Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 87
Filter
1.
Article in Chinese | WPRIM | ID: wpr-922045

ABSTRACT

Atherosclerosis is a chronic inflammatory disease commonly seen in clinical practice. It can lead to thickening of vascular intima, occlusion of lumen stenosis and thrombosis, leading to angina pectoris, hypertension, myocardial infarction and other diseases, posing a serious threat to human life and health. This study provides a method for removing shield needles from graphene oxide thrombus and its preparation. The graphene oxide shield needle mainly includes flexible rotating shaft, radial flexible rod, rotating needle, adsorption main pipe and dosing main pipe, laser measuring device, high definition camera and other structures, which has the following advantages:firstly, it achieves multi-angle rotation grinding thrombosis, precise rotation grinding, avoids vascular damage and infection; secondly, thrombolytic drugs can be applied in the process of rotary grinding and small thrombus can be adsorbed to effectively avoid secondary embolization of blood vessels; thirdly, it a coating of graphene oxide on a rotating needle, which protects against bacteria and infection. This study has practical reference value for the development of thrombotherapy and the application of graphene in the medical field.


Subject(s)
Adsorption , Graphite , Humans , Needles , Thrombosis/prevention & control
2.
Prensa méd. argent ; 106(10): 575-587, 20200000. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1362520

ABSTRACT

En diciembre de 2019 se descubrió un nuevo coronavirus, asociado a pacientes que sufrían un cuadro de neumonía en Hubei provincia de China, desde ese momento se estudia las características del virus, como también de la patología que produce. En los pacientes graves, se observó un estado proinflamatorio y procoagulante que provocó la disfunción multiorgánica, y, en muchos de ellos, la muerte. El objetivo de este trabajo consiste en describir la fisiopatología de la coagulopatía que esta infección, sorprendentemente, provoca. Es importante remarcar la relación que existe entre los estados inflamatorios y la cascada de la coagulación, cuyas disfunciones ocurren en situaciones de gravedad, como es la sepsis. El SARS-CoV-2 entrara a la célula mediante el receptor de la enzima convertidora de angiotensinógeno. En los estadios avanzados o críticos de la enfermedad, el estímulo hiperinflamatorio y el ambiente protrombótico provocarán un daño multiorgánico. El enfoque de los pacientes en estadios avanzados o críticos debe ser de soporte vital, junto a una terapia anticoagulante completa


In December 2019, a new coronavirus, SARS-CoV-2, was discovered in patients suffering from pneumonia. In critically ill patients, a proinflammatory and procoagulant state was observed: this led to multiorgan dysfunction, and, in many patients, to death. The objective of this work is to describe the pathophysiology of coagulopathy that this infection, surprisingly, causes. It is important to highlight the cross-talk between inflammation and coagulation in serious situations, such as sepsis. SARS-CoV-2 will enter the cell via the angiotensinogen converting enzyme receptor. In the advanced or critical stages of the disease, the hyperinflammatory stimulus and the prothrombotic environment will cause multi-organ damage. The approach of patients in advanced or critical stages should be life support, together with full anticoagulant therapy.


Subject(s)
Humans , Pneumonia/pathology , Thrombosis/prevention & control , Blood Coagulation Disorders/physiopathology , SARS-CoV-2/immunology , COVID-19/therapy , Immunity/physiology
3.
Pesqui. vet. bras ; 40(2): 113-120, Feb. 2020. tab, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1098439

ABSTRACT

Patients with chronic kidney disease (CKD) have paradoxical hemostatic potential because they have bleeding episodes but are also prone to thrombosis. Few studies have evaluated blood viscoelastic properties in dogs with kidney disease; on the other hand, hypercoagulability has been observed in these patients. It is also emphasized that the platelet function and its participation in this process have not yet been fully understood. The objective of this study was to evaluate and compare the Thrombin Generation Test (TGT) and also viscoelastic properties of the blood measured by thromboelastometry (TEM) in dogs with proteinuria in CKD. Twenty healthy dogs (Control Group) and 19 dogs with CKD in stage III or IV, classified according to International Renal Interest Society - IRIS, were selected, and the reference test of urine protein:creatinine ratio (UPCR) should be greater than one (CKD group). Blood samples for TEM, thrombin generation, Prothrombin Time (PT), activated Partial Thromboplastin Time (aPTT), and fibrinogen concentration was collected at a single time for both groups after inclusion criteria being confirmed. Statistical analysis was performed according to the distribution of variables at 5% significance level. Differences were observed between healthy dogs and those with proteinuria in CKD noted in TEM. The TGT was unable to differentiate between sick and healthy groups. However, when the nephropathy was stratified, increases in TTP and peak thrombin concentration by TGT were observed in females and dogs over 30 days of diagnosis of CKD. Both tests signaled a discrete state of hypercoagulability. In fact, TEM is more sensitive to detect hypercoagulability in dogs with CKD. However, the TGT has potential clinical application by allowing long-term sample storage.(AU)


