Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 63
Filter
1.
Radiol. bras ; 54(5): 283-288, Sept.-Oct. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1340579

ABSTRACT

Abstract Objective: To report the computed tomography (CT) features of acute cerebrovascular complications in severely ill patients with confirmed coronavirus disease 2019 (COVID-19) in the intensive care unit. Materials and Methods: We conducted a retrospective analysis of 29 intensive care unit patients with confirmed COVID-19 who underwent CT of the brain. We describe the CT features of the cerebrovascular complications of COVID-19, as well the demographic characteristics and clinical features, together with the results of laboratory tests, such as complete blood cell count, coagulation testing, renal function testing, and C-reactive protein assay. Results: Two patients were excluded because of brain death. Among the remaining 27 patients, CT revealed acute cerebrovascular complications in six (three men and three women; 49-81 years of age), whereas no such complications were seen in 21 (15 men and six women; 36-82 years of age). Conclusion: Radiologists should be aware of the risks of cerebrovascular complications of COVID-19 and the potential underlying etiologies. COVID-19-associated coagulopathy is likely multifactorial and may increase the risk of ischemic and hemorrhagic infarction.


Resumo Objetivo: Relatar as características da tomografia computadorizada (TC) das complicações cerebrovasculares agudas em pacientes com doença do coronavírus 2019 (COVID-19) grave, internados em unidade de terapia intensiva. Materiais e Métodos: Foi realizada análise retrospectiva de 29 pacientes com COVID-19 confirmada, internados em unidade de terapia intensiva, que realizaram TC de crânio. Descrevemos as alterações tomográficas das complicações cerebrovasculares, bem como as características demográficas, clínicas e exames laboratoriais, tais como hemograma completo, teste de coagulação, função renal e proteína C reativa desses pacientes. Resultados: Seis pacientes (três homens e três mulheres; faixa etária de 49-81 anos) apresentaram alterações cerebrovasculares reveladas por TC e 21 pacientes (15 homens e 6 mulheres; faixa etária de 36-82 anos) não apresentaram complicações cerebrovasculares agudas. Dois pacientes foram excluídos por morte encefálica. Conclusão: Os radiologistas devem estar cientes dos riscos de complicações cerebrovasculares da COVID-19 e das possíveis etiologias subjacentes. A coagulopatia relacionada à COVID-19 é provavelmente multifatorial e pode aumentar os riscos de infarto isquêmico e hemorrágico.

2.
Colomb. med ; 52(2): e4174810, Apr.-June 2021. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1339735

ABSTRACT

Abstract Damage control surgery has transformed the management of severely injured trauma patients. It was initially described as a three-step process that included bleeding control, abdominal cavity contamination, and resuscitation in the intensive care unit (ICU) before definitive repair of the injuries. When the patient is admitted into the ICU, the physician should identify all the physiological alterations to establish resuscitation management goals. These strategies allow an early correction of trauma-induced coagulopathy and hypoperfusion increasing the likelihood of survival. The objective of this article is to describe the physiological alterations in a severely injured trauma patient who undergo damage control surgery and to establish an adequate management approach. The physician should always be aware and correct the hypothermia, acidosis, coagulopathy and hypocalcemia presented in the severely injured trauma patients.


Resumen Cuando el paciente de trauma ingresa a la unidad de cuidado intensivo después de una cirugía de control de daños, generalmente aún presenta algún grado de hemorragia, hipoperfusión y lesiones que requieren reparo definitivo. La evaluación por parte del intensivista del grado de severidad de tales alteraciones, y las repercusiones sistémicas, permitirán establecer las necesidades de reanimación, prever potenciales complicaciones y hacer los ajustes al tratamiento con el fin de minimizar la morbilidad y mortalidad asociada al trauma. El objetivo de este artículo es describir las alteraciones que presentan los pacientes con trauma severo manejados con cirugía de control de daños y las consideraciones a tener en cuenta para su abordaje terapéutico. Se presentan los aspectos más relevantes del manejo del paciente con trauma severo y cirugía de control de daños a su ingreso a la UCI. El intensivista debe conocer las alteraciones fisiológicas que puede presentar el paciente de trauma sometido a cirugía de control de daños, especialmente las causadas por la hemorragia masiva. La evaluación de estas alteraciones, de la severidad del sangrado y del estado de choque, y estimar en qué punto de la reanimación se encuentra el paciente a su ingreso a la unidad de cuidados intensivos son fundamentales para definir la estrategia de monitoria y soporte a seguir. La corrección de la hipotermia, la acidosis y la coagulopatía es la prioridad en el tratamiento del paciente con trauma severo.

