Evolución a largo plazo y factores influyentes de los pacientes que ingresan con FANV en los servicios de Medicina Interna de Galicia / Long-term evolution and influential factors of patients admitted with NVAF in the Internal Medicine services of Galicia

Objectives: The objective of this study was to investigate the longterm evolution and influencing factors of patients with non-valvular atrial fibrillation (NVAF) admitted to internal medicine services. Patients and method: This is an observational and retrospective study of the evolution during five years of the patients admitted, between January-2016 and January-2017, with FANV in the Galician Internal Medicine services. For this end, it was quantified the emergency room visits, hospital admissions and survival. The factors with more influence over these variables were studied. Results: It was included 1.342 patients and followed for 5 years. There were 3.691 hospital admissions, and 8.687 visits to the emergency department (ED). They had a survival of 66,6%, with a median survival of 1.034,57 days. The univariate analysis found that age, antithrombotic treatment at discharge and Barthel's index influenced survival, but not sex. However, in the multivariate analysis only Barthel’s index was found to be independent variable that influence survival. Conclusions: Patients with NVAF admitted to internal medicine services constitute a subpopulation at high risk of hospital readmission and visits to the ED. A change in the model of transition to discharge and outpatient follow-up is necessary, through adapted proactive programs, capable of reducing hospital events and improving the quality of life of these patients and their caregivers. (AU)

Objetivos: Estudiar la evolución a lo largo plazo, así como los factores que influyen en la misma, de la población con fibrilación auricular no valvular (FANV) que ingresa en los servicios de Medicina Interna. Pacientes y método: Estudio observacional y retrospectivo de la evolución durante cinco años, de los pacientes ingresados con FANV en los servicios de Medicina Interna gallegos, entre enero-2016 y enero-2017. Para este fin se cuantificaron las visitas a urgencias, los ingresos hospitalarios y la supervivencia. Se estudiaron los factores que más influyeron en estas variables. Resultados: Se incluyeron 1.342 pacientes y se realizó un seguimiento durante 5 años. Se contabilizaron 3.691 ingresos hospitalarios, y 8.687 visitas al servicio de urgencias (SU). Tuvieron una supervivencia del 66,6%, con una mediana de supervivencia de 1.034,57 días. En el análisis univariante, la edad, el tratamiento antitrombótico al alta y el índice de Barthel influyeron en la supervivencia, no así el sexo. En el análisis multivariante, el índice de Barthel fue la única variable independiente que influyó en la supervivencia. Conclusiones: Los pacientes con FANV ingresados en los servicios de Medicina Interna, suponen una subpoblación de alto riesgo de reingreso hospitalario y visitas al SU. Es necesario un cambio en el modelo de transición al alta y de seguimiento ambulatorio, mediante programas proactivos adaptados, capaces de reducir eventos hospitalarios y mejorar la calidad de vida de estos pacientes y sus cuidadores. (AU)

Risk for recurrence of symptomatic upper-extremity deep vein thrombosis in patients without cancer: Analysis of three RIETE cohorts.

BACKGROUND: The natural history of patients with a pacemaker-related upper-extremity deep vein thrombosis (UEDVT) has not been consistently studied. METHODS: We used the RIETE registry data to compare the outcomes during anticoagulation and after its discontinuation in noncancer patients with symptomatic UEDVT associated with a pacemaker, other catheters, or no catheter. The major outcome was the composite of symptomatic pulmonary embolism or recurrent DVT. RESULTS: As of February 2022, 2578 patients with UEDVT were included: 156 had a pacemaker-related UEDVT, 557 had other catheters, and 1865 had no catheter. During anticoagulation, 61 patients (2.3%) developed recurrent VTE, 38 had major bleeding (1.4%), and 90 died (3.4%). After its discontinuation, 52 patients (4.4%) had recurrent acute venous thromboembolism (VTE) and six had major bleeding (0.5%). On multivariable analysis, there were no differences among subgroups in the rates of VTE recurrences or major bleeding during anticoagulation. After its discontinuation, patients with a pacemaker-related UEDVT had a higher risk for VTE recurrences than those with no catheter (adjusted OR: 4.59; 95% CI: 1.98-10.6). CONCLUSIONS: Patients with pacemaker-related UEDVT are at increased risk for VTE recurrences after discontinuing anticoagulation. If our findings are validated in adequately designed trials, this may justify changes in the current recommendations on the duration of anticoagulation.

