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1.
Int J Cardiol ; 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31954590

RESUMO

BACKGROUND: Limited data exist about the clinical presentation and outcomes of patients with inferior vena cava agenesis (IVCA) who develop deep vein thrombosis (DVT). METHODS: We used the RIETE (Registro Informatizado Enfermedad Trombo Embólica) registry to compare clinical characteristics and outcomes of patients with lower limb DVT, according to the presence or absence of IVCA. Major outcomes included recurrent DVT, major bleeding and post-thrombotic syndrome (PTS). RESULTS: Among 50,744 patients with lower-limb DVT recruited in October 2018, 31 (0.06%) had IVCA. On multivariable analysis, patients aged < 30 years (odds ratio [OR]: 17.9; 95%CI: 7.05-45.3), with unprovoked DVT (OR: 2.49; 95%CI: 1.17-5.29), proximal (OR: 2.81; 95%CI: 1.05-7.53) or bilateral DVT (OR: 11.5; 95%CI: 4.75-27.8) were at increased risk to have IVCA. Patients with DVT and IVCA had lower odds to present with coexisting PE (OR: 0.22; 95%CI: 0.07-0.73). During the first year of follow-up, the rates of DVT recurrences (hazard ratio [HR]: 1.30; 95%CI: 0.07-6.43), pulmonary embolism (HR: 2.30; 95%CI: 0.11-11.4) or major bleeding (HR: 1.32; 95%CI: 0.07-6.50) were not significantly different with those with versus those without IVCA. One year after the index DVT, IVCA patients had a higher rate of skin induration (OR: 3.70; 95%CI: 1.30-9.52), collateral vein circulation (OR: 3.57; 95%CI: 1.42-8.79) or venous ulcer (OR: 5.87; 95%CI: 1.36-1.87) in the lower limb than those without IVCA. CONCLUSIONS: Certain clinical features such as unprovoked and bilateral proximal DVT in young patients should raise the suspicion for IVCA. Patients with IVCA had higher odds for symptoms of post-thrombotic syndrome.

2.
Semin Thromb Hemost ; 44(4): 341-347, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29329472

RESUMO

Small studies have suggested differences in demographics and outcomes between left- and right-sided deep vein thrombosis (DVT), and also unilateral versus bilateral DVT. We investigated the clinical presentation and outcomes of patients with DVT based on thrombus sidedness. The authors used the data from the Registro Informatizado Enfermedad TromboEmbólica (RIETE) database (2001-2016) to identify patients with symptomatic proximal lower-extremity DVT. Main outcomes included cumulative 90-day symptomatic pulmonary embolism (PE) and 1-year mortality. Overall, 30,445 patients were included. The majority of DVTs occurred in the left leg (16,421 left-sided, 12,643 right-sided, and 1,390 bilateral; p < 0.001 for chi-squared test comparing all three groups). Comorbidities were relatively similar in those with left-sided and right-sided DVT. Compared with those with left-sided DVT, patients with right-sided DVT had higher relative frequency of PE (26% versus 23%, p < 0.001) and 1-year mortality (odds ratio [OR]: 1.08; 95% confidence interval [CI]: 1.00-1.18). This difference in mortality did not persist after multivariable adjustment (OR: 1.01; 95% CI: 0.93-1.1). Patients with bilateral DVT had a greater burden of comorbidities such as heart failure, and recent surgery compared with those with unilateral DVT (p < 0.001), and higher relative frequency of PE (48%), and 1-year mortality (24.1%). Worse outcomes in patients with bilateral DVT were attenuated but persisted after multivariable adjustment for demographics and risk factors (OR: 1.64; 95% CI: 1.43-1.87). Patients with bilateral DVT had worse outcomes during and after discontinuation of anticoagulation. There is a left-sided preponderance for proximal lower-extremity DVT. Compared with those with left-sided DVT, patients with right-sided DVT have slightly higher rates of PE. Bilateral DVT is associated with markedly worse short-term and 1-year outcomes.