3.
Arch. pediatr. Urug ; 92(1): e205, jun. 2021. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1248844

ABSTRACT

Resumen: Introducción: la hemofilia es una enfermedad hereditaria, ligada al cromosoma X, debida al déficit de factor VIII (tipo A) o IX (tipo B). La prevalencia estimada al nacimiento es de 24,6 casos cada 100.000 varones para hemofilia A y 5 casos cada 100.000 para hemofilia B. El Departamento de Medicina Transfusional (DMT) del Centro Hospitalario Pereira Rossell (CHPR) es el Centro de Referencia Nacional (CDRN) para los menores de 18 años. El abordaje integral, inter-disciplinario del paciente con hemofilia en un centro especializado disminuye la morbi-mortalidad y contribuye a mejorar la calidad de vida. Objetivo: describir las características epidemiológicas y clínicas de los menores de 18 años con hemofilia asistidos en el DMT-CHPR entre el 1 enero de 2016 y el 31 de diciembre de 2018. Metodología: estudio descriptivo, retrospectivo, de todos los menores de 18 años con hemofilia. Se describió: edad y circunstancias del diagnóstico, tipo y severidad de la hemofilia, controles en salud, estudios complementarios, complicaciones, frecuencia y motivos de hospitalización, tratamiento. El protocolo de estudio fue aprobado por el Comité de Ética Institucional. Resultados: se asistieron 67 pacientes, 57 con hemofilia A y 10 con hemofilia B. La mediana de edad fue 8 años. Presentaban hemofilia severa 61 pacientes, moderada 2 y leve 4. Presentaban antecedentes familiares de coagulopatía 41. La mediana de edad al diagnóstico fue 2 meses. Se diagnosticaron en el período neonatal 24 de los pacientes con hemofilia A y 5 con hemofilia B. Desarrollaron inhibidores 7 pacientes, todos con hemofilia severa. Conclusiones: en esta serie, predominaron los pacientes con hemofilia A, severa, antecedentes familiares conocidos de coagulopatía, en tratamiento profiláctico con factores de la coagulación. Esta comunicación aporta información valiosa sobre las características de estos pacientes, lo que contribuye a la gestión clínica y a planificar estrategias de mejora de la calidad asistencial.


Summary: Introduction: hemophilia is a hereditary disease, linked to chromosome X and caused by the deficit of factor VIII (type A) and IX (type B). Estimated prevalence at birth is 24.6 cases every 100,000 boys for hemophilia A and 5 cases every 100,000 cases for hemphilia B. The Transfusion Medical Department (TMD) of the Pereira Rossell Children's Hospital Center (CHPR, acronym in Spanish) is the national reference center (NRC) for patients under 18 years of age. A comprehensive, inter-disciplinary approach to hemophilic patients at a specialized center decreases morbidity and mortality and contributes to improving quality of life. Objective: to describe the epidemiologic, clinical and progression characteristics of hemophilic patients of under 18 years of age assisted at the TMD-CHPR between January 1st 2016 and December 31st, 2018. Methodology: descriptive, retrospective study of all hemophilic patients of under 18 years of age. Variables described: age, circumstances of diagnosis, type and severity of hemophilia, health check-ups, tests, complications, frequency and reasons for hospital admittance, treatment. The study protocol was approved by the Institutional Ethics Committee. Results: 67 patients were assisted, 57 with hemophilia A and 10 with hemophilia B. Median age was 8 years. Severe hemophilia was present in 61 patients, moderate in 2 and mild in 4. 41 had a family history of coagulopathy. Median age at diagnosis was 2 months. 24 patients with hemophilia A and 5 patients with hemophilia B were diagnosed during the neonatal period. 7 patients developed inhibitors, all of them with severe hemophilia. Conclusions: in this study there is a predominance of patients with severe hemophilia A, known family history of coagulopathy, under prophylactic treatment with coagulation factors. This study provides valuable information about the characteristics of these patients, which contributes to improved clinical management and planning strategies to improve their quality of care.


