Resultados del programa de cribado de enfermedad de Fabry en pacientes con córnea verticillata en el Hospital Universitario de Navarra / Results of the screening program for Fabry disease in patients with cornea verticillata at the University Hospital of Navarre

Introducción La cornea verticillata (CV) o queratopatía vortex se caracteriza por la presencia de depósitos en forma de espiral en el epitelio corneal. Las causas más frecuentes son los fármacos antipalúdicos y la amiodarona, y dentro de las causas sistémicas la enfermedad de Fabry (EF). Material y métodos Se realiza un estudio descriptivo prospectivo multidisciplinar en un centro de tercer nivel y de referencia en la Comunidad Foral de Navarra, tras la implementación de un programa de despistaje de la EF en los pacientes atendidos en consultas del servicio de oftalmología que eran diagnosticados de CV y posteriormente fueron remitidos a la consulta de enfermedades minoritarias del servicio de Medicina Interna del Hospital Universitario de Navarra para la realización del estudio de la EF. Resultados Dos mujeres y 4 varones, con una edad media de 76,8 años, se diagnosticaron de CV, de un total de 17.280 pacientes valorados en consultas externas por 3 especialistas de oftalmología durante el periodo de abril de 2018 a abril de 2020. Una paciente falleció antes de realizar el estudio de despistaje y en ningún paciente se diagnosticó la EF. Conclusiones A pesar de que el programa de despistaje de la EF en pacientes con CV en el Hospital Universitario de Navarra no confirmó ningún caso con EF, los especialistas en oftalmología deben tener en cuenta el posible diagnóstico de la EF en aquellos pacientes con CV en sus consultas rutinarias (AU)

Introduction Cornea verticillata (CV) or vortex keratopathy is characterized by the presence of spiral-shaped deposits in the corneal epithelium. The most frequent causes are antimalarial drugs and amiodarone and, among systemic causes, Fabry disease (FD). Material and methods A multidisciplinary, prospective, descriptive study was conducted in a tertiary reference center in Spain's Autonomous Community of Navarre after the implementation of a FD screening program for patients attended to in the Ophthalmology Department. The study analyzed those diagnosed with CV, who were subsequently referred to the rare disease clinic of the University Hospital of Navarre's Internal Medicine Department for an FD study. Results Two women and four men with a mean age of 76.8 years were diagnosed with CV out of a total of 17,280 patients evaluated in outpatient consultations by three ophthalmology specialists during the period from April 2018 to April 2020. One patient died before performing the screening study and no patients were diagnosed with FD. Conclusions Despite the fact that the University Hospital of Navarre's FD screening program for patients with CV did not confirm any cases of FD, ophthalmology specialists should consider the possible diagnosis of FD in patients with CV in their routine consultations (AU)

Results of the screening program for Fabry disease in patients with cornea verticillata at the University Hospital of Navarre.

INTRODUCTION: Cornea verticillata (CV) or vortex keratopathy is characterized by the presence of spiral-shaped deposits in the corneal epithelium. The most frequent causes are antimalarial drugs and amiodarone and, among systemic causes, Fabry disease (FD). MATERIAL AND METHODS: A multidisciplinary, prospective, descriptive study was conducted in a tertiary reference center in Spain's Autonomous Community of Navarre after the implementation of a FD screening program for patients attended to in the Ophthalmology Department. The study analyzed those diagnosed with CV, who were subsequently referred to the rare disease clinic of the University Hospital of Navarre's Internal Medicine Department for an FD study. RESULTS: Two women and four men with a mean age of 76.8 years were diagnosed with CV out of a total of 17,280 patients evaluated in outpatient consultations by three ophthalmology specialists during the period from April 2018 to April 2020. One patient died before performing the screening study and no patients were diagnosed with FD. CONCLUSIONS: Despite the fact that the University Hospital of Navarre's FD screening program for patients with CV did not confirm any cases of FD, ophthalmology specialists should consider the possible diagnosis of FD in patients with CV in their routine consultations.

