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1.
Acta ortop. mex ; 35(2): 163-168, mar.-abr. 2021. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1374163

ABSTRACT

Resumen: Introducción: Aún existe controversia en cuanto a la tromboprofilaxis para la disminución de la enfermedad tromboembólica en la cirugía ortopédica mayor. Objetivo: Responder la siguiente pregunta: ¿existe diferencia en la efectividad y seguridad en el manejo antitrombótico de pacientes con un régimen tradicional de enoxaparina contra ácido acetilsalicílico? Material y métodos: Las cirugías se llevaron a cabo por tres cirujanos, se aleatorizó la muestra y los pacientes fueron sometidos a los criterios del estudio. Evaluamos eficacia y seguridad así como la necesidad de reingreso y variables secundarias como infección, infarto agudo de miocardio, enfermedad vascular cerebral y muerte con un seguimiento de 90 días. Resultados: El total de la muestra fue de 402 pacientes, 214 en el grupo de enoxaparina y 188 en el de aspirina. Se presentaron cinco casos (1.24%) con enfermedad tromboembólica, tres (1.4%) enoxaparina y dos (1.06%) aspirina sin diferencia significativa (p = 0.23). En cuanto a seguridad, el sangrado mayor fue cero en ambos grupos, presentándose sangrado menor en siete pacientes (1.74%), cuatro (1.86%) fueron del grupo enoxaparina y tres (1.59%) del grupo aspirina sin diferencias significativas (p = 0.82). Los resultados secundarios mostraron cinco (1.24%) infecciones de herida quirúrgica superficiales y un IAM en los primeros 30 días del procedimiento en el grupo de enoxaparina. Conclusión: La aspirina como monoterapia es segura y eficaz en profilaxis antitrombótica en pacientes operados de artroplastía total de rodilla.


Abstract: Introduction: There is still controversy regarding thrombo-prophylaxis for the reduction of thromboembolic disease in major orthopedic surgery. Objective: To answer the following question: is there a difference in the effectiveness and safety in the antithrombotic management of patients with a traditional regimen of enoxaparin against acetyl salicylic acid? Material and methods: The surgeries were performed by 3 surgeons; the sample was randomized and the patients were subjected to the study criteria. We evaluated efficacy and safety as well as the need for readmission and secondary variables such as infection, acute myocardial infarction (AMI), cerebral vascular disease and death with a follow-up of 90 days. Results: The total sample was 402 patients; 214 in the enoxaparin group and 188 in the aspirin group. There were 5 cases (1.24%) with thromboembolic disease, 3 (1.4%) enoxaparin and 2 (1.06%) aspirin without significant difference (p = 0.23). In terms of safety, major bleeding was zero in both groups, with minor bleeding in 7 patients (1.74%), 4 (1.86%) were from the enoxaparin group and 3 (1.59%) from the aspirin group without significant differences (p = 0.82). Secondary outcomes showed 5 (1.24%) superficial surgical wound infections and one AMI in the first 30 days of the procedure in the enoxaparin group. Conclusion: Aspirin as monotherapy is safe, effective in antithrombotic prophylaxis in patients operated on total knee arthroplasty.

2.
Rev. colomb. gastroenterol ; 32(2): 150-159, 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-900688

ABSTRACT

Resumen En los últimos años se ha generado un avance importante en el tratamiento de las patologías procoagulantes con antiguos y nuevos medicamentos y se ha logrado un importante avance en los métodos diagnósticos y terapéuticos en la endoscopia digestiva. Además, la expectativa de vida de la población mundial se ha incrementado de forma considerable, por lo que más frecuentemente el gastroenterólogo debe realizar procedimientos endoscópicos en pacientes de mayor edad, quienes presentan comorbilidades por las que reciben terapias antitrombóticas, especialmente por patologías cardiovasculares. En la literatura aparecen muchas guías de manejo avaladas por importantes asociaciones, en las que se orienta sobre la realización de procedimientos endoscópicos en los pacientes sometidos a terapias antitrombóticas, procedimientos que representan un determinado riesgo de sangrado o trombosis en caso de la suspensión de los medicamentos, pero no se han realizado estudios prospectivos o controlados que permitan formular protocolos para las diversas técnicas endoscópicas diagnósticas o terapéuticas en estos pacientes. El gastroenterólogo debe realizar un balance entre el riesgo hemorrágico y embólico para determinar cuál es el momento más indicado para realizar un procedimiento endoscópico en estos pacientes; por lo tanto, es de gran importancia que tenga conocimiento de este tema. Se presenta una revisión actualizada de la literatura y las más recientes recomendaciones de la sociedad europea de gastroenterología.


