Thromboembolic and hemorrhagic complications in patients with prosthetic heart valves cared for in a tertiary care center. What have we learned?

BACKGROUND: Heart valve replacement surgery with mechanical or biological prostheses entails a risk of thromboembolism and bleeding complications. OBJECTIVE: To determine the complications related to complementary anticoagulation therapy and the probability of risk. METHODS: One-hundred and sixty-three patients who underwent heart valve replacement between 2002 and 2016 with either mechanical or biological prostheses, and who received vitamin K antagonists after hospital discharge, were studied. Anticoagulation therapy was categorized into optimal and non-optimal according to INR values prior to the development of complications. Patients with comorbidities and other risk factors for thrombosis and/or bleeding were excluded. RESULTS: In total, 68.7 % of patients received mechanical prostheses, and 31.3 %, biological prostheses (p ≤ 0.001); 25.2 % experienced the complications that motivated the study (p ≤ 0.001), which were hemorrhagic in 48.8 %, thromboembolic in 26.8 %, and of both types in 24.4 % (relative risk = 4.229). Among the patients with complications, 95.1 % received mechanical prostheses, and 4.9 %, biological (p = 0.005); non-optimal INR was identified in 49.7 % (p ≤ 0.001). CONCLUSIONS: Given the high risk of thromboembolic and hemorrhagic complications, valve prostheses must be carefully chosen, and care priorities should include prevention and follow-up, especially in those patients who require anticoagulation therapy.

ANTECEDENTES: El reemplazo valvular por prótesis mecánicas o biológicas implica riesgo de tromboembolismo y complicaciones hemorrágicas. OBJETIVO: Determinar las complicaciones relacionadas con la terapia de anticoagulación complementaria y la probabilidad de riesgo en pacientes portadores de prótesis valvulares del corazón. MÉTODOS: Se estudiaron 163 pacientes entre 2002 y 2016, portadores de prótesis mecánicas y biológicas, quienes recibieron antagonistas de la vitamina K posterior al egreso hospitalario. La terapia de anticoagulación se categorizó en óptima y no óptima conforme a los valores de INR previos a las complicaciones. Fueron excluidos los pacientes con comorbilidades y otros factores de riesgo de trombosis y/o sangrado. RESULTADOS: a 68.7 % de los pacientes se les colocó prótesis mecánica y a 31.3 %, biológica (p ≤ 0.001); 25.2 % presentó las complicaciones motivo de estudio (p ≤ 0.001), hemorrágicas en 48.8 %, tromboembólicas en 26.8 % y de ambos tipos en 24.4 % (riesgo relativo = 4.229); a 95.1 % de los pacientes con complicaciones se les colocó prótesis mecánica y a 4.9 %, biológica (p = 0.005); 49.7 % presentó INR no óptimo (p ≤ 0.001). CONCLUSIONES: Ante riesgo alto de complicaciones tromboembólicas y hemorrágicas, la elección de las prótesis valvulares, la prevención y el seguimiento son prioridades, principalmente en quienes requieren terapia de anticoagulación.

Complicaciones tromboembólicas y hemorrágicas en pacientes portadores de prótesis valvulares del corazón en un centro de tercer nivel. ¿Qué hemos aprendido? / Thromboembolic and hemorrhagic complications in patients with prosthetic heart valves at third level care center. What have we learned?

Resumen Antecedentes: El reemplazo valvular por prótesis mecánicas o biológicas implica riesgo de tromboembolismo y complicaciones hemorrágicas. Objetivo: Determinar las complicaciones relacionadas con la terapia de anticoagulación complementaria y la probabilidad de riesgo en pacientes portadores de prótesis valvulares del corazón. Métodos: Se estudiaron 163 pacientes entre 2002 y 2016, portadores de prótesis mecánicas y biológicas, quienes recibieron antagonistas de la vitamina K posterior al egreso hospitalario. La terapia de anticoagulación se categorizó en óptima y no óptima conforme a los valores de INR previos a las complicaciones. Fueron excluidos los pacientes con comorbilidades y otros factores de riesgo de trombosis y/o sangrado. Resultados: a 68.7 % de los pacientes se les colocó prótesis mecánica y a 31.3 %, biológica (p ≤ 0.001); 25.2 % presentó las complicaciones motivo de estudio (p ≤ 0.001), hemorrágicas en 48.8 %, tromboembólicas en 26.8 % y de ambos tipos en 24.4 % (riesgo relativo = 4.229); a 95.1 % de los pacientes con complicaciones se les colocó prótesis mecánica y a 4.9 %, biológica (p = 0.005); 49.7 % presentó INR no óptimo (p ≤ 0.001). Conclusiones: Ante riesgo alto de complicaciones tromboembólicas y hemorrágicas, la elección de las prótesis valvulares, la prevención y el seguimiento son prioridades, principalmente en quienes requieren terapia de anticoagulación.