Sintomatología muscular asociada a estatinas: ¿mito o realidad? / Statin-associated muscle symptoms: Myth or reality?

La sintomatología muscular asociada con estatinas es una entidad que engloba una constelación de diversas manifestaciones clínicas de distinta gravedad. Desde la introducción de las primeras estatinas se han publicado numerosos estudios acerca de su incidencia, fisiopatología, diagnóstico y tratamiento; sin embargo, a día de hoy estos aspectos siguen generando controversia. Con el aumento progresivo del uso de estatinas en la población general se han multiplicado las notificaciones de reacciones adversas relacionadas con su uso, particularmente las relacionadas con la toxicidad muscular. No obstante, las diferencias existentes entre los estudios publicados tanto en metodología como en resultados obtenidos hacen de esta relación un tema complejo y de gran interés para el clínico y los pacientes. La integración de la evidencia de la que disponemos actualmente puede ayudarnos a comprender mejor esta entidad y facilitar su manejo en la práctica clínica (AU)

Statin-associated muscle symptoms is an entity that encompasses a constellation of various clinical manifestations of variyng severity. Since the introduction of the first statins, numerous studies have been published regarding its incidence, pathophysiology, diagnosis and treatment; however, to this day these aspects are still controversial. With the progressive increase in the use of statins in the general population, notifications of adverse reactions related to its use have multiplied, particularly those related to muscular toxicity. Nevertheless, the differences between the published studies, both in methodology and in the results obtained, make this relationship a complex issue of great interest for clinicians and patients. The integration of the evidence that we currently have can help us understand better this entity and facilitate its management in clinical practice (AU)

Statin-associated muscle symptoms: Myth or reality?

Statin-associated muscle symptoms is an entity that encompasses a constellation of various clinical manifestations of variyng severity. Since the introduction of the first statins, numerous studies have been published regarding its incidence, pathophysiology, diagnosis and treatment; however, to this day these aspects are still controversial. With the progressive increase in the use of statins in the general population, notifications of adverse reactions related to its use have multiplied, particularly those related to muscular toxicity. Nevertheless, the differences between the published studies, both in methodology and in the results obtained, make this relationship a complex issue of great interest for clinicians and patients. The integration of the evidence that we currently have can help us understand better this entity and facilitate its management in clinical practice.

Utility of Doppler ultrasound for the study of ocular vascular disease.

Ocular vascular problems represent an emerging pathology within the activity of the internist. Ocular ultrasound is a widely used technique to evaluate a variety of eye conditions. Specifically, Doppler ultrasound of the ophthalmic vessels has become a very useful tool in diagnosing various eye diseases. Doppler ultrasound allows for examining blood flow in the eye even in the presence of eye opacities that impede viewing the posterior segment of the eye. In this review, we describe the principles and techniques of an ocular vascular Doppler ultrasound examination in clinical practice and provide a general approach to the ultrasound characteristics of the most important vascular eye disorders for internists. These include central retinal artery and vein occlusions, chronic retinal ischemic syndrome, anterior optic ischemic neuropathy, and diabetic retinopathy.

Acute stroke care during the COVID-19 pandemic. Ictus Madrid Program recommendations. / Atención al ictus agudo durante la pandemia por COVID-19. Recomendaciones Plan Ictus Madrid.

