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1.
Rev. cuba. anestesiol. reanim ; 20(1): e663, ene.-abr. 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1156366

ABSTRACT

Introducción: El pronóstico de morir por sangrado digestivo permite individualizar el tratamiento y disminuir la letalidad. Objetivos: Identificar los factores pronósticos de mortalidad por sangramiento digestivo no variceal en pacientes graves. Métodos: Se estudiaron casos y controles en pacientes ingresados en la Unidad de Cuidados Intensivos del Hospital Docente Clínico Quirúrgico Joaquín Albarrán Domínguez entre el 1ro de enero 2018 al 31 de diciembre de 2019. El universo estuvo constituido por 1060 pacientes, se seleccionaron 154 pacientes (137 controles y 17 casos). Se aplicó el Chi cuadrado y el Odds ratio (IC= 95 por ciento). Resultados: Del total de pacientes estudiados, 11,3 por ciento fallecieron, la edad promedio fue 69 ± 11,58 (grupo control) y 75± 11,42 (grupo casos). Las alteraciones del equilibrio ácido-base tuvieron 7,4 riesgo de morir con (IC 95 por ciento 2,5-21,9), la hipoxia 1,1 (IC 95 por ciento 0,41-3,2), las variaciones del potasio 4,9 (IC 95 por ciento 1,54-16,1), hiperlactemia 16,9 (IC 95 por ciento 5,3-52,0), las desviaciones del sodio 6,5 (IC 95 % 0,8-51,4). Con ventilación mecánica 2,17 (IC 95 por ciento 0,6-7,0), el apoyo de aminas vasoactivas 16,9 (IC 95 por ciento5,30-52,0), la trasfusión de glóbulos rojos, 11,7 (IC 95 por ciento 3,1-4,3) y con tratamiento dialítico 47,5 (IC 95 por ciento 8,6-258.0), las complicaciones 3,4 (IC 95 por ciento 1,15-10,4). El tratamiento endoscópico fue 93,5 por ciento de grupo control y 41,3 por ciento del grupo de casos, con OR en 0,04 (IC 95 por ciento 0,01-0,15). Conclusiones: Los factores pronósticos identificados fueron: alteraciones del pH, del sodio, el potasio, elevación del lactato, la ventilación mecánica, transfusiones más de 250 mL de glóbulos rojos, apoyo de aminas vasoactivas, tratamiento dialítico, y complicaciones relacionadas con el sangrado. El tratamiento endoscópico fue un factor de protección(AU)


Introduction: The prognosis of dying from digestive bleeding allows individualizing treatment and reducing mortality. Objectives: To identify the prognostic factors of mortality due to nonvariceal gastrointestinal bleeding in seriously-ill patients. Methods: Cases and controls were studied in patients admitted to the intensive care unit of Joaquín Albarrán Domínguez Clinical-Surgical Teaching Hospital, between January 1, 2018 and December 31, 2019. The universe consisted of 1060 patients, 154 of which were selected to make up the sample (137 controls and 17 cases). Chi-square and odds ratio (CI: 95 percent) were applied. Results: Of the total of patients studied, 11.3 percent died, the average age was 69±11.58 (control group) and 75±11.42 (case group). Alterations in acid-base balance accounted for 7.4 as risk of dying (CI: 95 percent; 2.5-21.9), hypoxia accounted for 1.1 (CI: 95 percent; 0.41-3.2), variations in potassium accounted for 4.9 (CI: 95 percent; 1.54-16.1), hyperlacthemia accounted for 16.9 (CI: 95 percent; 5.3-52.0), and sodium deviations accounted for 6.5 (CI: 95 percent; 0.8-51, 4), mechanical ventilation accounted for 2.17 (CI: 95 percent; 0.6-7.0), vasoactive amines support accounted for 16.9 (CI: 95 percent; 5.30-52.0), red blood cell transfusion accounted for 11.7 (CI: 95 percent; 3.1-4.3), dialysis treatment accounted for 47.5 (CI: 95 percent; 8.6-258.0), and complications accounted for 3.4 (CI: 95 percent; 1.15-10.4). Endoscopic treatment was 93.5 percent in the control group and 41.3 percent in the case group, with odds ratio at 0.04 (CI: 95 percent; 0.01-0.15). Conclusions: The prognostic factors identified were alterations in pH, sodium, potassium, elevated lactate, mechanical ventilation, transfusions of more than 250 mL of red blood cells, vasoactive amine support, dialysis treatment, and complications related to bleeding. Endoscopic treatment was a protective factor(AU)


Subject(s)
Humans , Digestive System Diseases/mortality , Digestive System Diseases/blood , Hemorrhage/complications , Prognosis , Case-Control Studies
2.
Rev. argent. cir ; 112(3): 317-324, jun. 2020. graf
Article in Spanish | LILACS | ID: biblio-1279745

ABSTRACT

RESUMEN Antecedentes: la pancreatitis aguda posduodenopancreatectomía cefálica inmediata es una complica ción cuya frecuencia puede llegar al 55% y condiciona la aparición de fístula pancreática. Objetivo: describir el manejo de 3 pacientes que presentaron pancreatitis aguda posduodenopancrea tectomía con complicaciones locales y realizar una revisión de la literatura. Material y métodos: se revisó una base de datos prospectiva de resecciones pancreáticas. Se identifi caron los pacientes con diagnóstico de pancreatitis aguda con lesiones locales posterior a la realización de duodenopancreatectomía. Se definió fístula pancreática de acuerdo con la clasificación del ISGPF y pancreatitis como la elevación de la amilasa o lipasa tres veces por encima del máximo valor sérico normal en asociación con dolor abdominal o confirmación radiológica. Resultados: entre 2008 y 2019 los autores realizaron 260 duodenopancreatectomías. Tres pacientes presentaron pancreatitis posoperatoria con complicaciones locales. Conclusiones: la pancreatitis aguda posoperatoria es una complicación de una frecuencia elevada. La mayoría de ellas se resuelven en forma espontánea. Pocos pacientes presentan complicaciones locales que pueden requerir tratamiento percutáneo o quirúrgico, predisponiendo al desarrollo de fístulas a veces de difícil manejo. No hay forma de prevenir la aparición de la fístula pancreática. El tratamiento de las complicaciones locales se realizará de acuerdo con su aparición y repercusión, pudiendo requerir desde la colocación de un drenaje percutáneo hasta la pancreatectomía total.


