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Treatment of patients with immune thrombocytopenic purpura (ITP) associated with recurrent venous and arterial thrombosis can represent a major challenge. We present the rare case of a 56-year-old female who was first diagnosed with severe ITP at the age of 36. She required corticosteroid therapy and splenectomy in evolution. However, in the last three years she had several episodes of recurrent venous thromboembolism for which she required different anticoagulant therapies despite severe thrombocythemia. The patient also developed acute myocardial infarction treated by primary percutaneous coronary intervention that was complicated with acute intrastent thrombosis. Thus, maximal antiplatelet therapy was mandatory. For ITP, the patient received intravenous steroids, platelet transfusion as well as eltrombopag. Moreover, the patient also suffered from a haemorrhagic uterine fibroma that required surgery. Thus, a close multidisciplinary approach was needed for the successful treatment of this patient. [ABSTRACT FROM AUTHOR]

Thrombophilia is a disorder associated with an increased tendency to thrombosis. Thrombophilia can be acquired or hereditary. Only a few of the inherited thrombophilia present a major risk of thrombosis and they should be diagnosed when thromboembolic disease or miscarriages occur in pregnant women. It is important to know the personal history and the family history of the patients, to look for the cause of venous or arterial thromboembolism and to investigate the patients at risk in order to apply the prophylaxis and the anticoagulant treatment when necessary. A special attention should be given to patients with antiphospholipid syndrome, sometimes requiring anticoagulation indefinitely. [ABSTRACT FROM AUTHOR]

The appearance of the coronavirus pandemic has prompted a renewed interest in thrombosis risk assessment, particularly since this disease is associated with a high risk of thrombotic events. It is known that the number one preventable cause of death in hospitalized patients including those having surgical procedures is fatal pulmonary emboli. There is also high-quality data that the use of anticoagulant drugs in the proper dose, and for the period of time shown to be efficacious, will prevent most fatal events. It is true that even with the use of the best anticoagulant regimes venous thromboembolic events (VTE) can still occur but are rarely fatal. We also realize that providing adequate anticoagulant prophylaxis for the entire period of risk is the key to preventing these deaths. Thrombosis risk scoring identifies who's at risk for these emboli and guides physician choices for appropriate preventive measures.

The patients with complicated surgical diseases are relating to the group of high risk of nascence of vein thrombosis and tromboembolism. Aim of the study: to measure of the anticoagulant abilities of bemiparin sodium among women were operated by laparoscopic access in gynecological practices. Materials and methods. 15 women who had been operated for multiple uterine fibroid were examined and enrolled in the basic group. The patients were administered bemiparin sodium 3500 IE (0.2 ml) injected subcutaneously in 6 hours after operative treatment, then once a day during 7 days for prevention of tromboembolic complications in the postoperative period. The control group included 10 healthy women. The following parameters were defined for the control of efficiency of using of bemiparin sodium, his influence on different components of the haemostatic system: D-dimer, thrombocytes quantity and level of fibrinogen. Results. The significant elevation of level of D-dimer and fibrinogen was discovered among patients of the basic group during the preoperative period (p

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Anticoagulation is an integral part of comprehensive care of patients with atrial fibrillation. In addition to vitamin K antagonists (VKA) used for years, more recently novel anticoagulant drugs have been increasingly prevailing, with edoxaban being the latest to have been approved for use. It is a drug with a favourable pharmacological profile, simple dosing schedule, minimal serious interactions, and efficacy confirmed by large randomized trials. Moreover, the safety and efficacy of edoxaban has been shown in the population of elderly patients as well as in those undergoing electrical cardioversion. [ABSTRACT FROM AUTHOR]

