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1.
Surgery ; 166(4): 564-571, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31439398

RESUMO

BACKGROUND: The population of patients on anticoagulant or antiplatelet therapy for medical conditions is increasing. The objective of this study was to investigate the effects of preinjury anticoagulation or antiplatelet therapy on outcomes after trauma. METHODS: This cohort study analyzed data from the Michigan Trauma Quality Improvement Program from 2012 to 2017 and included trauma patients age ≥16 years with an Injury Severity Score ≥5 treated at 29 hospitals. The primary outcome was in-hospital mortality. RESULTS: Of 115,042 trauma patients, 44.2% were women and 78.2% were white with a mean age (standard deviation) of 59.1 (23.2) years. A total of 23,196 patients were on antiplatelet therapy, 3,855 on warfarin, 1,893 on warfarin + antiplatelet agent, 1,306 on a direct oral anticoagulant, and 717 patients on direct oral anticoagulant + antiplatelet therapy. We observed an increased risk of mortality in patients on preinjury antiplatelet (odds ratio [OR] 1.17; 95% confidence interval [CI] 1.02-1.33), warfarin (OR 1.32; 95% CI 1.05-1.65), or warfarin + antiplatelet therapy (OR 1.59; 95% CI 1.18-2.14). Patients on a direct oral anticoagulant only were not at statistically increased risk for mortality. CONCLUSION: Preinjury antiplatelet and/or warfarin use was associated with an increased risk of mortality after traumatic injury. Preinjury direct oral anticoagulant use was not associated with a statistically increased risk of adverse outcomes.


Assuntos
Anticoagulantes/efeitos adversos , Causas de Morte , Inibidores da Agregação de Plaquetas/efeitos adversos , Vitamina K/antagonistas & inibidores , Ferimentos e Lesões/tratamento farmacológico , Ferimentos e Lesões/mortalidade , Administração Oral , Idoso , Anticoagulantes/administração & dosagem , Estudos de Coortes , Intervalos de Confiança , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Razão de Chances , Inibidores da Agregação de Plaquetas/administração & dosagem , Estudos Retrospectivos , Análise de Sobrevida , Centros de Traumatologia , Índices de Gravidade do Trauma , Vitamina K/administração & dosagem , Vitamina K/efeitos adversos , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/cirurgia
2.
Breast ; 46: 163-169, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31220790

RESUMO

OBJECTIVE: Balance between embolic and bleeding risk is challenging among patients with cancer. There is a lack of specific recommendations for the use of antithrombotic therapy in oncologic patients with atrial fibrillation (AF). We compared the embolic and bleeding risk, the preventive management and the incidence of events between patients with and without cancer. We further evaluated the effectiveness and safety of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) within patients with cancer. METHODS AND RESULTS: The AMBER-AF registry is an observational multicentre study that analysed patients with non-valvular AF treated in Oncology and Cardiology Departments in Spain. 1,237 female patients with AF were enrolled: 637 with breast cancer and 599 without cancer. Mean follow-up was 3.1 years. Both groups were similar in age, embolic risk and bleeding risk. Lack of guidelines-recommended therapies was more frequent among patients with cancer. Compared with patients without cancer, adjusted rates of stroke (hazard ratio [95% confidence interval]) in cancer patients were higher (1.56 [1.04-2.35]), whereas bleeding rates remained similar (1.25 [0.95-1.64]). Within the group of patients with cancer, the use of DOACs vs VKAs did not entail differences in the adjusted rates of stroke (0.91 [0.42-1.99]) or severe bleedings (1.53 [0.93-2.53]). CONCLUSIONS: Antithrombotic management of AF frequently differs in patients with breast cancer. While breast cancer is associated with a higher risk of incident stroke, bleeding events remained similar. Patients with cancer treated with DOACs experienced similar rates of stroke and bleeding as those with VKAs.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Neoplasias da Mama/complicações , Hemorragia/epidemiologia , Acidente Vascular Cerebral/epidemiologia , 4-Hidroxicumarinas/administração & dosagem , Idoso , Fibrilação Atrial/complicações , Feminino , Hemorragia/etiologia , Humanos , Incidência , Indenos/administração & dosagem , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Vitamina K/administração & dosagem , Vitamina K/antagonistas & inibidores
3.
Eur J Nutr ; 58(6): 2191-2205, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31119401