ABSTRACT Background: The incidence of acute pancreatitis immediately after cephalic pancreaticoduodenec tomy is up to 55% and is associated with the development of pancreatic fistula. Objective: The aim of this study is to report three cases of acute pancreatitis after pancreaticoduode nectomy with local complications with a review of the literature. Material and methods: The information about pancreatic resections was retrieved from a prospective database. Patients with diagnosis acute pancreatitis with local lesions immediately after pancreatico duodenectomy were identified. Pancreatic fistula was defined according to the International Study Group on Pancreatic Fistula (ISGPF) Definition and pancreatitis was defined as serum amylase or lipase >3x upper limit of normal associated with abdominal pain or imaging criteria. Results: A total of 260 pancreaticoduodenectomies were performed between 2008 and 2019. Three patients developed postoperative acute pancreatitis with local complications. Conclusions: Postoperative acute pancreatitis is a common complication that solves spontaneously in most cases. Few patients present local complications that may require percutaneous or surgical treatment, which may predispose to the development of fistulas that are sometimes difficult to mana ge. There is no way to prevent pancreatic fistulas. Local complications will be treated according to their occurrence and impact, and may require a variety of procedures, ranging from percutaneous drainage to total pancreatectomy.


Subject(s)
Humans , Female , Middle Aged , Aged , Pancreatitis/surgery , Pancreaticoduodenectomy/adverse effects , Postoperative Complications , Prospective Studies , Laparoscopy , Gastrointestinal Stromal Tumors/diagnosis , Duodenum , Endoscopy , Hemorrhage/complications
4.
Rev. medica electron ; 41(5): 1192-1204, sept.-oct. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1094122

ABSTRACT

RESUMEN Introducción: la hemorragia digestiva alta ocurre por una lesión sangrante localizada entre el esfínter esofágico superior y el ángulo de Treitz. Objetivo: determinar el comportamiento del tratamiento endoscópico del sangrado digestivo alto por úlcera péptica, en el departamento de Gastroenterología del Hospital Universitario Comandante "Faustino Pérez". Materiales y métodos: se realizó un estudio descriptivo, prospectivo para evaluar el resultado del tratamiento endoscópico en el sangrado digestivo alto por úlcera péptica en el Hospital Universitario Comandante "Faustino Pérez" de Matanzas, de enero del 2016 a febrero del 2018. El tratamiento endoscópico fue la inyectoterapia con epinefrina al 1:10000. Se analizaron las variables: grupo de edades, sexo, resultado del tratamiento endoscópico, estigmas endoscópicos de sangrado, recidiva hemorrágica, mortalidad directa, necesidad de cirugía, estadía hospitalaria y cantidad de unidades transfusionales. Resultados: se constató un predominio de pacientes masculinos (87.5 %), menores de 60 años (70%). Prevalecieron los pacientes con estigmas endoscópicos de sangrado activo venoso (45%). La terapia endoscópica tuvo un resultado satisfactorio (92.5%) en su mayoría. La ocurrencia de resangrado (45%), mortalidad directa por hemorragia digestiva, promedio de estadía hospitalaria, cantidad de unidades transfusionales y necesidad de intervención quirúrgica de urgencia (17.5%), resultó similar a los estudios reportados, demostrando que la inyectoterapia endoscópica aún constituye una opción eficaz si no se cuenta con otras terapias endoscópicas. Conclusiones: la mayoría de los casos tratados con inyectoterapia endoscópica tuvieron un sangrado activo venoso o Forrest IB que fue satisfactoria. La inyectoterapia no satisfactoria fue en pacientes con sangrado activo. La mortalidad directa relacionada con el sangrado fue infrecuente y en relación con el sangrado arterial. Se demostró que la inyectoterapia endoscópica aún constituye una opción eficaz si no se cuenta con otras terapias endoscópicas (AU).


SUMMARY Introduction: high digestive bleeding happens due to a bleeding lesion located between the upper anatomical sphincter of the esophagus and the angle of Treitz. Objective: to determine the endoscopic treatment behavior of high digestive bleeding caused by peptic ulcer, in the department of Gastroenterology of the University Hospital "Comandante Faustino Perez". Materials and methods: a prospective descriptive study was carried out to evaluate the result of the endoscopic treatment in high digestive bleeding caused by peptic ulcer in the University Hospital "Comandante Faustino Perez", of Matanzas, from January 2016 to February 2018. The endoscopic treatment was injecto-therapy with epinephrine at 1:10000. The analyzed variables were: age group, sex, result of the endoscopic treatment, bleeding endoscopic stigma, hemorrhagic relapse, direct mortality, surgery necessity, hospital staying, and quantity of transfusion units. Results: male patients (87.5 %), aged less than 60 years predominated. Patients with endoscopic stigma of venous active bleeding (45 %) prevailed. In most of cases, endoscopic therapy achieved satisfactory results (92.5 %). The authors found that bleeding relapse (45 %), direct mortality by digestive hemorrhage, average hospital staying, quantity of transfusion units and necessity of urgent surgeries (17.5 %) were similar to those reported in other studies. Conclusions: most cases treated with endoscopic injectotherapy had active venous or Forrest IB bleeding and treatment was satisfactory. Therapy was unsatisfactory in patients with active bleeding. The direct mortality related to bleeding was infrequent, and related to arterial bleeding. It was showed that endoscopic injectotherapy is still an efficacious option if other endoscopic therapies are not available (AU).


