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1.
Medicina (B.Aires) ; 81(3): 454-457, jun. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346484

ABSTRACT

Resumen La flegmasia cerulea dolens es una complicación rara y poco frecuente de la trombosis venos a profunda. Los principales factores predisponentes son los procesos neoformativos, estados de hiper coagulabilidad, insuficiencia cardíaca congestiva, embarazo, inmovilización prolongada y cirugías. Se caracteriza por edema masivo, dolor intenso y cianosis. Sin tratamiento evoluciona con isquemia, necrosis y amputación del miembro comprometido. No existe consenso en su tratamiento, pero éste debe ser rápido, multidisciplinario y agresivo. La anticoagulación con heparina, la fibrinólisis sistémica, la trombectomía percutánea con fibrinólisis local, la trombectomía quirúrgica, la fasciotomía, la colocación de filtro de vena cava inferior y la amputación son algunos de los tratamientos propuestos.


Abstract Phlegmasia cerulea dolens (FCD) is a rare complication of deep vein thrombosis. Its cause is unknown. The main predisposing factors for the disease are neoformative processes, hypercoagulable states, congestive heart failure, pregnancy, prolonged immobilization, and surgeries on the affected limb. FCD is characterized by massive edema, severe pain, and cyanosis. The diagnosis is clinical. It is associated in most cases with pulmonary embolism and can lead to loss of the compromised limb if not treated in time. So far there is no consensus on its treatment. In clinical practice the use of anticoagulation with heparin, local thrombolysis, systemic fibrinolysis, surgical thrombectomy, fasciotomy, and inferior vena cava filter are described. In irreversible cases amputation is required. We present the case of a patient with FCD, the treatment performed and the evolution.


Subject(s)
Humans , Thrombophlebitis/drug therapy , Thrombophlebitis/diagnostic imaging , Venous Thrombosis/drug therapy , Venous Thrombosis/diagnostic imaging , Heparin , Thrombectomy , Fibrinolysis
2.
Bol. méd. postgrado ; 37(1): 21-26, Ene-Jun 2021. graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1147874

ABSTRACT

El tratamiento anticoagulante oral con fármacos inhibidores de la vitamina K como la warfarina se viene utilizando desde hace décadas para la terapia y prevención de la enfermedad tromboembólica con efectos secundarios ampliamente conocidos, pero con una utilidad clínica bien contrastada. El objetivo de este estudio fue determinar la proporción de mortalidad y hospitalización de la consulta de anticoagulación y trombosis del Centro Cardiovascular Regional ASCARDIO en el año 2017 para lo cual se realizó un estudio descriptivo transversal que incluyó una muestra de 294 pacientes. La principal indicación de anticoagulación fue la fibrilación auricular (73%) seguida de la enfermedad tromboembólica venosa (13%) e isquemia miocárdica (9%). Se registró una mortalidad de 11,7% siendo la principal causa de muerte de origen cardíaco (58%). La edad promedio de los pacientes fallecidos fue de 65 años, siendo 53% del sexo femenino; para el momento de la muerte, el 65% de los pacientes estaba tomando warfarina. La hospitalización se observó en el 10% de la muestra siendo la principal causa de la misma la cardíaca (60%) seguida de causas hemorrágicas (18%); de los pacientes hospitalizados, la edad promedio fue de 66 años siendo 52% del sexo femenino; el 90% de los pacientes estaba tomando warfarina al momento de la hospitalización. El análisis de riesgo para mortalidad y hospitalización según causa y estatus de warfarina no mostró significancia estadística. No se evidenció relación de riesgo estadísticamente significativa entre muerte, hospitalización y estatus de la warfarina. Hubo mayor proporción de muertes (45%) y hospitalización (17%) en el grupo que ingresó con diagnóstico de isquemia miocárdica(AU)


Oral anticoagulant treatment with vitamin K inhibitor drugs such as warfarin has been used for decades for the therapy and prevention of thromboembolic disease with widely known side effects but with well-proven clinical utility. To determine the proportion of mortality and hospitalization of the anticoagulation and thrombosis clinic of the ASCARDIO Regional Cardiovascular Center in 2017 a descriptive cross-sectional study was carried out that included a sample of 294 patients. The results show that the main indication for anticoagulation was atrial fibrillation (73%) followed by venous thromboembolic disease (13%) and myocardial ischemia (9%). An 11.7% mortality rate was observed. The mean age of the deceased was 65 years with a slight prevalence of the female sex (53%). The main cause of death was cardiac (58%) and 65% of the deceased patients were taking warfarin at the moment of death. A 10% hospitalization rate was observed with an average age of hospitalized patients of 66 years; 52% were females. The main cause of hospitalization was cardiac (60%) followed by hemorrhage (18%) and 90% of the patients were taking warfarin at the time of hospitalization. The risk analysis for mortality and hospitalization according to cause and status of warfarin did not show statistical significance. There was a higher proportion of deaths (45%) and hospitalization (17%) in the group admitted with a diagnosis of myocardial ischemia(AU)


Subject(s)
Humans , Male , Female , Aged , Vitamin K/antagonists & inhibitors , Warfarin/therapeutic use , Venous Thrombosis/drug therapy , Anticoagulants , Atrial Fibrillation/drug therapy , Thromboembolism , Vascular Diseases , Myocardial Ischemia/drug therapy
3.
Article in Chinese | WPRIM | ID: wpr-921544

ABSTRACT

With the wide application of vascular Doppler ultrasound as well as the improvement of instrument precision and personnel operation practice,calf muscular venous thrombosis(CMVT)has been more and more frequently diagnosed among patients,becoming a common clinical disease.However,it is controversial about the anticoagulant therapy for CMVT patients.In this article,we summarize the current research progress of anticoagulation therapy,aiming to provide reference for the treatment of CMVT.