RESUMO

PURPOSE: We conducted a meta-analysis to systematically assess the prospective association between vitamin K and cardiovascular disease (CVD) events and all-cause mortality. METHODS: We searched PubMed and EMBASE through January 2019 for prospective studies that reported the association of vitamin K (assessed by dietary intake or circulating concentration) with CVD events [including total CVD, CVD mortality, total coronary heart disease (CHD), fatal CHD, nonfatal myocardial infarction (MI), and stroke] and all-cause mortality. Multivariable-adjusted hazard ratios (HRs) comparing top versus bottom tertiles of vitamin K were combined using random-effects meta-analysis. RESULTS: Twenty-one articles were included with 222,592 participants. A significant association was found between dietary phylloquinone and total CHD (pooled HR 0.92; 95% CI 0.84, 0.99; I2 = 0%; four studies), as well as menaquinone and total CHD (0.70; 95% CI 0.53, 0.93; I2 = 32.1%; two studies). No significant association was observed between dietary vitamin K and all-cause mortality, CVD mortality, or stroke. Elevated plasma desphospho-uncarboxylated MGP (dp-ucMGP), a marker of vitamin K deficiency, was associated with an increased risk of all-cause mortality (1.84; 95% CI 1.48, 2.28; I2 = 16.8%; five studies) and CVD mortality (1.96; 95% CI 1.47, 2.61; I2 = 0%; two studies). No significant association was observed between circulating total osteocalcin and all-cause mortality or total CVD. CONCLUSIONS: Our findings showed that higher dietary vitamin K consumption was associated with a moderately lower risk of CHD, and higher plasma dp-ucMGP concentration, but not total circulating osteocalcin, was associated with increased risks of all-cause and CVD mortality. However, causal relations cannot be established because of limited number of available studies, and larger prospective studies and randomized clinical trials are needed to validate the findings.


Assuntos
Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Morte , Dieta/métodos , Vitamina K/farmacologia , Doenças Cardiovasculares/dietoterapia , Humanos , Fatores de Risco , Vitamina K/administração & dosagem
4.
Res Vet Sci ; 124: 399-405, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31078787

RESUMO

Sodium dehydroacetate (Na-DHA), an antibiotic agent that combats growth of bacteria, fungi, and yeast, is used as a preservative in animal feed, food, and cosmetics. We previously reported that Na-DHA induces coagulation anomalies in Wistar rats, but the anticoagulant mechanism of Na-DHA remains to be established. Here we report that Na-DHA prolonged prothrombin time (PT) and activated partial thromboplastin time (APTT) in male and female Wistar rats. In addition, Na-DHA decreased vitamin K (VK) levels and increased the levels of protein induced by vitamin K absence/antagonist-II (PIVKA-II) in rat serum. Moreover, we found that treatment with VK not only reversed Na-DHA-decreased serum VK and -increased PIVKA-II levels, but also attenuated Na-DHA-prolonged PT and APTT, suggesting that Na-DHA-decreased serum VK level contributes to the anticoagulation due to Na-DHA. Further we found that Na-DHA inhibited vitamin K epoxide reductase complex subunit 1 (VKORC1), a key enzyme in VK recycling, in the liver tissue of Wistar rats, as evidenced by reduced mRNA and protein levels of VKORC1 following Na-DHA treatment. Taken together, our data indicate that Na-DHA inhibits liver VKORC1, resulting in a decrease of serum VK levels, leading to abnormal coagulation in rats.


