RESUMO
BACKGROUND: Patients with active cancer are often on chronic anticoagulation and frequently require interruption of this treatment for invasive procedures. The impact of cancer on periprocedural thromboembolism (TE) and major bleeding is not known. PATIENTS AND METHODS: Two thousand one hundred and eighty-two consecutive patients referred for periprocedural anticoagulation (2484 procedures) using a standardized protocol were followed forward in time to estimate the 3-month incidence of TE, major bleeding and survival stratified by anticoagulation indication. For each indication, we tested active cancer and bridging heparin therapy as potential predictors of TE and major bleeding. RESULTS: Compared with patients without cancer, active cancer patients (n=493) had more venous thromboembolism (VTE) complications (1.2% versus 0.2%; P=0.001), major bleeding (3.4% versus 1.7%; P=0.02) and reduced survival (95% versus 99%; P<0.001). Among active cancer patients, only those chronically anticoagulated for VTE had higher rates of periprocedural VTE (2% versus 0.16%; P=0.002) and major bleeding (3.7% versus 0.6%; P<0.001). Bridging with heparin increased the rate of major bleeding in cancer patients (5% versus 1%; P=0.03) without impacting the VTE rate (0.7% versus 1.4%, P=0.50). CONCLUSIONS: Cancer patients anticoagulated for VTE experience higher rates of periprocedural VTE and major bleeding. Periprocedural anticoagulation for these patients requires particular attention to reduce these complications.
Assuntos
Anticoagulantes/administração & dosagem , Hemorragia/etiologia , Neoplasias/sangue , Tromboembolia Venosa/etiologia , Idoso , Anticoagulantes/efeitos adversos , Feminino , Hemorragia/sangue , Hemorragia/induzido quimicamente , Heparina de Baixo Peso Molecular/administração & dosagem , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tromboembolia Venosa/sangue , Tromboembolia Venosa/induzido quimicamente , Varfarina/administração & dosagem , Varfarina/efeitos adversosRESUMO
Altogether 169 operations of patients with occlusion or stenosis of the brain arteries and brain magistral arteries are reviewed. In 151 patients the cause of disease was atherosclerosis. No one of the patients has died. According to the thorough investigation consisting of panangiography, dynamic scintigraphy, sonography, ophthalmodynamometry, CT and other clinical investigations, either extra-intra-cranial shunts (STA MCA), or endarterectomies were carried out. The indications for these operations were elaborated with regards to the cause of tandem changes in arteries or to bilateral atherosclerotic changes of the brain arteries. Out of the total 169 operations, 30 endarterectomies were performed. Only two post-surgical complications have appeared, one of them post STA MCA operation and the other after endarterectomy.
Assuntos
Infarto Cerebral/cirurgia , Revascularização Cerebral/métodos , Endarterectomia/métodos , Arteriosclerose Intracraniana/cirurgia , Ataque Isquêmico Transitório/cirurgia , Adolescente , Adulto , Idoso , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/cirurgia , Feminino , Seguimentos , Hemiplegia/cirurgia , Humanos , Embolia e Trombose Intracraniana/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologiaRESUMO
Elevated levels of alpha-1-fetoprotein (AFP) were found in the amniotic fluid of a 36-year-old woman in the 15th week of gestation. Because of this and the results of repeated ultrasonography, abortion was induced. An anencephalic fetus with trisomy 18 was delivered. The possible correlation among neural-tube defects, chromosomal abnormalities, and level of AFP is discussed.