Resumo: Introdução: o Departamento de Medicina Transfusional (DMT) do Centro Hospitalar Pereira Rossell (CHPR) é o Centro Nacional de Referência (CNR) para menores de 18 anos de idade. A abordagem abrangente e interdisciplinar do paciente com hemofilia em um centro especializado reduz a morbimortalidade e contribui para a melhoria da qualidade de vida. Objetivo: descrever as características epidemiológicas, clínicas e evolutivas em crianças menores de 18 anos com hemofilia atendidas no DMT-CHPR entre 1 de janeiro de 2016 e 31 de dezembro de 2018. Metodologia: estudo descritivo, retrospectivo, de todos os menores de 18 anos com hemofilia. Descrevemos: idade e circunstâncias do diagnóstico, tipo e gravidade da hemofilia, controles de saúde, estudos complementares, complicações, frequência e motivos de hospitalização, tratamento. O protocolo do estudo foi aprovado pelo Comitê de Ética Institucional. Resultados: 67 pacientes foram atendidos, 57 com hemofilia A e 10 com hemofilia B. A media de idade foi de 8 anos. Houve 61 pacientes com hemofilia grave, moderada 2 e leve 4. 41 tiveram história familiar de coagulopatia. A media de idade no diagnóstico foi de 2 meses. 24 dos pacientes com hemofilia A e 5 com hemofilia B foram diagnosticados no período neonatal e 7 desenvolveram inibidores, todos com hemofilia grave. Conclusões: neste estudo, predominaram pacientes com hemofilia A grave, história familiar conhecida de coagulopatia, em tratamento profilático com fatores de coagulação. O estudo fornece informações valiosas sobre as características desses pacientes, o que contribui para o manejo clínico e estratégias de planejamento para melhorar a qualidade do atendimento deles.

4.
International Journal of Surgery ; (12): 378-383,F3, 2021.
Article in Chinese | WPRIM | ID: wpr-907446

ABSTRACT

Objective:To construct nomogram model based on coagulation indicators to predict the risk of all-cause death in maintenance peritoneal dialysis patients.Methods:One hundred and sixty-five patients who underwent maintenance peritoneal dialysis treatment at the Department of Nephrology, Urumqi Friendred Hospital from January 2010 to December 2018 were selected retrospectively as the research objects and were followed up once a month after the start of peritoneal dialysis treatment: inpatients were in the patient′s ward; in-home treatment were followed up by telephone. The follow-up time of all the study subjects was until death or 24 months. After the end of the follow-up period, the study subjects were divided into survival group and death group according to whether they died. General information, blood coagulation indicators, renal function indicators, blood lipids, blood potassium, blood calcium, blood phosphorus and blood glucose of the research subjects were recorded and compared the differences between the two groups of patients. The measurement data conforming to the normal distribution were expressed as mean±standarad deviation ( Mean± SD), and the student t-test was used for comparison between groups; the Chi-square test was used for comparison of enumeration data between groups. Two categories Cox regression analysis was used to determine independent risk factors for death in peritoneal dialysis patients, Nomogram prediction model was constructed, and receiver operating characteristic (ROC) was drawn to evaluate the predictive ability of the nomogram model. Results:Combined diabetes, high platelet count, short prothrombin time, short activated partial thrombin time, low international standardization ratio, high fibrinogen level, short thrombin time, high prothrombin activity, high D-dimer level and advanced age were independent risk factors for death in peritoneal dialysis patients. The Nomogram model constructed based on these risk factors had a good fitting effect, and the area under the ROC curve was 0.809 (0.792-0.825), indicating that it had strong predictive ability.Conclusions:Abnormal coagulation indicators were closely related to the risk of death in peritoneal dialysis patients. Diabetes and advanced age also had a certain predictive ability for all-cause death in peritoneal dialysis patients. Nomogram model constructed in this study could be used as a quantitative tool to predict the risk of all-cause death in peritoneal dialysis patients, help to develop individualized treatment plans for peritoneal dialysis patients and improve the prognosis of patients.

5.
Rev. Soc. Bras. Med. Trop ; 54: e01572021, 2021. graf
Article in English | LILACS | ID: biblio-1250835

ABSTRACT

Abstract Approximately one-third of patients with coronavirus disease 2019 (COVID-19) present with coagulation disorders and hematological changes. However, the clinical manifestations of COVID-19 and prognoses of people living with human immunodeficiency virus (HIV) remain controversial. This study reports the case of a 27-year-old HIV-infected man who regularly used antiretroviral medications, had no other comorbidities and was admitted for acute respiratory distress syndrome caused by COVID-19. Complementary examinations during hospitalization revealed a diagnosis of pulmonary thromboembolism in association with an intracavitary thrombus.


