RESUMO
Eight patients with heparin associated thrombocytopenia (HAT) were treated by a low molecular weight heparin derivative (LMW). Biological and clinical improvement occurred in all patients. This efficiency confirms the antithrombotic activity of LMW and allows its use in patients with HAT.
Assuntos
Heparina/efeitos adversos , Heparina/uso terapêutico , Trombocitopenia/induzido quimicamente , Idoso , Plaquetas/imunologia , Feminino , Humanos , Imunoglobulina G/metabolismo , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Trombocitopenia/complicações , Trombocitopenia/tratamento farmacológico , Trombose/complicações , Trombose/tratamento farmacológicoRESUMO
Treatment monitoring based on a laboratory parameter increases the efficacy and safety of standard heparin therapy, but it is not known if this also applies to low-molecular-weight heparin (LMWH) therapy of acute deep vein thrombosis (DVT). In a prospective randomized trial involving 122 consecutive patients, group A (58 patients) received a weight adjusted dose of Fragmin (100 IU/kg) subcutaneously twice a day throughout the treatment period (10 days +/- 1), while in group B (64 patients) the dosage was based on the results of an anti factor Xa (anti Xa) amidolytic assay to obtain a target concentration from 0.5 to 1 IU/ml. AntiXa and antithrombin activities were also measured retrospectively on frozen plasma from all patients. The two regimens were comparable in terms of hemorrhagic complications (4 in group A and 3 in group B). Bilateral ascending phlebography was performed before inclusion and at the end of LMWH treatment. Treatment efficacy, based on Marder's score, did not differ between the two groups (p = 0.3). Dosage adjustment to between 0.5 to 1 IU anti-Xa/ml does not therefore appear to improve the efficacy or safety of LMWH treatment. However, correlations between the change in Marder's score and both anti-Xa (p < 0.001) and antithrombin activity (p < 0.001) were observed, suggesting a relationship between the degree of FXa or thrombin inhibition and antithrombotic activity.
Assuntos
Dalteparina/administração & dosagem , Tromboflebite/tratamento farmacológico , Doença Aguda , Adulto , Idoso , Dalteparina/efeitos adversos , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Embolia Pulmonar/tratamento farmacológico , Estudos Retrospectivos , Tromboflebite/sangueRESUMO
We compared in six patients successively treated with an unfractionated heparin (UFH) and a low molecular weight heparin (LMWH) the variations in plasma anti-Xa activity, measured in a chromogenic assay, during a 36 h constant infusion. The values varied in a wider range during UHF infusion, but remained in the therapeutic range except once in one patient. No circadian rhythm could be demonstrated in our six patients. LMWH infusion yielded very constant anti-Xa circulating activities. In both cases, there were no significant modifications of three proteins with high heparin affinity (antithrombin III, heparin cofactor II, histidine-rich glycoprotein). Our results suggest that the circadian rhythm of the biological activities previously observed in patients treated with constant heparin infusion using clotting method is due to other factors than heparin itself.
Assuntos
Heparina de Baixo Peso Molecular/administração & dosagem , Heparina/administração & dosagem , Adulto , Idoso , Ritmo Circadiano , Fator Xa , Heparina/sangue , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Inibidores de Serina Proteinase , Doenças Vasculares/sangue , Doenças Vasculares/tratamento farmacológicoRESUMO
In human plasma, heparin cofactor II (HCII) is a thrombin inhibitor which displays similarities with antithrombin III (ATIII). As previously reported for hereditary ATIII deficiency, cases of recurrent thrombosis were reported in patients with hereditary HCII deficiency. Here, plasma HCII activity was studied in 372 patients with a history of thrombosis, classified according to their anticoagulant therapy. The mean plasma HCII level was significantly higher in patients with acute deep vein thrombosis (DVT) under heparin therapy than in patients with a history of thrombosis, who were studied more than 3 months after the acute event, and were either on, or had been on, oral anticoagulant therapy. HCII and fibrinogen were significantly correlated in all three groups of patients. These results were strengthened by those of a follow-up study in 23 patients with acute DVT. Changes in plasma HCII activity paralleled those of fibrinogen. This suggests that HCII might behave like an acute phase reactant in patients with thrombosis and that the measurement of its plasma level as a risk factor for thrombosis should be performed some time after the acute episode. In conclusion, the prevalence of HCII deficiency in patients with a history of thrombosis might have been underestimated in series which included patients with acute thrombosis.
