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[PMID]:29386181
[Au] Autor:Adelborg K; Szépligeti SK; Holland-Bill L; Ehrenstein V; Horváth-Puhó E; Henderson VW; Sørensen HT
[Ad] Endereço:Department of Clinical Epidemiology, Aarhus University Hospital, Denmark kade@clin.au.dk.
[Ti] Título:Migraine and risk of cardiovascular diseases: Danish population based matched cohort study.
[So] Source:BMJ;360:k96, 2018 01 31.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To examine the risks of myocardial infarction, stroke (ischaemic and haemorrhagic), peripheral artery disease, venous thromboembolism, atrial fibrillation or atrial flutter, and heart failure in patients with migraine and in a general population comparison cohort. DESIGN: Nationwide, population based cohort study. SETTING: All Danish hospitals and hospital outpatient clinics from 1995 to 2013. PARTICIPANTS: 51 032 patients with migraine and 510 320 people from the general population matched on age, sex, and calendar year. MAIN OUTCOME MEASURES: Comorbidity adjusted hazard ratios of cardiovascular outcomes based on Cox regression analysis. RESULTS: Higher absolute risks were observed among patients with incident migraine than in the general population across most outcomes and follow-up periods. After 19 years of follow-up, the cumulative incidences per 1000 people for the migraine cohort compared with the general population were 25 17 for myocardial infarction, 45 25 for ischaemic stroke, 11 6 for haemorrhagic stroke, 13 11 for peripheral artery disease, 27 18 for venous thromboembolism, 47 34 for atrial fibrillation or atrial flutter, and 19 18 for heart failure. Correspondingly, migraine was positively associated with myocardial infarction (adjusted hazard ratio 1.49, 95% confidence interval 1.36 to 1.64), ischaemic stroke (2.26, 2.11 to 2.41), and haemorrhagic stroke (1.94, 1.68 to 2.23), as well as venous thromboembolism (1.59, 1.45 to 1.74) and atrial fibrillation or atrial flutter (1.25, 1.16 to 1.36). No meaningful association was found with peripheral artery disease (adjusted hazard ratio 1.12, 0.96 to 1.30) or heart failure (1.04, 0.93 to 1.16). The associations, particularly for stroke outcomes, were stronger during the short term (0-1 years) after diagnosis than the long term (up to 19 years), in patients with aura than in those without aura, and in women than in men. In a subcohort of patients, the associations persisted after additional multivariable adjustment for body mass index and smoking. CONCLUSIONS: Migraine was associated with increased risks of myocardial infarction, ischaemic stroke, haemorrhagic stroke, venous thromboembolism, and atrial fibrillation or atrial flutter. Migraine may be an important risk factor for most cardiovascular diseases.
[Mh] Termos MeSH primário: Doenças Cardiovasculares/etiologia
Transtornos de Enxaqueca/complicações
Infarto do Miocárdio/etiologia
Acidente Vascular Cerebral/etiologia
[Mh] Termos MeSH secundário: Adulto
Fibrilação Atrial/epidemiologia
Fibrilação Atrial/etiologia
Índice de Massa Corporal
Doenças Cardiovasculares/epidemiologia
Estudos de Coortes
Comorbidade
Dinamarca/epidemiologia
Feminino
Insuficiência Cardíaca/epidemiologia
Insuficiência Cardíaca/etiologia
Seres Humanos
Incidência
Hemorragias Intracranianas/epidemiologia
Hemorragias Intracranianas/etiologia
Masculino
Meia-Idade
Transtornos de Enxaqueca/diagnóstico
Transtornos de Enxaqueca/epidemiologia
Infarto do Miocárdio/epidemiologia
Avaliação de Resultados (Cuidados de Saúde)
Doença Arterial Periférica/epidemiologia
Doença Arterial Periférica/etiologia
Estudos Prospectivos
Fatores de Risco
Fumar/epidemiologia
Acidente Vascular Cerebral/epidemiologia
Tromboembolia Venosa/epidemiologia
Tromboembolia Venosa/etiologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180202
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.k96


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[PMID]:29301740
[Au] Autor:Hunt BJ; Levi M
[Ad] Endereço:King's College, London, UK Beverley.hunt@gstt.nhs.uk.
