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1.
Anticancer Res ; 40(1): 305-313, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892581

RESUMO

BACKGROUND: Cancer-associated thrombosis (CAT), the second leading cause of death in patients with cancer can be treated with low molecular weight heparin (LMWH) according to guidelines. PATIENTS AND METHODS: A multicenter prospective observational study was carried out to record anti-thrombotic treatment practice, assess thrombosis recurrence and bleeding, and identify potential risk factors. Adult patients from 18 Oncology Departments throughout Greece were followed-up for 12 months. RESULTS: A total of 120 patients with CAT receiving anticoagulant treatment were enrolled (35% incidental); 85% were treated for more than 6 months, 95.8% were treated with tinzaparin and smaller percentages with other agents. Thrombosis recurred in three patients and there was minor bleeding in four patients. Bleeding was associated with high body mass index (>35 kg/m2), trauma history, renal insufficiency and bevacizumab use. CONCLUSION: Incidental thrombosis contributes significantly to CAT burden. Long-term use of LMWH seems to be effective and safe. Several risk factors associated with bleeding should be considered during anti-coagulation therapy planning.


Assuntos
Neoplasias/complicações , Trombose/etiologia , Trombose/terapia , Feminino , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Fatores de Risco
2.
Ann Hematol ; 99(1): 49-55, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31853702

RESUMO

Immune thrombocytopenia (ITP) has been reported to be associated with thrombotic events. The incidence of thrombosis in 303 newly diagnosed ITP patients in our institute between 2000 and 2016 was retrospectively reviewed. During a median follow-up of 3.6 years, 16 thrombotic events (12 arterial and four venous) occurred. The median platelet count at thrombotic events was 102 × 109/l. At 10 years, the cumulative thrombosis incidence was 10%. A univariate analysis showed that smoking, hypertension, male gender, a history of thrombosis, and atrial fibrillation (Af) were significantly associated with the occurrence of thrombosis, and a multivariate analysis identified smoking and Af as independent risk factors. The thrombotic risk was not increased by lupus anticoagulant positivity or ITP treatment. At 5 years, the cumulative incidence of bleeding and overall survival probability was 5.6% and 92%, respectively. This study demonstrates that smoking and Af were associated with an increased risk of thrombosis. Previously identified risk factors were not confirmed in these Japanese ITP patients.


Assuntos
Púrpura Trombocitopênica Idiopática , Trombose , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Púrpura Trombocitopênica Idiopática/complicações , Púrpura Trombocitopênica Idiopática/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Trombose/etiologia , Trombose/mortalidade
3.
Medicine (Baltimore) ; 98(51): e18446, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861017

RESUMO

Thrombosis is one of the serious complications related to prophylactic balloon occlusion of the abdominal aorta (PBOAA). This study aims to retrospectively analyze the efficacy and safety of continuous low-flow infusion of diluted heparin saline to prevent this complication related to PBOAA and further to provide the theory and evidences for using PBOAA.A study was carried out at our hospital from March 2016 to December 2018. Women with pernicious placenta previa (PPP) were treated PBOAA to prevent massive bleeding during CS. According to whether continuous low-flow infusion of diluted heparin saline was used to prevent catheter-related thrombosis or not, they were divided into 2 groups, the test group and the control group. The incidence of thrombosis between the 2 groups was compared and the effective treatment of thrombosis was also discussed. The comparison of nonparametric values was accomplished by using Fisher exact test. Statistical significance was set at P < .05.There were 31 women with PPP who received PBOAA during CS who were included in our study. Six of 19 women in control group (31.6%) developed thrombotic complications, while none of 12 women in test group. There were statistically significant differences in the incidence of thrombosis between the 2 groups (P = .037). There was no statistically significant difference in the amount of estimated blood loss and blood transfusion during CS between the 2 groups, nor was there statistically significant difference in the hospital days after CS (P > .05). All 6 women with thrombotic complications had no positive symptoms and thrombotic sequelae. The managements of thrombus included systemic anticoagulation, catheter-directed thrombolysis, and catheter-directed anticoagulation. One of the 6 women was lost to follow-up, and the thrombus of the other 5 women were completely dissolved. No other adverse outcomes or complications related to PBOAA were observed in all women in this study.Continuous low-flow infusion of diluted heparin saline is a safe procedure when PBOAA is performed for patients with PPP. It can effectively reduce or even avoid thrombosis without increasing intraoperative blood loss during CS for PPP patients.