Abstract In recent years, treatment of pathologies related to hypercoagulation has advanced significantly as the result of the use of old and new drugs. In addition, significant advances have been achieved in diagnostic and therapeutic methods in digestive endoscopy. On the other hand, the life expectancy of the world population has increased considerably, so gastroenterologists must perform endoscopic procedures more frequently in older patients who present comorbidities for which they receive antithrombotic therapies, especially for cardiovascular diseases. Many treatment guides produced by important medical associations are available. They are oriented to the performance of endoscopic procedures in patients undergoing antithrombotic therapies. These patients are at risk of bleeding during or after these procedures, and they are at risk of thrombosis when medication is suspended. Nevertheless, no prospective or controlled studies have been performed to guide formulation of protocols for the various diagnostic and therapeutic endoscopic techniques that might be used for these patients. Gastroenterologists must balance the risks of bleeding and embolism to determine the most appropriate time to perform an endoscopic procedure in these patients. Therefore, it is of great importance that you have knowledge of this topic. We present an updated review of the literature and the most recent recommendations of the European society of gastroenterology.


Subject(s)
Endoscopy , Endoscopy, Digestive System , Platelet Aggregation Inhibitors , Therapeutics
3.
Medisan ; 16(3): 429-444, mar. 2012.
Article in Spanish | LILACS | ID: lil-628005

ABSTRACT

El síndrome antifosfolípido es un trastorno multisistémico adquirido y una importante causa de trombosis venosas o arteriales, así como también de morbilidad en el embarazo. Puede ser primario o secundario, este último sobre todo en pacientes con lupus eritematoso sistémico, infecciones y consumo de algunas drogas. Se exponen determinados elementos sobre sus manifestaciones clínicas y los criterios de clasificación actualizados para el diagnóstico. El tratamiento se basa en medidas de profilaxis antitrombóticas y control de los factores de riesgo asociados; pero aún muchos aspectos clínicos y de laboratorio concernientes a esta hipercoagulabilidad por la presencia de anticuerpos contra los fosfolípidos, se hallan sujetos a discusión e investigación.


The antiphospholipid syndrome is an acquired multisystemic disorder and an important cause of venous or arterial thrombosis, as well as of morbidity in pregnancy. It can be primary or secondary, the last one mainly in patients with systemic lupus erythematosus, infections and consumption of some drugs. Certain elements on its clinical manifestations and the updated classification criteria for the diagnosis are exposed. The treatment is based on antithrombotic prevention measures and control of the associated risk factors; but many clinical and laboratory aspects concerning this hypercoagulability due to the presence of antibodies against phospholipids, are still under discussion and research.

4.
Medicina (B.Aires) ; 71(3): 274-282, jun. 2011. ilus, graf, tab
Article in Spanish | LILACS | ID: lil-633860

ABSTRACT

La fibrilación auricular es la taquiarritmia cardíaca más frecuente. Su incidencia aumenta con la edad, presentándose en un 1.5% entre los 50 a 59 años, y en un 8-10% entre los 80 a 89 años. Esta arritmia incrementa en cinco veces el riesgo de sufrir un evento cerebrovascular isquémico cardioembólico y causa el 15% de todos los accidentes cerebrovasculares isquémicos. Su manejo se enfoca en la prevención de los fenómenos tromboembólicos y el control de la frecuencia y ritmo cardíaco. El tratamiento anticoagulante ha demostrado ser la principal herramienta en la prevención de eventos cardioembólicos. Aunque las complicaciones hemorrágicas por el tratamiento son esperables y aumentan con la edad, el beneficio de usar anticoagulación sobrepasa por mucho al riesgo de sangrado. Precisamente debido a la heterogeneidad clínica de esta arritmia y a la dificultad de establecer un tratamiento adecuado para cada caso en particular, el American College of Cardiology, la American Heart Association, la European Society of Cardiology y el American College of Chest Physicians han establecido guías para mejorar el tratamiento de estos pacientes. La revisión de esta enfermedad y de las directrices propuestas puede facilitar y mejorar notablemente el tratamiento de los pacientes con fibrilación auricular.


