Tromboprofilaxis durante el embarazo / Thromboprophylaxis during pregnancy

Resumen Introducción. En mujeres, el riesgo de desarrollar enfermedad tromboembólica venosa (ETV) es 5 a 6 veces mayor durante el embarazo, riesgo que puede aumentar considerablemente si existen antecedentes personales o familiares de otros estados protrombóticos. La ETV es una de las principales causas de morbimortalidad en esta población, por lo que para evaluar la pertinencia de usar tromboprofilaxis, ya sea farmacológica o no farmacológica, es necesario reconocer oportunamente los factores de riesgo clínico asociados a esta condición. Objetivo. Describir el uso de pruebas de tamizaje de estados protrombóticos y de la tromboprofilaxis farmacológica y no farmacológica para prevenir la ETV durante la gestación, durante el parto y durante el puerperio. Materiales y métodos. Se realizó una revisión de la literatura en Embase, ClinicalKey, ScienceDirect, Access Medicine, Scopus, ProQuest, PubMed y LILACS. Se buscaron estudios sobre trombofilia y tromboprofilaxis en el embarazo publicados entre enero de 2004 y marzo de 2018 en inglés y en español. Resultados. En la búsqueda inicial se identificaron 126 artículos, de los cuales 52 cumplieron los criterios de inclusión. La mayoría de estudios correspondió a revisiones narrativas (n = 15), revisiones sistemáticas (n=8) y guías de práctica clínica (n=6). Conclusión. Se recomienda el uso de pruebas de tamizaje de estados protrombóticos durante la gestación, el parto y el puerperio, ya que la identificación oportuna de la ETV permite disminuir las tasas de morbimortalidad en esta población mediante la implementación de medidas tromboprofilácticas, sean o no farmacológicas.

Abstract Introduction: The risk of developing venous thromboembolism (VTE) in women is 5 to 6 times higher during pregnancy. In addition, this risk can be significantly higher if the patient has a history or family history of hypercoagulate states. VTE is a leading cause of morbidity and mortality in this population, so in order to assess if it is appropriate to use thromboprophylaxis during pregnancy, whether pharmacological or non-pharmacological, it is necessary to timely recognize the clinical risk factors associated with this condition. Objective: To describe the use, on the one hand, of screening tests for hypercoagulate states and, on the other, of pharmacological and non-pharmacological thromboprophylaxis to prevent the development of VTE during pregnancy, labor and the puerperium Materials and methods: A literature review was conducted in the Embase, ClinicalKey, ScienceDirect, Acces Medicine, Scopus, ProQuest, PubMed and LILACS databases. The search included studies on thrombophilia and thrombophylaxis during pregnancy published in English or Spanish between January 2004 and March 2018. Results: After completing the initial search, 126 studies were identified, of which 52 met the inclusion criteria. Most studies were narrative reviews (n = 15), systematic reviews (n = 8) and clinical practice guidelines (n=6). Conclusion: The use of screening tests for hypercoagulate states during pregnancy, labor and the puerperium is recommended, since the timely identification of VTE will allow the reduction of morbidity and mortality rates in this population through the implementation of thromboprophylactic measures, whether they are pharmacological or non-pharmacological.

Analyze The Treatment Regimens And Thrombosis Prophylaxis Used In Coronary Artery Intervention At Interventional Cardiology Unit In Can Tho Central General Hospital

Objective: The study was conducted to analyze the rationality of treatment regimens and thrombosis prophylaxis used in coronary artery intervention to compare to guidelines for treatment according to VNHA and recommendation of ACC/AHA at Interventional cardiology in Can Tho Central General Hospital. Methods: The cross-sectional study was based on the data collected from entire medical records of patients at Interventional cardiology in Can Tho Central General Hospital from August 2017 to February 2018. The rationality of the antithrombotic regimen used at the Hospital is assessed through criteria such as medical combination, dosage, time to take medicine, clinical trials during the treatment. Results: The study found that 95.6% and 90.7% were suitable for medical combination before and after PCI; 100% fit for the use of medicine; and 100% was suitable for antithrombotic agents and clinical trials during treatment time; in terms of dosage, the result showed that entrance and maintenance were 84.9% and 100% for aspirin respectively; 71.7% and 100% for clopidogrel; 100% and 94.7% for ticagrelor; 90.2-92.8% and 98.1% for enoxaparin; especially, heparin-100% anticoagulant was appropriate to recommend. Conclusion: The study showed that treatment regimens and thrombosis prophylaxis in percutaneous coronary intervention at Interventional cardiology in Can Tho Central General Hospital were quite suitable compared to the recommendations of the Heart Association. The results from the study are a scientific basis for the Hospital to maintain or consider adjustments to improve the quality of treatment, ensure the effectiveness and safety of patients.

