humanos , Masculino , Atenção Primária à Saúde , SARS-CoV-2 , Espanha/epidemiologia , Trombose/epidemiologia
2.
J Autoimmun ; 129: 102832, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35512480

RESUMO

BACKGROUND: The proprotein convertase subtilisin/kexin type 9 (PCSK9) is emerging as a novel cardiovascular risk factor. Levels of PCSK9 in thrombotic primary antiphospholipid syndrome (PAPS) have never been investigated. METHODS: Cross sectional comparison of baseline characteristics of 91 PAPS patients enrolled in the multicenter prospective ATHERO-APS cohort study. PCSK9 levels were categorized into tertiles and the association with arterial and recurrent thrombosis were assessed by univariable and multivariable logistic regression analysis. RESULTS: Median age was 51 years and 71.4% (n = 65) were women. Overall, 33% (n = 30) experienced an arterial event while 31% (n = 28) had recurrent thrombotic events. Median PCSK9 levels were 1243 (1100-1650) pg/ml. Patients in the third PCSK9 tertile (>1458 pg/ml) showed a higher prevalence of dyslipidemia, lupus anticoagulant positivity and a history of previous arterial and recurrent thrombosis than patients in the first and second tertile. PCSK9 levels were higher in arterial than venous thrombosis (1502 vs. 1180 pg/ml, p = 0.002), and in patients with recurrent vs isolated thrombosis (1680 vs. 1150 pg/m, p < 0.001). High plasma PCSK9 levels were associated with a 4-fold increase risk for arterial events and with a 10-fold increase risk for recurrent thrombosis after adjustment for confounding factors. CONCLUSION: These preliminary data suggest that PCSK9 levels are increased in PAPS patients with arterial and recurrent thrombosis. Its role as a possible therapeutic target in PAPS needs further studies.


Assuntos
Síndrome Antifosfolipídica , Trombose , Síndrome Antifosfolipídica/epidemiologia , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pró-Proteína Convertase 9 , Estudos Prospectivos , Trombose/epidemiologia
3.
Curr Opin Pediatr ; 34(3): 261-267, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35634699

RESUMO

PURPOSE OF REVIEW: To provide an update regarding what is known about thrombotic events and thromboprophylaxis in critically ill children with SARS-CoV-2 infection. RECENT FINDINGS: Pediatric patients with SARS-CoV-2 generally have mild illness; however, intensive care is required in about 20-30% of hospitalized children with COVID-19 and an even higher proportion in those with MIS-C. Increased rates of thrombosis have been observed in adults hospitalized with COVID-19, and clinical trials have attempted to optimize thromboprophylaxis. There is significant variability in the estimated incidence of thrombosis in pediatric patients (0-27%) because of variation in patient populations and study design. Multiple studies demonstrate an increased rate of thrombosis compared with baseline in hospitalized pediatric patients. Few studies have evaluated risk factors for thrombosis, but critical illness, older age, and other known thrombosis risk factors appear to increase the risk. Thromboprophylaxis strategies are inconsistent, with little evidence of efficacy but few reports of major bleeding. SUMMARY: Critically ill children with SARS-CoV-2-related illnesses are at increased risk of thrombosis. Thromboprophylaxis should be considered in select patients with COVID-19 or MIS-C, though the optimal strategy is not yet known. More data is required to guide practice to prevent thrombosis in this population.


Assuntos
COVID-19 , Trombose , Tromboembolia Venosa , Adulto , Anticoagulantes/uso terapêutico , COVID-19/complicações , COVID-19/epidemiologia , Criança , Estado Terminal/terapia , Humanos , SARS-CoV-2 , Síndrome de Resposta Inflamatória Sistêmica , Trombose/epidemiologia , Trombose/etiologia , Trombose/prevenção & controle , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
4.
Nutrients ; 14(10)2022 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-35631302

RESUMO

Extraintestinal manifestations of celiac disease (CD) should be considered, even in patients without typical intestinal symptoms. The aim of our study is to examine the literature regarding the occurrence of thrombotic events in CD, and to synthesize the data from case reports and case series. A systematic review of the literature was conducted by searching the Pub-Med/MEDLINE database, from the date of database inception to January 2022, to identify published cases and case series on this topic, in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 55 cases were included in the study. The majority of patients were previously healthy individuals, with no comorbidities. In less than one-third of the cases (30.91%), the diagnosis of CD was established before the onset of thrombosis, while in the remaining cases (34.54%), thrombosis preceded the diagnosis or was diagnosed concomitantly with CD. The most common sites for thrombosis occurrence were hepatic veins (30.91%), while thrombosis of cerebral blood vessels, deep venous thrombosis of lower extremities, and pulmonary thromboembolism were less frequent. Thrombosis was most commonly isolated to one site only (78.18%). In 69.09% of cases (n = 38), some form of anticoagulation, along with a gluten-free diet, was initiated.


