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1.
Arch Bronconeumol ; 2020 Jan 03.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31902629

RESUMO

Persistent thrombotic lesions are common in patients with pulmonary embolism. These lesions occur on a clinical spectrum, ranging from an asymptomatic course with complete functional recovery to chronic thromboembolic pulmonary hypertension. The concept of chronic thromboembolic disease has emerged in recent years to describe a subgroup of patients with persistent thrombotic lesions who have symptoms on exertion and pulmonary vascular dysfunction, but no pulmonary hypertension at rest. The prevalence of this entity is unknown and the criteria for diagnosing it are not defined. The aim of this article is to analyze post- pulmonary embolism sequelae and review existing evidence on chronic thromboembolic disease, with special emphasis on its diagnosis and therapeutic approach.

2.
Artigo em Inglês | MEDLINE | ID: mdl-31784355

RESUMO

OBJECTIVE: Overlap exists between the risk factors for coronary artery disease and venous thromboembolism (VTE). However, a paucity of data is available on the incidence of major acute cardiovascular events (MACE) and major adverse limb events (MALE) among patients presenting with VTE. Moreover, it is unknown whether the rate of cardiovascular outcomes differs among patients with unprovoked vs provoked VTE. METHODS: We analyzed the data from 2009 to 2017 in the Registro Informatizado de Enfermedad Tromboembólica registry, an ongoing, multicenter, international registry of consecutive patients with a diagnosis of objectively confirmed VTE. The query was restricted it to patients with data entry for the arterial outcomes. The baseline prevalence of coronary artery disease risk factors was compared between patients with provoked (ie, immobility, cancer, surgery, travel >6 hours, hormonal causes) and unprovoked VTE. After the initial VTE event, we followed up patients for the composite primary outcome of incident MACE (ie, stroke, myocardial infarction, unstable angina) and/or MALE (ie, major limb events). We used the χ2 test for baseline associations and a Cox proportional hazard for multivariate analysis. We used IBM SPSS, version 24 (IBM Corp, Armonk, NY) for statistical analysis. A P value of <.05 was considered statistically significant. RESULTS: We analyzed the data from 41,259 patients with VTE, of whom 22,633 (55.6%) had experienced a provoked VTE. During follow-up, the patients with provoked VTE were more likely to develop MACE or MALE than were patients with unprovoked VTE (hazard ratio [HR], 1.3; 95% confidence interval [CI], 1.1-1.5). The association of arterial events with recent immobility (HR, 1.4; 95% CI, 1.5-12.1) and cancer (HR, 1.7; 95% CI, 1.4-1.9) was strong. After adjusting for multiple conventional cardiovascular risk factors, provoked VTE, compared with unprovoked VTE, was significantly associated with an increased hazard for MACE (HR, 1.4; 95% CI, 1.1-1.7). Cancer remained a significant adjusted predictor for both MACE (HR, 1.7; 95% CI, 1.4-2.1) and MALE (HR, 2.1; 95% CI 1.01-4.6) in those with provoked VTE. CONCLUSIONS: Among patients with VTE, provoked cases, specifically those with cancer-associated VTE, have an increased risk of major arterial events.

3.
Sci Rep ; 9(1): 20064, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31882805

RESUMO

In young patients with acute pulmonary embolism (PE), the predictive value of currently available prognostic tools has not been evaluated. Our objective was to compare prognostic value of 7 available tools (GPS, PESI, sPESI, Prognostic Algorithm, PREP, shock index and RIETE) in patients aged <50 years. We used the RIETE database, including PE patients from 2001 to 2017. The major outcome was 30-day all-cause mortality. Of 34,651 patients with acute PE, 5,822 (17%) were aged <50 years. Of these, 83 (1.4%) died during the first 30 days. Number of patients deemed low risk with tools was: PREP (95.9%), GPS (89.6%), PESI (87.2%), Shock index (70.9%), sPESI (59.4%), Prognostic algorithm (58%) and RIETE score (48.6%). The tools with a highest sensitivity were: Prognostic Algorithm (91.6%; 95% CI: 85.6-97.5), RIETE score (90.4%; 95%CI: 84.0-96.7) and sPESI (88%; 95% CI: 81-95). The RIETE, Prognostic Algorithm and sPESI scores obtained the highest overall sensitivity estimates for also predicting 7- and 90-day all-cause mortality, 30-day PE-related mortality, 30-day major bleeding and 30-day VTE recurrences. The proportion of low-risk patients who died within the first 30 days was lowest using the Prognostic Algorithm (0.2%), RIETE (0.3%) or sPESI (0.3%) scores. In PE patients less 50 years, 30-day mortality was low. Although sPESI, RIETE and Prognostic Algorithm scores were the most sensitive tools to identify patients at low risk to die, other tools should be evaluated in this population to obtain more efficient results.

