Hematologia

2 metanálises recentes destacam os benefícios de dupla antiagragação plaquetária com clopidogrel + aspirina por até 30 dias para pacientes com ataque isquêmico transitório de alto risco ou AVC isquêmico leve-moderado.

17 Mai, 2021 | 09:21h

Metanálise 1: Dual Antiplatelet Therapy Versus Aspirin in Patients With Stroke or Transient Ischemic Attack: Meta-Analysis of Randomized Controlled Trials – Stroke

Metanálise 2: Efficacy and Safety of Using Dual Versus Monotherapy Antiplatelet Agents in Secondary Stroke Prevention: Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials – Circulation (link para o resumo – $ para o texto completo)

Comentário: Dual vs. Monotherapy Antiplatelet Agents in Secondary Stroke Prevention – American College of Cardiology

Diretriz relacionada: Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke – The BMJ

[Preprint] Metanálise sobre trombocitopenia trombótica imune induzida por vacina após a vacina ChAdOx1-S recombinante – O risco geral é de 1 a cada 139.000 imunizados; para pacientes de 65 anos ou mais, o risco é cerca de 1 em 1 milhão; para pacientes com menos de 55 anos, o risco é de 1 a cada 20.000 a 60.000.

12 Mai, 2021 | 10:11h

Meta-Analysis of Risk of Vaccine-Induced Immune Thrombotic Thrombocytopenia Following ChAdOx1-S Recombinant Vaccine – medRxiv

Estudo de coorte: Eventos arteriais, tromboembolismo venoso, trombocitopenia e sangramento após vacinação com Oxford-AstraZeneca ChAdOx1-S: 11 eventos tromboembólicos venosos em excesso por 100.000 vacinações; 2,5 tromboses venosas cerebrais em excesso por 100.000 vacinações.

7 Mai, 2021 | 10:48h

Arterial events, venous thromboembolism, thrombocytopenia, and bleeding after vaccination with Oxford-AstraZeneca ChAdOx1-S in Denmark and Norway: population based cohort study – The BMJ

Editorial: Thromboembolism and the Oxford-AstraZeneca vaccine – The BMJ

Comentários: Thrombosis and bleeding after the Oxford-AstraZeneca covid-19 vaccination – The BMJ Opinion E Putting risks into context: covid-19 vaccines and blood clots – The BMJ Opinion E Expert reaction to study from Denmark and Norway looking at rare blood clots after the Oxford-AstraZeneca vaccine – Science Media Centre

Comentário no Twitter

NEW research sheds more light on rate of rare blood clots after Oxford-AstraZeneca vaccine

Rate of adverse events low; benefits of the vaccine still outweigh risks in most situations, say researchershttps://t.co/LslgvzWlWi @Pottegard

— The BMJ (@bmj_latest) May 6, 2021

Qual é o futuro das vacinas em relação aos raros distúrbios de coagulação? O jornal Science analisa as descobertas mais recentes.

5 Mai, 2021 | 09:37h

What’s the future of vaccines linked to rare clotting disorders? Science breaks down the latest – Science

Guia prático para o uso de anticoagulantes orais não antagonistas de vitamina K em pacientes com fibrilação atrial

4 Mai, 2021 | 09:45h

2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation – EP Europace

Comentário: EHRA Updates Its Popular ‘Practical’ NOAC Guide – TCTMD

Série de casos de 12 pacientes com trombose do seio venoso cerebral com trombocitopenia após vacinação com Ad26.COV2.S – Todas são mulheres com menos de 60 anos apresentando sintomas entre 6 e 15 dias depois da vacinação

3 Mai, 2021 | 10:50h

US Case Reports of Cerebral Venous Sinus Thrombosis With Thrombocytopenia After Ad26.COV2.S Vaccination, March 2 to April 21, 2021 – JAMA

Editorial: Assessing a Rare and Serious Adverse Event Following Administration of the Ad26.COV2.S Vaccine – JAMA

Ver também: Safety Monitoring of the Janssen (Johnson & Johnson) COVID-19 Vaccine — United States, March–April 2021 – Centers for Disease Control and Prevention E Updated Recommendations from the Advisory Committee on Immunization Practices for Use of the Janssen (Johnson & Johnson) COVID-19 Vaccine After Reports of Thrombosis with Thrombocytopenia Syndrome Among Vaccine Recipients — United States, April 2021 – Centers for Disease Control and Prevention

Relacionado: AHA/ASA Guidance: Diagnosis and Management of Cerebral Venous Sinus Thrombosis with Vaccine-Induced Thrombotic Thrombocytopenia – “No heparin products in any dose should be given.”

Estudo com 5 milhões de suecos aponta ligação entre grupos sanguíneos e riscos de doenças

3 Mai, 2021 | 10:22h

Comunicado de Imprensa: Study on five million Swedes finds links between blood groups and disease risks – Karolinska Institutet

Estudo Original: An agnostic study of associations between ABO and RhD blood group and phenome-wide disease risk – eLife

ECR: Ácido tranexâmico na prevenção de perda sanguínea após parto cesariano – Embora o uso de AT tenha resultado em redução na incidência da perda sanguínea estimada, a relevância clínica dos achados foi pequena.

30 Abr, 2021 | 09:17h

Tranexamic Acid for the Prevention of Blood Loss after Cesarean Delivery – New England Journal of Medicine

Comentários no Twitter

Another typically "positive" trial for TXA.

"the mean between-group difference was approximately 100 ml …. the clinical relevance of this narrow difference is questionable"
– No difference in RBC transfusions.
– 0.4% vs 0.1% VTE at 3 mos.

🤷‍♂️https://t.co/KX4OZUyZVK

— Ryan Radecki, MD MS (@emlitofnote) April 28, 2021

NEJM-Prevention of Blood Loss after Cesarean Delivery | tranexamic acid ➡️ significantly lower incidence of EBL greater than 1000 ml or RBC transfusion by day 2 than placebo, but did not result in a ⬇️ incidence of hemorrhage-related secondary outcomes https://t.co/ydF5HgHM0N

— Skeptical Scalpel (@Skepticscalpel) April 28, 2021

Orientações da AHA/ASA: Diagnóstico e tratamento da trombose de seio venoso cerebral associada a trombocitopenia trombótica induzida por vacina – “Nenhum tipo de heparina, em qualquer dose, deve ser administrado.”

30 Abr, 2021 | 09:02h

Diagnosis and Management of Cerebral Venous Sinus Thrombosis with Vaccine-Induced Thrombotic Thrombocytopenia – Stroke

Comunicado de Imprensa: Guidance on treatment for rare blood clots and low platelets related to COVID-19 vaccine – American Heart Association

Relacionado: ISTH Interim Guidance for the Diagnosis and Treatment on Vaccine Induced Immune Thrombotic Thrombocytopenia

Revisão: Coagulopatia associada a COVID-19 e agentes antitrombóticos – Em pacientes internados não críticos, anticoagulação em dose plena com heparina de baixo peso molecular pode melhorar os resultados clínicos. Em pacientes críticos, o mesmo tratamento não traz essa melhora, sendo recomendada a dose profilática

29 Abr, 2021 | 10:33h

COVID-19-associated coagulopathy and antithrombotic agents—lessons after 1 year – The Lancet Haematology

Relacionado: Full-dose Heparin best for moderate COVID-19 regardless of D-dimer — Data released from ACTIV-4a, ATTACC, and REMAP-CAP trials E RCT: Intermediate-dose enoxaparin (1 mg/kg/d) not better than standard-dose prophylactic anticoagulation in patients with Covid-19 admitted to the intensive care unit