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Clinical outcomes during anticoagulant therapy in fragile patients with venous thromboembolism.
(2017)
Moustafa F
;
Giorgi Pierfranceschi M
;
Di Micco P
;
Bucherini E
;
Lorenzo A
Background Subgroup analyses from randomized trials suggested favorable results for the direct oral anticoagulants in fragile patients with venous thromboembolism (VTE). The frequency and natural history of fragile patients with VTE have not been studied yet. Objectives To compare the clinical characteristics, treatment and outcomes during the first 3 months of anticoagulation in fragile vs non‐fragile patients with VTE. Methods Retrospective study using consecutive patients enrolled in the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry. Fragile patients were defined as those having age ≥75 years, creatinine clearance (CrCl) levels ≤50 mL/min, and/or body weight ≤50 kg. Results From January 2013 to October 2016, 15 079 patients were recruited. Of these, 6260 (42%) were fragile: 37% were aged ≥75 years, 20% had CrCl levels ≤50 mL/min, and 3.6% weighed ≤50 kg. During the first 3 months of anticoagulant therapy, fragile patients had a lower risk of VTE recurrences (0.78% vs 1.4%; adjusted odds ratio [OR]: 0.52; 95% confidence intervals [CI]: 0.37‐0.74) and a higher risk of major bleeding (2.6% vs 1.4%; adjusted OR: 1.41; 95% CI: 1.10‐1.80), gastrointestinal bleeding (0.86% vs 0.35%; adjusted OR: 1.84; 95% CI: 1.16‐2.92), haematoma (0.51% vs 0.07%; adjusted OR: 5.05; 95% CI: 2.05‐12.4), all‐cause death (9.2% vs 3.5%; adjusted OR: 2.02; 95% CI: 1.75‐2.33), or fatal PE (0.85% vs 0.35%; adjusted OR: 1.77; 95% CI: 1.10‐2.85) than the non‐fragile. Conclusions In real life, 42% of VTE patients were fragile. During anticoagulation, they had fewer VTE recurrences and more major bleeding events than the non‐fragile.
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ПРИКАЗ НА СЛУЧАЈ: ТРЕТМАН СО ЕМБОЛИЗАЦИЈА НА ХЕМАТОМ ВО ПРАВИОТ СТОМАЧЕН МУСКУЛ КАЈ ПАЦИЕНТ СО КОВИД-19 A CASE REPORT: EMBOLIZATION TREATMENT OF RECTUS SHEATH HEMATOMA IN A COVID-19 PATIENT
(Македонско лекарско друштво = Macedonian Medical Association, 2022-10)
;
Sopova, Zaklina
;
Osmani L., Arlinda
;
;
Introduction. In this case report we present a patient with COVID-19 pneumonia and rectus sheath hematoma (RSH) treated with embolization. Methods. A 63-year-old man positive for SARS-CoV- 2 presented with cough, fever and dyspnea to our Clinic. The patient was admitted and treated with oxygen, antibiotics, corticosteroid, anticoagulant and oral antiplatelet therapy. Thirteen days after admission the patient had severe abdominal pain, the CT scan confirmed left rectus sheath hematoma and he underwent a CT angiography with embolization of the left inferior epigastric artery. Ten days after embolization the patient recovered completely and was discharged. Result. SARS-CoV-2 infection is associated with coagulopathy, hence the anticoagulant therapy. The main side effect of anticoagulant therapy is an increased risk of bleeding. A rare complication of anticoagulant therapy is rectus sheath hematoma. The treatment is usually conservative with intravenous fluids, pain medication, discontinuation of anticoagulant therapy, and blood transfusion in cases of severe anemia. The computed tomography is the most common method to establish or confirm the diagnosis. Еmbolization of bleeding vessels can be performed in large RSH with hemodynamic instability and/or with evidence of active bleeding. Conclusion. Inpatient treatment of COVID-19 pneumonia includes anticoagulant agents, but clinicians must carefully monitor their possible side effects and suspect a rectus sheath hematoma in patients with abdominal pain and palpable mass. Those with clinically relevant rectus sheath hematoma that do not respond to supportive care can be successfully treated using embolization, thus avoiding invasive surgical approach.
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Vitamin K Antagonists After 6 Months of Low-Molecular-Weight Heparin in Cancer Patients with Venous Thromboembolism
(Elsevier, 2018-04)
Chai-Adisaksopha C
;
Iorio A
;
Crowther MA
;
de Miguel J
;
Salgado E
Background: Low-molecular-weight heparin (LMWH) is the treatment of choice in cancer patients with venous thromboembolism. However, data on continuing LMWH treatment beyond 6 months remain scanty. Methods: We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) registry to compare the rate of venous thromboembolism recurrences and major bleeding appearing beyond the first 6 months of anticoagulant therapy in cancer patients with venous thromboembolism, according to therapy with LMWH or vitamin K antagonists (VKA). We performed a propensity score-matched cohort study. Results: After propensity matching, 482 cancer patients continued to receive LMWH and 482 switched to VKA. During the course of anticoagulant therapy (mean 275.5 days), 57 patients developed venous thrombosis recurrences (recurrent pulmonary embolism 26, recurrent deep vein thrombosis 29, both 2), 28 had major bleeding, 38 had nonmajor bleeding, and 129 died. No patient died of recurrent venous thrombosis, and 5 patients died of bleeding (2 were on LMWH, 3 on VKA). Patients who continued with LMWH had a similar rate of deep vein thrombosis recurrences (relative risk [RR] 1.41; 95% confidence interval [CI], 0.68-2.93), pulmonary embolism recurrences (RR 0.73; 95% CI, 0.34-1.58), major bleeding (RR 0.96; 95% CI, 0.51-1.79), or nonmajor bleeding (RR 1.15; 95% CI, 0.55-2.40), compared with those who switched to VKA, but a higher mortality rate (RR 1.58; 95% CI, 1.13-2.20). Conclusions: In cancer patients with venous thromboembolism who completed 6 months of LMWH therapy, switching to VKA was associated with a similar risk of venous thrombosis recurrences or bleeding when compared with patients who continued LMWH.

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