Guía gallega de manejo de la trombosis asociada a cáncer. II edición

Esta guía práctica y sencilla, guiará en el diagnóstico y tratamiento de los pacientes con trombosis y cáncer. Pretende reducir la variabilidad en el manejo en la Comunidad Autónoma de Galicia y reducir el impacto negativo que la trombosis presenta en los pacientes con cáncer.This practical and simple guide will guide in the diagnosis and treatment of patients with thrombosis and cancer. It aims to reduce variability in management in the Autonomous Community of Galicia and reduce the negative impact that thrombosis has on cancer patients.Esta guía práctica e sinxela, guiará no diagnóstico e tratamento dos pacientes con trombose e cancro. Pretende reducir a variabilidade no manexo na Comunidade Autónoma de Galicia, e reducir o impacto negativo que a trombose presenta nos pacientes con cancro.Con el Aval de la Sociedad Oncológica de Galicia (SOG) y la Sociedade Galega de Medicina Interna (SOGAMI). Publicado en Barcelona por Bubblegum Communication Services el 25 de ocutubre de 2019. ISBN: 978-84-09-1419-4LEO Pharm

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Enfermedad tromboembólica en pacientes ingresados en Neurocirugía: características y manejo de la anticoagulación en un hospital terciario

Resumen Introducción y objetivos: Los pacientes neuroquirúrgicos tienen un elevado riesgo de enfermedad tromboembólica (ETV); sin embargo, su manejo es difícil dado el alto riesgo de sangrado grave. Analizamos características, evolución y tratamiento de los pacientes con ETV en Neurocirugía en nuestro centro. Material y métodos: revisión retrospectiva de historias clínicas de pacientes ingresados en Neurocirugía entre el 01/01/2017 y el 31/12/2021 con ETV. Resultados: Entre el 01/01/2017 y el 31/12/2021 13 pacientes ingresados en Neurocirugía recibieron el diagnóstico de ETV (77% varones, mediana de 66 años). La mayoría ingresaron para cirugía de tumor de SNC o hemorragia intracraneal. El 61% tenían tromboembolismo pulmonar (TEP), 23% trombosis venosa profunda (TVP) y 15% ambos. En 7 de los 13 pacientes la ETV se produjo tras la cirugía (mediana, 13 días después), y 4 pacientes el diagnóstico de ETV era previo (mediana, 26 días antes). La anticoagulación se inició una mediana de 12 días tras la cirugía con heparina de bajo peso molecular (HBPM), y en la mayoría a dosis infraterapéutica, que se fue aumentando progresivamente hasta alcanzar dosis plenas una mediana de 13 días tras la intervención. No se registró ninguna complicación hemorrágica. Dos pacientes fallecieron por su enfermedad de base. Conclusiones: los pacientes neuroquirúrgicos presentan varios factores de riesgo para ETV, que es particularmente difícil de manejar por el alto riesgo de sangrado. En nuestra muestra la mayoría recibieron inicialmente dosis infraterapéuticas de HBPM sin que se registraran hemorragias. Se precisan más estudios para guiar la anticoagulación en esta población. Abstract Introduction and objectives: The neurosurgical patients have a high risk of venous thromboembolism (VTE). However, the management is complex due to high risk of serious bleeding. We herein analyse characteristics, treatment and outcome of the neurosurgical patients with VTE in our centre Methods: retrospective analysis of medical records from the patients admitted to the Neurosurgery ward and with VTE from 01/01/22017 to 12/31/2021 Results: From 01/01/2017 to 12/31/2021, 13 patients admitted to Neurosurgery ward were diagnosed of VTE (77% male, median age 66 years-old). Most of them were admitted because of CNS tumour or intracranial bleeding. 61% had pulmonary embolism (PE) 23% deep venous thrombosis (DVT) and 15% both. In 7 out of 13 patients ETV occurred after surgery (median, 13 days after) and 4 has a previous diagnosis of VTE (median, 26 days before). Anticoagulation was initiated a median of 12 days after surgery with low molecular weight heparin (LMWH), in most of the cases with an infra-therapeutic dose which was progressively increased to maximum doses a median of 13 days after surgery. No bleeding complication was recorded. Two patients died due to their previous illness Conclusions: the neurosurgical patients have several risk factors for VTE, which is especially difficult to manage due to the high bleeding risk. In our centre most patients received initially infra-therapeutic doses of LMWH, and no bleeding events occurred. More studies are needed to guide anticoagulation in this population