Subject(s)
Anticoagulants/therapeutic use , Humans , Leg , Muscle, Skeletal , Pulmonary Embolism , Venous Thrombosis/drug therapy
4.
In. Machado Rodríguez, Fernando; Liñares, Norberto; Gorrasi, José; Terra Collares, Eduardo Daniel. Manejo del paciente en la emergencia: patología y cirugía de urgencia para emergencistas. Montevideo, Cuadrado, 2020. p.287-301, tab.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1343013
5.
Rev. bras. cancerol ; 65(3)19/09/2019.
Article in Portuguese | LILACS | ID: biblio-1048431

ABSTRACT

Introdução: A trombose venosa profunda é uma complicação comum e intimamente relacionada às neoplasias. Novos anticoagulantes orais foram lançados nos últimos anos, entre eles, a rivaroxabana. Objetivo: O estudo analisou o custo-efetividade e o impacto orçamentário da rivaroxabana versus enoxaparina. Método: Trata-se de uma coorte retrospectiva, realizada com população oncológica sob a perspectiva do Sistema Único de Saúde. Por meio do modelo de árvore de decisão, foram comparados desfechos de sangramento e retrombose, e custos do tratamento da trombose venosa profunda com rivaroxabana ou enoxaparina, em um horizonte temporal de sete meses. Custos diretos foram extraídos do Sistema de Gerenciamento da Sistema de Gerenciamento da Tabela de Procedimentos, Medicamentos, Órteses, Próteses e Materiais e Medicamentos Especiais do SUS (SIGTAP-SUS), e empregou-se a Planilha Brasileira de Impacto Orçamentário de tecnologias da saúde para avaliação do impacto orçamentário com base na população brasileira de 2017, em cinco anos. A análise de sensibilidade simulou cenários tanto na avaliação de custo-efetividade quanto na de impacto orçamentário. Resultados: Cento e cinquenta e três pacientes foram incluídos na análise de custo-efetividade com diversas neoplasias. A rivaroxabana demonstrou não inferioridade terapêutica comparada à enoxaparina. A razão de custo-efetividade incremental foi de R$ 5.521,71 por unidade de benefício ganho com a nova alternativa, rivaroxabana. Na análise de sensibilidade, a rivaroxabana manteve-se dominante. Foi demonstrada uma economia no impacto orçamentário incremental de R$ 85.950.791.129,21 com a utilização de rivaroxabana ao longo de cinco anos em comparação ao cenário de referência, e esta se manteve como opção mais econômica perante as análises de sensibilidade. Conclusão: A rivaroxabana, nesse contexto, apresentou-se como uma importante alternativa terapêutica.


Introduction: Deep vein thrombosis is a common complication and closely related to neoplasms. New oral anticoagulants have been launched in recent years, among them rivaroxaban. Objective: The study analyzed the cost-effectiveness and budget impact of rivaroxaban versus enoxaparin. Method: This is a retrospective cohort, performed with oncological population from the perspective of Sistema Único de Saúde (National Health System). The decision tree model compared outcomes of bleeding and rethrombosis, and costs of treatment of deep venous thrombosis with rivaroxaban or enoxaparin in a time horizon of seven months. Direct costs were extracted from the SIGTAP-SUS, and the Brazilian Spreadsheet for Budgetary Impact of Health Technologies was used to evaluate the budgetary impact based in the Brazilian population of 2017 over a five-year period. The sensitivity analysis simulated scenarios for both cost-effectiveness and budget impact assessments. Results: One hundred and fifty-three patients were included in the cost-effectiveness analysis with several neoplasms. Rivaroxaban demonstrated no therapeutic inferiority compared to enoxaparin. The incremental cost-effectiveness ratio was R$ 5,521.71 per benefit unit spared with the new alternative, rivaroxaban. In the sensitivity analysis, rivaroxaban remained dominant. An economy in incremental budget impact of R$ 85,950,791,129.21 was demonstrated with the use of rivaroxaban over five years in comparison to the reference scenario, and this continued as the most economic option in relation to sensitivity analyzes. Conclusion: In this context rivaroxaban was an important therapeutic alternative.


Introducción: La trombosis venosa profunda es una complicación común e íntimamente relacionada a las neoplasias. Los nuevos anticoagulantes orales. Objetivo: El estudio analizó el Costo-Efectividad y el Impacto Presupuestario de la rivaroxabana versus enoxaparina. Método: En el modelo de árbol de decisión se compararon los resultados de la hemorragia y la retrombosis, y los costos del tratamiento de la trombosis venosa profunda con rivaroxabana o enoxaparina, con una cohorte retrospectiva, realizada con población oncológica bajo la perspectiva del Sistema Único de Salud en un horizonte temporal de siete meses. Los costos directos fueron extraídos del SIGTAP-SUS, y se empleó la Planilla Brasileña de Impacto Presupuestario de Tecnologías de la Salud para evaluación del Impacto Presupuestario con base en la población brasileña de 2017 en un horizonte temporal de cinco años. El análisis de sensibilidad simuló escenarios tanto en la evaluación de Costo-Efectividad y en la de Impacto Presupuestario. Resultados: Ciento cincuenta y tres pacientes fueron incluidos en el análisis de Costo-Efectividad con diversas neoplasias. La rivaroxabana demostró no inferioridad terapéutica comparada a la enoxaparina. La razón de costo-efectividad incremental fue de R $ 5.521,71 por unidad de beneficio ganada con la nueva alternativa, rivaroxabana. En el análisis de sensibilidad, la rivaroxabana se mantuvo dominante. Se demostró una economía em el Impacto Presupuestario incremental de R$ 85.950.791.129,21 con la utilización de rivaroxabana a lo largo de 5 años en comparación al escenario de referencia, y ésta se mantuvo como opción más económica ante los análisis de sensibilidad. Conclusión: La rivaroxabana, en este contexto, se presentó como una importante alternativa terapéutica.


