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1.
Korean Circulation Journal ; : 163-175, 2020.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-786221

RESUMO

BACKGROUND AND OBJECTIVES: Although anticoagulation with warfarin is recommended as an international normalized ratio (INR) of prothrombin time between 2.0 and 3.0 and mean time in the therapeutic range (TTR) ≥70%, little has been proven that universal criteria might be suitable in Korean atrial fibrillation (AF) patients.METHODS: We analyzed 710 patients with non-valvular AF who took warfarin. INR value and clinical outcomes were assessed during 2-year follow-up. Intensity of anticoagulation was assessed as mean INR value and TTR according to target INR range. Primary net-clinical outcome was defined as the composite of new-onset stroke and major bleeding. Secondary net-clinical outcome was defined as the composite of new-onset stroke, major bleeding and death.RESULTS: Thromboembolism was significantly decreased when mean INR was over 1.6. Major bleeding was significantly decreased when TTR was over 70% and mean INR was less than 2.6. Mean INR 1.6–2.6 significantly reduced thromboembolism (adjusted hazard ratio [HR], 0.40; 95% confidence interval [CI], 0.19–0.85), major bleeding (HR, 0.43; 95% CI, 0.23–0.81), primary (HR, 0.50; 95% CI, 0.29–0.84) and secondary (HR, 0.45; 95% CI, 0.28–0.74) net-clinical outcomes, whereas mean INR 2.0–3.0 did not. Simultaneous satisfaction of mean INR 1.6–2.6 and TTR ≥70% was associated with significant risk reduction of major bleeding, primary and secondary net-clinical outcomes.CONCLUSIONS: Mean INR 1.6–2.6 was better than mean INR 2.0–3.0 for the prevention of thromboembolism and major bleeding. However, INR 1.6–2.6 and TTR ≥70% had similar clinical outcomes to INR 2.0–3.0 and TTR ≥70% in Korean patients with non-valvular AF.


Assuntos
Fibrilação Atrial , Seguimentos , Hemorragia , Humanos , Coeficiente Internacional Normatizado , Tempo de Protrombina , Comportamento de Redução do Risco , Acidente Vascular Cerebral , Tromboembolia , Varfarina
2.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-782262

RESUMO

BACKGROUND/OBJECTIVES: Vitamin D is a pleiotropic hormone that affects various body organ systems. We evaluated the prevalence of a vitamin D deficiency (VDD) and its potential role in the clinical condition of critically ill Korean children.SUBJECTS/METHODS: Patients under 18 years old with a 25(OH) vitamin D measurement on the first day of PICU admission were included from among the children admitted to the pediatric intensive care unit (PICU) of our tertiary children's hospital between October 2017 and January 2019.RESULTS: A total of 172 pediatric patients were enrolled. The mean 25(OH) vitamin D level was 17.5 ± 12.8 ng/mL. There was a 65.1% prevalence of VDD (25(OH) vitamin D level < 20 ng/mL). VDD was associated with age at PICU admission, gastrointestinal/hepatobiliary disorders, International Society of Thrombosis and Hemostasis disseminated intravascular coagulation (ISTH DIC) score, pediatric multiple organ dysfunction syndrome (pMODS) score and with several laboratory test findings including hemoglobin, platelet, C-reactive protein, serum albumin, total bilirubin, prothrombin time, and anti-thrombin III levels. Most of these parameters also showed significant linear correlations with the 25(OH) vitamin D level (P < 0.05). However, no statistically meaningful association was found between VDD and other clinical conditions such as the need for a mechanical ventilator, requirement for vasoactive drugs, duration of the PICU and hospital stays, or PICU mortality.CONCLUSION: There is a high prevalence of VDD in critically ill Korean children. There were significant associations between the 25(OH) vitamin D level and gastrointestinal/hepatobiliary disorders, the pMODS score and with coagulation related factors. Further large-scale studies with more specific subgroup analyses are required to more precisely assess the clinical implications of VDD in critically ill pediatric patients.


Assuntos
Bilirrubina , Plaquetas , Proteína C-Reativa , Criança , Estado Terminal , Coagulação Intravascular Disseminada , Hemostasia , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Mortalidade , Insuficiência de Múltiplos Órgãos , Pediatria , Prevalência , Tempo de Protrombina , Albumina Sérica , Trombose , Ventiladores Mecânicos , Deficiência de Vitamina D , Vitamina D , Vitaminas
3.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wprim-758473

