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2020, vol. 77, br. 12, str. 1336-1341
Da li bi trebalo terapiju antagonistima vitamina K otpočeti prvog dana kod bolesnika sa plućnom embolijom koji nemaju visok rizik?
aKlinički centar Niš, Klinika za kardiovaskularne bolesti
bKlinički centar Niš, Centar za radiologiju

e-adresagkoracevic@yahoo.com
Projekat:
Preventivni, terapijski i etički pristup prekliničkim i kliničkim istraživanjima gena i modulatora redoks ćelijske signalizacije u imunskom, inflamatornom i proliferativnom odgovoru ćelije (MPNTR - 41018)

Ključne reči: pluća, embolija; antikoagulansi; angiografija, tomografska, kompjuterizovana; pluća; d dimer; lečenje, ishod
Sažetak
Uvod. Protokoli i smernice poboljšavaju rezultate naše kliničke prakse. Ponekad postoje razlike između preporuka o istoj temi, ali obično te razlike nisu toliko važne. U vezi sa početkom primene antagonista vitamina K (VKA) kod bolesnika sa plućnom tromboembolijom (PTE), postoji globalni konsenzus (prisutan u svim savremenim smernicama) da bi to trebalo da bude na dan prijema ili dan kasnije. Međutim, postoje situacije u kojima davanje VKA od prvog (ili drugog) dana hospitalizacije može, zapravo, komplikovati tretman. Prikaz bolesnika. Kao ilustracija, naša 71-godišnja bolesnica, sa drugom neprovociranom PTE srednjeg rizika, je dobila heparin male molekulske težine (LMVH) + VKA od drugog dana hospitalizacije. Zbog izostanka poboljšanja simptoma, saturacije kiseonikom i D dimera nakon 9 dana, kompjuterizovana tomografski pulmonarna angiografija (CTPA) je ponovljena i nalaz je potvrdio minimalan napredak. Bolesnica je već postigla ciljni internacionalni normalizovani odnos (INR) i to je komplikovalo prelazak na fibrinolitičku terapiju. Zaključak. Korekcija terapijskog pristupa u lečenju PTE može biti potrebna čak i kad se lečenje sprovodi u skladu sa savremenim preporukama. Predlaže se odlaganje primene VKA od prvog (ili drugog) dana hospitalizacije (kao što se preporučuje u svim raspoloživim vodičima za bolesnike sa PTE koji nisu na visokom riziku), dok se ne postigne kliničko poboljšanje.
Reference
Naknadno pridodat članak: provera, normiranje i linkovanje referenci u toku.
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O članku

jezik rada: engleski
vrsta rada: prikaz slučaja
DOI: 10.2298/VSP170121001K
primljen: 21.01.2017.
revidiran: 18.12.2018.
prihvaćen: 19.12.2018.
objavljen onlajn: 20.12.2018.
objavljen u SCIndeksu: 06.01.2021.
metod recenzije: dvostruko anoniman
Creative Commons License 4.0

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