Navegando por Palavras-chave "Thromboembolism"
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- ItemSomente MetadadadosCirculating tumor cell detection during chemotherapy in patients with breast cancer is not associated with plasma homocysteine levels(Springer, 2013-10-01) Yoshihara, Renata Nunes; Teixeira, Bianca Marinelli; Adami, Fernando; Kuniyoshi, Renata K.; Alves, Beatriz C. A.; Gehrke, Flavia S.; Vilas-Boas, Viviane A.; Azzalis, Ligia A. [UNIFESP]; Junqueira, Virginia B. C. [UNIFESP]; Pereira, Edimar Cristiano [UNIFESP]; Fonseca, Fernando L. A. [UNIFESP]; ABC Med Sch; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)Breast cancer remains the second most frequent type of cancer in the world and the first among women, and systemic chemotherapy is an adjuvant therapeutic modality that improves survival in a great part of patients. Women with breast cancer, however, frequently show a higher risk of thromboembolism, an event associated to hyperhomocysteinemia and the presence of circulating tumor cells (CTC). Our aim is to correlate the presence of CTCs, detected by the analysis of CK19 and c-erbB2 gene expressions, and the homocysteine plasma levels in the peripheral blood in patients with breast cancer undergoing chemotherapy. Epithelial marker expression (CK19 and c-erbB2) and homocysteine levels were analyzed in a mononuclear fraction of the peripheral blood and plasma, respectively, obtained from 35 patients diagnosed with breast cancer at diagnosis and throughout chemotherapy treatment. No significant relation between the CK19 and c-erbB2 expressions and hyperhomocysteinemia was observed at any moment of the evaluation throughout the chemotherapy treatment (3 and 6 months after the onset). Among clinical data, only menopausal status showed a statistically significant correlation with homocysteine concentration. Although differences in the expressions of the analyzed epithelial markers were detected at 3 and 6 months of chemotherapy treatment, no relation between plasma homocysteine variations and the CK19 and c-erbB2 gene expressions was found in patients under chemotherapy treatment at any moment of the evaluation, suggesting that chemotherapy affects the expressions of the studied genes independently.
- ItemAcesso aberto (Open Access)Efeito da suplementação vitamínica em parâmetros de geração de trombina, fibrinólise e função endotelial em pacientes com tromboembolismo venoso: Estudo duplo-cego, randomizado, controlado com placebo(Universidade Federal de São Paulo (UNIFESP), 2006-12-31) Rodrigues, Celso Arrais [UNIFESP]; Lourenco, Dayse Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: Mild hyperhomocysteinemia is associated with an increased risk of venous thromboembolism (VTE) and other cardiovascular diseases. Previous studies suggest impaired endothelial function and increased thrombin generation in hyperhomocysteinemic patients. Whether decreasing homocysteine with B-vitamin supplementation interferes with its procoagulant effects is to be determined. Objectives: To evaluate the correlation between homocysteine and markers of thrombin generation and endothelial function and to evaluate the effect of lowering homocysteine by Bvitamin supplementation on these markers in patients with VTE. Patients/Methods: This study was a multicentre, randomized, double-blind, placebo-controlled trial. We randomized 105 patients with a first event of objectively confirmed VTE, aged between 18 and 70 years, to receive either vitamin supplementation (folic acid 5 mg, vitamin B6 50 mg and vitamin B12 0.4 mg) or placebo. Blood was collected at randomization and 8 weeks after the intervention period. Results: Ninety-nine (94.3%) completed the 8-week period of treatment. In patients treated with vitamins, there was a 29% decrease in the homocysteine levels and a significant increase in the tissue plasminogen activator (t-PA) levels (p=0.0008). Both t-PA and plasminogen activator inhibitor type 1 (PAI-1) levels significantly increased in the group of patients above the highest tertile of basal homocysteine (12.6 μmol/L) who received vitamin supplementation (p=0.0004 and p=0.014, respectively). There was no change in the levels of these two markers in patients with homocysteine levels below the lowest tertile or in patients who received placebo independently of the homocysteine level. All other markers (prothrombin fragment 1+2, thrombin-antithrombin complex, D-dimer, Factor VIII:C and von Willebrand factor antigen) were unaffected by both vitamins and placebo, even in patients above the highest tertile of homocysteine. There was no difference between patients with homocysteine above the highest tertile and those below the lowest tertile (9.9 μmol/L) in the levels of these markers. Conclusions: In patients with VTE, homocysteine reduction by B-vitamin supplementation significantly increased both t-PA and PAI-1 in patients with higher levels of homocysteine. However, there was no effect of homocysteine reduction by B-vitamin supplementation on other markers of endothelial function, fibrinolysis and thrombin generation.