INTRODUCTION: The COVID-19 pandemic has resulted in complete saturation of healthcare capacities, making it necessary to reorganise healthcare systems. In this context, we must guarantee the provision of acute stroke care and optimise code stroke protocols to reduce the risk of SARS-CoV-2 infection and rationalise the use of hospital resources. The Madrid Stroke multidisciplinary group presents a series of recommendations to achieve these goals. METHODS: We conducted a non-systematic literature search using the keywords "stroke" and "COVID-19" or "coronavirus" or "SARS-CoV-2." Our literature review also included other relevant studies known to the authors. Based on this literature review, a series of consensus recommendations were established by the Madrid Stroke multidisciplinary group and its neurology committee. RESULTS: These recommendations address 5 main objectives: 1) coordination of action protocols to ensure access to hospital care for stroke patients; 2) recognition of potentially COVID-19-positive stroke patients; 3) organisation of patient management to prevent SARS-CoV-2 infection among healthcare professionals; 4) avoidance of unnecessary neuroimaging studies and other procedures that may increase the risk of infection; and 5) safe, early discharge and follow-up to ensure bed availability. This management protocol has been called CORONA (Coordinate, Recognise, Organise, Neuroimaging, At home). CONCLUSIONS: The recommendations presented here may assist in the organisation of acute stroke care and the optimisation of healthcare resources, while ensuring the safety of healthcare professionals.

Frecuencia y características del dolor de rodilla en deportistas de élite de atletismo: estudio transversal / Frequency and characterization of knee pain in elite athletics: A cross-sectional study

OBJETIVOS: Conocer la frecuencia del dolor de rodilla en deportistas del atletismo de élite y qué modalidad es la más prevalente, explorar la relación del dolor con factores antropométricos y deportivos y las principales características de dicho dolor. Métodos: Se realizó un estudio transversal sobre el dolor de rodilla en el Centro de Alto Rendimiento de Madrid en enero de 2019. Para ello se elaboró un cuestionario autocumplimentable que rellenaron 118 atletas de élite. Los datos se analizaron con el programa IBM SPSS® Statistics V.23.0. RESULTADOS: El 21,2% de la muestra presentó dolor de rodilla en el momento del estudio. La prevalencia fue mayor en mujeres (23,3%) y en aquellos atletas que realizaban carrera de velocidad (24,4%) y saltos (29,6%). El 82,9% de los participantes indicó haber padecido dolor de rodilla en algún momento de su carrera deportiva. No se encontraron relaciones estadísticamente significativas con las variables analizadas. Las características de dolor más frecuentes fueron las de tipo nociceptivo. CONCLUSIONES: El dolor de rodilla es un problema frecuente en la población de atletismo de élite. Las características generales de este dolor son la unilateralidad, hinchazón, sensación de extensión del dolor hacia algún lugar del miembro inferior y la reagudización con el movimiento. Son necesarios estudios con una muestra mayor para contrastar estos resultados

OBJECTIVES: The purpose of this study is to determinate the frequency of knee pain in elite athletics, its relationship with anthropometric and sport factors and its main characteristics. METHODS: A cross-sectional study was performed in January 2019 in the High-Performance Centre of Madrid. A self-fulfilling questionnaire was prepared, filled in by 118 elite athletics. The data was analysed with the IBM SPSS® Statistics V.23.0 programme. RESULTS: 21.2% of the sample reported knee pain, particularly in females (23.3%), sprinters (24.4%) and jumpers (29.6%). Of the participants, 82.9% indicated that they had suffered knee pain at some point during their sports career. A statistically significant relationship was not shown with the variables analysed. The most common pain characteristics were the nociceptive type. CONCLUSIONS: Knee pain is a common problem in elite athletics. The main characteristics of this pain are one-sidedness, swelling and pain that spreads and increases with movement. Studies with a larger sample are required to contrast these results

Consensus document for the training of residents in cardiovascular risk. / Documento de consenso para la formación de residentes en riesgo vascular.

Vascular disease is currently a major health problem, not only for its high prevalence but also for the considerable morbidity, mortality and disability that it entails. Medical internists play a central role in diagnosing and treating vascular disease and controlling the cardiovascular risk factors (CRFs) that cause it. In fact, the clinical care of patients in cardiovascular risk units is a specific characteristic of an internist's field of action. This article contains the consensus document for the training of residents in CRFs. This proposal by the Cardiovascular Risk Workgroup of the Spanish Society of Internal Medicine emerged as a response by our Society to the specific need for training in CRFs. Implementing this proposal would provide an important benefit, not only for medical internists in training but also for society as a whole.