Assuntos
Doença Celíaca , Embolia Pulmonar , Trombose , Doença Celíaca/complicações , Doença Celíaca/epidemiologia , Humanos , Extremidade Inferior , Publicações , Trombose/epidemiologia , Trombose/etiologia
5.
Sci Rep ; 12(1): 9096, 2022 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-35641530

RESUMO

The prevalence of left ventricular (LV) thrombus formation following percutaneous mitral valve edge-to-edge repair (TMVR) with the MitraClip system is unclear. Decreased total stroke volume and perfusion of the LV apex after mitral valve repair may facilitate thrombus formation especially in the context of reduced LV function. LV thrombus may cause disabling stroke or other thromboembolic events in this elderly and multimorbid patient cohort. Analyses of the prevalence of and risk factors for left ventricular thrombus formation in patients treated with the MitraClip system due to severe mitral valve regurgitation. All discharge and follow-up transthoracic echocardiographic examinations up to 6 months of 453 consecutive patients treated with the MitraClip system were screened for the presence of LV thrombus. Prevalence of LV thrombus formation was 1.1% (5/453). Importantly, LV thrombi were exclusively found in patients with severely depressed left ventricular systolic function (LV-EF < 30%), comprising a prevalence of 4.4% in this subgroup (5/113). Importantly, two of these patients were under active DOAC therapy with Rivaroxaban and Apixaban, respectively. Apart from LV-EF, we did not identify other factors that might have facilitated LV thrombus formation. LV thrombus formation following percutaneous mitral valve repair occurred exclusively in patients with severely depressed LV-EF. As two patients developed LV thrombus despite of DOAC therapy, anticoagulation with a Vitamin K antagonist should be considered in patients with an indication for oral anticoagulation following TMVR.


Assuntos
Valva Mitral , Trombose , Idoso , Anticoagulantes , Humanos , Valva Mitral/cirurgia , Prevalência , Volume Sistólico , Trombose/epidemiologia , Trombose/etiologia
6.
Thorac Cancer ; 13(12): 1814-1821, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35567315

RESUMO

BACKGROUND: Current predictive tools assess catheter-related thrombosis (CRT) in patients with lung cancer in a static manner at a single time point of catheterization. The subsequent hazard changes over time are unknown. The conditional catheter-related thrombosis-free probability (CCFP) can provide dynamic information on continual CRT-free expectations. This study aimed to assess the CCFP and hazard rates based on risk categories and various venous access devices (VADs). METHODS: This retrospective study reviewed 939 patients with lung cancer with peripherally inserted central venous catheters (PICCs) or central venous catheters (CVCs) identified at the National Clinical Research Center for Cancer between January 1, 2015 and December 31, 2018. The incidence of CRT has also been reported. Patients were stratified into low- and high-risk groups according to multivariate Cox regression analyses. CCFP is defined as the CRT-free probability given that patients have no CRT for a definite time. RESULTS: A total of 507 patients with PICCs and 432 patients with CVCs were included in this study. The 3-month CCFP increased from 74.2% at catheter insertion to 93.6% at 3 months. The hazards of CRT in the first month were highest (16.4%) and slightly thereafter. The high-risk group initially had a higher (21.4%) but significantly decreased CRT hazard after 2 months (8.3%), whereas the low-risk group maintained a comparable lower risk hazard of less than 5% after 1 month. In the overall cohort, patients with CVCs had lower CRT probability than those with PICCs (HR, 1.76; 95% CI: 1.28-2.41; p < 0.01). Further analysis demonstrated that compared with PICCs, CVCs provided a CRT-free benefit in low-risk patients (p = 0.02) but not in high-risk patients (p = 0.06). CONCLUSIONS: CCFP increased, and the hazards of CRT decreased over time in a risk-dependent manner in patients with lung cancer. These valuable dynamic data may help optimize risk-adjusted choices of VADs and risk-adjusted prophylactic anticoagulation strategies for patients.