Atrial fibrillation is the most frequent cardiac arrhythmia in adults. Its frequency increases with age, being its incidence 1.5% in individuals 50 to 59 years old and 8-10% from 80 to 89 years. Atrial fibrillation increases 5 fold the risk of suffering stroke and actually causes 15% of all strokes. Its management focuses primary in the prevention of thromboembolic phenomena, heart rate and rhythm control. Anticoagulation, when indicated, has demonstrated to be the main tool in the prevention of these thromboembolic events. Although the bleeding complication is frequent in this population and increases with age, anticoagulation benefits are greater than the risks of bleeding. Due to the clinically heterogeneous nature of this arrythmia and the difficulty of establishing appropriate treatment for each particular case, the American College of Cardiology, the American Heart Association, European Society of Cardiology and American College of Chest Physicians have established guidelines to improve the management of these patients. The review of this condition and the proposed directives can notably facilitate and improve the management of the patients with atrial fibrillation.


Subject(s)
Adult , Aged, 80 and over , Humans , Middle Aged , Anticoagulants/therapeutic use , Atrial Fibrillation/complications , Thromboembolism/prevention & control , Thromboembolism/etiology
5.
Acta odontol. venez ; 47(1): 277-288, mar. 2009.
Article in Spanish | LILACS | ID: lil-630130

ABSTRACT

El presente manuscrito tiene como objetivo proporcionar una revisión bibliográfica del manejo odontológico del paciente que recibe terapia antitrombótica, debido a que las personas con enfermedad cardiovascular frecuentemente reciben este tipo de terapia y constituyen una amplia población en Venezuela, y junto a la alta prevalencia de caries y enfermedad periodontal, es necesario que los odontólogos y especialistas estén actualizados sobre el manejo de estos pacientes ya que, el tratamiento quirúrgico y no quirúrgico de las afecciones bucales pueden desencadenar complicaciones hemorrágicas y la suspensión del medicamento puede producir la aparición de un fenómeno trombótico, por otro lado, la terapéutica farmacológica empleada comúnmente en odontología puede interactuar con el tratamiento médico y provocar complicaciones; para el manejo de estos pacientes, es importante utilizar los agentes hemostáticos locales para evitar y controlar el sangrado intraoperatorio y postoperatorio.


The objective of the present work is to give information related to the dental management of patient receiving antithrombotic therapy, since people with heart disease frequently receive this kind of therapy, and they range a wide population in Venezuela , in addition to the high prevalence of cavities and periodontal disease ; therefore, it is necessary the specialists and dentist to be updated on the management of those patients, because the surgical and non surgical dental treatment may lead to hemorrhagic complications and on one hand, the withdrawal of medication may cause the onset of a thrombotic phenomenon, on the other hand, the pharmacological therapy commonly used in dentistry may interact to the medical treatment and cause complications; for managing those patients, it is important to use the haemostatic agents in order to avoid and control the local bleeding.

6.
Rev. bras. ter. intensiva ; 19(1): 67-73, jan.-mar. 2007. graf, tab
Article in Portuguese | LILACS | ID: lil-466771

ABSTRACT

JUSTIFICATIVA E OBJETIVOS: O uso de heparina de baixo peso molecular (HBPM) na profilaxia ou terapêutica de diversas doenças ou síndromes é de grande importância na prática clínica. O objetivo deste estudo foi avaliar a segurança e a eficácia da enoxaparina sódica, teste (ENOX-T) comparada ao medicamento de referência (ENOX-R). MÉTODO: Foi realizado estudo prospectivo, aleatório, comparativo, unicêntrico e aberto envolvendo pacientes com indicação de profilaxia ou tratamento antitrombótico. Foram incluídos 100 pacientes divididos em 2 braços: profilático (n = 50) e terapêutico (n = 50) divididos em 2 grupos para cada braço (grupo 1: ENOX-R e grupo 2: ENOX-T). Analisou-se em cada segmento os dados clínicos e laboratoriais. A atividade do anti-fator Xa foi aferida em três momentos: basal (1ª avaliação); 1º ou 2º dia (2ª avaliação) e 5º a 7º dia (3ª avaliação). O ultra-som Doppler dos membros inferiores foi realizado na 2ª ou 3ª avaliação do braço profilático. RESULTADOS: Os resultados demonstraram homogeneidade dos grupos nos 2 braços (profilático e terapêutico) quanto a sexo, idade, índice de massa corpórea, creatinina sérica e Apache II. Os valores do anti-fator Xa nos braços profilático e terapêutico demonstraram eficácia adequada dos medicamentos, sem diferença clínica ou estatística entre ambos. A ocorrência de eventos adversos não mostrou diferença clínica ou estatística entre os medicamentos. No braço profilático o ultra-som de membros inferiores acrescentou informações úteis sobre a eficácia dos fármacos estudados. CONCLUSÕES: A enoxaparina sódica teste (ENOX-T) foi segura e eficaz nos pacientes analisados e equivalente ao medicamento de referência (ENOX-R).