RESUMO

OBJECTIVE: Unperforated and perforated acute appendicitis need to be differentiated because appendicitis with a free perforation requires an emergency operation to prevent contamination inside the bowel from spreading into the peritoneal cavity. The sensitivity of imaging tests is not reliable enough alone for determining the existence of a perforation. The aim of this study was to determine the differences in laboratory values between unperforated and perforated acute appendicitis to help distinguish perforated acute appendicitis. METHODS: The laboratory values and demographic data of a total of 175 patients who visited the emergency room and were diagnosed with acute appendicitis were collected. The time elapsed from symptom presentation to the ER visit, length of admission, patient demographics, and laboratory values, including sex, age, leukocyte count, neutrophil %, neutrophil count, C-reactive protein (CRP), platelet count, prothrombin time (PT), activated partial thromboplastin time, international normalized ratio (INR), serum glucose, blood urea nitrogen, creatinine, total and direct bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and gamma-glutamyltransferase were analyzed. RESULTS: The factors associated with appendix perforations were an elevated leukocyte count, neutrophil count, neutrophil %, CRP, serum glucose and total bilirubin; and delayed PT and INR. CONCLUSION: Acute appendicitis patients without definite imaging evidence of the perforation but with the laboratory values suggesting a perforation, such as elevated leukocyte count, neutrophil count, neutrophil %, CRP, serum glucose, and total bilirubin; and delayed PT, and INR should raise concern for a possible undiscovered perforation.


Assuntos
Abdome Agudo , Alanina Transaminase , Fosfatase Alcalina , Apendicite , Apêndice , Aspartato Aminotransferases , Bilirrubina , Glicemia , Nitrogênio da Ureia Sanguínea , Proteína C-Reativa , Creatinina , Demografia , Diagnóstico Diferencial , Emergências , Serviço Hospitalar de Emergência , gama-Glutamiltransferase , Humanos , Coeficiente Internacional Normatizado , Contagem de Leucócitos , Neutrófilos , Tempo de Tromboplastina Parcial , Admissão do Paciente , Cavidade Peritoneal , Contagem de Plaquetas , Tempo de Protrombina
4.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wprim-762276

RESUMO

BACKGROUND: Biliary atresia is an extrahepatic progressive obliterate cholangiopathy that occurs in infants. Kasai procedure, a surgical method that can help re-establish bile flow from the liver into the intestine, is its first line treatment. Since infants with biliary atresia already have advanced hepatic dysfunction, all kinds of schemes should be considered to minimize further liver damage during surgery. The objective of this study was to compare the postoperative hepatic functions between the two commonly used inhalational anesthetics in infants undergoing the Kasai procedure (i.e., desflurane and sevoflurane). METHODS: This prospective, randomized, double-blind, single-center, and parallel group study included 40 children undergoing Kasai procedure. They were randomly allocated to Group S (sevoflurane) or Group D (desflurane). All the patients were anesthetized with designated anesthetic agent with the end-tidal concentration of about 0.8–1 minimum alveolar concentration. Postoperative hepatic functions were assessed by aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, prothrombin time, and total bilirubin. RESULTS: A total of 38 patients were selected for the study. In both groups, AST, ALT were increased in magnitude to the peak on postoperative day 0 and decreased to preoperative value at postoperative day 3. There were no significant differences between the groups in any laboratory results related to liver function. CONCLUSIONS: Sevoflurane and desflurane, inhalation anesthetics for maintaining anesthesia used in infants undergoing the Kasai procedure, did not show any difference in preserving postoperative hepatic function.


Assuntos
Alanina Transaminase , Anestesia , Anestésicos , Anestésicos Inalatórios , Aspartato Aminotransferases , Bile , Atresia Biliar , Bilirrubina , Criança , Humanos , Lactente , Intestinos , Fígado , Testes de Função Hepática , Métodos , Portoenterostomia Hepática , Estudos Prospectivos , Tempo de Protrombina
5.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wprim-741143

RESUMO

BACKGROUND: Prothrombin time (PT) measurement is an important test for screening blood coagulation disorders and monitoring anticoagulant therapy. In this study, we evaluated the analytical performance of HemosIL ReadiPlasTin (Instrumentation Laboratory, USA), a liquid reagent for PT measurement. METHODS: The precision of HemosIL ReadiPlasTin was evaluated according to the Clinical and Laboratory Standards Institute (CLSI) EP5-A3 guidelines. Further, comparison with HemosIL RecombiPlasTin 2G (Instrumentation Laboratory, USA) was made according to the CLSI EP9-A3 guidelines. The reference intervals were established according to the CLSI C28-A3 guidelines. RESULTS: The coefficient of variation values for repeatability and total imprecision at two levels of control materials were lower than 1.1% and 3.4%, respectively. The performance of HemosIL ReadiPlasTin was comparable to that of HemosIL RecombiPlasTin 2G, with a high correlation (r=0.996). The reference interval for normal subjects was 10.4–13.3 seconds. CONCLUSIONS: HemosIL ReadiPlasTin showed an acceptable degree of imprecision and its performance showed high correlation with that of a conventional reagent. Therefore, it is expected to be useful for PT measurement in clinical laboratories.