Abstract Background: Heart valve replacement surgery with mechanical or biological prostheses entails a risk of thromboembolism and bleeding complications. Objective: To determine the complications related to complementary anticoagulation therapy and the probability of risk. Methods: One-hundred and sixty-three patients who underwent heart valve replacement between 2002 and 2016 with either mechanical or biological prostheses, and who received vitamin K antagonists after hospital discharge, were studied. Anticoagulation therapy was categorized into optimal and non-optimal according to INR values prior to the development of complications. Patients with comorbidities and other risk factors for thrombosis and/or bleeding were excluded. Results: In total, 68.7 % of patients received mechanical prostheses, and 31.3 %, biological prostheses (p ≤ 0.001); 25.2 % experienced the complications that motivated the study (p ≤ 0.001), which were hemorrhagic in 48.8 %, thromboembolic in 26.8 %, and of both types in 24.4 % (relative risk = 4.229). Among the patients with complications, 95.1 % received mechanical prostheses, and 4.9 %, biological (p = 0.005); non-optimal INR was identified in 49.7 % (p ≤ 0.001). Conclusions: Given the high risk of thromboembolic and hemorrhagic complications, valve prostheses must be carefully chosen, and care priorities should include prevention and follow-up, especially in those patients who require anticoagulation therapy.

Prevalencia de fibrilación auricular paroxística en registros de holter de 24 horas realizados en Clínica Universitaria Reina Fabiola / Prevalence of paroxysmal atrial fibrillation in Holter records of 24 hours performed in Clínica Universitaria Reina Fabiola

INTRODUCCIÓN: La fibrilación Auricular Paroxística (FAP) es el tema central de este trabajo; su estudio es importante porque aumenta los riesgos de complicaciones tromboembolicas cerebrales, siendo estas las principales causas de mortalidad y morbilidad. OBJETIVOS: El objetivo principal del siguiente trabajo es evaluar la prevalencia de fibrilación auricular paroxística (FAP) en registros de Holter 24 hs y su relación con distintos factores de riesgo. EL objetivo secundario fue evaluar la relación de la FAP y sus complicaciones tromboembólicas cerebrales relacionándolas con diferentes variables. Material y Métodos: Fueron revisados 960 Holter 24 hs consecutivos realizados desde enero del 2014 hasta diciembre del 2015 entre los que se identificaron 39 pacientes con FAP. Se analizaron los antecedentes patológicos y presencia de complicaciones tromboembólicas cerebrales. Los datos se consignaron en una ficha diseñada para tal fin y los resultados se expresaron con la media ± DS para las variables cuantitativas y porcentajes para variables cuantitativas. Se consignó un valor de p <0,05 para determinar significación estadística. Se utilizó el test estadístico CHI 2. RESULTADOS: La cantidad de pacientes con FAP fueron 39 (4%) del total de estudios revisados, la edad promedio de los pacientes fue 67,92 (35-92) años, siendo la mayoría del sexo masculino 26 (67%). Las patologías de base fueron HTA 32 (82%); DLP 25 (64%); enfermedad vascular (EV) 15 (38%); DBT 14 (36%); IC 12 (31%); tabaquismo 8 (21%); 8 (21%) eran obesos y valvulopatía 3 (8%). De los pacientes con FAP, 11 (28%) sufrieron eventos tromboembólicos cerebrales; de ellos6 (55%) eran de sexo masculino. Nueve (82 %) padecieron ACV y 2 (18%) CIT. Las variables asociadas a eventos tromboembólicos cerebrales fueron la edad mayor a 75 años (p 0.009) y el antecedente de EV (p 0.01). CONCLUSIONES: En este estudio la prevalencia de FAP en Registro de Holter de 24 hs fue del 4 %, más frecuente en el sexo masculino y con patología de base predominante la HTA%. Se observó una alta prevalencia de eventos tromboembólicos cerebrales en pacientes con FAP que se relacionó significativamente con la edad mayor a 75 años y la presencia de EV. (AU)