Assuntos
Cateterismo Venoso Central , Neoplasias Pulmonares , Trombose , Cateterismo Venoso Central/efeitos adversos , Cateteres , Humanos , Neoplasias Pulmonares/etiologia , Estudos Retrospectivos , Fatores de Risco , Trombose/epidemiologia , Trombose/etiologia
7.
J Cardiothorac Vasc Anesth ; 36(8 Pt B): 3312-3317, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35577652

RESUMO

Extracorporeal membrane oxygenation (ECMO) is an established part of the treatment algorithm for coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome. An intense inflammatory response may cause an imbalance in the coagulation cascade making both thrombosis and bleeding common and notable features of the clinical management of these patients. Large observational and retrospective studies provide a better understanding of the pathophysiology and management of bleeding and thrombosis in COVID-19 patients requiring ECMO. Clinically significant bleeding, including intracerebral hemorrhage, is an independent predictor of mortality, and thrombosis (particularly pulmonary embolism) is associated with mortality, especially if occurring with right ventricular dysfunction. The incidence of heparin-induced thrombocytopenia is higher than the general patient cohort with acute respiratory distress syndrome or other indications for ECMO. The use of laboratory parameters to predict bleeding or thrombosis has a limited role. In this review, the authors discuss the complex pathophysiology of bleeding and thrombosis observed in patients with COVID-19 during ECMO support, and their effects on outcomes.


Assuntos
Transtornos da Coagulação Sanguínea , COVID-19 , Oxigenação por Membrana Extracorpórea , Síndrome do Desconforto Respiratório , Trombose , Transtornos da Coagulação Sanguínea/epidemiologia , COVID-19/complicações , Oxigenação por Membrana Extracorpórea/efeitos adversos , Hemorragia/epidemiologia , Humanos , Estudos Observacionais como Assunto , Síndrome do Desconforto Respiratório/terapia , Estudos Retrospectivos , Trombose/epidemiologia
8.
Neurol India ; 70(2): 623-632, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35532630

RESUMO

Background: An increased incidence of systemic macrothrombotic phenomena such as strokes has been observed in moderate and severe COVID. However, strokes have also been increasingly observed in mild COVID, post COVID, or without obvious COVID illness. Objective: To share our experience with a specific stroke type noted during the COVID pandemic period. Materials and Methods: A single-center observational study was conducted in Western India from January to December 2020, and data regarding stroke patients admitted under Neurology services were noted. Clinical, laboratory, and radiological characteristics of strokes and subtypes were documented. Results: A total of 238 stroke patients were admitted in 2020, 76.5% during the COVID pandemic period. Among 153 ischemic strokes, 16.3% and 56.2% had large vessel occlusion (LVO) in pre-COVID and COVID pandemic period, respectively. Of all ischemic strokes, 20.9% (18 patients) and 12% (3 patients) had free floating thrombus (FFT) in the COVID versus pre-COVID period, respectively. Only 44.4% of all FFT patients could be proven SARS-CoV-2 RT-PCR positive while 50% were COVID suspect with surrogate markers of heightened inflammation at time of stroke. All patients were given anticoagulation and average mRS at discharge was 3.1 (range: 1-6) and 1.84 (range: 0-4) at 3-month follow-up in survivors. Conclusions: This study highlights the presence of FFT causing LVO as a new stroke subtype during the COVID-19 pandemic. With renewed and steeper spike in COVID-19 cases, especially new variants, the resurgence of this stroke subtype needs to be actively explored early in the course of illness to reduce morbidity and mortality.


Assuntos
COVID-19 , AVC Isquêmico , Acidente Vascular Cerebral , Trombose , COVID-19/complicações , Humanos , AVC Isquêmico/diagnóstico por imagem , AVC Isquêmico/epidemiologia , AVC Isquêmico/etiologia , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Trombose/epidemiologia
10.
Semin Hematol ; 59(2): 72-75, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35512903

RESUMO

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a life-threatening syndrome of aggressive thrombosis, often profound thrombocytopenia, and frequently overt disseminated intravascular coagulation. It has been associated with 2 adenovirus vector COVID-19 vaccines: ChAdOx1 nCoV-19 (AstraZeneca) and Ad26.COV2.S (Janssen). Unlike the myriad of other conditions that cause thrombosis and thrombocytopenia, VITT has an important distinguishing feature: affected individuals have platelet activating anti-PF4 antibodies that appear in a predictable time frame following vaccination. The reported incidence of VITT differs between jurisdictions; it is dependent on accurate ascertainment of cases and accurate estimates of the size of the vaccinated population. The incidence ranges from 1 case per 26,500 to 127,3000 first doses of ChAdOx1 nCoV-19 administered. It is estimated at 1 case per 518,181 second doses of ChAdOx1 nCoV-19 administered, and 1 case per 263,000 Ad26.COV2.S doses administered. There are no clear risk factors for VITT, including sex, age, or comorbidities. VITT is a rare event, but its considerable morbidity and mortality merit ongoing pharmacovigilance, and accurate case ascertainment.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Púrpura Trombocitopênica Idiopática , Trombose , /efeitos adversos , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Humanos , Púrpura Trombocitopênica Idiopática/induzido quimicamente , Púrpura Trombocitopênica Idiopática/epidemiologia , Trombose/induzido quimicamente , Trombose/epidemiologia
11.
Glob Heart ; 17(1): 24, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35586746