Assuntos
Anticoagulantes/administração & dosagem , Sistema de Registros , Trombose Venosa , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Humanos , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Trombose Venosa/tratamento farmacológico , Trombose Venosa/mortalidade , Trombose Venosa/patologia
3.
TH Open ; 2(2): e210-e217, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31249944

RESUMO

Background The natural history of patients with lung cancer and venous thromboembolism (VTE) has not been consistently evaluated. Methods We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to assess the clinical characteristics, time course, and outcomes during anticoagulation of lung cancer patients with acute, symptomatic VTE. Results As of May 2017, a total of 1,725 patients were recruited: 1,208 (70%) presented with pulmonary embolism (PE) and 517 with deep vein thrombosis (DVT). Overall, 865 patients (50%) were diagnosed with cancer <3 months before, 1,270 (74%) had metastases, and 1,250 (72%) had no additional risk factors for VTE. During anticoagulation (median, 93 days), 166 patients had symptomatic VTE recurrences (recurrent DVT: 86, PE: 80), 63 had major bleeding (intracranial 11), and 870 died. The recurrence rate was twofold higher than the major bleeding rate during the first month, and over threefold higher beyond the first month. Fifty-seven patients died of PE and 15 died of bleeding. Most fatal PEs (84%) and most fatal bleeds (67%) occurred within the first month of therapy. Nine patients with fatal PE (16%) died within the first 24 hours. Of 72 patients dying of PE or bleeding, 15 (21%) had no metastases and 29 (40%) had the VTE shortly after surgery or immobility. Conclusion Active surveillance on early signs and/or symptoms of VTE in patients with recently diagnosed lung cancer and prescription of prophylaxis in those undergoing surgery or during periods of immobilization might likely help prevent VTE better, detect it earlier, and treat it more efficiently.

4.
TH Open ; 2(4): e428-e436, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31249971

RESUMO

Background The ideal duration of anticoagulant therapy in elderly patients with unprovoked venous thromboembolism (VTE) has not been consistently evaluated. Methods We used the RIETE ( R egistro I nformatizado E nfermedad T rombo E mbólica) registry to compare the rate and severity of pulmonary embolism (PE) recurrences versus major bleeding beyond the third month of anticoagulation in patients >75 years with a first episode of unprovoked VTE. Results As of September 2017, 7,830 patients were recruited: 5,058 (65%) presented with PE and 2,772 with proximal deep vein thrombosis (DVT). During anticoagulant therapy beyond the third month (median, 113 days), 44 patients developed PE recurrences, 36 developed DVT recurrences, 101 had major bleeding, and 241 died (3 died of recurrent PE and 19 of bleeding). The rate of major bleeding was twofold higher than the rate of PE recurrences (2.05 [95% confidence interval, CI: 1.68-2.48] vs. 0.90 [95% CI: 0.66-1.19] events per 100 patient-years) and the rate of fatal bleeding exceeded the rate of fatal PE events (0.38 [95% CI: 0.24-0.58] vs. 0.06 [95% CI: 0.02-0.16] deaths per 100 patient-years). On multivariable analysis, patients who had bled during the first 3 months (hazard ratio [HR]: 4.32; 95% CI: 1.58-11.8) or with anemia at baseline (HR: 1.87; 95% CI: 1.24-2.81) were at increased risk for bleeding beyond the third month. Patients initially presenting with PE were at increased risk for PE recurrences (HR: 3.60; 95% CI: 1.28-10.1). Conclusion Prolonging anticoagulation beyond the third month was associated with more bleeds than PE recurrences. Prior bleeding, anemia, and initial VTE presentation may help decide when to stop therapy.