Assuntos
Proteínas de Fase Aguda/metabolismo , Cofator II da Heparina/metabolismo , Tromboflebite/sangue , Administração Oral , Adolescente , Adulto , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Feminino , Fibrinogênio/metabolismo , Heparina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Tromboflebite/tratamento farmacológicoRESUMO
Thirty-five patients with peripheral arterial occlusion were treated by intra-arterial infusion of low dose urokinase associated with bolus of lys-plasminogen. Systemic fibrinolysis was moderate, thrombolysis was achieved in 26 patients (74%). Only one patient required blood transfusion, five patients (14%) had distal emboli. Infection at the catheter entry site occurred in 2 patients, 3 patients experienced proximal embolism. Six patients required leg amputation, 4 died, in 2 of them deaths were related to arterial catheterization. Local thrombolysis with limited systemic fibrinolysis is associated to a high rate of catheter-related complications.
Assuntos
Arteriopatias Oclusivas/terapia , Fragmentos de Peptídeos/administração & dosagem , Plasminogênio/administração & dosagem , Ativador de Plasminogênio Tipo Uroquinase/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Combinada , Feminino , Oclusão de Enxerto Vascular/terapia , Humanos , Infusões Intra-Arteriais , Isquemia/terapia , Perna (Membro)/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , RecidivaRESUMO
The authors report a case of a 48 year old woman admitted to hospital because of digital ischemia, in a context of antiphospholipid syndrome. The electrocardiogram-triggered electron beam computed tomography revealed an apical thrombus associated with a thinning left ventricular wall, suggesting painless myocardial infarction. The diagnosis was secondary confirmed by coronarography.
Assuntos
Síndrome Antifosfolipídica/complicações , Trombose Coronária/etiologia , Ventrículos do Coração/patologia , Angiografia Coronária , Trombose Coronária/diagnóstico , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
A 65 year-old man with an oesophageal carcinoma had an acute polymyositis with an extensive oedema of shoulders and arms which improved spontaneously. The significance of these disorders is discussed.
Assuntos
Carcinoma de Células Escamosas/complicações , Edema/etiologia , Neoplasias Esofágicas/complicações , Miosite/etiologia , Doença Aguda , Idoso , Braço , Humanos , Masculino , Remissão Espontânea , OmbroRESUMO
The authors study the biological variations which accompany an oral, thrombolytic treatment in which urokinase and lysyl-plasminogen are combined. Fibrinogen, the products of degradation of fibrinogen or fibrin, plasminogen and rapid alpha 2 antiplasmin are studied as a function of time. Two dimensional electrophoreses were carried out at precisely determined times. The combination of the two therapeutic agents causes the appearance of plasmin in the circulation, but it is neutralised by its rapid inhibitor. This therapeutic protocol entails moderate circulating fibrinolysis and may easily be monitored by determination of the circulating fibrinogen.
Assuntos
Arteriopatias Oclusivas/tratamento farmacológico , Fibrinólise/efeitos dos fármacos , Fragmentos de Peptídeos/administração & dosagem , Plasminogênio/administração & dosagem , Ativador de Plasminogênio Tipo Uroquinase/administração & dosagem , Doença Aguda , Adulto , Idoso , Arteriopatias Oclusivas/sangue , Quimioterapia Combinada , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio , Fibrinogênio , Humanos , Injeções Intra-Arteriais , Perna (Membro)/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , alfa 2-AntiplasminaRESUMO
Twenty-five in situ thrombolysis using Lysyl Plasminogen and low doses of urokinase were performed on 25 acute, recent and severe arterial occlusion of lower limbs. Early success were 56% and 44% with a follow up of 5 months. Complications were very limited. Thus the thrombolytic treatment used in this study appears as effective as locally administered streptokinase but higher tolerated. It seems to be able to win one of the best places in the treatment of the arterial disease of the lower limbs.
Assuntos
Arteriopatias Oclusivas/tratamento farmacológico , Fragmentos de Peptídeos/uso terapêutico , Plasminogênio/uso terapêutico , Ativador de Plasminogênio Tipo Uroquinase/uso terapêutico , Doença Aguda , Adulto , Idoso , Quimioterapia Combinada , Feminino , Humanos , Infusões Intra-Arteriais , Perna (Membro)/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
This open, randomised multicenter trial compares the efficacy and safety of Fragmin administered subcutaneously twice daily with standard heparin administered by continuous infusion in the treatment of deep vein thrombosis (DVT). The initial dose of Fragmin is 100 U anti-Xa/kg/12 h and the further doses are adjusted according to the anti-Xa activity between 0.5 and 0.8 U/ml, 3 hours after the morning injection. The initial dose of standard heparin is 240 UI/kg/12 h. The dose adjustments are based on the daily results of APTT (1.5 - 3 times the control). Treatments efficacy are appreciated when comparing the venography performed before and after 10 days of treatment. The safety is evaluated on clinical parameters and iterative biological tests. Sixty-six patients have been included in this study. Efficacy of the two treatments is equivalent with a phlebographic improvement in respectively 79.3 p. 100 (Heparin Group) and 71.0 p. 100 (Fragmin Group) of the cases and an aggravation in 3.4 p. 100 and 6.4 p. 100 (NS) respectively. The frequency of dosage adjustments is lower and the stability of biological tests is better in the Fragmin group. In conclusion, the administration of Fragmin twice daily by subcutaneous route seems to be equivalent at least to standard heparin continuous infusion in the treatment of recent DVT. The better convenience and safety of Fragmin have to be verified on a larger panel of patients.