Assuntos
Anticoagulantes/administração & dosagem , Aorta Abdominal , Oclusão com Balão/efeitos adversos , Heparina/administração & dosagem , Trombose/prevenção & controle , Adulto , Cesárea/efeitos adversos , Feminino , Humanos , Placenta Prévia/etiologia , Gravidez , Estudos Retrospectivos , Trombose/etiologia , Hemorragia Uterina/etiologia , Hemorragia Uterina/prevenção & controle
4.
Hinyokika Kiyo ; 65(10): 397-402, 2019 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-31697884

RESUMO

A 36-year-old female was referred to our hospital for a giant abdominal mass found by ultrasound examination. A computed tomographic scan showed a large retroperitoneal mass measuring 11 cm in diameter suspected to be liver invasion,a right atrial and inferior vena cava (IVC) tumor thrombus with obstruction of hepatic vein junction of IVC,and small lung metastases. She was diagnosed with cT4N0M1 adrenocortical carcinoma (ACC) by a needle biopsy and radiographic examination. Right adrenalectomy and thrombectomy were successfully performed without cardiac arrest and without liver dissection. The operative time was 485 minutes,and the estimated blood loss was 7,533 ml. No major peri- or postoperative complications were observed. For the residual lung mass,a first line combination chemotherapy with etoposide,doxorubicin,cisplatin and mitotane followed by a second line chemotherapy with gemcitabine and capecitabine were administered. She has been alive with disease for 45 months under mitotane treatment against residual lung metastases. In conclusion,extended surgery could be successfully performed for advanced ACC with right atrium and IVC tumor thrombus. Although careful planning is needed for successful surgery,combination therapy with extended surgery and subsequent systematic chemotherapy may provide a substantial benefit in patients with advanced ACC.


Assuntos
Neoplasias do Córtex Suprarrenal , Carcinoma Adrenocortical , Trombose , Neoplasias do Córtex Suprarrenal/complicações , Adrenalectomia , Carcinoma Adrenocortical/complicações , Adulto , Feminino , Humanos , Trombectomia , Trombose/etiologia , Veia Cava Inferior
5.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 41(5): 685-689, 2019 Oct 30.
Artigo em Chinês | MEDLINE | ID: mdl-31699201

RESUMO

Bullous pemphigoid(BP)is an autoimmune blister disease caused by antibodies to the basement membrane zone.It usually exhibits tense bullae in skin and mucous membrane.BP patients can suffer from thrombosis due to hypercoagulation and/or hemorrhage due to the presence of anti-coagulation factors,which may be explained by the eosinophils,antibodies to the coagulation factors,and fibrinolytic system hyperactivity or inhibition.


Assuntos
Transtornos da Coagulação Sanguínea/complicações , Penfigoide Bolhoso/complicações , Autoanticorpos , Vesícula , Fatores de Coagulação Sanguínea , Eosinófilos , Hemorragia/etiologia , Humanos , Membrana Mucosa/patologia , Pele/patologia , Trombose/etiologia
6.
Medicine (Baltimore) ; 98(44): e17757, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689833

RESUMO

Nursing staff play a crucial role in maintaining a functional port. Nursing guidelines recommend standard maintenance with 10 ml irrigation without consideration for variations among patients and individual nursing staff. The aim of this study is to identify the efficacy of the current maintenance strategy and analyze the correlation between complications and actual port presentations, based on disassembled intravenous ports after removal from patients. We attempt to organize the information and propose a definite maintenance strategy.After treatment completion, or due to complications, 434 implanted intravenous ports were removed from patients. All ports were deconstructed to observe their actual presentations and were then analyzed in conjunction with medical records. The correlation between complications and actual presentations was analyzed.From March 2012 to December 2017, 434 implanted intravenous ports were removed from oncology patients after completion of treatment or catheter related complications. From the view of maintenance related presentations, injection chamber blood clot was highly correlated with chemotherapy completion (P < .001) and malfunction (P = .005), while tip blood clot (P = .043) was related with chemotherapy completion and catheter fibrin (P = .015) was related to malfunction. From the view of structure related presentations, broken catheter integrity was correlated to chemotherapy completion (P = .007), fracture (P < .001), and malfunction (P = .008). Compression groove was related to chemotherapy completion (P = .03) and broken catheter at protruding stud was related to fracture (P = .04), while diaphragm rupture was correlated to chemotherapy completion (P = .048) and malfunction. (P < .001).Current port maintenance is insufficient for ideal port maintenance, whereby maintenance-related presentations, including tip clot, catheter fibrin, and injection chamber blood clot were identified. We propose a recommended maintenance strategy based on our findings. Structure-related presentations, including broken catheter integrity, broken catheter at protruding stud and diaphragm rupture were seen in patients with longer implantation period. Removal of the implanted port may be considered after 5 years if no disease relapse is noted.