5.
Thromb Res ; 151 Suppl 1: S11-S15, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28262227

RESUMO

BACKGROUND: In patients with venous thromboembolism (VTE) and factor V Leiden (FVL) or prothrombin 20210G-A mutation (PTM), the influence of gender on outcome has not been consistently studied. METHODS: We used the RIETE (Registro Informatizado Enfermedad TromboEmbolica) database to assess the existence of gender differences in the rate of VTE recurrences (deep vein thrombosis [DVT] or pulmonary embolism [PE]) or major bleeding during the course of anticoagulation and after its discontinuation in FVL and PTM carriers. RESULTS: From March 2001 to September 2016, 11,224 VTE patients underwent thrombophilia testing. Of these, 1,563 were FVL carriers (863 men and 700 women) and 1,231 were PTM carriers (659 men and 572 women). During the course of anticoagulant therapy, men with FVL had a 6-fold higher rate of VTE recurrences than major bleeds (31 vs. 5 events). In women with FVL, the rate of VTE recurrences was 2-fold higher (16 vs. 8), as was in men (17 vs. 8) or women (17 vs. 9) with PTM. After discontinuing anticoagulation, men with FVL had a 3-fold higher rate of DVT recurrences than women (hazard ratio [HR]: 3.13; 95% CI: 1.79-5.67), with no differences in PE recurrences. Among patients with PTM, there were no gender differences in the rate of DVT (HR: 1.89; 95% CI: 1.00-3.65) or PE recurrences (HR: 1.82; 95% CI: 0.83-4.12). CONCLUSIONS: During the anticoagulation course, men with FVL are at a much higher risk for VTE recurrences than bleeding. After discontinuing anticoagulation, men with FVL are at an increased risk for DVT recurrences.


Assuntos
Anticoagulantes/uso terapêutico , Fator V/genética , Protrombina/genética , Trombofilia/tratamento farmacológico , Trombofilia/epidemiologia , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/epidemiologia , Adulto , Idoso , Feminino , Hemorragia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Recidiva , Fatores Sexuais , Trombofilia/genética , Trombofilia/patologia , Resultado do Tratamento , Tromboembolia Venosa/genética , Tromboembolia Venosa/patologia
6.
Eur Respir J ; 48(5): 1377-1385, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27799388

RESUMO

There is a lack of comprehensive data on the prevalence, predictors and prognostic significance of right heart thrombi (RHT) in pulmonary embolism.In this study of patients with pulmonary embolism from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry, we assessed the prevalence and predictors of RHT, and the association between the presence of RHT and the outcomes of all-cause mortality, pulmonary embolism-related mortality, recurrences, and major bleeding through 30 days after initiation of pulmonary embolism treatment.Of 12 441 patients with pulmonary embolism and baseline echocardiographic data, 2.6% had RHT. The following increased the risk of RHT: younger age, previous bleeding, congestive heart failure, cancer, syncope, systolic blood pressure <100 mmHg, and arterial oxyhaemoglobin saturation <90%. Patients with RHT were significantly more likely to die from any cause (adjusted OR 2.50 (95% CI 1.62-3.84); p<0.001) and from pulmonary embolism (adjusted OR 4.29 (95% CI 2.45-7.48); p<0.001) during follow-up. RHT was associated with an increased risk of recurrence during follow-up (1.8% versus 0.7%; p=0.04). Major bleeding was similar in patients with and without RHT.In patients presenting with pulmonary embolism, RHT is relatively infrequent. Patients with RHT had a worse outcome when compared with those without RHT.


Assuntos
Anticoagulantes/uso terapêutico , Embolia Pulmonar/complicações , Trombose/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Ecocardiografia , Feminino , Coração/fisiologia , Insuficiência Cardíaca , Hemorragia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Razão de Chances , Oxiemoglobinas/metabolismo , Prevalência , Prognóstico , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/mortalidade , Sistema de Registros , Estudos Retrospectivos , Risco , Sístole , Trombose/epidemiologia , Trombose/mortalidade , Resultado do Tratamento
7.
Eur J Intern Med ; 36: 62-66, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27495947

