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[PMID]:28749042
[Au] Autor:Hooi KS; Lemetayer JD
[Ad] Endereço:Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, N1G 2W1, Canada.
[Ti] Título:The use of intravesicular alteplase for thrombolysis in a dog with urinary bladder thrombi.
[So] Source:J Vet Emerg Crit Care (San Antonio);27(5):590-595, 2017 Sep.
[Is] ISSN:1476-4431
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To describe the use of alteplase for intravesicular thrombolysis in a dog after development of urinary tract obstruction from a blood clot in the urinary bladder. CASE SUMMARY: A 5.8 kg, 6.5-year-old female neutered Bichon Frise was presented for signs of acute hematuria. A complete blood count (CBC) revealed marked thrombocytopenia and leukopenia, and nonregenerative anemia. Bone marrow aspirate cytology revealed mild hypercellularity, mild megakaryocytic hyperplasia, mildly left-shifted erythroid maturation, and moderately left-shifted myeloid maturation, suggesting ongoing recovery from an acute bone marrow insult. Thrombocytopenia and hematuria resolved concurrently; however, stranguria and oliguria developed acutely. Ultrasonography identified two large presumed thrombi within the urinary bladder. A urinary catheter was placed and 4 doses of 0.5 mg of alteplase diluted in 10 mL of 0.9% sodium chloride were instilled into the bladder with a 4-hour dwell time at 12-hour intervals. Prothombin and activated partial thromboplastin times were monitored during therapy and remained within normal limits. One thrombus was successfully dissolved after 48 hours of therapy and the remaining thrombus was reduced in size and was voided upon removal of the urinary catheter. NEW OR UNIQUE INFORMATION PROVIDED: This report describes the use of alteplase in a dog for thrombolysis of intravesicular thrombi. In patients that develop intravesicular thrombi, intravesical instillation of alteplase can be considered as a method for dissolution of these thrombi.
[Mh] Termos MeSH primário: Fibrinolíticos/uso terapêutico
Trombocitopenia/veterinária
Ativador de Plasminogênio Tecidual/uso terapêutico
Doenças da Bexiga Urinária/veterinária
[Mh] Termos MeSH secundário: Administração Intravesical
Animais
Cães
Feminino
Fibrinolíticos/administração & dosagem
Trombocitopenia/tratamento farmacológico
Trombose/tratamento farmacológico
Ativador de Plasminogênio Tecidual/administração & dosagem
Doenças da Bexiga Urinária/tratamento farmacológico
[Pt] Tipo de publicação:CASE REPORTS
[Nm] Nome de substância:
0 (Fibrinolytic Agents); EC 3.4.21.68 (Tissue Plasminogen Activator)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170728
[St] Status:MEDLINE
[do] DOI:10.1111/vec.12627


  2 / 27092 MEDLINE  
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[PMID]:29268649
[Au] Autor:Yurttas T; Filipovic M
[Ad] Endereço:1 Klinik für Anästhesie, Intensiv-, Rettungs- und Schmerzmedizin des Kantonsspitals St. Gallen.
[Ti] Título:Strategien zum Umgang mit antithrombotischen Medikamenten im perioperativen Umfeld..
[So] Source:Ther Umsch;74(7):361-367, 2017.
[Is] ISSN:0040-5930
[Cp] País de publicação:Switzerland
[La] Idioma:ger
[Mh] Termos MeSH primário: Perda Sanguínea Cirúrgica/prevenção & controle
Fibrinolíticos/administração & dosagem
Fibrinolíticos/efeitos adversos
Complicações Pós-Operatórias/induzido quimicamente
Complicações Pós-Operatórias/prevenção & controle
Hemorragia Pós-Operatória/induzido quimicamente
Hemorragia Pós-Operatória/prevenção & controle
[Mh] Termos MeSH secundário: Esquema de Medicação
Medicina Baseada em Evidências
Seres Humanos
Monitorização Intraoperatória/métodos
Hemorragia Pós-Operatória/diagnóstico
Hemorragia Pós-Operatória/etiologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Fibrinolytic Agents)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171223
[St] Status:MEDLINE
[do] DOI:10.1024/0040-5930/a000927


  3 / 27092 MEDLINE  
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[PMID]:29203753
[Au] Autor:Starostka-Tatar A; Labuz-Roszak B; Skrzypek M; Gasior M; Gierlotka M
[Ad] Endereço:Katedra I Klinika Neurologii W Zabrzu, Slaski Uniwersytet Medyczny W Katowicach, Zabrze, Polska.