Os pacientes com doença renal crônica (DRC) apresentam um potencial hemostático paradoxal, pois apresentam episódios de sangramento, mas também são propensos à trombose. Poucos estudos avaliaram as propriedades viscoelásticas sanguíneas em cães com doenças renais, entretanto, a hipercoagulabilidade já foi observada nestes pacientes. Ressalta-se ainda que a função plaquetária e sua participação neste processo ainda não foram totalmente esclarecidas. O objetivo foi avaliar e comparar o teste de geração de trombina (TGT) e as propriedades viscoelásticas sanguíneas medidas pela tromboelastometria (TEM) em cães com DRC proteinúrica. Foram selecionados 20 cães saudáveis (grupo controle) e 19 cães com DRC em estágios III ou IV classificados segundo o IRIS e a relação proteína/creatinina urinária maior que um (grupo DRC). As amostras de sangue para a realização da tromboelastometria (TEM), geração de trombina, tempo de protrombina (TP), tempo de tromboplastina parcial ativada (TTPA) e concentração de fibrinogênio foram colhidas em momento único para ambos os grupos após os critérios de inclusão confirmados. A análise estatística foi realizada de acordo com a distribuição das variáveis, ao nível de 5% de significância. Foi observada diferença entre os cães saudáveis e os com DRC proteinúrica observados na TEM. O teste de geração de trombina não foi capaz de diferenciar os grupos doente e saudável. Entretanto, quando os nefropatas foram analisados de forma estratificada, foram observados aumentos do ETP e da concentração máxima de trombina (peak) pelo TGT em fêmeas e em cães com mais de 30 dias de diagnóstico da DRC. Ambos os testes sinalizando para um discreto estado de hipercoagulabiliade. A tromboelastometria é mais sensível para detectar a hipercoagulabilidade em cães com DRC. Entretanto, o teste de geração de trombina tem melhor aplicabilidade por permitir o armazenamento da amostra em longo prazo.(AU)


Subject(s)
Animals , Dogs , Thrombosis/prevention & control , Thrombin , Renal Insufficiency, Chronic/blood , Renal Insufficiency, Chronic/veterinary , Hemorrhage/prevention & control , Hemorrhage/veterinary , Hemostasis , Proteinuria/veterinary , Thrombelastography/veterinary
5.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(1): 26-32, jan.-mar. 2018. ilus
Article in English, Portuguese | LILACS | ID: biblio-906709

ABSTRACT

Ao longo das décadas, alguns conceitos mudaram radicalmente a respeito do tratamento clínico da doença arterial coronariana (DAC). Inicialmente focado na redução dos sintomas isquêmicos, hoje a otimização da terapêutica clínica é fundamental para a redução de eventos cardiovasculares. No mesmo período, houve um grande desenvolvimento das técnicas de revascularização. A angioplastia coronária tornou-se uma das intervenções terapêuticas mais frequentemente realizadas e as técnicas de revascularização miocárdica vêm sendo objeto de mais ensaios clínicos randomizados, do que qualquer outra intervenção em Medicina. Ainda mais, várias modalidades de imagem invasivas e não invasivas foram desenvolvidas, permitindo estudar com maior precisão a doença arterial coronariana, reconhecer novos marcadores prognóstico, avaliar mais claramente os pacientes e indicar mais acertadamente o tratamento


Some concepts regarding the clinical management of coronary artery disease (CAD) have radically changed over the past decades. Initially focused on improving ischemic symptoms, today, optimal medical therapy is fundamental for reducing cardiovascular events. In the same time frame, there has been an immense development in revascularization treatment. Coronary angioplasty has become one of the most frequently performed therapeutic interventions, and myocardial revascularization techniques have been the subject of more randomized clinical trials than any other intervention in medicine. Furthermore, several invasive and non-invasive imaging modalities have been developed, enabling more accurate study of coronary artery disease, recognition of prognostic markers, clearer patient evaluation, and earlier treatment indications


Subject(s)
Humans , Coronary Artery Disease/physiopathology , Coronary Artery Disease/therapy , Drug Therapy/methods , Myocardial Revascularization/methods , Therapeutics , Thrombosis/prevention & control , Calcium Channel Blockers , Aspirin/administration & dosage , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Life Style
6.
Arch. cardiol. Méx ; 88(5): 339-346, dic. 2018. graf
Article in Spanish | LILACS | ID: biblio-1142140

ABSTRACT

Resumen De acuerdo a las guías actuales, aún es materia de debate el uso de anticoagulación en los primeros 3 meses en pacientes de bajo riesgo trombótico sometidos a cambio valvular aórtico con prótesis biológicas. En base a la evidencia actual, la aspirina a dosis bajas es razonable como alternativa a los antagonistas de la vitamina K (AVK) durante el posquirúrgico temprano en pacientes con prótesis biológicas en posición aórtica. Se comparó la incidencia de complicaciones trombóticas o hemorrágicas de acuerdo a la estrategia de terapia antitrombótica en los pacientes de bajo riesgo trombótico sometidos a cambio valvular aórtico con válvulas biológicas en el Instituto Nacional de Cardiología Ignacio Chávez. La hipótesis: la aspirina como monoterapia antitrombótica tiene un efecto benéfico comparado con los AVK. Se estudiaron los pacientes de bajo riesgo trombótico sometidos a cambio valvular aórtico con válvulas biológicas en el Instituto Nacional de Cardiología Ignacio Chávez. Se incluyeron los pacientes operados del año 2011 al 2015. Se identificó en el seguimiento a un año la presencia de complicaciones trombóticas o hemorrágicas y si se manejaron con cualquiera de las siguientes: aspirina únicamente, AVK solo y la combinación aspirina más AVK. Se analizaron 231 pacientes. Solo se presentó una complicación hemorrágica en un paciente tratado con AVK. No hubo complicaciones trombóticas. No se presentaron complicaciones trombóticas en pacientes que no recibieron anticoagulación oral formal durante los primeros 3 meses posquirúrgicos, lo que indica que es seguro el uso de aspirina como monoterapia en estos pacientes de bajo riesgo trombótico.