RESUMO

BACKGROUND: The balance between the efficacy and safety of anticoagulant therapy in patients aged ≥100years receiving anticoagulant therapy for venous thromboembolism (VTE) is uncertain. METHODS: We used data from the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to assess the rate of VTE recurrences, bleeding events, and mortality appearing during the course of anticoagulant therapy in VTE patients aged ≥100years. RESULTS: Of 61,173 patients enrolled in RIETE as of January 2016, 47 (0.08%) were aged ≥100years. Of these, 10 (21%) were men, 21 (45%) presented with pulmonary embolism (PE), and 26 with deep vein thrombosis alone. Overall, 35 patients (74%) had severe renal insufficiency, 14 (30%) chronic heart failure, 30 (64%) anemia, 16 (34%) were taking antiplatelets, and 6 (13%) corticosteroids or non-steroidal anti-inflammatory drugs. Most patients (95%) were treated initially with low-molecular-weight heparin (LMWH) (mean daily dose, 168±42IU/kg). Then, 14 (30%) switched to vitamin K antagonists and 29 (62%) kept receiving long-term LMWH therapy (mean, 148±51IU/kg/day). During the course of anticoagulant therapy (mean duration, 139days), mortality was high (15/47; 32%). Two patients died of PE (initial PE one, recurrent PE one) and 5 (11%) had minor bleeding, but no major bleeding was reported. CONCLUSIONS: Among patients with acute VTE aged ≥100years, the risk of VTE recurrences during the course of anticoagulation outweighed the risk of bleeding. Our data suggest the use of standard anticoagulant therapy in this patient population, even if they have severe renal insufficiency.


Assuntos
Anticoagulantes/uso terapêutico , Hemorragia/induzido quimicamente , Embolia Pulmonar/tratamento farmacológico , Sistema de Registros , Tromboembolia Venosa/tratamento farmacológico , Trombose Venosa/tratamento farmacológico , Idoso de 80 Anos ou mais , Anemia/epidemiologia , Comorbidade , Feminino , Insuficiência Cardíaca/epidemiologia , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Masculino , Embolia Pulmonar/epidemiologia , Recidiva , Insuficiência Renal/epidemiologia , Espanha/epidemiologia , Resultado do Tratamento , Tromboembolia Venosa/epidemiologia , Trombose Venosa/epidemiologia , Varfarina/uso terapêutico
8.
PLoS One ; 10(6): e0128741, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26076483

RESUMO

Current guidelines of antithrombotic therapy suggest early initiation of vitamin K antagonists (VKA) in non-cancer patients with venous thromboembolism (VTE), and long-term therapy with low-molecular weight heparin (LMWH) for those with cancer. We used data from RIETE (international registry of patients with VTE) to report the use of long-term anticoagulant therapy over time and to identify predictors of anticoagulant choice (regarding international guidelines) in patients with- and without cancer. Among 35,280 patients without cancer, 82% received long-term VKA (but 17% started after the first week). Among 4,378 patients with cancer, 66% received long term LMWH as monotherapy. In patients without cancer, recent bleeding (odds ratio [OR] 2.70, 95% CI 2.26-3.23), age >70 years (OR 1.15, 95% CI 1.06-1.24), immobility (OR 2.06, 95% CI 1.93-2.19), renal insufficiency (OR 2.42, 95% CI 2.15-2.71) and anemia (OR 1.75, 95% CI 1.65-1.87) predicted poor adherence to guidelines. In those with cancer, anemia (OR 1.83, 95% CI 1.64-2.06), immobility (OR 1.51, 95% CI 1.30-1.76) and metastases (OR 3.22, 95% CI 2.87-3.61) predicted long-term LMWH therapy. In conclusion, we report practices of VTE therapy in real life and found that a significant proportion of patients did not receive the recommended treatment. The perceived increased risk for bleeding has an impact on anticoagulant treatment decision.


Assuntos
Anticoagulantes/uso terapêutico , Tromboembolia Venosa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Fibrinolíticos/uso terapêutico , Seguimentos , Fidelidade a Diretrizes , Heparina de Baixo Peso Molecular , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Fatores de Tempo , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/etiologia , Vitamina K/antagonistas & inibidores
9.
Thromb Res ; 135(2): 311-7, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25543161