Assuntos
Transtornos da Coagulação Sanguínea , Testes de Coagulação Sanguínea , Programas de Rastreamento , Tempo de Protrombina , Protrombina , Tromboplastina
6.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-785373

RESUMO

During pregnancy, the procoagulant activity increases (manifested by elevation in factor VII, factor VIII, factor X, and fibrinogen levels), while the anticoagulant activity decreases (characterized by reduction in fibrinolysis and protein S activity), resulting in hypercoagulation. Standard coagulation tests, such as prothrombin time or activated partial thromboplastin time, are still used despite the lack of evidence supporting its accuracy in evaluating the coagulation status of pregnant women. Thromboelastography and rotational thromboelastometry, which are used to assess the function of platelets, soluble coagulation factors, fibrinogen, and fibrinolysis, can replace standard coagulation tests. Platelet count and function and the effect of anticoagulant treatment should be assessed to determine the risk of hematoma associated with regional anesthesia. Moreover, anesthesiologists should monitor patients for postpartum hemorrhage (PPH), and attention should be paid when performing rapid coagulation tests, transfusions, and prohemostatic pharmacotherapy. Transfusion of a high ratio of plasma and platelets to red blood cells (RBCs) showed high hemostasis success and low bleeding-related mortality rates in patients with severe trauma. However, the effects of high ratios of plasma and platelets and the ratio of plasma to RBCs and platelets to RBCs in the treatment of massive PPH were not established. Intravenous tranexamic acid should be administered immediately after the onset of postpartum bleeding. Pre-emptive treatment with fibrinogen for PPH is not effective in reducing bleeding. If fibrinogen levels of less than 2 g/L are identified, 2–4 g of fibrinogen or 5–10 ml/kg cryoprecipitate should be administered.


Assuntos
Anestesia por Condução , Fatores de Coagulação Sanguínea , Transfusão de Sangue , Tratamento Farmacológico , Eritrócitos , Fator VII , Fator VIII , Fator X , Feminino , Fibrinogênio , Fibrinólise , Hematoma , Hemorragia , Hemostasia , Humanos , Mortalidade , Tempo de Tromboplastina Parcial , Plasma , Contagem de Plaquetas , Hemorragia Pós-Parto , Período Pós-Parto , Gravidez , Gestantes , Proteína S , Tempo de Protrombina , Tromboelastografia , Ácido Tranexâmico
7.
Laboratory Medicine Online ; : 153-160, 2019.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wprim-760501

RESUMO

BACKGROUND: Liver fibrosis evaluation is an important issue in chronic liver disease patients. We aimed to develop noninvasive liver fibrosis biomarkers based on transient elastography (TE, FibroScan®) through retrospective review of clinicopathological data. METHODS: We recruited 278 chronic hepatitis B patients who underwent Fibroscan and HBV DNA testing. A total of 115 HBeAg-positive and 159 HBeAg-negative chronic hepatitis B patients were analyzed. A total of 100 hepatitis C patients were analyzed. Successful fibroscan data, gamma-glutamyl transferase (GGT) to platelet ratio (GPR), platelet count, AST, ALT, international normalized ratio of prothrombin time, total cholesterol, triglycerides, bilirubin, mean platelet volume, AST to platelet ratio index, fibrosis index based on four factors (FIB-4), neutrophil to lymphocyte ratio (NLR), and NLR to platelet ratio were analyzed to determine the new noninvasive markers for assessing liver fibrosis. RESULTS: Elevated GPR (OR=9.1, P=0.011) and FIB-4 (OR=2.3, P=0.01) were associated with greater risk of liver fibrosis in chronic hepatitis B patients. FIB-4 (OR=6.04, P=0.005) was a risk factor for liver fibrosis in HBeAg-positive patients. FIB-4 (OR=2.371, P=0.015) and GPR (OR=33.78, P=0.003) were liver fibrosis risk factor in HBeAg-negative patients. In chronic hepatitis C patients, GGT (OR=1.033, P=0.002), triglyceride (OR=−0.990, P=0.038) and FIB-4 (OR=3.499, P=0.006) showed statistical significances. The AUCs were 0.816 in FIB-4 (P<0.001) and 0.849 in GPR (P<0.001). CONCLUSIONS: FIB-4 and GPR may be useful blood markers for assessing liver fibrosis in chronic hepatitis B and hepatitis C patients. Further well-designed prospective study is required to validate these noninvasive blood markers in clinical practice.