Factores predictivos de la mortalidad al año en pacientes mayores de 80 años intervenidos de fractura del cuello femoral / Factors predicting one-year mortality of patients over 80 years operated after femoral neck fracture

Introducción: En la población española los estudios previos relacionados con la mortalidad tras fractura de cadera están basados en pacientes con edades entre 60 a 102años y no estratificaban los pacientes de acuerdo con el tipo de fractura. El objetivo de este estudio fue identificar los factores con influencia sobre la mortalidad al año postoperatorio en pacientes de 80años o más que sufrieron una fractura cervical de cadera. Material y método: Estudio retrospectivo de casos y controles. Fueron incluidos los pacientes consecutivos intervenidos entre 2015 y 2016. Se estudiaron las características basales, los antecedentes y la medicación previa, los parámetros analíticos, el índice de Charlson, la escala ASA, el índice de Barthel y el cuestionario Pfeiffer. Se registraron los datos quirúrgicos y las complicaciones durante el seguimiento. La supervivencia se evaluó mediante el método de Kaplan-Meier y las variables que la afectaban mediante la regresión de Cox. Resultados: La mortalidad al año postoperatorio fue del 21,1% y la supervivencia media de 10,3meses (IC95%: 9,7-10,9). La regresión de Cox mostraba que la edad >87años, la puntuación de Barthel ≤85 y la combinación de anticoagulantes con INR ≥1,5 eran predictores significativos de mortalidad durante el primer año de seguimiento. Conclusión: Los factores predictores de mortalidad durante el primer año postoperatorio por fractura cervical de cadera en pacientes octogenarios o mayores fueron la edad >87años, la dependencia física medida a través de una puntuación en el índice de Barthel ≤85 y el uso de anticoagulantes con un INR ≥1,5 al ingreso

Introduction: In the Spanish population, previous studies related to mortality after hip fracture are based on patients aged 60 to 102years and did not stratify patients according to the type of fracture. The objective of this study was to identify the factors with influence on mortality at one postoperative year in patients aged 80years or older after a femoral neck fracture. Material and method: Retrospective study of cases and controls. Consecutive patients operated between 2015 and 2016 were included. Baseline characteristics, medical history and previous medication, analytical parameters, Charlson index, ASA scale, Barthel index and Pfeiffer questionnaire were studied. Surgical data and complications were recorded during follow-up. Survival was assessed by the Kaplan-Meier method and the variables that affected it by Cox regression. Results: Mortality one year postoperatively was 21.1% and mean survival 10.3months (95%CI: 9.7-10.9). The Cox regression showed that age >87years, Barthel score ≤85 and the combination of anticoagulants with INR ≥1.5 were significant predictors of mortality during the first year of follow-up. Conclusion: The predictors of mortality during the first postoperative year after femoral neck fracture in octogenarian or older patients were: age>87years, physical dependence measured by a Barthel index score ≤85, and the use of anticoagulants with a INR ≥1.5 at admission

Factors predicting one-year mortality of patients over 80 years operated after femoral neck fracture. / Factores predictivos de la mortalidad al año en pacientes mayores de 80 años intervenidos de fractura del cuello femoral.