BACKGROUND AND OBJECTIVES: Use of low molecular weight heparins (LMWH), either prophylactic or therapeutic, is of most importance in several syndromes and diseases in daily clinical practice. Our objective in this clinical trial was to evaluate safety and efficacy of test sodium enoxaparin (ENOX-T) compared to the reference drug (ENOX-R). METHODS: We conducted a prospective, randomized, comparative, unicentric and open-labeled trial including patients with either prophylactic or therapeutic anti-thrombotic indications. A total of 100 patients were enrolled in two branches: prophylactic (n=50) and therapeutic (n=50) and two groups for each branch (group 1: ENOX-R and group 2: ENOX-T). We analyzed clinical and laboratory data in each segment. Anti-factor Xa was measured in three different moments: baseline (1st evaluation); 1st or 2nd day (2nd evaluation) and 5th to 7th day (3rd evaluation). Doppler-sonography of inferior limbs was performed on all patients in prophylactic group on 2nd or 3rd evaluation. RESULTS: The data showed that both branches (prophylactic and therapeutic) were homogenous in regard of sex, age, body mass index (BMI), serum creatinine and APACHE II severity score at admission. Anti-factor Xa results, in both prophylactic and therapeutic branches, showed expected efficacy to both drugs, without any clinical or statistical difference between them. Adverse events incurred in both groups in a similar way, without any clinical or statistical difference between them. In prophylactic branch, Doppler-sonography of inferior limbs added useful information on drugs efficacy. CONCLUSIONS: We conclude that test sodium enoxaparin (ENOX-T) was effective and safe in our patient's cohort and equivalent to reference drug (ENOX-R).


Subject(s)
Fibrinolytic Agents/administration & dosage , Fibrinolytic Agents/therapeutic use , Heparin, Low-Molecular-Weight/administration & dosage , Heparin, Low-Molecular-Weight/therapeutic use
7.
Iatreia ; 18(1): 153-162, mar. 2005. tab
Article in Spanish | LILACS | ID: lil-406204

ABSTRACT

La fibrilación auricular (FA) afecta a más de dos millones de personas en Estados Unidos y se calcula que afectará a más de tres millones para el año 2020. Se caracteriza por la presencia en el electrocardiograma de ondas rápidas e irregulares sobre la línea de base, que varían de tamaño, morfología y tiempo. Es particularmente frecuente en los ancianos. Se produce por múltiples circuitos de microrreentrada que salen de la aurícula, colisionan, se extinguen y reaparecen; es necesaria una masa critica de tejido auricular para sostener un mínimo de circuitos que permitan perpetuar la arritmia. Dos estudios recientes permiten concluir que la terapia dirigida solamente al control de la respuesta ventricular es igualmente efectiva para el control del ritmo cardíaco, lo que desvirtúa la conducta de intentar restablecer el ritmo sinusal en todos los pacientes con FA.Una de las complicaciones más severas de la FA son los eventos tromboembólicos sistémicos que se presentan principalmente al sistema nervioso central; a la FA se le atribuye ser el factor causal en el 15 por ciento de todos los casos y en el 30 por ciento de los que ocurren en personas mayores de 80 años. Se revisan y analizan diferentes estudios de prevención tanto primaria como secundaria en pacientes con FA no valvular, los cuales sustentan las recomendaciones de consensos internacionales para su tratamiento basado en anticoagulación o antiagregación


The number of people with atrial fibrillation (AF) in the United States has been projected to increase from the current 2.2 million to 3 million in 2020. It is characterized by the presence of rapid and irregular waves on the base line that vary in size, shape and timing. It is particularly frequent in the elderly. In AF multiple, small microreentrant circuits are constantly arising in the atria, colliding, being extinguished, and arising again; a critical mass of atrial tissue is required to sustain the minimal number of simultaneous circuits necessary for the perpetuation of the arrhythmia. Two recent studies permit to conclude that the rhythm control strategy offers no survival advantage over the rate control strategy, and there are potential advantages, such as the lower risk of adverse drug effects, with the rate control strategy. One of the most severe complications of AF are the thromboembolic events mainly to the central nervous system. AF is an important independent risk factor for the embolic stroke, responsible for as many as 15% of strokes and for 30% in the group 80 to 89 years old. We analyzed different primary and secondary prevention studies in patients with non-valvular FA, which support the recommendations of guidelines developed by the American College of Cardiology, the American Heart Association, the European Society of Cardiology and ACCP.


Subject(s)
Thromboembolism , Anticoagulants , Atrial Fibrillation , Platelet Aggregation Inhibitors
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