Subject(s)
Humans , Enoxaparin/economics , Venous Thrombosis/drug therapy , Rivaroxaban/economics , Neoplasms/complications , Unified Health System , Cost-Benefit Analysis , Economics, Pharmaceutical , Anticoagulants/economics
7.
Rev. latinoam. enferm. (Online) ; 26: e2990, 2018. tab, graf
Article in English | LILACS, BDENF | ID: biblio-961167

ABSTRACT

ABSTRACT Objectives: To evaluate case series studies that quantitatively assess the effects of catheter-directed thrombolysis (CDT) and compare the efficacy of CDT and anticoagulation in patients with acute lower extremity deep vein thrombosis (DVT). Methods: Relevant databases, including PubMed, Embase, Cochrane, Ovid MEDLINE and Scopus, were searched through January 2017. The inclusion criteria were applied to select patients with acute lower extremity DVT treated with CDT or with anticoagulation. In the case series studies, the pooled estimates of efficacy outcomes for patency rate, complete lysis, rethrombosis and post-thrombotic syndrome (PTS) were calculated across the studies. In studies comparing CDT with anticoagulation, summary odds ratios (ORs) were calculated. Results: Twenty-five articles (six comparing CDT with anticoagulation and 19 case series) including 2254 patients met the eligibility criteria. In the case series studies, the pooled results were a patency rate of 0.87 (95% CI: 0.85-0.89), complete lysis 0.58 (95% CI: 0.40-0.75), rethrombosis 0.11 (95% CI: 0.06-0.17) and PTS 0.10 (95% CI: 0.08-0.12). Six studies comparing the efficacy outcomes of CDT and anticoagulation showed that CDT was associated with a reduction of PTS (OR 0.38, 95%CI 0.26-0.55, p<0.0001) and a higher patency rate (OR 4.76, 95%CI 2.14-10.56, p<0.0001). Conclusion: Acute lower extremity DVT patients receiving CDT were found to have a lower incidence of PTS and a higher incidence of patency rate. In our meta-analysis, CDT is shown to be an effective treatment for acute lower extremity DVT patients.


RESUMO Objetivos: Avaliar os estudos de séries de casos e avaliar quantitativamente os efeitos da trombólise dirigida por cateter (TDC) e comparar a eficácia entre TDC e anticoagulação nos pacientes com trombose venosa profunda aguda das extremidades inferiores (TVP) para tratamento futuro. Métodos: Foram pesquisadas as seguintes bases de dados relevantes: PubMed, Embase, Cochrane, Ovid MEDLINE e Scopus​. Os critérios de inclusão foram aplicados para pacientes selecionados com TVP aguda de extremidades inferiores tratados com TDC comparada a TDC com anticoagulação. Nos estudos de série de casos, as estimativas agrupadas de resultados de eficácia para a taxa de permeabilidade, lise completa, retrombose e síndrome pós-trombótica (SPT) foram calculadas em todos os estudos. Em estudos comparando TDC com anticoagulação, foi calculada a razão de chance de resumo (summary odds ratio - OR). Resultados: Vinte e cinco artigos (seis comparando TDC com anticoagulação e 19 séries de casos), incluindo 2.254 pacientes, preencheram os critérios de elegibilidade. Nos estudos da série de casos, os resultados agrupados foram: taxa de permeabilidade 0,87 (IC95%: 0,85-0,89), lise completa 0,58 (IC95%: 0,40-0,75), e retrombose 0,11 (IC95%: 0,06-0,17), SPT 0,10 (IC95%: 0,08-0,12). Seis estudos que compararam os resultados de eficácia entre TDC e anticoagulação mostraram que TDC foi associada à redução da SPT (OR 0,38; IC95%: 0,26-0,55; p<0,0001) e maior taxa de permeabilidade (OR 4,76; IC95%: 2,14-10,56; p<0,0001). Conclusão: Pacientes com TVP aguda de extremidades inferiores que recebem TDC estão associados a uma menor incidência de SPT e maior incidência de taxa de permeabilidade. Em nossa metanálise, TDC é um tratamento eficaz para pacientes com TVP aguda de extremidades inferiores.