Arterial thromboembolism (ATE) is defined as an obstruction, usually followed by infarction of arterial beds. Aortic thromboembolism is clinically expressed by hind limb paresis or paralysis, the absence of reflexes, firm pelvic muscularity and hypersensitivity to manipulation, the impossibility of perceiving the femoral pulse, cold and cyanotic limbs. The therapeutic objectives in arterial thromboembolism therapy aim at managing pain, improving circulation and preventing the formation of new thrombi. [ABSTRACT FROM AUTHOR]

FUNDAMENTO: A fibrilação atrial (FA) associada à doença valvar mitral reumatismal (DVMR) aumenta a incidência de tromboembolismo (TE), sendo a Varfarina a medicação padrão, apesar das dificuldades na adesão e no controle terapêutico. OBJETIVO: Comparar a eficácia da Aspirina contra a Varfarina na prevenção do TE em pacientes com FA e DVMR. MÉTODOS: Acompanhamos 229 pacientes (pts), portadores de FA e DVMR, em estudo prospectivo e randomizado. 110 pts receberam Aspirina 200 mg/dia, compondo o Grupo A (GA), e 119, a Varfarina, em doses ajustáveis individualmente, compondo o Grupo V (GV). RESULTADOS: Ocorreram 15 eventos embólicos no GA e 24 no GV (p = 0,187), dos quais 21 com o INR menor que 2,0. Assim, excluindo os pacientes com INR inadequado, houve maior número de eventos embólicos no GA (15 vs 3) (p < 0,0061). Houve menor adesão ao tratamento no GV (p = 0,001). Não houve sangramentos maiores em ambos os grupos. Pequenos sangramentos foram mais frequentes no GV (p < 0,01). O nível sérico de colesterol e triglicérides aumentados constituiu fator de risco para maior número de eventos tromboembólicos na população estudada, não havendo diferença entre os grupos. CONCLUSÃO: Na DVMR com FA há menos de um ano e sem embolia prévia, a Aspirina é uma opção pouco eficaz na prevenção do TE. Nos portadores de valvopatia mitral com menor risco (insuficiência mitral e prótese biológica mitral), sobretudo se houver contraindicação ou baixa aderência à Varfarina, a Aspirina pode ter algum benefício na prevenção do TE.FUNDAMENTO: La fibrilación atrial (FA) asociada a la enfermedad valvar mitral reumática (DVMR) aumenta la incidencia de tromboembolismo (TE), siendo la Varfarina la medicación estándar, a pesar de las dificultades en la adhesión y en el control terapéutico. OBJETIVO: Comparar la eficacia de la Aspirina contra la Varfarina en la prevención del TE en pacientes con FA y DVMR. Métodos: Controlamos 229 pacientes (pts), portadores de FA y DVMR, en estudio prospectivo y randomizado. 110 pts recibieron Aspirina 200 mg/día, componiendo el Grupo A (GA), y 119, la Varfarina, en dosis ajustables individualmente, componiendo el Grupo V (GV). RESULTADOS: Ocurrieron 15 eventos embólicos en el GA y 24 en el GV (p = 0,187), de los cuales 21 con el INR menor que 2,0. Así, excluyendo los pacientes con INR inadecuado, hubo mayor número de eventos embólicos en el GA (15 vs. 3) (p < 0,0061). Hubo menor adhesión al tratamiento en el GV (p = 0,001). No hubo sangrados mayores en ambos grupos. Pequeños sangrados fueron más frecuentes en el GV (p < 0,01). El nivel sérico de colesterol y triglicéridos aumentados constituyó factor de riesgo para mayor número de eventos tromboembólicos en la población estudiada, no habiendo diferencia entre los grupos. CONCLUSIÓN: En la DVMR con FA hace menos de un año y sin embolia previa, la Aspirina es una opción poco eficaz en la prevención del TE. En los portadores de valvopatía mitral con menor riesgo (insuficiencia mitral y prótesis biológica mitral), sobre todo se hubiese contraindicación o baja adherencia a la Varfarina, la Aspirina puede tener algún beneficio en la prevención del TE.BACKGROUND: Atrial fibrillation (AF) associated to rheumatic mitral valve disease (RMVD) increases the incidence of thromboembolism (TE), with warfarin being the standard therapy, in spite of difficulties in treatment adherence and therapeutic control. OBJECTIVE: To compare the effectiveness of Aspirin vs Warfarin in TE prevention in patients with AF and RMVD. METHODS: A total of 229 patients (pts) with AF and RMVD were followed in a prospective and randomized study. The first group consisted of 110 pts receiving Aspirin - 200 mg/day (Group Aspirin - GA) and the second group consisted of 119 pts receiving Warfarin at individually-adjusted doses (Group Warfarin - GW). RESULTS: There were 15 embolic events in GA and 24 in GW (p = 0.187), of which 21 presented INR < 2.0. Thus, after excluding patients with inadequate INR, there was a higher number of embolic events in GA than in GW (15 vs 3) (p < 0.0061). The GW showed lower treatment adherence (p = 0.001). Neither group presented episodes of major bleeding. Small bleeding episodes were more frequent in the GW (p < 0.01). Increased serum levels of cholesterol and triglycerides constituted a risk factor for a higher number of thromboembolic events in the studied population, with no difference between the groups. CONCLUSION: In patients presenting RMVD with AF for less than a year and no previous embolism, Aspirin is little effective in preventing TE. Patients with lower-risk mitral valvulopathy (mitral regurgitation and mitral biological prosthesis), especially in cases presenting contraindication to or low adherence to Warfarin, Aspirin use can present some benefit in TE prevention.