Assuntos
Área Sob a Curva , Bilirrubina , Biomarcadores , Plaquetas , Colesterol , DNA , Técnicas de Imagem por Elasticidade , Fibrose , Hepatite B , Hepatite B Crônica , Hepatite C , Hepatite C Crônica , Hepatite , Hepatite Crônica , Humanos , Coeficiente Internacional Normatizado , Cirrose Hepática , Hepatopatias , Fígado , Linfócitos , Volume Plaquetário Médio , Neutrófilos , Contagem de Plaquetas , Estudos Prospectivos , Tempo de Protrombina , Estudos Retrospectivos , Fatores de Risco , Transferases , Triglicerídeos
8.
Journal of Liver Cancer ; : 59-63, 2019.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-765703

RESUMO

We present a case of spontaneous rupture of hepatocellular carcinoma with poor liver function managed by transcatheter arterial embolization (TAE). The patient's bilirubin level was 2.1 mg/dL, albumin level was 2.4 g/dL, and prothrombin time international normalized ratio was 2.1. In addition, the patient had also developed a large number of ascites. The tumor was supplied by the right renal capsular artery, as observed on angiography. With successful TAE, no hepatic failure occurred. We believe TAE can be a safe and effective treatment option, even in patients with poor liver function, if tumors are supplied only by extrahepatic collateral vessels.


Assuntos
Angiografia , Artérias , Ascite , Bilirrubina , Carcinoma Hepatocelular , Humanos , Coeficiente Internacional Normatizado , Fígado , Falência Hepática , Tempo de Protrombina , Ruptura Espontânea
9.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wprim-774117

RESUMO

OBJECTIVE@#To study the correlation between coagulation function and gestational age in preterm infants and the possible value of coagulation function measurement in predicting hemorrhagic diseases.@*METHODS@#The clinical data of preterm infants who were hospitalized between September 2016 and August 2017 were collected. The coagulation indicators were measured within 2 hours after birth. According to the gestational age, the preterm infants were divided into late preterm infant group (n=322), early preterm infant group (n=241) and extremely/very early preterm infant group (n=128). Coagulation function was compared among the three groups, as well as between the preterm infants with and without hemorrhagic diseases within 3 days after birth.@*RESULTS@#There were significant differences in thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen degradation product (FDP) and D-dimer (DD) among the three groups (P<0.05). APTT, PT, FDP and DD were negatively correlated with gestational age, while TT was positively correlated with gestational age (P<0.05). The preterm infants with hemorrhagic diseases had a longer APTT and a higher level of DD (P<0.05).@*CONCLUSIONS@#Coagulation function gradually becomes mature in preterm infants with the increase in gestational age. Abnormal APTT and DD indicate that preterm infants may have a higher risk of hemorrhagic diseases.


Assuntos
Coagulação Sanguínea , Testes de Coagulação Sanguínea , Idade Gestacional , Humanos , Recém-Nascido , Tempo de Tromboplastina Parcial , Tempo de Protrombina
10.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wprim-773711

RESUMO

Rat model of blood stasis syndrome was prepared by subcutaneous injecting of epinephrine hydrochlorid,then the model rats were administrated by Yunnan Baiyao for 15 days. Blood rheology,coagulation function and histopathology were chosen as indicators to evaluate the successful replication of blood stasis syndrome model and the treatment effect of Yunnan Baiyao. UPLC-Q-TOF-MS was used to rapidly analyze the serum samples of blood stasis syndrome rat after 15 days Yunnan Baiyao treatment,Progenesis QI software was employed to identify the alkaloids components. The results showed that Yunnan Baiyao reduced the plasma viscosity and whole blood viscosity of rats with blood stasis syndrome,prolonged thrombin and prothrombin time,reduced fibrinogen content,and effectively improved pathological state such as inflammatory cell infiltration,blood stasis,congestion and edema of various organs in rats with blood stasis syndrome. Seven alkaloids components from Aconitum kusnezoffii,including karacolidine,senbusine B,isotalatizidine,karakoline,denudatine,talatisamine and chasmanine were found in the rat serum after Yunnan Baiyao treatment. Based on the effectiveness of Yunnan Baiyao in the treatment of blood stasis syndrome induced by epinephrine hydrochloride in rats,alkaloids components from the root of A. kusnezoffii absorbed into blood after Yunnan Baiyao treatment were clarified rapidly and accurately with the help of UPLC-Q-TOF-MS. Karacolidine,senbusine B,isotalatizidine,karakoline,denudatine,talatisamine and chasmanine are the pharmacodynamic material basis of the root of A. kusnezoffii for activating blood circulation and removing blood stasis.


Assuntos
Aconitum , Química , Animais , Circulação Sanguínea , Viscosidade Sanguínea , Medicamentos de Ervas Chinesas , Farmacologia , Tempo de Protrombina , Ratos , Tempo de Trombina
11.
Rev. gaúch. enferm ; 40(spe): e20180322, 2019.
Artigo em Português | LILACS (Américas) | ID: biblio-1004112

RESUMO

Resumo OBJETIVO Descrever a implantação de um indicador de qualidade assistencial associado ao diagnóstico de enfermagem de pacientes com alto risco de sangramento, com base nos resultados alarmantes de tempo de protombina (TP), tempo de tromboplastina parcialmente ativada (TTPa) e plaquetas. MÉTODOS Relato de experiência retrospectivo de ações multidisciplinares desenvolvidas em um hospital universitário. As etapas do estudo envolveram reuniões de equipes, busca de estratégias de comunicação efetiva e criação de um novo indicador de qualidade assistencial. RESULTADOS O indicador foi denominado "Conformidade do Diagnóstico de Enfermagem Risco de Sangramento", monitorado mensalmente desde junho de 2016. A ficha técnica contempla as características e atributos do indicador. Com base nas suas análises são estabelecidos planos de ações para sua qualificação. CONCLUSÃO A implantação do indicador de qualidade assistencial associado ao diagnóstico de enfermagem aprimorou o processo de comunicação, monitoramento e cuidado de enfermagem a pacientes com risco de sangramento.