Assuntos
Cateteres de Demora/normas , Protocolos Clínicos , Neoplasias/enfermagem , Dispositivos de Acesso Vascular/normas , Adulto , Idoso , Cateteres de Demora/efeitos adversos , Falha de Equipamento/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Estudos Retrospectivos , Trombose/etiologia , Dispositivos de Acesso Vascular/efeitos adversos
7.
Praxis (Bern 1994) ; 108(13): 835-842, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31571535

RESUMO

CME: Polycythemia vera Abstract. Polycythemia vera is a myeloprolifere disease which is characterized by proliferation of all three (erythroid, megakaryocytic and granulocytic) cell lines. The causative mutation is in the JAK2-tyrosine kinase gene. The symptoms are related to the increased red blood cells. Common signs are itching (pruritus) and pain in the hands or feet. The most common complications are thrombotic events. Risk factors are age over 60 years and a thrombotic event in the patient's history. The treatment consists of phlebotomy combined with acetylsalicylic acid 100 mg a day. The goal of the therapy is the prevention of the common thrombotic events. During the course of the disease, cytoreductive treatment is indicated in most of the patients.


Assuntos
Policitemia Vera , Trombose , Humanos , Janus Quinase 2/genética , Flebotomia , Policitemia Vera/diagnóstico , Policitemia Vera/genética , Policitemia Vera/terapia , Trombose/etiologia
8.
Prague Med Rep ; 120(2-3): 39-51, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31586503

RESUMO

Lipoprotein(a) - Lp(a) - is an independent risk factor for cardiovascular disease (CVD). Indeed, individuals with plasma concentrations of Lp(a) > 200 mg/l carry an increased risk of developing CVD. Circulating levels of Lp(a) are remarkably resistant to common lipid lowering therapies, currently available treatment for reduction of Lp(a) is plasma apheresis, which is costly and labour intensive. The Lp(a) molecule is composed of two parts: LDL/apoB-100 core and glycoprotein, apolipoprotein(a) - Apo(a), both of them can interact with components of the coagulation cascade, inflammatory pathways and blood vessel cells (smooth muscle cells and endothelial cells). Therefore, it is very important to determine the molecular pathways by which Lp(a) affect the vascular system in order to design therapeutics for targeting the Lp(a) cellular effects. This paper summarises the cellular effects and molecular mechanisms by which Lp(a) participate in atherogenesis, thrombogenesis, inflammation and development of cardiovascular diseases.


Assuntos
Aterosclerose , Lipoproteína(a) , Trombose , Aterosclerose/etiologia , Células Endoteliais , Humanos , Fatores de Risco , Trombose/etiologia
9.
Khirurgiia (Mosk) ; (10): 75-81, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31626243

RESUMO

Postoperative complications in vascular surgery may be partly provoked by suture material. Analysis of the mechanisms of these complications may be useful for their prevention. Mechanisms of suture-induced thrombosis and neointimal hyperplasia, possible strategies for prevention of postoperative complications including those allowing drug deliveries directly to the vascular anastomosis area are discussed in the article. According to the literature data, heparin is the most optimal drug for modifying suture material and prevention of thrombosis and neointimal hyperplasia. Heparin delivery to the vascular anastomosis site will reduce the risk of thrombosis by inhibiting the activity of thrombin. Complex of heparin and antithrombin III increases inhibitory effect of antithrombin against thrombin. In addition, heparin is able to reduce proliferation of vascular smooth muscle cells through inhibition of the synthesis of extracellular matrix proteases involved in migration and proliferation of cells. Thus, heparin delivery to the vascular injury site may be used to prevent thrombosis and myoproliferative response. Moreover, this strategy prevents complications associated with systemic administration of anticoagulants.


