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Arch. cardiol. Méx ; 90(1): 69-76, Jan.-Mar. 2020. tab
Article in English | LILACS | ID: biblio-1131008


Abstract Atrial fibrillation (AF) is a frequent arrhythmia; its prevalence is near 2% in the general population; in Mexico, more than one-half million people are affected. AF needs to be considered as a public health problem. Because AF is an independent risk factor associated with mortality, due to embolic events, heart failure, or sudden death; early diagnosis is of utmost importance. In unstable patients with a recent onset of AF, electrical cardioversion should be practiced. In stable patients, once thromboembolic measures have been taken, it is necessary to assess whether it is reasonable to administer an antiarrhythmic drug to restore sinus rhythm or performed electrical cardioversion. For recidivating cases of paroxysmal and persistent presentation, the most effective strategy is performed pulmonary vein isolation with either radiofrequency or cryoballoon energy. Permanent AF is that in which recovery of sinus rhythm is not possible, the distinguishing feature of this phase is the uncontrollable variability of the ventricular frequency and could be treated pharmacologically with atrioventricular (AV) nodal blockers or with a VVIR pacemaker plus AV nodal ablation. The presence of AF has long been associated with the development of cerebral and systemic (pulmonary, limb, coronary, renal, and visceral) embolism. The prevention of embolisms in “valvular” AF should perform with Vitamin K antagonists (VKA). For patients with AF not associated with mitral stenosis or a mechanical valve prosthesis, a choice can be made between anticoagulant drugs, VKA, or direct oral anticoagulants. Antiplatelet agents have the weakest effect in preventing embolism.

Resumen La fibrilación auricular (FA) es una arritmia frecuente; su prevalencia es cercana al 2% en la población general, en México se ven afectados más de medio millón de personas por eso debe considerarse como un problema de salud pública. Debido a que la FA es un factor de riesgo independiente asociado a mortalidad, por eventos embólicos, insuficiencia cardíaca o muerte súbita, la identificación y diagnóstico temprano es de suma importancia. En el inicio reciente de FA en pacientes inestables, se debe practicar la cardioversión eléctrica. En pacientes estables, una vez que se han tomado medidas tromboembólicas, es necesario evaluar si es razonable administrar un medicamento antiarrítmico para restaurar el ritmo sinusal o realizar una cardioversión eléctrica. Para los casos que recidivan, ya sea paroxística o persistente, la estrategia más efectiva es realizar el aislamiento de la venas pulmonares con radiofrecuencia o crioablación con balón. La FA permanente es aquella en la que no es posible la recuperación del ritmo sinusal, la característica distintiva de esta fase de la FA es la variabilidad incontrolable de la frecuencia ventricular. Puede tratarse farmacológicamente con bloqueadores nodales AV o con un marcapasos VVIR mas ablación del nodo AV. La presencia de FA se ha asociado durante mucho tiempo con el desarrollo de embolia cerebral y sistémica (pulmonar, de extremidades, coronaria, renal y visceral). La prevención de embolias en la FA “valvular” debe realizarse con antagonistas de la vitamina K (AVK). Para los pacientes con FA no asociados con estenosis mitral o una prótesis valvular mecánica, se puede elegir entre medicamentos anticoagulantes, AVK o anticoagulantes orales directos (DOAC). Los agentes antiplaquetarios tienen el efecto más débil para prevenir la embolia.

Humans , Atrial Fibrillation/therapy , Thromboembolism/prevention & control , Anticoagulants/administration & dosage , Atrial Fibrillation/complications , Atrial Fibrillation/epidemiology , Thromboembolism/etiology , Electric Countershock/methods , Risk Factors , Cryosurgery/methods , Fibrinolytic Agents/administration & dosage , Radiofrequency Ablation/methods , Mexico/epidemiology , Anti-Arrhythmia Agents/administration & dosage
Clinics ; 75: e1373, 2020. tab, graf
Article in English | LILACS | ID: biblio-1055875


OBJECTIVES: Chronic thromboembolic pulmonary hypertension (CTEPH) is a unique form of pulmonary hypertension (PH) that arises from obstruction of the pulmonary vessels by recanalized thromboembolic material. CTEPH has a wide range of radiologic presentations. Commonly, it presents as main pulmonary artery enlargement, peripheral vascular obstructions, bronchial artery dilations, and mosaic attenuation patterns. Nevertheless, other uncommon presentations have been described, such as lung cavities. These lesions may be solely related to chronic lung parenchyma ischemia but may also be a consequence of concomitant chronic infectious conditions. The objective of this study was to evaluate the different etiologies that cause lung cavities in CTEPH patients. METHODS: A retrospective data analysis of the medical records of CTEPH patients in a single reference PH center that contained or mentioned lung cavities was conducted between 2013 and 2016. RESULTS: Seven CTEPH patients with lung cavities were identified. The cavities had different sizes, locations, and wall thicknesses. In two patients, the cavities were attributed to pulmonary infarction; in 5 patients, an infectious etiology was identified. CONCLUSION: Despite the possibility of being solely associated with chronic lung parenchyma ischemia, most cases of lung cavities in CTEPH patients were associated with chronic granulomatous diseases, reinforcing the need for active investigation of infectious agents in this setting.

Humans , Male , Female , Pulmonary Embolism/diagnosis , Thromboembolism/etiology , Granulomatous Disease, Chronic/pathology , Hypertension, Pulmonary/diagnosis , Pulmonary Embolism/complications , Pulmonary Embolism/therapy , Angiography/methods , Tomography, X-Ray Computed/methods , Chronic Disease , Retrospective Studies , Treatment Outcome , Perfusion Imaging , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/therapy , Lung/blood supply , Anticoagulants/therapeutic use
Rev. bras. cir. cardiovasc ; 34(5): 535-541, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042052