[Ti] Título:Urgent reversal of vitamin K antagonists.
[So] Source:BMJ;360:j5424, 2018 01 04.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Fibrilação Atrial/complicações
Encéfalo/diagnóstico por imagem
Hemorragias Intracranianas/induzido quimicamente
Paresia/diagnóstico
Vitamina K/antagonistas & inibidores
Varfarina/efeitos adversos
[Mh] Termos MeSH secundário: Administração Intravenosa
Idoso
Anticoagulantes/uso terapêutico
Fibrilação Atrial/tratamento farmacológico
Encéfalo/patologia
Serviço Hospitalar de Emergência
Fator V/administração & dosagem
Fator V/economia
Fator V/uso terapêutico
Fator Xa/administração & dosagem
Fator Xa/economia
Fator Xa/uso terapêutico
Seres Humanos
Coeficiente Internacional Normatizado/normas
Hemorragias Intracranianas/diagnóstico por imagem
Hemorragias Intracranianas/mortalidade
Masculino
Paresia/etiologia
Plasma
Tomografia Computadorizada por Raios X/métodos
Vitamina K/administração & dosagem
Vitamina K/uso terapêutico
Varfarina/uso terapêutico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants); 0 (prothrombinase complex); 12001-79-5 (Vitamin K); 5Q7ZVV76EI (Warfarin); 9001-24-5 (Factor V); EC 3.4.21.6 (Factor Xa)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180106
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5424


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[PMID]:28455322
[Au] Autor:Neuberger U; Möhlenbruch MA; Herweh C; Ulfert C; Bendszus M; Pfaff J
[Ad] Endereço:From the Department of Neuroradiology, Heidelberg University Hospital, Germany.
[Ti] Título:Classification of Bleeding Events: Comparison of ECASS III (European Cooperative Acute Stroke Study) and the New Heidelberg Bleeding Classification.
[So] Source:Stroke;48(7):1983-1985, 2017 07.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Intracranial hemorrhage (ICH) after acute ischemic stroke treatments represents a feared complication with possible prognostic implications. In recent years, ICHs were commonly classified according to the ECASS (European Cooperative Acute Stroke Study). To improve the clinical applicability and relevance, the new Heidelberg Bleeding Classification (HBC) has been proposed in 2015. Here, we compared the ECASS and HBC classification with regard to observed events and prognostic relevance. METHODS: A retrospective analysis of a prospectively compiled database of patients with acute ischemic stroke in the anterior circulation who received mechanical thrombectomy between February 2011 and March 2016 was performed. Presence of ICH after mechanical thrombectomy was evaluated on postinterventional computed tomographic imaging. ICHs were specified according to both ECASS III and HBC classification and analyzed with regard to their symptoms and outcome. RESULTS: ICHs were observed in 156 of 768 patients (20.3%). Using ECASS III classification, 101 ICHs could be unambiguously assigned, of which 28 (27.7%; 3.6% of all treated patients) were symptomatic ICHs. Using HBC, 55 additional ICHs could be categorized. Of these total 156 ICHs, 29 (18.6%; 3.8% of all treated patients) were classified as symptomatic according to HBC. CONCLUSIONS: Classification of ICH by ECASS III and HBC criteria show distinct differences. These differences warrant special attention during interpretation and comparison of scientific publications.
[Mh] Termos MeSH primário: Isquemia Encefálica/terapia
Hemorragias Intracranianas/classificação
Hemorragias Intracranianas/diagnóstico por imagem
Trombólise Mecânica/métodos
Complicações Pós-Operatórias/diagnóstico por imagem
Acidente Vascular Cerebral/terapia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Isquemia Encefálica/diagnóstico por imagem
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Acidente Vascular Cerebral/diagnóstico por imagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1707
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.117.016735


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[PMID]:29465539
[Au] Autor:Wang V; Hsieh CC; Huang YL; Chen CP; Hsieh YT; Chao TH
[Ad] Endereço:Department of Neurology, Cardinal Tien Hospital.