4.
Clin Cardiol ; 42(3): 346-351, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30706520

RESUMO

INTRODUCTION: Some previous studies have suggested a high prevalence of pulmonary embolism (PE) during exacerbations of chronic obstructive pulmonary disease (ECOPD). The SLICE trial aims to assess the efficacy and safety of an active strategy for the diagnosis and treatment of PE (vs usual care) in patients hospitalized because of ECOPD. METHODS: SLICE is a phase III, prospective, international, multicenter, randomized, open-label, and parallel-group trial. A total of 746 patients hospitalized because of ECOPD will be randomized in a 1:1 fashion to receive either an active strategy for the diagnosis and anticoagulant treatment of PE or usual care (ie, standard care without any diagnostic test for diagnosing PE). The primary outcome is a composite of all-cause death, non-fatal (recurrent) venous thromboembolism (VTE), or readmission for ECOPD within 90 days after enrollment. Secondary outcomes are (a) death from any cause within 90 days after enrollment, (b) non-fatal (recurrent) VTE within 90 days after enrollment, (c) readmission within 90 days after enrollment, and (d) length of hospital stay. RESULTS: Enrollment started in September 2014 and is expected to proceed until 2020. Median age of the first 443 patients was 71 years (interquartile range, 64-78), and 26% were female. CONCLUSIONS: This multicenter trial will determine the value of detecting PEs in patients with ECOPD. This has implications for COPD patient morbidity and mortality. TRIAL REGISTRATION NUMBER: NCT02238639.


Assuntos
Anticoagulantes/uso terapêutico , Tomografia Computadorizada Multidetectores/métodos , Doença Pulmonar Obstrutiva Crônica/complicações , Embolia Pulmonar/diagnóstico , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Terapia Trombolítica/métodos , Ultrassonografia/métodos , Idoso , Ensaios Clínicos Fase III como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Embolia Pulmonar/etiologia , Embolia Pulmonar/terapia , Reprodutibilidade dos Testes
5.
J Am Heart Assoc ; 7(17): e009042, 2018 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-30371152

RESUMO

Background Transthoracic echocardiography ( TTE ) is often considered for risk stratification of patients with acute pulmonary embolism ( PE ). We sought to determine the contemporary utilization of early TTE (within 72 hours of PE diagnosis) and explored the association between TTE findings and PE -related mortality. Methods and Results Data from the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry, a multicenter registry of consecutive patients with acute PE , were used (2001-July 2017). We used a generalized linear mixed model to determine predictors of early TTE performance. Moreover, the association between 3 TTE variables (right atrial enlargement, right ventricular hypokinesis, and presence of right heart thrombi) and 30-day PE -related mortality was assessed in generalized linear mixed models adjusted for PE severity index, and other comorbidities. Among 35 935 enrollees with acute PE , 15 375 (42.8%) underwent early TTE . There was an increase in early TTE utilization rate over time ( P<0.001 for trend). Younger age, female sex, enrollment in countries other than Spain, history of coronary disease, heart failure, atrial fibrillation, tachycardia, and hypotension were the main predictors of early TTE ( P<0.01 for all). In multivariable analyses, right atrial enlargement (adjusted odds ratio: 3.74; 95% confidence interval, 2.10-6.66), right ventricular hypokinesis (adjusted odds ratio: 3.11, 95% confidence interval: 1.85-5.21) and right heart thrombi (adjusted odds ratio: 4.39, 95% confidence interval, 1.99-9.71) were associated with increased odds for PE -related mortality. Conclusions Early TTE is commonly performed for acute PE and utilization rates have increased over time. Right atrial enlargement, right ventricular hypokinesis, and right heart thrombi are predictive of worse outcomes. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 02832245.


