Trombolisis sistémica complicada en embolia cerebral múltiple por trombo intraventricular / Systemic thrombolysis following multiple embolic cerebral lesions in a patient with myocardial infarction and intraventricular thrombus

RESUMEN Se presenta un caso de trombólisis sistémica complicada con transformación hemorrágica en paciente con evento isquémico cerebral sintomático por embolia múltiple a partir de trombo intraventricular en contexto de infarto agudo de miocardio por oclusión total de arteria descendente anterior con deterioro severo de función sistólica de ventrículo izquierdo.

ABSTRACT: We describe a case of complicated systemic thrombolysis with hemorrhagic transformation in a patient with a cerebral ischemic event due to multiple embolisms from intraventricular thrombus in the context of acute myocardial infarction due to total occlusion of the anterior descending artery and severe deterioration of left ventricular systolic function.

Recomendaciones para el uso de tromboprofilaxis en pacientes hospitalizados por COVID-19 en la Argentina / Recommendations for the use of thromboprophylaxis in hospitalized patients with COVID-19 in Argentina

Si bien la incidencia es incierta, algunos reportes de caso sugieren que la infección por COVID 19 se asocia con un aumento del riesgo de tromboembolismo venoso. Sugerimos iniciar tromboprofilaxis a todos los pacientes hospitalizados por síntomas asociados con una infección por COVID-19, a menos que esté contraindicado, con enoxaparina 40 mg SC diariamente si el clearance de creatinina es mayor a 30 ml/min.

Although the incidence is uncertain, some case reports suggest that COVID 19 infection is associated with an increased risk of venous thromboembolism. We suggest starting prophylactic anticoagulant therapy for all patients hospitalized with a symptomatic infection with COVID-19, unless contraindicated, with enoxaparin 40 mg SC daily if creatinine clearance is greater than 30 ml/min.

Recomendaciones actualizadas para profilaxis de la enfermedad tromboembólica venosa en Argentina / Updated recommendations for venous thromboembolic prophylaxis in Argentina

La enfermedad tromboembólica venosa (ETV) en adultos hospitalizados posee elevada morbimortalidad, es origen de complicaciones crónicas y determina incrementos de costos para el sistema de salud. Desde la publicación de recomendaciones de tromboprofilaxis en pacientes internados en 2013, han surgido nuevas alternativas y estrategias, que nos motivaron a actualizar nuestras recomendaciones. A pesar de que existen diferentes consensos y guías de práctica clínica la adherencia a las mismas es subóptima. Se han actualizado las diferentes alternativas terapéuticas para los adultos hospitalizados (clínicos no quirúrgicos, quirúrgicos no ortopédicos, con y sin cáncer, ortopédicos y embarazadas), poniendo particular atención en los fármacos disponibles en Argentina.

Venous thromboembolic disease (VTE) in hospitalized adults has high morbidity and mortality, is the origin of chronic complications and increased cost for the health system. Since the publication of recommendations for thromboprophylaxis in hospitalized patients in 2013, new alternatives and strategies have emerged, which motivated us to update our recommendations. Although there are different consensus and clinical practice guidelines, adherence to them is suboptimal. The different therapeutic alternatives for hospitalized adult patients (non-surgical, surgical non-orthopedic, with and without cancer, orthopedic an d pregnant) have been updated, paying particular attention to the drugs available in Argentina.

Effects of different anticoagulants on coagulation function in hemodialysis patients / 中国基层医药

Objective To investigate the effect of different anticoagulant drugs on the changes of coagulation index and the incidence of hemorrhage in hemodialysis patients.Methods 40 patients with hemodialysis were selected as study objects,according to the random number table method they were divided into three groups,20 cases received heparin in A group,10 cases received low molecular heparin in B group;10 cases received argatroban in C group.At the same time,10 healthy persons were selected as control group.The activated glass bead clotting time (gbACT),blood velocity (CR),platelet function (PF),prothrombin fragment 1+2 (PF1+2) and the surface of platelet alpha granule membrane protein (GMF-140) were observed and analyzed in all patients.Results Compared with the control group,the CR,PF,PF1+2 and GMF-140 before taking to machine in A group were significantly increased,which were (31.1±5.5)sig/min,(3.1±0.5),(478.2±74.3)pmol/L,(36.9±6.6)pmol/L,respectively,gbACT was significantly prolonged [(196.1±27.3)s].In A group,compared with before taking to machine,the CR,PF,PF1+2 and the GMF-140 before taking off machine were significantly decreased,which were (10.6±3.2)sig/min,(1.8±0.4),(400.1±85.5)pmol/L,(30.9±6.8)pmol/L,respectively,gbACT was significantly prolonged[(252.5±50.4)s],there were statistically significant differences (F=112.64,28.38,81.40,18.11,21.63 0.05,all P<0.05);B group compared with the control group,the CR,PF,PF1+2 and GMF-140 before taking to machine were significantly increased,which were (29.5±6.6)sig/min,(2.9±1.2),(475.5±97.0)pmol/L,(37.5±7.0)pmol/L,respectively,gbACT was significantly prolonged[(193.9±32.8)s].In B group,the CR and PF1+2 before taking off machine were significantly decreased,which were (22.3±6.8),(407.8±90.3)pmol/L,respectively,gbACT was significantly prolonged [(207.5±31.5)s],there were statistically significant differences (F=9.11,57.81,5.99,16.37,all P<0.05);C group compared with the control group,the CR,PF,PF1+2 and GMF-140 before taking to machine were significantly increased,which were (26.1±3.3)sig/min,(2.5±0.5),(443.5±64.1)pmol/L,(32.2±8.3)pmol/L,respectively,before taking off machine,the CR[(23.7±4.1)] was higher than (18.5±3.6) of the control group,there were statistically significant differences (F=11.14,3.04120.30,8.63,all P<0.05).40 hemodialysis patients were successfully treated without the occurrence of elevated venous pressure during and after treatment pipeline no or slight residual blood,puncture time and no significant prolongation.Conclusion Unfractionated heparin has strong anti-clotting effect,during and after hemodialysis has greater risk of bleeding,dalteparin has anticoagulant effect,but there is greater risk of bleeding during hemodialysis,the use of argatroban helps to improve the condition of bleeding.

