RESUMEN
Introduction The risk of venous thromboembolism (VTE) increases during pregnancy and the puerperium such that VTE is a leading cause of maternal mortality. Methods We describe the clinical characteristics, diagnostic strategies, treatment patterns, and outcomes of women with pregnancy-associated VTE (PA-VTE) enrolled in the Global Anticoagulant Registry in the FIELD (GARFIELD)-VTE. Women of childbearing age (<45 years) were stratified into those with PA-VTE ( n = 183), which included pregnant patients and those within the puerperium, and those with nonpregnancy associated VTE (NPA-VTE; n = 1,187). Patients with PA-VTE were not stratified based upon the stage of pregnancy or puerperium. Results Women with PA-VTE were younger (30.5 vs. 34.8 years), less likely to have pulmonary embolism (PE) (19.7 vs. 32.3%) and more likely to have left-sided deep vein thrombosis (DVT) (73.9 vs. 54.8%) compared with those with NPA-VTE. The most common risk factors in PA-VTE patients were hospitalization (10.4%), previous surgery (10.4%), and family history of VTE (9.3%). DVT was typically diagnosed by compression ultrasonography (98.7%) and PE by chest computed tomography (75.0%). PA-VTE patients more often received parenteral (43.2 vs. 15.1%) or vitamin K antagonists (VKA) (9.3 vs. 7.6%) therapy alone. NPA-VTE patients more often received a DOAC alone (30.2 vs. 13.7%). The risk (hazard ratio [95% confidence interval]) of all-cause mortality (0.59 [0.18-1.98]), recurrent VTE (0.82 [0.34-1.94]), and major bleeding (1.13 [0.33-3.90]) were comparable between PA-VTE and NPA-VTE patients. Uterine bleeding was the most common complication in both groups. Conclusion VKAs or DOACs are widely used for treatment of PA-VTE despite limited evidence for their use in this population. Rates of clinical outcomes were comparable between groups.
RESUMEN
Importance: Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes. Objective: To assess the treatment strategies and 1-year clinical outcomes of antithrombotic and CHF therapies for patients with newly diagnosed AF with concomitant CHF stratified by etiology (ischemic cardiomyopathy [ICM] vs nonischemic cardiomyopathy [NICM]). Design, Setting, and Participants: The GARFIELD-AF registry is a prospective, noninterventional registry. A total of 52â¯014 patients with AF were enrolled between March 2010 and August 2016. A total of 11â¯738 patients 18 years and older with newly diagnosed AF (≤6 weeks' duration) and at least 1 investigator-determined stroke risk factor were included. Data were analyzed from December 2017 to September 2018. Exposures: One-year follow-up rates of death, stroke/systemic embolism, and major bleeding were assessed. Main Outcomes and Measures: Event rates per 100 person-years were estimated from the Poisson model and Cox hazard ratios (HRs) and 95% confidence intervals. Results: The median age of the population was 71.0 years, 22â¯987 of 52â¯013 were women (44.2%) and 31â¯958 of 52â¯014 were white (61.4%). Of 11â¯738 patients with CHF, 4717 (40.2%) had ICM and 7021 (59.8%) had NICM. Prescription of oral anticoagulant and antiplatelet drugs was not balanced between groups. Oral anticoagulants with or without antiplatelet drugs were used in 2753 patients with ICM (60.1%) and 5082 patients with NICM (73.7%). Antiplatelets were prescribed alone in 1576 patients with ICM (34.4%) and 1071 patients with NICM (15.5%). Compared with patients with NICM, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (72.6% [3439] vs 60.3% [4236]) and of ß blockers (63.3% [2988] vs 53.2% [3737]) was higher in patients with ICM. Rates of all-cause and cardiovascular death per 100 patient-years were significantly higher in the ICM group (all-cause death: ICM, 10.2; 95% CI, 9.2-11.1; NICM, 7.0; 95% CI, 6.4-7.6; cardiovascular death: ICM, 5.1; 95% CI, 4.5-5.9; NICM, 2.9; 95% CI, 2.5-3.4). Stroke/systemic embolism rates tended to be higher in ICM groups compared with NICM groups (ICM, 2.0; 95% CI, 1.6-2.5; NICM, 1.5; 95% CI, 1.3-1.9). Major bleeding rates were significantly higher in the ICM group (1.1; 95% CI, 0.8-1.4) compared with the NICM group (0.7; 95% CI, 0.5-0.9). Conclusions and Relevance: Patients with ICM received oral anticoagulants with or without antiplatelet drugs less frequently and antiplatelets alone more frequently than patients with NICM, but they received angiotensin-converting enzyme inhibitors/angiotensin receptor blockers more often than patients with NICM. All-cause and cardiovascular death rates were higher in patients with ICM than patients with NICM. Trial Registration: ClinicalTrials.gov Identifier: NCT01090362.