RESUMEN Objetivos: Evaluar estudios de series de casos y evaluar cuantitativamente los efectos de la trombólisis dirigida por catéter (TDC) y comparar la eficacia entre la TDC y anticoagulación en pacientes con trombosis venosa profunda (TVP) aguda de las extremidades inferiores para el tratamiento futuro. Métodos: Se realizaron búsquedas en bases de datos relevantes, incluyendo PubMed, Embase, Cochrane, Ovid MEDLINE y Scopus hasta enero de 2017. Los criterios de inclusión se aplicaron a pacientes seleccionados con TVP aguda de extremidad inferior tratados con TDC o comparados con TDC y anticoagulación. En estudios de series de casos, las estimaciones agrupadas de los resultados de eficacia para la tasa de patencia, la lisis completa, la retrombosis y el síndrome postrombótico (SPT) se calcularon a través de los estudios. En estudios que compararon la TDC con la anticoagulación, se calculó el resumen de las razónes de posibilidades (RP). Resultados: 25 artículos (seis que comparan TDC con anticoagulación y 19 series de casos) que incluyeron 2254 pacientes qienes cumplieron los criterios de elegibilidad. En los estudios de series de casos, los resultados agrupados fueron: tasa de patencia 0,87 (IC 95%: 0,85; 0,89), lisis completa 0,58 (IC 95%: 0,40; 0,75), retrombosis 0,11 (IC 95%: 0,06; 17,0), SPT 0,10 (IC 95%: 0,08; 0,12). Seis estudios que compararon los resultados de eficacia entre la TDC y anticoagulación mostraron que la TDC se asoció con una reducción de SPT (RP 0,38; IC 95%: 0,26; 0,55; p<0,0001) y una mayor tasa de patencia (RP 4,76; IC 95%: 2,14; 10,56; p<0,0001). Conclusión: Los pacientes con TVP aguda de extremidad inferior que reciben TDC se asocian con una menor incidencia de SPT y una mayor incidencia de tasa de patencia. En nuestro metanálisis, la TDC es un tratamiento efectivo para pacientes con TVP aguda de extremidad inferior.


Subject(s)
Humans , Catheterization, Peripheral , Thrombolytic Therapy/methods , Venous Thrombosis/drug therapy , Lower Extremity/blood supply , Anticoagulants/therapeutic use , Acute Disease , Treatment Outcome
8.
Rev. guatemalteca cir ; 23(1): [76-82], ene-dic,2017.
Article in Spanish | LILACS | ID: biblio-884892

ABSTRACT

La trombosis de la vena mesentérica superior, es una patología del grupo de las isquemias intestinales agudas; de sintomatología inespecífica y dificil diagnóstico. Que tiene baja frecuencia 5-10% de las isquemias intestinales agudas; pero una gran mortalidad 50-75%. Presenta síntomas y signos parecidos a otras patologías de origen abdominal y los estudios complementarios dan resultados inespecíficos por lo que se diagnostica tardía y erróneamente en muchas ocasiones. Caso clínico. Se analiza el caso de un paciente masculino de 27 años, sin antecedentes de relevancia, con isquemia mesentérica aguda, que cursó con dolor abdominal inespecífico de 2 días de evolución. Discusión. La isquemia mesentérica es una patología con elevada mortalidad, su pronóstco depende de la rapidez del diagnóstco y el tratamiento acertado y precoz. Conclusión. El retraso del diagnóstico y la terapéutica aumentan la mortalidad. Tiene mejor pronóstico si tiene un precoz y adecuado diagnóstico y tratamiento agresivo.


Upper mesenteric vein thrombosis is a disease of acute intestinal ischemia; of non-specific symptoms and dificult diagnosis. It has low incidence, 5-10% of acute intestinal ischemia; but 50-75% of mortality. It presents symptoms and signs similar to other pathologies of abdominal origin and the complementary studies give unspecific results for what is a late diagnosis and erroneous in many occasions. We present the case of a 27 year old male patent, with no relevant history, with acute mesenteric ischemia, who had 2 days of non- specific abdominal pain. Mesenteric ischemia is a disease with high mortality rate, its prognosis depends on the timing of diagnosis and early treatment. Delayed diagnosis and therapy increases mortality.


Subject(s)
Humans , Male , Appendectomy/statistics & numerical data , Mesenteric Artery, Superior/pathology , Mesenteric Ischemia/diagnosis , Venous Thrombosis/drug therapy
9.
Rev. chil. obstet. ginecol. (En línea) ; 82(5): 534-538, Nov. 2017. tab, graf
Article in English | LILACS | ID: biblio-899939

ABSTRACT

Se presentan 3 casos de trombosis de la vena ovárica, uno en relación a cirugía pélvica y dos durante el postparto. La trombosis de la vena ovárica es una complicación rara, de presentación clínica inespecífica, lo que hace plantearse un diagnóstico diferencial con otras patologías más frecuentes (apendicitis, pielonefritis, etc), siendo la TAC el gold standard para su diagnóstico. El tratamiento más adecuado son los anticoagulantes.


We report 3 cases of varian vein thrombosis, one in relation with pelvic surgery and 2 during the postpartum period. The ovarian vein thrombosis is a rare complication, with inespecific symptoms, that is why it is obligatory to propose a differential diagnosis with more frecuent patologies (appendicitis, pyelonephritis, etc.), the CAT is the gold standard in its diagnosis. Anticoagulants are the most suitable treatment.


Subject(s)
Humans , Male , Adult , Middle Aged , Ovarian Diseases/complications , Ovary/blood supply , Venous Thrombosis/etiology , Venous Thrombosis/drug therapy , Gynecologic Surgical Procedures/adverse effects , Venous Thrombosis/diagnosis , Postpartum Period , Anticoagulants/therapeutic use
10.
Medicina (B.Aires) ; 75(5): 307-310, Oct. 2015. ilus
Article in Spanish | LILACS | ID: biblio-841518

ABSTRACT

La trombocitopenia inducida por heparina (TIH) es una reacción adversa inmunológica caracterizada por trombocitopenia y la asociación paradojal de trombosis arterial o venosa. Es causada por la formación de anticuerpos IgG contra el complejo multimolecular de heparina-factor plaquetario 4 (FP4). Fondaparinux es un inhibidor selectivo del factor Xa que tiene escasa afinidad por el FP4 y posee un menor potencial para inducir una respuesta inmunológica, haciendo del mismo un agente potencialmente útil en el tratamiento de la TIH. Se presenta el caso de una mujer de 73 años con TIH asociada a fenómenos trombóticos arteriales y venosos, que recibió exitosamente fondaparinux, con normalización del recuento plaquetario y sin progresión trombótica.