RESUMO

Background: Stent thrombosis (ST) remains the most feared complication of percutaneous coronary intervention (PCI). Therefore, this study aimed to determine acute and sub-acute ST incidence, predictors, and outcomes after primary PCI. Methods: This prospective observational study included patients who had undergone primary PCI at a tertiary care cardiac center. All the patients were followed at 30-days of index hospitalization for the incidence of acute or sub-acute ST. ST was further categorized as definite, probable, or possible per the Academic Research Consortium definition. All the survivors of ST were followed after 6-months for the incidence of major adverse cardiovascular events. Results: An aggregate of 1756 patients were included with 79% (1388) male patients and mean age was 55.59 ± 11.23 years. The incidence of ST was 4.9% (86) with 1.3% (22) acute and 3.6% (64) sub-acute. ST was categorized as definite in 3.3% (58) and probable in 1.6% (28). Independent predictor of ST were observed to be male gender (odds ratio (OR); 2.51 [1.21-5.2]), left ventricular end-diastolic pressure ≥20 mmHg (OR; 2.55 [1.31-4.98]), and pre-procedure thrombolysis in myocardial infarction (TIMI) flow 0 (OR; 3.27 [1.61-6.65]). Cumulative all-cause mortality among patients with ST after 164.1 ± 76.2 days was 46.5% (40/86). Conclusion: We observed a substantial number of patients vulnerable to the acute or sub-acute ST after primary PCI. Male gender, LVEDP, pre-procedure TIMI flow grade can be used to identify and efficiently manage highly vulnerable patients.


Assuntos
Stents Farmacológicos , Intervenção Coronária Percutânea , Trombose , Adulto , Idoso , Stents Farmacológicos/efeitos adversos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Trombose/epidemiologia , Trombose/etiologia , Resultado do Tratamento
12.
J Ayub Med Coll Abbottabad ; 34(2): 263-268, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35576283

RESUMO

BACKGROUND: Advances in imaging techniques and longer survival of chronic medical conditions contribute to the increase in paediatric thrombosis. We aim to determine the incidence, underlying risk factors, management and clinical outcome of paediatric thrombosis at a multidisciplinary facility of Pakistan. METHODS: A retrospectively analysis of the medical records of patients in the paediatric age group admitted at the Aga Khan University hospital from January 2013-September 2018 was performed. Site of thrombosis, associated risks factors, management options and outcome of thrombotic event were evaluated. RESULTS: Of the 22,320 paediatric hospitalization, 35 paediatric patients were diagnosed with thrombosis (15 cases per 10,000 admissions). The median age of the study group was 15 years and twenty patients (57%) were male. The commonest site of thrombosis was in lower limb venous 11 (31%), followed by upper limb venous thrombosis 6 (17%), abdominal vein thrombosis 7 (20%), cerebral venous thrombosis 5 (14%), pulmonary embolism and arterial thrombosis 3(9% each). Eighty three percent had underlying clinical condition including central venous catheter [CVC] (26%), malignancy and infection (14% each), antiphospholipid antibody syndrome (9%), inherited thrombophilia (9%), congenital heart disease (6%), while thrombotic thrombocytopenic purpura and autoimmune disorder (3% each). Twelve (34%) patients were treated with heparin only, 8 (23%) received heparin followed by warfarin while warfarin as a single agent was given in 2 (5.7%) patients. One patient died of pulmonary embolism while 9 (25%) had persistence or recurrence of thrombosis. CONCLUSIONS: Incidence of paediatric thrombosis was 0.15%. CVC placement was the most common associated risk factor. Warfarin and heparin both were found to be safe anticoagulation option. Recurrence rate was found to be high.