Assuntos
Suturas/efeitos adversos , Trombose/prevenção & controle , Doenças Vasculares/prevenção & controle , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Anticoagulantes/administração & dosagem , Heparina/administração & dosagem , Humanos , Hiperplasia/etiologia , Hiperplasia/patologia , Hiperplasia/prevenção & controle , Neointima/patologia , Trombose/etiologia , Doenças Vasculares/etiologia
10.
Rev Port Cir Cardiotorac Vasc ; 26(2): 143-145, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31476816

RESUMO

INTRODUCTION: Mechanical prosthetic valve thrombosis (PVT) and obstruction is a lifethreatening event. The significant morbidity and mortality associated with this condition warrants rapid diagnostic evaluation and treatment. CASE REPORT: A 66-year-old female patient with a history of aortic valve replacement 13 years before, was admitted to our intensive cardiac care unit with symptoms and signs of prosthetic aortic valve dysfunction. During cardiac angiography, she collapsed and fluoroscopy showed an immobile disc, stopped in an open position and causing free aortic regurgitation. Cardio-pulmonary resuscitation (CPR) was initiated and a VA-ECMO was inserted as a bridge to emergent cardiac surgery. Surgery was then performed and the patient was successfully discharged with no neurological impairment. DISCUSSION: We present a case where Veno-Arterial Extracorporeal Membrane Oxygenation (VA- ECMO) was successfully used as a bridge to emergent surgery in a cardiac arrest patient due to prosthetic valve thrombosis. CONCLUSIONS: This case illustrates how a relative contraindication (severe aortic insufficiency) to VA-ECMO may, in the end, be an indication in a very particular scenario.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Oxigenação por Membrana Extracorpórea , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Trombose/etiologia , Idoso , Insuficiência da Valva Aórtica/etiologia , Feminino , Humanos , Trombose/cirurgia
11.
Anticancer Res ; 39(9): 4619-4625, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519559

RESUMO

Cancer patients are at risk for both venous and arterial thrombotic events. Accumulating evidence suggests a link between cancer and arterial thrombosis events. The pathophysiology of arterial thrombosis in cancer is complex and multifactorial. The risk of arterial thrombosis in cancer patients relies on individual risk factors, on cancer-related hypercoagulability, on anticancer drugs and radiotherapy often via a common underlying mechanism of endothelial dysfunction. This review describes the mechanisms involved in the development of arterial thrombotic events and their clinical manifestations. Furthermore, it provides an overview on therapeutic agents associated with arterial thrombosis.


Assuntos
Artérias/patologia , Neoplasias/complicações , Trombose/etiologia , Animais , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Gerenciamento Clínico , Humanos , Neoplasias/epidemiologia , Neoplasias/patologia , Neoplasias/terapia , Neovascularização Patológica , Radioterapia/efeitos adversos , Radioterapia/métodos , Avaliação de Sintomas , Trombose/diagnóstico , Trombose/epidemiologia
12.
Zhonghua Yi Xue Za Zhi ; 99(33): 2611-2614, 2019 Sep 03.
Artigo em Chinês | MEDLINE | ID: mdl-31510722