[Ti] Título:[Definition and treatment of stroke over the centuries].
[So] Source:Wiad Lek;70(5):982-987, 2017.
[Is] ISSN:0043-5147
[Cp] País de publicação:Poland
[La] Idioma:pol
[Ab] Resumo:Stroke was already diagnosed in the ancient times. For hundreds of years the treatment of this disease has changed radically. According to the current WHO definition, stroke is a clinical syndrome caused by focal or generalized brain injury that lasts more than 24 hours or leads to death and has no other cause than vascular. Stroke constitutes a big social and economic problem, as it can lead to death or disability. In the highly developed countries stroke is the third most common cause of adult deaths, the second leading cause of dementia, and the most common cause of disability. The consequences of stroke also include epilepsy and depression. In the twentieth century, stroke was only treated symptomatically and rehabilitation was limited to passive exercises. The first breakthrough in ischemic stroke therapy was the introduction of aspirin (ASA), followed by intravenous thrombolysis using recombinant tissue plasminogen activator (rtPA), initially available in our country only in the drug programs, and since 2009 it has been reimbursed by the National Health Fund (NFZ). Gradually invasive stroke treatment has been developed. Mechanical thrombectomy is currently only performed in selected centers, giving hope for more effective stroke treatment. The purpose of this work was to show how stroke treatment has changed over the centuries.
[Mh] Termos MeSH primário: Isquemia Encefálica/terapia
Reabilitação do Acidente Vascular Cerebral
Acidente Vascular Cerebral/terapia
[Mh] Termos MeSH secundário: Terapia Combinada
Fibrinolíticos/uso terapêutico
Seres Humanos
Trombectomia/métodos
Terapia Trombolítica/métodos
Ativador de Plasminogênio Tecidual/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Fibrinolytic Agents); EC 3.4.21.68 (Tissue Plasminogen Activator)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE


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[PMID]:28747462
[Au] Autor:Mistry EA; Mistry AM; Nakawah MO; Chitale RV; James RF; Volpi JJ; Fusco MR
[Ad] Endereço:From the Department of Neurology, University of Cincinnati, OH (E.A.M); Department of Neurology, Houston Methodist Neurological Institute, TX (M.O.N., J.J.V.); Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN (A.M.M., R.V.C., M.R.F.); and Department of Neurosurgery, Un
[Ti] Título:Mechanical Thrombectomy Outcomes With and Without Intravenous Thrombolysis in Stroke Patients: A Meta-Analysis.
[So] Source:Stroke;48(9):2450-2456, 2017 09.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Whether prior intravenous thrombolysis provides any additional benefits to the patients undergoing mechanical thrombectomy for large vessel, acute ischemic stroke remains unclear. METHODS: We conducted a meta-analysis of 13 studies obtained through PubMed and EMBASE database searches to determine whether functional outcome (modified Rankin Scale) at 90 days, successful recanalization rate, and symptomatic intracerebral hemorrhage rate differed between patients who underwent mechanical thrombectomy with (MT+IVT) and without (MT-IVT) pre-treatment with intravenous thrombolysis. RESULTS: MT+IVT patients compared with MT-IVT patients had better functional outcomes (modified Rankin Scale score, 0-2; summary odds ratio [OR], 1.27 [95% confidence interval (CI), 1.05-1.55]; =0.02; n=1769/1174), lower mortality (OR, 0.71 [95% CI, 0.55-0.91]; =0.006; n=1774/1202), and higher rate of successful recanalization (OR, 1.46 [95% CI, 1.09-1.96]; =0.01; n=1652/1216) without having increased odds of symptomatic intracerebral hemorrhage (OR, 1.11 [95% CI, 0.69-1.77]; =0.67; n=1471/1143). A greater number of MT+IVT patients required ≤2 passes with a neurothrombectomy device to achieve successful recanalization (OR, 2.06 [95% CI, 1.37-3.10]; =0.0005; n=316/231). CONCLUSIONS: Our results demonstrated that MT+IVT patients had better functional outcomes, lower mortality, higher rate of successful recanalization, requiring lower number of device passes, and equal odds of symptomatic intracerebral hemorrhage compared with MT-IVT patients. The results support the current guidelines of offering intravenous thrombolysis to eligible patients even if they are being considered for mechanical thrombectomy. Because the data are compiled from studies where the 2 groups differed based on eligibility for intravenous thrombolysis, randomized trials are necessary to accurately evaluate the added value of intravenous thrombolysis in patients treated with mechanical thrombectomy.