[Ti] Título:Different utilization of intensive care services (ICSs) for patients dying of hemorrhagic and ischemic stroke, a hospital-based survey.
[So] Source:Medicine (Baltimore);97(8):e0017, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The intensive care service (ICS) saves lives and rescues the neurological function of stroke patients. We wondered the different utilization of ICS for patients with ischemic and hemorrhagic stroke, especially those who died within 30 days after stroke.Sixty-seven patients died during 2011 to 2015 due to acute stroke (42 due to intracranial hemorrhage [ICH]; 25 due to cerebral infarct [CI]). The durations of hospital stay (hospital staying days [HSDs]) and ICS staying days (ISDs) and codes of the do-not-resuscitate (DNR) were surveyed among these medical records. Statistics included chi-square and descriptive analyses.In this study, CI patients had a longer HSD (mean 14.3 days), as compared with ICH patients (mean 8.3 days); however, the ICH patients had a higher percentage of early entry within the first 24 hours of admission into ICS than CI group (95.1% vs 60.0%, P = .003). A higher rate of CI patients died in holidays or weekends than those with ICH (44.0% vs 21.4%, P = .051). DNR, requested mainly from direct descendants (children or grandchildren), was coded in all 25 CI patients (100.0%) and 38 ICH patients (90.5%). More cases with early DNR coded within 24 hours after admission occurred in ICH group (47%, 12% in CI patients, P = .003). None of the stroke patient had living wills. Withhold of endotracheal intubation (ETI) occurred among CI patients, more than for ICH patients (76.0% vs 18.4%, P < .005).In conclusion, CI patients longer HSD, ISD, higher mortality within holidays or weekends, and higher ETI withhold; but less percentage of ICS utilization expressed by a lower ISD/HSD ratio. This ICS utilization is a key issue of medical quality for stroke care.
[Mh] Termos MeSH primário: Infarto Cerebral/terapia
Cuidados Críticos/utilização
Hospitais/estatística & dados numéricos
Hemorragias Intracranianas/terapia
Acidente Vascular Cerebral/terapia
[Mh] Termos MeSH secundário: Idoso
Causas de Morte
Infarto Cerebral/mortalidade
Feminino
Hospitalização/estatística & dados numéricos
Seres Humanos
Hemorragias Intracranianas/mortalidade
Masculino
Sistema de Registros
Acidente Vascular Cerebral/mortalidade
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000010017


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[PMID]:27777129
[Au] Autor:Coyle C; Cafferty FH; Rowley S; MacKenzie M; Berkman L; Gupta S; Pramesh CS; Gilbert D; Kynaston H; Cameron D; Wilson RH; Ring A; Langley RE; Add-Aspirin investigators
[Ad] Endereço:MRC Clinical Trials Unit, UCL, Aviation House, 125 Kingsway, London WC2B 6NH, UK.
[Ti] Título:ADD-ASPIRIN: A phase III, double-blind, placebo controlled, randomised trial assessing the effects of aspirin on disease recurrence and survival after primary therapy in common non-metastatic solid tumours.
[So] Source:Contemp Clin Trials;51:56-64, 2016 11.
[Is] ISSN:1559-2030
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: There is a considerable body of pre-clinical, epidemiological and randomised data to support the hypothesis that aspirin has the potential to be an effective adjuvant cancer therapy. METHODS: Add-Aspirin is a phase III, multi-centre, double-blind, placebo-controlled randomised trial with four parallel cohorts. Patients who have undergone potentially curative treatment for breast (n=3100), colorectal (n=2600), gastro-oesophageal (n=2100) or prostate cancer (n=2120) are registered into four tumour specific cohorts. All cohorts recruit in the United Kingdom, with the breast and gastro-oesophageal cohort also recruiting in India. Eligible participants first undertake an active run-in period where 100mg aspirin is taken daily for approximately eight weeks. Participants who are able to adhere and tolerate aspirin then undergo a double-blind randomisation and are allocated in a 1:1:1 ratio to either 100mg aspirin, 300mg aspirin or a matched placebo to be taken daily for at least five years. Those participants ≥75years old are only randomised to 100mg aspirin or placebo due to increased toxicity risk. RESULTS: The primary outcome measures are invasive disease-free survival for the breast cohort, disease-free survival for the colorectal cohort, overall survival for the gastro-oesophageal cohort, and biochemical recurrence-free survival for the prostate cohort, with a co-primary outcome of overall survival across all cohorts. Secondary outcomes include adherence, toxicity including serious haemorrhage, cardiovascular events and some cohort specific measures. CONCLUSIONS: The Add-Aspirin trial investigates whether regular aspirin use after standard therapy prevents recurrence and prolongs survival in participants with four non-metastatic common solid tumours.