Subject(s)
Middle Aged , Aged , Peptic Ulcer/diagnosis , Endoscopy/statistics & numerical data , Hemorrhage/therapy , Peptic Ulcer/etiology , Behavior , Epinephrine/therapeutic use , Epidemiology, Descriptive , Prospective Studies , Hemorrhage/complications , Hemorrhage/diagnosis , Hemorrhage/epidemiology
5.
Int. j. cardiovasc. sci. (Impr.) ; 32(5): 449-456, Sept-Oct. 2019. tab
Article in English | LILACS | ID: biblio-1040108

ABSTRACT

There is limited evidence in the literature regarding the administration of clopidogrel to acute coronary syndrome (ACS) in patients over 75 years of age. Most studies excluded this age group, making the subject controversial due to the increased risk of bleeding in this population. Objective: This is a retrospective, unicentric, and observational study aimed at assessing whether the administration of clopidogrel loading dose increases bleeding rates in patients over 75 years of age. Methods: Patients were divided into two groups: group I: 75 mg of clopidogrel; group II: 300-to 600-mg loading dose of clopidogrel. A total of 174 patients (129 in group I and 45 in group II) were included between May 2010 and May 2015. Statistical analysis: The primary outcome was bleeding (major and/or minor). The secondary outcome was combined events (cardiogenic shock, reinfarction, death, stroke and bleeding). The comparison between groups was performed through Q-square and T-test. The multivariate analysis was performed by logistic regression, being considered significant p < 0.05. Results: Comparisons between groups I and II showed differences in the prevalence of diabetes (46.5% vs. 24.4%, p = 0.01), arterial hypertension (90.7% vs. 75, p = 0.01), dyslipidemia (62% vs. 42.2%, p = 0.021), ST segment elevation (11.6% vs. 26.6%, p = 0.016) and coronary intervention percutaneous (16.5% vs. 62.2%, p < 0.0001), respectively. In the multivariate analysis, significant differences were observed between groups I and II in relation to the occurrence of bleeding (8.5% vs. 20%, OR = 0.173, 95% CI: 0.049 - 0.614, p = 0.007). Conclusion: A loading dose of 300 mg or more of clopidogrel


Subject(s)
Humans , Male , Female , Aged , Aged , Treatment Outcome , Acute Coronary Syndrome/complications , /therapeutic use , Platelet Aggregation Inhibitors/therapeutic use , Stents , Data Interpretation, Statistical , Multivariate Analysis , Retrospective Studies , Risk Factors , Coronary Angiography , Coronary Angiography/methods , Electrocardiography/methods , Percutaneous Coronary Intervention/methods , Hemorrhage/complications
8.
J. vasc. bras ; 18: e20180021, 2019.
Article in Portuguese | LILACS | ID: biblio-984688

ABSTRACT

O tromboembolismo venoso (TEV) é uma doença frequente e de alta morbimortalidade, sendo considerada a maior causa evitável de mortalidade em pacientes hospitalizados. Apesar da incidência altíssima de TEV em todos os países e das evidências de que a tromboprofilaxia reduz as complicações tromboembólicas em pacientes clínicos e cirúrgicos, e a custo baixo, persistem grandes dúvidas quanto à segurança desse tipo de intervenção nos pacientes e quanto à tromboprofilaxia ideal. Inúmeros estudos e recomendações baseadas em evidências comprovam a eficácia da profilaxia na prevenção do TEV e/ou da morte dos pacientes, mas ainda hoje ela é subutilizada. Neste artigo, apresentamos uma ampla revisão dos métodos de profilaxia existentes até os dias atuais, publicados em diretrizes e estudos nacionais e internacionais sobre tromboprofilaxia


Venous thromboembolism (VTE) is a common disease with high rates of morbidity and mortality and is considered the number one cause of avoidable mortality among hospitalized patients. Although VTE incidence is extremely high in all countries and there is ample evidence that thromboprophylaxis inexpensively reduces the rate of thromboembolic complications in both clinical and surgical patients, a great deal of doubt remains with respect to patient safety with this type of intervention and in relation to the ideal thromboprophylaxis methods. Countless studies and evidence-based recommendations confirm the efficacy of prophylaxis for prevention of VTE and/or patient deaths, but it remains underutilized to this day. This article presents a wide-ranging review of existing prophylaxis methods up to the present, from guidelines and national and international studies of thromboprophylaxis


Subject(s)
Humans , Male , Female , Disease Prevention , Venous Thromboembolism/prevention & control , Inpatients , Pulmonary Embolism/therapy , Risk Factors , Practice Guidelines as Topic/standards , Enoxaparin/therapeutic use , Lower Extremity , Factor Xa Inhibitors/therapeutic use , Rivaroxaban/therapeutic use , Dabigatran/therapeutic use , Hemorrhage/complications , Anticoagulants/therapeutic use
9.
Int. j. cardiovasc. sci. (Impr.) ; 31(6): 562-568, nov.- dez. 2018. tab, graf
Article in English | LILACS | ID: biblio-979704

ABSTRACT

Background: In coronary procedures, although the radial approach protects patients from hemorrhagic complications, it is technically more complex than the femoral approach. Objectives: To test the hypothesis that the radial approach is the procedure of choice in ACS patients due to the high risk of bleeding; and to identify independent predictors of the choice for radial access. Methods: Patients admitted for ACS who underwent invasive coronary procedure were included. We registered the type of access (femoral or radial) chosen by the physician for the first angiography; the investigators did not interfere with this choosing process. Student's t-test was used for comparisons between the CRUSADE and ACUITY scores. Predictors of radial access were compared between the groups. Statistical significance was defined by p < 0,05.Results: Radial access was chosen in 67% of 347 consecutive patients. Patients who underwent radial approach had lower risk of bleeding determined by CRUSADE (30 ± 14 vs. 37 ± 15; p < 0.001) as compared with femoral access. In multivariate analysis, four variables were identified as independent predictors negatively associated with radial access ­ age (OR = 0.98; 95%CI = 0.96 ­ 0.99), creatinine (OR = 0.54; 95%CI = 0.3 ­ 0.98), signs of left ventricular failure (OR = 0.45; 95% CI = 0.22 ­ 0.92) and previous CABG (OR = 0.022; 95%CI = 0.003 ­ 0.166). Conclusion: The propensity to choose radial over femoral access in coronary intervention was not primarily influenced by patients' bleeding risk. Predictors of this decision, identified in the study, indicated less complex patients, suggesting that the difficulty in performing the technique was a stronger determinant than its potential antihemorrhagic effect


