Upper extremities deep vein thrombosis treated with oral direct anticoagulants: A prospective cohort study.

BACKGROUND: Limited data are available on the role of direct oral anticoagulants (DOACs) for the treatment of upper extremities deep vein thrombosis (UEDVT). OBJECTIVES: The aim of this study was to assess the effectiveness and safety of DOACs in the treatment of UEDVT. METHODS: Patients with an objectively confirmed acute UEDVT treated with DOACs were merged from prospective cohorts to a collaborative database. Primary study outcomes were recurrent venous thromboembolism (VTE) and major bleeding occurring during DOAC treatment. RESULTS: Overall, 188 patients were included in the study: mean age 52.4 ± 20.4 years, males 43.6%, patients with active cancer 29.2%. Twenty-nine percent of patients had 2 or more risk factors for VTE, 33.0% had catheter-related or pacemaker-related UEDVT. In 13.8% of patients, DOACs were started one month after UEDVT diagnosis or later. Active cancer was an independent predictor for delayed initiation of DOACs (OR 8.1, 95% CI 3.0-22.2). Mean duration of treatment with DOACs was 5.1 ± 2.8 months. During treatment with DOACs, recurrent VTE occurred in 0.9 per 100 patient-year, major bleeding in 1.7 and all-cause deaths in 6.0 per 100 patient-year. No fatal bleeding or fatal VTE recurrence were observed. During 232.1 patient-years of follow-up after DOAC withdrawal, recurrent VTE occurred in 3.0 per 100 patient-year. The 2019 ESC categories for risk of VTE recurrences were able to discriminate patient groups at different risk of events in the on and off-treatment periods. CONCLUSIONS: Our data support the feasibility as well as the effectiveness and safety of DOACs for the treatment of acute UEDVT.

Prognostic value of respiratory index in haemodynamically stable patients with acute pulmonary embolism: The Respiratory Index model study.

BACKGROUND: Current strategies for prognostic stratification in haemodynamically stable patients with acute pulmonary embolism require improvement. The aims of this study in haemodynamically stable patients with acute pulmonary embolism were (a) to evaluate the prognostic value of a novel respiratory index (oxygen saturation in air to respiratory rate ratio) and (b) to derive a risk model which includes the respiratory index and evaluate its value in predicting 30-day mortality. METHODS: Prospective cohorts of haemodynamically stable patients with acute pulmonary embolism were merged to a collaborative database that served to create two subsequent derivation and validation cohorts based on a temporal criterion. The study outcome was 30-day all-cause death. RESULTS: Thirty-day all-cause death occurred in 7.5% and in 6.9% of patients in the derivation and validation cohorts (each composed of 319 patients). In the derivation cohort, the respiratory index (odds ratio 0.66, 95% confidence interval 0.48-0.90) and simplified Pulmonary Embolism Severity Index (odds ratio 9.16, 95% confidence interval 1.22-68.89) were predictors of 30-day mortality. The cut-off value of the respiratory index ⩽3.8 was identified to best predict 30-day all-cause death (15.4% vs 5.0%, odds ratio 2.94, 95% confidence interval 1.22-7.11). The respiratory index ⩽3.8 was combined with the simplified Pulmonary Embolism Severity Index to create the Respiratory Index model that showed a good discriminatory power in the derivation (c-statistic 0.703, 95% confidence interval 0.60-0.80) and in the validation cohort (c-statistic 0.838, 95% confidence interval 0.768-0.907). CONCLUSION: In hemodynamically stable patients with acute pulmonary embolism, the respiratory index was an independent predictor of 30-day all-cause death. The Respiratory Index model which includes the simplified Pulmonary Embolism Severity Index and the respiratory index, provides a good risk stratification of haemodynamically stable patients with acute pulmonary embolism.