INTRODUCTION: In the Spanish population, previous studies related to mortality after hip fracture are based on patients aged 60 to 102years and did not stratify patients according to the type of fracture. The objective of this study was to identify the factors with influence on mortality at one postoperative year in patients aged 80years or older after a femoral neck fracture. MATERIAL AND METHOD: Retrospective study of cases and controls. Consecutive patients operated between 2015 and 2016 were included. Baseline characteristics, medical history and previous medication, analytical parameters, Charlson index, ASA scale, Barthel index and Pfeiffer questionnaire were studied. Surgical data and complications were recorded during follow-up. Survival was assessed by the Kaplan-Meier method and the variables that affected it by Cox regression. RESULTS: Mortality one year postoperatively was 21.1% and mean survival 10.3months (95%CI: 9.7-10.9). The Cox regression showed that age >87years, Barthel score ≤85 and the combination of anticoagulants with INR ≥1.5 were significant predictors of mortality during the first year of follow-up. CONCLUSION: The predictors of mortality during the first postoperative year after femoral neck fracture in octogenarian or older patients were: age>87years, physical dependence measured by a Barthel index score ≤85, and the use of anticoagulants with a INR ≥1.5 at admission.

La socialización de los profesionales sanitarios y el papel de la resiliencia en el desarrollo de conductas de bienestar en el trabajo / Health personnel socialization and the role of resilience in the development of occupational well-being

Introducción. La socialización durante la formación de especialistas es una etapa clave en el posterior ajuste y bienestar laboral de los sanitarios en la organización hospitalaria. Objetivo. Analizar la relación de la socialización y la resiliencia con las respuestas de engagement en especialistas en formación. Método. Se llevó a cabo un muestreo de conveniencia, participando en el estudio 110 profesionales provenientes de 6 unidades docentes de diferentes hospitales. Se llevaron a cabo análisis descriptivos y mediacionales de las variables de estudio mediante SPSS 21 y Macro de Preacher y Hayes (2004). Resultados. Se muestran relaciones estadísticamente significativas entre socialización, resiliencia y engagement. También se muestra el papel mediador de la resiliencia (β=0,10; se=0,12; p<0,05; IC: [0,02-0,23]) para generar engagement en los profesionales sanitarios. Conclusiones. Se observa una interacción entre socialización y especialidad que modera la resiliencia. Así, se señalan cómo una socialización positiva y la resiliencia pueden promover un buen desempeño (AU)

Introduction. Socialization during the training of specialists is a key step in the subsequent adjustment and occupational well-being of health professionals in the hospital organisation. Objective. To analyse the relationship of socialization and resilience with the engagement responses of specialists in training. Method. Convenience sampling was used, with 110 professionals from six teaching units of different hospitals participating in the study. Descriptive and mediational analysis of the study variables were performed using SPSS 21 and Macro Preacher and Hayes (2004). Results. The results show statistically significant relationships between socialization, resilience, and engagement. The mediating role of resilience is also shown (β=0.10; se=0.12; p<0.05, 95% CI: [0.02-0.23]) to generate engagement in health professionals. Conclusions. An interaction effect is observed between socialization, and specialty moderates resilience. Therefore it can be seen that positive socialization and resilience can promote good performance (AU)

[Health personnel socialization and the role of resilience in the development of occupational well-being]. / La socialización de los profesionales sanitarios y el papel de la resiliencia en el desarrollo de conductas de bienestar en el trabajo.

INTRODUCTION: Socialization during the training of specialists is a key step in the subsequent adjustment and occupational well-being of health professionals in the hospital organisation. OBJECTIVE: To analyse the relationship of socialization and resilience with the engagement responses of specialists in training. METHOD: Convenience sampling was used, with 110 professionals from six teaching units of different hospitals participating in the study. Descriptive and mediational analysis of the study variables were performed using SPSS 21 and Macro Preacher and Hayes (2004). RESULTS: The results show statistically significant relationships between socialization, resilience, and engagement. The mediating role of resilience is also shown (ß=0.10; se=0.12; p<0.05, 95% CI: [0.02-0.23]) to generate engagement in health professionals. CONCLUSIONS: An interaction effect is observed between socialization, and specialty moderates resilience. Therefore it can be seen that positive socialization and resilience can promote good performance.