Assuntos
Anticoagulantes/farmacologia , Coagulação Sanguínea/efeitos dos fármacos , Fígado/efeitos dos fármacos , Substâncias Protetoras/administração & dosagem , Pironas/farmacologia , Vitamina K/administração & dosagem , Animais , Feminino , Fígado/enzimologia , Masculino , Tempo de Tromboplastina Parcial , Tempo de Protrombina , Ratos , Ratos Wistar , Vitamina K Epóxido Redutases
5.
Eur J Pediatr ; 178(7): 1033-1042, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31062090

RESUMO

Vitamin K prophylaxis in infancy aims to prevent life-threatening vitamin K deficiency bleeding (VKDB). The Dutch prophylactic oral daily regimen was increased sixfold from 25 to 150 µg because of a high failure rate. To evaluate the efficacy of this new regimen, incidences of intracranial VKDB under both regimens were compared using both general and targeted surveillance. Late VKDB in the general pediatric population was identified by the Netherlands Pediatric Surveillance Unit, between 1 October 2014 and 31 December 2016. Additionally, infants with intracranial vitamin K deficiency bleeding were identified using the Dutch Pediatric Intensive Care Evaluation registry. The incidence of intracranial VKDB as assessed by general and targeted surveillance decreased from 1.6 per 100,000 (95% CI, 0.4-5.1) to 1.3 per 100,000 (95% CI, 0.5-3.2) and from 3.1 per 100,000 live births (95% CI, 1.9-5.0) to 1.2 per 100,000 live births (95% CI, 0.6-2.3), respectively. Median time between consecutive cases in the latter increased from 24 to 154 days (p < 0.001).Conclusion: A sixfold increase in oral vitamin K prophylaxis was associated with a surprisingly modest reduction in the incidence of intracranial VKDB, indicating that factors other than the dose need addressing to improve efficacy. What is Known: • The efficacy of intramuscular vitamin K prophylaxis is threatened by an increasing number of parents opting out. • Oral prophylaxis represents an attractive and less invasive alternative but is inferior, especially in infants with malabsorption of vitamin K due to cholestasis. What is New: • Increasing the daily oral dose of vitamin K sixfold had a surprisingly modest effect on the incidence of late vitamin K deficiency bleeding. • This finding indicates that factors other than the dose must play an important role.


Assuntos
Antifibrinolíticos/administração & dosagem , Sangramento por Deficiência de Vitamina K/prevenção & controle , Vitamina K/administração & dosagem , Administração Oral , Estudos Transversais , Relação Dose-Resposta a Droga , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Hemorragias Intracranianas/epidemiologia , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/prevenção & controle , Masculino , Países Baixos/epidemiologia , Sangramento por Deficiência de Vitamina K/epidemiologia
6.
Nutrients ; 11(4)2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30959758

RESUMO

Few studies assessed the associations between dietary vitamin K and depressive symptoms. We aimed to investigate the association between dietary vitamin K and depressive symptoms in a large cohort of North American People. In this cross-sectional analysis, 4,375 participants that were aged 45⁻79 years from the Osteoarthritis Initiative were included. Dietary vitamin K intake was collected through a semi-quantitative food frequency questionnaire and categorized in quartiles. Depressive symptoms were diagnosed using the 20-item Center for Epidemiologic Studies-Depression (CES-D) ≥ 16. To investigate the associations between vitamin K intake and depressive symptoms, logistic regression analysis were run, which adjusted for potential confounders. Overall, 437 (=10%) subjects had depressive symptoms. After adjusting for 11 confounders, people with the highest dietary vitamin K intake had lower odds of having depressive symptoms (OR = 0.58; 95%CI: 0.43⁻0.80). This effect was only present in people not taking vitamin D supplementation. In conclusion, higher dietary vitamin K intake was significantly associated with a lower presence of depressive symptoms, also after accounting for potential confounders. Future longitudinal research is required to explore the directionality of the association.