Assuntos
Embolia Pulmonar , Trombose , Trombose Venosa , Adolescente , Anticoagulantes/uso terapêutico , Criança , Feminino , Heparina/uso terapêutico , Humanos , Masculino , Paquistão/epidemiologia , Embolia Pulmonar/complicações , Embolia Pulmonar/tratamento farmacológico , Estudos Retrospectivos , Centros de Atenção Terciária , Trombose/epidemiologia , Trombose/etiologia , Trombose Venosa/tratamento farmacológico , Trombose Venosa/epidemiologia , Varfarina/uso terapêutico
13.
Phlebology ; 37(5): 326-337, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35403487

RESUMO

INTRODUCTION: COVID-19 associated VTE is a new disease entity with high morbidity and mortality. The aim of this paper is to review contemporary emerging literature on the incidence, pathophysiology, predictive prognostic indicators, and management consensus for Covid-19 related thrombotic complications, in particular DVT and PE. METHODS: A literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. All searches were done via PubMed. References of review articles were further screened according to the exclusion criteria. RESULTS: In total, 154 records were identified and 20 duplicates were removed. A final 68 articles were included in the qualitative analysis. COVID-19 related thrombosis can affect multiple organs of the body, presenting in the form of arterial or venous thrombosis such as ischemic stroke, myocardial infarction, mesenteric ischemia, limb ischemia, DVT, or PE. DVT and PE has an overall incidence of 6-26%, and severely ill COVID-19 patients have even higher incidence of thromboembolism. On the other hand, incidence of arterial thromboembolism is much lower with incidence of 0.7%-3.7%. D-dimer is found to be an independent risk factor, and IMPROVE score, Caprini score, and Padua score have all been used as predictors. International guidelines suggest the use of low molecular weight heparin (LMWH) or fondaparinux for prophylaxis of VTE, and therapeutic dosage of weight adjusted LMWH for treatment if confirmed diagnosis. CONCLUSIONS: Contemporary rapidly evolving evidence shows that COVID-19 associated thrombosis was a novel clinical entity, especially in severely ill COVID-19 patients. There are multiple society-driven guidelines only, but without any level 1 evidence for management regimen. The ideal dose for prophylaxis is not established and may vary depending on balance of bleeding and thrombosis risk. The risk of bleeding may be increased in patients in intensive care unit.


Assuntos
COVID-19 , Embolia Pulmonar , Trombose , Tromboembolia Venosa , Anticoagulantes , COVID-19/complicações , Hemorragia/induzido quimicamente , Heparina de Baixo Peso Molecular , Humanos , Embolia Pulmonar/epidemiologia , Trombose/epidemiologia , Trombose/etiologia , Tromboembolia Venosa/prevenção & controle
14.
J Am Heart Assoc ; 11(7): e023276, 2022 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-35377181

RESUMO

Background Stent thrombosis (ST) remains a significant medical issue. In particular, longer-term mortality and clinical predictors after ST occurrence have yet to be elucidated. Methods and Results This was a multicenter, retrospective, observational study. A total of 187 definite ST cases from January 2008 to December 2017 were enrolled, and the long-term clinical outcomes were investigated. The primary outcome measure was the cumulative mortality after ST occurrence. In addition, independent predictors of mortality were assessed. Among the stent types causing ST, bare-metal stent, first-generation drug-eluting stent, second-generation drug-eluting stent, and third-generation drug-eluting stent comprised 31.0%, 19.3%, 36.9%, and 6.4% of cases, respectively. Median duration from stent implantation to ST was 680.5 (interquartile range, 33.8-2450.5) days. Cumulative mortality was 14.6%, 17.4%, 21.2%, 24.4%, and 33.8% at 1, 2, 3, 5 and 10 years, respectively. The cumulative mortality did not significantly differ by type of stent, and mortality of late ST was higher than that of early ST and very late ST; however, it did not reach statistical significance after the multivariate analysis. Independent predictors of mortality were hemodialysis (hazard ratio [HR], 7.80; 95% CI, 3.07-19.81; P<0.001), culprit lesions in the left main trunk (HR, 8.14; 95% CI, 1.71-38.75; P=0.008), culprit lesions in the left coronary artery (HR, 2.77; 95% CI, 1.10-6.96; P=0.030), and peak creatine kinase (HR, 1.017; 95% CI, 1.011-1.022; P<0.001). Conclusions The 10-year cumulative mortality after ST reached 33.8%. Close follow-up is thus mandatory for patients with ST, especially with hemodialysis, culprit lesions in the left main trunk and left coronary artery, and high peak creatine kinase.