Assuntos
Heparina de Baixo Peso Molecular/uso terapêutico , Tromboflebite/tratamento farmacológico , Adulto , Idoso , Feminino , Heparina/administração & dosagem , Heparina/uso terapêutico , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Infusões Intravenosas , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Distribuição AleatóriaRESUMO
35 patients with acute arterial occlusions [27] and graft thromboses [8], responsible for severe and recent ischemia, were treated by fibrinolytic therapy (Urokinase: 1 000 units/kg/hour, and Lys Plasminogen). These drugs were delivered at the site of occlusions using a 5 French catheter. Angiographically, initial success was obtained in 30 patients (85%) and a significant clinical benefit persisted 5 months later, in 20 patients (57%). 4 distal embolisms during the treatment were noted, and one woman died a few hours after the withdrawal of an axillary catheter of a cerebellar infarction. Only two minor (6%) and one severe (3%) groin hematoma were encountered. No patient had at any moment a fibrinogen concentration lower than 1 g/l. Thus, the thrombolytic treatment used in the study appears as effective as locally administered Streptokinase but better tolerated.
Assuntos
Arteriopatias Oclusivas/tratamento farmacológico , Perna (Membro)/irrigação sanguínea , Fragmentos de Peptídeos/administração & dosagem , Plasminogênio/administração & dosagem , Ativador de Plasminogênio Tipo Uroquinase/administração & dosagem , Doença Aguda , Adulto , Idoso , Angiografia , Quimioterapia Combinada , Feminino , Fibrinólise , Seguimentos , Humanos , Infusões Intra-Arteriais , Injeções Intra-Arteriais , Masculino , Pessoa de Meia-Idade , Fragmentos de Peptídeos/uso terapêutico , Plasminogênio/uso terapêutico , Fatores de Tempo , Ativador de Plasminogênio Tipo Uroquinase/uso terapêuticoRESUMO
A pulmonary angiography through peripheral venous approach was systematically performed in 40 consecutive patients presenting a recent deep venous thrombosis. None of these patients had been sent for a suspected pulmonary embolus. The analysis of the images that were obtained, enabled to confirm the diagnosis of pulmonary migration in 9 of these patients (22.5%). The retrospective study of the files confirms the fact that these pulmonary emboli present few symptoms or are asymptomatic in 17.5 p. cent of the cases. The quality of the images, the good acceptability and the moderate cost of pulmonary angiography through peripheral venous approach allow the performance of this examination during the initial work-up of a deep venous thrombosis. The demonstration of a latent pulmonary embolus must enable to separate high risk patients and thus guide subsequent therapy.
Assuntos
Diagnóstico por Computador , Embolia Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Tromboflebite/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pulmão/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
Thirty-eight consecutive patients with severe arterial disease of the lower extremities benefited from an exploration of the coronary reserve by myocardial scintigraphy with thallium dipyridamole. With this examination, it has been possible to screen 20 p. cent of asymptomatic patients and at least modify the perioperative treatment or even the very indication for surgery.
Assuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Arteriosclerose/diagnóstico por imagem , Dipiridamol , Coração/diagnóstico por imagem , Radioisótopos de Tálio , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Perna (Membro)/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica , CintilografiaRESUMO
Among deep venous thromboses of the calf, isolated gastrocnemic vein thrombosis is a rare condition. Its main characteristics could be extracted from 5 cases. Following a positional or mechanical triggering factor, the diagnosis is suggested by pain localized to the calf. Ultrasonography shows the intraluminal thrombus better than phlebography, since the gastrocnemic veins, which bypass the larger deep veins, can be opacified only after a garrot is placed above the knee. The thrombus may extend to the popliteal vein, with a risk of pulmonary embolism and post-phlebitis disease. Treatment consists of anticoagulants and elastic bandage.