RESUMEN
BACKGROUND: No prior studies have identified which patients with deep vein thrombosis in the lower limbs are at a low risk for adverse events within the first week of therapy. METHODS: We used data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) to identify patients at low risk for the composite outcome of pulmonary embolism, major bleeding, or death within the first week. We built a prognostic score and compared it with the decision to treat patients at home. RESULTS: As of December 2013, 15,280 outpatients with deep vein thrombosis had been enrolled. Overall, 5164 patients (34%) were treated at home. Of these, 12 (0.23%) had pulmonary embolism, 8 (0.15%) bled, and 4 (0.08%) died. On multivariable analysis, chronic heart failure, recent immobility, recent bleeding, cancer, renal insufficiency, and abnormal platelet count independently predicted the risk for the composite outcome. Among 11,430 patients (75%) considered to be at low risk, 15 (0.13%) suffered pulmonary embolism, 22 (0.19%) bled, and 8 (0.07%) died. The C-statistic was 0.61 (95% confidence interval [CI], 0.57-0.65) for the decision to treat patients at home and 0.76 (95% CI, 0.72-0.79) for the score (P = .003). Net reclassification improvement was 41% (P < .001). Integrated discrimination improvement was 0.034 for the score and 0.015 for the clinical decision (P < .001). CONCLUSIONS: Using 6 easily available variables, we identified outpatients with deep vein thrombosis at low risk for adverse events within the first week. These data may help to safely treat more patients at home. This score, however, should be validated.
Asunto(s)
Atención Ambulatoria/normas , Anticoagulantes/uso terapéutico , Trombosis de la Vena/terapia , Adulto , Anciano , Anciano de 80 o más Años , Atención Ambulatoria/estadística & datos numéricos , Femenino , Humanos , Extremidad Inferior/irrigación sanguínea , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios/estadística & datos numéricos , Pronóstico , Medición de Riesgo/métodos , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnósticoRESUMEN
Presentamos un caso de enfermedad ateroembólica por cristales de colesterol que fue tratado con prostaglandinas durante 90 días consiguiendo un resultado favorable. Indicamos el planteamiento diagnóstico y terapéutico en esta difícil patología
This paper reports on a case of cholesterol crystal embolization treated with prostaglandins over a 90-day period with a favourable outcome. The diagnostic and therapeutic approach to this complex pathology is discussed
Asunto(s)
Masculino , Persona de Mediana Edad , Humanos , Alprostadil/uso terapéutico , Prostaglandinas E/uso terapéutico , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/tratamiento farmacológico , Ticlopidina/uso terapéutico , Isquemia/diagnóstico , Vasculitis/complicaciones , Vasculitis/diagnóstico , Embolia por Colesterol/diagnóstico , Embolia por Colesterol/tratamiento farmacológico , Vasodilatadores/uso terapéutico , Diagnóstico Diferencial , Vasculitis/epidemiología , Vasculitis/terapia , Anticolesterolemiantes/uso terapéuticoRESUMEN
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