Subject(s)
Humans , Male , Adult , Pulmonary Embolism/etiology , Thrombosis , HIV Infections/complications , COVID-19 , HIV , SARS-CoV-2
6.
Rev. cuba. hematol. inmunol. hemoter ; 36(2): e1085, abr.-jun. 2020. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1149899

ABSTRACT

Introducción: La desmopresina es un análogo sintético de la vasopresina que aumenta los niveles plasmáticos del factor VIII y del factor de von Willebrand. Algunos autores señalan el tiempo de mantenimiento del efecto hemostático entre 6 y 8 h, por lo que es necesario estudiar su efecto en el tiempo. Objetivo: Determinar la variación de las variables de laboratorio de pacientes con enfermedad de von Willebrand y hemofilia tipo A posterior a la administración de desmopresina. Métodos: Estudio de cohorte retrospectivo en un hospital universitario en Bogotá. Se realizó un muestreo no aleatorio, se incluyeron 24 pacientes mayores de 18 años con diagnóstico de enfermedad de von Willebrand (67 por ciento) y hemofilia tipo A no grave (33 por ciento), a quienes se les realizó la prueba de desmopresina. Se conformaron dos grupos de pacientes, independientemente del diagnóstico: 15 pacientes con valores basales de factor VIII ; 50 UI y 13 pacientes con valores basales de antígeno von Willebrand lt; 50 UI. Se efectúo análisis estadístico descriptivo y correlacional en Stata 13. Resultados: El 87 por ciento de los pacientes del grupo I alcanzó el valor terapéutico a las 2 h de administrada la desmopresina (p= 0,000), el cual se mantuvo hasta 6 h en el 77 por ciento (p= 0,000). En el grupo II el 92 por ciento logró el valor terapéutico en 2 h (p= 0,003), que continuó hasta las 6 h en el 83 por ciento (p= 0,000). Conclusiones: La respuesta a la administración de desmopresina fue máxima a las 2 h posteriores, cuando comenzó a disminuir progresivamente, pero mantuvo el efecto terapéutico. Aunque no se encontraron efectos adversos, existe variabilidad de respuesta entre pacientes(AU)


Introduction: Desmopressin is a synthetic analog for vasopressin that increases the plasma levels of factor VIII and of von Willebrand factor. Some authors indicate maintenance time of hemostatic effect between 6 and 8 hours, so it is necessary to study its effect over time. Objective: To determine the variation of laboratory variables in patients with von Willebrand disease and type A hemophilia after desmopressin administration. Methods: Retrospective cohort study carried out in a university hospital in Bogotá. Nonrandomized sampling was used, including 24 patients older than 18 years and with a diagnosis of von Willebrand disease (67 percent) and non-severe type A hemophilia (33 percent), who underwent the desmopressin test. Two groups of patients were created, regardless of diagnosis: 15 patients with baseline values of factor-VIII 8203; #8203;lower than 50 IU and 13 patients with baseline values of von Willebrand antigen8203;8203;lower than 50 IU. Descriptive and correlational statistical analysis was performed in Stata 13. Results: 87 percent of patients in group I reached the therapeutic value two hours after desmopressin administration (p=0.000), which was maintained for up to six hours in 77 percent (p=0.000). In group II, 92 percent achieved the therapeutic value in two hours (p=0.003), which continued until six hours in 83 percent (p=0.000). Conclusions: Response to desmopressin administration was maximum at two hours, when it began to decrease progressively, but maintained the therapeutic effect. Although no adverse effects were found, there is variability of response among patients(AU)


Subject(s)
Humans , von Willebrand Diseases/diagnosis , von Willebrand Diseases/drug therapy , Deamino Arginine Vasopressin/therapeutic use , Cohort Studies
7.
Medisur ; 18(2): 171-176, mar.-abr. 2020. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1125192