Prevalencia del dolor de hombro en nadadores de competición: estudio piloto / Shoulder pain prevalence in competitive swimmers: a pilot study

Objetivos: conocer la prevalencia de dolor de hombro en nadadores de competición, sus características y su relación con factores antropométricos y deportivos. Métodos: estudio de prevalencia. Ciento cuarenta nadadores/as entre 12 y 24 años cumplimentaron un cuestionario durante una fase de entrenamiento específico. Resultados: el 25,7% revelaron padecer dolor de hombro. Se hallaron relaciones estadísticamente significativas entre el dolor de hombro y episodios previos de dolor (p<0,001), experiencia superior a tres años (p=0,014), Índice de Masa Corporal (p=0,015) y la especialidad estilo (p=0,008) y distancia (p=0,011). El dolor fue significativamente más intenso durante la actividad que en reposo (p<0,001).Conclusiones: el dolor de hombro en nadadores de competición entre 12 y 24 años parece ser un problema frecuente y repetitivo, que aumenta con la experiencia y que se asocia a la actividad, a un mayor Índice de Masa Corporal y a la especialidad del nadador (AU)

Objectives: to investigate the prevalence of shoulder pain in competitive swimmers and find out the characteristics of pain as well as its relation to anthropometric and sports factors.Methods: prevalence study. A hundred and forty competitive swimmers between 12 and 24 years old completed a questionnaire in a high intensity training phase. Results: 25.7% swimmers reported shoulder pain. There were significant statistical correlations between shoulder pain and previous episodes of pain (p<0.001), more than three years of experience (p=0.014), Body Mass Index (p=0.015) and stroke (p=0.008) and distance (p=0.011) specialty. Pain was statistically correlated with activity (p<0.001). Conclusions: shoulder pain seems to be a frequent and repetitive problem in competitive swimmers between 12 and 24 years old, which increases with years of practice. Furthermore, it seems to be associated with the activity, a higher Body Mass Index and the swimmers’ specialty (AU)

Comparative studies on the inhibitory activities of selected benzoic acid derivatives against secretory phospholipase A2, a key enzyme involved in the inflammatory pathway.

Inflammation is considered to be a key factor in major diseases like cancer, Alzheimer's disease, Parkinson's disease, etc. For the past few decades, pharmaceutical companies have explored new effective medications against inflammation. As a part of their detailed studies, many drug targets and drugs have been introduced against inflammation. In the present study, the inhibiting capacities of selected benzoic acid derivatives like gallic acid, vannilic acid, syringic acid and protocatechuic acid against secretory phospholipase A2 (sPLA2), a major enzyme involved in the inflammatory pathway, have been investigated. The detailed in vitro, biophysical and in silico studies carried out on these benzoic acid derivatives revealed that all the selected compounds have a uniform mode of binding in the active site of sPLA2 and are inhibitory in micromolar concentrations. The study also focuses on the non-selective inhibitory activity of an NSAID, aspirin, against sPLA2.

Presencia de puntos gatillo miofasciales y discinesia escapular en nadadores de competición con y sin dolor de hombro: estudio piloto transversal / Presence of myofascial trigger points and scapular dyskinesis in competitive swimmers with and without shoulder pain: a cross-sectional pilot study

Objetivos: Valorar, en nadadores de competición con y sin dolor de hombro, tanto la presencia de discinesia escapular como la de puntos gatillo miofasciales, activos y latentes, en 19 músculos en los que su presencia puede generar dolor de hombro o discinesia escapular. Material y métodos: Quince nadadores varones de competición (5 con dolor de hombro y 10 sin dolor) participaron en un estudio transversal en el que se valoró la presencia de discinesia escapular mediante el Scapular Dyskinesis Test y de puntos gatillo miofasciales activos y latentes en músculos de la cintura escapular y del miembro superior según los criterios diagnósticos de Simons, Travell & Simons. Resultados: Dos nadadores con dolor de hombro y 3 sin dolor mostraron discinesia escapular obvia. Treinta y seis de los 95 músculos explorados en los nadadores con dolor mostraron puntos gatillo miofasciales activos, más frecuentemente en los músculos subescapular (4/5), pectoral mayor, redondo mayor, redondo menor, cabeza larga del tríceps braquial y trapecio superior (3/5). Cincuenta y uno de los 190 músculos explorados en nadadores sin dolor mostraron puntos gatillo miofasciales latentes, más frecuentemente en los músculos trapecio superior, pectoral mayor, infraespinoso y redondo mayor. Conclusiones: La discinesia escapular está presente en nadadores con dolor de hombro y en nadadores sin dolor. En los nadadores con dolor existe una elevada frecuencia de puntos gatillo miofasciales activos, principalmente en músculos implicados en la fase propulsiva de la brazada