[Mh] Termos MeSH primário: Fibrinolíticos/uso terapêutico
Acidente Vascular Cerebral/terapia
Trombectomia/métodos
Terapia Trombolítica/métodos
Ativador de Plasminogênio Tecidual/uso terapêutico
[Mh] Termos MeSH secundário: Administração Intravenosa
Hemorragia Cerebral/induzido quimicamente
Hemorragia Cerebral/epidemiologia
Terapia Combinada
Seres Humanos
Mortalidade
Razão de Chances
Complicações Pós-Operatórias/epidemiologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Nm] Nome de substância:
0 (Fibrinolytic Agents); EC 3.4.21.68 (Tissue Plasminogen Activator)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170728
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.117.017320


  5 / 27092 MEDLINE  
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[PMID]:29489640
[Au] Autor:Saad M; Shaikh DH; Adrish M
[Ad] Endereço:Department of Internal Medicine.
[Ti] Título:A rare case report of a saddle pulmonary embolism presenting with high grade fevers, responsive to anticoagulation.
[So] Source:Medicine (Baltimore);97(9):e0002, 2018 Mar.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Pulmonary embolism can manifest by a myriad of clinical symptoms. High grade fever is a rare presentation of thromboembolic phenomenon. PATIENT CONCERNS: A middle aged woman presented with high grade fevers. DIAGNOSES: Patient remained febrile despite broad spectrum antibiotics. All cultures were negative. CT angiogram of the chest was done, eliciting a large saddle embolus. INTERVENTIONS: Intravenous tissue plasminogen activator (t-PA) was administered and subsequently started on anticoagulation. Patient became afebrile 3 days after initiation of anticoagulation and all antibiotics were discontinued. OUTCOMES: We demonstrate a case of a saddle pulmonary embolism presenting with high grade fevers that responded to anticoagulation. LESSONS: It is imperative to include pulmonary embolism in the differential diagnosis, when presented with high-grade fever in patients with unclear diagnosis.
[Mh] Termos MeSH primário: Febre/etiologia
Fibrinolíticos/uso terapêutico
Embolia Pulmonar/diagnóstico por imagem
Embolia Pulmonar/tratamento farmacológico
Ativador de Plasminogênio Tecidual/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Angiografia por Tomografia Computadorizada
Feminino
Seres Humanos
Tromboembolia Venosa/diagnóstico por imagem
Tromboembolia Venosa/tratamento farmacológico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Fibrinolytic Agents); EC 3.4.21.68 (Tissue Plasminogen Activator)
[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:180301
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000010002


  6 / 27092 MEDLINE  
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[PMID]:29249767
[Au] Autor:Yildirim F; Özer A
[Ad] Endereço:Department of Pulmonary and Critical Care Medicine, Diskapi Yildirim Beyazit Education and Research Hospital, Turkey.
[Ti] Título:High-risk Pulmonary Embolism: Should We Be Less Patient with Thrombolytic Therapy?
[So] Source:Intern Med;56(24):3407, 2017.