Abstract According to current guidelines, in patients without additional risk factors who have undergone aortic valve replacement with a bioprosthesis, anticoagulation in the first 3 months after surgery is still a matter of debate. According to current evidence, aspirin in low doses is a reasonable alternative to vitamin K antagonists (VKA). A comparison is made between the incidence of thrombotic and haemorrhagic complications in patients with low thrombotic risk who underwent aortic valve replacement with a bioprosthesis in the National Institute of Cardiology of Ignacio Chávez of Mexico. The hypothesis: aspirin as monotherapy has a beneficial effect compared to VKA. The studied patients were the low thrombotic risk patients who underwent aortic valve replacement with a bioprosthesis in the National Institute of Cardiology of Ignacio Chávez of Mexico from 2011 to 2015. The groups studied were: aspirin only, VKA only, and the combination of VKA plus aspirin. The patients were retrospectively followed-up for 12 months, and the thrombotic and haemorrhagic complications were documented. Of the 231 patients included in the study, only one patient in the VKA only group presented with a haemorrhagic complication. No thrombotic complications were observed. In the present study no thrombotic complications were observed in patients who did not receive anticoagulation in the first 3 months after an aortic valve replacement with a bioprosthesis after a follow up period of 12 months. This suggests that the use of aspirin only is safe during this period.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Thrombosis/prevention & control , Aspirin/administration & dosage , Heart Valve Prosthesis Implantation/methods , Anticoagulants/administration & dosage , Aortic Valve/surgery , Thrombosis/etiology , Vitamin K/antagonists & inhibitors , Bioprosthesis , Heart Valve Prosthesis , Aspirin/adverse effects , Retrospective Studies , Risk Factors , Follow-Up Studies , Drug Therapy, Combination , Fibrinolytic Agents/administration & dosage , Hemorrhage/chemically induced , Mexico , Anticoagulants/adverse effects
7.
Egyptian Journal of Hospital Medicine [The]. 2018; 71 (2): 2447-2453
in English | IMEMR | ID: emr-192482

ABSTRACT

Background: Acute deep vein thrombosis [DVT] of the lower limbs occurs in about 1.0 person per 1000 population per year and is associated with substantial morbidity. Although anticoagulation effectively prevents thrombus extension, pulmonary embolism, death, and recurrence may occur. Moreover, many patients develop venous dysfunction resulting in post-thrombotic syndrome [PTS]. PTS is associated with reduced individual health-related quality of life and a substantially increased economic burden. Hence, additional and more aggressive treatment, including systemic thrombolysis, thrombectomy, and catheter- directed thrombolysis [CDT], has been introduced to accelerate thrombus removal. Numerous studies suggest that additional CDT may provide highly effective clot lysis. There is little doubt that the overall benefit of thrombolysis depends on multiple factors, including predisposing risks, symptom duration, thrombus extension, and technical approaches and interventional success


Aim of the Work: This study aimed to define predictors of immediate and mid-long-term anatomic and clinical failures to guide patient selection and to set a standard for patient and physician expectations


Patients and Methods: This is a prospective observational cohort study that enrolled 20 patients [22 limbs] who presented to the Ain Shams University hospitals in the period from 7/2015 to 7/2017 with acute iliofemoral deep venous thrombosis [IFDVT] and fulfilled the inclusion criteria [mentioned below]. Intrathrombus catheter directed thrombolysis [CDT] was done. Assessments of predictors of immediate periprocedural success was based on degree of clot lysis and resolution of symptoms and signs. Incidence of postthrombotic syndrome [PTS] was calculated at 6 months postoperative using Villalta score [>/=5 vs <5]


Results: During the study duration, 20 patients [22 limbs] were recruited. The mean age was 40.95 +/- 12.35 years old, 11 patients [12 limbs] were women. The indication for CDT was severe progressive pain/swelling [18 limbs], and phlegmasia cerulea dolens [4 limbs]. 5 patients [7 limbs] had IVC thrombosis at the initial venography. 5 limbs had balloon dilatation only while iliac stenting was done in 12 limbs. 15 patients received CDT for 48 hours while 5 patients [7 limbs] received CDT for 24 hours [mean duration of CDT was 1.68 days]. As regards bleeding, only 2 cases of those who had CDT for 24 hours had bleeding, while bleeding occurred in 12 cases of those who had CDT for 48 hours. There were no recurrent DVT, intra or postoperative pulmonary embolism nor death within the study population till the end of the follow up period [6months]. 6 months post intervention, 7 limbs were free of PTS [Villalta score < 5], 15 limbs had mild to moderate PTS, and no patients had severe PTS. The mean Villalta score was 5.14 +/- 1.859


Conclusion: In our study, determinants of outcome following CDT for acute IFDVT were: 1] access site, 2] dose of thrombolytic agent used, 3] duration of thrombolysis, and 4] thrombus score at the end of the procedure. More studies should be done comparing not only the effect of CDT on incidence of PTS but also its effect on its severity [e.g. Villalta score] on short and long term


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Thrombosis/prevention & control , Femoral Vein , Iliac Vein , Central Venous Catheters , Mechanical Thrombolysis , Anticoagulants , Treatment Outcome , Prospective Studies , Cohort Studies
8.
Rev. Bras. Saúde Mater. Infant. (Online) ; 17(4): 693-698, Oct.-Dec. 2017. tab
Article in English | LILACS | ID: biblio-1013050

ABSTRACT

Abstract Objectives: to evaluate the maternalfetal outcomes of thromboprophylaxis with enoxa parin based on scoring system in women with serum markers for hereditary thrombophilia and previous obstetric complications. Methods: a retrospective study was undertaken based on data collected from clinical records. We included 54 pregnant women with serum markers for hereditary thrombophilia undergoing therapeutic intervention with enoxaparin in the period from November 2009 to December 2013. The initial dose of low molecular weight heparin was guided by a scoring system. The maternalfetal outcomes of previous pregnancies and, subsequently, the treatment were compared using the chisquare (χ2) test with the Yates correction and Fisher's Exact Test; p<0.05 was considered significant. Results: we observed significant reduction in fetal/perinatal deaths (p<0.05) and spontaneous abortions (p<0.001) after intervention. The live births at fullterm delivery (p<0.001) and live births at preterm delivery (p<0.05) increased significantly after intervention. Conclusions: the therapeutic intervention with enoxaparin based on scoring system during pregnancy seems to improve the fetal prognosis.