Assuntos
Depressão/etiologia , Dieta , Deficiência de Vitamina K/complicações , Vitamina K/administração & dosagem , Idoso , Estudos de Coortes , Estudos Transversais , Feminino , Análise de Alimentos , Humanos , Masculino , Pessoa de Meia-Idade
7.
Ital J Pediatr ; 45(1): 30, 2019 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-30832683

RESUMO

BACKGROUND: Vitamin K is a key point for guarantee normal blood clotting and its level in newborns is commonly low, so a supplementation after delivery is mandatory. Vitamin K prophylaxis in newborns is still an open field of debate: many types of protocol have been proposed in different years and Countries, and sometimes with great variability inside the same Nation (for instance, in Italy a national consensus is not available, so different protocols are employed). Recommendations include different protocols for healthy newborns born at term, but the unpreventable presence of bleeding favouring factors (i.e. blood vessels malformations) or limiting intestinal absorption of liposoluble vitamins (i.e. cholestasis), which could be unrecognized or subclinical in the perinatal period, rises some concerning about the most precautionary route of administration and the timing of further doses after the first one given at birth. The purpose of this report is to underline the most recent evidences available in literature and to arise a debate about this topic, in order to stimulate the production of evidence-based guidelines concerning the prophylaxis with vitamin K1 in newborn infants, considering that many bleeding risk factors are not recognizable at birth. CASE PRESENTATION: We are hereby presenting an emblematic case concerning the risk of intracranial bleeding in an apparently healthy newborn: the described infant did not show any pathological elements in pregnancy history or perinatal life which suggest a possible increased risk of bleeding and the needing of a particular approach in the administration of vitamin K1, but at the end of the first week of life presented an intracranial bleeding with neurological symptoms that required treatment for vitamin K deficiency. CONCLUSIONS: Univocal recommendations about vitamin K prophylaxis are not available and the contrast between oral and intramuscular routes persists unsolved. The difficulty to certainly identify an infant eligible for oral administration of vitamin K1 at birth suggests that the intramuscular route should be preferred. How to prosecute the supplementation in the first months of life is still an open topic of debate.


Assuntos
Hemorragias Intracranianas/etiologia , Guias de Prática Clínica como Assunto , Sangramento por Deficiência de Vitamina K/complicações , Sangramento por Deficiência de Vitamina K/tratamento farmacológico , Vitamina K/administração & dosagem , Medicina Baseada em Evidências , Feminino , Humanos , Recém-Nascido , Injeções Intramusculares , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/tratamento farmacológico , Itália , Imagem por Ressonância Magnética/métodos , Determinação de Necessidades de Cuidados de Saúde , Neonatologia/normas , Medição de Risco , Nascimento a Termo , Sangramento por Deficiência de Vitamina K/diagnóstico
8.
Orthop Clin North Am ; 50(2): 171-179, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30850076

RESUMO

Active assessment and management of hypovitaminosis D among orthopedic patients is low-risk and low-cost while retaining significant potential to improve patient care. Vitamin D has an established role in musculoskeletal development and calcium homeostasis, and vitamin D deficiency is pervasive in orthopedic trauma populations. Clinical guidelines for screening and supplementation for hypovitaminosis D are lacking. Literature on the effects of vitamin K on bone health is limited. Anabolic hormone analogues may have a future role in delayed union or nonunion treatment. Vitamin D deficiency and other endocrine abnormalities should be considered in orthopedic trauma patients presenting with fracture nonunion of uncertain cause.


Assuntos
Fraturas não Consolidadas/etiologia , Fraturas não Consolidadas/prevenção & controle , Sistema Musculoesquelético/efeitos dos fármacos , Deficiência de Vitamina D/epidemiologia , Vitamina D/administração & dosagem , Adulto , Idoso , Anabolizantes/efeitos adversos , Antifibrinolíticos/uso terapêutico , Conservadores da Densidade Óssea/uso terapêutico , Cálcio/administração & dosagem , Cálcio/uso terapêutico , Programas de Triagem Diagnóstica/normas , Feminino , Fraturas não Consolidadas/fisiopatologia , Homeostase/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Resultado do Tratamento , Vitamina D/uso terapêutico , Deficiência de Vitamina D/etiologia , Deficiência de Vitamina D/prevenção & controle , Vitamina K/administração & dosagem , Vitamina K/uso terapêutico
9.
Crit Care Nurs Q ; 42(2): 205-207, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30807347

RESUMO

Parents must make an educated decision regarding vitamin K administration for their infant prior to birth. With an abundance of information available regarding this topic, the nurse needs to guide the parents through this process. Using Knowles' Theory of Adult Learning Principles as a framework can increase the parents' knowledge and assist the nurse in providing thorough information.


