RESUMEN
Los nuevos anticoagulantes orales compiten actualmente, con alguna ventaja, con la terapéutica tradicional en la prevención de la cardioembolia en fibrilación auricular, y en la prevención y el tratamiento de la enfermedad tromboembólica venosa. Estudios recientes han demostrado una eficacia equivalente a la de los antagonistas de la vitamina K, con un mejor perfil de seguridad. Además, superan algunos inconvenientes de estos antagonistas, como la necesidad de ajuste de dosis y el monitoreo frecuente de la RIN, las múltiples interacciones farmacológicas y los cuidados con la dieta. Pero con los nuevos agentes debemos ser cautos, porque el riesgo de sangrado puede aumentar significativamente en ciertos grupos de pacientes con insuficiencia renal, añosos o muy frágiles. Aunque se emplean usualmente en dosis fijas, en casos especiales (peso <50 kg, edad avanzada, disfunción renal, alto riesgo de sangrado), esta dosis se debe modificar. Si bien, en la práctica clínica, no es necesario hacer pruebas de monitoreo de la coagulación, no contamos con pruebas adecuadas para evaluar su eficacia clínica y tampoco tenemos hoy, en nuestro medio, un antídoto eficaz en caso de sangrado importante. Sin embargo, se están realizando estudios con nuevas pruebas de hemostasia que pueden ayudarnos a interpretar el nivel de anticoagulación en estos pacientes y ya se han desarrollado antídotos para algunos de los anticoagulantes de acción directa que pronto estarán disponibles en nuestro medio.(AU)
New oral anticoagulants represent an interesting alternative to traditional therapy for the prevention of stroke in atrial fibrillation, and the thromboprophylaxis and treatment of venous thromboembolic disease. Several studies demonstrated equivalent efficacy to that of vitamin K antagonists with a more favourable safety profile. New oral anticoagulants overcome some of the main problems of these antagonists: the need of tailoring dosing, frequent interactions with other drugs and diet. But physicians have to keep in mind that new oral anticoagulants are not absolutely free of complications, and must be cautious with patients at high risk of bleeding. Also in special cases (<50 kg, advanced age, renal impairment) the usual dose must be adapted. At present there are not specific tests to evaluate the effect of these new anticoagulants, although it is usually not necessary to do any coagulation test in clinical practice. Another concern regarding new oral anticoagulants is the absence of specific antidotes, although specific antidotes are under clinical investigation and are soon going to be available in our country.(AU)
Asunto(s)
Humanos , Fibrinolíticos , Anticoagulantes , HemostasisAsunto(s)
Humanos , Guía , Síndrome Coronario Agudo , Urgencias Médicas , Unidades de Cuidados IntensivosRESUMEN
La Necrólisis epidérmica tóxica (N.E.T), es un desorden poco frecuente, caracterizado por una muerte epidérmica extensa, producido por una reacción idiosincrática por drogas. Es una enfermedad grave que puede eventualmente ocasionar la muerte por complicaciones sépticas o fallo multiorgánico, en alrededor del 30 % de los pacientes. El caso clínico que se describe, se asocia con el uso de Nevirapine que es un fármaco antirretroviral inhibidor de la Transcriptasa inversa, no análogo de nucleosidos, esta droga se vincula a la aparición de N.E.T en el 1% de los tratamientos(AU)
Toxic epidermal necrolysis (TEN) is a very uncommon disorder, characterized by extensive epidermal death, produced by an idiosyncratic drug reaction. Is a severe disease that eventually can be lethal. Death may be caused by septic complications or multiorgan failure, in about 30% of patients. In this case report the disease is related to the use of Nevirapine. This antiretroviral drug is a nonnucleoside reverse transcriptase inhibitor that is supposed to cause TEN in 1% of the patients.(AU)
Asunto(s)
Humanos , Femenino , Epidermólisis Ampollosa , Síndrome de Stevens-Johnson , Nevirapina/efectos adversos , Eritema MultiformeRESUMEN
This is a report of a 61 year old man who was admitted at the Intensive Care Unit because of massive hemoptysis and respiratory failure. Four years before he had had an aortic dissection type A, and at that time an aortic valve, ascending aorta and aortic arch replacement, had been carried out. A thorax CT scan showed an aneurysm of the ascending aorta. A bronchoscopy was normal. In the angiography, a collateral of the left mammary artery was identified as the cause of bleeding and was subsequently embolized. After the procedure, the patient had a new episode of massive hemoptysis, and surgery was recommended. During surgery, the diagnosis of aortobronchial fistula was confirmed but the patient died during the intervention.
Asunto(s)
Enfermedades de la Aorta/complicaciones , Fístula Bronquial/complicaciones , Hemoptisis/etiología , Fístula Vascular/complicaciones , Aorta Torácica , Enfermedades de la Aorta/cirugía , Fístula Bronquial/cirugía , Resultado Fatal , Hemoptisis/cirugía , Humanos , Masculino , Persona de Mediana Edad , Fístula Vascular/cirugíaRESUMEN
This is a report of a 61 year old man who was admitted at the Intensive Care Unit because of massive hemoptysis and respiratory failure. Four years before he had had an aortic dissection type A, and at that time an aortic valve, ascending aorta and aortic arch replacement, had been carried out. A thorax CT scan showed an aneurysm of the ascending aorta. A bronchoscopy was normal. In the angiography, a collateral of the left mammary artery was identified as the cause of bleeding and was subsequently embolized. After the procedure, the patient had a new episode of massive hemoptysis, and surgery was recommended. During surgery, the diagnosis of aortobronchial fistula was confirmed but the patient died during the intervention.
RESUMEN
We report a 63 year old white man admitted to our hospital because of fever, productive cough and a severe respiratory failure. Bronchoalveolar lavage revealed a positive microscopy for acid-fast bacilli and a four drug scheme for tuberculosis was initiated. There was no improvement in the patient's condition and mechanical ventilation was needed. A thorax CT scan disclosed images that suggested lipoid pneumonia (lower lobes involvement, hypodensity and negative sign in the angiogram). At this point the patient's relatives indicated that he was a long term user of paraffin oil for chronic constipation. Treatment with high doses of steroids was initiated and after whole lung lavage, mechanical respiratory assistance could be interrupted. We comment the association of this entity with lung infections produced by atypical mycobacteria.
Asunto(s)
Vaselina/envenenamiento , Neumonía Lipoidea/inducido químicamente , Insuficiencia Respiratoria/etiología , Adulto , Lavado Broncoalveolar , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Neumonía Lipoidea/terapiaRESUMEN
We report a 63 year old white man admitted to our hospital because of fever, productive cough and a severe respiratory failure. Bronchoalveolar lavage revealed a positive microscopy for acid-fast bacilli and a four drug scheme for tuberculosis was initiated. There was no improvement in the patients condition and mechanical ventilation was needed. A thorax CT scan disclosed images that suggested lipoid pneumonia (lower lobes involvement, hypodensity and negative sign in the angiogram). At this point the patients relatives indicated that he was a long term user of paraffin oil for chronic constipation. Treatment with high doses of steroids was initiated and after whole lung lavage, mechanical respiratory assistance could be interrupted. We comment the association of this entity with lung infections produced by atypical mycobacteria.