- ItemAcesso aberto (Open Access)Effect of estrogen-progestin hormonal replacement therapy on blood coagulation and fibrinolysis in postmenopausal women(Faculdade de Medicina / USP, 2007-01-01) Bonduki, Claudio Emilio [UNIFESP]; Lourenco, Dayse Maria [UNIFESP]; Motta, Eduardo Leme Alves da [UNIFESP]; Soares Júnior, José Maria [UNIFESP]; Haidar, Mauro Abi [UNIFESP]; Baracat, Edmund Chada [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate antithrombin III (AT), thrombin (Fragment 1+2 [F1+2] and thrombin-antithrombin [TAT]) generation markers, as well as other coagulation parameters, such as prothrombin time, partial activated thromboplastin time, thrombin time, fibrinogen, euglobulin lysis time, and platelet count, in postmenopausal women after hormonal therapy. STUDY DESIGN: Forty-five patients who received either 0.625 mg/day unopposed oral conjugated equine estrogen (CEE), 0.625 mg/day oral CEE plus medroxyprogesterone acetate (MP), or 50 µg/day transdermal 17beta-estradiol plus MP, were included. Tests were performed before (T0) and after 3 (T3), 6 (T6) and 12 (T12) months of treatment. AT was determined by an amidolytic method, whereas F1+2 and TAT complex were measured by ELISA. RESULTS: There was a significant reduction in the AT level of patients who received oral CEE plus MP at T3. There was no AT reduction in patients taking either oral CEE alone or transdermal 17beta-estradiol plus MP. F1+2 increased in all patients, but it reached statistical significance only in patients receiving transdermal 17beta-estradiol MP at T3. CONCLUSIONS: The CEE associated with MP treatment may reduce AT levels, whereas unopposed CEE or transdermal 17beta-estradiol plus MP does not change AT. These changes might not be clinically relevant in the general population; however, hormonal replacement therapy may increase the risk of thrombosis in women with congenital or acquired thrombophilia.
- ItemSomente MetadadadosEffect of estrogen-progestin hormonal replacement therapy on plasma antithrombin III of postmenopausal women(Munksgaard Int Publ Ltd, 1998-03-01) Bonduki, Claudio Emilio [UNIFESP]; Lourenço, Dayse Maria [UNIFESP]; Baracat, Edmund Chada [UNIFESP]; Haidar, Mauro Abi [UNIFESP]; Noguti, Maria Aparecida Eiko [UNIFESP]; Motta, Eduardo Leme Alves da [UNIFESP]; Lima, Geraldo Rodrigues de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background. This study was performed to evaluate antithrombin III levels in postmenopausal women receiving hormonal replacement treatment.Methods. It is a prospective randomized study concerning 19 postmenopausal patients, aged 40 to 65 years, who received either continuous daily oral equine conjugated estrogen 0.625 mg (group A, N=10) or daily transdermal 17 beta-estradiol 50 mu g (group B, N=9). Medroxyprogesterone acetate (5 mg/day, 14 days monthly) was given to all patients. Blood samples were obtained before and after 3, 6, 9 and 12 months of treatment. Coagulation tests included Antithrombin III (functional method), prothrombin time, partial activated prothrombin time, thrombin time, factor V, fibrinogen, platelet count and euglobulin lysis time. Friedman analysis of variance and Mann-Whitney test were used for statistical analysis.Results. Antithrombin III level was reduced (p<0.05) in group A but not in group B, although it remained within normal range. No changes were detected in the other coagulation tests.Conclusions. These data suggest that oral conjugated estrogen replacement reduces functional ATIII, whereas transdermal estradiol replacement therapy does not modify it.
- ItemAcesso aberto (Open Access)Vena cava thrombosis associated with nephrotic syndrome in the puerperal gestational cycle(Associação Paulista de Medicina - APM, 2001-01-04) Araújo, Maíta Poli; Gonçalves, Carla; Gonçalves, Roberta; Braga Júnior, José Wilson Ramos [UNIFESP]; Peterson, Thaís Vilela; Atallah, Álvaro Nagib [UNIFESP]; Sato, Emilia Inoue [UNIFESP]; Trevisani, Virgínia Fernandes Moça [UNIFESP]; Universidade de Santo Amaro; Universidade Federal de São Paulo (UNIFESP); Universidade de Santo Amaro Discipline of RheumatologyCONTEXT: The puerperal gestational cycle is accompanied by a state of physiological hypercoagulability. Thromboembolic phenomena may occur at this time. OBJECTIVE: To report on a clinic case involving a patient that presented a family history of thromboembolism and developed deep vein thrombosis in a lower limb and vena cava thrombosis during the puerperal gestational cycle, displaying nephrotic syndrome as the main complication. DESIGN: Case report.