Assuntos
Tomada de Decisões , Aprendizagem , Pais/educação , Educação de Pacientes como Assunto , Vitamina K/administração & dosagem , Humanos , Recém-Nascido , Vitamina K/efeitos adversos
11.
Hematol Oncol Stem Cell Ther ; 12(1): 44-49, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30605629

RESUMO

OBJECTIVE/BACKGROUND: Autologous stem cell transplant has been shown to prolong survival in multiple myeloma (MM). A common complication of the pre-transplant conditioning chemotherapy is severe multi-lineage cytopenias, resulting in significant transfusion requirements. Jehovah's Witnesses are members of a religious group that do not accept the transfusion of blood products. Many large transplant centers refuse to perform transplantation in Jehovah's Witnesses due to the complexity of treating cytopenic patients without blood product transfusions. However, some transplant centers that specialize in "bloodless" medicine and surgery have successfully transplanted in Jehovah's Witnesses without transfusion support. METHODS: In order to maximize successful outcomes in this population, potential transplant candidates are treated with a variety of agents to maximize baseline hemoglobin and platelet counts. In preparation for the first two "bloodless" transplants for MM at our institution, we conducted a retrospective study of patients with MM who underwent a transplant in the preceding year. RESULTS: Of the 60 patients reviewed, only six required packed red blood cell transfusion, whereas 39 required at least one platelet transfusion. These findings helped us to design a novel protocol for a "bloodless" autologous transplant. We administered romiplostim, a thrombopoietin (TPO) agonist, along with aminocaproic acid, desmopressin, and vitamin K post-transplant to two Jehovah's Witness patients to mitigate the risk of thrombocytopenia. Neither patient experienced significant bleeding nor qualified for platelet transfusion, and underwent successful and uncomplicated transplantation. CONCLUSION: We propose that the use of romiplostim or similar TPO agonists can be used to maximize the chance of a successful "bloodless" transplant for stem cell recipients.


Assuntos
Ácido Aminocaproico/administração & dosagem , Desamino Arginina Vasopressina/administração & dosagem , Testemunhas de Jeová , Mieloma Múltiplo/terapia , Receptores Fc/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Transplante de Células-Tronco , Trombopoetina/administração & dosagem , Vitamina K/administração & dosagem , Adulto , Idoso , Autoenxertos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/sangue
12.
Drugs R D ; 19(1): 67-71, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30689138

RESUMO

A recent multi-state outbreak of life-threatening bleeding following inhalation of synthetic cannabinoids has been attributed to contamination with the long-acting anticoagulant rodenticide (LAAR) brodifacoum, a second-generation, highly potent, long-acting derivative of the commonly used blood thinner warfarin. While long-term treatment with high-dose vitamin K1 restores coagulation, it does not affect brodifacoum metabolism or clearance, and, consequently, brodifacoum remains in the human body for several months, thereby predisposing to risk of bleeding recurrence and development of coagulation-independent injury in extrahepatic tissues and fetuses. This has prompted the evaluation of pharmacological measures that accelerate brodifacoum clearance from poisoned patients. Since the induction of certain cytochrome P450 (CYP) enzymes accelerates warfarin metabolism, using CYP inducers, such as phenobarbital, to accelerate brodifacoum clearance seems plausible. However, unlike warfarin, brodifacoum does not undergo significant metabolism in the liver, nor have the effects of phenobarbital on vitamin K1 metabolism been previously determined. In addition, the safety of phenobarbital in brodifacoum-poisoned patients has not been established. Therefore, we propose that CYP inducers should not be used to accelerate the clearance of brodifacoum from poisoned patients, but that alternative approaches such as reducing enterohepatic recirculation of brodifacoum, or using lipid emulsions to scavenge brodifacoum throughout the body, be considered.


