Subject(s)
Anti-Asthmatic Agents/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Churg-Strauss Syndrome/drug therapy , Eosinophils/immunology , Eosinophils/drug effects , Granulomatosis with Polyangiitis/drug therapy , Humans , Male , Middle Aged , Receptors, Interleukin-5/immunologyABSTRACT
Introducción: Las escalas predictivas de recurrencias de ETV son útiles para decidir la duración del tratamiento anticoagulante. Aunque hay varias escalas, desconocemos la aplicabilidad de las mismas en nuestro medio. Por ello nos planteamos validar el modelo predictivo DASH y el nomograma de Viena a 12 meses. Métodos: Estudio retrospectivo de pacientes consecutivos no seleccionados con ETV no provocada desde 2006 hasta 2014. Comparamos la capacidad de predecir recurrencias de ETV de la escala DASH y el nomograma de Viena. La validación se realizó estratificando a los pacientes como de bajo o alto riesgo, según cada escala (discriminación) y comparando las recurrencias observadas frente a las esperadas (calibración). Resultados: De 353 pacientes evaluados, se analizaron 195, con una edad media de 53,5+/-19 años. Hubo 21 recurrencias a 1 año (10,8%, IC95%: 6,8-16%). Según la escala DASH, fueron catalogados de bajo riesgo el 42%, observando ETV recurrente en el grupo de bajo fue del 4,9% (IC95%: 1,3-12%) vs. el grupo de alto riesgo en que fue del 15% (IC95%: 9-23%) (p < 0,05). Según el nomograma de Viena, fueron catalogados de bajo riesgo el 30%, observando ETV recurrente en el grupo de bajo vs. alto riesgo en el 4,2% (IC95%: 0,5-14%) vs. 16,2% (IC95%: 9,9-24,4%) (p < 0,05). Conclusiones: Nuestro estudio valida la escala DASH y el nomograma de Viena en nuestra población. El modelo predictivo DASH sería el más aconsejable, tanto por su sencillez como por la capacidad de identificar a más pacientes de bajo riesgo frente al nomograma de Viena (42% vs. 30%)
Introduction: Scales for predicting venous thromboembolism (VTE) recurrence are useful for deciding the duration of the anticoagulant treatment. Although there are several scales, the most appropriate for our setting has not been identified. For this reason, we aimed to validate the DASH prediction score and the Vienna nomogram at 12 months. Methods: This was a retrospective study of unselected consecutive VTE patients seen between 2006 and 2014. We compared the ability of the DASH score and the Vienna nomogram to predict recurrences of VTE. The validation was performed by stratifying patients as low-risk or high-risk, according to each scale (discrimination) and comparing the observed recurrence with the expected rate (calibration). Results: Of 353 patients evaluated, 195 were analyzed, with an average age of 53.5 ± 19 years. There were 21 recurrences in 1 year (10.8%, 95% CI: 6.8%-16%). According to the DASH score, 42% were classified as low risk, and the rate of VTE recurrence in this group was 4.9% (95% CI: 1.3%-12%) vs. the high-risk group that was 15% (95% CI: 9%-23%) (p <.05). According to the Vienna nomogram, 30% were classified as low risk, and the rate of VTE recurrence in the low risk group vs. the high risk group was 4.2% (95% CI:0.5%-14%) vs. 16.2% (95% CI: 9.9%-24.4%) (p <.05). Conclusions: Our study validates the DASH score and the Vienna nomogram in our population. The DASH prediction score may be the most advisable, both because of its simplicity and its ability to identify more low-risk patients than the Vienna nomogram (42% vs. 30%)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Venous Thromboembolism/complications , Anticoagulants/administration & dosage , Predictive Value of Tests , Nomograms , Pulmonary Embolism/diagnosis , Decision Support Techniques , Venous Thromboembolism/therapy , Retrospective Studies , Pulmonary Embolism/drug therapy , Venous Thrombosis/complications , ROC CurveABSTRACT
INTRODUCTION: Scales for predicting venous thromboembolism (VTE) recurrence are useful for deciding the duration of the anticoagulant treatment. Although there are several scales, the most appropriate for our setting has not been identified. For this reason, we aimed to validate the DASH prediction score and the Vienna nomogram at 12 months. METHODS: This was a retrospective study of unselected consecutive VTE patients seen between 2006 and 2014. We compared the ability of the DASH score and the Vienna nomogram to predict recurrences of VTE. The validation was performed by stratifying patients as low-risk or high-risk, according to each scale (discrimination) and comparing the observed recurrence with the expected rate (calibration). RESULTS: Of 353 patients evaluated, 195 were analyzed, with an average age of 53.5 ± 19 years. There were 21 recurrences in 1 year (10.8%, 95% CI: 6.8%-16%). According to the DASH score, 42% were classified as low risk, and the rate of VTE recurrence in this group was 4.9% (95% CI: 1.3%-12%) vs. the high-risk group that was 15% (95% CI: 9%-23%) (p <.05). According to the Vienna nomogram, 30% were classified as low risk, and the rate of VTE recurrence in the low risk group vs. the high risk group was 4.2% (95% CI:0.5%-14%) vs. 16.2% (95% CI: 9.9%-24.4%) (p <.05). CONCLUSIONS: Our study validates the DASH score and the Vienna nomogram in our population. The DASH prediction score may be the most advisable, both because of its simplicity and its ability to identify more low-risk patients than the Vienna nomogram (42% vs. 30%).
