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41.
Alana E. Sigmund Yixin Fang Matthew Chin Harmony R. Reynolds Leora I. Horwitz Ezra Dweck Eduardo Iturrate 《Mayo Clinic proceedings. Mayo Clinic》2017,92(1):98-105
Objective
To determine the clinical significance of tachycardia in the postoperative period.Patients and Methods
Individuals 18 years or older undergoing hip and knee arthroplasty were included in the study. Two data sets were collected from different time periods: development data set from January 1, 2011, through December 31, 2011, and validation data set from December 1, 2012, through September 1, 2014. We used the development data set to identify the optimal definition of tachycardia with the strongest association with the vascular composite outcome (pulmonary embolism and myocardial necrosis and infarction). The predictive value of this definition was assessed in the validation data set for each outcome of interest, pulmonary embolism, myocardial necrosis and infarction, and infection using multiple logistic regression to control for known risk factors.Results
In 1755 patients in the development data set, a maximum heart rate (HR) greater than 110 beats/min was found to be the best cutoff as a correlate of the composite vascular outcome. Of the 4621 patients who underwent arthroplasty in the validation data set, 40 (0.9%) had pulmonary embolism. The maximum HR greater than 110 beats/min had an odds ratio (OR) of 9.39 (95% CI, 4.67-18.87; sensitivity, 72.5%; specificity, 78.0%; positive predictive value, 2.8%; negative predictive value, 99.7%) for pulmonary embolism. Ninety-seven patients (2.1%) had myocardial necrosis (elevated troponin). The maximum HR greater than 110 beats/min had an OR of 4.71 (95% CI, 3.06-7.24; sensitivity, 47.4%; specificity, 78.1%; positive predictive value, 4.4%; negative predictive value, 98.6%) for this outcome. Thirteen (.3%) patients had myocardial infarction according to our predetermined definition, and the maximum HR greater than 110 beats/min had an OR of 1.72 (95% CI, 0.47-6.27).Conclusion
Postoperative tachycardia within the first 4 days of surgery should not be dismissed as a postoperative variation in HR, but may precede clinically significant adverse outcomes. 相似文献42.
直接溶栓治疗急性下肢深静脉血栓的临床探讨 总被引:2,自引:0,他引:2
依临床表现及顺行性下肢静脉造影诊断的73例急性下肢深静脉血栓,经病变远肢端静脉滴注蝮蛇抗酶行五接溶栓治疗,蝮蛇抗栓酶剂量为0.025IU/kg体重,每天1次,2周为1疗程,22例治疗后经造影复查。该法安全、方便且有赦,无明显利作用,值得推广应用。 相似文献
43.
《JACC: Cardiovascular Interventions》2014,7(12):1333-1351
Direct oral anticoagulants (DOACs) are approved for multiple thromboembolic disorders and provide advantages over existing agents. As with all anticoagulants, management protocols for the eventuality of bleeding are important. Randomized phase III studies generally show that DOACs have a similar risk of clinically relevant bleeding compared with standard anticoagulants, with reductions in major bleeding in some cases. This may be particularly important in patients with atrial fibrillation, for whom the rate of intracranial hemorrhage was approximately halved with DOACs compared with warfarin. Conversely, the risk of gastrointestinal bleeding may be increased. Specific patient characteristics, such as renal impairment, comedications, and particular aspects of each drug, including the proportion eliminated by the kidneys, must be taken into account when assessing the risk of bleeding. Although routine coagulation monitoring of DOACs is not required, it may be useful under some circumstances. Of the traditional clotting assays, a sensitive and calibrated prothrombin time may be useful for detecting the presence or absence of clinically relevant factor Xa inhibitor concentrations (rivaroxaban or apixaban), but specific anti–factor Xa assays can measure drug levels quantitatively. For dabigatran, the results of an activated partial thromboplastin time test may exclude a clinically relevant pharmacodynamic effect, but a calibrated dilute thrombin time assay can be used for quantification of drug levels. In the event of mild or moderate bleeding, normal hemostatic support measures are recommended. For life-threatening bleeding, use of nonspecific prohemostatic agents may be considered, although clinical evidence is scarce. Specific antidotes are in development. 相似文献
44.