Disfunción del ventrículo derecho en la embolia pulmonar aguda: NT-proBNP frente a troponina T / Right ventricular dysfunction in acute pulmonary embolism: NT-proBNP vs. troponin T

Introducción y objetivos: La disfunción del ventrículo derecho (VD) es un parámetro de gravedad en la embolia pulmonar (EP) aguda. La valoración ecocardiográfica no siempre es posible en urgencias, de ahí la necesidad de predecir la presencia de disfunción de VD mediante parámetros de fácil medición. Analizar el valor de NT-proBNP y troponina T como marcadores de disfunción del VD en los pacientes con EP aguda. Como objetivo secundario, valorar la relación entre fallo de VD y diferentes parámetros clínicos relacionados con la EP. Material y método: Estudio analítico, observacional, transversal y retrospectivo que compara los valores de NT-proBNP, troponina T y síntomas de presentación de EP entre pacientes con fallo de VD y sin fallo. Resultados: Se incluyeron 172 pacientes (52 con fallo de VD, 120 sin fallo de VD). Todos los síntomas se presentaron con similar frecuencia entre ambos grupos, salvo la disnea y el síncope (más frecuentes en el grupo con fallo de VD). Tanto el NT-proBNP como la troponina T presentaron valores significativamente mayores en el grupo de pacientes con fallo de VD. Sin embargo, el valor explicativo de fallo de VD fue mayor para el NT-proBNP en al análisis multivariante. Conclusión: El NT-proBNP se muestra como un parámetro diagnóstico de fallo de VD con mayor sensibilidad en el contexto de EP aguda (AU)

Background and objective: Dysfunction of the right ventricle (RV) is a parameter of severity in acute pulmonary embolism (PE). Echocardiographic assessment is not always possible in accident and emergency, hence the need to predict the presence of RV dysfunction using easily measurable parameters. To analyse the value of NT-proBNP and troponin T as markers of RV dysfunction in patients with acute PE. Secondarily, to assess the relationship between RV failure and clinical parameters related to PE. Material and method: Analytical, observational, cross-sectional and retrospective study comparing the values NT-proBNP, troponin T and presenting symptoms of PE among patients with and without RV dysfunction. Results: One hundred seventy-two patients (52 with RV failure,120 without) were included. All symptoms occurred with similar frequency between the 2groups except dyspnea and syncope (more common in the group with RV failure). Both NT-proBNP and troponin T had significantly higher values in the group of patients with RV dysfunction. However, in the multivariate analysis, NT-proBNP had a higher explanatory value for RV failure than troponin T. Conclusion: NT-proBNP is a diagnostic parameter of RV dysfunction with higher sensitivity in the context of acute PE (AU)

Right ventricular dysfunction in acute pulmonary embolism: NT-proBNP vs. troponin T. / Disfunción del ventrículo derecho en la embolia pulmonar aguda: NT-proBNP frente a troponina T.

BACKGROUND AND OBJECTIVE: Dysfunction of the right ventricle (RV) is a parameter of severity in acute pulmonary embolism (PE). Echocardiographic assessment is not always possible in accident and emergency, hence the need to predict the presence of RV dysfunction using easily measurable parameters. To analyse the value of NT-proBNP and troponin T as markers of RV dysfunction in patients with acute PE. Secondarily, to assess the relationship between RV failure and clinical parameters related to PE. MATERIAL AND METHOD: Analytical, observational, cross-sectional and retrospective study comparing the values NT-proBNP, troponin T and presenting symptoms of PE among patients with and without RV dysfunction. RESULTS: One hundred seventy-two patients (52 with RV failure,120 without) were included. All symptoms occurred with similar frequency between the 2groups except dyspnea and syncope (more common in the group with RV failure). Both NT-proBNP and troponin T had significantly higher values in the group of patients with RV dysfunction. However, in the multivariate analysis, NT-proBNP had a higher explanatory value for RV failure than troponin T. CONCLUSION: NT-proBNP is a diagnostic parameter of RV dysfunction with higher sensitivity in the context of acute PE.

Cutaneous plaque in a diabetic patient - a case study.

CASE STUDY: A man, 31 years of age, with type 1 diabetes, presents with a slightly pruritic plaque located on the lateral aspect of his left elbow.