Resumen OBJETIVO Describir la implementación de un indicador de calidad asistencial asociado al diagnóstico de enfermería de pacientes con alto riesgo de sangrado, con base en los resultados alarmantes de tiempo de protombina (Tp), tiempo de tromboplastina parcialmente activada (TTPa) y plaquetas. MÉTODO Relato de experiencia retrospectiva de acciones multidisciplinares desarrolladas en un hospital universitario. Las etapas del estudio involucraron reuniones de equipos, búsqueda de estrategias de comunicación efectiva y creación de un nuevo indicador de calidad asistencial. RESULTADOS El indicador se denominó "Conformidad del Diagnóstico de Enfermería Riesgo de Sangrado", y se monitoreó mensualmente desde junio de 2016. La ficha técnica contempla las características y atributos del indicador. Con base en los análisis del indicador se establecen planes de acción para su cualificación. CONCLUSIÓN La implementación del indicador de calidad asistencial asociado al diagnóstico de enfermería mejoró el proceso de comunicación, el monitoreo y el cuidado de enfermería a pacientes con riesgo de sangrado.


Abstract OBJECTIVE To describe the implantation of a care quality indicator associated to the nursing diagnosis of patients at high risk of bleeding, based on the alarming results of prothrombin time (PT), partially activated thromboplastin time (aPTT) and platelets. METHODS Retrospective experience report of multidisciplinary actions developed in a university hospital. The stages of the study involved team meetings, search for effective communication strategies and creation of a new indicator of quality of care. RESULTS The indicator was called "Compliance of Nursing Diagnosis Risk for bleeding", monitored monthly since June 2016. The technical file includes the characteristics and attributes of the indicator. Based on the analyzes of the indicator, action plans are established for its qualification. CONCLUSION The implementation of the quality of care indicator associated to the nursing diagnosis improved the communication process, the monitoring and the nursing care to patients at risk of bleeding.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Adulto , Diagnóstico de Enfermagem , Indicadores de Qualidade em Assistência à Saúde , Segurança do Paciente , Transtornos Hemorrágicos/enfermagem , Tempo de Tromboplastina Parcial , Equipe de Assistência ao Paciente , Contagem de Plaquetas , Tempo de Protrombina , Qualidade da Assistência à Saúde , Risco , Estudos Retrospectivos , Comunicação Interdisciplinar , Hemorragia/prevenção & controle , Transtornos Hemorrágicos/sangue , Transtornos Hemorrágicos/epidemiologia , Hospitais Universitários
12.
Yonsei Medical Journal ; : 626-632, 2019.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-762098

RESUMO

PURPOSE: To compare the effect of apixaban and low molecular weight heparin (LMWH) in the prevention and treatment of deep venous thrombosis (DVT) after total knee arthroplasty in older adult patients. MATERIALS AND METHODS: A total of 220 patients (average age of 67.8±6.4 years) undergoing total knee arthroplasty were randomly selected as research subjects and were divided into apixaban and LMWH groups (110 in each group). RESULTS: The incidence of DVT was lower in the apixaban group than in the LMWH group (5.5% vs. 20.0%, p=0.001). Activated partial thromboplastin times (35.2±3.6 sec vs. 33.7±2.2 sec, p=0.010; 37.8±4.6 sec vs. 34.1±3.2 sec, p<0.001; 39.6±5.1 sec vs. 35.7±3.0 sec, p=0.032) and prothrombin times (14.0±1.0 sec vs. 12.8±0.9 sec, p<0.001; 14.5±1.2 sec vs. 13.0±1.1 sec, p<0.001; 15.3±1.4 sec vs. 13.2±1.3 sec, p=0.009) in the apixaban group at 1 week after surgery, 3 weeks after surgery, and the end of treatment were higher than those in the LMWH group. Platelet and fibrinogen levels in the apixaban group were lower than those of the LMWH group. Also, capillary plasma viscosity and erythrocyte aggregation in the apixaban group at 1 week after surgery, 3 weeks after surgery, and the end of treatment were lower than those in the LMWH group. CONCLUSION: Apixaban, which elicits fewer adverse reactions and is safer than LMWH, exhibited better effects in the prevention and treatment of DVT after total knee arthroplasty in older adults.