Assuntos
Ecocardiografia/estatística & dados numéricos , Átrios do Coração/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Trombose/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem , Doença Aguda , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Doença das Coronárias/epidemiologia , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Hipotensão/epidemiologia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/mortalidade , Medição de Risco , Fatores Sexuais , Taquicardia/epidemiologia
6.
Arch. bronconeumol. (Ed. impr.) ; 54(4): 205-215, abr. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-173027

RESUMO

La hipertensión pulmonar es un trastorno hemodinámico definido por el aumento anómalo de la presión arterial pulmonar, que puede presentarse en numerosas enfermedades y situaciones clínicas. Las causas de hipertensión pulmonar se clasifican en 5 grandes grupos: arterial, debida a cardiopatía izquierda, debida a enfermedad pulmonar y/o hipoxemia, tromboembólica crónica y de mecanismo no establecido y/o multifactorial. El presente documento expone de forma resumida las recomendaciones de la Guía de Diagnóstico y Tratamiento de la Hipertensión Pulmonar de la Sociedad Española de Neumología y Cirugía Torácica. En dicha guía se presentan las pautas actuales de diagnóstico y tratamiento de los distintos grupos de hipertensión pulmonar


Pulmonary hypertension is a hemodynamic disorder defined by abnormally high pulmonary artery pressure that can occur in numerous diseases and clinical situations. The causes of pulmonary hypertension are classified into 5 major groups: arterial, due to left heart disease, due to lung disease and/or hypoxemia, chronic thromboembolic, with unclear and/or multifactorial mechanisms. This is a brief summary of the Guidelines on the Diagnostic and Treatment of Pulmonary Hypertension of the Spanish Society of Pulmonology and Thoracic Surgery. These guidelines describe the current recommendations for the diagnosis and treatment of the different pulmonary hypertension groups


Assuntos
Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/terapia , Circulação Pulmonar , Prognóstico , Hipertensão Pulmonar/classificação , Hipertensão Pulmonar/etiologia
8.
PLoS One ; 13(3): e0194673, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29558509

RESUMO

The usefulness of a diagnostic workup for occult cancer in patients with venous thromboembolism (VTE) is controversial. We used the RIETE (Registro Informatizado Enfermedad Trombo Embólica) database to perform a nested case-control study to validate a prognostic score that identifies patients with unprovoked VTE at increased risk for cancer. We dichotomized patients as having low- (≤2 points) or high (≥3 points) risk for cancer, and tried to validate the score at 12 and 24 months. From January 2014 to October 2016, 11,695 VTE patients were recruited. Of these, 1,360 with unprovoked VTE (11.6%) were eligible for the study. At 12 months, 52 patients (3.8%; 95%CI: 2.9-5%) were diagnosed with cancer. Among 905 patients (67%) scoring ≤2 points, 22 (2.4%) had cancer. Among 455 scoring ≥3 points, 30 (6.6%) had cancer (hazard ratio 2.8; 95%CI 1.6-5; p<0.01). C-statistic was 0.63 (95%CI 0.55-0.71). At 24 months, 58 patients (4.3%; 95%CI: 3.3-5.5%) were diagnosed with cancer. Among 905 patients scoring ≤2 points, 26 (2.9%) had cancer. Among 455 patients scoring ≥3 points, 32 (7%) had cancer (hazard ratio 2.6; 95%CI 1.5-4.3; p<0.01). C-statistic was 0.61 (95%CI, 0.54-0.69). We validated our prognostic score at 12 and 24 months, although prospective cohort validation is needed. This may help to identify patients for whom more extensive screening workup may be required.