RESUMO

Objective: To analyze the risk factors of catheter-related right jugular venous thrombosis in patients undergoing abdominal surgery. Methods: A total of 125 patients (18-90 years, ASA Ⅰ-Ⅲ) scheduled for abdominal surgery underwent right internal jugular in our study. Ultrasound-guided central venous catheterization were carried out before surgery and Doppler ultrasound examination were conducted daily postoperatively until the catheter was removed. The patients were divided into thrombosis positive or negative group based on the Doppler ultrasound examinations. General clinical data of all patients including name, gender, age, BMI, preoperative Caprini score, bleeding, duration of operation and anesthesia, were also collected. D-dimer test was performed on the third postoperative day. Results: Of the 125 patients, 16(12.8%) were found to have catheter-related right internal jugular vein thrombosis. There were 16 cases (9 males and 7 females) in the thrombosis positive group, with an average age of (73±7) years old, body mass index (22.8±2.9) kg/m(2), and preoperative Caprini score (6.1±1.4).In the thrombosis negative group,among whom 72 were men and 37 were women. The average age of these patients was (66±11) years old, BMI was (22.6±2.9)kg/m(2), and preoperative Caprini score was (5.9±1.3).There was no statistical difference between the two groups regarding age, gender, BMI, preoperative Caprini score (P>0.05).The average operating time, anesthesia time, bleeding amount and D-dimer level on the third postoperative day were (189±46) min, (211±59) min, (288±96) ml,(3.4±1.6) mg/L in thethrombosis positive group, and (139±39) min, (171±46) min, (175±114) ml,(2.0±0.9) mg/L in the thrombosis negative group, respectively. Duration of surgery, bleeding amount and D-dimer level on the third postoperative day significantly affected the occurrence of catheter-related right internal jugular venous thrombosis (U=10.768, 359.000, 390.000, P<0.05), but no statistically significant differences in anesthesia time between the two groups.Logistic regression analysis screened out duration of surgery, bleeding amount and D-dimer level on the third postoperative day as risk factors for catheter-related right jugular venous thrombosis(OR=10.037, 1.011, 3.274, P<0.05). Conclusion: The high incidence of catheter-related right jugular venous thrombosis in patients undergoing abdominal surgery is closely related to intraoperative blood loss, operation time, D-dimer level on the third postoperative day and other factors.


Assuntos
Abdome/cirurgia , Cateterismo Venoso Central , Cateteres Venosos Centrais , Trombose , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo Venoso Central/efeitos adversos , Feminino , Humanos , Veias Jugulares , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Trombose/etiologia , Adulto Jovem
13.
Adv Gerontol ; 32(3): 415-421, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31512429

RESUMO

Aged patients with atrial fibrillation (AF) are at high risk of both thromboembolic and haemorrhagic complications of disease and of its treatment. A study was provided to assess the role of D-dimer plasma level as a marker of thrombosis in aged patients with AF having no clinical signs of active thrombosis depending on used treatment strategy and quantitative thrombotic and haemorrhagic risk of AF. The results show that D-dimer plasma levels correlate with scores of thromboembolic and haemorrhagic risks in group on antiplatelet agents but not anticoagulants, with the difference in D-dimer level driven by subgroup on CHA2DS2-VASc score ≥5. High D-dimer level was associated with in-hospital mortality and rhythm of AF at the moment of blood sample collection. Therefore, an accuracy of risk prognosis of fatal complications of AF for elderly patients may be increased by using the laboratory markers of thrombus formation such as D-dimer and by using the obtained results to guide an antithrombotic therapy.


Assuntos
Fibrilação Atrial , Biomarcadores , Produtos de Degradação da Fibrina e do Fibrinogênio , Trombose , Idoso , Fibrilação Atrial/complicações , Biomarcadores/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Fatores de Risco , Trombose/diagnóstico , Trombose/etiologia
14.
Ann Hematol ; 98(10): 2283-2291, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31396670

RESUMO

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired hemolytic disease with thrombosis as a major complication. The mechanism of thrombosis and related risk factors in PNH patients are still not well characterized. We retrospectively enrolled 99 patients with newly diagnosed PNH at our institute from 2011 to 2016. According to binary logistic regression model analysis, we first identified four baseline clinical risk factors which may be associated with incidence of thrombosis in the PNH cohort, including PNH clone sizes (fluorescent aerolysin of neutrophil) ≤ 80 (OR 1.056, 95%CI 1.016-1.097, P = 0.005), hemoglobin ≤ 75 g/L (OR 4.202, 95%CI 0.984-17.954, P = 0.053), platelet > 100 × 109/L (OR 6.547, 95%CI 1.490-28.767, P = 0.013) and rs495828 = G (OR 5.243, 95%CI 1.314-20.916, P = 0.019). These independent risk factors were combined together to develop a risk model to evaluate thrombosis risk (AUC = 0.756, 95%CI 0.607-0.905, P < 0.001). Our risk model revealed a higher cumulative incidence of thrombosis and an earlier thrombosis events in PNH patients with high risk (risk score ≥ 23) compared with those with low risk (risk score < 23, P < 0.001 and P = 0.043, respectively). Although with some limitations, we set up a prediction model for thrombosis risk in patients with PNH for the first time, but it needed to be verified in a prospective study with larger patients and longer follow-up time in the future.