Asunto(s)
Anticoagulantes/uso terapéutico , Fibrilación Atrial/tratamiento farmacológico , Adhesión a Directriz/estadística & datos numéricos , Insuficiencia Cardíaca/tratamiento farmacológico , Accidente Cerebrovascular/prevención & control , Antagonistas Adrenérgicos beta/uso terapéutico , Anciano , Anciano de 80 o más Años , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Fibrilación Atrial/complicaciones , Cardiomiopatías/complicaciones , Cardiomiopatías/fisiopatología , Cardiotónicos/uso terapéutico , Enfermedades Cardiovasculares/mortalidad , Estudios de Cohortes , Digoxina/uso terapéutico , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/fisiopatología , Hemorragia/inducido químicamente , Humanos , Masculino , Persona de Mediana Edad , Antagonistas de Receptores de Mineralocorticoides/uso terapéutico , Mortalidad , Isquemia Miocárdica/complicaciones , Inhibidores de Agregación Plaquetaria/uso terapéutico , Guías de Práctica Clínica como Asunto , Modelos de Riesgos Proporcionales , Sistema de Registros , Inhibidores del Simportador de Cloruro Sódico y Cloruro Potásico/uso terapéutico , Accidente Cerebrovascular/etiología , Volumen SistólicoRESUMEN
O VII Simpósio Internacional de Trombose e Anticoagulação (ISTA) foi realizado em São Paulo, SP, Brasil, nos dias 24 e 25 de outubro de 2014, tendo como principais propósitos a discussão e o compartilhamento de conhecimentos sobre os avanços recentes na abordagem diagnóstica e terapêutica de pacientes com distúrbios trombóticos, nas suas diversas formas de apresentação clínica. O programa científico deste simpósio foi cuidadosamente desenvolvido por líderes de três importantes institutos de pesquisa clínica: o Instituto Brasileiro de Pesquisa Clínica(BCRI), o Duke Clinical Research Institute (DCRI), e Instituto de Pesquisa do Hospital do Coração. Composto por dois dias de apresentações acadêmicas e discussão aberta, o simpósio teve como principal objetivo educar, motivar e inspirar os clínicos, cardiologistas, hematologistas, e outros médicos através de apresentações e discussões de aspectos práticos de condutas que envolvem síndromes relacionadas à trombose e suas respectivas terapias antitrombóticas. Estas atividades possibilitaram uma interação direta entre a plateia e o corpo de palestrantes, composto por médicos de grande experiência clínica e pelos médicos pesquisadores que desenvolveram os principais estudos publicados que guiam nossas condutas em situações relacionadas ao tema "trombose e anticoagulação". Este artigo resume os anais deste simpósio.
The VII International Symposium on Thrombosis and Anticoagulation (ISTA) was held in São Paulo, Brazil, on 24 and 25 October 2014, with the main objectives to discuss and share knowledge on recent advances in the diagnosis and management of patients with thrombotic disorders. The scientific program of this symposium was carefully developed by leaders of three major clinical research institutes: the Brazilian Institute of Clinical Research (BCRI), the Duke Clinical Research Institute from Duke University, and the Research Institute from Hospital do Coração. Comprising two days of academic presentations and open discussion, the symposium aimed to educate, motivate and inspire clinicians, cardiologists, hematologists, and other doctors through presentations and discussions of practical aspects in themes related to thrombosis and anticoagulation. These activities were presented by physicians of great clinical experience and who participated in the main publications that guide our approach on situations related to the theme "thrombosis and anticoagulation". This article summarizes the proceedings of this symposium.