[Is] ISSN:1349-7235
[Cp] País de publicação:Japan
[La] Idioma:eng
[Mh] Termos MeSH primário: Embolia Pulmonar
Terapia Trombolítica
[Mh] Termos MeSH secundário: Fibrinolíticos
Seres Humanos
[Pt] Tipo de publicação:LETTER; COMMENT
[Nm] Nome de substância:
0 (Fibrinolytic Agents)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171219
[St] Status:MEDLINE
[do] DOI:10.2169/internalmedicine.8202-16


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[PMID]:28465460
[Au] Autor:Menjot de Champfleur N; Saver JL; Goyal M; Jahan R; Diener HC; Bonafe A; Levy EI; Pereira VM; Cognard C; Yavagal DR; Albers GW
[Ad] Endereço:From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (G.W.A.); Department of Radiology (M.G.) and Department of Clinical Neurosciences (M.G.), University of Calgary, Alberta, Canada; Division of Interventional Neuroradiology (
[Ti] Título:Efficacy of Stent-Retriever Thrombectomy in Magnetic Resonance Imaging Versus Computed Tomographic Perfusion-Selected Patients in SWIFT PRIME Trial (Solitaire FR With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke).
[So] Source:Stroke;48(6):1560-1566, 2017 06.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: The majority of patients enrolled in SWIFT PRIME trial (Solitaire FR With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke) had computed tomographic perfusion (CTP) imaging before randomization; 34 patients were randomized after magnetic resonance imaging (MRI). METHODS: Patients with middle cerebral artery and distal carotid occlusions were randomized to treatment with tPA (tissue-type plasminogen activator) alone or tPA+stentriever thrombectomy. The primary outcome was the distribution of the modified Rankin Scale score at 90 days. Patients with the target mismatch profile for enrollment were identified on MRI and CTP. RESULTS: MRI selection was performed in 34 patients; CTP in 139 patients. Baseline National Institutes of Health Stroke Scale score was 17 in both groups. Target mismatch profile was present in 95% (MRI) versus 83% (CTP). A higher percentage of the MRI group was transferred from an outside hospital ( =0.02), and therefore, the time from stroke onset to randomization was longer in the MRI group ( =0.003). Time from emergency room arrival to randomization did not differ in CTP versus MRI-selected patients. Baseline ischemic core volumes were similar in both groups. Reperfusion rates (>90%/TICI [Thrombolysis in Cerebral Infarction] score 3) did not differ in the stentriever-treated patients in the MRI versus CTP groups. The primary efficacy analysis (90-day mRS score) demonstrated a statistically significant benefit in both subgroups (MRI, =0.02; CTP, =0.01). Infarct growth was reduced in the stentriever-treated group in both MRI and CTP groups. CONCLUSIONS: Time to randomization was significantly longer in MRI-selected patients; however, site arrival to randomization times were not prolonged, and the benefits of endovascular therapy were similar. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01657461.
[Mh] Termos MeSH primário: Isquemia Encefálica/diagnóstico por imagem
Isquemia Encefálica/terapia
Circulação Cerebrovascular
Imagem de Difusão por Ressonância Magnética/métodos
Fibrinolíticos/uso terapêutico
Avaliação de Processos e Resultados (Cuidados de Saúde)
Stents
Acidente Vascular Cerebral/diagnóstico por imagem
Acidente Vascular Cerebral/terapia
Trombectomia/métodos
Ativador de Plasminogênio Tecidual/uso terapêutico
Tomografia Computadorizada por Raios X/métodos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Isquemia Encefálica/etiologia
Doenças das Artérias Carótidas/complicações
Terapia Combinada
Feminino
Seres Humanos
Infarto da Artéria Cerebral Média/complicações
Masculino
Meia-Idade
Método Simples-Cego
Acidente Vascular Cerebral/etiologia
Fatores de Tempo
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Fibrinolytic Agents); EC 3.4.21.68 (Tissue Plasminogen Activator)
[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:170504
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.117.016669


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Registro de Ensaios Clínicos
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[PMID]:29364767
[Au] Autor:Albers GW; Marks MP; Kemp S; Christensen S; Tsai JP; Ortega-Gutierrez S; McTaggart RA; Torbey MT; Kim-Tenser M; Leslie-Mazwi T; Sarraj A; Kasner SE; Ansari SA; Yeatts SD; Hamilton S; Mlynash M; Heit JJ; Zaharchuk G; Kim S; Carrozzella J; Palesch YY; Demchuk AM; Bammer R; Lavori PW; Broderick JP; Lansberg MG; DEFUSE 3 Investigators
[Ad] Endereço:From the Departments of Neurology and Neurological Sciences (G.W.A., S. Kemp, S.C., J.P.T., S.H., M.M., M.G.L.), Diagnostic Radiology (M.P.M., J.J.H., G.Z.), Radiology (R.B.), and Biomedical Data Science (P.W.L.), Stanford University School of Medicine, Stanford, and the Department of Neurology, Kec
[Ti] Título:Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging.
