Tratamiento anticoagulante en pacientes con enfermedad tromboembólica venosa: revisión bibliográfica y análisis epidemiológico de los pacientes pertenecientes al sector III de Zaragoza

Introducción: El seguimiento de la trombosis venosa profunda puede resultar complejo debido a la falta de consenso y a la gran variabilidad clínica de los pacientes que la presentan. Métodos: Revisión bibliográfica de las últimas guías de práctica clínica a través del sistema de gestión de tratamiento anticoagulante Gota (Werfen). Resultados: Se han analizado 287 pacientes diagnosticados de TVP en el año 2015; de ellos 153 son mujeres y 134 hombres. Sufrieron una TVP provocada el 69,7% de los pacientes, y el resto (30,3%) fue no provocada. De los 287 pacientes, el 87,5% (251) mantiene el tratamiento más de 90 días; de ellos 180 son TVP provocadas y 71 no provocadas. Conclusiones: La mayoría de los pacientes revisados lleva tratamiento extenso sin que exista una justificación clínica o biológica, a pesar de las recomendaciones de práctica clínica

ANÁLISIS DESCRIPTIVO DE LOS PACIENTES EN PREVENCIÓN SECUNDARIA DE TROMBOSIS RECURRENTE EN EL SECTOR III DE ZARAGOZA

ANTECEDENTESLa recurrencia de la ETEV y su tratamiento es un problema no resuelto a día de hoy: las guías de práctica clínica limitan el tratamiento entre 6 y 12 meses dependiendo de las circunstancias de aparición del evento y los factores clínicos de riesgo.Es un reto en nuestras consultas realizar una selección adecuada de los pacientes que precisan tratamiento extendido más allá de este periodo establecido para evitar recurrencias. En los últimos años, los ACODs son una alternativa terapéutica como tratamiento del evento agudo y también como prevención de recurrencias en este subgrupo de pacientes.OBJETIVOSEl objetivo principal se trata de describir las características los pacientes de nuestro sector que tienen indicación de recibir prevención secundaria de ETEV con ACODs.MATERIAL Y MÉTODOSSe trata de un estudio observacional, descriptivo, retrospectivo sobre una cohorte de pacientes que se encuentran en tratamiento de prevención secundaria de trombosis recurrentes con ACODs del sector III de Aragón.RESULTADOSSe recogieron datos de una cohorte de 27 pacientes. Se obtuvieron variables demográficas, clínicas y biológicas, tanto en el evento inicial como en el seguimiento y reevaluación posteriores.CONCLUSIONESLos ACODs a dosis de prevención secundaria son una opción terapéutica eficaz y segura en los pacientes que requieren tratamiento extendido.PALABRAS CLAVEPrevención secundaria, enfermedad tromboembólica venosa, trombosis venosa profunda, embolia pulmonar, anticoagulantes orales de acción directa<br /

Consensus Statement on Hemostatic Management, Anticoagulation, and Antiplatelet Therapy in Liver Transplantation

Anticoagulation and antiplatelet therapies are increasingly used in liver transplant (LT) candidates and recipients due to cardiovascular comorbidities, portal vein thrombosis, or to manage posttransplant complications. The implementation of the new direct-acting oral anticoagulants and the recently developed antiplatelet drugs is a great challenge for transplant teams worldwide, as their activity must be monitored and their complications managed, in the absence of robust scientific evidence. In this changing and clinically heterogeneous scenario, the Spanish Society of Liver Transplantation and the Spanish Society of Thrombosis and Haemostasis aimed to achieve consensus regarding the indications, drugs, dosing, and timing of anticoagulation and antiplatelet therapies initiated from the inclusion of the patient on the waiting list to post-LT surveillance. A multidisciplinary group of experts composed by transplant hepatologists, surgeons, hematologists, transplant-specialized anesthesiologists, and intensivists performed a comprehensive review of the literature and identified 21 clinically relevant questions using the patient-intervention-comparison-outcome format. A preliminary list of recommendations was drafted and further validated using a modified Delphi approach by a panel of 24 transplant delegates, each representing a LT institution in Spain. The present consensus statement contains the key recommendations together with the core supporting scientific evidence, which will provide guidance for improved and more homogeneous clinical decision making

Genetic Cross-Interaction between APOE and PRNP in Sporadic Alzheimer's and Creutzfeldt-Jakob Diseases