[Mh] Termos MeSH primário: Anti-Inflamatórios não Esteroides/uso terapêutico
Aspirina/uso terapêutico
Recidiva Local de Neoplasia/epidemiologia
Neoplasias/tratamento farmacológico
Taxa de Sobrevida
[Mh] Termos MeSH secundário: Neoplasias da Mama/tratamento farmacológico
Quimioterapia Adjuvante
Neoplasias Colorretais/tratamento farmacológico
Intervalo Livre de Doença
Método Duplo-Cego
Hipersensibilidade a Drogas/etiologia
Neoplasias Esofágicas/tratamento farmacológico
Feminino
Hemorragia Gastrointestinal/induzido quimicamente
Seres Humanos
Índia/epidemiologia
Hemorragias Intracranianas/induzido quimicamente
Estudos Longitudinais
Degeneração Macular/induzido quimicamente
Masculino
Recidiva Local de Neoplasia/sangue
Úlcera Péptica/induzido quimicamente
Neoplasias da Próstata/sangue
Neoplasias da Próstata/tratamento farmacológico
Neoplasias Gástricas/tratamento farmacológico
Zumbido/induzido quimicamente
Reino Unido/epidemiologia
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE III; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anti-Inflammatory Agents, Non-Steroidal); R16CO5Y76E (Aspirin)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180209
[Lr] Data última revisão:
180209
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161030
[St] Status:MEDLINE


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[PMID]:29382019
[Au] Autor:Wang Y; Li D; Qiao L; Zhao F
[Ad] Endereço:Department of Pediatric.
[Ti] Título:Infant Central Nervous System Aspergillosis with First-episode of Intracranial Hemorrhage: A case report.
[So] Source:Medicine (Baltimore);96(47):e8893, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Central nervous system (CNS) aspergillosis has the characteristics of multifocality, polymorphism, and coexistence of pathological types, and missed diagnosis and misdiagnosis frequently occur at the initial stage. The thesis reports a rare case of infant infection of CNS aspergillosis with the first-episode of intracranial hemorrhage. PATIENT CONCERNS: An 11-month-old female infant suffered convulsion and coma two days after the onset of fever and emesis. Its cranial computed tomography (CT) displayed subdural hemorrhage in the left tentorium cerebelli and tests indicated normal cerebrospinal fluid (CSF). Three days after being hospitalized, the infant had difficulty breathing and its CT presents consolidation in the right lung. However, treatment with ceftriaxone (ivgtt) had no effect on the baby. DIAGNOSIS: The patient's bronchoalveolar lavage fluid (BALF) was cultured into Aspergillus spp, its galactomannan (GM) antigen in CSF counted 3.0, higher than that in BALF which counted 2.6, and cranial magnetic resonance imaging (MRI) revealed multiple ring reinforced tubercles in sulci. Hence it was clinically diagnosed with CNS aspergillosis. INTERVENTIONS: Voriconazole for intravenous injection. After the intravenous injection, its trough concentration was 4.2 µg/mL, and it was within the recommended range. OUTCOMES: After one week's treatment with voriconazole, the infant's consciousness was improved. Four weeks later, with normothermia and clear consciousness, the patient was discharged. With oral administration of voriconazole up to 16 weeks, its physical state suggests no relapse and cranial MRI indicated disappearance of nodules in sulci. LESSONS: CNS aspergillosis with first-episode of intracranial hemorrhage probably leads to misdiagnosis and GM test combined with cranial MRI can augment its accuracy in the early diagnosis.
