Long-term survival in venous thromboembolic disease: rivaroxaban vs. warfarin - propensity score matching study.

BACKGROUND: Venous thromboembolic disease (VTE) is characterized by obstruction of venous blood flow by a thrombus. Survival data, frequency of disease recurrence, and bleeding rate in patients on anticoagulant therapy with warfarin compared to rivaroxaban in the Latin American population are limited in VTE. METHODS: A retrospective cohort study with propensity score matching analysis was conducted in patients with pulmonary embolism and/or deep vein thrombosis anticoagulated with warfarin or rivaroxaban treated. Survival analysis was performed using a Kaplan-Meier curve for each of the intervention groups, and it was compared using a Log Rank test. RESULTS: Of 2193 potentially eligible patients with a suspected diagnosis of VTE, 505 patients entered the analysis; of these, 285 subjects were managed with warfarin and 220 anticoagulated with rivaroxaban. Major bleeding at 12 months occurred in 2.7% (6/220) of patients treated with Rivaroxaban, compared to 10.2% (29/285) in the Warfarin group in the unmatched population (p = 0.001). In the matched population, bleeding at 12 months occurred in 2.9% (6/209) of patients on Rivaroxaban and in 11.0% (23/209) of patients on Warfarin (p = 0.001). The survival rates at 6 months were 97.1% for Rivaroxaban and 97.6% for Warfarin (p = 0.76). At 12 months, the survival rates were 94.7% for Rivaroxaban and 95.7% for Warfarin (p = 0.61). CONCLUSION: In the treatment of VTE, there is no differences on 6 and 12-month survival or a reduction in the occurrence of new thromboembolic events when comparing rivaroxaban to warfarin. However, a lower risk of major bleeding is observed at 12 months with Rivaroxaban.

Identification of Multiple High-Risk Human Papillomavirus Infections in a Rural Population of Canatlan, Durango, Mexico.

Background: The human papillomavirus (HPV) is the most frequent etiological agent driving development of cervical cancer (CC); therefore typing and classifying the status of these infections are of great importance for treatment. The frequency of the various HPV types may change in relation to low-grade lesions and have the potential to cause more severe lesions. Objective: The purpose of this study was the identification and typing of HPV in a rural population in Mexico. Methods: Detection and typing were determined by PCR-RFLPs and confirmed by viral DNA sequencing. Results: HPV was detected in 17.28% of the samples, this was 3.58% higher than had been determined in a rural population in Central Mexico. Viral types 16, 18 and 52 were found most frequently. Analysis of all HPV-positive samples revealed that 14.3% had a single infection; 57.1% had a double infection; and 28.6% had a triple infection. Thus, 85.7% of positive cases presented with multiple infections with HPV16 being the most prevalent. Only the lifetime number of sexual partners was found to have an association with the colposcopic diagnoses (OR = 7.08; 95% CI: 1.68-29.8; p > 0.008). Conclusion: A higher frequency of multiple HPV infections was found among our test population compared to other rural populations in Durango and Central Mexico. HPV type 16 was the most frequent infection.