RESUMO

BACKGROUND: Even in the absence of evidence on its long-term efficacy and safety, a number of patients with venous thromboembolism (VTE) receive long-term therapy with fondaparinux alone in everyday practice. METHODS: We used the Registro Informatizado de Enfermedad Tromboembólica (RIETE) registry to compare the rate of VTE recurrences and major bleeding at 10 and 90 days in patients with and without cancer. For long-term therapy, fondaparinux was compared with vitamin K antagonists (VKA) in patients without cancer and with low-molecular-weight heparin (LMWH) in those with cancer. RESULTS: Of 47,378 patients recruited, 46,513 were initially treated with heparin, 865 with fondaparinux. Then, 263 patients (78 with cancer) were treated for at least 3 months with fondaparinux. After propensity-score matching, there were no differences between patients receiving initial therapy with heparin or fondaparinux. Among patients with cancer, there were no differences between fondaparinux and LMWH. Among patients without cancer, the long-term use of fondaparinux was associated with an increased risk of major bleeding (3.24 % vs. 0.95 %, p<0.05). CONCLUSIONS: An unexpected high rate of major bleeding was observed in non-cancer patients treated with long-term fondaparinux. Our small sample does not allow to derive relevant conclusions on the use of fondaparinux in cancer patients.


Assuntos
Anticoagulantes/uso terapêutico , Polissacarídeos/uso terapêutico , Tromboembolia Venosa/tratamento farmacológico , Anticoagulantes/administração & dosagem , Feminino , Fondaparinux , Humanos , Masculino , Pessoa de Meia-Idade , Polissacarídeos/administração & dosagem , Resultado do Tratamento
10.
Clin Appl Thromb Hemost ; 20(8): 772-8, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24798686

RESUMO

OBJECTIVES: Registro Informatizado de Enfermedad TromboEmbólica (RIETE) database was used to investigate whether neurosurgical patients with venous thromboembolism (VTE) were more likely to die of bleeding or VTE and the influence of anticoagulation on these outcomes. METHODS: Clinical characteristics, treatment details, and 3-month outcomes were assessed in those who developed VTE after neurosurgery. RESULTS: Of 40 663 patients enrolled, 392 (0.96%) had VTE in less than 60 days after neurosurgery. Most patients in the cohort (89%) received initial therapy with low-molecular-weight heparin, (33% received subtherapeutic doses). In the first week, 10 (2.6%) patients died (8 with pulmonary embolism [PE], no bleeding deaths; P = .005). After the first week, 20 (5.1%) patients died (2 with fatal bleeding, none from PE). Overall, this cohort was more likely to develop a fatal PE than a fatal bleed (8 vs 2 deaths, P = .058). CONCLUSIONS: Neurosurgical patients developing VTE were more likely to die from PE than from bleeding in the first week, despite anticoagulation.


Assuntos
Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/tratamento farmacológico , Sistema de Registros , Tromboembolia Venosa/tratamento farmacológico , Adulto , Idoso , Anticoagulantes/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Embolia Pulmonar/mortalidade , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/mortalidade
11.
Eur J Prev Cardiol ; 20(3): 486-95, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21968571

RESUMO

BACKGROUND: The influence of smoking cessation on outcome in patients with peripheral arterial disease (PAD) has not been thoroughly studied. METHODS: FRENA is an ongoing registry of stable outpatients with symptomatic coronary artery disease (CAD), cerebrovascular disease (CVD), or PAD. We compared the mortality rate of those who quit vs. those who continued smoking. RESULTS: As of December 2010, 3523 patients were recruited, of whom 1182 (34%) were current smokers. Of these, 475 patients (40%) had CAD, 240 (20%) had CVD, and 467 (40%) had PAD. In all, 512 patients (43%) quit smoking. Over a mean follow-up of 14 months, 32 patients (2.7%) died and 95 (8.0%) had subsequent ischaemic events (myocardial infarction 32, ischaemic stroke 20, critical limb ischaemia/disabling claudication 53). In patients with CAD, the mortality rate was significantly lower in recent quitters (0.77 vs. 3.73 deaths per 100 patient-years; p = 0.013) than in persistent smokers. No quitter with CVD died (0.0 vs. 2.18 deaths; p = 0.092); but in patients with PAD there was a trend towards a higher mortality in quitters than in those who continued smoking (4.29 vs. 2.27 deaths; p = 0.357). On multivariate analysis, the relative risk for death in quitters was 0.20 (95% CI 0.05-0.75) in patients with CAD, 0.0 in those with CVD, and 1.83 (95% CI 0.65-5.15) in those with PAD. CONCLUSIONS: Smoking cessation was associated with a significant decrease in mortality in patients with CAD, a non-significant decrease in those with CVD, and a non-significant increase in those with PAD.