Assuntos
Trombose Coronária , Stents Farmacológicos , Intervenção Coronária Percutânea , Trombose , Trombose Coronária/etiologia , Stents Farmacológicos/efeitos adversos , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Estudos Retrospectivos , Fatores de Risco , Stents/efeitos adversos , Trombose/epidemiologia , Resultado do Tratamento
15.
Public Health ; 207: 14-18, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35461122

RESUMO

OBJECTIVES: Vaccination is one of the most effective measures to combat the COVID-19 pandemic. The main reason for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination hesitancy is the potential side-effects. This study aimed to investigate the incidence of venous thrombosis and pulmonary embolism in patients who received SARS-CoV-2 vaccination. STUDY DESIGN: This was a retrospective cohort study. METHODS: Individuals aged ≥18 years who received an initial vaccination for COVID-19 in one of 1134 general practices in Germany between April and June 2021 were included in the study. Vaccinated patients were matched to unvaccinated individuals by age, sex, index month (April to June 2020 [unvaccinated cohort] or April to June 2021 [vaccinated cohort]) and diagnoses that may be associated with an increased incidence of thrombosis documented within 12 months before the index date. The incidences of thrombosis and non-fatal pulmonary embolism as a function of COVID-19 vaccination were analysed. RESULTS: The present study included 326,833 individuals who were vaccinated against COVID-19 and 326,833 matched unvaccinated individuals. During the follow-up period, 406 vaccinated patients and 342 individuals in the control group received a diagnosis of thrombosis or non-fatal pulmonary embolism. This resulted in an incidence rate of 11.9 vs 11.3 cases per 1000 patient-years for vaccinated vs unvaccinated individuals, respectively, and a non-significant overall incidence rate ratio (IRR: 1.06; 95% confidence interval [CI]: 0.93-1.22). The highest IRR was observed in the 41-60 years age group (IRR: 1.30; 95% CI: 0.98-1.73), and the lowest IRR was seen in the 18-40 years age group (IRR: 0.6; 95% CI: 0.0-1.05); however, none of the individual age group incidence rates was significant. CONCLUSIONS: The results indicate that the occurrence of thrombosis or pulmonary embolism after COVID-19 vaccination is a coincidental finding rather than a consequence of vaccination.


Assuntos
COVID-19 , Embolia Pulmonar , Trombose , Trombose Venosa , Adolescente , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Alemanha/epidemiologia , Humanos , Incidência , Pandemias/prevenção & controle , Embolia Pulmonar/complicações , Embolia Pulmonar/etiologia , Estudos Retrospectivos , SARS-CoV-2 , Trombose/complicações , Trombose/epidemiologia , Vacinação/efeitos adversos , Trombose Venosa/complicações , Trombose Venosa/etiologia
16.
Turk Kardiyol Dern Ars ; 50(3): 168-174, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35450840

RESUMO

OBJECTIVE: The left ventricular thrombus is one of the serious complications of ischemic cardiomyopathy. In this study, we aimed to search for the independent factors to predict the resolution of left ventricular thrombus. METHODS: This retrospective study included all patients with coronary artery disease, aged above 18 years old, and with the thrombus at the apical location of the left ventricle. Demographic, clinical, and echocardiographic characteristics of the patients were recorded. Major adverse cardiovascular events developed within the follow-up period were recorded. The time in the therapeutic range of each patient was calculated. The presence of left ventricular thrombus beyond 180 days despite warfarin usage was classified as persistent left ventricular thrombus. RESULTS: The study included 174 subjects (169 males and 5 females). The mean age of the study population was 54.5 ± 11.0 years. The number of patients in whom the left ventricular thrombus resolved with treatment in less than 180 days was 56 (32.2%). Median anticoagulation time in the study population was 252 [150-480] days and the meantime in the therapeutic range of the patients was 54 ± 19%. The time in therapeutic range value of the groups was similar (P=.593). It was found that concomitant clopidogrel use (P=.003) and left ventricular thrombus area (P < .001) were the independent predictors of left ventricular thrombus resolution within less than 180 days in the logistic regression analysis. CONCLUSION: Concomitant use of clopidogrel was found to be associated with left ventricular thrombus resolution but left ventricular thrombus size was related to left ventricular thrombus persistency. Although standard 3-6 months of anticoagulation is advised for left ventricular thrombus, considering the presence of these predictors in such patients may guide the physicians to individualize the treatment.


