Faculty of Medicine

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    Item type:Publication,
    CLINICAL ASPECTS OF CANCER-ASSOCIATED THROMBOSIS
    (2023)
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    Active cancer accounts for 20% of the total incidence of venous thrombembolism (VTE), a condition called cancer-associated thrombosis (CAT) . Cancer is the leading cause of death in patients with VTE and vice versa. Risk factors for VTE can be classified into three groups: patient-related, cancer-related, and treatment-related. This review contains the most relevant, up to date, randomized controlled studies for carcinoma-associated thrombosis, pathogenesis and risk factors for CAT, risk assessment models, and most importantly, recommendation for thromboprophylaxis of patients with carcinoma, treatment of patients with CAT for both, hospitalized and outpatients, and secondary prevention of VTE, comparing efficacy and safety of low-molecular weight heparin (LMWH) to direct oral anticoagulans (DOAC), balancing between the risk of recurrent VTE and major bleeding.
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    Item type:Publication,
    Clinical Characteristics and Outcomes of Patients with Lung Cancer and Venous Thromboembolism
    (2018)
    Ruiz-Artacho P,
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    Trujillo-Santos J,
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    López-Jiménez L,
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    Font C,
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    Díaz-Pedroche MDC,
    Background The natural history of patients with lung cancer and venous thromboembolism (VTE) has not been consistently evaluated. Methods We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to assess the clinical characteristics, time course, and outcomes during anticoagulation of lung cancer patients with acute, symptomatic VTE. Results As of May 2017, a total of 1,725 patients were recruited: 1,208 (70%) presented with pulmonary embolism (PE) and 517 with deep vein thrombosis (DVT). Overall, 865 patients (50%) were diagnosed with cancer <3 months before, 1,270 (74%) had metastases, and 1,250 (72%) had no additional risk factors for VTE. During anticoagulation (median, 93 days), 166 patients had symptomatic VTE recurrences (recurrent DVT: 86, PE: 80), 63 had major bleeding (intracranial 11), and 870 died. The recurrence rate was twofold higher than the major bleeding rate during the first month, and over threefold higher beyond the first month. Fifty-seven patients died of PE and 15 died of bleeding. Most fatal PEs (84%) and most fatal bleeds (67%) occurred within the first month of therapy. Nine patients with fatal PE (16%) died within the first 24 hours. Of 72 patients dying of PE or bleeding, 15 (21%) had no metastases and 29 (40%) had the VTE shortly after surgery or immobility. Conclusion Active surveillance on early signs and/or symptoms of VTE in patients with recently diagnosed lung cancer and prescription of prophylaxis in those undergoing surgery or during periods of immobilization might likely help prevent VTE better, detect it earlier, and treat it more efficiently.
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    Item type:Publication,
    Once versus twice daily enoxaparin for the initial treatment of acute venous thromboembolism
    (Thieme Medical Publishers, 2017)
    Trujillo-Santos J
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    Bergmann JF
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    Bortoluzzi C
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    López-Reyes R
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    Giorgi-Pierfranceschi M
    Essentials In venous thromboembolism (VTE), it is uncertain if enoxaparin should be given twice or once daily. We compared the 15- and 30-day outcomes in VTE patients on enoxaparin twice vs. once daily. Patients on enoxaparin once daily had fewer major bleeds and deaths than those on twice daily. The rate of VTE recurrences was similar in both subgroups. Summary: Background In patients with acute venous thromboembolism (VTE), it is uncertain whether enoxaparin should be administered twice or once daily. Methods We used the RIETE Registry data to compare the 15- and 30-day rates of VTE recurrence, major bleeding and death between patients receiving enoxaparin twice daily and those receiving it once daily. We used propensity score matching to adjust for confounding variables. Results The study included 4730 patients: 3786 (80%) received enoxaparin twice daily and 944 once daily. During the first 15 days, patients on enoxaparin once daily had a trend towards more VTE recurrences (odds ratio [OR], 1.79; 95% confidence interval [CI], 0.55-5.88), fewer major bleeds (OR, 0.42; 95% CI, 0.17-1.08) and fewer deaths (OR, 0.32; 95% CI, 0.13-0.78) than those on enoxaparin twice daily. At day 30, patients on enoxaparin once daily had more VTE recurrences (OR, 2.5; 95% CI, 1.03-5.88), fewer major bleeds (OR, 0.40; 95% CI, 0.17-0.94) and fewer deaths (OR, 0.58; 95% CI, 0.33-1.00). On propensity analysis, patients on enoxaparin once daily had fewer major bleeds at 15 (hazard ratio [HR], 0.30; 95% CI, 0.10-0.88) and at 30 days (HR, 0.16; 95% CI, 0.04-0.68) and also fewer deaths at 15 (HR, 0.37; 95% CI, 0.14-0.99) and at 30 days (HR, 0.19; 95% CI, 0.07-0.54) than those on enoxaparin twice daily. Conclusions Our findings confirm that enoxaparin prescribed once daily results in fewer major bleeds than enoxaparin twice daily, as suggested in a meta-analysis of controlled clinical trials.
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    Item type:Publication,
    PREGNANCY WITH POLYCYTHEMIA VERA - AN OBSTETRIC CHALLENGE
    (DEPARTMENT OF ANAESTHESIA AND REANIMATION, FACULTY OF MEDICINE, “SS. CYRIL AND METHODIUS” UNIVERSITY, SKOPJE, MACEDONIA, 2022)
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    Polycythemia vera (PV) is a rare chronic myeloproliferative disorder of the haematopoietic stem cell type characterized by increased erythrocyte production. The disease is associated to a high risk of clinical complications - arterial and venous thrombosis, especially in pregnancy, bleeding, possible evolution to myelofibrosis and acute myeloid leukemia. We present the case of a 28-years-old patient, whose diagnosis was made 2 years before pregnancy (positive for mutation JAK2 V617F, bcr-abl negative, MPL, CALR negative). She was regularly monitored at the Hematology Clinic, had therapeutic venipunctures performed and anticoagulant therapy was prescribed. Pregnancy was regularly followed, with proper fetal growth and development, regular screening for fetal abnormalities, under anticoagulant therapy and under the supervision of a hematologist. At 34 weeks gestation, due to bleeding and pain, she was hospitalized in the Peripartal Intensive Care Department suspected of placental abruption. A caesarean section was performed immediately, a premature fetus was delivered in relatively good condition, and during the operation abruption of 1/3 of the placenta was found. The operative and postoperative periods were stable, the patient received replacement therapy and was discharged from the hospital on the 5th postoperative day in good general condition. The newborn was stabilized and discharged in good general condition after 3 weeks of stay at the Neonatal Intensive Care Department. Conclusion: Pregnancy in patients with this disease carries serious risks to the life and health of both mother and fetus, which requires special attention during pregnancy in order to reduce antenatal and postnatal morbidity.
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    Item type:Publication,
    Hormonal changes in women with abnormal endometrial bleeding in peri and postmenopause
    (European Society of Endocrinology, 2022-05)
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    Bashkim Ismaili
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    Dimitar Georgiev
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    SHpishikj Pushevska, Anamarija