Resumo Objetivos: avaliar os desfechos maternosfetais da tromboprofilaxia com enoxaparina com base em sistema de pontuação em mulheres com marcadores séricos para trombofilia hereditária e antecedentes de complicações obstétricas. Métodos: realizouse estudo retrospectivo com base em dados coletados de prontuários. Foram Incluídas 54 mulheres grávidas com marcadores séricos de trombofilia hereditária submetidos à intervenção terapêutica com enoxaparina no período de novembro de 2009 a dezembro de 2013. A dose inicial de heparina de baixo peso molecular foi norteada por um sistema de pontuação. Os resultados maternosfetais de gestações anteriores e subsequentes ao tratamento foram comparados utilizando Teste quiquadrado com correção de Yates ou Exato de Fisher; p<0,05 foi considerado significativo. Resultados: observouse significativa redução de mortes fetais / perinatais (p<0,05) e abortos espontâneos (p<0,001) após intervenção. Os nascidos vivos com parto a termo (p<0,001) e nascidos vivos no parto prematuro (p<0,05) elevaramse significativamente após a intervenção. Conclusão: a intervenção terapêutica com enoxaparina com base no sistema de pontuação durante a gravidez parece melhorar o prognóstico fetal.


Subject(s)
Humans , Female , Thrombosis/prevention & control , Biomarkers , Enoxaparin , Heparin, Low-Molecular-Weight , Maternal-Fetal Relations , Brazil , Pregnancy Outcome , Chi-Square Distribution , Abortion, Spontaneous , Term Birth , Live Birth , Fetal Death , Perinatal Death , Obstetric Labor, Premature
9.
Rev. paul. pediatr ; 35(4): 375-382, out.-dez. 2017. tab, graf
Article in Portuguese | LILACS | ID: biblio-902867

ABSTRACT

RESUMO Objetivo: Descrever como as crianças respondem à anticoagulação oral com varfarina, verificando a influência da idade, da condição clínica, da via de administração da varfarina e do uso de Nutrição Parenteral Total (NPT), e apresentar a presença de fatores de risco para eventos tromboembólicos (TE). Métodos: Estudo transversal retrospectivo com pacientes ≤18 anos que iniciaram o uso da varfarina em um hospital universitário. Os pacientes foram divididos conforme condição clínica, idade, forma de administração do medicamento e uso de NPT. Foram utilizados os dados dos prontuários dos pacientes, considerando os fatores de risco para TE já descritos na literatura, o tempo e a dose necessária para atingir a primeira Razão Normalizada Internacional (INR) no alvo e eventos adversos nesse período. No período posterior ao alcance de INR, foi verificada a manutenção da anticoagulação, por meio da dose prescrita e dos exames de INR. Resultados: Vinte e nove pacientes foram incluídos no estudo. O principal fator de risco para TE foi o uso de cateter venoso central, em 89,6% dos pacientes. Os pacientes com síndrome do intestino curto e em uso de NPT necessitaram de doses significativamente maiores (p≤0,05) para atingir e manter a INR no alvo. Os pacientes com ≤1 ano levaram mais tempo e necessitaram de uma dose maior para anticoagular e para manter o INR no alvo que os pacientes mais velhos. A mediana de exames de INR abaixo do alvo foi de 48,2% nos grupos estudados. Conclusões: A complexidade da terapia anticoagulante reforça a necessidade da elaboração de protocolos que orientem a prática clínica.


ABSTRACT Objective: To describe how children respond to oral anticoagulation with warfarin, verifying the influence of age, clinical condition, route of administration of warfarin and use of total parenteral nutrition (TPN), as well as to describe risk factors for the occurrence of thrombotic events (TE) in childhood. Methods: A retrospective descriptive study including all patients ≤18 years old for whom warfarin was prescribed in a university hospital. Patients were divided according to clinical condition, age, route of medication administration and use of TPN. Data was collected from the patients' medical records and the analysis considered the risk factors for TE already described in the literature, the time and the dose required in order to reach the first International Normalized Ratio (INR) in the target and the adverse events in this period. After reaching the INR, the maintenance of anticoagulation was verified by the prescribed dose and INR tests. Results: Twenty-nine patients were included in the study. The major risk factor for TE was the use of a central venous catheter in 89.6% of the patients. Patients with short bowel syndrome and total parenteral nutrition required significantly higher doses (p≤0.05) to achieve and maintain the INR in the target. Patients ≤1 year old needed longer periods and required an increased dose of anticoagulation and maintenance than older patients. The mean number of INR examinations below the target was 48.2% in the groups studied. Conclusions: The observed complexity of anticoagulant therapy reinforces the need to develop protocols that guide clinical practice.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Warfarin/therapeutic use , Anticoagulants/therapeutic use , Thrombosis/prevention & control , Thrombosis/epidemiology , Warfarin/pharmacology , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Parenteral Nutrition, Total , Anticoagulants/pharmacology
11.
Arq. neuropsiquiatr ; 74(8): 679-686, Aug. 2016. tab
Article in English | LILACS | ID: lil-792518

ABSTRACT

ABSTRACT The use of anticoagulants and antiplatelet agents has largely increased. Diagnostic lumbar puncture in patients taking these drugs represents a challenge considering the opposing risks of bleeding and thrombotic complications. To date there are no controlled trials, specific guidelines, nor clear recommendations in this area. In the present review we make some recommendations about lumbar puncture in patients using these drugs. Our recommendations take into consideration the pharmacology of these drugs, the thrombotic risk according to the underlying disease, and the urgency in cerebrospinal fluid analysis. Evaluating such information and a rigorous monitoring of neurological symptoms after lumbar puncture are crucial to minimize the risk of hemorrhage associated neurological deficits. An individualized patient decision-making and an effective communication between the assistant physician and the responsible for conducting the lumbar puncture are essential to minimize potential risks.