Abstract Introduction: Metabolic syndrome (MetS) is defined as an association between diabetes, hypertension, obesity and dyslipidemia and an increased risk of cardiovascular disease. Mitral annular calcification (MAC) is associated with several cardiovascular disorders, including coronary artery disease, atrial fibrillation (AF), heart failure, ischemic stroke and increased mortality. The CHA2DS2-VASc score is used to estimate thromboembolic risk in AF. However, the association among MAC, MetS and thromboembolic risk is unknown and was evaluated in the current study. Methods: The study group consisted of 94 patients with MAC and 86 patients with MetS. Patients were divided into two groups: those with and those without MAC. Results: Patients with MAC had a higher MetS rate (P<0.001). In patients with MAC, the CHA2DS2-VASc scores and the rate of cerebrovascular accident and AF were significantly higher compared to those without MAC (P<0.001, for both parameters). The results of the multivariate regression analysis showed that history of smoking, presence of MetS and high CHA2DS2-VASc scores were associated with the development of MAC. ROC curve analyses showed that CHA2DS2-VASc scores were significant predictors for MAC (C-statistic: 0.78; 95% CI: 0.706-0.855, P<0.001). Correlation analysis indicated that MAC was positively correlated with the presence of MetS and CHA2DS2-VASc score (P=0.001, r=0.264; P<0.001, r=0.490). Conclusion: We have shown that CHA2DS2-VASc score and presence of MetS rates were significantly higher in patients with MAC compared without MAC. Presence of MAC was correlated with CHA2DS2-VASc score, presence of MetS, AF and left atrial diameter and negatively correlated with left ventricular ejection fraction.

Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Thromboembolism/etiology , Calcinosis/complications , Heart Valve Diseases/complications , Mitral Valve/physiopathology , Atrial Fibrillation/physiopathology , Stroke Volume/physiology , Thromboembolism/physiopathology , Calcinosis/physiopathology , Echocardiography , Logistic Models , Prospective Studies , Risk Factors , Sensitivity and Specificity , Statistics, Nonparametric , Risk Assessment/methods , Metabolic Syndrome/complications , Metabolic Syndrome/physiopathology , Heart Valve Diseases/physiopathology
Arq. neuropsiquiatr ; 77(2): 80-83, Feb. 2019. tab
Article in English | LILACS | ID: biblio-983886


ABSTRACT Objectives: To compare warfarin and dabigatran for thromboembolic event prevention in patients with nonvalvular atrial fibrillation or atrial flutter. Methods: This was a retrospective cohort of participants with nonvalvular atrial fibrillation or atrial flutter using either warfarin or dabigatran in a reference center in Brazil. Results: There were 112 patients (mean age 65.5 years), with 55.3% using warfarin. The median duration of follow-up was 1.9 years for warfarin and 1.6 years for dabigatran (p = 0.167). Warfarin patients had a higher median of medical appointments per year (8.3 [6.8-10.4] vs 3.1 [2.3-4.2], p < 0.001) and the frequency of minor bleeding was more than four times higher (17.7% vs 4.0%, p = 0.035). Among patients with prior stroke, those using warfarin had 2.6 times more medical appointments for person-years of follow-up (8.5 vs 3.3). There was no major bleeding or embolic event during follow-up period. Conclusion: The dabigatran group had a lower frequency of minor bleeding and number of medical appointments than the warfarin group, without more embolic events or major bleeding.

RESUMO Objetivos: Comparar varfarina e dabigatrana para prevenção de eventos tromboembólicos em pacientes com fibrilação atrial não valvar ou flutter (FA). Métodos: Coorte retrospectiva de pacientes com FA em uso de varfarina ou dabigatrana em serviço especializado no Brasil. Resultados: Foram avaliados 112 pacientes (média idade 65,5), com 55,3% no grupo varfarina. A mediana do tempo de seguimento foi de 1,9 anos para o grupo varfarina e 1,6 para dabigatrana (p = 0,167). No grupo varfarina houve maior mediana de consultas médicas (CM) por ano (8,3[6,8-10,4] vs. 3,1[2,3-4,2], p < 0,001), com frequência de sangramento menor quatro vezes maior (17,7% vs. 4,0%, p = 0,035). Nos pacientes com acidente vascular cerebral isquêmico prévio, o grupo varfarina teve 2,6 vezes mais CM por pessoas-ano de seguimento (8,5 vs. 3,3). Não houve sangramento maior ou eventos embólicos no período de seguimento. Conclusão: Pacientes em uso de dabigatrana tiveram menor número de sangramento menor e CM que aqueles em uso de varfarina, sem aumentar eventos embólicos ou sangramentos maiores.

Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Atrial Fibrillation/prevention & control , Atrial Flutter/prevention & control , Thromboembolism/prevention & control , Warfarin/therapeutic use , Dabigatran/therapeutic use , Anticoagulants/therapeutic use , Atrial Fibrillation/complications , Atrial Flutter/complications , Thromboembolism/etiology , Brazil , Retrospective Studies , Risk Factors , Follow-Up Studies , Treatment Outcome , Statistics, Nonparametric , Stroke/etiology , Stroke/prevention & control , Ambulatory Care Facilities , Hemorrhage/prevention & control , Anti-Arrhythmia Agents/therapeutic use
In. Consolim-Colombo, Fernanda M; Saraiva, José Francisco Kerr; Izar, Maria Cristina de Oliveira. Tratado de Cardiologia: SOCESP / Cardiology Treaty: SOCESP. São Paulo, Manole, 4ª; 2019. p.705-713.
Monography in Portuguese | LILACS | ID: biblio-1009195
West Indian med. j ; 67(1): 84-88, Jan.-Mar. 2018. graf
Article in English | LILACS | ID: biblio-1045805


ABSTRACT Non-compaction cardiomyopathy is a rare form of cardiac disease that presents with symptoms of congestive heart failure, ventricular arrhythmias or thromboembolism. Within the Caribbean setting, there are limited data regarding its existence. We present a case of non-compaction cardiomyopathy, diagnosed by transthoracic echocardiogram and cardiac magnetic resonance imaging, with the use of established criteria. It is interesting to highlight such a condition within the small Caribbean population, especially given its link to heritability and the ease with which it can be mistaken for a dilated cardiomyopathy.

RESUMEN La miocardiopatía no compactada o espongiforme es una forma rara de enfermedad cardíaca que se presenta con síntomas de insuficiencia cardíaca congestiva, arritmias ventriculares o tromboembolismos. En el entorno caribeño, hay datos limitados sobre su existencia. Presentamos un caso de cardiomiopatía no compactada, diagnosticada mediante ecocardiograma transtorácico y resonancia magnética cardíaca, con el uso de criterios establecidos. Es interesante destacar tal condición dentro de la pequeña población caribeña, especialmente dada su relación con la heredabilidad y la facilidad con la que se le puede confundir con una miocardiopatía dilatada.