Assuntos
Detecção Precoce de Câncer/métodos , Neoplasias/complicações , Neoplasias/diagnóstico , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Bases de Dados Factuais , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Desconhecidas/complicações , Neoplasias Primárias Desconhecidas/diagnóstico , Prognóstico , Sistema de Registros , Projetos de Pesquisa , Fatores de Risco
9.
Arch Bronconeumol ; 54(4): 205-215, 2018 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29472044

RESUMO

Pulmonary hypertension is a hemodynamic disorder defined by abnormally high pulmonary artery pressure that can occur in numerous diseases and clinical situations. The causes of pulmonary hypertension are classified into 5 major groups: arterial, due to left heart disease, due to lung disease and/or hypoxemia, chronic thromboembolic, with unclear and/or multifactorial mechanisms. This is a brief summary of the Guidelines on the Diagnostic and Treatment of Pulmonary Hypertension of the Spanish Society of Pulmonology and Thoracic Surgery. These guidelines describe the current recommendations for the diagnosis and treatment of the different pulmonary hypertension groups.


Assuntos
Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/terapia , Algoritmos , Terapia Combinada , Doenças do Tecido Conjuntivo/complicações , Doenças do Tecido Conjuntivo/diagnóstico , Técnicas de Diagnóstico Cardiovascular/normas , Técnicas de Diagnóstico do Sistema Respiratório/normas , Gerenciamento Clínico , Quimioterapia Combinada , Medicina Baseada em Evidências , Cardiopatias Congênitas/complicações , Cardiopatias/complicações , Cardiopatias/diagnóstico , Septos Cardíacos/cirurgia , Unidades Hospitalares/organização & administração , Humanos , Hipertensão Pulmonar/classificação , Hipertensão Pulmonar/etiologia , Transplante de Pulmão , Doenças Metabólicas/complicações , Mutação , Oxigenoterapia , Encaminhamento e Consulta/organização & administração , Transtornos Respiratórios/complicações
10.
Clin Appl Thromb Hemost ; 24(3): 489-495, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28681634

RESUMO

In patients with venous thromboembolism (VTE), male sex has been associated with an increased risk of occult cancer. The influence of sex on clinical characteristics, treatment, cancer sites, and outcome has not been thoroughly investigated yet. We used the Registro Informatizado Enfermedad TromboEmbólica registry to compare the clinical characteristics, treatment strategies, cancer sites, and clinical outcomes in patients with VTE having occult cancer, according to sex. As of June 2014, 5864 patients were recruited, of whom 444 (7.6%; 95% confidence interval: 6.8-8.2) had occult cancer. Of these, 246 (55%) were men. Median time elapsed from VTE to occult cancer was 4 months (interquartile range: 2-8.4), with no sex differences. Women were older, weighed less, and were less likely to have chronic lung disease than men. The most common cancer sites were the lung (n = 63), prostate (n = 42), and colorectal (n = 29) in men and colorectal (n = 38), breast (n = 23), uterine (n = 18), hematologic (n = 17), or pancreas (n = 15) in women. Men were more likely to have lung cancer than women (2.18% vs 0.30%; P < .01) and less likely to have pancreatic cancer (0.17% vs 0.5%; P = .03). Interestingly, breast cancer was more likely found in women aged ≥50 years than in those aged <50 years (0.97% vs 0.14%; P = .03). This study highlights the existence of sex differences in patients with VTE having occult cancer. One in every 2 men had lung, prostate, or colorectal cancer. In women, there is a heterogeneity of cancer sites, increasing risk of breast cancer in those aged >50 years.


Assuntos
Neoplasias/etiologia , Fatores Sexuais , Tromboembolia Venosa/complicações , Adulto , Fatores Etários , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Sistema de Registros , Fatores de Tempo
11.
Thromb Res ; 157: 90-96, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28719850

RESUMO

INTRODUCTION: The safety and efficacy of low-molecular-weight heparin (LMWH) treatment in patients with cancer-associated thrombosis (CAT) beyond 6months are unknown. Our aim was to determine the safety of long-term tinzaparin use in patients with CAT. METHODS: We performed a prospective, open, single arm, multicentre study in patients with CAT receiving treatment with tinzaparin. We evaluated the rate of clinically relevant bleeding events (major and non-major clinically relevant bleeding) and venous thromboembolism (VTE) recurrence. RESULTS: A total of 247 patients were recruited, with a crude incidence of major bleeding of 4.9% (12/247). The rate of clinically relevant bleeding during months 1-6 and 7-12, was 0.9% [95% confidence interval (95% CI) 0.5 to 1.6%] and 0.6% (95% CI 0.2 to 1.4%) (p=0.5) per patient and month, respectively. Male gender showed greater risk for clinically relevant bleeding with a hazard ratio (HR) of 2.97 (95% CI 1.01 to 8.1; p=0.02). The incidence of VTE recurrence at months 1-6 and 7-12 was 4.5% (95% CI 2.2 to 7.8%) and 1.1% (95% CI 0.1 to 3.9%), respectively. One patient died due to VTE recurrence and two because of severe bleeding. CONCLUSIONS: Treatment with tinzaparin beyond 6months is safe in patients with CAT.