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Radial Artery , Acute Coronary Syndrome , Femoral Artery , Percutaneous Coronary Intervention/methods , Coronary Artery Disease , Catheterization/methods , Stents , Data Interpretation, Statistical , Multivariate Analysis , Risk Factors , Angioplasty/methods , Hemorrhage/complications , Angina, Unstable
10.
Int. j. cardiovasc. sci. (Impr.) ; 31(5)set.-out. 2018. graf
Article in English | LILACS | ID: biblio-914706

ABSTRACT

Background: The aortic arch diseases exhibit high morbidity and mortality rates. Some surgical strategies recommend partial preservation of the aortic arch and the supra-aortic vessels, but the immediate and mediumterm mortality rates of patients undergoing this surgical strategy is uncertain. Objectives: To compare overall mortality and mid- term survival curve of patients undergoing surgical strategy of partial preservation of the aortic arch and supra-aortic vessels (group A) compared to conventional strategies of the aortic arch approach (group B); to assess cardiovascular mortality over time. Methods: Descriptive and retrospective study of the medical records of patients undergoing aortic arch repair surgery between February 2000 and July 2013. We analyzed 111 patients, 29 in group A and 82 in group B. The overall survival and survival from cardiovascular events were assessed by Kaplan-Meier test. Results: In- hospital mortality from any cause was 31% in group A and 29.3% in group B. At 1 year, 2 year, and 5 year general survival was similar between the groups. In-hospital, 2 years and 5 years mortality from cardiovascular causes was 13.8%, 14.8%, e 22.7% in group A and 26.8%, 34.6% e 50.9% in group B. The difference between the groups in 5 years showed statistical significance (p = 0.0234). Survival from cardiovascular causes in 2 years and 5 years was 85.2% and 77,3% in group A and 65.4% and 49,1% in group B. Occurrence of urgent and emergency procedures were greater in group A, but without statistical significance. Conclusions: There was no difference in all-cause mortality over time between the groups. Group A showed lower cardiovascular mortality at 5 years than group B


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aorta, Thoracic/physiopathology , Aorta, Thoracic/surgery , Aortic Aneurysm/surgery , Mortality , Survivorship , Cardiovascular Diseases/mortality , Continuity of Patient Care , Data Collection/methods , Dissection/methods , Hemorrhage/complications , Prostheses and Implants , Retrospective Studies , Risk Factors , Data Interpretation, Statistical , Surgical Procedures, Operative , Surveys and Questionnaires
11.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(4): 421-427, out.-dez. 2018. ilus, tab
Article in English, Portuguese | LILACS | ID: biblio-970567

ABSTRACT

Os fibrinolíticos pertencem a uma classe de medicamentos especializada em promover a lise da fibrina e a consequente dissolução do trombo. Esse efeito baseia-se na transformação do plasminogênio em plasmina, potente enzima proteolítica. A sua aplicação nas diferentes síndromes cardiovasculares agudas alterou o curso natural do infarto agudo do miocárdio, da embolia pulmonar e do acidente vascular cerebral isquêmico agudo. Na prática, temos três gerações de fibrinolíticos disponíveis: estreptoquinase, alteplase e tenecteplase, essa última com alta afinidade à fibrina. As complicações hemorrágicas, embora raras, devem ser identificadas e tratadas de forma precoce. Isso se deve aos distúrbios da coagulação, especialmente, queda do fibrinogênio e outros fatores de coagulação, mais predominantes com a estreptoquinase. A correção baseia-se na administração de crioprecipitado e plasma fresco, ricos, respectivamente, em fibrinogênio e fatores de coagulação. A inexperiência ao administrar tais medicamentos e o receio hemorrágico tem sido fator agravante na sobrevida dessas doenças. Campanhas educacionais poderão amenizar tal cenário, especialmente, em centros mais carentes de recursos tecnológicos


Fibrinolytics belong to a class of drugs specialized in promoting lysis of fibrin and consequent dissolution of the thrombus. This effect is based on the conversion of plasminogen into plasmin, a potent proteolytic enzyme. Its application in different acute cardiovascular syndromes has changed the natural course of acute myocardial infarction, pulmonary embolism, and acute ischemic stroke. In practice, three generations of fibrinolytics are available: streptokinase, alteplase, and tenecteplase (the latter having high affinity to fibrin). Hemorrhagic complications, although rare, must be identified and treated early. This is due to coagulation disorders, especially the decrease in fibrinogen and other coagulation factors, more prevalent with streptokinase. Correction is based on the administration of cryoprecipitate and fresh plasma, which are rich in fibrinogen and coagulation factors, respectively. Inexperience in administering these drugs and hemorrhagic fear are aggravating factors of disease progression. Educational programs can mitigate such scenarios, especially in centers that lack technological resources.Inexperience administering such medicines and hemorrhagic fear has been an aggravating factor in the lives of these diseases. Educational campaigns will be able to mitigate such a scenario especially in the most lacking centers of technological resources