Objectives: To assess the presence of scapular dyskinesis and that of active and latent myofascial trigger points in 19 muscles that can lead to shoulder pain or scapular dyskinesis in competitive swimmers with and without shoulder pain. Material and methods: Fifteen male competitive swimmers (5 with pain and 10 without pain) participated in a cross-sectional study in which scapular dyskinesis was measured by Scapular Dyskinesis Test. Muscles of shoulder girdle and upper extremity were explored to detect active and latent myofascial trigger points following the Simons, Travell & Simons diagnostic criteria. Results: Two swimmers with shoulder pain and 3 swimmers without shoulder pain showed obvious scapular dyskinesis. Active myofascial trigger points were found in 36 out of the 95 muscles explored in swimmers with shoulder pain, more frequently in the following muscles: subscapularis (4/5), pectoralis major, teres major, teres minor, long head of triceps brachialis and upper trapezius (3/5). A total of 51 out of 190 muscles explored in swimmers without shoulder pain showed latent myofascial trigger points, more frequently in upper trapezius, pectoralis major, infraspinatus, and teres major. Conclusions: Scapular dyskinesis is present in swimmers with and without shoulder pain. Active myofascial trigger points are frequently present in swimmers with shoulder pain, mainly in muscles involved in propulsive phase of the stroke

Análisis coste-efectividad de apixaban frente a dabigatrán en la prevención de la tromboembolia venosa en pacientes intervenidos de artroplastia total de rodilla o de cadera / Cost-effectiveness analysis of apixaban compared to dabigatran in the prevention of venous thromboembolism in patients subjected to total knee or hip replacement

Objetivo. Análisis de coste-efectividad de apixaban frente a dabigatrán en la prevención de la tromboembolia venosa (TEV) en la artroplastia total de rodilla (ATR) o cadera (ATC). Métodos. Modelo con 2 periodos: posprevención de 90 días (corto plazo) y a 5 años (Markov). Se incluyeron las complicaciones de la TEV (trombosis venosa profunda distal y proximal, embolia pulmonar, sangrados y síndrome postrombótico). La eficacia comparada se obtuvo de un metaanálisis y los costes de fuentes españolas. Se aplicó una tasa de descuento del 3,5% anual para costes y beneficios. Resultados. Según el metaanálisis, el riesgo relativo (RR) de TEV o muerte, frente a enoxaparina, fue menor con apixaban que con dabigatrán en ATR (RR: 0,89; IC 95% 0,32-1,65 y RR: 1,35, IC 95% 0,19-3,39) y en ATC (RR: 0,35, IC 95% 0,05-2,51 y RR: 0,89, IC 95% 0,22-3,21, respectivamente). A corto plazo, con apixaban se obtendrían más años de vida (AVG) y más años de vida ajustados por calidad (AVAC) por paciente, tanto en ATR (0,2037; 0,1908) como en ATC (0,2417; 0,1921) que con dabigatrán (0,1818; 0,1901, y 0,2345; 0,1918, respectivamente). Habría menos costes por paciente con apixaban en ATR (-14 €) por lo que este sería el tratamiento dominante. En ATC se producirían costes adicionales (15 €) con un coste por AVG de 2.083 y de 50.000 € por AVAC ganado. A 5 años, apixaban fue más barato y más efectivo en ATR y en ATC. Conclusiones. Según el presente estudio, apixaban es un tratamiento coste-efectivo en comparación con dabigatrán en la prevención de la TEV (AU)