Management of Patients on Antithrombotic Agents Undergoing Endoscopy / 대한소화기학회지

Antithrombotic agents are used increasingly in Asia. The management of patients on antithrombotics undergoing elective or emergency endoscopy has become an increasing clinical challenge for gastroenterologists. Current practice guidelines have been developed by societies from western countries. On the other hand, these guidelines cannot meet the specific needs of the Asian Pacific region, raising the need for separate guidelines in Asia. This review compares the recommendations of previous guidelines with the most recently published Asian guidelines regarding the management of patients on antithrombotic agents undergoing elective and emergency endoscopy.

Ponderações nos procedimentos cirúrgicos odontológicos em pacientes sob terapia antitrombótica: revisão de literatura / Weightings on dental surgical procedures in patients on antithrombotic therapy: Literature review

Objetivo: a intensão deste estudo foi identificar, através da literatura pertinente, a conduta mais ponderada no tratamento odontológico dos indivíduos que fazem uso de anticoagulantes e ou antiagregantes plaquetários. Material e Métodos: a pesquisa, realizada em julho 2016, incluiu as bases eletrônicas de dados bibliográficos MEDLINE/ PubMed e BVS entre os anos de 2000 a 2016. A busca inicial identificou 141 artigos indexados, sendo que 25 foram selecionados conforme metodologia. Resultados: os artigos avaliados indicaram contextos variados no atendimento deste grupo de pacientes que faz uso de medicações anticoagulante e ou antiagregantes plaquetários. As ocorrências de hemorragias foram tratadas de forma satisfatória na totalidade. Conclusão: os pacientes podem seguramente submeter a procedimentos cirúrgicos odontológicos desde que seja avaliada a via extrínseca da coagulação para determinação da tendência de coagulação do sangue, isto é, a INR. Além disso, considerar o risco cirúrgico de acordo com o tipo de intervenção, procurar minimizar o trauma cirúrgico, fazer uso de métodos locais de hemostasia e prestar orientações pós-operatórias detalhadas.

Objective: the aim of this study was to identify, through literature, the most appropriate strategy for the dental treatment of patients taking anticoagulants or antiplatelet agents. Materials and Methods: the survey, conducted in July 2016, included the electronic bibliographic databases MEDLINE/ PubMed and BVS, between the years 2000 and 2016. The initial search identified 141 articles indexed, and 25 were selected according to the methodology. Results: the articles were analyzed and various contexts in the care of this group of patients taking anticoagulant and/or antiplatelet agents were pointed out. The bleeding events were all handled satisfactorily. Conclusion: patients can safely undergo dental surgical procedures provided that the extrinsic pathway of coagulation to determine the blood clotting tendency is assessed, i.e., the INR. Furthermore, it is advisable to assess the surgical risk according to the type of procedure, approaches to minimize surgical trauma, the use of local hemostasis agents, and provide detailed postoperative instructions.

Simultaneous Development of ST-Segment Elevation Myocardial Infarction and Pulmonary Embolism in an Healthy Elderly Woman

A 73-year-old woman who presented with chest discomfort visited the emergency room. The 12-lead electrocardiography showed ST-segment elevation in II, III, and lead augmented vector foot. Emergent coronary angiography revealed a thrombus in the distal right coronary artery. Percutaneous coronary angioplasty with a stent was performed. After the procedure, persistent dyspnea occurred. Her chest computed tomography (CT) showed occlusion of the bilateral pulmonary artery. We could not find a source for the embolization or a hypercoagulable state. We started a course of dual antiplatelets with oral anticoagulants. Pulmonary embolism was resolved at follow-up chest CT scan. Aspirin, clopidogrel and warfarin were given for 6 months. The patient is doing well now 1 year after the episode.

Research progress in thrombosis and mechanism of new antithrombotic agents / 中国药理学通报

Literatures available was reviewed on the thrombosis and mechanism of new antithrombotic agents.The pathophysiology of the thrombosis involves dysfunction of endothelium and cell adhesion.The new antithrombotic drugs include factor Ⅹa inhibitors, GPⅡb/Ⅲa receptor blocking agents and the drugs modulating the function of endothelium.