[Mh] Termos MeSH primário: Infecções Fúngicas do Sistema Nervoso Central/complicações
Hemorragias Intracranianas/parasitologia
Neuroaspergilose/complicações
[Mh] Termos MeSH secundário: Antifúngicos/administração & dosagem
Infecções Fúngicas do Sistema Nervoso Central/tratamento farmacológico
Seres Humanos
Lactente
Neuroaspergilose/tratamento farmacológico
Voriconazol/administração & dosagem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antifungal Agents); JFU09I87TR (Voriconazole)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008893


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[PMID]:27776795
[Au] Autor:Chang R; Folkerson LE; Sloan D; Tomasek JS; Kitagawa RS; Choi HA; Wade CE; Holcomb JB
[Ad] Endereço:Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX; Department of Surgery, University of Texas Health Science Center, Houston, TX. Electronic address: ronald.chang@uth.tmc.edu.
[Ti] Título:Early plasma transfusion is associated with improved survival after isolated traumatic brain injury in patients with multifocal intracranial hemorrhage.
[So] Source:Surgery;161(2):538-545, 2017 02.
[Is] ISSN:1532-7361
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Plasma-based resuscitation improves outcomes in trauma patients with hemorrhagic shock, while large-animal and limited clinical data suggest that it also improves outcomes and is neuroprotective in the setting of combined hemorrhage and traumatic brain injury. However, the choice of initial resuscitation fluid, including the role of plasma, is unclear for patients after isolated traumatic brain injury. METHODS: We reviewed adult trauma patients admitted from January 2011 to July 2015 with isolated traumatic brain injury. "Early plasma" was defined as transfusion of plasma within 4 hours. Purposeful multiple logistic regression modeling was performed to analyze the relationship of early plasma and inhospital survival. After testing for interaction, subgroup analysis was performed based on the pattern of brain injury on initial head computed tomography: epidural hematoma, intraparenchymal contusion, subarachnoid hemorrhage, subdural hematoma, or multifocal intracranial hemorrhage. RESULTS: Of the 633 isolated traumatic brain injury patients included, 178 (28%) who received early plasma were injured more severely coagulopathic, hypoperfused, and hypotensive on admission. Survival was similar in the early plasma versus no early plasma groups (78% vs 84%, P = .08). After adjustment for covariates, early plasma was not associated with improved survival (odds ratio 1.18, 95% confidence interval 0.71-1.96). On subgroup analysis, multifocal intracranial hemorrhage was the largest subgroup with 242 patients. Of these, 61 (25%) received plasma within 4 hours. Within-group logistic regression analysis with adjustment for covariates found that early plasma was associated with improved survival (odds ratio 3.34, 95% confidence interval 1.20-9.35). CONCLUSION: Although early plasma transfusion was not associated with improved in-hospital survival for all isolated traumatic brain injury patients, early plasma was associated with increased in-hospital survival in those with multifocal intracranial hemorrhage.
[Mh] Termos MeSH primário: Transfusão de Componentes Sanguíneos/métodos
Lesões Encefálicas Traumáticas/terapia
Mortalidade Hospitalar/tendências
Hemorragias Intracranianas/terapia
Sistema de Registros
[Mh] Termos MeSH secundário: Adulto
Anticoagulantes/administração & dosagem
Lesões Encefálicas Traumáticas/complicações
Lesões Encefálicas Traumáticas/diagnóstico
Lesões Encefálicas Traumáticas/mortalidade
Estudos de Coortes
Terapia Combinada
Feminino
Escala de Coma de Glasgow
Seres Humanos
Escala de Gravidade do Ferimento
Hemorragias Intracranianas/complicações
Hemorragias Intracranianas/diagnóstico
Hemorragias Intracranianas/mortalidade
Masculino
Meia-Idade
Plasma
Estudos Retrospectivos
Medição de Risco
Análise de Sobrevida
Centros de Traumatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Nm] Nome de substância:
0 (Anticoagulants)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:180201
[Lr] Data última revisão:
180201
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE


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[PMID]:29267368
[Au] Autor:Fletcher-Sandersjöö A; Thelin EP; Bartek J; Elmi-Terander A; Broman M; Bellander BM
[Ad] Endereço:Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
[Ti] Título:Management of intracranial hemorrhage in adult patients on extracorporeal membrane oxygenation (ECMO): An observational cohort study.