RESUMO O uso de anticoagulantes e de agentes antiplaquetários tem aumentado nos últimos anos. A realização de punção lombar diagnóstica em pacientes utilizando tais medicamentos representa um desafio, em função dos riscos de complicações hemorrágicas ou trombóticas, estas últimas em pacientes que interrompem o tratamento para a realização do procedimento. Não há ainda estudos controlados nem diretrizes específicas nesta área. Neste artigo de revisão, algumas recomendações são feitas, levando-se em conta aspectos farmacológicos destas medicações, o risco de complicações trombóticas de acordo com a doença de base, e a urgência na coleta do líquor. A avaliação cuidadosa destas informações e uma monitorização neurológica rigorosa visando a detecção e o tratamento precoce de complicações podem reduzir o risco de sequelas neurológicas decorrentes de hemorragia. Uma decisão individualizada e uma efetiva comunicação entre o médico assistente e o responsável pela realização da punção lombar é essencial para minimizar potenciais riscos.


Subject(s)
Humans , Spinal Puncture/methods , Platelet Aggregation Inhibitors/administration & dosage , Anticoagulants/administration & dosage , Spinal Puncture/adverse effects , Thrombosis/prevention & control
12.
Medicina (B.Aires) ; 76(4): 230-234, Aug. 2016. tab
Article in Spanish | LILACS | ID: biblio-841582

ABSTRACT

La trombocitopenia inducida por heparina (TIH) es una reacción adversa inmunológica mediada por la formación de anticuerpos contra el complejo heparina-factor plaquetario 4 (FP4), caracterizada por la presencia de trombocitopenia y la asociación paradojal de trombosis arterial o venosa. Es una complicación poco frecuente pero grave del uso de cualquier tipo de heparina. En tratados con procedimientos cardiovasculares como intervención coronaria percutánea y cirugía de revascularización cardiaca, la prevalencia de anticuerpos es significativamente mayor que en otros escenarios clínicos. El reconocimiento de las características clínicas y de laboratorio permite la suspensión inmediata de la heparina y la instauración de tratamiento anticoagulante alternativo, para evitar la progresión y formación de nuevos trombos y sus complicaciones. En la presente revisión se resumen las diferentes alternativas terapéuticas para la TIH, en particular los anticoagulantes orales directos (DOACS) como el dabigatran, rivaroxaban y apixaban que pueden proporcionar una nueva opción para el tratamiento de TIH.


Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse reaction due to antibodies to a multimolecular complex of heparin and platelet factor 4 (PF4) characterized by moderate thrombocytopenia and paradoxical arterial or venous thrombosis. It is a relatively infrequent complication related to the administration of any type of heparin. In patients undergoing percutaneous coronary revascularization or coronary artery by-pass graft the prevalence of HIT is higher than in other clinical settings. Recognizing clinical and laboratory features of HIT allow immediate discontinuation of heparin and the use of alternative anticoagulants to avoid serious thrombotic complications. In this review, we summarize different therapeutic options for the treatment of HIT with special emphasis on direct oral anticoagulants (DOACS) such as dabigatran, rivaroxaban and apixaban. DOACS might represent a therapeutic alternative for HIT treatment.


Subject(s)
Humans , Thrombocytopenia/chemically induced , Thrombocytopenia/drug therapy , Heparin/adverse effects , Antithrombins/therapeutic use , Anticoagulants/adverse effects , Anticoagulants/therapeutic use , Thrombocytopenia/immunology , Thrombosis/prevention & control , Platelet Factor 4/immunology , Heparin/immunology , Venous Thrombosis/prevention & control , Anticoagulants/immunology
13.
Rev. chil. cardiol ; 35(2): 109-117, 2016. ilus, tab, graf
Article in Spanish | LILACS | ID: lil-796796

ABSTRACT

Introducción: El cierre percutáneo de orejuela izquierda con dispositivos percutáneos (CPOI) ha demostrado ser útil en la prevención de embolia arterial como alternativa al tratamiento anticoagulante (TACO) en pacientes con fibrilación auricular no valvular (FANV). Sin embargo, en las primeras semanas post implante, existe el riesgo de formación de trombos sobre el dispositivo. Objetivos: Describir e Identificar los factores de riesgo para la formación de trombos sobre el dispositivo posterior al cierre de orejuela izquierda. Métodos: Se incluyeron 15 pacientes con FANV y alto riesgo hemorrágico, sometidos a CPOI con dispositivo Ultrasept (Cardia Inc., Eagan, MN), en el Hospital Clínico de la Universidad Católica, entre Abril 2013 y Junio 2014. A todos se les realizó eco-cardiograma transesofágico (ETE) al primer, tercer y sexto mes post implante. Todos los pacientes recibieron aspirina en forma permanente y TACO por 45 días el que se reemplazó por clopidogrel hasta el sexto mes post implante. Se analizaron parámetros clínicos y ecocardiográficos en forma retrospectiva para identificar los factores de riesgo asociados a la formación de trombos sobre el dispositivo. Resultados: La edad promedio de los pacientes fue 77± 8 años, 73% de sexo masculino. El 80% tenía FA permanente y 20% FA paroxística. EL Score de CHA2DS2VASc promedio fue de 5 (mínimo 3, máximo 8 puntos). En 4 pacientes (26.6%), encontramos trombos en el dispositivo en el seguimiento con ETE (1 paciente al primer mes y 3 al tercer mes), sin consecuencias clínicas. Al comparar los pacientes que formaron trombos con el resto, no hubo diferencias en las variables clínicas (edad, sexo, Hipertensión arterial (HTA), Diabetes Mellitus (DM), Dislipidemia, Tabaquismo, Insuficiencia Renal, AVE previos), ni en las variables ecocardiográficas estudiadas, como el área de la aurícula izquierda (AI), contraste espontáneo en la AI, insuficiencia mitral ni cierre incompleto de orejuela (medida por la existencia de flujo peridispositivo). Sin embargo, los pacientes con trombos presentaron CHA2DS2VASc score más alto (7.1 vs 4.7; p= 0.001) y fracción de eyección (FE) más baja (43% vs 55%; p= 0.001). En la curva ROC de CHA2DS2VASc para predecir una mayor probabilidad de formación de trombos, un valor > 6 obtiene una sensibilidad de un 100% y una especificidad de un 80%. En nuestro seguimiento clínico de 2 años ± 5.7 meses posterior al implante, 1 paciente tuvo un AVE isquémico identificando como fuente enfermedad carotidea (no tenía trombos en el dispositivo). El resto de los pacientes se mantienen asintomáticos. Conclusiones: En nuestra experiencia, el CHA2DS-2VASc score (> 6) y la fracción de eyección baja, fueron factores de riesgo para la formación de trombos sobre el dispositivo de cierre de orejuela. Este hallazgo debería confirmarse en series más grandes dado que podría cambiar la estrategia de anticoagulación post implante.


