Adäquate Kontrazeption bei Übergewicht und Adipositas

Wie in allen Ländern der westlichen Welt steigt die Prävalenz von Übergewicht und Adipositas auch in der Schweiz. Zugleich zeigt sich, dass adipöse Frauen häufiger unerwartet und ungewollt schwanger werden als normalgewichtige Frauen (1). Die unzureichende Applikation effektiver Kontrazeptionsmethoden liegt zum einen an pathophysiologischen Besonderheiten, zum anderen aber auch an psychosozialen Faktoren. All das ist bei einer adäquaten Kontrazeptionsberatung zu berücksichtigen

Anticoagulation management practices and outcomes in elderly patients with acute venous thromboembolism: A clinical research study

Whether anticoagulation management practices are associated with improved outcomes in elderly patients with acute venous thromboembolism (VTE) is uncertain. Thus, we aimed to examine whether practices recommended by the American College of Chest Physicians guidelines are associated with outcomes in elderly patients with VTE. We studied 991 patients aged ≥65 years with acute VTE in a Swiss prospective multicenter cohort study and assessed the adherence to four management practices: parenteral anticoagulation ≥5 days, INR ≥2.0 for ≥24 hours before stopping parenteral anticoagulation, early start with vitamin K antagonists (VKA) ≤24 hours of VTE diagnosis, and the use of low-molecular-weight heparin (LMWH) or fondaparinux. The outcomes were all-cause mortality, VTE recurrence, and major bleeding at 6 months, and the length of hospital stay (LOS). We used Cox regression and lognormal survival models, adjusting for patient characteristics. Overall, 9% of patients died, 3% had VTE recurrence, and 7% major bleeding. Early start with VKA was associated with a lower risk of major bleeding (adjusted hazard ratio 0.37, 95% CI 0.20-0.71). Early start with VKA (adjusted time ratio [TR] 0.77, 95% CI 0.69-0.86) and use of LMWH/fondaparinux (adjusted TR 0.87, 95% CI 0.78-0.97) were associated with a shorter LOS. An INR ≥2.0 for ≥24 hours before stopping parenteral anticoagulants was associated with a longer LOS (adjusted TR 1.2, 95% CI 1.08-1.33). In elderly patients with VTE, the adherence to recommended anticoagulation management practices showed mixed results. In conclusion, only early start with VKA and use of parenteral LMWH/fondaparinux were associated with better outcomes

Associations between anticoagulation practices and clinical outcomes at 6 months.

<p>Associations between anticoagulation practices and clinical outcomes at 6 months.</p

Patient baseline characteristics (N = 991).

<p>Patient baseline characteristics (N = 991).</p

Association between anticoagulation practices and length of hospital stay^*.

<p>Association between anticoagulation practices and length of hospital stay^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0148348#t004fn002" target="_blank">*</a>}.</p