ABSTRACT

RESUMEN Fundamento: La enfermedad de Wilson constituye un problema de salud mundial. Las manifestaciones clínicas son muy variables, lo cual contribuye a las dificultades en el diagnóstico. La presencia de trastornos de los factores de la coagulación, asociados a ella, no es común, pero se han informado casos en la literatura. Objetivo: identificar trastornos de la coagulación y su causa molecular en pacientes cubanos con diagnóstico clínico de enfermedad de Wilson. Métodos: estudio descriptivo de 50 pacientes cubanos con diagnóstico clínico de enfermedad de Wilson, realizado en el Centro Nacional de Genética Médica, La Habana. Se extrajo el ADN de la sangre de los pacientes por precipitación salina. Se realizó la búsqueda de mutaciones en los exones: 2, 3, 6, 8, 10 y 14 del gen atp7b mediante las técnicas SSCP, digestión enzimática y secuenciación. Resultados: solo en un paciente fue identificado el trastorno de coagulación (mutación p.L708P), lo que representó el 2 % del total. El análisis de dicha mutación mostró una puntuación de 0,74, lo que significó que puede provocar daño a la proteína ATP7B. Conclusión: La frecuencia de aparición de trastornos de los factores de la coagulación en pacientes cubanos con diagnóstico clínico de enfermedad de Wilson resultó baja respecto a la informada por otros estudios. Sin embargo, hay que considerarla como una probabilidad real, y realizar las pruebas necesarias para su confirmación.


Foundation: Wilson's disease is a global health problem. Clinical manifestations are quite variable, which makes the diagnosis difficult. The presence of factor coagulation disorders associated with it is not common, but cases have been reported in literature. Objective: to identify coagulation disorders and their molecular cause in Cuban patients with a clinical diagnosis of Wilson's disease. Methods: descriptive study of 50 Cuban patients with clinical diagnosis of Wilson's disease, conducted at the National Center for Medical Genetics, Havana. DNA was extracted from patients' blood by saline precipitation. Exon mutations: 2, 3, 6, 8, 10 and 14 of the atp7b gene were searched using SSCP techniques, enzymatic digestion and sequencing. Results: only one patient was identified with coagulation disorder (mutation p.L708P), which represented 2% of the total. The analysis of this mutation showed a score of 0.74, which meant that it could cause damage to the ATP7B protein. Conclusion: The frequency of occurrence of factor coagulation disorders in Cuban patients with a clinical diagnosis of Wilson's disease was low compared to that reported by other studies. However, it must be considered as a real probability, and perform the necessary tests for confirmation.

8.
Einstein (Säo Paulo) ; 18: eAO5032, 2020. tab, graf
Article in English | LILACS | ID: biblio-1133784

ABSTRACT

ABSTRACT Objective To describe the implementation of a care protocol based on rapid response teams, for management and resolution of bleeding. Methods A hospital protocol called Hemorrhage Code (Code H) was devised and developed. In a flow line, a multidisciplinary team provides comprehensive, fast and effective care to the patient with a severe hemorrhagic condition. In another flow line, professionals based at the hospital pharmacy focus on identifying patients at risk of bleeding, to avoid this event. Several hospital professionals and sectors were trained, each with specific roles, ensuring full support to the medical and nursing staffs. Results After implementing this protocol, we were able to significantly reduce the number of catastrophic events related to failure in bleeding management. Conclusion Code H is an example of a value-based medicine and precision medicine project by delivering comprehensive and multidisciplinary care, in addition to point-of-care testing introduced in clinical practice, optimizing patient safety and care practices at the hospital. Furthermore, it will be possible to minimize the risk of lawsuits for the hospital and physicians, as well as rationalizing resources with benefits for administrators and payers.


RESUMO Objetivo Descrever a implantação de um protocolo de atendimento nos moldes de times de resposta rápida, para manejo e resolução do sangramento. Métodos Foi idealizado e desenvolvido um protocolo institucional, chamado Código Hemorrágico, ou Código H, no qual, em um fluxo, um time multiprofissional e multidisciplinar foi constituído para atendimento integral, rápido e eficaz do paciente com doença hemorrágica grave. Em um outro fluxo, os profissionais, centralizados na farmácia do hospital, focavam na identificação do paciente com risco de hemorragia, no sentido de evitar o evento. Vários profissionais e setores do hospital foram treinados, e cada um, com funções específicas, deveria oferecer garantia total de apoio e suporte às equipes médica e de enfermagem. Resultados Após a implementação do protocolo, o número de eventos catastróficos relacionados à falha no manejo do sangramento reduziu significativamente. Conclusão O Código H é um exemplo de projeto de medicina baseada em valor e de medicina de precisão, por meio de atendimento integral e multidisciplinar, além de testes point of care introduzidos na prática clínica, com otimização da segurança do paciente e da prática assistencial na instituição. Ainda, por meio dele, deve ser possível minimizar o risco de ações judiciais para o hospital e os médicos, além de racionalizar recursos, com benefícios para administradores e fontes pagadoras.