Assuntos
Adulto , Artroplastia do Joelho , Plaquetas , Capilares , Agregação Eritrocítica , Fibrinogênio , Heparina de Baixo Peso Molecular , Humanos , Incidência , Plasma , Tempo de Protrombina , Sujeitos da Pesquisa , Tromboplastina , Trombose Venosa , Viscosidade
13.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-759982

RESUMO

Intramuscular hematomas on the psoas muscle are rare and usually occur as a result of trauma, iatrogenic etiology during lumbar surgery, rupture of the aortic aneurysm, and hematologic diseases. The incidence of spontaneous psoas muscle hematomas has slowly increased as a result of using anticoagulation and antiplatelet agents. Magnetic resonance (MR) imaging is a more sensitive option compared to computed tomography (CT) when diagnosing a hematoma. Coronal T2-weighted images are more useful. CT imaging is also useful to establish the rapid diagnosis of hematoma. When a prolonged prothrombin time and international normalized ratio and decrease platelet count are noted, psoas muscle hematomas should be considered, if there was no lesion in the spinal canal. Most hematomas resolve spontaneously without clinical complications if the hematoma is not large or it is not compressing the surrounding important structures, irrespective of cause.


Assuntos
Aneurisma Aórtico , Diagnóstico , Doenças Hematológicas , Hematoma , Incidência , Coeficiente Internacional Normatizado , Imagem por Ressonância Magnética , Inibidores da Agregação de Plaquetas , Contagem de Plaquetas , Tempo de Protrombina , Músculos Psoas , Ruptura , Canal Vertebral
14.
Yonsei Medical Journal ; : 440-445, 2019.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-742562

RESUMO

PURPOSE: Patients with liver cirrhosis are considered to be at risk for additional adverse events during endoscopic retrograde cholangiopancreatography (ERCP). The present study was designed as a propensity-score matched analysis to investigate whether cirrhotic liver increases the risk of bleeding complications in patients undergoing ERCP. MATERIALS AND METHODS: In total, 8554 patients who underwent ERCP from January 2005 to December 2015 were retrospectively analyzed. To adjust for the imbalance between patients with and those without liver cirrhosis, 1:3 propensity score matching was performed according to age and sex. RESULTS: Liver cirrhosis was identified in 264 (3.1%) patients. After propensity score matching, a total of 768 patients were included in each of the cirrhotic (n=192) and non-cirrhotic groups (n=576). Post-procedure bleeding (10.9% vs. 4.7%, p=0.003) was more frequently observed in patients with liver cirrhosis than in those without. In multivariate analyses, liver cirrhosis was identified as an independent risk factor associated with post-ERCP bleeding (p=0.003) after further adjustment for prothrombin time, antiplatelet/coagulant, duration of ERCP, and stent insertion. Child-Pugh (CP) class C was found to be associated with an increased incidence of post-ERCP bleeding in patients with cirrhosis (odds ratio 6.144, 95% confidence interval 1.320–28.606; p=0.021). CONCLUSION: The incidence of post-ERCP bleeding in patients with liver cirrhosis was higher than that in patients without liver cirrhosis. In particular, CP class C cirrhosis was significantly associated with post-ERCP bleeding.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Fibrose , Hemorragia , Humanos , Incidência , Cirrose Hepática , Fígado , Análise Multivariada , Pontuação de Propensão , Tempo de Protrombina , Estudos Retrospectivos , Fatores de Risco , Stents
15.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-758424

RESUMO

PURPOSE: This study examined the association between the prothrombin time (PT) prolongation during cardiopulmonary resuscitation (CPR) and the outcome after an out-of-hospital cardiac arrest (OHCA). METHODS: From the Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance database, CPR-attempted and adult OHCAs with a cardiac etiology transported to emergency departments (EDs) from January to December 2014 were included. The PT was measured immediately after arrival to the ED during CPR, and PT prolongation was categorized into 3 groups, the normal group (international normalized ratio [INR] < 1.1), mild group (1.1≤INR < 1.4), and severe group (1.4≤INR). The primary and secondary outcomes were survival to hospital discharge and a good cerebral performance scale (CPC) of 1 or 2. The potential confounders were adjusted for calculating the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) in multivariable logistic regression analysis. RESULTS: The survival and good CPC rates were 17.2% and 11.8% in the normal group, 12.2% and 4.5% in the mild group, and 3.6% and 0.6% in the severe group, respectively (p < 0.01). The AORs (95% CIs) on survival were 0.72 (0.41 to 1.27) for the mild group and 0.28 (0.11 to 0.69) for the severe group. The AORs (95% CIs) for good CPC were 0.41 (0.19 to 0.91) for the mild group and 0.14 (0.02 to 0.83) for the severe group. CONCLUSION: The PT prolongation measured at the ED was found to be associated with poor outcomes in adult OHCAs with cardiac etiology.