Assuntos
Transtornos Cerebrovasculares/terapia , Doença da Artéria Coronariana/terapia , Doença Arterial Periférica/terapia , Abandono do Hábito de Fumar , Prevenção do Hábito de Fumar , Idoso , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/mortalidade , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/mortalidade , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Fumar/efeitos adversos , Fumar/mortalidade , Espanha/epidemiologia , Fatores de Tempo , Resultado do Tratamento
12.
Thromb Res ; 130(2): 173-7, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22374336

RESUMO

BACKGROUND: The natural history of venous thromboembolism (VTE) in patients with dementia has not been thoroughly studied. METHODS: We used the RIETE Registry data to assess the clinical characteristics, treatment strategies and outcome during the first 3 months after acute VTE in all immobilized patients with dementia. RESULTS: As of August 2011, 37988 patients had been enrolled, of whom 1316 (3.5%) had dementia. Most patients in both subgroups were initially treated with low-molecular-weight heparin (LMWH). Then, 48% of patients with dementia and 25% of those without dementia received LMWH as long-term therapy. During the first 3 months of anticoagulant therapy, patients with dementia had a higher incidence of fatal pulmonary embolism (PE): 4.0% vs. 1.2% (odds ratio: 3.3; 95% CI: 2.5-4.4) and fatal bleeding: 1.4% vs. 0.5% (odds ratio: 2.9; 95% CI: 1.8-4.6) than those without dementia. In demented patients initially presenting with PE, the incidence of fatal PE during the first week outweighed that of fatal bleeding (42 vs. 4 deaths), but from Day 8, the incidence of fatal PE was similar to the incidence of fatal bleeding. In patients initially presenting with deep vein thrombosis (DVT), there were 4 fatal PE and 8 fatal bleeding events. CONCLUSIONS: VTE patients with dementia had a high incidence of fatal PE and fatal bleeding. In those initially presenting with PE, the risk of dying of PE far outweighed that of fatal bleeding. In patients presenting with DVT alone, the risk of fatal PE was lower than that of fatal bleeding.


Assuntos
Anticoagulantes/uso terapêutico , Demência/complicações , Heparina de Baixo Peso Molecular/uso terapêutico , Tromboembolia Venosa/complicações , Tromboembolia Venosa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Feminino , Hemorragia/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/etiologia , Sistema de Registros , Resultado do Tratamento
14.
Curr Opin Pulm Med ; 16(5): 432-6, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20671514

RESUMO

PURPOSE OF REVIEW: There is some uncertainty about the management of pulmonary embolism in nonagenarians. RECENT FINDINGS: Immobility plays an important role in the pathogenesis of venous thromboembolism in the elderly. Of 858 nonagenarians with acute venous thromboembolism enrolled in Registro Informatizado de la Enfermedad TromboEmbolica venosa registry, 41% had recent immobility and only 7.7% had recent surgery. Comorbidity is common: 19% of patients had chronic heart failure, 9.8% chronic lung disease, 14% cancer, and 63% had abnormal creatinine levels. Most (92%) of the patients were initially treated with low-molecular-weight heparin and then 46% switched to antivitamin K drugs. During follow-up, the proportion of patients who developed recurrent venous thromboembolism (4.9%) or major bleeding complications (6.2%) was similar, but the 5.9% of fatal pulmonary embolisms by far exceeded the 2.2% of fatal bleeding events. The most common clinical symptoms are isolated dyspnea and syncope, and presentation as pulmonary infarction (with hemoptysis and pleuritic chest pain) is rare. SUMMARY: In patients aged at least 90 years presenting with acute pulmonary embolism, the incidence of fatal pulmonary embolism by far outweighs the incidence of fatal bleeding, and pulmonary embolism is the most common cause of death. Thus, there seems to be more reason to be concerned about fatal pulmonary embolism than about bleeding in elderly patients presenting with pulmonary embolism.