Assuntos
Cardiopatias Congênitas , Trombose , Adolescente , Adulto , Idoso , Anticoagulantes/uso terapêutico , Clopidogrel/uso terapêutico , Ecocardiografia , Feminino , Cardiopatias Congênitas/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Trombose/diagnóstico por imagem , Trombose/tratamento farmacológico , Trombose/epidemiologia
17.
Kardiologiia ; 62(3): 21-27, 2022 Mar 31.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-35414356

RESUMO

Aim      To evaluate the incidence and features of left atrial appendage (LAA) thrombosis in patients with persistent atrial fibrillation (AF) after novel coronavirus infection (COVID-19).Material and methods  Percutaneous echocardiography (pcEchoCG) was performed for 128 patients with persistent AF prepared for cardioversion, 36 (28.1 %) of whom had had COVID-19. In 3 (8.3 %) patients, the lung lesion area was 50-75 %; in 31 (86.1 %) patients, 25-50 %; in 1 (2.8 %) patient, less than 25 %. One patient had no lung lesion. Median time from the onset of COVID-19 to the patient enrollment in the study was 76.5 days. At the time of enrollment, the polymerase chain reaction test for SARS-CoV-2 was negative in all patients.Results Patients after COVID-19 and those who had not had COVID-19 were comparable by age (62.5±9.2 and 62.4±9.1 years, respectively; р=0.956), gender (men 52.8 and 59.8 %, respectively; р=0.471), and risk of stroke (score 2.19±1.28 and score 1.95±1.35, respectively; р=0.350). Duration of the last arrhythmia episode was longer for patients after COVID-19 than for the comparison group (76.5 and 45.0 days, respectively; р=0.011). All patients received oral anticoagulants. 55.6 % of COVID-19 patients received rivaroxaban, whereas 62.0% of patients who had not had COVID-19 were treated with apixaban. Median duration of the anticoagulant treatment was longer for COVID-19 patients than for the comparison group (61.5 and 32.0 days; р=0.051). LAA thrombus was detected in 7 (19.4 %) patients after COVID-19 and in 6 (6.5 %) patients of the comparison group (р=0.030). In COVID-19 patients, the thrombus adhered to LAA wall over the entire thrombus length whereas in patients who had not have COVID-19, the thrombus had a free part that formed a sharp angle with LAA walls. In the presence of LAA thrombus, the LAA blood flow velocity was considerably higher for COVID-19 patients than for the comparison group (31.0±8.9 and 18.8±4.9 cm/sec, respectively; p=0.010). At the follow-up examination performed at 24.0 days on the average, the thrombus was found to be dissolved in 80 and 50% of patients after and without COVID-19, respectively (р=0.343).Conclusion      In patients with persistent AF after the novel coronavirus infection, LAA thrombosis was detected more frequently than in patients who had never had COVID-19; it was characterized by mural localization and was not associated with a decrease in LAA blood flow velocity.


Assuntos
Apêndice Atrial , Fibrilação Atrial , COVID-19 , Cardiopatias , Trombose , Idoso , Anticoagulantes/uso terapêutico , Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , COVID-19/complicações , Ecocardiografia Transesofagiana/efeitos adversos , Cardiopatias/complicações , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Trombose/diagnóstico , Trombose/epidemiologia , Trombose/etiologia
18.
J Pharm Pract ; 35(2): 205-211, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35484870

RESUMO

INTRODUCTION: The Coronavirus Disease 2019 (COVID-19) is associated with severe hypercoagulability. There is currently limited evidence supporting the routine use of therapeutic anticoagulation in the setting of COVID-19. OBJECTIVES: The primary objective was to compare the incidence of thromboembolic events in adult patients with COVID-19 treated with an unfractionated heparin (UFH) infusion versus prophylactic dose anticoagulation. Secondary objectives included exploration of the efficacy and safety of an UFH infusion through the evaluation of organ function and incidence of minor and major bleeding. METHODS: Retrospective observational cohort study with propensity score matching of COVID-19 patients who received an UFH infusion targeting an aPTT between 40 and 60 seconds. RESULTS: Fifty-six patients were included in this study. There was no difference in the composite of thromboembolic events comprised of venous thromboembolism, arterial thrombosis, and catheter-related thrombosis between the UFH and control group (17.9% vs. 3.6%, P = 0.19). There was a significant increase in median D-dimer concentrations from day 1 to day 7 in the control group (475 ng/mL [291-999] vs. 10820 ng/mL [606-21033], P = 0.04). Patients treated with UFH had a higher incidence of minor bleeding (35.7% vs. 0%, P < 0.005) and required more units of packed red blood cell transfusion (0.8 units ± 1.6 vs. 0 units, P = 0.01). CONCLUSION: Continuous infusion of UFH for patients with COVID-19 infection did not decrease the overall incidence of thromboembolic complications. UFH was associated with stabilization of D-dimer concentrations and increased rates of minor bleeding and transfusions.