Heparin induced thrombocytopenia (HIT) is an immune-mediated adverse reaction characterized by thrombocytopenia and paradoxical arterial or venous thrombosis, due to the formation IgG antibodies directed to a multimolecular complex of heparin-platelet factor 4 (PF4). Fondaparinux is a selective factor Xa inhibitor with little affinity for PF4 and thus less likely to induce an immune response, making fondaparinux a potentially useful drug for the treatment of HIT. Herein we report the case of a 73 years old woman with HIT associated with arterial and venous thrombosis that was successfully treated with fondaparinux, with normalization of the platelet countand without progression of thrombosis.


Subject(s)
Humans , Female , Aged , Polysaccharides/therapeutic use , Thrombocytopenia/drug therapy , Heparin/adverse effects , Venous Thrombosis/drug therapy , Anticoagulants/therapeutic use , Platelet Count , Thrombocytopenia/chemically induced , Platelet Factor 4/immunology , Treatment Outcome , Venous Thrombosis/chemically induced , Fondaparinux , Anticoagulants/adverse effects , Necrosis
11.
Rev. cuba. angiol. cir. vasc ; 16(1): 44-53, ene.-jun. 2015.
Article in Spanish | LILACS | ID: lil-739164

ABSTRACT

Introducción: la extensión de las indicaciones del tratamiento anticoagulante oral y el incremento en la edad de los pacientes que requieren de este tratamiento, posibilitaron cambios en su uso y control sin disminuir su eficacia, por lo que se considera una terapéutica de beneficio para el adulto mayor. Objetivos: describir el comportamiento del control del tratamiento anticoagulante oral en población geriátrica con enfermedad tromboembólica venosa. Métodos: estudio descriptivo, analítico, en 76 pacientes (60-85 años) atendidos por consulta especializada en el Instituto Nacional de Angiología y Cirugía Vascular un en un periodo de dos años. Se evaluó el grado de control de la anticoagulación y se determinó la frecuencia de eventos hemorrágicos y otras complicaciones. Resultados: hubo buen control de la anticoagulación oral durante los dos años en pacientes mayores y menores de 60 años. No se encontraron diferencias estadísticamente significativa entre ambos grupos. Se observó un mayor índice de eventos hemorrágicos menores en la muestra estudiada. Conclusiones: el control del tratamiento anticoagulante oral en el adulto mayor tiene un comportamiento similar en ambos grupos de edades estudiados, por lo que dicho tratamiento se debe utilizar en todas las indicaciones si se tiene en cuenta la relación riesgo-beneficio(AU)


Introduction: the scope of the oral anticoagulant treatment indications and the older age of patients in need of this treatment favored changes in its use and control without reducing its efficacy, so this is considered beneficial therapeutics for the elderly. Objective: to describe the behavior of the control of oral anticoagulant treatment in the elderly population with thromboembolic venous disease. Methods: a descriptive and analytical study of 76 patients (60 to 85 years) seen at the specialized service of the National Institute of Angiology and Vascular Surgery in two years. The level of control of anticoagulation was evaluated, the frequency of hemorrhagic events and other complications were determined. Results: good control of the oral anticoagulant treatment was reached during the 2 year-period in younger than and over 60 years-old patients. No significant statistical difference was found when comparing the two groups. A higher index of slight hemorrhagic events was found in the study sample Conclusions: the control of the oral anticoagulant treatment in the older adult behaved similarly to that of the patient younger than 60 years, so the above mentioned treatment should be used in all the indications if the risk-benefit ratio is considered(AU)


Subject(s)
Aged , Anticoagulants/therapeutic use , Venous Thrombosis/drug therapy , Epidemiology, Descriptive
12.
Rev. chil. pediatr ; 85(6): 708-713, dic. 2014. ilus, tab
Article in Spanish | LILACS | ID: lil-734812

ABSTRACT

Thrombosis of the inferior vena cava represents a significant percentage of all venous thrombosis that take place during the neonatal period, generally associated with risk factors such as the use of central venous catheter. The incidence of bacterial endocarditis in preterm infants is low. Objectives: To characterize the case of a preterm neonate with both conditions and to detail the disease changing spectrum in the neonatal population and its therapeutic possibilities. Case report: Premature newborn, 31 + 5 weeks of gestation who presented Enterococcus faecalis bacteremia, developed progressive thrombosis of the inferior vena cava and right atrium secondary to the use of umbilical venous catheter, with subsequent diagnosis of endocarditis. He was treated with anticoagulation with subcutaneous low molecular weight heparin. Given a favorable evolution, it was decided to continue the anticoagulation therapy for 4-6 weeks, and at the time of discharge, aspirin treatment was given. Conclusions: The preterm infant with infective endocarditis and intracardiac thrombus presents an interesting management dilemma. Treatment should be individualized according to the clinical evolution and safety profile of thrombolytic and/or anticoagulant agents. Availability and advantages of low molecular weight heparin have led to its use as an alternative treatment in neonates and infants with deep venous thrombosis.


