ABSTRACT
Background Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. Objectives This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PRE dicting bleeding Complications in patients undergoing stent Implantation and Sub sequent Dual Anti Platelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. Methods Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. Results Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference: −3.86%; 95% confidence interval: −7.71 to +0.06) and noncomplex PCI strata (absolute risk difference: −1.14%; 95% confidence interval: −2.26 to −0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. Conclusions Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT. (AU)
Subject(s)
Humans , Cardiovascular Diseases/prevention & control , Nutrition Assessment , Diet, Food, and NutritionABSTRACT
Objetivo: Os objetivos do presente estudo foram identificar os tipos de neoplasias e avaliar sua prevalência em 415 pacientes com trombose venosa profunda.Método: Foi investigada a presença de neoplasias, em estudo prospectivo, em 415 pacientes com trombose venosa profunda em membras inferiores, com idades entre 11 e 92 anos; média de 55,2 anos. O diagnóstico de trombose foi realizado com dúplex em todos pacientes e nos casos de dúvida foi confirmado pela flebografia. Procederam-sea história clínica e o exame físico, além de exames bioquímicas, por imagem, biópsias e cirurgias quando indicadas. Entre os principais exames laboratoriais, nos casos de suspeita clínica, realizaram-se asradiografias de tórax, endoscopia, ultra-som de abdômen, tomografia computadorizada e a ressonância magnética. Foram incluídos todos os pacientes que apresentaram trombose venosa profunda e excluídos os pacientes que já tinham diagnóstico prévio de neoplasia.Resultados: Detectou-se a presença de neoplasias em 58 (415)pacientes, representando 13,9 por cento, sendo que 27,5 por cento envolveu o trato gastrointestinal, 17,2 por cento o sistema ginecológico, 17,2 por cento o sistema nervaso central, 15,5 por cento o sistema urológico, 8,6 por cento o sistema respiratório,6,8 por cento o sistema tegumentar, 3,4 por cento o esquelético, 1,7 por cento o retroperitôneo e 1,7 por cento o reticuloendotelial.Conclusão: Conclui-se que pacientes com trombose venosa profunda apresentam uma alta prevalência de neoplasias, sendo sugerido o seu rastreamento.
Subject(s)
Humans , Male , Female , Adult , Prevalence , Venous Thrombosis/complications , Venous Thrombosis/diagnosis , Phlebography/statistics & numerical data , Phlebography/methodsABSTRACT
Nasal haemorrhage or nosebleed, is the most common of haemorrhages due to the intense vasculization of the nose, the fragility of the nasal mucous membrane and its vulnerability to traumas and irritant agents. The aim of this study is to report on a reduction of episodes of nosebleed in two patients with the use of amnophtone. A 34-year-old male patient and a 44- year-old female patient presented with histories of two or more nosebleeds per week, despite treatment during the acute phase. They both sought medical assistance for other vascular complaints, which were suggestive of vascular insufficiency as, during the physical examination petechia lesions in the lower limbs were detected. They were treated with 75 mg of amnaphtone three times daily. One week after, at the follow-up, they reported an improvement of the vascular symptoms, however, more markedly was the significant improvement in relation to the nosebleeds which were frequent but had not been reported in the first consultation. In conclusion, amnaphtone demonstrated to be efficient in the prevention of recurrence of nosebleed in these patients