Objective. Cost-effectiveness analysis of apixaban vs. dabigatran in preventing venous thromboembolism (VTE) in total knee (TKR) or hip (THR) replacement. Methods. Model with two periods: post-prophylaxis period of 90 days (short term) and 5 years (Markov). VTE complications (distal and proximal deep vein thrombosis, pulmonary embolism, bleeding and post-thrombotic syndrome) were included. The comparative efficacy was obtained from a meta-analysis, and the costs from Spanish sources. An annual discount rate of 3.5% for costs and benefits was applied. Results. According to the meta-analysis, the relative risk (RR) of VTE or death, compared with enoxaparin, was lower with apixaban than with dabigatran in TKR (RR 0.89, 95% CI 0.32 to 1.65 and RR 1.35, 95% CI, 0.19 to 3.39) and THR (RR 0.35, 95% CI, 0.05 to 2.51 and RR 0.89, 95% CI 0.22 to 3.21, respectively). In the short term, there were more life years (LYG) and more quality-adjusted life years (QALY) per patient in TKR (0.2037; 0.1908) and THR (0.2417; 0.1921) with apixaban than with dabigatran (0.1818; 0.1901 and 0.2345; 0.1918, respectively) were obtained. With apixaban lower costs per patient in TKR (-14 €) were generated, so it was the dominant treatment. Additional costs (15 €) could be incurred in THR, with a cost per LYG of 2,083 € and 50,000 € per QALY gained. In 5 years, apixaban was cheaper and more effective in both TKR and THR. Conclusions. According to this study, apixaban was shown to be a cost-effective treatment compared with dabigatran for VTE prevention (AU)

[Cost-effectiveness analysis of apixaban compared to dabigatran in the prevention of venous thromboembolism in patients subjected to total knee or hip replacement]. / Análisis coste-efectividad de apixaban frente a dabigatrán en la prevención de la tromboembolia venosa en pacientes intervenidos de artroplastia total de rodilla o de cadera.

OBJECTIVE: Cost-effectiveness analysis of apixaban vs. dabigatran in preventing venous thromboembolism (VTE) in total knee (TKR) or hip (THR) replacement. METHODS: Model with two periods: post-prophylaxis period of 90 days (short term) and 5 years (Markov). VTE complications (distal and proximal deep vein thrombosis, pulmonary embolism, bleeding and post-thrombotic syndrome) were included. The comparative efficacy was obtained from a meta-analysis, and the costs from Spanish sources. An annual discount rate of 3.5% for costs and benefits was applied. RESULTS: According to the meta-analysis, the relative risk (RR) of VTE or death, compared with enoxaparin, was lower with apixaban than with dabigatran in TKR (RR 0.89, 95% CI 0.32 to 1.65 and RR 1.35, 95% CI, 0.19 to 3.39) and THR (RR 0.35, 95% CI, 0.05 to 2.51 and RR 0.89, 95% CI 0.22 to 3.21, respectively). In the short term, there were more life years (LYG) and more quality-adjusted life years (QALY) per patient in TKR (0.2037; 0.1908) and THR (0.2417; 0.1921) with apixaban than with dabigatran (0.1818; 0.1901 and 0.2345; 0.1918, respectively) were obtained. With apixaban lower costs per patient in TKR (-14 €) were generated, so it was the dominant treatment. Additional costs (15 €) could be incurred in THR, with a cost per LYG of 2,083 € and 50,000 € per QALY gained. In 5 years, apixaban was cheaper and more effective in both TKR and THR. CONCLUSIONS: According to this study, apixaban was shown to be a cost-effective treatment compared with dabigatran for VTE prevention.