Subject(s)
Humans , Shock, Hemorrhagic/therapy , Blood Coagulation Disorders/therapy , Blood Transfusion , Practice Guidelines as Topic , Patient Safety , Patient Care/standards , Hemorrhage/therapy , Brazil , Retrospective Studies , Hemorrhage/prevention & control
9.
Article in English | LILACS, BBO | ID: biblio-1135559

ABSTRACT

Abstract Objective: To compare the status of oral hygiene and dentition in patients with congenital hemorrhagic disorders with their age-matched healthy counterparts. Also, the prevalence of fear of dentists/ dental treatment among these patients was assessed. Material and Methods: This study was performed on children and adults with von Willebrand disease (vWD), hemophilia (A or B), and healthy subjects. Oral health and dentition status was assessed using the simplified oral hygiene index (OHI-S), plaque index, and the decayed, missing, filled teeth (dmft/DMFT) index. One-way ANOVA test was employed to compare the oral hygiene and dentition status of subjects in the three groups. A p-value of <0.05 was considered statistically significant. Results: The DMFT score did not vary significantly between the groups (p>0.05). Higher OHI-S scores and a poor oral hygiene status was observed more in the hemophilia group than the vWD group and healthy controls. A total of 27.3% of the subjects in the vWD group, 18.2% of subjects in the hemophilia group, and no subjects in the healthy group had a fear of dentists or dental treatment. Conclusion: Subjects with vWD had a higher number of carious teeth when compared to the other groups. Poor oral hygiene status was observed in subjects with hemophilia.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adult , Oral Hygiene , von Willebrand Diseases , Oral Health , Dentition , Hemophilia A , Oral Hygiene Index , Cross-Sectional Studies/methods , Analysis of Variance , Dentists , India
10.
Rev. Assoc. Med. Bras. (1992) ; 65(6): 772-774, June 2019.
Article in English | LILACS | ID: biblio-1041042

ABSTRACT

SUMMARY The essential thrombocythemia is one of the seven described forms of myeloproliferative neoplasms. It is characterized by megakaryocytic hyperplasia with consequent thrombocytosis maintained in the peripheral blood, favoring the occurrence of thrombo-hemorrhagic phenomena. We present the case of an 81-year-old woman with a history of ischemic stroke in the context of a sustained thrombocytosis, which led to a spinal study and a search for the V617F mutation in the JAK2 gene, which was positive. The patient started cytoreductive therapy with hydroxyurea with favorable current evolution.


Subject(s)
Humans , Female , Aged , Stroke/etiology , Thrombocythemia, Essential/complications , Risk Factors , Stroke/genetics , Janus Kinase 2/genetics , Thrombocythemia, Essential/genetics , Mutation
11.
Article in English | WPRIM | ID: wpr-765924

ABSTRACT

Coagulopathy may be defined as the loss of balance between hemostatic and fibrinolytic processes resulting in excessive bleeding, intravascular thrombosis or abnormalities in coagulation testing. It is frequently encountered across a wide range of conditions seen in the neurocritical care unit and can contribute to poor outcomes. Early recognition and appropriate management are key, with traumatic brain injury, acute ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage presenting unique challenges to the neurointensivist. We will discuss techniques to assess coagulopathies as well as treatment strategies for the brain injured patient.


Subject(s)
Anticoagulants , Blood Coagulation Disorders , Brain , Brain Injuries , Cerebral Hemorrhage , Hemorrhage , Humans , Platelet Aggregation Inhibitors , Stroke , Subarachnoid Hemorrhage , Thrombosis
12.
Article in English | WPRIM | ID: wpr-762262

ABSTRACT

Sugammadex provides fast and safe recovery from neuromuscular blockade without causing major adverse effects, and its clinical use is increasing. However, there are some reports on the potential risks of sugammadex, such as severe bradycardia, interactions with steroids, coagulopathy, and neuronal damage. Although these potential risks are not clearly proven, they are considered to be dose-dependent and occur more frequently with the free-form of sugammadex. Until further pieces of evidence are accumulated, it is prudent to be aware of these potential risks and avoid an overdose of sugammadex.