[So] Source:N Engl J Med;378(8):708-718, 2018 02 22.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Thrombectomy is currently recommended for eligible patients with stroke who are treated within 6 hours after the onset of symptoms. METHODS: We conducted a multicenter, randomized, open-label trial, with blinded outcome assessment, of thrombectomy in patients 6 to 16 hours after they were last known to be well and who had remaining ischemic brain tissue that was not yet infarcted. Patients with proximal middle-cerebral-artery or internal-carotid-artery occlusion, an initial infarct size of less than 70 ml, and a ratio of the volume of ischemic tissue on perfusion imaging to infarct volume of 1.8 or more were randomly assigned to endovascular therapy (thrombectomy) plus standard medical therapy (endovascular-therapy group) or standard medical therapy alone (medical-therapy group). The primary outcome was the ordinal score on the modified Rankin scale (range, 0 to 6, with higher scores indicating greater disability) at day 90. RESULTS: The trial was conducted at 38 U.S. centers and terminated early for efficacy after 182 patients had undergone randomization (92 to the endovascular-therapy group and 90 to the medical-therapy group). Endovascular therapy plus medical therapy, as compared with medical therapy alone, was associated with a favorable shift in the distribution of functional outcomes on the modified Rankin scale at 90 days (odds ratio, 2.77; P<0.001) and a higher percentage of patients who were functionally independent, defined as a score on the modified Rankin scale of 0 to 2 (45% vs. 17%, P<0.001). The 90-day mortality rate was 14% in the endovascular-therapy group and 26% in the medical-therapy group (P=0.05), and there was no significant between-group difference in the frequency of symptomatic intracranial hemorrhage (7% and 4%, respectively; P=0.75) or of serious adverse events (43% and 53%, respectively; P=0.18). CONCLUSIONS: Endovascular thrombectomy for ischemic stroke 6 to 16 hours after a patient was last known to be well plus standard medical therapy resulted in better functional outcomes than standard medical therapy alone among patients with proximal middle-cerebral-artery or internal-carotid-artery occlusion and a region of tissue that was ischemic but not yet infarcted. (Funded by the National Institute of Neurological Disorders and Stroke; DEFUSE 3 ClinicalTrials.gov number, NCT02586415 .).
[Mh] Termos MeSH primário: Fibrinolíticos/uso terapêutico
Imagem de Perfusão
Acidente Vascular Cerebral/cirurgia
Trombectomia
[Mh] Termos MeSH secundário: Idoso
Isquemia Encefálica/diagnóstico por imagem
Isquemia Encefálica/cirurgia
Angiografia Cerebral
Terapia Combinada
Procedimentos Endovasculares
Feminino
Seres Humanos
Masculino
Meia-Idade
Método Simples-Cego
Acidente Vascular Cerebral/diagnóstico por imagem
Acidente Vascular Cerebral/tratamento farmacológico
Acidente Vascular Cerebral/mortalidade
Tempo para o Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Nm] Nome de substância:
0 (Fibrinolytic Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180125
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMoa1713973


  9 / 27092 MEDLINE  
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[PMID]:28460762
[Au] Autor:Nagamalesh UM; Prakash VS; Naidu KCK; Sarthak S; Hegde AV; Abhinay T
[Ad] Endereço:Department of Cardiology, MS Ramaiah Medical College, MS Ramaiah Memorial Hospital, Bangalore, Karnataka, India. Electronic address: nmalesh@yahoo.co.in.
[Ti] Título:Acute pulmonary thromboembolism: Epidemiology, predictors, and long-term outcome - A single center experience.
[So] Source:Indian Heart J;69(2):160-164, 2017 Mar - Apr.