Alzheimer's disease (AD) and Creutzfeldt-Jakob disease (CJD) represent two distinct clinical entities belonging to a wider group, generically named as conformational disorders that share common pathophysiologic mechanisms. It is well-established that the APOE ε4 allele and homozygosity at polymorphic codon 129 in the PRNP gene are the major genetic risk factors for AD and human prion diseases, respectively. However, the roles of PRNP in AD, and APOE in CJD are controversial. In this work, we investigated for the first time, APOE and PRNP genotypes simultaneously in 474 AD and 175 sporadic CJD (sCJD) patients compared to a common control population of 335 subjects. Differences in genotype distribution between patients and control subjects were studied by logistic regression analysis using age and gender as covariates. The effect size of risk association and synergy factors were calculated using the logistic odds ratio estimates. Our data confirmed that the presence of APOE ε4 allele is associated with a higher risk of developing AD, while homozygosity at PRNP gene constitutes a risk for sCJD. Opposite, we found no association for PRNP with AD, nor for APOE with sCJD. Interestingly, when AD and sCJD patients were stratified according to their respective main risk genes (APOE for AD, and PRNP for sCJD), we found statistically significant associations for the other gene in those strata at higher previous risk. Synergy factor analysis showed a synergistic age-dependent interaction between APOE and PRNP in both AD (SF = 3.59, p = 0.027), and sCJD (SF = 7.26, p = 0.005). We propose that this statistical epistasis can partially explain divergent data from different association studies. Moreover, these results suggest that the genetic interaction between APOE and PRNP may have a biological correlate that is indicative of shared neurodegenerative pathways involved in AD and sCJD

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

Análisis descriptivo de los pacientes con enfermedad tromboembólica venosa recurrente no provocada en el sector III de Zaragoza

En los pacientes con un primer episodio de enfermedad tromboembólica venosa no provocada el riesgo de recurrencia es significativo. Algunos factores, como el sexo masculino, elevación de la concentración de dímero-D tras finalizar la anticoagulación, se asocian a un mayor riesgo de recidiva por lo que deberían tenerse en cuenta; otros factores, como la trombofilia y la trombosis venosa residual, tienen una relación más controvertida. Se han propuesto algunos modelos de predicción del riesgo de recurrencia trombótica tras la anticoagulación en la tromboembolia venosa no provocado, pero necesitan una validación externa para conocer su utilidad real en la práctica clínica. En este estudio descriptivo, observacional, restrospectivo, se analizan unas variables biológicas, clínicas y analíticas de 27 pacientes, pertenecientes al sector III de Zaragoza, que han presentado un segundo evento trombótico durante el tratamiento anticoagulante o una vez finalizado

Treatment preferences as basis for decision making in patients using direct oral anticoagulants in Spain.

Treatment preferences are considered a relevant decision-making driver by the main atrial fibrillation (AF) guidelines. Direct Oral Anticoagulants (DOACs), considered as similar clinically, have administration differences useful for treatment individualization. Preferences, priorities and satisfaction of DOAC users were assessed through an observational, multicentric (25 hospitals), cross-sectional study including adult AF-patients (and/or caregivers) in Spain. Three study groups were considered according to DOAC posology preferences: (A) once-daily, with water; (B) once-daily, with food; (C) twice-daily. Overall, 332 patients and 55 caregivers were included. Mean (SD) age was 73.7 (10.7) years [58.7 (13.9) for caregivers]; 51.5% women [69.1% for caregivers]; 80.7% showed comorbidities and poly-pharmacy [6.6 (3.3) drugs/day]. No statistically significant differences were shown among study groups. Once-daily administration was preferred by 274 patients (82.5%) [60.8% (Group A); 21.7% (Group B); 17.5% (Group C)], and 47 caregivers (85.5%) [58.2% (Group A); 27.3% (Group B); 14.5% (Group C)]. Once-daily DOACs were prescribed in 42.8% of the patients. Bleeding risk was the main concern for both, patients and caregivers, followed by DOAC posology and interactions. Although treatment satisfaction (patients and caregivers) was high (9.0 and 9.1 points, respectively), match between individual treatment preferences and real prescriptions was only shown in 41.0% of AF-patients, evidencing a need for patient involvement on treatment decision-making. There is not a patient profile linked to treatment preferences, and clinical criteria must be the main driver for decision-making. However, for most AF-patients (elderly patients), aged, with comorbidity, poly-pharmacy and high cardiovascular risk, once-daily DOACs would be the preferred option