Subject(s)
Blood Coagulation Disorders , Bradycardia , Drug Interactions , Neuromuscular Blockade , Neurons , Neurotoxicity Syndromes , Steroids
13.
Article in English | WPRIM | ID: wpr-760853

ABSTRACT

Damage control resuscitation is a relatively new resuscitative strategy for patients with severe traumatic hemorrhage. This strategy consists of permissive hypotension and early balanced transfusion, and transfers the patients to subsequent surgery. There is growing evidence on harms of excessive fluids. Since 2013, survival benefit of massive transfusion protocol has been proven in adults. Despite insufficient evidence, pediatric massive transfusion protocols are widely used in North American trauma centers. This review focuses on the concept of damage control resuscitation, and summarizes the relevant pediatric evidence.


Subject(s)
Adult , Blood Coagulation Disorders , Blood Transfusion , Child , Emergency Medicine , Hemorrhage , Hemostasis , Humans , Hypotension , Hypotension, Controlled , Resuscitation , Trauma Centers , Wounds and Injuries
14.
International Journal of Surgery ; (12): 208-212, 2019.
Article in Chinese | WPRIM | ID: wpr-743024

ABSTRACT

Cardiac valve replacement is the most common surgical procedure in cardiac surgery,which often results in non-surgical bleeding.There are many factors that cause non-surgical bleeding after cardiac surgery,which can be summed up as the disease itself,the artificial device of cardiopulmonary bypass and the special requirements during the operation,including the abnormality of liver function,extracorporeal circulation conduits,oxygenators and blood pumps,hypothermia,hemodilution,neutralization between protamine and heparin.At present,most hospitals still use the results of blood loss and coagulation test as the reference for blood transfusion.Only a few hospitals have used thromboelastogram to guide blood transfusion,which is still in the exploratory stage,so far there is no unified reference standard.This review will focus on the related factors leading to non-surgical bleeding and the concept of accurate blood transfusion and reducing blood transfusion after heart valve replacement in order to prevent the occurrence of rethoracotomy to hemostasis.

15.
Article in English | WPRIM | ID: wpr-785887

ABSTRACT

Acquired hemophilia A (AHA) is a rare disease where typically coagulation factor VIII is inhibited by autoantibodies. It occurs in patients with no personal or familial history of bleeding. In this case study a 61-year-old male presented with a huge psoas hematoma. He had no history of bleeding disorders. He was initially diagnosed with delayed traumatic hematoma. Despite conservative and surgical treatments, coagulopathy was not resolved and postoperative bleeding continued. Consequently, coagulation factor tests were performed and showed reduced activity of factor VIII (2.7%). In addition, factor VIII inhibitor was detected. The patient was diagnosed with AHA and administered recombinant factor VIII for 3 days which resulted in the cessation of bleeding. AHA can lead to a life-threatening hemorrhage, and needs to be considered in differential diagnoses in any patients presenting with unexplained and repeated bleeding, where there is no personal or familial history of bleeding disorders.


Subject(s)
Autoantibodies , Blood Coagulation Disorders , Blood Coagulation Factors , Diagnosis, Differential , Factor VIII , Hematoma , Hemophilia A , Hemorrhage , Humans , Male , Middle Aged , Rare Diseases
17.
Rev. méd. Chile ; 146(3): 277-281, mar. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-961391

ABSTRACT

Background: Compared to standard coagulation essays (SCE), such as international normalized ratio (INR), prothrombin activated partial thromboplastin time (aPTT), or platelet count, thromboelastograhy (TEG) offers precise and real-time information about hemostasis. TEG tests both platelet function and coagulation by assaying several parameters of clot formation dynamically in whole blood. Aim: To evaluate hemostasis in cirrhotic patients undergoing liver transplantation and determine the positive and negative predictive values of SCE for alterations of TEG. Material and Methods: Preoperative SCE and TEG were prospectively analyzed in 25 patients. Results were categorized as normal, laboratory alteration or clinical alteration. SCE results were compared with TEG parameters to determine positive (PPV) and negative predictive values (NPV). Results: Hemostasis was abnormal and laboratory abnormalities were observed in all patients. One patient had clinical signs of excessive bleeding. SCE were abnormal in all patients and TEG was normal in nine patients. The most common alteration in TEG was hypocoagulability, in some cases associated with hypercoagulability and hyperfibrinolysis. Two patients had solely hypercoagulability. PPV of INR, aPTT, platelet count and fibrinogenemia were 0, 0, 0.5 and 0.17 respectively. NPV of the same tests were 1, 1, 0.34 and 1 respectively. Conclusions: Hypocoagulability was the most common laboratory alteration, however, clinical signs of coagulopathy were rarely present. SCE had a poor predictive value to diagnose o discard hemostatic abnormalities.