La trombosis de la vena cava inferior corresponde a un porcentaje importante de las trombosis venosas en la etapa neonatal, generalmente asociado a factores de riesgo como el uso de catéter venoso central. La incidencia de endocarditis bacteriana en recién nacidos prematuros es baja. Objetivos: Caracterizar el caso de un neonato pretérmino en que se asociaron ambas patologías y detallar el espectro cambiante de esta enfermedad en la población neonatal y sus posibilidades terapéuticas. Caso clínico: Recién nacido prematuro de 31 + 5 semanas de gestación, que presentó bacteriemia por Enterococo faecalis, evolucionó con trombosis progresiva de la vena cava inferior y aurícula derecha secundaria al uso de catéter venoso umbilical, con posterior diagnóstico de endocarditis. Se manejó con anticoagulación con heparina de bajo peso molecular en forma subcutánea, dada evolución favorable, se decidió continuar manejo médico con terapia anticoagulante por 4-6 semanas, y al alta manejo con aspirina. Conclusiones: El neonato pretérmino con endocarditis infecciosa y trombo intracardiaco presentan un dilema interesante de manejo, por lo cual se debe individualizar el tratamiento según la evolución clínica y el perfil de seguridad de los agentes trombolíticos y/o anticoagulantes. La disponibilidad y las ventajas de la heparina de bajo peso molecular ha dado lugar a su uso como una alternativa de tratamiento en neonatos y niños con trombosis venosa profunda.


Subject(s)
Female , Humans , Infant, Newborn , Endocarditis, Bacterial/diagnosis , Gram-Positive Bacterial Infections/diagnosis , Vena Cava, Inferior/pathology , Venous Thrombosis/pathology , Anticoagulants/therapeutic use , Bacteremia/microbiology , Endocarditis, Bacterial/microbiology , Enterococcus faecalis/isolation & purification , Gram-Positive Bacterial Infections/microbiology , Heparin, Low-Molecular-Weight/therapeutic use , Infant, Premature , Venous Thrombosis/drug therapy
13.
Rev. chil. obstet. ginecol ; 79(5): 429-434, oct. 2014. ilus, tab
Article in Spanish | LILACS | ID: lil-729407

ABSTRACT

La trombosis venosa cerebral es una enfermedad poco frecuente, pero de pronóstico potencialmente grave. Debido a los cambios hemostáticos durante la gestación, es una patología que puede asociarse al embarazo. Presenta un amplio rango de signos y síntomas. El diagnóstico y tratamiento precoz mejoran el pronóstico. Presentamos el caso de una mujer de 30 años, que en la semana 8 de gestación acude a Urgencias por cefalea intensa y cuya resonancia magnética reveló una trombosis venosa cerebral. La paciente presentó un segundo episodio en la semana 33, a pesar del correcto tratamiento anticoagulante recibido.


Cerebral venous thrombosis is a rare disease, but with a potentially serious prognosis. It is a condition that can be associated with pregnancy because of the hemostatic changes during gestation. It has a wide range of signs and symptoms. Early diagnosis and treatment improve prognosis. We report the case of a 30-year-old woman, at week 8 of pregnancy, who came to the emergency department for severe headache and whose magnetic resonance imaging revealed a cerebral venous thrombosis. The patient had a second episode at week 33, despite correct anticoagulation received.


Subject(s)
Humans , Adult , Pregnancy Complications, Cardiovascular , Intracranial Thrombosis/diagnosis , Intracranial Thrombosis/drug therapy , Venous Thrombosis/diagnosis , Venous Thrombosis/drug therapy , Anticoagulants/therapeutic use , Heparin/therapeutic use
14.
An. bras. dermatol ; 89(5): 822-824, Sep-Oct/2014. graf
Article in English | LILACS | ID: lil-720787

ABSTRACT

The livedoid vasculopathy is an obstructive vascular process of etiology not yet fully known, being possibly associated with several prothrombotic events. It is clinically characterized by the presence of painful and recurring purpuric lesions, which usually suffer ulceration and evolve with formation of white atrophic scars usually located in the lower limbs. Two cases are here reported of painful ulcerated lesions on the lower limbs, in which the identification of VL enabled the diagnosis of systemic diseases.


Subject(s)
Adult , Female , Humans , Livedo Reticularis/pathology , Skin Ulcer/pathology , Livedo Reticularis/drug therapy , Skin Ulcer/drug therapy , Treatment Outcome , Venous Thrombosis/drug therapy , Venous Thrombosis/pathology
15.
Gut and Liver ; : 696-703, 2013.
Article in English | WPRIM | ID: wpr-209556

ABSTRACT

BACKGROUND/AIMS: We investigated the effects of sorafenib monotherapy on advanced hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT) in a clinical setting. METHODS: In total, 143 consecutive patients with unresectable HCC were treated with sorafenib. Among these patients, 30 patients with advanced HCC and PVTT (Vp3 or 4) were treated with sorafenib monotherapy. RESULTS: All patients had a performance status of 1 to 2 (Eastern Cooperative Oncology Group 1/2, 20/10) and Child-Pugh class A or B (A/B, 17/13). Eleven patients had modified Union for International Cancer Control stage IVA tumors, whereas 19 had stage IVB tumors. All patients had PVTT (Vp3, 6; Vp4, 24). Following sorafenib monotherapy, three patients (10.0%) had a partial response with PVTT revascularization, and nine (30.0%) had stable disease, with a disease control rate of 33.3%. The median overall survival was 3.1 months (95% confidence interval [CI], 2.70 to 3.50), and the median progression-free survival was 2.0 months (95% CI, 1.96 to 2.05). Fatigue and hand-foot skin reactions were the most troublesome side effects. CONCLUSIONS: A limited proportion of patients with advanced HCC and PVTT exhibited a remarkable outcome after sorafenib monotherapy, although the treatment results in this type of patient is extremely poor. Further studies to predict good responders to personalized therapy are warranted.