Assuntos
Fibrinolíticos/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Neoplasias/complicações , Trombose/tratamento farmacológico , Feminino , Fibrinolíticos/farmacologia , Heparina de Baixo Peso Molecular/farmacologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Tinzaparina
12.
13.
Eur J Radiol ; 87: 66-75, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28065377

RESUMO

OBJECTIVE: To analyze the prognostic value of pulmonary artery obstruction versus right-ventricle (RV) dysfunction radiologic indices in cancer-related pulmonary embolism (PE). METHODS: We enrolled 303 consecutive patients with paraneoplastic PE, evaluated by computed tomography pulmonary angiography (CTPA) between 2013 and 2014. The primary outcome measure was serious complications at 15days. Multivariate analyses were conducted by using binary logistic and robust regressions. Radiological features such as the Qanadli index (QI) and RV dysfunction signs were analyzed with Spearman's partial rank correlations. RESULTS: RV diameter was the only radiological variable associated with an adverse outcome. Subjects with enlarged RV (diameter>45mm) had more 15-day complications (58% versus 40%, p=0.001). The QI correlated with the RV diameter (r=0.28, p<0.001), left ventricle diameter (r=-0.19, p<0.001), right ventricular-to-left ventricular diameter ratio (r=0.39, p<0.001), pulmonary artery diameter (r=0.22, p<0.001), and pulmonary artery/ascending aorta ratio (r=0.27, p<0.001). A QI≥50% was only associated with 15-day complications in subjects with enlarged RV, inverted intraventricular septum, or chronic cardiopulmonary diseases. The central or peripheral PE location did not affect the correlations among radiological variables and was not associated with clinical outcomes. CONCLUSIONS: Right ventricular dysfunction signs in CTPA are more useful than QI in predicting cancer-related PE outcome.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Neoplasias/complicações , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico por imagem , Disfunção Ventricular Direita/complicações , Disfunção Ventricular Direita/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Artéria Pulmonar/diagnóstico por imagem , Reprodutibilidade dos Testes , Estudos Retrospectivos , Disfunção Ventricular Direita/fisiopatologia
14.
Eur Respir J ; 49(1)2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-28052954

RESUMO

The study aimed to identify predictors of overall 30-day mortality in cancer patients with pulmonary embolism including suspected pulmonary embolism (SPE) and unsuspected pulmonary embolism (UPE) events. Secondary outcomes included 30- and 90-day major bleeding and venous thromboembolism (VTE) recurrence.The study cohort included 1033 consecutive patients with pulmonary embolism from the multicentre observational ambispective EPIPHANY study (March 2006-October 2014). A subgroup of 497 patients prospectively assessed for the study were subclassified into three work-up scenarios (SPE, truly asymptomatic UPE and UPE with symptoms) to assess outcomes.The overall 30-day mortality rate was 14%. The following variables were associated with the overall 30-day mortality on multivariate analysis: VTE history, upper gastrointestinal cancers, metastatic disease, cancer progression, performance status, arterial hypotension <100 mmHg, heart rate >110 beats·min-1, basal oxygen saturation <90% and SPE (versus overall UPE).The overall 30-day mortality was significantly lower in patients with truly asymptomatic UPE events (3%) compared with those with UPE-S (20%) and SPE (21%) (p<0.0001). Thirty- and 90-day VTE recurrence and major bleeding rates were similar in all the groups.In conclusion, variables associated with the severity of cancer and pulmonary embolism were associated with short-term mortality. Our findings may help to develop pulmonary embolism risk-assessment models in this setting.


