Tromboprofilaxis en pacientes médicos hospitalizados. ¿A todos por igual? / Thromboprophylaxis in hospitalized medical patients. Do all alike?

Venous thromboembolic disease is the leading preventable cause of hospital mortality. Up to 75 percent of these are in non - surgical patients. This is a large, heterogeneous group of patients; so to know the risk factors for deep venous thrombosis crucial to provide a correct prevention. This article reviewed the indications, contraindications and complications of thromboprophylaxis. Difficult cases in elderly, obese, chronic kidney disease, critical care and cirrhotic patients were reviewed. The purpose of this article is to support decision – making on dvt prevention in hospitalized medical patients...

Frecuencia de tromboembolismo venoso en pacientes hospitalizados con cáncer: factores de riesgo y eficacia de la tromboprofilaxis farmacológica / Frequency of venous thromboembolism among hospitalized patients with cancer

Background: Hospitalized patients with cancer have a high risk of venous thromboembolism (VTE). Aim: To study the frequency of VTE and its risk factors in hospitalized patients with cancer. Material and methods: Retrospective analysis of clinical records of patients with cancer, hospitalized at a university hospital between 2002 and 2004. Patients with the diagnosis of VTE at admission or using anticoagulants, were excluded from the analysis. Results: The medical records of 366 patients were reviewed. Fifty three percent had a digestive cáncer, 19 percent lung cáncer, 10 percent breast cancer and 18 percent had a tumor of other origin. In 77 percent, the tumor was in an advanced stage. The most common admission diagnoses were pneumonía, vomiting and dehydration, gastrointestinal bleeding and urinary infection. In 125 patients (34 percent) pharmacological thrombo-prophylaxis was not used and 242 (66 percent) received regular or low molecular weight heparin. VTE was detected in 11 patients (3 percent) and was significantly more common among patients not receiving thrombo prophylaxis compared to those receiving heparin (6.4 percent and 1.2 percent, respectively p =0.014). Factors associated to VTE were a history ofprevious VTE with an odds ratio (OR) of 12.9 (p <0.01), obesity with an OR of 13.3 (p <0.01), recent chemotherapy with an OR of 6.9 (p =0.01). The use of pharmacological thromboprophylaxis had an OR of 0.24 (p =0.05). Conclusions: Three percent of patients in this series had VTE during the hospitalization. Pharmacological thrombo-prophylaxis significantly reduced the risk of VTE.

Valor pronóstico del nuevo sistema de etapificación internacional en mieloma múltiple: Comparación con el sistema de Durie-Salmon / Prognostic value of the new international staging system in multiple myeloma: Comparison with Durie-Salmon staging system

Background: Since 1975, the Durie-Salmon staging system (D&S) has been a widely accepted prognostic classification of multiple myeloma (MM) patients. Recently, the new International Staging System (ISS) was developed using only the values of albumin and betaZ-microglobulin. Aim: To compare survival of patients with MM treated in six medical centers in Chile according to the D&S system and the new ISS. Material and methods: Retrospective analysis of demographic information, clinical features and survival rate of patients treated between 1998 and 2002, and grouped according to both systems. Results: Information of 81 patients aged 38 to 90 years (43 women) was retrieved. According D&S system 11 percent were in stage I 12 percent in stage II and 73 percent in stage III According to ISS, 34 percent were in stage I 35 percent in stage II and 31 percent in stage III Median of survival of all patients was 32 months. Both staging systems had a prognostic value. However, median survival for the three stages of the ISS system was significantly different (67, 29 and 14 months in stages III and III, respectively, p =0.02). Patients in advanced stages II and III of the ISS, had a higher frequency of anemia, hypercalcemia, renal failure and hypoalbuminemia. In stages II and III of ISS the presence of renal failure was associated with a non significantly different lower survival. Conclusions: The ISS is a simple and effective grouping method for patients with MM, that predicts survival. The presence of renal insufficiency might identify a subgroup of patients included in stages II and III of ISS with a higher mortality.