RESUMEN
BACKGROUND: Age is a major risk factor for venous thromboembolism (VTE), yet patients aged ≥90 years are under-represented in clinical trials of anticoagulant therapy. The objectives were to describe and compare patient clinical characteristics, treatments, and outcomes (VTE recurrence, bleeding, and mortality) during the first 3 months of anticoagulation between VTE patients aged ≥90 years and those aged <90 years. METHODS: We analyzed data from the Registro Informatizado Enfermedad TromboEmbá½lica (RIETE), an ongoing global observational registry of patients with objectively confirmed acute VTE. RESULTS: From January 2001 to October 2022, 96,701 patients were registered in RIETE, of whom 3262 (3.4%) were aged ≥90 years. Patients aged ≥90 years were less likely to be men, and to have experienced cancer or recent surgery, but more likely to manifest immobility, chronic heart failure, anemia, renal insufficiency, or dementia than those aged <90 years. Most (99.6%) patients aged ≥90 years were receiving anticoagulant therapy. During the first 3 months, 26 patients aged ≥90 years developed VTE recurrences, 116 experienced major bleeding, and 564 died. Among patients initially presenting with pulmonary embolism (PE), deaths due to PE exceeded those due to fatal bleeding (76 vs. 19). Among those initially presenting with isolated deep-vein thrombosis (DVT), it was the reverse (2 vs. 11 deaths). CONCLUSIONS: In patients aged ≥90 years, the difference in the outcome of anticoagulant treatment depending on the initial presentation of VTE could suggest a need for different management approaches. Clinical trials evaluating the optimal duration of anticoagulation according to initial VTE presentation are warranted to limit excess deaths in this particular population.
Asunto(s)
Embolia Pulmonar , Tromboembolia Venosa , Femenino , Humanos , Masculino , Anticoagulantes/efectos adversos , Hemorragia/inducido químicamente , Hemorragia/epidemiología , Embolia Pulmonar/tratamiento farmacológico , Recurrencia , Sistema de Registros , Tromboembolia Venosa/tratamiento farmacológico , Anciano de 80 o más Años , Estudios Observacionales como AsuntoRESUMEN
BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is the most severe long-term complication of acute pulmonary embolism (PE). We aimed to evaluate the impact of a symptom screening programme to detect CTEPH in PE survivors. METHODS: This was a multicentre cohort study of patients diagnosed with acute symptomatic PE between January 2017 and December 2018 in 16 centres in Spain. Patients were contacted by phone 2 years after the index PE diagnosis. Those with dyspnoea corresponding to a New York Heart Association (NYHA)/WHO scale≥II, visited the outpatient clinic for echocardiography and further diagnostic tests including right heart catheterisation (RHC). The primary outcome was the new diagnosis of CTEPH confirmed by RHC. RESULTS: Out of 1077 patients with acute PE, 646 were included in the symptom screening. At 2 years, 21.8% (n=141) reported dyspnoea NYHA/WHO scale≥II. Before symptom screening protocol, five patients were diagnosed with CTEPH following routine care. In patients with NYHA/WHO scale≥II, after symptom screening protocol, the echocardiographic probability of pulmonary hypertension (PH) was low, intermediate and high in 76.6% (n=95), 21.8% (n=27) and 1.6% (n=2), respectively. After performing additional diagnostic test in the latter 2 groups, 12 additional CTEPH cases were confirmed. CONCLUSIONS: The implementation of this simple strategy based on symptom evaluation by phone diagnosed more than doubled the number of CTEPH cases. Dedicated follow-up algorithms for PE survivors help diagnosing CTEPH earlier. TRIAL REGISTRATION NUMBER: NCT03953560.
Asunto(s)
Hipertensión Pulmonar , Embolia Pulmonar , Humanos , Enfermedad Aguda , Enfermedad Crónica , Estudios de Cohortes , Disnea/diagnóstico , Disnea/etiología , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/complicaciones , Embolia Pulmonar/complicaciones , Embolia Pulmonar/diagnóstico , Factores de RiesgoRESUMEN
In patients receiving anticoagulant therapy for venous thromboembolism (VTE), the important issue of anemia influence on the risk of bleeding has not been consistently studied. We used the large registry data RIETE (Registro Informatizado Enfermedad Tromboembólica) to compare the rate of major bleeding in patients receiving anticoagulant therapy for VTE according to the presence or absence of anemia at baseline. Patients with or without cancer were separately studied. Until August 2016, 63492 patients had been enrolled. Of these, 21652 (34%) had anemia and 14312 (23%) had cancer. Anemia was found in 57% of the patients with cancer and in 28% without (odds ratio 3.46; 95% CI 3.33-3.60). During the course of anticoagulant therapy, 680 patients with cancer had a major bleeding event (gastrointestinal tract 43%, intracranial 14%, hematoma 12%). Cancer patients with anemia had a higher rate of major bleeding (rate ratio [RR]: 2.52; 95% CI 2.14-2.97) and fatal bleeding (RR 2.73; 95% CI 1.95-3.86) than those without anemia. During the course of anticoagulation, 1133 patients without cancer had major bleeding (gastrointestinal tract 32%, hematoma 24%, intracranial 21%). Patients with anemia had a higher rate of major bleeding (RR 2.84; 95% CI 2.52-2.39) and fatal bleeding (RR 2.76; 95% CI 2.07-3.67) than those without. On a multivariable analysis, anemia independently predicted the risk for major bleeding in patients with and without cancer (hazard ratios: 1.66; 95% CI 1.40-1.96 and 1.95; 95% CI 1.72-2.20, respectively). During anticoagulation for VTE, both cancer- and non-cancer anemic patients had a higher risk for major bleeding than those without anemia. In anemic patients (with or without cancer), the rate of major bleeding during the course of anticoagulant therapy exceeded the rate of VTE recurrences. In patients without anemia the rate of major bleeding was lower than the rate of VTE recurrences.
Asunto(s)
Anemia/complicaciones , Anticoagulantes/efectos adversos , Hemorragia/inducido químicamente , Neoplasias/complicaciones , Tromboembolia Venosa/complicaciones , Anticoagulantes/uso terapéutico , Humanos , Sistema de Registros , Riesgo , Tromboembolia Venosa/tratamiento farmacológicoRESUMEN
PURPOSE: The aim of the study was to investigate whether floppy eyelid syndrome (FES) could be an indicator of glaucoma in patients with obstructive sleep apnea (OSA). MATERIALS AND METHODS: A total of 152 patients were included: 75 patients with OSA and without FES; 52 patients with OSA and FES; and 25 non-OSA patients. The presence of FES was defined by easy upper eyelid eversion and tarsal papillary conjunctivitis. All the patients underwent a complete ophthalmologic examination to diagnose glaucoma; this included computerized perimetry and retinal fiber layer measurements with optical coherence tomography. RESULTS: The prevalence of glaucoma in OSA patients without FES was 5.33% (4/75). One patient had primary open-angle glaucoma and 3 had previously diagnosed glaucoma. The prevalence of glaucoma in OSA patients with FES was 23.07% (12/52). Six patients had normal-tension glaucoma, 5 had primary open-angle glaucoma and one patient had previously diagnosed glaucoma. None of the 25 patients without OSA had glaucoma. The difference in the prevalence of glaucoma between OSA patients without FES (5.3%) and OSA patients with FES (23.07%) was statistical significant (P=0.004). When adjustments were made for age and body mass index, this significance remained (P=0.04). CONCLUSIONS: These data suggest that FES may offer a useful way to identify individuals with a greater probability of having glaucoma in the OSA population.