Assuntos
Neoplasias/complicações , Neoplasias/mortalidade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/epidemiologia , Tromboembolia Venosa/diagnóstico por imagem , Tromboembolia Venosa/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Hemorragia/epidemiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Medição de Risco , Fatores de Risco , Espanha/epidemiologia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Adulto Jovem
15.
Chest ; 151(3): 564-571, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27815153

RESUMO

BACKGROUND: The benefits of a diagnostic workup for occult cancer in patients with VTE are controversial. Our aim was to provide and validate a risk score for occult cancer in patients with VTE. METHODS: We designed a nested case-control study in a cohort of patients with VTE included in the RIETE (Registro Informatizado Enfermedad TromboEmbólica) registry from 2001 to 2014. Cases included cancer detected beyond the first 30 days and up to 24 months after VTE. Control subjects were defined as patients with VTE with no cancer in the same period. RESULTS: Of 5,863 eligible patients, 444 (7.6%; 95% CI, 6.8%-8.2%) were diagnosed with occult cancer. On multivariable analysis, variables selected were male sex, age > 70 years, chronic lung disease, anemia, elevated platelet count, prior VTE, and recent surgery. We built a risk score assigning points to each variable. Internal validity was confirmed using bootstrap analysis. The proportion of patients with cancer who scored ≤ 2 points was 5.8% (241 of 4,150) and that proportion in those who scored ≥ 3 points was 12% (203 of 1,713). We also identified scores divided by sex and age subgroups. CONCLUSIONS: This is the first risk score that has identified patients with VTE who are at increased risk for occult cancer. Our score needs to be externally validated.


Assuntos
Neoplasias/epidemiologia , Embolia Pulmonar/epidemiologia , Sistema de Registros , Trombose Venosa/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anemia/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Pneumopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias/diagnóstico , Reprodutibilidade dos Testes , Medição de Risco , Fatores Sexuais , Espanha/epidemiologia , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Trombocitose/epidemiologia , Tromboembolia Venosa/epidemiologia
16.
J Am Coll Cardiol ; 67(2): 162-170, 2016 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-26791063

RESUMO

BACKGROUND: Despite advances in hospital management in recent years, it is not clear whether mortality after acute pulmonary embolism (PE) has decreased over time. OBJECTIVES: This study describes the trends in the management and outcomes of acute symptomatic PE. METHODS: We identified adults with acute PE enrolled in the registry between 2001 and 2013. We assessed temporal trends in length of hospital stay and use of pharmacological and interventional therapies. Using multivariable regression, we examined temporal trends in risk-adjusted rates of all-cause and PE-related death to 30 days after diagnosis. RESULTS: Among 23,858 patients with PE, mean length of stay decreased from 13.6 to 9.3 days over time (32% relative reduction, p < 0.001). For initial treatment, use of low-molecular-weight heparin increased from 77% to 84%, whereas the use of unfractionated heparin decreased from 22% to 8.4% (p < 0.001 for trend for all comparisons). Thrombolytic therapy use increased from 0.7% to 1.0% (p = 0.07 for trend) and surgical embolectomy use doubled from 0.3% to 0.6% (p < 0.01 for trend). Risk-adjusted rates of all-cause mortality decreased from 6.6% in the first period (2001 to 2005) to 4.9% in the last period (2010 to 2013) (p = 0.02 for trend). Rates of PE-related mortality decreased over time, with a risk-adjusted rate of 3.3% in 2001 to 2005 and 1.8% in 2010 to 2013 (p < 0.01 for trend). CONCLUSIONS: In a large international registry of patients with PE, improvements in length of stay and changes in the initial treatment were accompanied by a reduction in short-term all-cause and PE-specific mortality.