Subject(s)
Adult , Aged , Aged, 80 and over , Anorexia/chemically induced , Antineoplastic Agents/adverse effects , Carcinoma, Hepatocellular/drug therapy , Diarrhea/chemically induced , Disease-Free Survival , Fatigue/chemically induced , Female , Hand-Foot Syndrome/etiology , Humans , Kaplan-Meier Estimate , Liver Neoplasms/drug therapy , Magnetic Resonance Imaging , Male , Middle Aged , Nausea/chemically induced , Neoplasm Invasiveness , Niacinamide/adverse effects , Phenylurea Compounds/adverse effects , Portal Vein/pathology , Proportional Hazards Models , Tomography, Spiral Computed , Venous Thrombosis/drug therapy
16.
Gastroenterol. latinoam ; 24(supl.1): S60-S63, 2013. ilus
Article in Spanish | LILACS | ID: lil-763723

ABSTRACT

Portal vein thrombosis (PVT) is a common complication ocurring in cirrhotic patients, mainly in unstable patients. The decrease of the portal vein flow (< 15 cm/sec) is the only independent factor related to the development of PVT. It has been well demonstrated that the polymorphism G202210A of prothrombin gene and mutation TT677 of methylene tetrahydrofolate reductase are significantly more frequent in cirrhotic patients with PVT, increasing the risk in more than 5 times. For this reason, the assessment of thrombophilia is always recommended. The clinical manifestations are diverse; from asymptomatic patients (43 percent) up to intestinal infarction. PVT diagnosis depends on imaging studies including Doppler ultrasonography as a first line, and computed tomography (CT) and magnetic resonance imaging (MRI) to confirm the diagnosis and evaluate the extension of the disease. The use of anticoagulant therapy has not yet clearly been established for cirrhotic patients, but it seems to be safe and effective. Patients who are candidates to liver transplantation and in patients with demonstrated thrombophilia should be treated life-long.


La trombosis portal (TP) es un evento frecuente en pacientes cirróticos, principalmente en pacientes descompensados. La disminución del flujo portal (< 15 cm/ seg) es la única variable independiente asociada a desarrollo de TP. Se ha demostrado que el polimorfismo TT677 de la metiltetrahidrofolato reductasa y el polimorfismo G20210A en el gen de la protrombina son significativamente más frecuentes en los pacientes cirróticos que presentan TP, aumentando el riesgo de TP en más de cinco veces; por lo que se sugiere siempre el estudio de trombofilia. La forma de presentación es variable: asintomáticos (43 por ciento) hasta infarto intestinal. La técnica diagnóstica de primera línea es la ecografía doppler, utilizando tomografía computada (TC) o resonancia nuclear magnética (RNM) para confirmarla y evaluar la extensión. El uso de anticoagulantes no está normado en pacientes cirróticos, pero parece ser seguro y eficaz. Éste debe ser recomendado a permanencia en pacientes en lista de trasplante hepático y en pacientes con hallazgo de trombofilia.


Subject(s)
Humans , Anticoagulants/therapeutic use , Liver Cirrhosis/complications , Portal Vein , Venous Thrombosis/etiology , Venous Thrombosis/drug therapy , Patient Selection
18.
Article in English | WPRIM | ID: wpr-89582

ABSTRACT

OBJECTIVE: To retrospectively evaluate the frequency and risk factors for developing thrombus in a systemic vein such as the infrarenal inferior vena cava or the iliac vein, in which a balloon-occluded retrograde transvenous obliteration (B-RTO) catheter was indwelled. MATERIALS AND METHODS: Forty-nine patients who underwent B-RTO for gastric varices were included in this study. The B-RTO procedure was performed from the right femoral vein, and the B-RTO catheter was retained overnight in all patients. Pre- and post-procedural CT scans were retrospectively compared in order to evaluate the development of thrombus in the systemic vein in which the catheter was indwelled. Additionally, several variables were analyzed to assess risk factors for thrombus in a systemic vein. RESULTS: In all 49 patients (100%), B-RTO was technically successful, and in 46 patients (94%), complete thrombosis of the gastric varices was achieved. In 6 patients (12%), thrombus developed in the infrarenal inferior vena cava or the right common-external iliac vein. All thrombi lay longitudinally on the right side of the inferior vena cava or the right iliac vein. One of the aforementioned 6 patients required anticoagulation therapy. No symptoms suggestive of pulmonary embolism were observed. Prothrombin time-international normalized ratio and the addition of 5% ethanolamine oleate iopamidol, on the second day, were related to the development of thrombus. CONCLUSION: Development of a thrombus in a systemic vein such as the inferior vena cava or iliac vein, caused by indwelling of the B-RTO catheter, is relatively frequent. Physicians should be aware of the possibility of pulmonary embolism due to iliocaval thrombosis.


Subject(s)
Adult , Aged , Aged, 80 and over , Balloon Occlusion/methods , Catheters, Indwelling/adverse effects , Esophageal and Gastric Varices/etiology , Female , Femoral Vein , Humans , International Normalized Ratio , Iopamidol/administration & dosage , Male , Middle Aged , Oleic Acids/administration & dosage , Prothrombin Time , Retrospective Studies , Risk Factors , Statistics, Nonparametric , Tomography, X-Ray Computed , Treatment Outcome , Venous Thrombosis/drug therapy
19.
Invest. clín ; 52(3): 230-238, sep. 2011. tab
Article in Spanish | LILACS | ID: lil-659213