Background: Percutaneous closure of the left atrial appendage (LAA) has been shown to be useful in the prevention of arterial embolism as an alternative to oral anticoagulants in patients with non valvular atrial fibrillation. However, thrombus formation may develop in the first weeks following device implantation/ Aim: to identify risk factors for thrombus development on devices used for LAA closure. Methods: 15 patients with non valvular AF and high risk for anticoagulant treatment were included. Patients received an Ultrasept (Cardia Inc., Eagan, MN) between April 2013 and June 2014. Transesophageal echocardiography was performed in all patients 1, 3 and 6 months post implant. All patients received aspirin permanently and acenocumarol for 45 days, followed by clopidogrel until 6 months post implant. Results: Mean age was 77 years old (SD 8). 73% were males. AF was permanent in 80% and paroxysmal in 20%. Mean CHA2DS2VASC was 8 (range 3 to 8). Thrombus were revealed by TEE in 4 patients (26.6%), at 1 month (1 patient) and at 3 months post implant (3 patients). No complications occurred in these patients. Clinical variables (age, sex, hyper-tension, diabetes, dyslipidemia, smoking habit, renal failure and prior strokes) were no different in patients with or without thrombus. The same was true for left atrial size, mitral insufficiency or incomplete closure of LAA. In contrast, patients with thrombus formation had a higher CHA2DS2VASc score (7.1 vs 4.7, p=0.001 and a lower LV ejection fraction (43% vs 55%, p=0.001). A CHA2DS2VASc score > 6 was 100% sensible and 80% specific for thrombus formation (ROC curve). After a follow-up of 24 ± 5 months only 1 patients had and ischemic cerebro-vascular event which was attributed to carotid artery disease (the patient had no evidence of device thrombus). All other patients remain asymptomatic. Conclusion: A CHA2DS2VASc score > 6 and a low ejection fraction were risk factors for thrombus formation on LAA closing device. Confirmation of these findings in a larger series of patients could lead to a change in anticoagulant strategy following the implantation of devices to close the LAA.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Atrial Fibrillation/surgery , Thrombosis/prevention & control , Cardiac Catheterization/adverse effects , Atrial Appendage/surgery , Atrial Appendage/diagnostic imaging , Thrombosis/etiology , Thrombosis/diagnostic imaging , Echocardiography/methods , Retrospective Studies , Risk Factors , ROC Curve , Follow-Up Studies , Risk Assessment/methods , Embolism/prevention & control , Forecasting
14.
Rev. Soc. Bras. Clín. Méd ; 14(4): 204-211, 2016.
Article in Portuguese | LILACS | ID: biblio-827214

ABSTRACT

OBJETIVO: Identificar o conhecimento de profissionais da saúde sobre o uso da varfarina no âmbito hospitalar. MÉTODOS: Trata-se de um estudo transversal, qualitativo, realizado em um hospital do Estado do Rio Grande do Sul, com 18 profissionais. RESULTADOS: A maioria dos entrevistados possui pouco conhecimento sobre as interações varfarina-medicamento, as quais poderiam ser fornecidas pela equipe de farmácia. As interações medicamentosas podiam representar riscos ao indivíduo e aumento de gastos ao sistema de saúde. Os profissionais também desconheciam a interação da varfarina com alimentos ricos em vitamina K, que podiam interferir no controle adequado da anticoagulação. CONCLUSÃO: As informações sobre seu uso e manejo estão descritas na literatura, mas os profissionais não têm como reter todas elas. Assim, verifica-se a importância das instituições de saúde implementarem programas específicos para manejo desses pacientes, como base em trabalho conjunto da equipe de saúde multiprofissional.


OBJECTIVE: To identify health professionals' knowledge about the use of warfarin in hospitals. METHODS: This is a crosssectional, qualitative study, conducted in a hospital of the state of Rio Grande do Sul, Brazil, with 18 professionals. RESULTS: It was found that most interviewees have little knowledge about warfarin drug interactions, and this information could be provided to professionals by the pharmacy staff. Drug interactions may pose risks to the patient and increase costs for the health system. These professionals also ignore warfarin interaction with food rich in vitamin K, which can interfere with the proper control of anticoagulation. CONCLUSION: The information on use and handling of this product is widely described in the literature, but health professionals are not able to remember all of them. Thus, it is important that healthcare institutions implement specific programs for these patients' management, based on joint work of a multidisciplinary health team.


Subject(s)
Humans , Male , Female , Anticoagulants/therapeutic use , Thrombosis/drug therapy , Thrombosis/prevention & control , Warfarin/administration & dosage , Warfarin/therapeutic use , Drug Interactions
15.
J. oral res. (Impresa) ; 4(1): 58-64, feb.2015.
Article in English | LILACS | ID: lil-776899

ABSTRACT

Population aging and the increasing rates of cardiovascular diseases have raised the number of patients receiving antithrombotic therapy in elective or emergency dental care, including surgical procedures. The aim of this article is to review the evidence and clinical guidelines for management of patients on antithrombotic therapy published in the past five years. TheAmerican Antithrombotic Therapy Guideline - 2012 - generally recommends not to suspend antiplatelet or anticoagulant treatment in dental procedures since they are considered to have low bleeding risk and easy resolution. In the dental field, there is ample published evidence regarding oral surgical procedure management, especially by maxillofacial surgeons, showing a low number of complications associated with extractions or other minor oral surgical procedures without suspending antithrombotic drugs and only taking some minimum safeguards, such as healing by first intention or the use of some local hemostatic agents. In general, patients under chronic antithrombotic therapy should keep their medication when undergoing low and medium complexity dental procedures, since complications are minor and easy to handle. Due to interactions between them, particular care should be taken with patients using more than one drug...


