由于直接作用的口服抗凝剂吸收不良导致的肺梗塞
Niroop Rajashekar1, Darius Mostaghimi1, Feng Jiang2
1Yale School of Medicine.
Journal of Brown hospital medicine
|March 3, 2025
概括
袖子胃切除术可能导致里瓦罗克萨班的吸收不良,导致复发性静脉血栓栓塞事件 (VTE). 这一案例凸显了需要考虑VTE患者的吸收不良,尽管在减肥手术后使用抗凝剂.
科学领域:
- 医学案例研究 医学案例研究
- 胃肠病学 胃肠病学
- 心脏病学 心脏病学
背景情况:
- 一位患有袖子胃切除术和多重静脉血栓栓塞事件 (VTE) 的病史的患者出现了持续的咳.
- 对于被认为是社区获得的肺炎的初始治疗是无效的.
研究的目的:
- 为了调查在有袖胃切除术和抗凝药治疗史的患者中复发性静脉动脉瘤的原因.
- 为了突出腹手术后潜在的吸收不良问题.
主要方法:
- 对胸部计算机断层扫描 (CT) 扫描的审查.
- 用对比度增强的CT来评估肺栓塞.
- 评估患者对利瓦罗克萨班和高凝血功效的坚持.
主要成果:
- 最初的CT显示了磨砂玻璃和结合,被视为肺炎.
- 重新评估显示了形空域疾病,涉及到肺梗塞.
- 对比CT显示肺栓塞和慢性血栓形成的急性肺栓塞增加.
结论:
- 由于袖子胃切除术的二次性,Rivaroxaban的吸收不良被确定为抗凝剂失效的原因.
- 过渡到华法林治疗成功管理了复发性VTE.
- 腹腔外科手术诱导的吸收不良是治疗直接作用口服抗凝剂的患者中复发性静脉瘤的一个关键考虑因素.
相关概念视频
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
1.1K
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
1.1K
Anticoagulant Drugs: Low-Molecular-Weight Heparins
590
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
590
Factors Influencing Drug Absorption: Disease States and Pharmacology
399
Multiple disease states can significantly influence the oral drug absorption process by affecting blood flow and the functionality of the gastrointestinal (GI) system. Various GI diseases, including conditions that alter GI motility, such as diarrhea, decreased acid secretions (achlorhydria), and infections, have been associated with reduced drug absorption.
Substances such as alcohol and specific drugs, including antineoplastics, can also negatively impact drug absorption. For instance,...
Substances such as alcohol and specific drugs, including antineoplastics, can also negatively impact drug absorption. For instance,...
399
Non-Oral Extravascular Drug Absorption Routes
192
Non-oral extravascular routes, which encompass sublingual, buccal, topical, intramuscular, and inhalation methods, primarily utilize passive diffusion to transport drugs into the systemic circulation. The absorption rates and effectiveness of these routes depend on the drug's physicochemical properties, as well as the patient's anatomical and pathophysiological state.
Lipophilic drugs that are stable at salivary pH (6) and exhibit minimal binding to the oral mucosa are absorbed more...
Lipophilic drugs that are stable at salivary pH (6) and exhibit minimal binding to the oral mucosa are absorbed more...
192
Disorders of Hemostasis
676
Hemostasis, the process that stops bleeding after a blood vessel injury, is crucial for maintaining the integrity of the circulatory system. However, disorders of hemostasis can disrupt this delicate balance, leading to either excessive clotting or bleeding. These disorders can be broadly classified into thromboembolic disorders and bleeding disorders.
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
676
Inflammatory Bowel Disease I: Ulcerative Colitis
112
Introduction
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
112