Subject(s)
Anticoagulants/administration & dosage , Nomograms , Venous Thromboembolism/drug therapy , Adult , Aged , Female , Humans , Male , Middle Aged , Recurrence , Retrospective Studies , Risk Assessment , Withholding TreatmentABSTRACT
La hipertensión pulmonar tromboembólica crónica es un estado fisiopatológico, resultante de la falta de resolución de un episodio de embolia pulmonar aguda (EP), único o recurrente, sea o no sintomático, después del tratamiento anticoagulante correcto. En esta revisión, se exponen sus factores de riesgo, se discute sobre la fisiopatología y se actualiza el protocolo diagnóstico y terapéutico actualmente en vigor
Chronic pulmonary thromboembolic hypertension is a physiopathological state resulting from failing to resolve an episode of acute pulmonary embolism (PE), single or recurrent, whether symptomatic or not, after correct treatment with anti-coagulants. This review presents the risk factors, the pathophysiology is discussed and the diagnostic and therapeutic protocol currently used is updated
Subject(s)
Humans , Pulmonary Embolism/physiopathology , Hypertension, Pulmonary/physiopathology , Chronic Disease , Anticoagulants/therapeutic use , Risk FactorsABSTRACT
INTRODUCTION: Randomized clinical trials have demonstrated non-inferiority of rivaroxaban compared with vitamin K antagonists (VKAs) in the treatment of venous thromboembolism (VTE). Our objective was to analyze in real life, tolerance, recurrence, bleeding and adverse events of rivaroxaban in patients with acute symptomatic VTE. MATERIAL AND METHODS: Open follow-up study of a cohort of patients aged 18 and over diagnosed with deep vein thrombosis (DVT) and/or pulmonary embolism (PE) treated with rivaroxaban from December 2011 to January 2014. RESULTS: The total number of patients treated with rivaroxaban was 103. The mean age was 58+/-17 years. The most frequent co-morbidities were: hypertension (30.0%), dyslipidemia (23.3%) and respiratory disease (25.2%). The type of thromboembolic event treated was: DVT (64.1%), PE (18.4%), DVT+PE (17.5%). Of the rivaroxaban-treated patients, 30% did so from the initial anticoagulant therapy and the other 70% in long-term or extended anticoagulant therapy. The median time of treatment with rivaroxaban was 6 months [corrected]. There was one recurrence and no deaths occurred. Six patients had bleeding, one of which was severe. CONCLUSIONS: Rivaroxaban provides a therapeutic alternative in a group of patients with VTE with advantages over VKAs, because of the convenience in dosing, lack of requirements for periodic monitoring and limited interaction with other drugs.