Assuntos
4-Hidroxicumarinas/farmacocinética , 4-Hidroxicumarinas/envenenamento , Indutores das Enzimas do Citocromo P-450/administração & dosagem , Anticoagulantes/administração & dosagem , Coagulação Sanguínea/efeitos dos fármacos , Circulação Êntero-Hepática/efeitos dos fármacos , Emulsões Gordurosas Intravenosas , Meia-Vida , Hemorragia/induzido quimicamente , Hemorragia/tratamento farmacológico , Hemorragia/metabolismo , Humanos , Inativação Metabólica/efeitos dos fármacos , Vitamina K/administração & dosagem
13.
Adv Clin Exp Med ; 28(4): 469-477, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30088350

RESUMO

BACKGROUND: The strategies of perioperative bridging anticoagulation in orthopedic surgical patients during oral anticoagulation (OAC) therapy with vitamin K antagonists (VKA) vary from center to center. OBJECTIVES: The aim of this single-center study was to assess the risk of bleeding and thromboembolic events (TEs) in bridged patients on VKA who underwent orthopedic surgery due to trochanteric or hip fracture. MATERIAL AND METHODS: The retrospective study included 64 patients (mean age: 80 years) who received VKA for at least 3 months prior to orthopedic procedure. All subjects were bridged with enoxaparin (40 mg once a day). The control group (n = 69) comprised of age-, sexand procedure-matched patients operated on for the same indications, but with neither a history of VKA therapy nor perioperative bridging anticoagulation. RESULTS: Severe postoperative bleeding occurred in 19 (29.7%) patients from the VKA group and in 13 (18.8%) controls (p = 0.16). Within the VKA group, intertrochanteric fractures (52.6%) and femoral neck fractures (47.4%) occurred more often in patients with bleeding than other lower extremity fractures (0%; p = 0.03). Severe adverse events (SAEs) were more common in the VKA group than in the controls (12.5% vs 1.5%; p = 0.01). Patients from the VKA group did not differ from the controls in the incidence of TEs (6.3% vs 8.9%; p = 0.31). No intrahospital mortality was documented. CONCLUSIONS: Prophylactic administration of enoxaparin is a common strategy of bridging anticoagulation in a hospital setting. This approach does not seem to be associated with an increase in thromboembolic risk nor higher risk of bleeding in orthopedic patients who received VKA preoperatively.


Assuntos
Anticoagulantes/administração & dosagem , Perda Sanguínea Cirúrgica/prevenção & controle , Fraturas do Quadril/cirurgia , Assistência Perioperatória/métodos , Tromboembolia Venosa/prevenção & controle , Vitamina K/antagonistas & inibidores , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Feminino , Heparina de Baixo Peso Molecular , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Tromboembolia Venosa/diagnóstico , Vitamina K/administração & dosagem
14.
Dtsch Med Wochenschr ; 143(20): 1450-1454, 2018 10.
Artigo em Alemão | MEDLINE | ID: mdl-30286493

RESUMO

Hospital mortality of severe sepsis and septic shock is still around 40 % according to recent studies. In accordance to the current sepsis definition, sepsis is a life-threatening organ dysfunction caused by a dysregulated response of the organism to infection. Septic shock is defined by vasopressor-dependent circulatory failure and lactic acidosis. Patients with sepsis and septic shock are often old and/or characterized by severe comorbidities, e. g. tumor or liver disease. These factors also predispose to malnutrition and hence to a corresponding deficiency of essential nutritional components e. g. vitamins. A number of recent studies and reviews have addressed the question whether deficiencies in certain vitamins may facilitate the transition from infection to septic shock. In addition, studies have investigated the effect of high-dose vitamin therapies on sepsis mortality and sepsis-associated organ dysfunctions. This article would like to summarize this current discussion with a focus on vitamin B1 (thiamine), vitamin C and vitamin D.