El envejecimiento poblacional y el aumento patologías cardiovasculares ha aumentado la cantidad de pacientes bajo terapia antitrombótica que reciben atención dental electiva o de urgencia, incluidos los procedimientos quirúrgico. El objetivo de este artículo es revisar la evidencia y las guías clínicas publicadas en los últimos 5 anos respecto al manejo odontológico de pacientesbajo terapia antitrombótica. La guía clínica americana de terapia antitrombótica del ano 2012 recomienda en general no suspender la terapia antiplaquetaria ni anticoagulante, en los procedimientos dentales ya que son considerados como de bajo riesgo de sangrado y de fácil resolución. En el área odontológica existe amplia evidencia publicada respecto al manejo de procedimientos quirúrgicos bucales, especialmente por cirujanos maxilofaciales, que ha demostrado la baja cantidad de complicaciones asociadas a exodoncias u otras cirugías menores de la cavidad bucal; sin la necesidad de suspender los medicamentos antitrombóticos y tomando algunos resguardos mínimos como la cicatrización por primera intención o el uso de algunos agentes hemostáticos locales. En términos generales los pacientes bajo terapia antitrombótica crónica deben mantener sus medicamentos cuando son sometidos a procedimientos dentales de baja y mediana complejidad, ya que las complicaciones son menores y de sencillo manejo. Se debe poner especialatención en pacientes con más de un medicamento, por las interacciones entre ellos...


Subject(s)
Humans , Surgery, Oral/methods , Fibrinolytic Agents/therapeutic use , Thrombosis/prevention & control , Aspirin/therapeutic use , Preoperative Care/adverse effects , Fibrinolytic Agents/adverse effects , Hemorrhage/chemically induced , Risk
16.
Rev. gastroenterol. Perú ; 35(1): 63-71, ene. 2015. tab
Article in Spanish | LILACS, LIPECS | ID: lil-746995

ABSTRACT

La selección de un medicamento específico perteneciente a una clase farmacológica es bajo criterios de eficacia, seguridad, costo y conveniencia. Los Antiinflamatorios No Esteroideos (AINEs) actualmente se constituyen en uno de los medicamentos más consumidos en el mundo, por lo tanto es de gran importancia la revisión de los aspectos de seguridad de este grupo farmacológico. El presente trabajo tiene el objetivo de analizar bajo las evidencias disponibles hasta la actualidad, la seguridad de los AINES con 3 criterios principales: gastrolesividad, cardiotoxicidad y nefrotoxicidad.


The choice of a specific medication belonging to a drug class is under the criteria of efficacy, safety, cost and suitability. NSAIDs currently constitute one of the most consumed drugs in the world, so it is very important review of the safety aspects of this drug class. This review has the objective of analyze the safety of NSAIDs on 3 main criteria: gastrolesivity, cardiotoxicity and nephrotoxicity.


Subject(s)
Animals , Female , Humans , Mice , Macrophages/metabolism , Thromboplastin/metabolism , Thrombosis/blood , Thrombosis/therapy , Apolipoproteins E/metabolism , Blood Coagulation/physiology , Thrombosis/prevention & control
17.
Rev. urug. cardiol ; 29(3): 311-316, dic. 2014. tab
Article in Spanish | LILACS | ID: lil-754318

ABSTRACT

Introducción: la eficacia terapéutica y seguridad de la warfarina en prevención de trombosis en pacientes con fibrilación auricular (FA)/flutter y/o prótesis valvulares depende del adecuado nivel de anticoagulación, valorado mediante mediante la relación normalizada internacional o international normalized ratio (INR) (INR). El porcentaje de tiempo en rango terapéutico (TRT) valora la calidad de la anticoagulación con warfarina y se vincula inversamente con la incidencia de complicaciones trombóticas o hemorrágicas. Objetivos: valorar la calidad de anticoagulación oral con warfarina a través del análisis del TRT en la policlínica de cardiología. Identificar factores asociados a un adecuado nivel de anticoagulación (TRT ³ 65%). Material y método: estudio retrospectivo, observacional y analítico de una cohorte de 117 pacientes anticoagulados con warfarina entre el 1º de junio de 2012 y el 31 de julio de 2013. El TRT individual se calculó mediante método de Rosendaal (interpolación lineal). Las variables analizadas fueron: edad, sexo, indicación de anticoagulación, nivel de instrucción, grado de adherencia, situación familiar, comorbilidades y número de fármacos concomitantes. Resultados: la media de edad fue de 67 ± 14 años, sexo femenino 62%, anticoagulación por FA 63% y por válvula mecánica 37%. La media de TRT fue de 56,6%. Solo el 38% de los pacientes tuvieron una media de TRT adecuada (³ 65%) y esta se asoció de forma positiva a un rango etario entre 50-74 años (70,5%) (p = 0,04) y al uso concomitante de tres o más fármacos (79,5%) (p = 0,044). Conclusión: la media de TRT estuvo por debajo del nivel definido como adecuada calidad de anticoagulación. Una adecuada anticoagulación se asoció a menor edad y uso de tres o más fármacos. Estos resultados constituyen la base para el desarrollo de estrategias futuras para una mejor asistencia.