Assuntos
Heparina de Baixo Peso Molecular/uso terapêutico , Embolia Pulmonar , Trombectomia , Terapia Trombolítica , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Gerenciamento Clínico , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prognóstico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/terapia , Medição de Risco , Espanha/epidemiologia , Análise de Sobrevida , Trombectomia/métodos , Trombectomia/estatística & dados numéricos , Terapia Trombolítica/métodos , Terapia Trombolítica/estatística & dados numéricos
17.
Eur J Intern Med ; 28: 65-9, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26603210

RESUMO

BACKGROUND: Venous and arterial thrombosis share a number of pathogenic mechanisms, but the burden of pulmonary embolism (PE) has not been consistently compared with that in other arterial diseases. METHODS: We used the Spanish National Discharge Database to compare the frequency, clinical characteristics and mortality rate of all patients with PE, acute coronary syndrome (ACS) or ischemic stroke admitted from 2001 to 2010. Patients were classified as having primary diagnosis (the process leading to hospital admission) or secondary diagnosis (it appeared during hospital stay for other reasons) RESULTS: During the study period, 31,949,739 patients were discharged. Of these, 165,229 (0.52%) were diagnosed with PE, 562,837 (1.76%) with ACS and 495,427 (1.55%) with ischemic stroke. Overall, 31% of patients with PE, 8.4% with ACS and 13% with ischemic stroke had secondary diagnoses. The most common reasons for admission in patients with secondary PE were: cancer (21%), acute respiratory failure (11%), acute heart failure (6.4%) and stroke (5.5%). Mean hospital stay was: 14 ± 13 days in PE patients, 9.7 ± 9.7 in those with ACS and 13 ± 14 days in those with stroke. In-hospital mortality rate was: 10.5%, 10.1% and 12.3% respectively in patients with primary diagnosis, and 36%, 34% and 29% in those with secondary diagnosis. CONCLUSIONS: Patients hospitalized with PE were 3-4 times less frequent than those with ACS or stroke, but had a higher mortality. One in every 3 patients with PE (but only one in every 10 with ACS or stroke) had secondary diagnosis, and these patients had the highest mortality.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Embolia Pulmonar/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Síndrome Coronariana Aguda/mortalidade , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/complicações , Comorbidade , Bases de Dados Factuais , Feminino , Insuficiência Cardíaca/epidemiologia , Mortalidade Hospitalar , Hospitalização , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Embolia Pulmonar/mortalidade , Insuficiência Respiratória/epidemiologia , Espanha/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade
18.
Med Clin (Barc) ; 144 Suppl 1: 31-7, 2015 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-25771090

RESUMO

Pulmonary thromboembolism (PE) is a common cause of morbidity and mortality in patients with cancer. Having cancer is an independent risk factor for death in the general series of patients with PE and is included as a variable in the prognostic scales of acute symptomatic PE. This fact limits the discriminatory power of these general scales for patients with cancer and has prompted the development of specific prognostic tools: POMPE-C and a scale derived from the RIETE registry. Whether the increased risk of death by PE in patients with cancer is due to complications related to the neoplasm or to a greater severity of the thromboembolic episode in this population has not been well studied. Moreover, the introduction of computed multidetector tomography in recent years has led to a growing diagnosis of incidental PE, which currently represents up to half of pulmonary embolisms in patients with cancer. The EPIPHANY study attempts to further the understanding of the characteristics of pulmonary embolisms in patients with cancer by including incidental and symptomatic events. Its primary objectives are a) to understand the clinical and epidemiological patterns of pulmonary embolism associated with cancer and b) to develop and validate a specific prognosis model for PE in this population. The registry includes variables of interest to oncology (cancer type and extent, oncospecific treatments, patient's functional condition, cancer progression), radiological variables (thrombotic burden, signs of ventricular overload and other findings), location of treatment (hospital or outpatient), acute complications and causes of death in patients with PE associated with cancer.


Assuntos
Técnicas de Apoio para a Decisão , Neoplasias/complicações , Embolia Pulmonar/diagnóstico , Protocolos Clínicos , Humanos , Achados Incidentais , Prognóstico , Embolia Pulmonar/etiologia , Embolia Pulmonar/mortalidade , Sistema de Registros , Projetos de Pesquisa , Medição de Risco , Fatores de Risco , Espanha
19.
Thorax ; 70(9): 909-11, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25666436

RESUMO

This study aimed to determine the effect of an evidence-based clinical decision support (CDS) algorithm on the use and yield of CT pulmonary angiography (CTPA) and on outcomes of patients evaluated in the emergency department (ED) for suspected PE. The study included 1363 consecutive patients evaluated for suspected PE in an ED during 12 months before and 12 months after initiation of CDS use. Introduction of CDS was associated with decreased CTPA use (55% vs 49%; absolute difference (AD), 6.3%; 95% CI 1.0% to 11.6%; p=0.02). The use of CDS was associated with fewer symptomatic venous thromboembolic events during follow-up in patients with an initial negative diagnostic evaluation for PE (0.7% vs 3.2%; AD 2.5%; 95% CI 0.9% to 4.6%; p<0.01).