INTRODUÇÃO: Somente seis casos de aneurismas da veia femoral simulando hérnia inguinal foram descritos na literatura. RELATO DO CASO: Um caso de aneurisma da veia femoral comum direita que simulava uma hérnia inguinal é descrito em jovem de 19 anos de idade com uma massa dolorosa de consistência mole na região inguinal direita de seis meses de duração. Durante a consulta médica, o paciente morreu durante em episódio de convulsão generalizada. Na necropsia, tromboembolismo pulmonar maciço e um aneurisma da veia femoral comum de 8x8x7 cm com trombos foram diagnosticados.BACKGROUND: Only six cases of femoral vein aneurysm are related on medical literature. CASE REPORT: A case of a right common femoral vein aneurysm simulating an inguinal hernia in a 19 year-old male. He had a soft and painful mass in the right inguinal area of six months of duration. At medical consultation, the patient died during a generalized convulsive episode. At necropsy, massive pulmonary thromboembolism and an 8x8x7 cm common femoral vein aneurysm with thrombus were recognized.

Background: Thromboembolism is the most important complication of cancers.The aim of this study was to determine D-dimer levels in benign and malignant tumors of the uterus, ovary and cervix. Subjects and Methods: This was a cross sectional study and it was conducted on 90 female patients referred to Imam Khomeini and Arash Hospitals because of uterine, cervical and ovarian tumors in 2013-2014. After surgical resection or tissue biopsy, 2 cc of each patient’s blood was taken to be sent to laboratory of hospitals. “Nycocard” kit was chosen to measure D-dimer levels in Mg/Lit by neflumetry method. Data were analyzed in SPSS-16 by T-test and One-Way ANOVA test. Results: The highest mean of D-dimer was 3.9 (± 2.9SD) in malignant cervical tumors. The mean plasma levels of D-dimer in malignant uterine cancers (P = 0.008), ovarian cancers (P = 0.007) and cervical cancers (P = 0.006) was significantly higher than benign tumors. In all three types of uterine, ovarian and cervical cancers, D-dimer was significantly higher in advanced stages than lower stages. Conclusion: The plasma D-dimer levels in patients with malignant tumors of the uterus, cervix and ovary were higher than benign types. By increasing the stage of gynecologic malignant tumors, the levels of plasma D-dimer were increased.