Assuntos
Adulto , Reanimação Cardiopulmonar , Serviço Hospitalar de Emergência , Monitoramento Epidemiológico , Parada Cardíaca , Humanos , Modelos Logísticos , Estudo Observacional , Razão de Chances , Parada Cardíaca Extra-Hospitalar , Tempo de Protrombina , Protrombina
16.
Journal of Liver Cancer ; : 121-129, 2018.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-765694

RESUMO

BACKGROUND/AIMS: The treatments and outcomes of hepatocellular carcinoma (HCC) with bile duct invasion are not well known. We aimed to confirm the safety of transarterial chemolipiodolization (TACL) and identify prognostic factors for patients with bile duct invasion treated with TACL. METHODS: Fifty patients with central bile duct invasion treated with TACL between 2005 and 2017 were enrolled. Patients were divided into three groups: hyperbilirubinemia (total bilirubin ≥2.5 mg/dL) with pre-TACL biliary drainage, hyperbilirubinemia without biliary drainage, and without hyperbilirubinemia. Tumor response to TACL, survival outcomes, length of hospitalization, adverse events using Common Terminology Criteria for Adverse Events (CTCAE), and factors affecting overall survival were compared. RESULTS: TACL-induced changes of mean CTCAE grades for albumin, alanine aminotransferase, creatinine, prothrombin time, and platelet were not significantly different among patients with or without initial hyperbilirubinemia. Serum bilirubin level was not significantly changed after TACL in all the three groups. Overall survival was not significantly different among the three groups (P=0.097). On multivariate analysis, alpha-fetoprotein < 400 ng/dL (hazard ratio [HR]=0.477, P=0.048) and highest total bilirubin level of < 2.5 mg/dL within one month after TACL (HR=0.335, P=0.004) were significantly associated with longer survival. CONCLUSIONS: TACL was a safe treatment for HCC patients with central bile duct invasion, irrespective of the presence of initial hyperbilirubinemia.


Assuntos
Alanina Transaminase , alfa-Fetoproteínas , Ductos Biliares , Bile , Bilirrubina , Plaquetas , Carcinoma Hepatocelular , Quimioembolização Terapêutica , Creatinina , Drenagem , Hospitalização , Humanos , Hiperbilirrubinemia , Análise Multivariada , Tempo de Protrombina
17.
Journal of Stroke ; : 321-331, 2018.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-717273

RESUMO

Development of direct oral anticoagulants and their antidotes has led to the need to reconsider the eligibility of acute stroke patients who have been taking oral anticoagulants for intravenous thrombolysis. Officially authorized Japanese guidelines on this issue were revised twice at the time of approval for clinical use of direct oral anticoagulants and idarucizumab, a specific reversal agent for dabigatran. A unique recommendation in the latest Japanese clinical guides was that thrombolysis can be recommended if the time of the last dose of direct oral anticoagulants exceeds 4 hours and if commonly available anticoagulation markers are normal or subnormal, i.e., international normalized ratio of prothrombin time < 1.7 and activated partial thromboplastin time < 1.5 times the baseline value (≤40 seconds only as a guide). These criteria are partly supported by the findings of domestic multicenter and single-center surveys that symptomatic or asymptomatic intracranial hemorrhage following thrombolysis was rare under the conditions of the criteria. Even for dabigatran users, stroke thrombolysis can be considered without pretreatment by idarucizumab if patients meet the above criteria. If not, direct mechanical thrombectomy can be considered without pretreatment by idarucizumab or thrombolysis, and use of idarucizumab, followed immediately by thrombolysis, can be considered only when thrombectomy cannot be quickly performed. These clinical guides are practical and to some extent economical, but they have some limitations, including lack of corroborating information from sufficient numbers of relevant cases. The guides will be further modified based on the results of future research.


Assuntos
Anticoagulantes , Antídotos , Grupo com Ancestrais do Continente Asiático , Fibrilação Atrial , Consenso , Dabigatrana , Humanos , Coeficiente Internacional Normatizado , Hemorragias Intracranianas , Japão , Tempo de Tromboplastina Parcial , Tempo de Protrombina , Acidente Vascular Cerebral , Trombectomia
18.
Journal of Stroke ; : 292-301, 2018.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-716867

RESUMO

Oral anticoagulant-associated intracerebral hemorrhage (OAC-ICH) accounts for nearly 20% of all ICH. The number of patients with an indication for oral anticoagulant therapy (OAT) increases with increasing age. OAT became less complicate with the introduction of non-vitamin K oral anticoagulants (NOAC) OAT because of easier handling, favorable risk-benefit profile, reduced rates of ICH compared to vitamin K antagonists and no need for routine coagulation testing. Consequently, despite a better safety profile of NOAC the number of patients with OAC-ICH will increase. The mortality and complication rates of OAC-ICH are high and therefore they are the most feared complication of OAT. Immediate normalization of coagulation is the main goal and therefore knowledge of pharmacodynamics and coagulation status is essential. Laboratory measurements of anticoagulant activity in NOAC patients is challenging as specific tests are not widely available. More accessible tests such as the prothrombin time and activated partial thromboplastin time have important limitations. In dabigatran-associated ICH 5 g Idarucizumab should be administered. In rivaroxaban and apixaban-associated ICHs administration of andexanet alpha should be considered. Prothrombin complex concentrate may be considered if andexanet alpha is not available or in case of an ICH associated with edoxaban.