Subject(s)
Humans , Male , Female , Adult , Thrombolytic Therapy/methods , Fibrinolytic Agents/therapeutic use , Hemorrhage/complications , Myocardial Infarction/therapy , Pulmonary Embolism , Streptokinase , Blood Coagulation Factors , Cardiovascular Diseases , Reperfusion , Stroke
12.
Int. j. cardiovasc. sci. (Impr.) ; 31(4): 383-392, jul.-ago. 2018. tab, graf
Article in English | LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-954120

ABSTRACT

The score is an effective instrument for the assessment of treatment adherence in users of oral anticoagulants and maintenance of INR (international normalized ratio) within the therapeutic range. Objective: To develop an adherence score for oral anticoagulant users for the maintenance of INR within the therapeutic range. Methods: This was an analytical, observational, cross-sectional study, with a quantitative approach, conducted in a public cardiology hospital. A total of 607 patients who met the inclusion criteria were evaluated. Variables with a significance level of 5% in the exploratory analysis and considered clinically relevant were included and subjected to a multiple logistic regression model. Predictive accuracy of the model was determined using the C statistic. Results: The variables with a significance level of 5% in the multivariate analysis were: education, family income, inadequate use of medications, drug-drug interactions, invasive procedures, food-drug interactions, physical activity, medical conditions, other factors, and complications related to oral anticoagulant therapy. The following prognostic variables were identified: family income, inadequate use of medications, invasive procedures, drug-drug interactions, dietary habits, medical conditions, other factors (stress, thinness, weight loss). C-statistic for adherence score was 0.94. Conclusion: The Simonetti adherence score proved to be easily applicable and feasible, with high predictive value for influencing factors, promoting the improvement of adherence and maintenance of INR in the ideal range


O escore é um instrumento eficaz na avaliação da adesão de usuários de anticoagulante oral e na manutenção do RNI (razão normalizada internacional) na faixa terapêutica segundo recomendações americanas e europeias. Objetivo: Construir um escore de adesão aos usuários de Anticoagulante Oral para a manutenção na faixa terapêutica. Métodos: Estudo analítico, observacional, transversal e abordagem quantitativa, realizado em hospital público especializado em cardiologia. Foram avaliados 607 pacientes que atenderam aos critérios de inclusão. Consideram-se as variáveis que apresentaram nível de significância menor que 5% na análise exploratória ou que foram apreciadas de relevância clínica e submetidas a um modelo de regressão logística múltipla. A acurácia preditiva do modelo foi determinada pelo C statistic. Resultados: As variáveis com nível de significância menor que 5% na análise multivariada: escolaridade, renda familiar, uso inadequado, interação medicamentosa, procedimentos invasivos, interações alimentar, atividade física, condições clínicas, outros fatores e complicações próprias do uso do anticoagulante oral. Foram identificadas variáveis prognósticas: renda familiar, uso inadequado, procedimento invasivo, interação medicamentosa, hábitos alimentares, condições clínicas, outros fatores (estresse, emagrecimento, perda de peso). O C Statistic para o Escore de Adesão foi de 0,94. Conclusão: O escore de adesão Simonetti mostrou-se de aplicabilidade fácil e exequível, com alto valor preditivo mediante os fatores intervenientes, facilitando a melhoria da adesão e manutenção do RNI na faixa ideal


Subject(s)
Humans , Male , Female , Middle Aged , Thromboembolism/therapy , Probability , Medication Adherence , Anticoagulants/therapeutic use , Cardiac Care Facilities , Cardiovascular Diseases/therapy , Health Education , Data Collection , Data Interpretation, Statistical , Risk Factors , Age Factors , Drug Interactions , Tertiary Care Centers , Observational Study , Hemorrhage/complications
13.
Rev. argent. cir ; 110(2): 111-113, jun. 2018. ilus
Article in Spanish | LILACS | ID: biblio-957905

ABSTRACT

Entre las complicaciones alejadas de las hernioplastias inguino-crurales, el pseudoquiste hemorrágico crónico, no ha sido referido en nuestro país. Se describen los métodos complementarios de imagenología para el diagnóstico y se destaca la resección quirúrgica como el tratamiento definitivo. Se concluye que esta complicación al igual que la inguinodinia y la recidiva herniaria influyen en el grado de satisfacción posoperatoria.


Among the long term complications of hernioplasty, chronic hemorrhagic pseudocyst has not been reported so far in our country. Complementary imaging methods for diagnosis are described and surgical resection is highlighted as the definitive treatment. It is concluded that this complication as well as inguinodynia and hernia recurrence influence the degree of postoperative satisfaction.


Subject(s)
Humans , Female , Aged , Cysts/surgery , Herniorrhaphy/adverse effects , Pelvis/diagnostic imaging , Tomography, X-Ray Computed , Ultrasonography, Doppler , Cysts/diagnostic imaging , Hemorrhage/complications
14.
J. vasc. bras ; 17(1): 26-33, jan.-mar. 2018. ilus, tab
Article in Portuguese | LILACS | ID: biblio-904898

ABSTRACT

Contexto: A cirurgia bariátrica é considerada a melhor opção para o tratamento da obesidade, cujos pacientes são considerados de alto risco para fenômenos tromboembólicos. Objetivos: Comparar o uso de doses diferentes de heparina de baixo peso molecular (HBPM) na profilaxia da trombose venosa profunda (TVP) em pacientes candidatos à cirurgia bariátrica em relação ao risco de TVP, alteração na dosagem do fator anti-Xa e sangramento pré ou pós-operatório. Métodos: Estudo comparativo transversal em pacientes submetidos à cirurgia bariátrica distribuídos em dois grupos, que receberam doses de HBPM de 40 mg (grupo controle, GC) e 80 mg (grupo de estudo, GE). Foram avaliados por ultrassonografia vascular e dosagem de KPTT, TAP, plaquetas e fator anti-Xa. Resultados: Foram avaliados 60 pacientes, sendo 34 no GC e 26 no GE. Foi observada diferença significativa somente no peso (p = 0,003) e índice de massa corporal (p = 0,018) no GE em relação ao GC. Não houve diferença na dosagem de KPTT, TAP, plaquetas e fator anti-Xa entre os grupos. Não foram detectados TVP ou sangramentos significativos em ambos os grupos. Conclusões: Não houve diferença estatisticamente significativa na utilização de doses maiores de HBPM na profilaxia da TVP em pacientes candidatos à cirurgia bariátrica em relação ao risco de TVP, dosagem do fator anti-Xa e sangramento pré ou pós-operatório