[Is] ISSN:0019-4832
[Cp] País de publicação:India
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Acute pulmonary thromboembolism (PTE) is a life-threatening disease. Mortality in PTE still remains very high in spite of progress in diagnostic tools. Mortality rate is about 30% in patients with unrecognized acute PTE. METHODS: It is a single center observational study of 31 consecutive patients who were hospitalized in the Department of Cardiology at MS Ramaiah Memorial hospital between January 1, 2010 and June 2015. All the patients confirmed with diagnosis of acute PTE by CT scan (either HRCT or CTPA) were included in the study. Following relevant investigations chosen patients were risk stratified as per standard guidelines into massive, sub massive or low risk and treated accordingly. The included patients were followed up for a period of 1 year with 2D-echocardiogram and other relevant investigations for comparison to assess improvement. Mortality due to either acute PTE or other causes was noted in the study. RESULTS: Of the 31 patients enrolled in our study, 71% (n=22) of the patients belonged to the age range 20-50 years with those in the age group 31-40 years comprising 39% (n=12) of the total. Elderly people over 65 years of age comprised only 19% (n=6) of the total number of patients. Dyslipidemia, prolonged immobilization, deep vein thrombosis, post-operative state, malignancy and post-partum period were the commonly reported risk factors. We thrombolysed a total of 18 (58%) patients with massive and submassive PTE, of which 12 (39%) received tenecteplase and 6 patients received streptokinase (19%). Three (9%) patients required repeat thrombolysis with streptokinase due to failed thrombolytic therapy with tenecteplase. CONCLUSIONS: Our study reported higher incidence of acute PTE in the middle age group population. Prevalence of dyslipidemia was high in this cohort of patients studied although the exact association of it in APE could not be determined. Thrombolytic therapy can be considered for patients with both massive and submassive pulmonary thromboembolism. Repeat thrombolysis can be considered in case one thrombolytic agent failed to give the desirable results.
[Mh] Termos MeSH primário: Fibrinolíticos/uso terapêutico
Embolia Pulmonar/epidemiologia
Terapia Trombolítica/métodos
[Mh] Termos MeSH secundário: Doença Aguda
Adulto
Idoso
Eletrocardiografia
Feminino
Seguimentos
Seres Humanos
Incidência
Índia/epidemiologia
Masculino
Meia-Idade
Prognóstico
Embolia Pulmonar/diagnóstico
Embolia Pulmonar/tratamento farmacológico
Estudos Retrospectivos
Fatores de Risco
Fatores de Tempo
Tomografia Computadorizada por Raios X
Ultrassonografia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Fibrinolytic Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


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[PMID]:29363105
[Au] Autor:Hakoum MB; Kahale LA; Tsolakian IG; Matar CF; Yosuico VE; Terrenato I; Sperati F; Barba M; Schünemann H; Akl EA
[Ad] Endereço:Family Medicine, American University of Beirut, Beirut, Lebanon, 1107 2020.
[Ti] Título:Anticoagulation for the initial treatment of venous thromboembolism in people with cancer.