Assuntos
Heparina de Baixo Peso Molecular/uso terapêutico , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/epidemiologia , 4-Hidroxicumarinas/efeitos adversos , 4-Hidroxicumarinas/uso terapêutico , Fatores Etários , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Feminino , Hemorragia/epidemiologia , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Incidência , Indenos/efeitos adversos , Indenos/uso terapêutico , Masculino , Fatores de Risco , Espanha , Vitamina K/efeitos adversos , Vitamina K/antagonistas & inibidores , Vitamina K/uso terapêutico
15.
Thromb Res ; 125 Suppl 2: S58-61, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20434007

RESUMO

BACKGROUND: Cancer patients with venous thromboembolism (VTE) have an increased incidence of bleeding complications while on anticoagulant therapy. METHODS: RIETE is an ongoing registry of consecutive patients with acute VTE. We tried to identify which cancer patients are at a higher risk for major bleeding. RESULTS: Up to May 2009, 4,709 patients with active cancer had been enrolled in RIETE registry. During the first 3 months of anticoagulant therapy, 200 (4.2%) patients developed major bleeding. Then, 38 (0.8%) further patients bled beyond the first 90 days of therapy, 3 bled after withholding anticoagulant therapy. The most common sites of bleeding were the gastrointestinal tract (118 patients, 49%), genitourinary system (43 patients, 18%) and the brain (27 patients, 11%). In all, 160 patients (66%) died within 30 days after bleeding: 88 (55%) died of bleeding, 3 (1.9%) died of recurrent pulmonary embolism. CONCLUSIONS: Major bleeding is a frequent and severe complication in cancer patients with VTE, even beyond the third month. One third of the patients who bled died due the bleeding event.


Assuntos
Anticoagulantes/efeitos adversos , Hemorragia/induzido quimicamente , Neoplasias/complicações , Tromboembolia Venosa/complicações , Tromboembolia Venosa/tratamento farmacológico , Idoso , Feminino , Hemorragia/etiologia , Humanos , Masculino
16.
Thromb Haemost ; 101(6): 1112-8, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19492156

RESUMO

The balance between the efficacy and safety of anticoagulant therapy in patients aged >/=90 years with venous thromboembolism (VTE) is uncertain. RIETE is an ongoing, prospective registry of consecutive patients with acute, objectively confirmed, symptomatic VTE. We evaluated the efficacy and safety of anticoagulant therapy during the first three months in all patients aged >/=90 years. In addition, we tried to identify those at a higher risk for VTE. Of 21,873 patients enrolled from March 2001 to February 2008, 610 (2.8%) were aged >/=90 years. Of these, 307 (50%) presented with pulmonary embolism (PE), 240 (39%) had immobility >/=4 days, and 271 (44%) had abnormal creatinine levels. During the first three months of therapy, 140 patients aged >/=90 years (23%) died. Of these, 45 (32%) died of PE (34 of the initial episode, 11 of recurrent PE), 18 (13%) had fatal bleeding. Recent immobility >/=4 days was the most common risk factor for VTE (240 of 610 patients, 39%), but only 54 of them (22%) had received thromboprophylaxis. The most frequent causes for immobility were senile dementia, acute infection, trauma or decompensated heart failure. The duration of immobility was <4 weeks in 126 patients (52%), and most of them were bedridden at home. In conclusion, one in every four VTE patients aged >/=90 years died during the first three months of therapy. Of these, one in every three died of PE, one in every eight had fatal bleeding. Identifying at-risk patients may help to prevent some of these deaths.