Asunto(s)
Humanos , Anticoagulantes/farmacología , Terapia Trombolítica , Trombosis , Accidente Cerebrovascular , Embolia Pulmonar , Fibrilación Atrial , Tromboembolia VenosaRESUMEN
INTRODUÇAO: Nos últimos anos, a punção aspirativa transbrônquica por agulha vem sendo utilizada cada vez com maior freqüência no diagnóstico e estadiamento do câncer de pulmão, principalmente nos EUA. Entretanto, muito pouco se tem publicado a respeito do método em nosso país. OBJETIVO: Avaliar a efetividade da punção aspirativa transbrônquica por agulha no diagnóstico e estadiamento do câncer de pulmão. MÉTODO: Setenta e quatro punções aspirativas transbrônquicas por agulha, realizadas no Hospital do Câncer-INCA/MS, foram revistas retrospectivamente. Todos os pacientes realizaram tomografia computadorizada do tórax previamente ao procedimento. RESULTADOS: Onze (15 por cento) pacientes tinham massas mediastinais e 63 (85 por cento) massas hilares. Foram encontradas 76 alterações endoscópicas: alargamento da carina principal em 44 (59 por cento) pacientes, alargamento de carina secundária em 12 (16 por cento), compressão paratraqueal em 5 (7 por cento), compressão da parede posterior da traquéia em 3 (4 por cento), e compressão de brônquio principal em 5 (7 por cento) pacientes. O material foi satisfatório para o diagnóstico em 42 (57 por cento) pacientes e em 34 (46 por cento) o diagnóstico foi confirmado. O diagnóstico de doença maligna foi confirmado em 30/34 (88 por cento) pacientes: carcinoma indiferenciado de pequenas células em 10/30 (33 por cento), carcinoma escamoso em 7/30 (23 por cento), adenocarcinoma em 7/30 (23 por cento), e carcinoma não pequenas células em 6/30 (20 por cento) pacientes. Em 4/30 (12 por cento) pacientes foram diagnosticadas patologias benignas: tuberculose em 2/4 (50 por cento) e sarcoidose em 2/4 (50 por cento) pacientes. Não observamos nenhuma complicação com o método. CONCLUSAO: Nossa experiência em 74 pacientes mostrou que o procedimento é seguro, rápido em sua realização, com mínimas complicações e de utilidade no diagnóstico e estadiamento de pacientes com neoplasia pulmonar.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Biopsia con Aguja Fina/métodos , Neoplasias Pulmonares/patología , Estadificación de Neoplasias , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
OBJECTIVE: To determine the contribution of percutaneous biopsy with core cutting needle in the diagnosis of mediastinal tumors. METHOD: Retrospective review of 22 patients with mediastinal lesions who were submitted to percutaneous core cutting needle biopsy, oriented, but not guided by computer assisted tomography of the thorax, between 1999 and 2002. RESULTS: Percutaneous biopsy with core cutting needle provided adequate material in 18/22 cases, with a total positive sample rate of 82 percent. In 4/22 cases, the material was insufficient to define the diagnosis (18 percent). Percutaneous core cutting needle biopsy established a specific histologic diagnosis in 82 percent of the patients: 8/22 (36 percent) lymphoma; 5/22 (28 percent) thymoma; 2/22 (11 percent) thymic carcinoma; 1/22 (6 percent) metastatic adenocarcinoma; 1/22 (6 percent) neuroectodermic primitive tumor; and 1/22 (6 percent) plasmocytoma. All the patients were submitted to a thoracic X-ray after the biopsy. No complications were found in these patients. CONCLUSION: Percutaneous core cutting needle biopsy oriented, but not guided by computer assisted tomography of the thorax, is an easy and safe procedure which can provide a precise diagnosis in most mediastinal tumors, and can prevent the exploratory thoracic surgery in inoperable or chemotherapy-treated cases.