RESUMO
Neoplasm history increases morbidity and mortality after solid organ transplantation and has disqualified patients from transplantation. Studies are needed to identify factors to be considered when deciding on the suitability of a patient with previous tumor for heart transplantation. A retrospective epidemiological study was conducted in heart transplant (HT) recipients (Spanish Post-Heart Transplant Tumor Registry) comparing the epidemiological data, immu-nosuppressive treatments and incidence of post-HT tumors between patients with previous malignant noncardiac tumor and with no previous tumor (NPT). The impact of previous tumor (PT) on overall survival (OS) was also assessed. A total of 4561 patients, 77 PT and 4484 NPT, were evaluated. The NPT group had a higher proportion of men than the PT group (p < 0.001). The incidence of post-HT tumors was 1.8 times greater in the PT group (95% confidence interval [CI] 1.2-2.6; p < 0.001), mainly due to the increased risk in patients with a previous hematologic tumor (rate ratio 2.3, 95% CI 1.3-4.0, p < 0.004). OS during the 10-year posttransplant period was significantly lower in the PT than the NPT group (p = 0.048) but similar when the analysis was conducted after a first post-HT tumor was diagnosed. In conclusion, a history of PT increases the incidence of post-HT tumors and should be taken into account when considering a patient for HT.
Assuntos
Cardiopatias/complicações , Transplante de Coração/efeitos adversos , Neoplasias/epidemiologia , Neoplasias/fisiopatologia , Complicações Pós-Operatórias/epidemiologia , Idoso , Feminino , Seguimentos , Cardiopatias/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Fatores de TempoRESUMO
Novel platelet glycoprotein IIb/IIIa receptor inhibitors have appeared as promising antithrombotic agents. However, their increased risk of bleeding complications, although known, is not well established. We report the case of a serious bleeding complication, a massive pulmonary hemorrhage, in a patient who was treated with one of these agents. Further studies defining guidelines and indications of treatment with platelet glycoprotein IIb/IIIa inhibitors are needed before their routine application to daily practice.