Background: the efficacy and safety of warfarin in preventing thrombosis in patients with atrial fibrillation/flutter or prosthetic valves depends on adequate anticoagulation levels expressed as INR (International Randomized Ratio). The percentage of time in therapeutic range (TTR) assesses the quality of warfarin anticoagulation and is inversely associated with the presence of thrombotic or hemorrhagic complications. Objective: to assess the quality of anticoagulation through analysis of TTR. Identify factors associated with an adequate level of anticoagulation (TTR³65%). Method: observational, retrospective and analytic study of a cohort of 117 patients anticoagulated with warfarin from June 1, 2012 to July 31, 2013. The individual TTR was calculated using Rosendaal method (linear interpolation). The variables analyzed were age, sex, indication for anticoagulation, level of education, degree of adherence, family status, comorbidities and number of concomitant drugs. X² test was used for statistical analysis of categorical variables. Result: mean age was 67 ± 14 years, 62 % were female and indication for anticoagulation was FA in 63% and mechanical valve in 37% of patients. The mean TTR was 56,6%. Only 38% had an adequate TTR and it was associated with age between 50-74 years (70.5%) (p=0,04) and concomitant use of 3 or more drugs (79.5%) (p=0,044). Conclusion: The mean TTR was below the value defined as good control. Better control was associated with younger age and use of three or more drugs. These results support the development of strategies for a better quality of assistance.


Subject(s)
Humans , Male , Adult , Thrombosis/prevention & control , Warfarin/pharmacokinetics , International Normalized Ratio , Anticoagulants , Warfarin/therapeutic use , Administration, Oral
18.
Rev. bras. cir. cardiovasc ; 29(4): 595-605, Oct-Dec/2014. tab, graf
Article in Portuguese | LILACS | ID: lil-741722

ABSTRACT

Objetivo: Comparar a eficácia do AAS e da Varfarina na profilaxia da trombose em pacientes submetidos a operação cavopulmonar total. Avaliar se fatores de coagulação (VII, VIII e Proteína C), dados clínicos, fenestração ou fatores hemodinâmicos, interferem na trombose no pós-operatório. Métodos: Estudo prospectivo e randomizado de 30 pacientes, randomizados em Grupo I (Varfarina) e Grupo II (AAS), submetidos à derivação cavopulmonar total com tubo extracardíaco, entre 2008 e 2011, com seguimento de dois anos. Foram realizadas consultas clínicas que avaliavam efeitos colaterais e aderência. Realizado ecocardiograma transesofágico no pós-operatório imediato, 3, 6,12 e 24 meses; angiotomografia aos 6, 12 e 24 meses de pós-operatório para avaliação de alterações na parede interna do tubo ou trombos e cintilografia pulmonar, para avaliar possível TEP. Resultados: Dois óbitos no grupo I; 33,3% dos pacientes apresentaram trombo (46,7% no Grupo II). A ocorrência prévia de trombo e baixos níveis de proteína C da coagulação foram os únicos fatores que influenciaram no tempo livre de trombo (P=0,035 e 0,047). Avaliação angiotomográfica: 35,7% dos pacientes do grupo II tinham atapeteamento maior que 2 mm (P=0,082). Cintilografia: dois pacientes apresentaram TEP no grupo II. Cinco pacientes tiveram dificuldade de aderência, 4 no grupo I com INR variando de 1 a 6,4. Conclusão: A ocorrência prévia de trombo é um fator de risco para trombose no pós-operatório. Pacientes em uso de AAS tendem a depósito de material na parede do tubo. O número reduzido da amostra não permitiu concluir qual a droga mais eficaz na prevenção da trombose na população estudada. .


Objective: To compare the efficacy of aspirin and warfarin for prophylaxis of thrombosis in patients undergoing total cavopulmonary anastomosis. Evaluate whether coagulation factors (VII, VIII and protein C), clinical data, fenestration or hemodynamic factors, interfere with postoperative thrombosis. Methods: A prospective, randomized study of 30 patients, randomized into Group I (Warfarin) and Group II (AAS), underwent total cavopulmonary shunt with extracardiac conduit, between 2008 and 2011, with follow-up by clinical visits to evaluate side effects and adhesion. Performed transesophageal echocardiography in post operatory time, 3, 6,12 and 24 months; angiotomography at 6, 12 and 24 months to evaluate changes in the internal tube wall or thrombi and pulmonary scintigraphy to evaluate possible PTE. Results: Two deaths in group I; 33.3% of patients had thrombus (46.7% in Group II). The previous occurrence of thrombus and low levels of coagulation protein C were the only factors that influenced the time free of thrombus (P=0.035 and 0.047). Angiotomographic evaluation: 35.7% in group II presented material accumulation greater than 2 mm (P=0.082). Scintigraphy: two patients had PTE in group II. Five patients had difficulty to comply with the treatment, 4 in group I with INR ranging from 1 to 6.4. Conclusion: The previous occurrence of thrombus is a risk factor for thrombosis in the postoperative period. Patients using AAS tend to deposit material in the tube wall. The small sample size did not allow to conclude which is the most effective drug in the prevention of thrombosis in this population. .


Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Anticoagulants/therapeutic use , Aspirin/therapeutic use , Fontan Procedure/methods , Platelet Aggregation Inhibitors/therapeutic use , Thrombosis/prevention & control , Warfarin/therapeutic use , Echocardiography , Fontan Procedure/adverse effects , Fontan Procedure/mortality , Kaplan-Meier Estimate , Prospective Studies , Postoperative Complications/drug therapy , Postoperative Complications/prevention & control , Pulmonary Embolism/prevention & control , Pulmonary Embolism , Radionuclide Imaging , Statistics, Nonparametric , Time Factors , Tomography, X-Ray Computed , Treatment Outcome , Thrombosis/drug therapy , Thrombosis/mortality , Ventricular Dysfunction/physiopathology
SELECTION OF CITATIONS
SEARCH DETAIL