随着骨科大手术(包括人工全髋关节置换术THR,人工全膝关节置换术TKR和髋部周围骨折手术HFS)[1]的普遍开展,其术后并发症越来越受到临床医生的重视,下肢深静脉血栓(DVT)是骨科大手术后的严重并发症之一。据统计,国外骨科大手术后DVT发生率THR为42%~57%,TKR为41%~85%以及HFS 46%~60%[1]。一项亚洲7个国家19个骨科中心407例骨科大手术术后DVT发生率调查研究[2]表明,经静脉造影证实深静脉血栓形成发生率为43.2%(120/278)。近年来,中医药对骨科大手术后DVT的研究、预防和治疗,也日益重视,并取得了较好的临床效果[3]。 相似文献
45.
目的:探讨失效模式和效应分析(FMEA)在预防髋关节置换(THA)术后下肢深静脉血栓形成(DVT)中的应用效果。方法:将2010年1~12月在我院行THA的96例患者随机分为对照组和观察组各48例,对照组按骨科常规护理方法进行护理,观察组在此基础上应用FMEA预防人工髋关节置换术后下肢深静脉血栓形成。结果:实施FMEA后6个高危因子的RPN值显著低于实施前(P<0.01);两组患者对预防下肢DVT相关知识的掌握程度、住院时间、满意度比较差异均有统计学意义(P<0.01,P<0.05);观察组住院期间未发生下肢DVT,对照组发生3例下肢DVT。结论:应用FMEA预防人工髋关节置换术后下肢深静脉血栓形成,能够准确的把握相应流程中的重点工作,防范于未然,提高护理质量。 相似文献
46.
Lucrecia María Burgos Juan Pablo Costabel Victoria Galizia Brito Alan Sigal Daniela Maymo Ana Iribarren Marcelo Trivi 《The American journal of emergency medicine》2018,36(6):911-915
Introduction
Floating right heart thrombi (FRHTS) are a rare phenomenon associated with high mortality. Immediate treatment is mandatory, but optimal therapy is controversial.Objective
To compare the clinical characteristics according to different treatment strategies and to identify predictors of mortality on patients with FRHTS.Methods
We conducted a systematic search of reported clinical cases of TTRH from 2006 to 2016.Results
207 patients were analyzed, median age was 60 years, 51.7% were men, 31.4% presented with shock. Pulmonary thromboembolism was present in 85% of the cases. The treatments administered were anticoagulation therapy in 44 patients (21.28%), surgical embolectomy in 89 patients (43%), thrombolytic therapy in 66 patients (31.8%), percutaneous thrombectomy in 3 patients (1.93%) and fibrinolytic in situ in 4 (1.45%). The overall mortality rate was 21.3%. The mortality associated with anticoagulation alone was higher than surgical embolectomy or thrombolysis (36.4 vs 18% vs 18.2%, respectively, p = 0.03), and in percutaneous thrombectomy and fibrinolytics in situ was 0%. At multivariate analysis, only anticoagulation alone (odds ratio [OR] 2.4, IC 95% 1.07–5.4, p = 0.03), and shock (OR 2.87 (IC 95% 1.3–5.9, p = 0.005) showed a statistically significant effect on mortality.Conclusion
FRHTS represent a serious form of thromboembolism that requires rapid decisions to improve the survival. Anticoagulation as the only strategy does not seem to be sufficient, while thrombolysis and surgical thrombectomy show better and similar results. A proper individualization of the risk and benefits of both techniques is necessary to choose the most appropriate strategy for our patients. 相似文献47.