Assuntos
Angiografia/métodos , Sistemas de Apoio a Decisões Clínicas , Embolia Pulmonar/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Algoritmos , Serviço Hospitalar de Emergência , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade
20.
Med. clín (Ed. impr.) ; 144(supl.1): 31-37, ene. 2015. tab
Artigo em Espanhol | IBECS | ID: ibc-136048

RESUMO

La tromboembolia pulmonar (TEP) constituye una causa frecuente de morbimortalidad en los pacientes oncologicos. Tener cancer es un factor de riesgo de muerte independiente en las series generales de pacientes con TEP y se incluye como variable en las escalas pronosticas de TEP aguda sintomatica. Este hecho limita el poder discriminatorio de estas escalas generales en los pacientes con cancer y ha motivado el desarrollo de herramientas pronosticas especificas: POMPE-C y una escala derivada del registro RIETE. No esta bien estudiado si el mayor riesgo de muerte por TEP en los pacientes con cancer se debe a complicaciones relacionadas con la neoplasia o a una mayor gravedad del episodio tromboembolico en esta poblacion. Por otro lado, la introduccion de la tomografia computarizada multidetector en los ultimos años ha comportado un diagnostico creciente de TEP incidental, que en la actualidad representa hasta la mitad de las embolias pulmonares en los pacientes oncologicos. El estudio EPIPHANY pretende profundizar en las caracteristicas propias de la embolia pulmonar en el paciente oncologico incluyendo TEP incidental y sintomatica. Sus objetivos principales son: a) conocer los patrones clinicoepidemiologicos de la embolia pulmonar asociada al cancer; b) desarrollar y validar un modelo pronostico especifico de TEP en esta poblacion. Incluye el registro de variables de interes en oncologia (tipo y extension del cancer, tratamientos oncoespecificos, estado funcional del paciente, progresion del cancer), variables radiologicas (carga trombotica, signos de sobrecarga ventricular y otros hallazgos adicionales), lugar de tratamiento (hospitalizacion o ambulatorio), complicaciones agudas y causas de muerte en los pacientes con TEP asociado al cáncer (AU)


Pulmonary thromboembolism (PE) is a common cause of morbidity and mortality in patients with cancer. Having cancer is an independent risk factor for death in the general series of patients with PE and is included as a variable in the prognostic scales of acute symptomatic PE. This fact limits the discriminatory power of these general scales for patients with cancer and has prompted the development of specific prognostic tools: POMPE-C and a scale derived from the RIETE registry. Whether the increased risk of death by PE in patients with cancer is due to complications related to the neoplasm or to a greater severity of the thromboembolic episode in this population has not been well studied. Moreover, the introduction of computed multidetector tomography in recent years has led to a growing diagnosis of incidental PE, which currently represents up to half of pulmonary embolisms in patients with cancer. The EPIPHANY study attempts to further the understanding of the characteristics of pulmonary embolisms in patients with cancer by including incidental and symptomatic events. Its primary objectives are a) to understand the clinical and epidemiological patterns of pulmonary embolism associated with cancer and b) to develop and validate a specific prognosis model for PE in this population. The registry includes variables of interest to oncology (cancer type and extent, oncospecific treatments, patient's functional condition, cancer progression), radiological variables (thrombotic burden, signs of ventricular overload and other findings), location of treatment (hospital or outpatient), acute complications and causes of death in patients with PE associated with cancer (AU)


Assuntos
Humanos , Embolia Pulmonar/epidemiologia , Tromboembolia Venosa/complicações , Neoplasias/complicações , Trombofilia/fisiopatologia , Indicadores de Morbimortalidade , Prognóstico , Fatores de Risco , Risco Ajustado
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