Background: Bariatric surgery is considered the best treatment option for patients with obesity who are classed as high risk for thromboembolic events. Objectives: To compare two different doses of low weight molecular heparin (LWMH) for prevention of deep venous thrombosis (DVT) in candidates for bariatric surgery, in terms of DVT risk, abnormal anti-Xa levels, and preoperative and/or postoperative bleeding. Methods: A cross-sectional comparative study of bariatric surgery patients divided into two groups given different doses of LWMH; 40 mg of LWMH (control group, CG) and 80 mg of LWMH (study group, SG), both evaluated by vascular ultrasonography (VU) and according to the results of PTT, PT, platelets, and anti-Xa factor assays. Results: Sixty patients were evaluated, 34 in the CG and 26 in the SG. The only significant differences between the patients in the SG and the CG were weight (p = 0.003) and body mass index (p = 0.018). There were no differences between the groups in PTT, PT, platelets, or anti-Xa factor levels. There was no DVT or significant bleeding in either group. Conclusions: There were no statistical differences when higher doses of LWMH were used for prevention of DVT in bariatric surgery patients, in terms of DVT risk, anti-Xa factor levels, or preoperative and postoperative bleeding


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Comparative Study , Heparin/administration & dosage , Venous Thrombosis/surgery , Venous Thrombosis/therapy , Disease Prevention , Bariatric Surgery/methods , Hemorrhage/complications , Coagulants/administration & dosage , Body Mass Index , Case-Control Studies , Control Groups , Data Interpretation, Statistical , Risk Factors , Laparoscopy/methods , Diabetes Mellitus , Hypertension
15.
São Paulo; s.n; 2018. 26 p. ilust, tabelas.
Thesis in Portuguese | LILACS, Inca | ID: biblio-1280897

ABSTRACT

Estudo da segurança e eficácia da rivaroxabana no tratamento de tromboembolismo venoso em pacientes com câncer ativo. Materiais e Métodos: Foi realizada uma coorte retrospectiva com 400 pacientes com câncer ativo e tromboembolismo venoso (trombose venosa profunda ou embolia pulmonar). Objetivo: Avaliação da eficácia através da incidência de recorrência do tromboembolismo venoso e da segurança através da avaliação da incidência de sangramento maior e menor durante o tratamento com a rivaroxabana. Dos 400 pacientes estudados, 223 (55,8%) eram do sexo feminino. Um total de 362 pacientes (90,5%) tinham tumores sólidos e 244 (61%) doença metastática. Receberam dose inicial de enoxaparina 302 pacientes (mediana: 3, média: 5,6, desvio padrão: 6,4 dias), seguida da rivaroxabana. Noventa e oito pacientes receberam apenas rivaroxabana conforme a bula da medicação. A incidência de recorrência foi 3,25% e a incidência de sangramento maior 5,5% durante a anticoagulação com a rivaroxabana. Houve maior incidência de sangramento menor em pacientes ECOG 3 e 4, 25,8% comparado com 10,8%, 15,7% e 24,2% ECOG respectivamente 0, 1 e 2, P=0,05. O tempo mediano de tratamento foi 118 dias e a média 163,9 dias (desvio padrão: 159,9 dias). Conclusão: Esses resultados sugerem que a rivaroxabana é uma opção para o tratamento do tromboembolismo venoso no paciente com câncer


Purpose: To study the safety and efficacy of rivaroxaban - a direct oral anticoagulant - in the treatment of patients with active cancer and venous thromboembolism (VTE). Patients and Methods: Retrospective cohort study of 400 patients with active cancer and VTE, defined as deep venous thrombosis and/or pulmonary embolism. This single-center study was carried out from January 2012 to June 2015. The aim of this study was to determine the efficacy and safety, using the incidence of recurrent symptomatic VTE and major bleeding respectively, throughout the treatment with rivaroxaban. Results: Of the 400 patients enrolled, 223 (55.8%) were female. A total of 362 (90.5%) patients had solid tumors and 244 (61%) had metastatic disease. A total of 302 (75.5%) received initial parenteral therapy with enoxaparin (median: 3, mean: 5.6, standard deviation [SD]: 6.4 days) followed by rivaroxaban. Ninety-eight patients (24.5%) were treated with on label rivaroxaban. Recurrence rates were 3.25% with major bleeding ocurring in 5.5% during the anticoagulant therapy (median: 118, mean: 163.9, SD: 159.9 days). Nonmajor bleeding occurred in 61 (15.2%) patients. Patients with higher ECOG score are more likely to have nonmajor bleeding (10.8%, 15.7%, 24.2% and 25.8% in patients with ECOG scores 0, 1, 2 and 3 + 4, respectively; P=0.05) Conclusion: Rivaroxaban can be an attractive alternative for treatment of cancer-associated thrombosis


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Recurrence , Therapeutics/methods , Venous Thromboembolism , Rivaroxaban/therapeutic use , Hemorrhage/complications , Neoplasms , Retrospective Studies
16.
Int. j. cardiovasc. sci. (Impr.) ; 30(6): f:517-l:525, Nov.-Dez. 2017. tab, graf
Article in Portuguese | LILACS | ID: biblio-876067