[So] Source:PLoS One;12(12):e0190365, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Intracranial hemorrhage (ICH) is a common complication in adults treated with extracorporeal membrane oxygenation (ECMO). The aim of this study was to identify predictors of outcome and investigate intervention strategies following ICH development in ECMO-treated adult patients. METHODS: We conducted a retrospective review of adult patients (≥18 years) who developed an ICH during ECMO treatment at the Karolinska University Hospital (Stockholm, Sweden) between September 2005 and May 2017. Outcome was assessed by 30-day mortality and Glasgow Outcome Scale (GOS) after 6 months. The statistical analysis was supplemented by a case series of patients who were surgically treated for an ICH. RESULTS: Sixty-five patients developed an ICH during ECMO treatment. 30-day mortality was 74% (n = 48), and was significantly associated with low level of consciousness at ICH diagnosis (p = 0.036), presence of intraparenchymal hematoma (IPH) (p = 0.049), IPH volume (p = 0.002), presence of intraventricular hemorrhage (p = 0.001), subarachnoid hemorrhage Fisher grade (p<0.001), hydrocephalus (p<0.001), midline shift (p = 0.026) and absent basal cisterns (p<0.001). Among the 30-day survivors (n = 17), 63% (n = 10) had favorable neurological outcome (GOS 4-5) after six months. Five patients were surgically treated for their ICH, some with dire hemorrhagic consequences, however one patient made a complete recovery. CONCLUSIONS: ICH in adult ECMO patients is associated with a high mortality rate. Outcome predictors can help to identify patients where ICH treatment is indicated. Treating a patient with an ICH during ECMO represents an intricate balance between pro- and anticoagulatory demands. Furthermore, surgical treatment is associated with several risks but may be indicated in life-threatening lesions. Prospective studies are warranted.
[Mh] Termos MeSH primário: Oxigenação por Membrana Extracorpórea/efeitos adversos
Hemorragias Intracranianas/terapia
[Mh] Termos MeSH secundário: Adulto
Estudos de Coortes
Feminino
Seres Humanos
Hemorragias Intracranianas/etiologia
Hemorragias Intracranianas/mortalidade
Masculino
Meia-Idade
Estudos Retrospectivos
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; OBSERVATIONAL STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190365


  9 / 5185 MEDLINE  
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[PMID]:28468796
[Au] Autor:Mantia C; Uhlmann EJ; Puligandla M; Weber GM; Neuberg D; Zwicker JI
[Ad] Endereço:Department of Medicine and.
[Ti] Título:Predicting the higher rate of intracranial hemorrhage in glioma patients receiving therapeutic enoxaparin.
[So] Source:Blood;129(25):3379-3385, 2017 06 22.
[Is] ISSN:1528-0020
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Venous thromboembolism occurs in up to one-third of patients with primary brain tumors. Spontaneous intracranial hemorrhage (ICH) is also a frequent occurrence in these patients, but there is limited data on the safety of therapeutic anticoagulation. To determine the rate of ICH in patients treated with enoxaparin, we performed a matched, retrospective cohort study with blinded radiology review for 133 patients with high-grade glioma. After diagnosis of glioma, the cohort that received enoxaparin was 3 times more likely to develop a major ICH than those not treated with anticoagulation (14.7% vs 2.5%; = .036; hazard ratio [HR], 3.37; 95% confidence interval [CI], 1.02-11.14). When enoxaparin was analyzed as a time-varying covariate, anticoagulation was associated with a >13-fold increased risk of hemorrhage (HR, 13.26; 95% CI, 3.33-52.85; < .0001). Overall survival was significantly shorter for patients who suffered a major ICH on enoxaparin compared with patients not receiving anticoagulation (3.3 vs 10.2 months; log-rank = .012). We applied a validated ICH prediction risk score PANWARDS (platelets, albumin, no congestive heart failure, warfarin, age, race, diastolic blood pressure, stroke), and observed that all major ICHs on enoxaparin occurred in the setting of a PANWARDS score ≥25, corresponding with a sensitivity of 100% (95% CI, 63% to 100%) and a specificity of 40% (95% CI, 25% to 56%). We conclude that caution is warranted when considering therapeutic anticoagulation in patients with high-grade gliomas given the increased risk of ICH and poor prognosis after a major hemorrhage on anticoagulation. The PANWARDS score may assist clinicians in identifying the patients at greatest risk of suffering a major intracranial hemorrhage with anticoagulation.
