Anticoagulantes orales directos (ACOD) en enfermedad tromboembólica venosa: evaluación de la escala SAMe-TT2R2 para determinar su utilización frente a antivitamina K y utilidad clínica de los ACOD en diferentes escenarios

La enfermedad tromboembólica venosa (ETV) es la tercera causa de muerte cardiovascular, con una elevada morbilidad y mortalidad. El pilar del tratamiento de la ETV es la anticoagulación, que previene de forma eficaz la recurrencia de la enfermedad, pero cuyo principal efecto adverso es el sangrado. El tratamiento anticoagulante clásico incluye fármacos parenterales como las heparinas y fármacos orales como los antivitamina K (AVK). En los últimos años, se han desarrollado nuevos anticoagulantes orales de acción directa (ACODs) que inhiben los factores de la coagulación II (dabigatran) o Xa (rivaroxaban, edoxaban y apixaban). Los ACODs han desplazado a los AVK como anticoagulantes de administración oral de elección en la ETV en pacientes sin cáncer, ya que son tan eficaces como el tratamiento convencional pero con menos riesgo de sangrado; además, son más cómodos de usar por su dosis fija, sin necesidad de monitorización, la ausencia de interacción con los alimentos (a diferencia de los AVK) y sus escasas interacciones con otros fármacos..

Absceso de psoas por Staphylococcus lugdunensis

ResumenStaphylococcus lugdunensis es un estafilococo coagulasa negativo, de protagonismo creciente y comportamiento atípico. Cada vez son más y de mayor espectro las infecciones descritas que lo señalan como agente causal. Los abscesos de psoas ocasionados por este germen son muy poco frecuentes. En este trabajo, presentamos un caso de absceso de psoas causado por S. lugdunensis en una paciente con diabetes mellitus y artritis reumatoide, que fue tratada con cloxacilina intravenosa, con buena evolución posterior.AbstractStaphylococcus lugdunensis is a coagulase-negative staphylococcus of growing importance and atypical behavior. The infections caused by this microorganism are becoming more frequent, having a broader spectrum. Psoas abscesses caused by this germ are rare, with few cases reported in the literature. In this work, we present a case of a psoas abscess caused by S. lugdunensis in a patient suffering from diabetes mellitus and rheumatoid arthritis, which was treated with intravenous cloxacillin with a good outcome

Update on Extended Treatment for Venous Thromboembolism

The importance of assessing the probability of venous thromboembolism recurrence, a condition that includes deep vein thrombosis and pulmonary embolism, lies in the fact that it is the most important factor in deciding the duration of anticoagulant treatment. Risk of recurrence depends mostly on the presence of a risk factor for developing venous thromboembolism, with patients with unprovoked events being at the higher risk of recurrence. The risk of recurrence needs to be balanced with the risk of bleeding and the potential severity of these thrombotic and hemorrhagic events. In patients with an unprovoked venous thromboembolism who complete treatment for the acute (first 10 days) and post-acute phase of the disease (from day 10 to 3-6 months), decision has to be made regarding prolonged antithrombotic therapy to prevent recurrences. The main goal of extended treatment is preventing recurrences with a safe profile in terms of bleeding risk. Many therapeutic options are now available for these patients, including antiplatelet therapy with aspirin or direct oral anticoagulants. Moreover, apixaban and rivaroxaban at prophylactic doses have demonstrated efficacy in preventing recurrences with a low risk of bleeding

Trombosis venosa superficial extensa y síndrome de Behçet

Superficial venous thrombosis is frequent; its main risk factor is variceal veins’ presence in lower limbs, although it can occur in other prothrombotic states. Behçet syndrome is a chronic disease characterized by recurrent oral and genital aphthous and ocular involvement; vascular involvement may also appear, which is a diagnostic criterion. A 62-year-old woman, with recurrent oral and ocular involvement (uveitis) was admitted in the emergency room because of superficial venous thrombosis, meeting diagnostic criteria for Behçet syndrome. The treatment of vein thrombosis in Behçet syndrome is immunosuppression. We started azathioprine, and no recurrences were registered.La trombosis venosa superficial es frecuente; su principal factor de riesgo es la presencia de venas varicosas en miembros inferiores, aunque también puede ocurrir en otros estados protrombóticos. El síndrome de Behçet es una enfermedad crónica, caracterizada por aftas orales y genitales y afectación ocular, que también puede aparecer con manifestaciones vasculares, actual criterio diagnóstico. Mujer de 62 años, con antecedentes de episodios de aftas orales y uveítis, acude a Urgencias por trombosis venosa superficial; cumple los criterios para el diagnóstico de síndrome de Behçet. El tratamiento de las trombosis venosas en el síndrome de Behçet es la inmunosupresión. Se inició tratamiento con azatioprina sin recurrencias posteriores.