[So] Source:Cochrane Database Syst Rev;1:CD006649, 2018 01 24.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Compared with people without cancer, people with cancer who receive anticoagulant treatment for venous thromboembolism (VTE) are more likely to develop recurrent VTE. OBJECTIVES: To compare the efficacy and safety of three types of parenteral anticoagulants (i.e. fixed-dose low molecular weight heparin (LMWH), adjusted-dose unfractionated heparin (UFH), and fondaparinux) for the initial treatment of VTE in people with cancer. SEARCH METHODS: A comprehensive search included a major electronic search of the following databases: Cochrane Central Register of Controlled Trials (CENTRAL) (2018, Issue 1), MEDLINE (via Ovid) and Embase (via Ovid); handsearching of conference proceedings; checking of references of included studies; use of the 'related citation' feature in PubMed; and a search for ongoing studies. This update of the systematic review was based on the findings of a literature search conducted on 14 January 2018. SELECTION CRITERIA: Randomized controlled trials (RCTs) assessing the benefits and harms of LMWH, UFH, and fondaparinux in people with cancer and objectively confirmed VTE. DATA COLLECTION AND ANALYSIS: Using a standardized form, we extracted data in duplicate on study design, participants, interventions outcomes of interest, and risk of bias. Outcomes of interested included all-cause mortality, symptomatic VTE, major bleeding, minor bleeding, postphlebitic syndrome, quality of life, and thrombocytopenia. We assessed the certainty of evidence for each outcome using the GRADE approach. MAIN RESULTS: Of 15440 identified citations, 7387 unique citations, 15 RCTs fulfilled the eligibility criteria. These trials enrolled 1615 participants with cancer and VTE: 13 compared LMWH with UFH enrolling 1025 participants, one compared fondaparinux with UFH and LMWH enrolling 477 participants, and one compared dalteparin with tinzaparin enrolling 113 participants. The meta-analysis of mortality at three months included 418 participants from five studies and that of recurrent VTE included 422 participants from 3 studies. The findings showed that LMWH likely decreases mortality at three months compared to UFH (risk ratio (RR) 0.66, 95% confidence interval (CI) 0.40 to 1.10; risk difference (RD) 57 fewer per 1000, 95% CI 101 fewer to 17 more; moderate certainty evidence), but did not rule out a clinically significant increase or decrease in VTE recurrence (RR 0.69, 95% CI 0.27 to 1.76; RD 30 fewer per 1000, 95% CI 70 fewer to 73 more; moderate certainty evidence).The study comparing fondaparinux with heparin (UFH or LMWH) did not exclude a beneficial or detrimental effect of fondaparinux on mortality at three months (RR 1.25, 95% CI 0.86 to 1.81; RD 43 more per 1000, 95% CI 24 fewer to 139 more; moderate certainty evidence), recurrent VTE (RR 0.93, 95% CI 0.56 to 1.54; RD 8 fewer per 1000, 95% CI 52 fewer to 63 more; moderate certainty evidence), major bleeding (RR 0.82, 95% CI 0.40 to 1.66; RD 12 fewer per 1000, 95% CI 40 fewer to 44 more; moderate certainty evidence), or minor bleeding (RR 1.53, 95% CI 0.88 to 2.66; RD 42 more per 1000, 95% CI 10 fewer to 132 more; moderate certainty evidence)The study comparing dalteparin with tinzaparin did not exclude a beneficial or detrimental effect of dalteparin on mortality (RR 0.86, 95% CI 0.43 to 1.73; RD 33 fewer per 1000, 95% CI 135 fewer to 173 more; low certainty evidence), recurrent VTE (RR 0.44, 95% CI 0.09 to 2.16; RD 47 fewer per 1000, 95% CI 77 fewer to 98 more; low certainty evidence), major bleeding (RR 2.19, 95% CI 0.20 to 23.42; RD 20 more per 1000, 95% CI 14 fewer to 380 more; low certainty evidence), or minor bleeding (RR 0.82, 95% CI 0.30 to 2.21; RD 24 fewer per 1000, 95% CI 95 fewer to 164 more; low certainty evidence). AUTHORS' CONCLUSIONS: LMWH is possibly superior to UFH in the initial treatment of VTE in people with cancer. Additional trials focusing on patient-important outcomes will further inform the questions addressed in this review. The decision for a person with cancer to start LMWH therapy should balance the benefits and harms and consider the person's values and preferences.
[Mh] Termos MeSH primário: Anticoagulantes/uso terapêutico
Neoplasias/complicações
Tromboembolia Venosa/tratamento farmacológico
[Mh] Termos MeSH secundário: Dalteparina/uso terapêutico
Fibrinolíticos/uso terapêutico
Hemorragia/induzido quimicamente
Heparina/uso terapêutico
Heparina de Baixo Peso Molecular/uso terapêutico
Seres Humanos
Polissacarídeos/uso terapêutico
Ensaios Clínicos Controlados Aleatórios como Assunto
Recidiva
Prevenção Secundária
Tromboembolia Venosa/mortalidade
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Fibrinolytic Agents); 0 (Heparin, Low-Molecular-Weight); 0 (Polysaccharides); 7UQ7X4Y489 (tinzaparin); 9005-49-6 (Heparin); J177FOW5JL (fondaparinux); S79O08V79F (Dalteparin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180125
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD006649.pub7



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