The postparum period is the highest risk period for thrombosis. The risk can be further stratified by maternal age and time since delivery. Risk of trombotic events persist until at least 12 weeks after delivery. Tromboembolic disease is the leading cause of maternal mortality in many countries. Starting from this fact, identification of those pregnant or post-partum women at high risk for thrombolism is especially important. This measure is necesary because those women need prophylaxis immediately in order to minimize the consequences of the disease. Another important issue that matters in the struggle with thrombosis is the knowledge of risk factors that lead to disease. One of the main benefits is to avoid some complications and to initiate from the begining an appropriate treatment. Doing that, the chances of recovery increase significantly. [ABSTRACT FROM AUTHOR]

Background: Thromboembolism is the most important complication of cancers. The aim of this study was to determine D-dimer levels in benign and malignant tumors of the uterus, ovary and cervix. Subjects and Methods: This was a cross sectional study and it was conducted on 90 female patients referred to Imam Khomeini and Arash Hospitals because of uterine, cervical and ovarian tumors in 2013-2014. After surgical resection or tissue biopsy, 2 cc of each patient's blood was taken to be sent to laboratory of hospitals. "Nycocard" kit was chosen to measure D-dimer levels in Mg/Lit by neflumetry method. Data were analyzed in SPSS-16 by T-test and One-Way ANOVA test. Results: The highest mean of D-dimer was 3.9 (± 2.9SD) in malignant cervical tumors. The mean plasma levels of D-dimer in malignant uterine cancers (P = 0.008), ovarian cancers (P = 0.007) and cervical cancers (P = 0.006) was significantly higher than benign tumors. In all three types of uterine, ovarian and cervical cancers, D-dimer was significantly higher in advanced stages than lower stages. Conclusion: The plasma D-dimer levels in patients with malignant tumors of the uterus, cervix and ovary were higher than benign types. By increasing the stage of gynecologic malignant tumors, the levels of plasma D-dimer were increased. [ABSTRACT FROM AUTHOR]

The prevention of Venous Thromboembolism (VTE) in case of elderly patients with proximal femoral fracture benefits from a more and more complex range of anticoagulants which reduce the risk of pulmonary thromboembolism, a severe complication involving life-threatening risks. [ABSTRACT FROM AUTHOR]

The prevention of Venous Thromboembolism (VTE) in case of elderly patients with proximal femoral fracture benefits from a more and more complex range of anticoagulants which reduce the risk of pulmonary thromboembolism, a severe complication involving life-threatening risks. [ABSTRACT FROM AUTHOR]

Background: PHACE syndrome is a neurocutaneous disease of unknown etiology. It consists of the association of a large hemangioma in the face or neck combined with one or more abnormalities in other parts of the body. A syndrome that is little known in world literature is reported and the musculoskeletal alterations that it involves are described. Clinical case: Female patient, 8 years and 9 months old, with diagnosis of PHACE syndrome and the following alterations: sunken chest, hemangiomas in the right paraciliary and left mandibular regions, and in the anterior and posterior right thigh with leg length discrepancy. Treatment consisted of braces and the patient was scheduled for lengthening surgery by means of monofocal callotaxis. Discussion: The reported findings include the combined vascular malformations located in the extremities, which may be complicated by thrombophlebitis, regional osteolysis and even thromboembolism. Face and body capillaries are prone to darkening; there is propensity to skin hyperplasia and gradual hypertrophy of the underlying soft tissues and the skeleton. The percentage of reported cases of hemangiomas of the bones, spleen or kidneys is 6% or less. PHACE syndrome is little known in world literature, as we only found 71 papers in the following databases: Pubmed, Embase, Medigraphic, Lilacs, Artemisa. Conclusions: Reporting the musculoskeletal alterations that occurred with this syndrome in the case presented herein represents a contribution to orthopedic knowledge. [ABSTRACT FROM AUTHOR]