Subject(s)
Humans , Male , Female , Middle Aged , Thrombelastography , Blood Coagulation Tests , Liver Transplantation , Preoperative Period , Prospective Studies
18.
Article in Korean | WPRIM | ID: wpr-718921

ABSTRACT

Viscoelastic coagulation tests provide simultaneous measurements of multiple aspects of whole-blood coagulation, including interactions between the plasma components and cellular components of the coagulation cascade. This can be carried out immediately using a point of care technique. Viscoelastic tests could predict the patient's outcome, including mortality, and detect coagulopathy more sensitively, resulted in reduced blood loss. The transfusion strategy based on the viscoelastic parameters rather than a conventional coagulation test has been shown to reduce the transfusion requirements. Although there are concerns about the reliability and accuracy of this method, viscoelastic tests, including ROTEM, would be a useful method to guide patient blood management strategies.


Subject(s)
Blood Coagulation Disorders , Blood Coagulation Tests , Blood Transfusion , Humans , Methods , Mortality , Plasma , Point-of-Care Systems , Thrombelastography
19.
Article in Chinese | WPRIM | ID: wpr-693029

ABSTRACT

The risk to suffer from ischemic stroke in cancer patients is higher than subjects without cancer.Some studies suggest that stroke,in some cases,is caused by underlying malignancy.This article reviews the pathogenesis of cancer-related ischemic stroke.

20.
Article in Chinese | WPRIM | ID: wpr-742952

ABSTRACT

Objective To investigate the predictive value of thromboelastography (TEG) parameters for hematoma enlargement after intracerebral hemorrhage.Methods Patients with primary intracerebral hemorrhage within 6 h after onset admitted to the Second People's Hospital of Changshu between March 2016 and March 2018 were enrolled prospectively.Hematoma enlargement was defined as the volume of hematoma detected by CT within 48 h after onset increased by > 12.5 cm3 or > 33% compared with that at admission.The baseline data in the hematoma enlargement group and the non-hematoma enlargement group were compared.Multiple logistic regression analysis was used to determine the independent correlation between TEG parameters and hematoma enlargement.The receiver operating characteristic (ROC) curve was used to analyze the predictive value of TEG parameters for hematoma enlargement.Results A total of 141 patients with intracerebral hemorrhage were enrolled,of which 38 (27.0%) had hematoma enlargement.Compared with the non-hematoma enlargement group,the baseline National Institutes of Health Stroke Scale score (P =0.001),thrombin time (P =0.022),fasting blood glucose (P =0.007),hematoma ruptured into the ventricle (P =0.001),baseline hematoma volume (P =0.001),and coagulation reaction time measured by TEG (P=0.002) were significantly increased in the hematoma enlargement group,while the baseline Glasgow Coma Scale score (P =0.001) and α angle measured by TEG (P =0.021) were significantly decreased.Multivariate logistic regression analysis showed that after adjusting confounding factors,the prolonged coagulation reaction time (odds ratio [OR] 3.436,95% confidence interval [CI] 1.083-9.905;P =0.036) and decreased α angle (OR 0.777,95% CI0.656-0.921;P =0.004) were the independent predictors of hematoma enlargement after intracerebral hemorrhage.The area under the curve of coagulation reaction time predicting hematoma enlargement was 0.680 (95% CI 0.588-0.772;P =0.004),and the sensitivity and specificity were 84.2% and 52.4% when 4.0 min was the cut-off value.The area under the curve of α angle predicting hematoma enlargement was 0.636 (95% CI 0.534-0.738;P =0.007).The sensitivity and specificity were 73.7% and 57.3% when the cut-off value was 65.1 °.Conclusion The prolonged coagulation reaction time and the decrease of α angle detected by TEG had certain predictive value for hematoma enlargement after cerebral hemorrhage.

SELECTION OF CITATIONS
SEARCH DETAIL