Thesis (Ph. D.)--Duke University, 2008.

No description available.

Purpose: The impact of temperature on the coagulative response to exercise has not been well described. The purpose of this study was to assess the response of plasma thrombin-antithrombin (TAT) to exercise during exposure to both hot and cold temperatures, and to compare those responses to exercise under normal, temperate conditions. Methods: Fifteen healthy male subjects (25.3 + 4.3 years) volunteered to participate in this study. Subjects completed maximal cycle ergometer exercise tests in three different temperatures (20°C, 5° or 8° C, and 30°C) in an environmental chamber. All tests were conducted in random order and separated by at least seven days. Blood samples were obtained before and immediately after exercise and analyzed by Elisa to determine plasma concentrations of thrombin-antithrombin complex (TAT). Results: Subjects demonstrated significantly elevated plasma levels of TAT in all three temperatures immediately after exercise (normal =1.04 ± 0.44 ng/ml, cold =1.34 ± 0.79 ng/ml, hot =1.18 + 0.95 ng/ml) when compared to baseline measures (normal = 0.45 ± 0.26 ng/ml, cold = 0.88 + 0.57 ng/ml, hot = 0.64 + g/ml). Subjects also showed significant elevations in TAT concentrations both before and after exercise in the cold temperature when compared with the normal temperature. There was no significant difference between the hot and normal temperatures. Conclusion: An individual's coagulation potential is increased following maximal physical exertion and may be further increased by exposure to colder temperature. Key Words: coagulation, physical exertion, temperature, thrombosis. / School of Physical Education, Sport, and Exercise Science

Orientador: Ana Terezinha Guillaumon / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T00:25:35Z (GMT). No. of bitstreams: 1 Paschoa_AdilsonFerraz_D.pdf: 1209751 bytes, checksum: 841d1a79e90d1ef1c6bb14b58b807236 (MD5) Previous issue date: 2006 / Resumo: O tromboembolismo venoso (TEV) afeta de 1 a 3 indivíduos por mil habitantes/ano. O conhecimento atual das trombofilias permite a associação com cerca de 40% dos casos de TEV. Há controvérsias quanto ao valor da pesquisa laboratorial de trombofilia para o benefício dos doentes com tromboembolismo venoso. Procuraram-se as variáveis preditivas para a pesquisa positiva de trombofilia e avaliar o impacto desses resultados nas decisões clínicas. Foram avaliados 84 doentes consecutivos com TEV confirmado por métodos de imagem no período entre janeiro de 2001 e novembro de 2003. Após o período previsto de anticoagulação definido por critérios clínicos, os doentes foram submetidos à pesquisa das principais causas de trombofilia. Os resultados laboratoriais permitiram a dois examinadores independentes reavaliar caso-a-caso a indicação de ¿mudança de conduta¿, caracterizada pela interferência no tempo de profilaxia secundária ou ¿atenção especial¿ para medidas de maior vigilância diante de situações de risco ou para a extensão da pesquisa aos familiares assintomáticos. A trombofilia foi encontrada em 35 dos 84 casos (41,66%), sendo que em 27 (32,12%) havia uma causa genética. O fator V Leiden foi a alteração mais freqüente (15,47%), seguida do conjunto de deficiência dos anticoagulantes naturais (11,9%). Não houve diferença significativa da freqüência de trombofilia relacionada à faixa etária nem diferença de idade de aparecimento do primeiro evento trombótico entre doentes trombofílicos e não trombofílicos. Houve significância estatística para ocorrência de trombofilia nos doentes com tromboflebite superficial, recorrência e na associação com fatores de risco não cirúrgicos. A ¿mudança de conduta¿ foi atribuída a 6 dos 84 doentes (7,14%), estatisticamente significativa para aqueles com recorrência em relação aos que tiveram apenas um episódio de TEV. A ¿atenção especial¿ foi atribuída a 34 dos 84 casos (40,47%).A tromboflebite superficial de aparecimento espontâneo, a ocorrência de TEV relacionada a causas não cirúrgicas e a recorrência foram os principais achados preditivos de trombofilia. A ¿mudança de conduta¿ aplicou-se a uma pequena porcentagem de doentes, e refletiu predominantemente a confirmação da necessidade de prolongamento da profilaxia secundária. A ¿atenção especial¿ diante de situações de risco e a extensão da profilaxia primária a familiares de primeiro grau assintomáticos expostos a situações de risco parecem-nos a melhor indicação para a pesquisa laboratorial da trombofilia. Palavras-chave: trombofilia, fator V Leiden, mutação G20210A, proteína S, proteína C, antitrombina, hiperhomocisteinemia, anticorpos antifosfolípides, tromboembolismo venoso / Abstract: The venous thromboembolism (VTE) affects 1 to 3 individuals per a thousand habitants/year. Nowadays its possible to associated VTE with a cause of thrombophilia in about 40% of patients. There are some inconclusive points about the real benefit of the laboratorial investigation on thrombophilia for patients with VTE. We tried to identify the variables that point to the positive test results and the impact of these results on clinical decisions.The screening for the more common causes of thrombophilia was applied to 84 consecutive patients with VTE confirmed by image examination between January 2001 and November 2003. After test results, two independent observers evaluated, in a case by case basis, the indication of a ¿change on prophylaxis¿, in order to modify the period of anticoagulant intake (secondary prophylaxis), or ¿special attention¿ when considering to have a higher medical surveillance before risk situations or for the extension of the research to the first degree asymptomatic relatives.Thrombophilia was found in 41.66% (35/84), and in 32.12% (27/84) it involved agenetic cause. The factor V Leiden was the more prevalent alteration, identified in 15.47% of the cases, followed by the natural anticoagulants disfunction (11.9%). There was no significative difference of thrombophilia frequency between ages, nor a difference of age in the onset of the first thrombotic event between thrombophilic and non-thrombophilic patients. There was a higher prevalence of thrombophilia in patients with superficial thrombophlebitis of spontaneous onset, in cases of recurrence and when associated with non-surgical predisponent factors. The ¿change on prophylaxis¿ resulted in 7.14% (6/84), and there was statistically significance for patients with recurrent episodes when compared to patients with just one. The ¿special attention¿ was applied in 40.47% (34/84). Spontaneous superficial thrombophlebitis, occurrence of VTE related to nonsurgical causes and recurrence, were the main findings which suggested thrombophilia. The ¿change of prophylaxis¿ was applied to a small percentage of patients. The ¿special attention¿ for risk situations and the extension of the primary prophylaxis to the asymptomatic family members seem to be the best indication for the laboratorial research on thrombophilia. Key words: thrombophilia, factor V Leiden, G20210A mutation, protein C, protein S, antithrombin, hyperhomocysteinaemia, antiphospholipids antibodies, venous thromboembolism / Doutorado / Cirurgia / Doutor em Cirurgia