ABSTRACT

Fundamento: O escore HAS-BLED foi desenvolvido para avaliar o risco em um ano de sangramento maior em pacientes com fibrilação atrial (FA) anticoagulados com antagonistas da vitamina K (AVK). Objetivo: O objetivo deste estudo foi avaliar a capacidade do escore HAS-BLED e de seus componentes em predizer sangramento maior em pacientes atendidos em um ambulatório de anticoagulação de um hospital terciário. Métodos: Foi realizado um estudo coorte retrospectivo com pacientes com FA tratados com AVK. Análise de regressão logística foi realizada para avaliar a capacidade de cada componente do escore em predizer sangramento maior. O nível de significância adotado em todos os testes foi de 5%. Resultados: Foram estudados 263 pacientes com média de idade de 71,1 ± 10,5 anos ao longo de um período de tratamento de 237,6 pacientes-ano. A mediana do escore HAS-BLED foi de 2 (1-3). A incidência de sangramento maior foi de 5,7%, sendo mais elevada nos pacientes de alto risco que nos pacientes de baixo risco (9,6 vs. 3,1%; p = 0,052). A área sob a curva ROC foi de 0,70 (p = 0,01). Um ponto de corte ≥ 3 mostrou sensibilidade de 66,7%, especificidade de 62,1%, valor preditivo positivo de 9,6% e valor preditivo negativo de 96,9%. Sobrevida livre de sangramento maior foi menor no grupo de alto risco (p = 0,017). Na análise multivariada, o único preditor independente de sangramento maior entre os componentes do escore foi o uso concomitante de antiplaquetários (OR 5,13, IC95%: 1,55-17,0; p = 0,007). Conclusão: O escore HAS-BLED foi capaz de prever sangramento maior na população de pacientes com FA estudada. Entre os componentes do escore, atenção especial deve ser dada para o uso concomitante de antiplaquetários, que mostrou associação independente. Em pacientes com FA em uso de AVK como terapia anticoagulante, o uso de antiplaquetários deve ser realizado somente naqueles pacientes com avaliação risco-benefício favorável


Background: HAS-BLED s core was developed to assess 1-year major bleeding risk in patients anticoagulated with vitamin K antagonists (VKA) due to atrial fibrillation (AF). Objective: Of this study was to assess the ability of HAS-BLED score and its components to predict major bleeding in patients treated in an anticoagulation outpatient clinic of a tertiary hospital. Methods: A retrospective cohort study on AF patients treated with VKA was conducted. Logistic regression analysis was performed to evaluate the ability of individual score components to predict major bleeding. The significance level adopted in all tests was 5%. Results: We studied 263 patients with a mean age of 71.1 ± 10.5 years over a period of 237.6 patients-year. Median HAS-BLED score was 2 (1-3). The overall incidence of major bleeding was 5.7%, and it was higher among high-risk HAS-BLED score patients than in low risk patients (9.6 vs. 3.1%; p = 0.052). Area under the ROC curve was 0.70 (p = 0.01). Cut-off point ≥ 3 showed sensibility of 66.7%, specificity of 62.1%, positive predictive value of 9.6% and negative predictive value of 96.9%. Major bleeding-free survival was lower in high-risk group (p = 0.017). In multivariate analysis, concurrent antiplatelet use was the only independent predictor of major bleeding among score components (OR 5.13, 95%CI: 1.55-17.0; p = 0.007). Conclusion: HAS-BLED score was able to predict major bleeding in this cohort of AF patients. Among score components, special attention should be given for concomitant antiplatelet use, which was independently associated to this outcome. Antiplatelets in AF patients under VKA anticoagulation should be used in selected patients with favorable risk-benefit assessment


Subject(s)
Humans , Male , Female , Anticoagulants/therapeutic use , Hemorrhage/complications , Outpatient Clinics, Hospital , Tertiary Care Centers , Atrial Fibrillation/physiopathology , Cardiovascular Diseases/physiopathology , Predictive Value of Tests , Retrospective Studies , Risk Factors , ROC Curve , Data Interpretation, Statistical , Stroke/complications , Vitamin K
17.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 27(4): 278-281, out.-dez. 2017. tab
Article in Portuguese | LILACS | ID: biblio-879459

ABSTRACT

A doença neoplásica associa-se a um aumento da incidência de eventos tromboembólicos. Os fatores associados a esses fenômenos englobam não apenas o estado pró-trombótico associado ao câncer, mas também os efeitos colaterais dos quimioterápicos, além da imobilidade associada a algumas situações, como intervenções cirúrgicas, por exemplo. De acordo com a American Cancer Society (ACS), que desenvolveu a mais recente diretriz sobre profilaxia e tratamento da TVP em pacientes oncológicos, somando os fatores de risco já existentes aos fatores intrínsecos dos pacientes oncológicos, esses pacientes são, quase sempre, classificados como de alto risco. A simplicidade de administração oral sem necessidade de monitorização laboratorial torna os novos anticoagulantes orais uma alternativa atrativa para a prevenção e o manejo de eventos tromboembólicos em pacientes oncológicos. Subgrupos de estudos maiores demonstram a eficácia e segurança dessa classe de fármacos nesse grupo de pacientes, porém, mais estudos estão sendo conduzidos, a fim de responder com mais clareza a esta questão. O estado pró-trombótico promovido pela doença neoplásica acarreta maior risco de fenômenos embólicos em pacientes oncológicos com fibrilação atrial (FA). Não existem recomendações específicas para terapia antitrombótica para pacientes com FA e câncer. Não há evidência que essa população apresente risco aumentado de acidente vascular cerebral embólico em comparação com os pacientes com FA sem neoplasia associada. Os pacientes portadores de FA e câncer concomitantemente são mais idosos do que os pacientes portadores apenas de FA. Ainda existem muitas controvérsias com relação à anticoagulação no paciente oncológico. Novos estudos com foco nessa temá- tica contribuirão muito para o manejo mais homogêneo e embasado nessa população


