Association between hypocalcemia and rivaroxaban in coagulation disorders: a case report / Associação entre hipocalcemia e rivaroxaban em distúrbios de coagulação: relato de caso

ABSTRACT We describe a patient with tertiary hyperparathyroidism with history of three episodes of deep vein thrombosis and on rivaroxaban. The patient underwent a subtotal parathyroidectomy, developing cervical hematoma with airway compression. Therefore, emergency surgical decompression was necessary. Later, on the ninth postoperative day, the serum ionized calcium levels were low. Medical team knowledge about preexisting diseases and their implication in the coagulation state are essential conditions to reduce morbidity and mortality of surgeries. However, no reports were found in literature about the association of hypocalcemia with the use of the new class of anticoagulants, which act as factor X inhibitors (Stuart-Prower factor), predisposing to increased bleeding in the immediate postoperative period.

RESUMO Descrevemos um paciente com hiperparatireoidismo terciário com história de três episódios de trombose venosa profunda e em uso de rivaroxabana. O paciente foi submetido a uma paratireoidectomia subtotal, desenvolvendo hematoma cervical com compressão das vias aéreas. Foi necessária descompressão cirúrgica de emergência. No nono dia de pós-operatório, os níveis séricos de cálcio iônico estavam baixos. O conhecimento da equipe médica sobre doenças preexistentes e de sua implicação no estado de coagulação é condição indispensável para a redução da morbimortalidade do procedimento cirúrgico. No entanto, não há relatos na literatura associando hipocalcemia com o uso da nova classe de anticoagulantes que atuam como inibidores do fator X (fator de Stuart-Prower), predispondo ao aumento do sangramento no pós-operatório imediato.

Experiencia clínica en tiroidectomía total del Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello Hospital Guillermo Grant Benavente / Clinical experience in total thyroidectomy of the Department of Otolaryngology and Head and Neck Surgery of Guillermo Grant Benavente Hospital

Introducción: La tiroidectomía es una de las cirugías más frecuentes realizadas en cabeza y cuello. Existen escasos reportes de experiencia en tiroidectomías en servicios de otorrinolaringología en Chile. Objetivo: Analizar la experiencia clínica con las tiroidectomías totales realizadas en el Servicio de ORL y Cirugía de Cabeza y Cuello de nuestro hospital. Material y método: Estudio descriptivo retrospectivo. Revisión de fichas clínicas de pacientes sometidos a tiroidectomías totales (TT) entre los años 2010 y 2014 en nuestro servicio. Resultados: Se realizaron 271 tiroidectomías totales. La indicación más frecuente fue por tamaño (51%). Los diagnósticos más frecuentes fueron carcinomas papilares (46%) e hiperplasia folicularcoloidea (37%). Se presentaron lesiones transitorias del nervio laríngeo recurrente en 2,9%, y lesiones persistentes en 2,5%. Hipocalcemia transitoria se presentó en el 25% de los pacientes. Discusión: Nuestra serie presenta resultados concordantes con la literatura, presenta una baja tasa de complicaciones, las cuales se observan principalmente en pacientes con vaciamiento cervical y/o en que se observaron 2 o menos paratiroides. Conclusiones: La tiroidectomía total es una técnica quirúrgica segura y nuestra experiencia presenta resultados concordantes a los publicados en la literatura internacional.

Introduction: Thyroidectomy is one of the most common surgeries performed in head and neck. There are few reports of experience in thyroidectomy in otolaryngology services in Chile. Aim: To analyze the clinical experience with total thyroidectomy performed in the service of ENT and Head and Neck Surgery of our hospital. Material and method: Retrospective descriptive study. Review of medical records of patients undergoing total thyroidectomy (TT) between 2010 and 2014 in our service records. Results: A total of 271 thyroidectomy were performed. The most frequent indication was size (51%). The most frequent diagnoses were papillary carcinomas (46%) and follicular colloid hyperplasia (37%). We found 2.5% of transient recurrent laryngeal nerve injury and 2.9% had persistent lesions. Transient hypocalcemia occurred in 25% of patients. Discussion: Our series shows good agreement with literature, it has a low rate of complications, which are mainly seen in patients with neck dissection and/or observed 2 or less parathyroid during surgery. Conclusions: Total thyroidectomy is a safe surgical technique, and our experience shows consistent results to those reported in international literature.