Humans , Male , Middle Aged , Isolated Noncompaction of the Ventricular Myocardium/diagnostic imaging , Arrhythmias, Cardiac/etiology , Thromboembolism/etiology , Magnetic Resonance Imaging , Echocardiography , Isolated Noncompaction of the Ventricular Myocardium/complications , Heart Failure/etiology
Hosp. Aeronáut. Cent ; 13(2): 84-88, 2018. tabl
Article in Spanish | LILACS, BINACIS | ID: biblio-1021137


Introducción: La histerectomía es uno de los procedimientos quirúrgicos que con más frecuencia se realiza en Ginecología. La frecuencia de aparición de absceso de cúpula varía desde un 0,7% a un 14%. La infección generalmente es polimicrobiana y los gérmenes implicados son los de la flora vaginal y endocervical de la mujer sana. En el Hospital Aeronáutico Central, desde el año 2007, además de la profilaxis intraoperatoria con cefalosporinas de primera generación, se realiza en las 12 horas previas a la cirugía programada, profilaxis con óvulos vaginales polivalentes. Objetivos: Evaluar la disminución de la incidencia de absceso de cúpula vaginal post cirugía ginecológica, que implique la manipulación de la vagina, con administración pre-quirúrgica de óvulos vaginales polivalentes. Material y Método: Estudio observacional, descriptivo y retrospectivo. Se incluyeron 220 pacientes que se les realizaron 220 histerectomías totales: 202 por vía abdominal, 5 laparoscópicas y 13 vaginales. Se realizó profilaxis intraoperatoria con cefalosporinas de 1º generación. Se les administró por vía vaginal un óvulo polivalente compuesto por: metronidazol 300 mg, miconazol nitrato 100 mg, neomicina sulfato 48,8 mg, polimixina b sulfato 4,4 mg, centella asiática 15 mg y excipientes. Se evaluó la aparición de absceso de cúpula vaginal en los 6 meses posteriores a la cirugía. Resultados: Se hallaron complicaciones post quirúrgicas en 10 pacientes (4.5%): 4 pacientes (1,8%) con infección del tracto urinario, 3 pacientes (1,4%) con infección de herida quirúrgica, 1 paciente (0,4%) con fístula vesico-vaginal, 1 paciente con Tromboembolismo pulmonar, 1 paciente con granuloma de cúpula vaginal y 1 paciente con absceso de cúpula vaginal. Esta paciente no recibió el óvulo vaginal polivalente. Conclusión: De los datos obtenidos de las 220 pacientes analizadas, y teniendo en cuenta la bibliografía consultada, podemos concluir que las pacientes que son sometidas a histerectomías totales con técnica de cúpula vaginal cerrada y que reciben como profilaxis preoperatoria un óvulo vaginal polivalente, presentan menor incidencia de complicaciones post operatorias, principalmente a nivel de la cúpula vaginal, y en particular abscesos de cúpula.

Introduction: Hysterectomy is one of the surgical procedures most frecuently performed in gynecology. Vault abscess frequency of appearance varies from 0.7% to 14%. The infection is usually polymicrobial and involved germs are those from vaginal and endocervical flora of the healthy woman. In the Hospital Aeronáutico Central, since 2007, in addition to intraoperative prophylaxis with first-generation cephalosporins, prophylaxis with polyvalent vaginal ovules is performed within 12 hours prior to scheduled surgery. Objectives: Evaluate the decrease in the incidence of vaginal vault abscess after gynecological surgery, involving the manipulation of the vagina, with pre-surgical administration of polyvalent vaginal ovules. Material and Method: Observational, descriptive and retrospective. 220 patients who underwent 220 total hysterectomies were included: 202 abdominal via, 5 laparoscopic and 13 vaginal. Intraoperative prophylaxis was performed with 1st generation cephalosporins. They were administered through vaginal via with Polyvalent ovule composed of: metronidazole 300 mg, miconazole nitrate 100 mg, neomycin sulfate 48.8 mg, polymyxin b sulfate 4.4 mg, gotu kola 15 mg and excipients. The appearance of vaginal dome abscess was evaluated in the 6 months following surgery. Results: Post-surgical complications were found in 10 patients (4.5%): 4 patients (1.8%) with urinary tract infection, 3 patients (1.4%) with surgical wound infection, 1 patient (0.4%) ) with vesico-vaginal fistula, 1 patient with pulmonary thromboembolism, 1 patient with vaginal vault granuloma and 1 patient with abscess of vaginal vault. This patient did not receive the polyvalent vaginal ovum. Conclusion: Data obtained from the 220 patients analyzed, and taking into account the bibliography consulted, we can conclude that patients who undergo total hysterectomies with a closed vaginal vault technique who receive a polyvalent vaginal ovum as a preoperative prophylaxis, present a lower incidence of post-operative complications, mainly at the level of the vaginal vault, and in particular dome abscesses

Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Antibiotic Prophylaxis/trends , Hysterectomy, Vaginal/adverse effects , Surgical Wound Infection/etiology , Thromboembolism/etiology , Endometrial Neoplasms/complications , Pelvic Organ Prolapse/complications , Reproductive Tract Infections/etiology , Menorrhagia/complications
Arq. bras. cardiol ; 108(4): 290-296, Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-838729


Abstract Background: The SAMe-TT2R2 score was developed to predict which patients on oral anticoagulation with vitamin K antagonists (VKAs) will reach an adequate time in therapeutic range (TTR) (> 65%-70%). Studies have reported a relationship between this score and the occurrence of adverse events. Objective: To describe the TTR according to the score, in addition to relating the score obtained with the occurrence of adverse events in patients with nonvalvular atrial fibrillation (AF) on oral anticoagulation with VKAs. Methods: Retrospective cohort study including patients with nonvalvular AF attending an outpatient anticoagulation clinic of a tertiary hospital. Visits to the outpatient clinic and emergency, as well as hospital admissions to the institution, during 2014 were evaluated. The TTR was calculated through the Rosendaal´s method. Results: We analyzed 263 patients (median TTR, 62.5%). The low-risk group (score 0-1) had a better median TTR as compared with the high-risk group (score ≥ 2): 69.2% vs. 56.3%, p = 0.002. Similarly, the percentage of patients with TTR ≥ 60%, 65% or 70% was higher in the low-risk group (p < 0.001, p = 0.001 and p = 0.003, respectively). The high-risk group had a higher percentage of adverse events (11.2% vs. 7.2%), although not significant (p = 0.369). Conclusions: The SAMe-TT2R2 score proved to be effective to predict patients with a better TTR, but was not associated with adverse events.