Rationality Analysis of the Utilization of Anticoagulant Drugs in the Inpatients of Our Hospital during 2013-2015 / 中国药房

OBJECTIVE:To provide reference for rational use of anticoagulant drugs in the clinic. METHODS:Medical or-ders of anticoagulant drugs were collected from hospital information system of our hospital during 2013-2015. Those medical orders were analyzed in respects of consumption sum,DDDs,DDC and drug utilization. RESULTS:During 2013-2015,the sum tatio of Low-molecular-weight heparins calcium injection(6000 AXaIU),Enoxaparin sodium injection(6000 AXaIU),Dalteparin sodium injection(5000 IU) and Rivaroxaban tablets(10 mg)were on the rise,while those of Nadroparin calcium infection(6150,4100 AXaIU)and Fondaparinux sodium injection(2.5 mg)were in the decline. DDDs of Nadroparin calcium injection(4100 AXaIU), Dalteparin sodium injection(5000 IU)and Enoxaparin sodium injection(6000 AXaIU)took up the first 3 places. DDC of Rivar-oxaban tablets was the highest,being 167.60-180.25 yuan. The utilization of Nadroparin calcium injection(6150,4100 AXaIU), Low-molecular-weight heparins calcium injection (6000 AXaIU),Fondaparinux sodium injection(2.5 mg) and Warfarin sodium tablets(3 mg)showed good synchronization within 3 years,and the values of B/A ranged 0.50-1.50. Both consumption sum and utili-zation rate of rivaroxaban took up the first place in vascular surgery department. CONCLUSIONS:Based on the spectrum of diseases, the features of drugs and ADR,the utilization of anticoagulant drugs in our hospital is rational during recent 3 years. However,the uti-lization of anticoagulant drugs should be still used as routine pharmaceutical monitoring content.

Application value of atorvastatin combined with anticoagulation drugs in elderly patients with steroid-induced avascular necrosis of the femoral head / 中国生化药物杂志

Objective To study the application value of atorvastatin combined with anticoagulation drugs in the treatment of steroid-induced necrosis of the femoral head in the elderly.Methods From February 2013 to January 2016, 112 cases elderly patients accepted treatment of steroid-induced necrosis of the femoral head in our hospital were selected.They were divided into observation group and control group with 56 cases in each group randomly.The two groups were treated with anticoagulant therapy, the observation group received atorvastatin on the basis of control group.The efficacy and indicators between two groups after treatment were compared.Results The excellent and good rate was in observation group was 92.86%, which was higher than 66.07% in control group ( P <0.05 ) .The pain degree, walking ability and total joint mobility score of the observation group were significantly higher than those in the control group(P<0.05).After treatment, plasma viscosity and hematocrit of the observation group were significantly lower than the control group(P<0.05).The time of collapse of the femoral head and the index of necrosis of the observation group were significantly lower than the control group(P <0.05).Conclusion Atorvastatin combined with anticoagulant drugs in the treatment of elderly patients with steroid-induced femoral head necrosis has significant effect, could effectively improve the quality of life of patients with good safety, high application value.