Shock séptico y tóxico secundario a fascitis necrotizante facial por estreptococo betahemolítico del grupo A en un paciente inmunocompetente

We present the case of a 74 year-old male with previous history of chronic global respiratory failure that was admitted for fever, pain and swelling in the area around the left eye. The clinical picture rapidly progressed in a few hours, affecting the contralateral face and progressing towards the supraclavicular zone. Streptococcus pyogenes was confirmed and the patient required emergent surgical treatment, where he developed hemodynamic instability in the form of septic shock.Se expone el caso de un varón de 74 años con historia previa de insuficiencia respiratoria global crónica que acude por episodio de fiebre, dolor e inflamación a nivel periorbitario izquierdo. El cuadro clínico progresó de forma muy llamativa en pocas horas, afectando a la hemicara contralateral y extendiéndose hacia región supraclavicular ipsilateral. Se confirmó la presencia de Streptococcus pyogenes y el paciente requirió tratamiento quirúrgico urgente, donde presentó inestabilidad hemodinámica en forma de shock séptico

Trombosis venosa profunda de miembro superior, embarazo y trombofilia múltiple

We present the case of a 11-week pregnant woman with previous history of recurrent venous thromboembolic disease consulting for a new episode of deep vein thrombosis despite anticoagulation and adequate therapeutic compliance. She is diagnosed of a high risk thrombophilia. It is discussed the therapeutic management and the most important aspects of anticoagulation in a pregnant woman with thrombophilia.Se expone el caso de una gestante de 11 semanas con historia previa de enfermedad tromboembólica venosa  de repetición que acude por un episodio de trombosis venosa profunda de miembro superior izquierdo, a pesar de encontrarse recibiendo tratamiento anticoagulante con buen cumplimiento terapéutico. En el estudio realizado se diagnostica una trombofilia de alto riesgo. Se discute el manejo terapéutico que se llevó a cabo en esta paciente y los aspectos más destacados de la anticoagulación en la embarazada con trombofilia

Machine learning to predict major bleeding during anticoagulation for venous thromboembolism: possibilities and limitations

Predictive tools for major bleeding (MB) using machine learning (ML) might be advantageous over traditional methods. We used data from the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) to develop ML algorithms to identify patients with venous thromboembolism (VTE) at increased risk of MB during the first 3 months of anticoagulation. A total of 55 baseline variables were used as predictors. New data prospectively collected from the RIETE were used for further validation. The RIETE and VTE-BLEED scores were used for comparisons. External validation was performed with the COMMAND-VTE database. Learning was carried out with data from 49 587 patients, of whom 873 (1.8%) had MB. The best performing ML method was XGBoost. In the prospective validation cohort the sensitivity, specificity, positive predictive value and F1 score were: 33.2%, 93%, 10%, and 15.4% respectively. F1 value for the RIETE and VTE-BLEED scores were 8.6% and 6.4% respectively. In the external validation cohort the metrics were 10.3%, 87.6%, 3.5% and 5.2% respectively. In that cohort, the F1 value for the RIETE score was 17.3% and for the VTE-BLEED score 9.75%. The performance of the XGBoost algorithm was better than that from the RIETE and VTE-BLEED scores only in the prospective validation cohort, but not in the external validation cohort

Mid-Regional Pro-Adrenomedullin, Methemoglobin and Carboxyhemoglobin as Prognosis Biomarkers in Critically Ill Patients with COVID-19: An Observational Prospective Study

Depto. de MedicinaFac. de MedicinaTRUEpu

Inflammatory Biomarkers in the Short-Term Prognosis of Venous Thromboembolism: A Narrative Review

The relationship between inflammation and venous thrombosis is not well understood. An inflammatory response may be both the cause and consequence of venous thromboembolism (VTE). In fact, several risk factors of VTE modulate thrombosis through inflammatory markers. Acute pulmonary embolism (PE) is burdened by a remarkable mortality rate, up to 34% in severely ill patients presenting with hemodynamic instability. Initial mortality risk stratification is based on hemodynamic instability. Patients with a situation of hemodynamic stability require immediate further risk assessment based on clinical, imaging, and circulating biomarkers, as well as the presence of comorbidities. Some inflammatory biomarkers have shown potential usefulness in the risk stratification of patients with VTE, especially acute PE. C-reactive protein on admission is associated with 30-day mortality and bleeding in VTE patients. P-selectin is associated with right ventricle dysfunction in PE patients and might be associated with VTE recurrences and the extension of thrombosis. Tissue factor microparticles are associated with VTE recurrence in cancer-associated thrombosis. Other inflammatory biomarkers present scarce evidence (inflammatory cytokines, erythrocyte sedimentation rate, fibrinogen, leukocyte count). In this manuscript, we will review the prognostic role of different inflammatory biomarkers available both for clinical practice and research in VTE patients

A rare case of stroke as a complication after percutaneous mechanical thrombectomy in a patient with intermediate-high risk pulmonary embolism and patent foramen ovale

We present an extremely rare case of a patient with intermediate-high risk pulmonary embolism treated with percutaneous mechanical thrombectomy, complicated with stroke as a form of paradoxical embolism through a previously unknown patent foramen ovale. We reviewed the literature for indications, efficacy, and safety of this procedure, as well as for experience on this technique in patients with patent foramen ovale