Resumo Fundamento: O escore SAMe-TT2R2 foi desenvolvido visando predizer quais pacientes em anticoagulação oral com antagonistas da vitamina K (AVKs) atingirão um tempo na faixa terapêutica (TFT) adequado (> 65%-70%) no seguimento. Estudos também o relacionaram com a ocorrência de eventos adversos. Objetivos: Descrever o TFT de acordo com o escore, além de relacionar a pontuação obtida com a ocorrência de eventos adversos adversos em pacientes com fibrilação atrial (FA) não valvar em anticoagulação oral com AVKs. Métodos: Estudo de coorte retrospectivo incluindo pacientes com FA não valvar em acompanhamento em ambulatório de anticoagulação de um hospital terciário. Foi realizada uma avaliação retrospectiva de consultas ambulatoriais, visitas a emergência e internações hospitalares na instituição no período de janeiro-dezembro/2014. O TFT foi calculado aplicando-se o método de Rosendaal. Resultados: Foram analisados 263 pacientes com TFT mediano de 62,5%. O grupo de baixo risco (0-1 ponto) obteve um TFT mediano maior em comparação com o grupo de alto risco (≥ 2 pontos): 69,2% vs. 56,3%, p = 0,002. Da mesma forma, o percentual de pacientes com TFT ≥ 60%, 65% ou 70% foi superior nos pacientes de baixo risco (p < 0,001, p = 0,001 e p = 0,003, respectivamente). Os pacientes de alto risco tiveram um percentual maior de eventos adversos (11,2% vs. 7,2%), embora não significativo (p = 0,369). Conclusões: O escore SAMe-TT2R2 foi uma ferramenta eficaz na predição do TFT em pacientes com FA em uso de AVKs para anticoagulação, porém não se associou à ocorrência de eventos adversos.

Humans , Male , Female , Middle Aged , Aged , Atrial Fibrillation/complications , Thromboembolism/prevention & control , Stroke/prevention & control , Hemorrhage/chemically induced , Anticoagulants/adverse effects , Anticoagulants/therapeutic use , Prothrombin Time , Thromboembolism/etiology , Vitamin K/antagonists & inhibitors , Warfarin/adverse effects , Warfarin/therapeutic use , Severity of Illness Index , Predictive Value of Tests , Retrospective Studies , Decision Support Techniques , Disease-Free Survival , International Normalized Ratio , Stroke/etiology
Arch. cardiol. Méx ; 87(1): 5-12, ene.-mar. 2017. tab
Article in Spanish | LILACS | ID: biblio-887488


Resumen: Objetivo: La fibrilación auricular (FA) es una de las arritmias más comunes, y su prevalencia aumenta con la edad. Se asocia con alto riesgo de embolia cerebral. La prevención de dichas tromboembolias se realiza mediante anticoagulantes orales, que en nuestro país parecen estar subutilizados. El Registro CARMEN-AF tiene como objetivo primario determinar cuál es el estado actual de la tromboprofilaxis de la FA no valvular en México. Como objetivo secundario pretende conocer la morbimortalidad asociada a la FA no valvular en por lo menos un año de seguimiento. Métodos: El Registro CARMEN-AF es un estudio observacional, longitudinal, multicéntrico y nacional sobre el empleo de los anticoagulantes orales en pacientes con FA no-valvular que pretende la inclusión de pacientes mayores de 18 años de edad diagnosticados con FA no valvular durante los últimos 6 meses y con al menos un factor de riesgo para desarrollar una tromboembolia de acuerdo con la escala de CHA2DS2-Vasc. Serán recolectados datos demográficos y clínicos en las visitas clínicas habituales a lo largo de un seguimiento de 2 años. El reclutamiento comenzó el 19 de septiembre de 2014 y se prevé la inclusión del último paciente el 18 de septiembre de 2016. Se estima la inclusión de 1,200 pacientes dada la incidencia de FA reportada a nivel mundial y tomando en consideración la población mexicana total. Conclusiones: El registro de FA y riesgo embólico en México (CARMEN-AF) permitirá conocer el estado actual de la tromboprofilaxis en pacientes con FA no valvular y permitirá obtener una panorámica del cumplimiento de las guías nacionales e internacionales de práctica clínica en esta materia.

Abstract: Objective: Atrial fibrillation (AF) is one of the most common arrhythmias, and its prevalence increase with age. It is associated with high risk of stroke. The prevention of such thromboembolism is done with oral anticoagulants, which in our country seem to be underused. CARMEN-AF registry aims primarily to determine the current status of thromboprophylaxis of non-valvular AF in Mexico. A secondary objective is to know the morbidity and mortality associated with non-valvular AF in at least one year of follow-up. Methods: CARMEN-AF registry is an observational, longitudinal, multicenter, and national survey about the use of oral anticoagulants in patients with non-valvular AF. Patients 18 years old or older, diagnosed with AF during the last 6 months, and with at least one risk factor of thromboembolism based in the CHA2DS2-Vasc score are being selected. Demographic and clinical data will be collected during the visits to their usual clinic with a follow-up of 2 years. The recruitment began on September 19, 2014, and the inclusion of the last patient is expected on September 18, 2016. According to the reported incidence of AF globally and taking into account the total Mexican population, the inclusion of 1,200 patients is estimated. Conclusions: The Atrial Fibrillation and Embolic Risk Registry (CARMEN-AF) will reveal the current status of thromboprophylaxis in patients with non-valvular AF, and will allow to get an overview of the national and international clinical practice guidelines accomplishment in this area.

