Q112563314
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Narastajúci objem dát a skúseností s použitím priamych orálnych antikoagulancií (DOAK) v primárnej aj sekundárnej prevencii venózneho tromboembolizmu u onkologických pacientov (CAVTE) viedol ku zmenám v početných medzinárodných odporúčaniach. Reflektujeme tieto zmeny s ohľadom na podmienky v SR. V primárnej prevencii CAVTE rozlišujeme onkologických pacientov na tých, ktorí podstupujú v súvislosti s ochorením chirurgický zákrok a na nechirurgických pacientov: hospitalizovaných a ambulantne liečených. Za základné liečivá v primárnej prevencii naďalej považujeme heparíny s nízkou molekulovou hmotnosťou (LMWH). V liečbe a sekundárnej prevencii CAVTE odporúčame uvažovať vždy aj o možnosti použiť DOAKy ako z hľadiska účinnosti rovnocennú alternatívu LMWH. LMWH je potrebné preferovať pred DOAKmi aj warfarinom u všetkých pacientov s klinicky nestabilnou situáciou s vysokým rizikom krvácania a vysokým rizikom interakcie so systémovou liečbou. Predovšetkým ide o pacientov s intraluminálnymi nádormi hornej časti gastrointestinálneho traktu a urogenitálnymi malignitami s vysokým rizikom krvácania. Pre nedostatočný objem dát sú LMWH stále preferované aj u pacientov s primárnymi nádormi a metastatickým postihnutím centrálnej nervovej sústavy a u hematoonkologických pacientov.
The increasing volume of the data and experience with direct oral anticoagulants (DOACS) in the primary and secondary prevention of venous thromboembolism in oncologic patients (CAVTE) has recently lead to changes in several international guidelines. We reflect these changes within the conditions in Slovak republic. In the primary prevention of CAVTE we recognise oncosurgical patients and nonsurgical patients: hospitalised and out patients. Low molecular weight heparins are still dominant in the primary prevention of CAVTE. Regarding the treatment and the secondary prevention of CAVTE, we recommend always to consider the possibility to use DOACs as they proved to be non inferior to LMWH. However, LMWH should be prefered over DOACs as well as over warfarin (VKA) in all patients who are in a clinically unstable condition with the high risk of bleeding and/or interaction with the systemic treatment. Primarily in the patients with intraluminal tumours of the upper part of the gastrointestinal tract and genitourinary tumours with the high risk of bleeding. As for the lack of data, LMWH are still preferd also in patients with primary tumours and metastatic disease of the central nervous system and in hemato oncology.
The association between gene variant rs7635818 located on chromosome 3p12.3 and abdominal aortic aneurysm (AAA) was not unambiguously determined by the results of genome-wide association studies. The aim of our study was to examine this possible association in the Slovak population, with respect to the presence and severity of AAA.A cross-sectional study was conducted between August 2016 and March 2020. The study included 329 participans, 166 AAA patients and a control group of 163 subjects without confirmed AAA with comparable distribution of genders. The anteroposterior diameter of the abdominal aorta was determined by duplex ultrasonography. AAA was defined as subrenal aortic diameter ≥ 30 mm. DNA samples were genotyped using real-time polymerase chain reaction and subsequent high-resolution melting analysis in presence of unlabelled probe. Genetic models studying the possible association were adjusted to age, sex, smoking, arterial hypertension, diabetes mellitus, creatinine and body mass index (BMI) in multivariate analysis. In the additive model, presence of each C-allele of rs7635818 polymorphism was associated with an almost 50 % increase in probability of developing AAA (OR 1.49; 95 % CI 1.06-2.08; p=0.020). Compared to GG homozygotes, CC homozygotes had more than two times higher risk of developing AAA (OR 2.23; 95 % CI 1.14-4.39; p=0.020). The risk of AAA was also in the recessive model higher for CC homozygotes compared to G-allele carriers (GC/GG) (OR 1.79; 95 % CI 1.01-3.19; p=0.047).The abdominal aortic diameter in CC homozygotes of the rs7635818 polymorphism was 7.66 mm greater compared to GG homozygotes (42.5±22.0 mm vs 34.8±21.3 mm; p=0.022) and 5.88 mm greater compared to G-allele carriers (GC/GG) (42.5±22.0 mm vs 36.6±21.0 mm; p=0.04) in univariate analysis. C-allele variant in rs7635818 G>C polymorphism is associated with a higher probability of developing AAA in the Slovak population.
- MeSH
- aneurysma břišní aorty diagnostické zobrazování etnologie genetika MeSH
- běloši genetika MeSH
- fenotyp MeSH
- genetická predispozice k nemoci MeSH
- genetické asociační studie MeSH
- hodnocení rizik MeSH
- jednonukleotidový polymorfismus * MeSH
- lidé středního věku MeSH
- lidé MeSH
- lidské chromozomy, pár 3 * MeSH
- průřezové studie MeSH
- rizikové faktory MeSH
- senioři MeSH
- studie případů a kontrol MeSH
- stupeň závažnosti nemoci MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
- MeSH
- angioplastika MeSH
- arteria subclavia diagnostické zobrazování patologie MeSH
- infarkt myokardu * diagnóza etiologie terapie MeSH
- ischemická choroba srdeční komplikace terapie MeSH
- koronární bypass škodlivé účinky MeSH
- koronaro-subklaviální steal syndrom * diagnóza etiologie terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