Filtro de vena cava y embarazo: algunas certezas y muchas incertidumbres / Vena cava filter and pregnancy: some certainties and many doubts

El embarazo constituye un estado protrombótico durante el cual se producen en la mujer cambios anatómicos y fisiológicos que conllevan un incremento en la incidencia de fenómenos tromboembólicos. Así, las mujeres embarazadas tienen un riesgo 5 veces mayor de padecer un evento tromboembólico que las no embarazadas. La enfermedad tromboembólica venosa es una causa importante de morbilidad y mortalidad maternas y la embolia pulmonar es la causa más común de mortalidad materna en los países desarrollados. En el presente trabajo se revisan aspectos como la valoración de riesgo tromboembólico en la mujer embarazada, el diagnóstico, profilaxis y tratamiento, con especial atención al uso del filtro de vena cava en mujeres embarazadas en términos de indicaciones, colocación, efectividad, complicaciones y riesgos tanto para la madre como para el feto. (AU)

Pregnancy constitutes a prothrombotic state during which anatomical and physiological changes occur in women. This situation leads to an increase in the incidence of thromboembolic phenomena. Thus, pregnant women have a 5 times increased risk of suffering a thromboembolic event than non-pregnant women. Venous thromboembolic disease is a major cause of maternal morbidity and mortality, and pulmonary embolism is the most common cause of maternal mortality in developed countries. In the present work, aspects such as the assessment of thromboembolic risk in pregnant women, diagnosis, prophylaxis and treatment are reviewed, focusing on the use of the vena cava filter in pregnant women in terms of indications, placement, effectiveness, complications and risks for both mother and fetus. (AU)

Endocarditis trombótica no bacteriana y adenocarcinoma de endometrio / Non-bacterial thrombotic endocarditis and endometrious adenocarcinoma

Se describe el caso de una mujer de 80 años, con antecedentes de trombosis venosa profunda en tratamiento con apixaban, que presenta clínica focal neurológica. Las pruebas de imagen evidencian múltiples émbolos arteriales en cerebro, riñones y bazo, así como imagen sugestiva de neoplasia uterina. Una biopsia tras histeroscopia, confirma el diagnóstico de adenocarcinoma de endometrio. La ecocardiografía transesofágica constata la existencia de vegetaciones en válvulas cardíacas, siendo los estudios infecciosos negativos. Es diagnosticada de endocarditis trombótica no bacteriana relaciona con una neoplasia. Se cambia apixaban por heparina de bajo peso molecular, confirmando la práctica desaparición delas vegetaciones. (AU)

We present a case of an 80-year-old woman with a history of deep vein thrombosis, treated with apixaban, which has a focal neurological clinic. Imaging tests show multiple arterial ischemic lesions in brain, kidneys and spleen, as well as suggestive imaging of uterine neoplasia. A biopsy after hysteroscopy confirms the diagnosis of endometrial adenocarcinoma. Transesophageal echocardiography shows vegetations in valves, with negative blood cultures. The diagnostic was non-bacterial thrombotic endocarditis related to cancer. The anticoagulant was changed to low molecular weight heparin, confirming the disappearance of vegetations. (AU)

Covid 19 and venous thromboembolic disease. Review on a series of patients

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Cat-scratch disease presenting as parotid gland abscess and aseptic meningitis / Absceso de parótida y meningitis linfocitaria como presentación de enfermedad por arañazo de gato

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IgG4-Related Disease: Results From a Multicenter Spanish Registry.

IgG4-related disease (IgG4-RD) is a rare entity consisting of inflammation and fibrosis that has been described in multiple organs. Concrete diagnostic criteria have been established recently and there is a lack of large series of patients.To describe the clinical presentation, histopathological characteristics, treatment and evolution of a series of IgG4-RD Spanish patients.A retrospective multicenter study was performed. Twelve hospitals across Spain included patients meeting the current 2012 consensus criteria on IgG4-RD diagnosis.Fifty-five patients were included in the study, 38 of whom (69.1%) were male. Median age at diagnosis was 53 years. Thirty (54.5%) patients were included in the Histologically Highly Suggestive IgG4-RD group and 25 (45.5%) in the probable IgG4-RD group. Twenty-six (47.3%) patients had more than 1 organ affected at presentation. The most frequently affected organs were: retroperitoneum, orbital pseudotumor, pancreas, salivary and lachrymal glands, and maxillary sinuses.Corticosteroids were the mainstay of treatment (46 patients, 83.6%). Eighteen patients (32.7%) required additional immunosuppressive agents. Twenty-four (43.6%) patients achieved a complete response and 26 (43.7%) presented a partial response (<50% of regression) after 22 months of follow-up. No deaths were attributed directly to IgG4-RD and malignancy was infrequent.This is the largest IgG4-RD series reported in Europe. Patients were middle-aged males, with histologically probable IgG4-RD. The systemic form of the disease was frequent, involving mainly sites of the head and abdomen. Corticosteroids were an effective first line treatment, sometimes combined with immunosuppressive agents. Neither fatalities nor malignancies were attributed to IgG4-RD.