Assuntos
Hemoglobinúria Paroxística , Modelos Biológicos , Trombose , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Hemoglobinúria Paroxística/sangue , Hemoglobinúria Paroxística/complicações , Hemoglobinúria Paroxística/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Trombose/sangue , Trombose/epidemiologia , Trombose/etiologia
15.
J Vasc Access ; 20(5): 545-552, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31379248

RESUMO

OBJECTIVE: This study aimed to determine the long-term patency duration and rate of thrombosis of autologous arteriovenous fistulas and synthetic grafts treated with endovascular methods in a large patient population. METHODS: A total of 144 arteriovenous accesses (37 radiocephalic, 51 brachiobasilic, 41 brachiocephalic, and 15 femorofemoral) from 143 patients were included in the study. A total of 304 endovascular thrombolytic treatment procedures were performed for 94 (65%) arteriovenous fistula and 50 (35%) arteriovenous graft accesses. RESULTS: The procedural technical success rate was 98.7%. The mean follow-up duration was 32.5 (range, 3-132) months. The primary patency rates for arteriovenous fistulas and arteriovenous grafts were 78% and 78% at 6 months, 66% and 63% at 1 year, and 45% and 0% at 36 months, respectively. The assisted primary patency rates for arteriovenous fistulas and arteriovenous grafts were 82% and 84% at 6 months, 71% and 69% at 1 year, 51% and 29% at 36 months, and 30% and 1% at 60 months, respectively. The secondary patency rates for arteriovenous fistulas and arteriovenous grafts were 94% and 93% at 6 months, 85% and 85% at 1 year, 58% and 59% at 36 months, and 47% and 48% at 60 months, respectively. CONCLUSION: Although the primary patency durations for arteriovenous fistulas were better after endovascular thrombolytic treatment than those for arteriovenous grafts, the long-term outcomes of assisted primary and secondary patency durations after repeated procedures were similar for both types of arteriovenous accesses.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares , Oclusão de Enxerto Vascular/cirurgia , Trombectomia/métodos , Trombose/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Endovasculares/efeitos adversos , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Trombectomia/efeitos adversos , Trombose/diagnóstico por imagem , Trombose/etiologia , Trombose/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Turquia , Grau de Desobstrução Vascular , Adulto Jovem
16.
Hematol Oncol ; 37(4): 434-437, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31465530

RESUMO

The conventional thrombotic risk stratification in essential thrombocythemia (ET) distinguishes patients in two risk groups based on previous thrombosis and age (< or >60). The IPSET-thrombosis takes into account four risk factors: age greater than 60 years and the presence of CV risk factors, thrombosis history and JAK2 V617F presence. The revised IPSET-thrombosis uses three adverse variables to delineate four risk categories: age greater than 60, thrombosis history, and JAK2 V617F presence. We compared different risk models in the estimation of thrombotic risk in 191 patients with ET and the role of specific driver mutations affecting overall survival, according to thrombotic risk. We also evaluated the mutational status of patients showing history of thrombosis or cardiovascular events versus patients who did not. Finally, we verified whether the thrombotic risk had a significant impact on survival in our ET patients. The data analysis has been performed through the conventional statistics and overall survival estimated by using the Kaplan-Meyer method. Interestingly, either using the traditional system for thrombotic risk or the IPSET-t prognostic score or the current stratification for the thrombotic risk, high-risk patients are always highly represented. This evidence is of note, being the high-risk category indicated for cytoreduction, affecting quality of life, despite the good overall prognosis of patients with ET diagnosis in general. The analysis of overall survival in our patients, according to different models for thrombotic risk, highlighted the poor prognosis of high-risk patients compared with those with a lower thrombotic risk, in particular when using traditional stratification and current stratification. In conclusion, the occurrence of thrombotic or cardiovascular events represents one of the most severe complications at diagnosis or during follow-up of ET despite current recommendations, having a significant impact on morbidity and survival.