Subject(s)
Factor Xa Inhibitors/therapeutic use , Pulmonary Embolism/drug therapy , Rivaroxaban/therapeutic use , Venous Thromboembolism/drug therapy , Venous Thrombosis/drug therapy , Adult , Aged , Factor Xa Inhibitors/adverse effects , Female , Hemorrhage/chemically induced , Humans , Male , Middle Aged , Patient Selection , Pulmonary Embolism/blood , Pulmonary Embolism/diagnosis , Recurrence , Risk Factors , Rivaroxaban/adverse effects , Spain , Time Factors , Treatment Outcome , Venous Thromboembolism/blood , Venous Thromboembolism/diagnosis , Venous Thrombosis/blood , Venous Thrombosis/diagnosisABSTRACT
Fundamento y objetivo: El modelo predictivo de Khorana se desarrolló para estratificar el riesgo de enfermedad tromboembólica en pacientes con cáncer y en tratamiento con quimioterapia y, por tanto, identificar a aquellos que podrían beneficiarse de tromboprofilaxis. Analizar los resultados de la aplicación del modelo predictivo de Khorana en una cohorte de pacientes con cáncer y que fueron diagnosticados de trombosis venosa profunda (TVP). Pacientes y métodos: Análisis retrospectivo de las características pronósticas del modelo de Khorana en 122 pacientes con cáncer y TVP, basado en una recogida prospectiva de datos. Resultados: Se catalogó al 79% como pacientes de riesgo bajo e intermedio, y al 21% como de alto riesgo. La escala de Khorana tuvo una sensibilidad y exactitud pronóstica del 20,8% (intervalo de confianza del 95% [IC 95%]: 14,6-28,7) y una proporción de falsos negativos de 79,2% (IC 95%: 1,3-85,4). Conclusiones: La aplicación de este modelo en nuestros pacientes resultaría insuficiente como única herramienta para identificar a los enfermos con cáncer que deberían ser tratados con tromboprofilaxis. El uso de biomarcadores junto a modelos clínicos parece ser la mejor estrategia costo-efectivas para identificar a pacientes candidatos al tratamiento profiláctico. Estudios amplios, prospectivos, randomizados y con placebo deberían decidir si esta estrategia es la más válida (AU)
Background and objective: Khorana predictive model was developed for scoring the risk of thromboembolic disease in cancer patients on chemotherapy and to identify which patients would benefit from thromboprophylaxis . We analyze the results and apply the predictive model Khorana in patients with cancer who were diagnosed with deep vein thrombosis. Material and methods: Retrospective analysis of prognostic features Khorana model in 122 patients on the basis of a prospective analysis. Results: Seventy -nine percent of the total were in the category of low and intermediate risk and 21 % had a high risk according to the predictive model Khorana . This model had a sensitivity and prognostic accuracy of 20.8 % (95 % confidence interval [95% CI ] : 14.6 to 28.7 ) and a false negative rate of 79.2 % ( 95% CI : 1 , 3 to 85.4 ) . Conclusions: The application of this model in our patients would not be sufficient as the only tool to identify patients with cancer who should receive tromboprophylaxis . The use of both biomarkers and clinical models seems to be the best strategy for this purpose cost effective. Further studies , prospective, randomized , placebo-controlled to find better treatment strategies in cancer patients are needed (AU)
Subject(s)
Humans , Venous Thromboembolism/complications , Neoplasms/complications , Anticoagulants/therapeutic use , Forecasting/methods , Retrospective Studies , Severity of Illness IndexABSTRACT
BACKGROUND AND OBJECTIVE: The predictive Khorana's model was developed to score the thromboembolic disease risk in cancer patients on chemotherapy and to identify which patients would benefit from thromboprophylaxis. We analized the results and applied the predictive Khorana's model in patients with cancer and who were diagnosed with deep vein thrombosis. MATERIAL AND METHODS: Retrospective analysis of prognostic characteristics of Khorana's model in 122 patients based on a prospective analysis. RESULTS: Seventy-nine percent of the total were in the low and intermediate risk category and 21% had high risk according to the Khorana's predictive model. This model had a sensitivity and prognostic precision of 20.8% (95% confidence interval [95% CI]: 14.6-28.7) and a false negatives proportion of 79.2% (95% CI: 1.3-85.4). CONCLUSIONS: Application of this model in our patients would not be enough as the unique tool to identify cancer patients who should receive tromboprophylaxis. The use of both biomarkers and clinical models seems to be the best cost-effective strategy for this purpose. Future, randomized, prospective, placebo-controlled studies are needed for find better treatment strategies in cancer patients.
