Real life results of direct-acting oral anticoagulants recommended-dose in obese vs normal-weight patients with venous thromboembolism.

BACKGROUND: There is scarce evidence on the effectiveness and safety of recommended-dose direct acting oral anticoagulants (DOACs) in obese patients with venous thromboembolism (VTE). MATERIAL AND METHODS: We used the data in the RIETE registry to compare the rates of VTE recurrences and major bleeding during long-term therapy with DOACs at recommended doses in patients with body mass index ≥30 kg/m2 (obese) vs. those with BMI 18.5-24.9 kg/m2 (normal weight). We performed regression models with competing risks for death. RESULTS: From January 2013 through October 2022, 2885 obese patients and 2676 with normal weight in RIETE received rivaroxaban (n = 3020), apixaban (n = 1754), edoxaban (n = 636) or dabigatran (n = 151). Median age was 63 years and 52 % were female. At baseline, obese patients were more likely to have diabetes (18.6 % vs. 8.4 %), hypertension (51.9 % vs. 31.4 %) or pulmonary embolism (67.7 % vs. 61 %), and less likely to have renal insufficiency (5.3 % vs. 16 %) or anaemia (21.8 % vs. 28 %%). During anticoagulation (median, 147 vs. 101 days), the obese had a similar rate of VTE recurrences (1.71 vs. 2.14 events per 100 patients-years; hazard ratio (HR): 0.81; 95 % CI: 0.49-1.34) or major bleeding (1.45 vs. 1.76 per 100 patients-years; HR: 0.91; 95 % CI: 0.52-1.59) than those with normal weight. These findings persisted after multivariable analysis (recurrent VTE, HR: 0.80; 95 % CI: 0.48-1.32; major bleeding, HR: 1.11; 95 % CI: 0.60-2.07). CONCLUSION: The use of DOACs at recommended doses in obese patients with VTE was associated with similar rates of VTE recurrences or major bleeding than in patients with normal weight.

[Non-invasive mechanical ventilation in the treatment of acute heart failure]. / Ventilación mecánica no invasiva en el tratamiento de la insuficiencia cardíaca aguda.

When acute heart failure progresses and there is acute cardiogenic pulmonary edema, routine therapeutic measures should be accompanied by other measures that help to correct oxygenation of the patient. The final and most drastic step is mechanical ventilation. Non-invasive ventilation has been developed in the last few years as a method that attempts to improve oxygenation without the need for intubation, thus, in theory, reducing morbidity and mortality in these patients. The present article describes the controversies surrounding the results of this technique and discusses its indications. The article also discusses how to start non-invasive ventilation in patients with acute pulmonary edema from a practical point of view.

Ventilación mecánica no invasiva en el tratamiento de la insuficiencia cardíaca aguda / Non-invasive mechanical ventilation in the treatment of acute heart failure

Cuando la insuficiencia cardíaca aguda progresa y se presenta edema agudo de pulmón, las medidas habituales de tratamiento deben acompañarse de otras que ayuden a la correcta oxigenación del paciente, siendo la ventilación mecánica el último y más drástico paso. La ventilación mecánica no invasiva surge en los últimos años como un método que trata de mejorar la oxigenación evitando la intubación y consiguiendo, con ello, teóricamente, mejores resultados en la morbimortalidad de estos pacientes. A lo largo del presente capítulo presentaremos las controversias sobre sus resultados, plantearemos sus indicaciones y enfocaremos, de un modo práctico, la manera de instaurar un tratamiento con ventilación no invasiva en pacientes con edema agudo de pulmón (AU)

When acute heart failure progresses and there is acute cardiogenic pulmonary edema, routine therapeutic measures should be accompanied by other measures that help to correct oxygenation of the patient. The final and most drastic step is mechanical ventilation. Non-invasive ventilation has been developed in the last few years as a method that attempts to improve oxygenation without the need for intubation, thus, in theory, reducing morbidity and mortality in these patients. The present article describes the controversies surrounding the results of this technique and discusses its indications. The article also discusses how to start non-invasive ventilation in patients with acute pulmonary edema from a practical point of view (AU)

Descripción y resultados de una unidad de corta estancia con un modelo de gestion clínica abierta / No disponible

Objetivos: Valorar la utilidad de una unidad de corta estancia (UCE) gestionada como unidad abierta, inicialmente de servicios médicos, con un responsable de sala adscrito a medicina interna. Material y métodos: Describimos y reflejamos los pasos de instauración de la unidad, y el estudio prospectivo y descriptivo de los resultados de los primeros 6 meses de funcionamiento Resultados: En los 6 meses de funcionamiento, la unidad ha conseguido disminuir la estancia media (EM) global del servicio en 2 días respecto al año previo (p < 0,001), así como en las distintas especialidades, sin aumentar los reingresos. Conclusiones: Las UCE con una organización abierta permiten disminuir la EM de los servicios que participan, a la vez que se implica a un mayor número de profesionales en la gestión clínica, sin necesidad de cambios estructurales ni aumento del consumo de recursos

Objectives: To analyze the usefulness of a short-stay unit, managed as an open unit (in which several services converge and share facilities and nursing staff but each service maintains its own hierarchy), initially consisting of medical services, with an internist in charge of the ward. Material and methods: We describe the steps required for the development of the unit and perform a descriptive and prospective study of the results of the first 6 months of its existence. Results: During the first 6 months of activity, the unit reduced the overall mean length of stay by 2 days compared with that in the previous year (p < 0.001), as well as the mean length of stay in all the distinct medical services without increasing hospital readmissions. Conclusions: Open short-stay units can reduce the mean length of stay of the services that manage them, with more professionals taking part in clinical management. These units do not involve structural changes or increased expenditure