Assuntos
Deficiência de Vitaminas , Sepse , Ácido Ascórbico/administração & dosagem , Ácido Ascórbico/uso terapêutico , Deficiência de Vitaminas/complicações , Deficiência de Vitaminas/fisiopatologia , Humanos , Sepse/complicações , Sepse/tratamento farmacológico , Sepse/mortalidade , Sepse/fisiopatologia , Vitamina D/administração & dosagem , Vitamina D/uso terapêutico , Vitamina K/administração & dosagem , Vitamina K/uso terapêutico
16.
Can Fam Physician ; 64(10): 736-739, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30315016

RESUMO

Newborns are at risk for vitamin K deficiency bleeding (VKDB) caused by inadequate prenatal storage and deficiency of vitamin K in breast milk. Systematic review of evidence to date suggests that a single intramuscular (IM) injection of vitamin K at birth effectively prevents VKDB. Current scientific data suggest that single or repeated doses of oral (PO) vitamin K are less effective than IM vitamin K in preventing VKDB. The Canadian Paediatric Society and the College of Family Physicians of Canada recommend routine IM administration of a single dose of vitamin K at 0.5 mg to 1.0 mg to all newborns. Administering PO vitamin K (2.0 mg at birth, repeated at 2 to 4 and 6 to 8 weeks of age) should be confined to newborns whose parents decline IM vitamin K. Health care providers should clarify with parents that newborns are at increased risk of VKDB if such a regimen is chosen. Current evidence is insufficient to recommend routine intravenous vitamin K administration to preterm infants undergoing intensive care.Keywords HDNB; Newborn; Prophylaxis; Vitamin K; VKDB.


Assuntos
Sangramento por Deficiência de Vitamina K/prevenção & controle , Vitamina K/administração & dosagem , Administração Oral , Canadá , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Injeções Intramusculares , Guias de Prática Clínica como Assunto , Risco , Sociedades Médicas
17.
J Stroke Cerebrovasc Dis ; 27(11): 3345-3349, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30172677

RESUMO

INTRODUCTION: Intracranial hemorrhage (ICH) is a complication of warfarin-associated anticoagulation resulting in significant morbidity and mortality. The purpose of this study was to assess whether interhospital transfer delays the administration of 4-factor prothrombin complex concentrate to patients with warfarin-associated ICH. MATERIALS AND METHODS: This was a retrospective cohort study of all patients presenting to a 60,000 visit academic ED between August 2013 and July 2017 requiring emergent anticoagulation reversal for warfarin-associated ICH. Patients were divided into 2 cohorts: (1) transfer patients who arrived at the academic center after receiving care in a local community hospital and (2) control patients who presented directly to the academic center ED. The primary outcome was time to administration of 4-factor prothrombin complex concentrate. Secondary outcomes included hematoma expansion, guideline-adherent vitamin K administration (10mg IV), intensive care unit and hospital length of stay, disposition at discharge, and in-hospital mortality. RESULTS: This study included 203 patients (177 transfer patients, 26 control). The median time to arrival in transfer patients was 186 minutes (IQR 145-242). The median time to administration of guideline-adherent therapy in transfer patients was 296 minutes, compared to 119 minutes in patients who were not transferred (median difference= -176, 95% confidence interval -143 to -208, P ≤ .001). Delay in anticoagulation reversal did not result in hematoma expansion, intensive care unit and hospital length of stay, discharge disposition, or in-hospital mortality. CONCLUSIONS: Patients requiring interhospital transfer experienced significant delays in guideline-adherent anticoagulation reversal for warfarin-associated ICH, but this delay was not associated with worse outcomes.