Humans , Atrial Fibrillation/complications , Thromboembolism/etiology , Thromboembolism/epidemiology , Registries , Research Design , Thromboembolism/prevention & control , Administration, Oral , Risk Factors , Longitudinal Studies , Mexico , Anticoagulants/administration & dosage
Med. interna (Caracas) ; 33(3): 180-184, 2017. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1009102


La infección por VIH ha sido reconocida en la actualidad como una condición protrombótica, reportándose en pacientes con SIDA 10 veces mayor riesgo de desarrollo de eventos tromboembólicos de los sistemas arterial y venoso; la literatura reciente ha estimado una incidencia entre el 0.26% y 7.6 %; dicha incidencia se describe asociada a infecciones. oportunistas y/o malignidades. Una variedad de mecanismos potenciales relacionados con factores del hospedador, el virus y el TARV (tratamiento antiretroviral), están implicados en el estado de hipercoagulabilidad en pacientes con SIDA, cuya fisiopatología conduce a alteraciones en la respuesta inflamatoria y de la cascada de coagulación que no han sido bien dilucidadas; sin embargo, incluye la presencia de anticuerpos anticardiolipinas, disminución de anticoagulantes naturales, y otros factores independientes que en conjunto originan morbi-mortalidad creciente si dicha predisposición a eventos trombóticos no es reconocida por el médico. Los autores de este artículo describen 2 casos de eventos trombóticos en pacientes con síndrome de inmunodeficiencia humana hospitalizados en el Servicio de Medicina Interna de Hospital Universitario de Caracas(AU)

AIDS infection has now been recognized as a prothrombotic condition reported in patients with this disease, and have been found 10 times at greater risk of developing thromboembolic events with systemic involvement. Recent literature has estimated an incidence between 0.26% and 7.6%, also described in association with opportunistic infections and / or malignancies. A variety of potential mechanisms related to host factors, virus and antiretroviral therapy (ART) are implicated in the hypercoagulability status in HIV-positive patients, the pathophysiology leading to alterations in the inflammatory response and the coagulation cascade. It has not been well understood and includes the presence of anticardiolipin antibodies, reduction of natural anticoagulants, and other independent factors that lead to increased morbidity and mortality if such predisposition to thrombotic events is not recognized by the clinician. The authors of this article describe 2 cases of thrombotic events in patients with human immunodeficiency syndrome hospitalized in the Hospital Universitario of Caracas, Venezuela(AU)

Humans , Male , Adult , Middle Aged , Thromboembolism/etiology , Warfarin/administration & dosage , HIV Infections/complications , Venous Thrombosis/physiopathology , Blood Coagulation/drug effects , Internal Medicine
Rev. bras. cir. cardiovasc ; 31(3): 239-245, May.-June 2016. tab
Article in English | LILACS | ID: lil-796128


ABSTRACT Introduction: In patients with mechanical prosthetic heart valves or atrial fibrillation requiring anticoagulation to prevent thromboembolic events, several factors influence adherence and anticoagulation complications. Objective: To evaluate the factors that interfere with the quality and complications of anticoagulation with vitamin K antagonists. Methods: A retrospective cohort study of 100 patients, in the period from 2011 to 2014, was performed. Anticoagulation conditions in the last year, regarding the presence of complications (embolisms/bleeding) and inadequate treatment were assessed: achievement of less than 8 annual prothrombin times and International Normalized Ratio outside therapeutic target in more than 40% of prothrombin times. Results: There were 31 complications (22 minor bleeding without hospitalization and 9 major complications: 7 bleeding with hospitalization and two emboli); 70 were with International Normalized Ratio outside the target in more than 40% of the tests and 36 with insufficient number of prothrombin times. Socioeconomic factors, anticoagulant type and anticoagulation reason had no relationship with complications or with inadequate treatment. There were more complications in patients with longer duration of anticoagulation (P=0.001). Women had more International Normalized Ratio outside the target range (OR 2.61, CI:1.0-6.5; P=0.04). Patients with lower number of annual prothrombin times had longer times of anticoagulation (P=0.03), less annual consultations (P=0.02) and less dose adjustments (P=0.003). Patients with longer duration of anticoagulation have more complications (P=0.001). Conclusion: There was a high rate of major complications and International Normalized Ratio was outside the goal. Less annual prothrombin times was related to longer duration of anticoagulation, less annual consultations and less dose adjustments. More major complications occurred in patients with longer duration of anticoagulation.

Humans , Male , Female , Aged , Postoperative Complications/etiology , Vitamin K/antagonists & inhibitors , Postoperative Hemorrhage/etiology , Ambulatory Care Facilities/statistics & numerical data , Cardiac Surgical Procedures/adverse effects , Prothrombin Time/statistics & numerical data , Atrial Fibrillation/complications , Socioeconomic Factors , Thromboembolism/complications , Thromboembolism/etiology , Time Factors , Vitamin K/adverse effects , Warfarin/adverse effects , International Normalized Ratio/statistics & numerical data , Cardiac Surgical Procedures/statistics & numerical data , Anticoagulants/adverse effects
Arq. bras. cardiol ; 105(1): 3-10, July 2015. tab, ilus
Article in English | LILACS | ID: lil-755003



Atrial fibrillation and atrial flutter account for one third of hospitalizations due to arrhythmias, determining great social and economic impacts. In Brazil, data on hospital care of these patients is scarce.


To investigate the arrhythmia subtype of atrial fibrillation and flutter patients in the emergency setting and compare the clinical profile, thromboembolic risk and anticoagulants use.


Cross-sectional retrospective study, with data collection from medical records of every patient treated for atrial fibrillation and flutter in the emergency department of Instituto de Cardiologia do Rio Grande do Sul during the first trimester of 2012.


We included 407 patients (356 had atrial fibrillation and 51 had flutter). Patients with paroxysmal atrial fibrillation were in average 5 years younger than those with persistent atrial fibrillation. Compared to paroxysmal atrial fibrillation patients, those with persistent atrial fibrillation and flutter had larger atrial diameter (48.6 ± 7.2 vs. 47.2 ± 6.2 vs. 42.3 ± 6.4; p < 0.01) and lower left ventricular ejection fraction (66.8 ± 11 vs. 53.9 ± 17 vs. 57.4 ± 16; p < 0.01). The prevalence of stroke and heart failure was higher in persistent atrial fibrillation and flutter patients. Those with paroxysmal atrial fibrillation and flutter had higher prevalence of CHADS2 score of zero when compared to those with persistent atrial fibrillation (27.8% vs. 18% vs. 4.9%; p < 0.01). The prevalence of anticoagulation in patients with CHA2DS2-Vasc ≤ 2 was 40%.


