Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine

Background and objectives: Patients with heart failure (HF) often present with non-valvular atrial fibrillation and require oral anticoagulation with coumarin anticoagulants such as acenocoumarol. The objective of this study was to evaluate the relationship between time in therapeutic range (TTR) and the risk of early readmission. Materials and Methods: A retrospective descriptive study was carried out on hospitalized patients with a diagnosis of HF between 2014 and 2018 who had adverse effects due to oral anticoagulation with acenocoumarol (underdosing, overdosing, or hemorrhage). Clinical, analytical, therapeutic, and prognostic variables were collected. TTR is defined as the duration of time in which the patient’s International Normalized Ratio (INR) values were within a desired range. Early readmission was defined as readmission within 30 days after hospital discharge. Patients were divided into two groups depending on whether or not they had a TTR less than 60% (TTR < 60%) over the 6 months prior to the adverse event. Results: In the cohort of 304 patients, the mean age was 82 years, 59.9% of the patients were female, and 54.6% had a TTR < 60%. Patients with TTR < 60% had a higher HAS-BLED score (4.04 vs. 2.59; p < 0.001) and INR (6 vs. 5.31; p < 0.05) but lower hemoglobin (11.67 vs. 12.22 g/dL; p < 0.05). TTR < 60% was associated with early readmission after multivariate analysis (OR: 2.05 (CI 95%: 1.16–3.61)). They also had a higher percentage of hemorrhagic events and in-hospital mortality but without reaching statistical significance. Conclusions: Patients with HF and adverse events due to acenocoumarol often have poor INR control, which is independently associated with a higher risk of early readmission

Anemia falciforme: manifestaciones clínicas y estrategias terapéuticas

La anemia falciforme es una de las hemoglobinopatías de origen genético más prevalentes, en el mundo afecta a millones de personas. Localizada inicialmente de zonas como África subsahariana y Sudamérica, ha comenzado a llegar a nuestro medio debido al fenómeno de la inmigración. Esta enfermedad se caracteriza por una anemia crónica, crisis de dolor vasooclusivo y daño multiorgánico por la oclusión de la microvasculatura producida por los eritrocitos patológicos. La mejora producida en los últimos años en el tratamiento, con el uso de hydroxyurea, terapia transfusional o el transplante de precursores hematopoyéticos, ha aumentado la esperanza de vida considerablemente en los países desarrollados. Sin embargo, a pesar de estos avances, la enfermedad todavía causa gran impacto en la calidad y esperanza de vida de los pacientes, especialmente en aquellos que viven en zonas subdesarrolladas. Esta revisión se centra en las principales manifestaciones clínicas, así como en el tratamiento de esta enfermedad

Travelling across Cultures / Viaxes interculturais. The Twentieth-Century American Experience

Actas IV Congreso Spanish Association for American Studies, Santiago de Compostela, 24-26 marzo de 199

Peculiaridades del estudio en las principales áreas de conocimiento de la Universidad de Santiago de Compostela

Aportación al simposio "La calidad de la enseñanza y el aprendizaje en educación superior". Congreso Nacional de Modelos de Investigación Educativa (10º. 2001. La Coruña