RESUMEN
Up to 20% of cancer patients will develop some manifestation of venous thromboembolic disease (VTD) during their clinical course. VTD greatly impacts morbidity, mortality, quality of life and pharmaceutical expenditure. In addition, both thrombotic relapse and major haemorrhages derived from VTD treatment are more likely in oncological patients. To make the decision to establish secondary thromboprophylaxis as an indefinite treatment in these patients, it is important to review all the risk factors involved, whether related to the disease, the patient or the prior thrombotic event. The objectives of this consensus of the Spanish Society of Internal Medicine (Sociedad Española de Medicina Interna-SEMI) and the Spanish Society of Medical Oncology (Sociedad Española de Oncología Médica-SEOM) are to establish recommendations that help assess the risk of recurrence of VTD and haemorrhagic risk in patients with cancer, as well as to analyse the evidence that exists on the currently available drugs, which will allow the establishment of a protocol for shared decision-making with the informed patient.
Asunto(s)
Consenso , Inhibidores del Factor Xa/uso terapéutico , Hemorragia/inducido químicamente , Neoplasias/complicaciones , Prevención Secundaria/métodos , Tromboembolia Venosa/prevención & control , Factores de Edad , Inhibidores de la Angiogénesis/efectos adversos , Anticoagulantes/uso terapéutico , Antineoplásicos/efectos adversos , Toma de Decisiones Conjunta , Inhibidores del Factor Xa/efectos adversos , Humanos , Medicina Interna , Oncología Médica , Mutación , Neoplasias/genética , Neoplasias/patología , Neoplasias/terapia , Recurrencia , Factores de Riesgo , Prevención Secundaria/normas , Sociedades Médicas , España , Tromboembolia Venosa/sangre , Tromboembolia Venosa/etiologíaRESUMEN
BACKGROUND: There is little information on the influence of body mass index (BMI) on mortality in patients with acute venous thromboembolism (VTE). PATIENTS AND METHODS: RIETE is an ongoing registry of consecutive patients with symptomatic, objectively confirmed, acute VTE. We examined the association between BMI and mortality during the first 3 months of therapy. RESULTS: Of the 10 114 patients enrolled as of March 2007: 153 (1.5%) were underweight (BMI < 18.5); 2882 (28%) had a normal weight (BMI 18.5-24.9); 4327 (43%) were overweight (BMI 25.0-30); and 2752 (27%) were obese (BMI > 30). The overweight and obese patients were significantly older, and were less likely to have had cancer, recent immobility or renal insufficiency. After 3 months of therapy their death rates were 28%, 12%, 6.2% and 4.2%, respectively. In multivariate analysis, the relative risks for death after adjusting for confounding variables including age, cancer, renal insufficiency or idiopathic VTE were: 2.1 (95% CI, 1.5-2.7); 1.0 (reference); 0.6 (95% CI, 0.5-0.7); and 0.5 (95% CI, 0.4-0.6), respectively. The rates of fatal pulmonary embolism (2.0%, 2.1%, 1.2% and 0.8%, respectively) also decreased with BMI. There were no differences in the rate of fatal bleeding, but patients who were underweight had an increased incidence of major bleeding complications (7.2% vs. 2.7%; odds ratio, 2.7; 95% CI, 1.4-5.1). CONCLUSIONS: Obese patients with acute VTE have less than half the mortality rate when compared with normal BMI patients. This reduction in mortality rates was consistent among all subgroups and persisted after multivariate adjustment.
Asunto(s)
Índice de Masa Corporal , Sistema de Registros/estadística & datos numéricos , Tromboembolia Venosa/mortalidad , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/efectos adversos , Anticoagulantes/uso terapéutico , Argentina/epidemiología , Comorbilidad , Europa (Continente)/epidemiología , Femenino , Hemorragia/inducido químicamente , Hemorragia/mortalidad , Humanos , Israel/epidemiología , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Obesidad/epidemiología , Estudios Prospectivos , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/mortalidad , Insuficiencia Renal/epidemiología , Tromboembolia Venosa/tratamiento farmacológicoRESUMEN
The history of a 12 year old male, who developed a bidirectional tachycardia and sudden death without evidence of neurological or cardiac disease is described. The role of bidirectional tachycardia related to sudden death is discussed, as well as its possible origin and mechanisms, based on the case described.