Assuntos
Fatores Etários , Anticoagulantes/administração & dosagem , Heparina/administração & dosagem , Sistema de Registros , Tromboembolia Venosa/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Criança , Feminino , Hemorragia/induzido quimicamente , Hemorragia/mortalidade , Hemorragia/prevenção & controle , Heparina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Espanha , Taxa de Sobrevida , Resultado do Tratamento , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/mortalidade , Vitamina K/antagonistas & inibidores
17.
Angiology ; 59(4): 427-34, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18388061

RESUMO

There is little information on the effectiveness of secondary prevention interventions in very elderly patients. In this article, the incidence of major cardiovascular events during a 12-month follow-up period in a series of consecutive patients with coronary, cerebrovascular, or peripheral artery disease is analyzed. As of October 2006, 1264 patients had been enrolled. Of these, 324 (26%) were >or=75 years of age. Their incidence rate of 22 events per 100 patient-years (95% CI, 17-28) was over 2-fold the 7.9 (95% CI, 6.2-10) found in those <75 years of age. Among them, only chronic heart failure and diabetes were independently associated with an increased risk for major events, whereas the use of angiotensin II antagonists was associated with a lower risk. Patients >or=75 years of age had an over 2-fold higher incidence of major cardiovascular events. The use of angiotensin II antagonists was associated with a lower risk.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Transtornos Cerebrovasculares/tratamento farmacológico , Doença da Artéria Coronariana/tratamento farmacológico , Doenças Vasculares Periféricas/tratamento farmacológico , Fatores Etários , Idoso , Doenças Cardiovasculares/etiologia , Transtornos Cerebrovasculares/complicações , Doença da Artéria Coronariana/complicações , Humanos , Razão de Chances , Doenças Vasculares Periféricas/complicações , Estudos Prospectivos , Sistema de Registros , Medição de Risco , Fatores de Risco , Prevenção Secundária , Espanha , Resultado do Tratamento
18.
Ann Hematol ; 86(7): 519-26, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17437112

RESUMO

The objective was to assess the use of suboptimal doses (60-149 UI kg(-1) day(-1)) of low molecular weight heparin (LMWH) in the treatment of acute venous thromboembolism (VTE) in actual clinical practice and to evaluate the outcomes compared to standard doses (> or = 150 UI kg(-1) day(-1)). Retrospective analysis of data from a multicenter registry of patients with VTE (RIETE; Registro Informatizado de Enfermedad TromboEmbólica). Patient characteristics, antithrombotic treatments, and 3-month outcomes were analyzed. We studied 12,302 patients with VTE; 10,524 patients were treated initially only with LMWH; 1,547 patients received suboptimal LMWH (mean = 122 UI kg(-1) day(-1)), and 8,977 patients received full-dose LMWH (mean = 191 UI kg(-1) day(-1)). The suboptimal group included significantly more patients with recent major bleeding, weight more than 100 kg, raised creatinine, or deep vein thrombosis. No significant differences in mortality rate (7.7 vs 7.8%), VTE recurrence (2.7 vs 2.3%), or fatal hemorrhage (0.6 vs 0.6%) occurred between the suboptimal and the standard group. Major bleeding episodes occurred more frequently in the patients with pulmonary embolism treated with suboptimal LMWH (4.5 vs 2.4%; p = 0.02). In the multivariate analysis, after adjusting for bleeding risk factors, major hemorrhage was not associated with the heparin dose. Suboptimal doses of LMWH are used in actual clinical practice in a reduced group of patients at an outcome rate not very different to that of standard doses. Bleeding episodes depend more on the patient's characteristics than on the LMWH dose. Randomized trials should be performed to corroborate these results.


Assuntos
Hemorragia/etiologia , Heparina de Baixo Peso Molecular/administração & dosagem , Padrões de Prática Médica/estatística & dados numéricos , Embolia Pulmonar/tratamento farmacológico , Trombose Venosa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Relação Dose-Resposta a Droga , Hemorragia/mortalidade , Humanos , Pessoa de Meia-Idade , Mortalidade , Embolia Pulmonar/complicações , Embolia Pulmonar/mortalidade , Recidiva , Sistema de Registros , Estudos Retrospectivos , Espanha/epidemiologia , Análise de Sobrevida , Trombose Venosa/complicações , Trombose Venosa/mortalidade
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