ABSTRACT

El objetivo de este trabajo fue determinar la efectividad de un rango de la Razón Normalizada Internacional (INR) entre 1,5 y 1,9 en la prevención de la recurrencia de trombosis venosa y de las complicaciones hemorrágicas asociadas al uso de warfarina. Entre enero del 2006 y noviembre del 2009, se estudiaron 39 pacientes, con edades entre 10 y 78 años y diagnóstico de trombosis venosa profunda y/o embolismo pulmonar que recibieron warfarina al menos durante 6 meses. Los sujetos fueron separados aleatoriamente en dos grupos: a 20 pacientes se le ajustó la dosis para mantener el INR entre 1,5 y 1,9 y a 19 pacientes se les mantuvo el INR entre 2 y 3. A cada individuo se le cuantificó la actividad plasmática de los factores II, VII, IX y X a la primera y entre la cuarta y quinta semanas, luego de estabilizado el INR. En ambos grupos, la actividad de los factores se encontró por debajo del valor normal con diferencia significativa entre los grupos (p<0,05). No se detectó recurrencia de trombosis durante el seguimiento. Solo se presentaron manifestaciones hemorrágicas menores en un sujeto con INR entre 1,5 y 1,9 y en cuatro del otro grupo (p = NS). Los resultados del presente trabajo sugieren que un rango de INR entre 1,5 y 1,9, provee un esquema de anticoagulación eficaz para la prevención de recurrencia de trombosis venosa con menor frecuencia de hemorragias. Sin embargo, es necesario seguir incorporando más individuos en el estudio para obtener mayor certeza en el análisis de estos resultados.


The object of this work was to determine the efficacy of a low range International Normalized Ratio (INR) between 1.5 and 1.9, in preventing recurrent venous thrombosis and the hemorrhagic manifestations that can complicate anticoagulation with warfarin. Thirty nine patients, 10 to 78 years of age were studied between January 2006 and November 2009. All of them had been treated with warfarin, for at least 6 months, due to deep venous thrombosis or pulmonary embolism. The subjects were separated, at random, into two groups. In group A (20 patients), the doses of warfarin were adjusted until the INR was stabilized between 1.5 and 1.9; in group B, the INR was maintained between 2 and 3. The coagulant activities of plasma factors II, VII, IX and X were determined in a week and between the fourth and fifth weeks, after stabilization of the INR. Plasma activities of the coagulation factors assayed were abnormally low in both groups, in the two opportunities they were determined, although significantly lower in group B (p<0.05). No thromboembolic episodes occurred during the study, in any of the patients. One of the patients from group A and four from group B, presented minor hemorrhagic manifestations (p N.S.) The above results suggest that a range on INR lower that 2, could be sufficient to prevent recurrent thrombotic episodes while diminishing the frequency of hemorrhagic complications associated with the use of warfarin. However, it is necessary to continue incorporating more individuals in the study to obtain greater certainty in the analysis of these results.


Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Anticoagulants/therapeutic use , International Normalized Ratio , Pulmonary Embolism/drug therapy , Venous Thrombosis/drug therapy , Warfarin/therapeutic use , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Blood Coagulation Factors/analysis , Dose-Response Relationship, Drug , Drug Monitoring , Hemorrhage/chemically induced , Pulmonary Embolism/blood , Recurrence , Venous Thrombosis/blood , Warfarin/administration & dosage , Warfarin/adverse effects
20.
Article in English | WPRIM | ID: wpr-36588

ABSTRACT

OBJECTIVE: We wanted to evaluate the feasibility of catheter-directed thrombolysis with a continuous infusion of low-dose urokinase for treating non-acute (less than 14 days) deep venous thrombosis of the lower extremity. MATERIALS AND METHODS: The clinical data of 110 patients who were treated by catheter-directed thrombolysis with a continuous infusion of low-dose urokinase for lower extremity deep venous thrombosis was analysed. Adjunctive angioplasty or/and stenting was performed for the residual stenosis. Venous recanalization was graded by pre- and post-treatment venography. Follow-up was performed by clinical evaluation and Doppler ultrasound. RESULTS: A total of 112 limbs with deep venous thrombosis with a mean symptom duration of 22.7 days (range: 15-38 days) were treated with a urokinase infusion (mean: 3.5 million IU) for a mean of 196 hours. After thrombolysis, stent placement was performed in 25 iliac vein lesions and percutaneous angioplasty (PTA) alone was done in five iliac veins. Clinically significant recanalization was achieved in 81% (90 of 112) of the treated limbs; complete recanalization was achieved in 28% (31 of 112) and partial recanalization was achieved in 53% (59 of 112). Minor bleeding occurred in 14 (13%) patients, but none of the patients suffered from major bleeding or symptomatic pulmonary embolism. During follow-up (mean: 15.2 months, range: 3-24 months), the veins were patent in 74 (67%) limbs. Thirty seven limbs (32%) showed progression of the stenosis with luminal narrowing more than 50%, including three with rethrombosis, while one revealed an asymptomatic iliac vein occlusion; 25 limbs (22%) developed mild post-thrombotic syndrome, and none had severe post-thrombotic syndrome. Valvular reflux occurred in 24 (21%) limbs. CONCLUSION: Catheter-directed thrombolysis with a continuous infusion of low-dose urokinase combined with adjunctive iliac vein stenting is safe and effective for removal of the clot burden and for restoration of the venous flow in patients with non-acute lower extremity deep venous thrombosis.


Subject(s)
Adult , Aged , Angioplasty, Balloon , Catheterization, Peripheral , Combined Modality Therapy , Female , Fibrinolytic Agents/administration & dosage , Humans , Infusion Pumps , Infusions, Intravenous , Leg/blood supply , Male , Middle Aged , Phlebography , Thrombolytic Therapy/methods , Ultrasonography, Doppler , Urokinase-Type Plasminogen Activator/administration & dosage , Vascular Patency , Venous Thrombosis/drug therapy
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