Neoplastic disease is associated with an increase in the incidence of thromboembolic events. Factors associated with these phenomena include not only the prothrombotic state associated with cancer, but also the side effects of chemotherapy, and the immobility associated with certain situations, such as surgical interventions. According to the American Cancer Society (ACS), which produced the latest guidelines on prophylaxis and treatment of DVT in cancer patients, adding the existing risk factors to the intrinsic factors of cancer patients, these patients are almost always classified as high risk. The simplicity of oral administration, without the need for laboratory monitoring, makes the new oral anticoagulants an attractive alternative in the prevention and management of thromboembolic events in cancer patients. Subgroups of larger studies demonstrate the efficacy and safety of this class of drugs in this group of patients. However, further studies are being conducted in order to answer this question more clearly. The prothrombotic state promoted by the neoplastic disease presents a higher risk of embolic phenomena in cancer patients with atrial fibrillation (AF). There are no specific recommendations for antithrombotic therapy in patients with AF and cancer. There is no evidence that this population presents an increased risk of embolic cerebrovascular event compared to patients with AF without associated neoplasia. It is known that cancer patients with concomitant cancer and AF are older than non-cancer patients. There is still much controversy regarding anticoagulation in cancer patients. New studies focusing on this theme will contribute to a more homogeneous and grounded management of this population


Subject(s)
Humans , Male , Female , Blood Coagulation Factors , Blood Coagulation Factor Inhibitors , Coagulation Protein Disorders , Neoplasms/complications , Postoperative Period , Atrial Fibrillation , Cardiology , Risk Factors , Venous Thrombosis/therapy , Hemorrhage/complications , Hospitalization , Anticoagulants/therapeutic use
18.
Rev. argent. radiol ; 81(3): 214-218, set. 2017. ilus
Article in Spanish | LILACS | ID: biblio-1041853

ABSTRACT

La enfermedad diverticular del intestino delgado constituye una entidad de rara presentación, que suele confundirse con otras patologías más comunes cuando se complica. Los falsos divertículos son de origen primario o secundario, y asientan mayoritariamente en el duodeno. El divertículo verdadero más frecuente es el de Meckel. Las complicaciones aparecen en menos del 15% de los casos. Entre ellas, se destacan, por frecuencia, la perforación y/o inflamación, la obstrucción, el sangrado, y/o la diarrea crónica. El objetivo de este trabajo es mostrar el rol de la tomografía computada multidetector en el diagnóstico y manejo de la enfermedad diverticular del intestino delgado, exponiendo casos de la práctica diaria con correlato quirúrgico de pacientes evaluados en nuestra institución.


Small bowel diverticula is an uncommon and underdiagnosed pathology. False diverticula may be primary or secondary in origin and are frequently located in the duodenum. Meckel's diverticula is the most common true diverticula. Less than 15% of cases suffer complications, of which the following are, with decreasing frequency: inflammation and perforation, obstruction, bleeding, or chronic diarrhoea. In order to contribute to the best diagnosis and management of small-bowel diverticulosis, cases are presented that were initially evaluated with multislice computed tomography and confirmed surgically in our institution.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Diverticulitis/therapy , Diverticulitis/diagnostic imaging , Intestinal Diseases/diagnostic imaging , Intestine, Small/diagnostic imaging , Diarrhea/complications , Multidetector Computed Tomography/methods , Hemorrhage/complications
20.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 27(3): 243-250, jul.-set. 2017. ilus, tab
Article in Portuguese | LILACS | ID: biblio-875570

ABSTRACT

O uso da terapia anticoagulante em idosos tem sido muito discutido, principalmente após o surgimento dos anticoagulantes de ação direta (DOACs). Por anos, os antagonistas da vitamina K (representados principalmente pela varfarina) foram a única opção de prevenção de acidente vascular cerebral (AVC) e de embolia sistêmica (ES) em pacientes com fibrilação atrial (FA), bem como prevenção e tratamento de tromboembolismo venoso (TEV). Os DOACs tornaram-se opção melhor que a varfarina na população idosa por serem tão ou mais eficazes e apresentarem um risco de sangramento igual ou menor e risco mais baixo de hemorragia intracraniana. Além disso, têm menor interação medicamentosa e alimentar e não requerem monitoramento laboratorial contínuo. A população idosa tem sido subtratada devido aos riscos e aos receios dos profissionais quanto ao uso dos anticoagulantes. Seja pelo risco de quedas, de sangramento, polifarmácia ou presença de comprometimento cognitivo, os riscos devem ser muito bem avaliados e adequadamente abordados, uma vez que o benefício da anticoagulação é evidente nos idosos. A idade não é contraindicação para terapia anticoagulante e seu uso diminui a mortalidade e aumenta a sobrevida livre de incapacidade


The use of anticoagulant therapy in the elderly has been much discussed, especially after the development of direct oral anticoagulants (DOACs). For years, the vitamin K antagonists (represented mainly by warfarin) were the only option for stroke and systemic embolism (SE) prevention in patients with atrial fibrillation (AF), as well as for the treatment and prevention of venous thromboembolism (VTE). DOACs have become a better option than warfarin in the elderly population because they are as good as or more effective and present an equal or lesser bleeding risk and a lower risk of intracranial hemorrhage. In addition, they have limited drug and food interactions and do not require continuous laboratory monitoring. The elderly population has been under-treated because of the risks and professionals fears prescribing anticoagulants. Whether due to the risk of falls, bleeding, polypharmacy, or the presence of cognitive impairment, the risks should be well evaluated and appropriately addressed, since the benefit of anticoagulation is evident in the elderly. Age is not a contraindication for anticoagulant therapy, and its use decreases mortality and increases disability-free survival


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Atrial Fibrillation/therapy , Aged, 80 and over , Aged , Risk Factors , Anticoagulants/therapeutic use , Thromboembolism/therapy , Warfarin/adverse effects , Warfarin/therapeutic use , Accidental Falls , Sex Factors , Age Factors , Pharmacologic Actions , Stroke/complications , Rivaroxaban/therapeutic use , Dabigatran/therapeutic use , Hemorrhage/complications
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