Assuntos
Anticoagulantes/efeitos adversos , Fatores de Coagulação Sanguínea/administração & dosagem , Coagulação Sanguínea/efeitos dos fármacos , Coagulantes/administração & dosagem , Hemorragias Intracranianas/tratamento farmacológico , Transferência de Pacientes , Tempo para o Tratamento , Varfarina/efeitos adversos , Centros Médicos Acadêmicos , Idoso , Idoso de 80 Anos ou mais , Esquema de Medicação , Feminino , Fidelidade a Diretrizes , Mortalidade Hospitalar , Hospitais Comunitários , Humanos , Hemorragias Intracranianas/sangue , Hemorragias Intracranianas/induzido quimicamente , Hemorragias Intracranianas/diagnóstico , Tempo de Internação , Masculino , Alta do Paciente , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Vitamina K/administração & dosagem
18.
Pediatrics ; 142(2)2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30030367

RESUMO

BACKGROUND AND OBJECTIVE: Refusal of intramuscular (IM) vitamin K administration by parents is an emerging problem. Our objective was to assess the frequency of and factors associated with refusal of IM vitamin K administration in well newborns in the United States. METHODS: We determined the number of newborns admitted to well newborn units whose parents refused IM vitamin K administration in the Better Outcomes through Research for Newborns network and, in a nested patient-control study, identified factors associated with refusal of IM vitamin K administration by using a multiple logistic regression model. RESULTS: Of 102 878 newborns from 35 Better Outcomes through Research for Newborns sites, parents of 638 (0.6%) refused IM vitamin K administration. Frequency of refusal at individual sites varied from 0% to 2.3%. Exclusive breastfeeding (adjusted odds ratio [aOR] = 3.4; 95% confidence interval [CI]: 2.1-5.5), non-Hispanic white race and/or ethnicity (aOR = 1.7; 95% CI: 1.2-2.4), female sex (aOR = 1.6; 95% CI: 1.2-2.3), gestational age (aOR = 1.2; 95% CI: 1.1-1.4), and mother's age (aOR = 1.05; 95% CI: 1.02-1.08) were significantly associated with refusal of IM vitamin K administration. Refusal of the administration of both ocular prophylaxis and hepatitis B vaccine was also strongly associated with refusal of IM vitamin K administration (aOR = 88.7; 95% CI: 50.4-151.9). CONCLUSIONS: Refusal of IM vitamin K by parents of newborns is a significant problem. Interventions to minimize risks to these newborns are needed.


Assuntos
Pais/psicologia , Recusa do Paciente ao Tratamento/psicologia , Recusa do Paciente ao Tratamento/tendências , Sangramento por Deficiência de Vitamina K/prevenção & controle , Vitamina K/administração & dosagem , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Sangramento por Deficiência de Vitamina K/epidemiologia , Sangramento por Deficiência de Vitamina K/psicologia , Adulto Jovem
19.
Colloids Surf B Biointerfaces ; 170: 521-528, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-29966905

RESUMO

Poorly soluble vitamin K cannot be absorbed by patients suffering from cholestasis due to extremely low level of bile salts in the intestine. A formulation of vitamin K including glycocholic acid (i.e. Konakion® MM), does not increase bioavailability because it is unstable due to protonation of glycocholic acid at gastric pH. To develop a stable formulation, saponins were introduced as neutral surfactants to (partly) replace glycocholic acid. Experimental design was made to investigate the effect of the composition on particle size at neutral pH and upon acidification at pH 1.5. Two formulations that were within the optimized composition window were loaded with vitamin K and those showed superior stability at low pH as compared to Konakion® MM: sizes were between 43 and 46 nm at pH 7.3 and between 46 and 58 nm after 1 h incubation at pH 1.5, respectively, but large aggregates were formed at pH 1.5 in presence of Konakion® MM. Micelles were cytocompatible with Caco-2 cells at concentration of surfactants (saponins and glycocholic acid) up to 0.15 mg/ml. Uptake of vitamin K by Caco-2 cells was 4.2-4.9 nmol/mg protein for saponins-containing formulations and 7.1 nmol/mg protein for Konakion® MM. This, together with the superior stability at low pH, makes saponins-containing mixed micelles promising oral formulations for vitamin K.


Assuntos
Micelas , Saponinas/química , Vitamina K/administração & dosagem , Administração Oral , Células CACO-2 , Sobrevivência Celular , Humanos , Concentração de Íons de Hidrogênio , Vitamina K/química , Vitamina K/metabolismo
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