INTRODUCTION: The main target of the following work is to evaluate the AF predominance in records of 24hs Holter and its relation with different risk factors. The secondary target was to evaluate the relation betwen AF and brain tromboembolics complication relating them to different variables. MATERIAL AND METHODS: 960 consecutive studies were checked realized from January, 2014 until December, 2015. 39 patients were included with AF, its case histories were checked seeing its pathological precedents and if they presented brain tromboembolics complication. The information was recorded in a card designed for such an end and the results SD expressed himself with the average ± for the quantitative variables and percentages presented in the shape of graphs or stage as it should correspond. As statistical tool used the program SPSS v11. 0Sp. A value was recorded of p <0.05 to determine statistical significance in case of comparison between groups. RESULTS: The patients' quantity with AF there were 39 that correspond to 4 % of the checked studies, the age average of the patients was 67,92 years (35-92 years) being most of the masculine sex 26 (67 %). The base pathologies were a HBP 32 (82 %); Dyslip 25 (64 %); VD 15 (38 %); DM 14 (36 %); HF 12 (31%); Tabaquic 8 (21 %); 8 (21 %) was obese and only 3 (8 %) Valvulopathies. Of the patients with AF, 11 (28 %) suffered brain tromboembolics events and 28 (72 %) was not affected; of those who had brain tromboembolic events it was of masculine sex 6 (55 %) and feminine 5 (45 %) in turn 9 (82 %) endured BTE and 2 (18 %) TCI and the variables that marked a difference as per statistics significant as for brain tromboembolic events were the age oldest than 75 years (p 0.009) and the precedent of Vascular Illness (p 0. 01) CONCLUSIONS: High AF predominance in Record of Holter of 24 hs was 4 % more frequent in the masculine sex a 67 % and that the pathology of predominant base was the hypertension in 82 %. High predominance of 28 % of Brain tromboembolic events in patients with AF and that was related significantly to the age biggest than 75 years and the presence of Vascular Illness. (AU)

Efficacy of 2 grammes of intravenous transexamic acid in the reduction of post-surgical bleeding after total hip and knee replacement. / Eficacia de 2 gramos intravenosos de ácido tranexámico en la reducción del sangrado postoperatorio de la artroplastia total de cadera y rodilla.

BACKGROUND: There is currently sufficient clinical evidence to recommend tranexamic acid (TXA) for reducing post-operative blood loss in total knee and hip arthroplasty, however, its optimal dose and administration regimes are unknown. OBJECTIVE: Analyse effectiveness and safety of TXA in total hip and knee arthroplasty using 2 grammes (g) intravenously in two different regimes. MATERIAL AND METHODS: A prospective randomised intervention study was conducted on a total of 240 patients. The patients were divided into 3 groups: 1) control; 2) 1g of TXA intraoperative, followed by another postoperative; and 3): 2g preoperative. Each group consisted of 40 patients undergoing total knee arthroplasty, and 40 total hip arthroplasty. Postoperative blood loss, transfusion rate, and thromboembolic complications were studied. RESULTS: There were significant differences (p<.005) when comparing mean total blood loss and transfusion between group 1 and 2, and between group 1 and 3, but not between the two TXA groups (2 and 3). The authors only recorded one complication in group 1 (deep vein thrombosis). DISCUSION: This study was not performed to investigate the already well established effectiveness of TXA, but to confirm if 2 empirical intravenous g is safe, and what is most beneficial regimen. In conclusion, according to the literature, both proven patterns of 2g intravenous of TXA are effective in reducing blood loss and transfusion requirements, without increasing the complication rate.