Agentes antitrombóticos en Terapia Intensiva: manejo práctico de los nuevos anticoagulantes orales directos / Antithrombotic agents in Intensive therapy: management practical of the new oral oral anticoagulants

Los nuevos anticoagulantes orales compiten actualmente, con alguna ventaja, con la terapéutica tradicional en la prevención de la cardioembolia en fibrilación auricular, y en la prevención y el tratamiento de la enfermedad tromboembólica venosa. Estudios recientes han demostrado una eficacia equivalente a la de los antagonistas de la vitamina K, con un mejor perfil de seguridad. Además, superan algunos inconvenientes de estos antagonistas, como la necesidad de ajuste de dosis y el monitoreo frecuente de la RIN, las múltiples interacciones farmacológicas y los cuidados con la dieta. Pero con los nuevos agentes debemos ser cautos, porque el riesgo de sangrado puede aumentar significativamente en ciertos grupos de pacientes con insuficiencia renal, añosos o muy frágiles. Aunque se emplean usualmente en dosis fijas, en casos especiales (peso <50 kg, edad avanzada, disfunción renal, alto riesgo de sangrado), esta dosis se debe modificar. Si bien, en la práctica clínica, no es necesario hacer pruebas de monitoreo de la coagulación, no contamos con pruebas adecuadas para evaluar su eficacia clínica y tampoco tenemos hoy, en nuestro medio, un antídoto eficaz en caso de sangrado importante. Sin embargo, se están realizando estudios con nuevas pruebas de hemostasia que pueden ayudarnos a interpretar el nivel de anticoagulación en estos pacientes y ya se han desarrollado antídotos para algunos de los anticoagulantes de acción directa que pronto estarán disponibles en nuestro medio.(AU)

New oral anticoagulants represent an interesting alternative to traditional therapy for the prevention of stroke in atrial fibrillation, and the thromboprophylaxis and treatment of venous thromboembolic disease. Several studies demonstrated equivalent efficacy to that of vitamin K antagonists with a more favourable safety profile. New oral anticoagulants overcome some of the main problems of these antagonists: the need of tailoring dosing, frequent interactions with other drugs and diet. But physicians have to keep in mind that new oral anticoagulants are not absolutely free of complications, and must be cautious with patients at high risk of bleeding. Also in special cases (<50 kg, advanced age, renal impairment) the usual dose must be adapted. At present there are not specific tests to evaluate the effect of these new anticoagulants, although it is usually not necessary to do any coagulation test in clinical practice. Another concern regarding new oral anticoagulants is the absence of specific antidotes, although specific antidotes are under clinical investigation and are soon going to be available in our country.(AU)

Una enfermedad prevenible: el accidente cerebrovascular en la fibrilación auricular no valvular. ¿Qué lugar ocupan los nuevos anticoagulantes orales? / A preventable disease: stroke in non-valvular atrial fibrillation. What is the role of the new oral anticoagulants?

La fibrilación auricular no valvular (FANV) es la arritmia cardíaca sostenida más frecuente. El accidente cerebrovascular (ACV) asociado a la (FANV), es una complicación devastadora, prevenible, con secuelas neurológicas, recurrencias, mortalidad precoz y al año mayor que el (ACV) no asociado a la (FANV). La warfarina demostró en prevención primaria una reducción del riesgo de 64%. El presente trabajo aborda nuevos scores de riesgo de embolia en la (FANV), riesgo de sangrado, y los resultados de 3 trabajos multicéntricos que comparan dabigatran, rivaroxaban y apixaban vs. warfarina en prevención del (ACV) asociado a (FANV). Intenta, de acuerdo a lo anterior, un posicionamiento de los nuevos anticoagulantes orales (NAO) como opción frente a la warfarina. Realiza consideraciones prácticas generales y en situaciones puntuales para el uso de los (NAO).

Non valvular atrial fibrillation (NVAF) is the most common sustained arrhythmia. NVAF-associated stroke is a devastating, preventable condition with neurological sequels, recurrences, early mortality and greater than NVAF-independent stroke annually. Warfarin showed a 64% risk reduction in primary prevention. The paper herein approaches new risk scores for embolism in NVAF, risk for bleeding, and the results of 3 multicentric studies comparing dabigatran, rivaroxaban and apixaban vs. Warfarin in the prevention of NVAF-associated stroke. Based on the above, it is intended to position the new oral anticoagulants (NOA) as a potential option vis à vis warfarin. The authors reach practical considerations, both general and in specific situations for the use of NOAs.

Utilization of Anticoagulant Drugs in Our Hospital During 2004～2007 / 中国药房

OBJECTIVE:To probe into the status quo and tendency of the utilization of anticoagulant drugs in our hospital. METHODS:The utilization of anticoagulant drugs in our hospital from 2004 to 2007 were analyzed statistically with regard to drug varieties,consumption quantity and consumption sum as well as DDDs. RESULTS:The consumption sum of anticoagulant drugs in our hospital increased year by year. Of all the anticoagulant drugs,leading the list in terms of consumption sum were ozagrel,low molecular heparin calcium and clopidogrel. CONCLUSION:The utilization of anticoagulant drugs in our hospital is basically in line with the current medication principle of anticoagulant drugs and the general medication trend both at home and abroad.