Assuntos
COVID-19 , Trombofilia , Trombose , Tromboembolia Venosa , Adulto , Anticoagulantes , COVID-19/tratamento farmacológico , Hemorragia/induzido quimicamente , Heparina , Humanos , Estudos Retrospectivos , Trombofilia/tratamento farmacológico , Trombofilia/etiologia , Trombose/tratamento farmacológico , Trombose/epidemiologia , Trombose/etiologia , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
19.
JACC Cardiovasc Interv ; 15(8): 861-872, 2022 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-35367170

RESUMO

OBJECTIVES: The aim of this study was to investigate the effects of rivaroxaban on left ventricle thromboprophylaxis in patients with anterior ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Anterior STEMI is associated with an increased risk of left ventricular thrombus (LVT) formation. The contemporary role of prophylactic rivaroxaban therapy remains unclear. METHODS: We randomly assigned 279 patients with anterior STEMI who had undergone primary percutaneous coronary intervention to receive, in a 1:1 ratio, low-dose rivaroxaban (2.5 mg twice daily for 30 days) and dual antiplatelet therapy (DAPT) or only DAPT. The primary efficacy outcome was the LVT formation within 30 days. Net clinical adverse events were assessed at 30 days and 180 days, including all-cause mortality, LVT, systemic embolism, rehospitalization for cardiovascular events, and bleeding. RESULTS: The addition of low-dose rivaroxaban to DAPT reduced LVT formation within 30 days compared with only DAPT (0.7% vs 8.6%; HR: 0.08; 95% CI: 0.01-0.62; P = 0.015; P < 0.001 for superiority). Net clinical adverse events were lower within 30 days in the rivaroxaban group versus those in the only DAPT group and remained relatively low throughout the follow-up period. There were no significant differences in bleeding events between the 2 groups in 30 days and 180 days. However, 1 case of intracranial hemorrhage (major bleeding) occurred in the rivaroxaban group within 30 days. CONCLUSIONS: Our results supported that the short-duration addition of low-dose rivaroxaban to DAPT could prevent LVT formation in patients with anterior STEMI following primary percutaneous coronary intervention. A larger multiple-institution study is necessary to determine the generalizability.


Assuntos
Rivaroxabana , Infarto do Miocárdio com Supradesnível do Segmento ST , Trombose , Terapia Antiplaquetária Dupla/efeitos adversos , Hemorragia/induzido quimicamente , Humanos , Intervenção Coronária Percutânea , Inibidores da Agregação Plaquetária/efeitos adversos , Rivaroxabana/efeitos adversos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Trombose/epidemiologia , Trombose/prevenção & controle , Resultado do Tratamento
20.
Croat Med J ; 63(1): 16-26, 2022 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-35230002

RESUMO

AIM: To evaluate the burden and predictors of thromboembolic complications in a large real-life cohort of hospitalized patients with established coronavirus disease 2019 (COVID-19). METHODS: We retrospectively reviewed the records of 4014 consecutive adult patients admitted to a tertiary-level institution because of COVID-19 from March 2020 to March 2021 for the presence of venous and arterial thrombotic events. RESULTS: Venous-thromboembolic (VTE) events were present in 5.3% and arterial thrombotic events in 5.8% patients. The majority of arterial thromboses occurred before or on the day of admission, while the majority of VTE events occurred during hospitalization. The majority of both types of events occurred before intensive care unit (ICU) admission, although both types of events were associated with a higher need for ICU use and prolonged immobilization. In multivariate logistic regression, VTE events were independently associated with metastatic malignancy, known thrombophilia, lower mean corpuscular hemoglobin concentration, higher D-dimer, lower lactate dehydrogenase, longer duration of disease on admission, bilateral pneumonia, longer duration of hospitalization, and immobilization for at least one day. Arterial thromboses were independently associated with less severe COVID-19, higher Charlson comorbidity index, coronary artery disease, peripheral artery disease, history of cerebrovascular insult, aspirin use, lower C reactive protein, better functional status on admission, ICU use, immobilization for at least one day, absence of hyperlipoproteinemia, and absence of metastatic malignancy. CONCLUSION: Among hospitalized COVID-19 patients, venous and arterial thromboses differ in timing of presentation, association with COVID-19 severity, and other clinical characteristics.


Assuntos
COVID-19 , Trombose , Tromboembolia Venosa , Adulto , COVID-19/complicações , COVID-19/epidemiologia , Humanos , Incidência , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2 , Trombose/epidemiologia , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
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