The population in our registry was similar in its comorbidities and demographic profile to those of North American and European registries. Despite the high thromboembolic risk, the use of anticoagulants was low, revealing difficulties for ...


A fibrilação atrial e o flutter atrial são responsáveis por um terço das hospitalizações por arritmias, com impacto socioeconômico significativo. Os dados brasileiros a respeito desses atendimentos são escassos.


Investigar o subtipo fibrilação atrial ou flutter em pacientes atendidos em emergência em virtude dessas arritmias e comparar os perfis de comorbidades, risco de eventos tromboembólicos e uso de anticoagulantes.


Estudo transversal retrospectivo, com coleta de dados de prontuário de todos os pacientes atendidos por flutter e fibrilação atrial na emergência do Instituto de Cardiologia do Rio Grande do Sul no primeiro trimestre de 2012.


Foram incluídos 407 pacientes (356 com fibrilação atrial e 51 com flutter). Os pacientes com fibrilação atrial paroxística eram, em média, 5 anos mais jovens do que aqueles com fibrilação atrial persistente. Comparados àqueles com fibrilação atrial paroxística, os pacientes com fibrilação atrial persistente e flutter tinham maior diâmetro atrial (48,6 ± 7,2 vs. 47,2 ± 6,2 vs. 42,3 ± 6,4; p < 0,01) e menor fração de ejeção (66,8 ± 11 vs. 53,9 ± 17 vs. 57,4 ± 16; p < 0,01). A prevalência de acidente vascular cerebral e insuficiência cardíaca foi maior naqueles com fibrilação atrial persistente e flutter. Os pacientes com fibrilação atrial paroxística e flutter apresentavam mais frequentemente escore CHADS2 de zero em relação àqueles com fibrilação atrial persistente (27,8% vs. 18% vs. 4,9%; p < 0,01). A prevalência de anticoagulação nos pacientes com escore CHA2DS2-Vasc ≥ 2 foi de 40%.


A população de nossa amostra teve características demográficas e perfil de comorbidades ...

Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Anticoagulants/therapeutic use , Atrial Fibrillation/physiopathology , Atrial Flutter/physiopathology , Age Factors , Atrial Fibrillation/epidemiology , Atrial Flutter/epidemiology , Brazil/epidemiology , Comorbidity , Epidemiologic Methods , Reference Values , Risk Factors , Sex Factors , Stroke/etiology , Stroke/prevention & control , Thromboembolism/etiology , Thromboembolism/prevention & control
Ann Card Anaesth ; 2015 Jul; 18(3): 453-459
Article in English | IMSEAR | ID: sea-162402


Intra Aortic Balloon Pump (IABP) is conventionally used to support coronary perfusion and weaning from cardiopulmonary bypass. IABP in situ has its own share of complications. We present a case where a patient on IABP support who had reduced peripheral pulsations of the ipsilateral limb and was initially misdiagnosed as IABP catheter associated thromboembolism. A negative embolectomy ruled out the same. Further looking for the cause of reduction of ipsilateral pulses it was found that the tight compressive bandage at saphenous vein conduit harvesting site had led to development of compartment syndrome (CS).

Adult , Blood Vessel Prosthesis , Compartment Syndromes/epidemiology , Compartment Syndromes/etiology , Compression Bandages/adverse effects , Humans , Intra-Aortic Balloon Pumping/epidemiology , Male , Pressure , Saphenous Vein , Thromboembolism/epidemiology , Thromboembolism/etiology , Tissue and Organ Harvesting
Rev. gastroenterol. Perú ; 35(1): 25-31, ene. 2015. ilus, tab
Article in Spanish | LIPECS, LILACS, LIPECS | ID: lil-746991


Objetivo: Validar el score de Rockall en adultos mayores con hemorragia digestiva alta no variceal, como un discriminante de mayor riesgo para mortalidad y recidiva de hemorragia a 30 días de seguimiento. Material y métodos: Se incluyeron los pacientes mayores de 60 años que cursaron con hemorragia digestiva alta no variceal demostrada por endoscopía, desde junio 2009 hasta junio 2013, en un hospital general de tercer nivel. Los datos se analizaron con la curva ROC y se calculó el área bajo la curva para evaluar la utilidad del score de Rockall. Resultados: Entre los 190 pacientes registrados, el 64,2% fueron varones y la edad promedio de 74 ± 9,4 años, teniéndose 29% de pacientes con 80 o más años (55 pacientes). Se halló una mortalidad de 16,8% (32 pacientes), siendo la insuficiencia respiratoria y el resangrado las causas más frecuentes (34,3% y 31,3%). El 6,84% (13 pacientes) tuvieron recidiva de hemorragia y un 24,7% (47 pacientes) necesitó transfusión de más de 2 paquetes globulares. El área bajo la curva ROC para el riesgo de mortalidad fue de 0,76 (IC: 0,68-0,84), para recidiva de hemorragia de 0,71 (IC: 0,55-0,88) y para transfusión de más de 2 paquetes globulares de 0,66 (IC: 0,58-0,74). Conclusión: El score de Rockall es un buen predictor de mortalidad y de recidiva de hemorragia durante los 30 días posteriores a un episodio de hemorragia digestiva altano variceal en adultos mayores, siendo los score 5 y 6, respectivamente, los de mejor sensibilidad y especificidad.

Objective: To validate the Rockall score in elderly patients with non variceal upper gastrointestinal bleeding, in terms of mortality and recurrent bleeding at 30 days follow-up. Material and methods: Patients older than 60 year-old, with non variceal upper gastrointestinal bleeding demonstrated by endoscopy, who were attended in a third level general hospital from June 2009 to June 2013, were included. Data was analyzed with the ROC (Receiver Operating Characteristic) curve. The area under curve was obtained to assess the Rockall score. Results: One hundred ninety patients were included, 64.2% were males, with an average age of 74 years old. Overall mortality was 16.8% and respiratory failure with second bleeding episode was the most common cause of death (34.3% and 31.3% respectively). 5.52% of patients presented a second bleeding episode. A transfusion of more than 2 blood-packs was needed in the 24.7% of the patients. The area under ROC curve using the Rockall score was 0,76 (IC: 0.68-0.84) for mortality risk, 0.71 (IC: 0.55-0.88) for the risk of rebleeding and 0.66 (IC: 0.58-0.74) for needing a more than 2 blood-packs transfusion. Conclusions: Rockall score is a good predictor for mortality and rebleeding during the 30 day-period after a non-variceal bleeding episode in elderly patients. The best sensibility and specificity was obtained with the scores of 5 and 6, respectively.