Thyroid fine needle biopsy (FNB) is the procedure of choice for the management of thyroid nodules. Serious complications after FNB are rare, but there is also an underestimation of complication risk because of record, selection and publication biases. Hypothesis: Apart from the well-documented post-FNB complications, we hypothesized that there are potential complications following FNB, albeit supported by limited evidence in the literature. According to our hypothesis, there may be five distinct expected rare complications: 1) cyst fluid leakage; 2) anaphylactic reaction; 3) pneumothorax; 4) thromboembolism and 5) needle tract seeding of medullary thyroid carcinoma (MTC) or thyroid lymphoma. Conclusions: Cyst fluid leakage and pneumothorax may be of minimal clinical significance. Needle tract seeding of MTC or thyroid lymphoma may not have significant clinical consequences, if someone considers the easiness and effectiveness of surgical removal of needle tract seeding in cases of differentiated thyroid carcinoma. On the contrary, anaphylactic reaction or thromboembolism may be life-threatening. The performers of thyroid FNB are hereby encouraged to publish these complications, if they ever occur, because awareness of them could render FNB even safer. Hippokratia 2011; 15 (2): 116-119 [ABSTRACT FROM AUTHOR]

A multicentric investigation was practiced in fourteen different medical centers in the country (161 cases) in total hip arthroplasty (THA) patients with high risk for developing a venous thromboembolism disease (VTD). No one of them has hematologic pathologies or tumoral processes. All of them took 40 mg subcutaneous of Low -Molecular-Weight- Heparins before surgery process up to at least ten days after it. All these patients had one to five risk factors of VTD. Tobacco was dominant in men and fatness and hypertension in females. 80% of these cases, hemoglobin was more than 10 mg and hematocrit more than 30. Three cases with bleeding more than normal average of THA, but with no adverse reactions. Nobody presented subsequent clinical data of VTD and this is why it's better previously know all risk factors of each patients and face them. Even better to avoid fearing bleeding and use anti coagulants before any bad experience. [ABSTRACT FROM AUTHOR]

Triathlon followers increase each year and long-distance events have seen major growth worldwide. In the cycling phase, athletes must maintain an aerodynamic posture on the bike for long periods of time. We report a case of a 38-year-old triathlete with symptoms of an axillary vein thrombosis 48h after a long triathlon competition. After 3days of hospitalization with a treatment consisted on enoxaparin anticoagulant and acenocumarol, the patient was discharged with instructions to continue treatment under home hospitalization with acetaminophen. Four weeks after the process, the patient was asymptomatic and the diameter of his arm was near normality. Due to the growing popularity of events based on endurance exercise, it is necessary more research to determine the etiopathogeny of deep venous thrombosis in athletes. [ABSTRACT FROM AUTHOR]

Background: Thromboembolism is the most important complication of cancers.The aim of this study was to determine D-dimer levels in benign and malignant tumors of the uterus, ovary and cervix., Subjects and Methods: This was a cross sectional study and it was conducted on 90 female patients referred to Imam Khomeini and Arash Hospitals because of uterine, cervical and ovarian tumors in 2013-2014. After surgical resection or tissue biopsy, 2 cc of each patient's blood was taken to be sent to laboratory of hospitals. "Nycocard" kit was chosen to measure D-dimer levels in Mg/Lit by neflumetry method. Data were analyzed in SPSS-16 by T-test and One-Way ANOVA test., Results: The highest mean of D-dimer was 3.9 (± 2.9SD) in malignant cervical tumors. The mean plasma levels of D-dimer in malignant uterine cancers (P = 0.008), ovarian cancers (P = 0.007) and cervical cancers (P = 0.006) was significantly higher than benign tumors. In all three types of uterine, ovarian and cervical cancers, D-dimer was significantly higher in advanced stages than lower stages., Conclusion: The plasma D-dimer levels in patients with malignant tumors of the uterus, cervix and ovary were higher than benign types. By increasing the stage of gynecologic malignant tumors, the levels of plasma D-dimer were increased.