Assuntos
Anticoagulantes , Antídotos , Avena , Hemorragia Cerebral , Dabigatrana , Hemorragia , Humanos , Mortalidade , Tempo de Tromboplastina Parcial , Protrombina , Tempo de Protrombina , Rivaroxabana , Vitamina K
19.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-716623

RESUMO

BACKGROUND: The incidence of cardiovascular and neurovascular diseases has been increasing with the aging of the population, and antiplatelet drugs (APDs) are more frequently used than in the past. With the average age of spinal surgery patients also increasing, there has been a great concern on the adverse effects of APD on spine surgery. To our knowledge, though there have been many studies on this issue, their results are conflicting. In this study, we aimed to determine the influence of APDs on spine surgery in terms of intraoperative bleeding and postoperative spinal epidural hematoma complication. METHODS: Patients who underwent posterior thoracolumbar decompression and instrumentation at our institution were reviewed. There were 34 APD takers (APDT group). Seventy-nine non-APD takers (NAPDT group) were selected as a control group in consideration of demographic and surgical factors. There were two primary endpoints of this study: the amount of bleeding per 10 minutes and cauda equina compression by epidural hematoma measured at the cross-sectional area of the thecal sac in the maximal compression site on the axial T2 magnetic resonance imaging scans taken on day 7. RESULTS: Both groups were homogeneous regarding age and sex (demographic factors), the number of fused segments, operation time, and primary/revision operation (surgical factors), and the number of platelets, prothrombin time, and activated partial thromboplastin time (coagulation-related factors). However, the platelet function analysis-epinephrine was delayed in the APDT group than in the NAPDT group (203.6 seconds vs. 170.0 seconds, p = 0.050). Intraoperative bleeding per 10 minutes was 40.6 ± 12.8 mL in the APDT group and 43.9 ± 9.9 mL in the NAPDT group, showing no significant difference between the two groups (p = 0.154). The cross-sectional area of the thecal sac at the maximal compression site by epidural hematoma was 120.2 ± 48.2 mm2 in the APDT group and 123.2 ± 50.4 mm2 in the NAPDT group, showing no significant difference between the two groups (p = 0.766). CONCLUSIONS: APD medication did not increase intraoperative bleeding and postoperative spinal epidural hematoma. Therefore, it would be safer to perform spinal surgery without discontinuation of APD therapy in patients who are vulnerable to cardiovascular and neurovascular complications.


Assuntos
Envelhecimento , Plaquetas , Cauda Equina , Descompressão , Hematoma , Hematoma Epidural Espinal , Hemorragia , Humanos , Incidência , Imagem por Ressonância Magnética , Tempo de Tromboplastina Parcial , Inibidores da Agregação de Plaquetas , Tempo de Protrombina , Coluna Vertebral
20.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wprim-718676

RESUMO

PURPOSE: The purpose of this study was to determine whether hepatotoxicity could be predicted early using biochemical markers in patients with acetaminophen (AAP) poisoning and to assess the usefulness of predictive factors for acute liver injury or hepatotoxicity. METHODS: This study was a retrospective observational study involving a medical records review. The participants were patients who were admitted to the emergency department (ED) with AAP overdose at two hospitals over a 10-year period. Demographic data, age, time from ingestion to visit, initial AAP level, initial hepatic aminotransferases, and initial prothrombin time were recorded. Acute liver injury was defined as a peak serum ALT >50 U/L or double the admission value, and hepatotoxicity was defined as a peak ALT >1,000 U/L. Receiver operating characteristic curve analyses were performed to compare the prognostic performance among variables. RESULTS: A total of 97 patients were admitted to the ED with AAP overdose, of whom 26 had acute liver injury and 6 had hepatotoxicity. Acute liver injury was associated with the time interval after taking the drug, and hepatotoxicity was associated with the initial PT and the ALT level. The scoring system proposed by the authors has a significant ability to predict both acute liver injury and hepatotoxicity. CONCLUSION: To predict the prognosis of AAP poisoning patients, the time interval after taking AAP was important, and initial prothrombin time and ALT level were useful tests. Also a scoring system combining variables may be useful.


Assuntos
Acetaminofen , Biomarcadores , Doença Hepática Induzida por Substâncias e Drogas , Ingestão de Alimentos , Serviço Hospitalar de Emergência , Humanos , Fígado , Registros Médicos , Estudo Observacional , Envenenamento , Prognóstico , Tempo de Protrombina , Estudos Retrospectivos , Curva ROC , Transaminases
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