Background
Numerous new oral anticoagulants (NOACs) have been compared to a parenteral anticoagulant/oral vitamin K antagonist (VKA) for the treatment of acute venous thromboembolism (VTE). We aimed to conduct a systematic review and adjusted indirect comparison meta-analysis to compare the efficacy and safety of NOACs for this indication.Methods
We conducted a systematic literature search through November 2013 for randomized trials that evaluated treatment of acute VTE with a NOAC including rivaroxaban, apixaban, dabigatran and edoxaban. Trials had to report at least one of the following outcomes of interest: mortality, recurrent VTE, recurrent pulmonary embolism (PE), recurrent deep vein thrombosis (DVT), or major bleeding. Included trials were evaluated for quality using the Cochrane Risk of Bias tool. We performed an adjusted indirect comparison meta-analysis to evaluate the comparative efficacy and safety of NOACs, reporting relative risks (RRs) and 95% confidence intervals for each outcome.Results
Six trials (n = 27,069) met inclusion criteria, one each evaluating apixaban and edoxaban and two trials each evaluating rivaroxaban and dabigatran. Risk of bias was low for all trials. NOACS did not differ significantly in the risk of mortality, recurrent VTE, recurrent PE or recurrent DVT. Dabigatran increased major bleeding risk compared to apixaban [RR 2.69 (1.19 to 6.07)] as did edoxaban compared to apixaban [RR 2.74 (1.40 to 5.39)].Conclusion
Although NOACs do not appear to differ in the efficacy of treating acute VTE, data suggests apixaban to be the safer than some of its competitors. 相似文献48.
Hansen JB Fernández JA Borch KH Griffin JH Brox JH Braekkan SK 《Thrombosis research》2012,129(4):502-507
Introduction
The protein C anticoagulant system is of major importance in the regulation of thrombotic risk, but it is not known whether low plasma levels of activated protein C (APC) in vivo reflect a compromised anticoagulant situation with increased thrombotic risk. Previous studies have reported low, normal or increased plasma APC levels in unselected patients with venous thromboembolism (VTE).Materials and methods
We performed a population-based, case-control study in patients with a previous history of unprovoked VTE and subjected the participants to a standard fat tolerance test (1 g fat/kg body weight) in order to promote physiological coagulation activation.Results
VTE patients had higher BMI (28.3 ± 4.4 kg/m2 versus 26.3 ± 3.9 kg/m2, p = 0.045) and greater waist circumference (98.2 ± 12.5 cm versus 93.4 ± 13.4 cm, p = 0.041) than age and sex matched controls. APC levels were equal in fasting plasma (3.00 ± 0.74 ng/ml and 2.99 ± 0.60 ng/ml, p = 0.66) but higher in postprandial plasma (3.18 ± 0.57 ng/ml and 2.81 ± 0.38 ng/ml, p = 0.008) collected from VTE patients and controls, respectively. Endogenous thrombin generation in plasma following a standardized meal, assessed by thrombin-antithrombin complex (TAT), increased similarly in both groups, whereas APC increased only among the VTE patients during the postprandial state. Plasma levels of APC increased linearly with TAT in the postprandial state (p for linear trend = 0.012).Conclusions
Our findings fail to support the hypothesis that low APC levels are linked to increased thrombotic risk in unprovoked VTE, and they suggest that plasma APC is a biomarker of thrombin generation. 相似文献49.
《Expert opinion on drug safety》2013,12(5):585-597
Stroke is a common cause for morbidity and mortality, causing substantial economic costs. Because thrombosis plays a key role in the pathogenesis of ischaemic stroke, heparins, platelet inhibitors and anticoagulants have been used in stroke management. There were high hopes that patients might benefit from the use of heparins. Unfortunately, these expectations have not been met. Instead, thrombolytics have been shown to result in an improvement of outcome in a considerable fraction of patients with ischaemic stroke. Yet, in other areas of stroke management, such as the prevention of venous thromboembolism after stroke, heparins have found their niche. In this review, we report on the currently available literature on heparins for the reduction of stroke-related morbidity and mortality, the prevention of recurrent stroke as well as the prevention of venous thromboembolism in both ischaemic and haemorrhagic stroke with respect to their risks, such as the haemorrhagic transformation of ischaemic strokes. 相似文献
50.
John Schomburg Suprita Krishna Ayman Soubra Katherine Cotter Yunhua Fan Graham Brown Badrinath Konety 《Urologic oncology》2018,36(2):77.e9-77.e13