Assuntos
Índice de Gravidade de Doença , Trombocitemia Essencial/complicações , Trombofilia/etiologia , Trombose/etiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Calreticulina/genética , Feminino , Seguimentos , Humanos , Incidência , Janus Quinase 2/genética , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Mutação de Sentido Incorreto , Prognóstico , Receptores de Trombopoetina/genética , Recidiva , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Trombocitemia Essencial/genética , Trombocitemia Essencial/mortalidade , Trombofilia/genética , Trombose/epidemiologia , Adulto Jovem
17.
Georgian Med News ; (291): 64-66, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31418733

RESUMO

A serious long-term complication of drug-eluting stent (DES) implantation is the occurrence of very late stent thrombosis (VLST) beyond 1 year after implantation. While VLST has been observed as late as 1 year following the initial procedure, it remains unknown whether DES thrombosis is a finite phenomenon that abates over time or is a risk that persists indefinitely. Very late stent thrombosis is an infrequent yet potentially fatal complication associated with drug-eluting stents. We report the case of a 40-year-old man who sustained an ST-segment-elevation myocardial infarction 2 years after initial paclitaxel-eluting stent implantation. Focal incomplete endothelialization of the stent struts is the likely cause of VLST; neointimal formation, neoatherosclerosis, and late stent malapposition might also have contributed. According to the current guidelines 12 months of dual antiplatelet therapy (DAPT) is recommended following DES implantation. However, there are uncertainties surrounding the optimal duration of dual antiplatelet therapy in patients who suffer from drug-eluting very late stent thrombosis. Clinicians face challenges in treating these patients, particularly when competing medical demands necessitate the discontinuation of dual antiplatelet therapy.


Assuntos
Stents Farmacológicos/efeitos adversos , Trombose/etiologia , Adulto , Humanos , Masculino , Paclitaxel/administração & dosagem , Inibidores da Agregação de Plaquetas/administração & dosagem , Fatores de Tempo , Resultado do Tratamento
18.
Beijing Da Xue Xue Bao Yi Xue Ban ; 51(4): 684-688, 2019 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-31420622

RESUMO

OBJECTIVE: To summarize the experience of diagnosis and operation related to massive adrenal area tumor with venous tumor thrombus in clinic. METHODS: From October 2017 to March 2019, a total of 8 cases of massive adrenal area tumor (>7 cm) with venous tumor thrombus were admitted at Peking University Third Hospital including 5 males and 3 females with mean age 50.6 years (31-62 years). There were 6 cases on the right side and 2 cases on the left side. The first symptoms included abdominal discomfort, hypertension, Cushing syndrome and abnormal menstruation; special past history included cirrhosis and lung cancer. Computed tomography (CT) and routine endocrine hormone tests were examined. Preoperative imaging confirmed 5 cases masses with tumor thrombus in inferior vena cava (IVC) and 1 case with tumor thrombus in left renal vein. Two cases presented with tumor thrombus in central adrenal vein were found intraoperatively. Open adrenalectomy and thrombectomy were performed in 4 cases of right side complicated with high tumor thrombus of inferior vena cava. Laparoscopic adrenalectomy and thrombectomy were performed in 3 cases, including 2 cases on the right and 1 case on the left. The case with tumor thrombus in left renal vein gave up operation. The patients were followed up with outpatient and telephone. RESULTS: The mean size of the tumor was 8.9 cm (7-11 cm), the mean operative time was 319 min (120-510 min), while the estimated blood loss was 629 mL (50-1 200 mL). Intraoperative blood transfusion was required in 2 cases and 1 case encountered wound infection. The pathological types included pheochromocytoma, adrenocortical carcinoma, adrenal metastases of haptic carcinoma, and leiomyosarcoma. The case with left lung carcinoma who underwent left pneumonectomy one month before was highly suspected adrenal metastases of lung carcinoma. Tumor thrombus of pheochromocytoma was combined with blood thrombus. Capsule of adrenocortical carcinoma was fragile in adrenocortical carcinoma. Abundant blood supply existed in adrenal metastases. The leiomyosarcoma had unabundant blood supply and invaded IVC to form tumors thrombus. The mean follow-up time was 8.4 months (1-15 months). One case with adrenocortical carcinoma died after 1 year in the follow-up. CONCLUSION: We present the rare cases of different pathological types of massive adrenal tumors with tumor thrombus extending into the IVC extension or other vein. Preoperative diagnosis needs comprehensive evaluation and perfect preoperative preparation. Surgery is difficult and varied. Open approach as well as retroperitoneal laparoscopic approach is feasible.