[Mh] Termos MeSH primário: Anticoagulantes/uso terapêutico
Neoplasias Encefálicas/complicações
Enoxaparina/uso terapêutico
Glioma/complicações
Hemorragias Intracranianas/induzido quimicamente
Tromboembolia Venosa/prevenção & controle
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Anticoagulantes/efeitos adversos
Estudos de Coortes
Enoxaparina/efeitos adversos
Feminino
Seres Humanos
Estimativa de Kaplan-Meier
Masculino
Meia-Idade
Estudos Retrospectivos
Fatores de Risco
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Enoxaparin)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180113
[Lr] Data última revisão:
180113
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1182/blood-2017-02-767285


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[PMID]:28456465
[Au] Autor:McClure LA; Loop MS; Crosson W; Kleindorfer D; Kissela B; Al-Hamdan M
[Ad] Endereço:Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania. Electronic address: lam439@drexel.edu.
[Ti] Título:Fine Particulate Matter (PM ) and the Risk of Stroke in the REGARDS Cohort.
[So] Source:J Stroke Cerebrovasc Dis;26(8):1739-1744, 2017 Aug.
[Is] ISSN:1532-8511
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Ambient particulate matter has been shown to be associated with declining human health, although the association between fine particulate matter (PM ) and stroke is uncertain. METHODS: We utilized satellite-derived measures of PM to examine the association between exposure and stroke in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. We used a time-stratified case-crossover design, with exposure lags of 1 day, 2 days, and 3 days. We examined all strokes, as well as ischemic and hemorrhagic strokes separately. RESULTS: Among 30,239 participants in the REGARDS study, 746 incident events were observed: 72 hemorrhagic, 617 ischemic, and 57 of unknown type. Participants exposed to higher levels of PM more often resided in urban areas compared to rural, and in the southeastern United States. After adjustment for temperature and relative humidity, no association was observed between PM exposure and stroke, regardless of the lag (1-day lag OR = .99, 95% CI: .83-1.19; 2-day lag OR = .95, 95% CI: .80-1.14; 3-day lag OR = .95, 95% CI = .79-1.13). Similar results were observed for the stroke subtypes. CONCLUSIONS: In this large cohort of African-Americans and whites, no association was observed between PM and stroke. The ability to examine this association with a large number of outcomes and by stroke subtype helps fill a gap in the literature examining the association between PM and stroke.
[Mh] Termos MeSH primário: Afroamericanos
Isquemia Encefálica/etnologia
Grupo com Ancestrais do Continente Europeu
Exposição por Inalação/efeitos adversos
Hemorragias Intracranianas/etnologia
Material Particulado/efeitos adversos
Acidente Vascular Cerebral/etnologia
[Mh] Termos MeSH secundário: Idoso
Isquemia Encefálica/diagnóstico
Comorbidade
Estudos Cross-Over
Feminino
Inquéritos Epidemiológicos
Seres Humanos
Incidência
Hemorragias Intracranianas/diagnóstico
Modelos Logísticos
Masculino
Meia-Idade
Razão de Chances
Tamanho da Partícula
Estudos Prospectivos
Medição de Risco
Fatores de Risco
Saúde da População Rural
Fatores Socioeconômicos
Sudeste dos Estados Unidos/epidemiologia
Acidente Vascular Cerebral/diagnóstico
Fatores de Tempo
Saúde da População Urbana
Tempo (Meteorologia)
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Particulate Matter)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180109
[Lr] Data última revisão:
180109
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170501
[St] Status:MEDLINE



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