Aged , Female , Humans , Male , Atrial Fibrillation/physiopathology , Percutaneous Coronary Intervention/methods , Prognosis , Risk Assessment , Risk Factors , Stroke/etiology , Thromboembolism/etiology , Treatment Outcome
Arq. bras. cardiol ; 103(4): 315-322, 10/2014. tab, graf
Article in English | LILACS | ID: lil-725315


Background: Studies on atrial fibrillation (AF) in decompensated heart failure (DHF) are scarce in Brazil. Objectives: To determine AF prevalence, its types and associated factors in patients hospitalized due to DHF; to assess their thromboembolic risk profile and anticoagulation rate; and to assess the impact of AF on in-hospital mortality and hospital length of stay. Methods: Retrospective, observational, cross-sectional study of incident cases including 659 consecutive hospitalizations due to DHF, from 01/01/2006 to 12/31/2011. The thromboembolic risk was assessed by using CHADSVASc score. On univariate analysis, the chi-square, Student t and Mann Whitney tests were used. On multivariate analysis, logistic regression was used. Results: The prevalence of AF was 40%, and the permanent type predominated (73.5%). On multivariate model, AF associated with advanced age (p < 0.0001), non-ischemic etiology (p = 0.02), right ventricular dysfunction (p = 0.03), lower systolic blood pressure (SBP) (p = 0.02), higher ejection fraction (EF) (p < 0.0001) and enlarged left atrium (LA) (p < 0.0001). The median CHADSVASc score was 4, and 90% of the cases had it ≥ 2. The anticoagulation rate was 52.8% on admission and 66.8% on discharge, being lower for higher scores. The group with AF had higher in-hospital mortality (11.0% versus 8.1%, p = 0.21) and longer hospital length of stay (20.5 ± 16 versus 16.3 ± 12, p = 0.001). Conclusions: Atrial fibrillation is frequent in DHF, the most prevalent type being permanent AF. Atrial fibrillation is associated with more advanced age, non-ischemic etiology, right ventricular dysfunction, lower SBP, higher EF and enlarged LA. Despite the high thromboembolic risk profile, anticoagulation is underutilized. The presence of AF is associated with longer hospital length of stay and high mortality. .

Fundamento: Estudos sobre fibrilação atrial (FA) na insuficiência cardíaca descompensada (ICD) são muito escassos no Brasil. Objetivos: Determinar a prevalência, os tipos e os fatores associados à FA em pacientes hospitalizados por ICD; analisar perfil de risco embólico e taxa de anticoagulação; e avaliar o impacto da FA na mortalidade hospitalar e no tempo de internação. Métodos: Estudo seccional de casos incidentes, retrospectivo, observacional. Analisaram-se 659 internações consecutivas por ICD entre 01/01/2006 a 31/12/2011. Risco embólico foi avaliado pelo acrônimo CHADSVASc. Na análise univariada, foram utilizados o qui-quadrado, teste t de Student ou Mann Whitney. Na análise multivariada, utilizou-se a regressão logística. Resultados: A prevalência de FA foi de 40%, predominando o tipo permanente (73,5%). No modelo multivariado, a FA se associou à idade avançada (p < 0,0001), etiologia não isquêmica (p = 0,02), disfunção ventricular direita (VD) (p = 0,03), menor pressão arterial sistólica (PAS) (p = 0,02), maior fração de ejeção (FE) (p < 0,0001) e aumento atrial esquerdo (AE) (p < 0,0001). A mediana do CHADSVASc foi quatro e 90% tinham escore ≥ 2. A taxa de anticoagulação foi de 52,8% na admissão e 66,8% na alta, sendo menor em escores mais elevados. O grupo com FA apresentou maior mortalidade hospitalar (11,0% versus 8,1%, p = 0,21) e internação mais prolongada (20,5 ± 16 versus 16,3 ± 12, p = 0,001). Conclusões: A FA é frequente na ICD, predominando o tipo permanente. Associa-se com idade avançada, etiologia não isquêmica, disfunção de VD, menor PAS, maior FE e aumento AE. O perfil de risco embólico é elevado e a anticoagulação é subutilizada. ...

Aged , Female , Humans , Male , Middle Aged , Atrial Fibrillation/epidemiology , Atrial Fibrillation/physiopathology , Hospital Mortality , Heart Failure/epidemiology , Heart Failure/physiopathology , Brazil/epidemiology , Cross-Sectional Studies , Echocardiography , Hospitalization , Length of Stay , Prevalence , Retrospective Studies , Risk Assessment , Risk Factors , Statistics, Nonparametric , Thromboembolism/etiology
Invest. clín ; 55(2): 173-184, jun. 2014. tab
Article in Spanish | LILACS | ID: lil-749975


El síndrome drepanocítico (SD) comprende un grupo de anemias hemolíticas hereditarias de tipo multisistémico asociadas a la hemoglobina S. Los pacientes que padecen este síndrome tienen un mayor riesgo, en comparación con individuos sanos, de presentar accidentes cerebrovasculares, hipertensión pulmonar, necrosis avascular de articulaciones, síndrome torácico agudo y complicaciones durante el embarazo, asociados a un estado de hipercoagulabilidad inducido por alteraciones en los diferentes componentes de la hemostasia, que incluyen la activación del endotelio y de los sistemas plaquetario, de la coagulación y de la fibrinólisis. Esta revisión resume las alteraciones en la hemostasia reportadas en los pacientes con SD, en los cuales se ha demostrado: mayor interacción de células endoteliales con leucocitos, hematíes y plaquetas; aumento de la expresión de proteínas de adhesión, como el factor von Willebrand y sus multímeros de alto peso molecular; aumento de la adhesión y la agregación plaquetaria y de la expresión de proteínas en sus membranas. En el sistema de coagulación se ha detectado aumento en la expresión del factor tisular (FT) en micropartículas derivadas de diferentes células, aumento de marcadores de activación de este sistema, entre estos los fragmentos 1.2 de la protrombina y los complejos trombina-antitrombina y una disminución de las proteínas C y S que actúan como anti-coagulantes. Adicionalmente, se han encontrado aumentados los marcadores de activación del sistema fibrinolítico como los dímeros D y los complejos plasmina/antiplasmina. Todas estas manifestaciones favorecen la aparición de complicaciones trombóticas, implicadas en el deterioro de la calidad de vida de los pacientes. Se recomienda implementar en el diagnóstico y seguimiento de esta enfermedad, la determinación de variables del sistema hemostático, con el fin de identificar alteraciones en etapas tempranas y aplicar terapias que puedan prevenir complicaciones trombóticas.