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia with a prevalence of 15% of patients over 80 years. Coronary artery disease co-exists in 20–30% of patients with atrial fibrillation. The need for triple anticoagulation therapy makes the management of these patients challenging following PCI. Methods: Nationwide inpatient sample which is a set of longitudinal hospital inpatient databases was used to evaluate the outcome of patients with AF who underwent PCI. All patients undergoing PCI between 2002 and 2011 were included in the study. Specific ICD-9-CM codes were used to identify the study patients and their outcomes. Results: There were 3,226,405 PCIs during the time period of the study of which 472,609 (14.6%) patients had AF. AF patients were older and predominantly male (60%). The number of PCIs had a declining trend from 2002 to 2011. Age adjusted inpatient mortality was significantly higher in PCI AF group compared to the PCI non-AF group (100.82 ± 9.03 vs 54.07 ± 8.96 per 100,000; P < 0.01). Post PCI predictors of mortality were AF (OR 1.56, CI 1.53–1.59), CKD (OR 1.41, CI 1.37–1.46), PAD (OR 1.20, CI 1.15–1.24), acute myocardial infarction (OR 2.42 CI 2.37–2.46 and cardiogenic shock (OR 13.92 CI 13.60–14.24) P < 0.001. Conclusion: AF is common in patients undergoing PCI and those AF patients have a higher age-adjusted all cause inpatient mortality. There is a decline in total number of PCIs over time in US. Atrial fibrillation, chronic kidney disease, peripheral artery disease, MI and cardiogenic shock were associated with increased mortality following PCI.

No description available.

Made available in DSpace on 2016-01-26T12:51:10Z (GMT). No. of bitstreams: 1 fransciscoricardomarqueslobo_tese.pdf: 196880 bytes, checksum: f40e2b740711953b1294f3b6b0e252f2 (MD5) Previous issue date: 2007-01-23 / Disseminated intravascular coagulation (DIC) is a syndrome caused by systemic activation of clotting factors and it is frequently associated with several diseases such as sepsis, trauma, shock, cancer, and immune and vascular disorders. Sepsis is the main clinical condition associated to DIC. In some cases, the clinical outcome is very fast and severe, and an early management establishes a better outcome. Using a score suggested by the International Society of Thrombosis and Haemostasis to perform a DIC diagnosis, we were able to evaluate the frequency of its occurrence in patients admitted to the intensive care unit. The serum concentrations of coagulation and fibrinolysis markers within the first 72 hours of admission and the role of these markers as early predictors in the development of DIC were retrospectively estimated. Fifty clinical and surgical patients presenting sepsis, shock, and multiple traumas were included in the study. Of the 50 patients examined, 10 (20%) developed DIC within the first 48 hours of ICU admission. The logistic regression analysis showed that the decreased antithrombin level (p = 0.0355) on admission are predictive of DIC development. This result may have a relevant involvement in clinical outcome because the early intervention can change the DIC prognosis. / A Coagulação intravascular disseminada (CIVD) é uma síndrome causada por ativação sistêmica da coagulação e freqüentemente associada com diversas doenças como sepse, trauma, choque, câncer e anormalidades imunológicas e vasculares. A sepse é a principal condição clínica associada à CIVD. Em alguns casos, a evolução clínica é muito rápida e grave e o tratamento precoce determina melhor evolução. Com o uso do escore para diagnóstico de CIVD proposto pela Sociedade Internacional de Trombose e Hemostasia avaliamos a freqüência de ocorrências de CIVD em pacientes admitidos em unidade de terapia intensiva. As concentrações séricas dos marcadores da coagulação e fibrinólise nas primeiras 72 horas da internação e o papel desses marcadores como preditores precoces do desenvolvimento de CIVD foram avaliados retrospectivamente. Cinqüenta pacientes (clínicos e cirúrgicos) apresentando sepse, choque e politrauma foram incluídos no estudo. Dos 50 pacientes avaliados, 10 pacientes (20%) desenvolveram CIVD durante as primeiras 48 horas de internação na UTI. A análise por regressão logística mostrou que o nível diminuído de antitrombina (p= 0,0355) na admissão é preditivo do desenvolvimento de CIVD. Esse resultado pode ter implicação relevante na evolução clínica, pois a intervenção precoce poderá mudar o prognóstico da CIVD.