Assuntos
Neoplasias das Glândulas Suprarrenais , Trombose , Neoplasias das Glândulas Suprarrenais/complicações , Adulto , Carcinoma de Células Renais , Feminino , Humanos , Neoplasias Renais , Masculino , Pessoa de Meia-Idade , Nefrectomia , Trombectomia , Trombose/etiologia , Veia Cava Inferior
19.
Life Sci ; 233: 116659, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31323274

RESUMO

AIMS: Endothelial-to-mesenchymal transition (EndMT) is a pathophysiological change of vascular endothelium commonly seen in the cardiovascular system. Iliac vein compression syndrome (IVCS) is known to be often associated with intimal hyperplasia and thrombosis. However, whether EndMT exists in IVCS has not yet been reported. The purpose of this study was to investigate the relationship between EndMT and thrombosis in IVCS. MAIN METHODS: Using IVCS models in pig and mouse, we detected intimal changes and thrombus in stenotic iliac vein by immunofluorescence staining. Primary human umbilical vein endothelial cells (HUVEC) were stimulated by transforming growth factor ß1 (TGF-ß1) and thrombin, and cell phenotypic transition and antithrombotic function of HUVEC were examined through q-PCR, western blot and ELISA. In the end, by immunofluorescence staining, we observed the effect of anticoagulant on interstitial changes of venous endothelial cells in IVCS models. KEY FINDINGS: We showed that iliac vein compression induced EndMT, of which its inhibition reduced thrombus formation. Further studies showed that HUVECs undergoing EndMT lost their anticoagulation and thrombolytic function. Interestingly, thrombin aggravated EndMT through TGF-ß/Smad3 signaling. Moreover, compared with wild type (WT) mice, EndMT in stenotic iliac vein was reduced in WT mice fed with rivaroxaban or factor VII knockout mice, implying that anticoagulation alleviated EndMT in IVCS models. SIGNIFICANCE: Our findings indicate that EndMT and thrombosis reinforce reciprocally in IVCS, implying that targeting EndMT could be a potential strategy in prevention and treatment of thrombosis in IVCS.


Assuntos
Transição Epitelial-Mesenquimal , Células Endoteliais da Veia Umbilical Humana/patologia , Síndrome de May-Thurner/complicações , Trombose/etiologia , Animais , Movimento Celular , Células Cultivadas , Células Endoteliais da Veia Umbilical Humana/metabolismo , Humanos , Síndrome de May-Thurner/patologia , Camundongos , Transdução de Sinais , Suínos , Trombose/patologia
20.
Int Heart J ; 60(4): 994-997, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31257336

RESUMO

Pump thrombosis (PT) is a serious complication after continuous-flow left ventricular assist device (LVAD) implantation. To detect PT, echocardiographic ramp test using left ventricular end-diastolic diameter (LVEDD) is known to be useful. However, this method has several limitations. In this study, we propose an alternative novel ramp test using the flow velocity of outflow graft (OG). A 46-year-old man underwent continuous-flow LVAD (HeartMate II, Abbott Laboratories, Lake Forest, IL, USA) implantation for advanced heart failure due to idiopathic dilated cardiomyopathy. About 2 years after implantation, he suffered from hemolysis and symptoms of heart failure, and PT was strongly suspected. The change in LVEDD was minimal with increase in pump speed (-0.06 cm/400 rotations per minute (rpm)), suggesting PT. The systolic to diastolic velocity (S/D) ratio of OG flow, which we proposed as a new indicator of PT, also showed minimal change (-0.07/400 rpm). His clinical symptoms improved with anticoagulation therapy, and the changing slope of the S/D ratio dramatically improved to -0.92/400 rpm. Although its consistency should be verified in many other cases, this novel method can be useful for detecting PT and evaluating its clinical course.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Insuficiência Cardíaca/terapia , Coração Auxiliar/efeitos adversos , Fluxo Sanguíneo Regional/fisiologia , Trombose/etiologia , Função Ventricular Esquerda/fisiologia , Ecocardiografia , Falha de Equipamento , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Trombose/diagnóstico , Trombose/fisiopatologia
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