Sickle cell syndrome (SCS) includes a group of congenital hemolytic anemias associated to the presence of hemoglobin S, which is characterized by acute pain episodes and progressive damage of different organs. Some patients with sickle cell syndrome have shown, when compared with healthy individuals, an increased risk of presenting stroke, pulmonary hypertension, avascular necrosis of joints, acute chest syndrome and pregnancy complications, associated to a hypercoagulable state induced by alterations in different components of hemostasis, such as changes that include activation of the endothelium, platelet activity, coagulation and fibrinolytic systems. This paper compiles hemostasis disorders, associated with thrombotic manifestations, reported until now in sickle cell syndrom. These patients have an increase in activation markers of the coagulation system, such as prothrombin fragment 1.2, thrombin-antithrombin complex, etc., depletion of natural anticoagulant proteins, abnormal activation of the fibrinolytic system and increased tissue factor expression. Similarly, abnormal expression of glycoproteins and increased adhesion and platelet aggregation have been reported. All these alterations produce a hypercoagulable state, which induces, among other things, the appearance of thrombotic complications. In view of the importance of controlling the different complications that can occur in patients with sickle cell syndrome, we recommend the implementation, in diagnosis and monitoring studies, of the evaluation of the different components of the hemostatic system, identifying alterations at an early stage and applying effective treatments to prevent thrombotic complications.

Humans , Anemia, Sickle Cell/blood , Hemostasis , Thrombophilia/etiology , ADAM Proteins/blood , Blood Proteins/analysis , Cell-Derived Microparticles , Cell Adhesion Molecules/blood , Erythrocytes, Abnormal , Fibrinolysis , Fibrin Fibrinogen Degradation Products/analysis , Fibrinolysin/analysis , Interleukins/blood , Platelet Activation , Peptide Fragments/analysis , Prothrombin/analysis , Risk , Thromboembolism/etiology , /analysis , von Willebrand Factor/analysis
Rev. bras. cir. cardiovasc ; 29(1): 59-68, Jan-Mar/2014. tab, graf
Article in Portuguese | LILACS | ID: lil-710075


Introdução: Pacientes portadores de próteses valvares cardíacas mecânicas devem medicados continuamente com anticoagulantes orais para evitar acidentes tromboembólicos. Estes pacientes são avaliados continuamente para o controle da anticoagulação oral. Objetivo: Comparar a ocorrência de complicações tromboembólicas e hemorrágicas em portadores de próteses valvares cardíacas mecânicas de um (mono) e de dois (bi) folhetos na posição mitral em terapêutica anticoagulante. Métodos: Foram estudados, no intervalo de 10 anos, 117 pacientes portadores de prótese na posição mitral, sendo 48 com próteses de folheto único e 69 de folheto duplo. Avaliou-se a ocorrência de complicações tromboembólicas e hemorrágicas de grau maior e menor de acordo com a gravidade. Os resultados estão apresentados sob forma de estudo atuarial e de frequência linearizada de ocorrência de eventos. Resultados: As curvas atuariais mostraram que, ao longo do tempo, os pacientes portadores de próteses valvares monofolheto estiveram menos livres de complicações tromboembólicas que os pacientes com próteses bifolheto, enquanto que, estes últimos (bifolheto) estiveram menos livres de acidentes hemorrágicos. As frequências linearizadas de ocorrência para tromboembolismo foram maiores nos pacientes com próteses monofolheto. Nos episódios hemorrágicos as taxas foram maiores para os portadores de próteses bifolheto. Conclusão: Os portadores de próteses valvares cardíacas monofolheto mostraram-se mais propensos à ocorrência de acidentes tromboembólicos graves em relação aos com próteses bi folheto. Os pacientes com prótese bifolheto apresentaram maior sangramento que os pacientes com prótese ...

Introduction: Patients with mechanical heart valve prostheses must continuously be treated with oral anticoagulants to prevent thromboembolic events related to prosthetesis. These patients should be continually evaluated for the control of oral anticoagulation. Objective: To compare the occurrence of thromboembolic and hemorragic complications in patients with mechanical heart valve prosthesis with one (mono) and two (bi) leaflets in the mitral position in anticoagulant therapy. Methods: We studied the 10-year interval, 117 patients with prosthesis in the mitral position, 48 with prosthetic single leaflet and 69 with two leaflets. We evaluated the occurrence of thromboembolic and hemorrhagic major and minor degree under gravity. The results are presented in an actuarial study and the frequency of occurrence of linear events. Results: The actuarial survival curves showed that over time, patients with prosthetic heart valve with one leaflet were less free of thromboembolic complications than patients with two leaflet prosthetic valve, while the latter (two leaflet) were less free of hemorrhagic accidents. The linearized frequency of occurrence of thromboembolism were higher in patients with mono leaflet prosthesis. Bleeding rates were higher for patients with bi leaflet prosthetic valve. Conclusion: Patients with mono leaflet prosthetic heart valve showed that they are more prone to the occurrence of serious thromboembolic events compared to those with bi leaflet prosthetic valve. Patients with bi leaflet prosthetic valve had more bleeding than patients with mono leaflet prosthetic valve, however this difference was restricted to the bleeding of minor nature. .

Adult , Female , Humans , Male , Heart Valve Prosthesis/adverse effects , Hemorrhage/etiology , Mitral Valve/surgery , Postoperative Complications/etiology , Prosthesis Design/adverse effects , Thromboembolism/etiology , Anticoagulants/therapeutic use , Heart Valve Prosthesis Implantation/adverse effects , Risk Factors , Time Factors