riesgo de enfermedad tromboembólica venosa en pacientes con enfermedad aguda internados en urgencias


reSUMen antecedentes: la enfermedad tromboembólica venosa es un problema de salud pública grave en todo el mundo y una de las principales causas de muerte potencialmente prevenible en hospitales. Es necesario conocer los factores de riesgo para enfermedad tromboembólica venosa desde los servicios de urgencias. objetivo: conocer los factores de riesgo para enfermedad tromboembólica venosa en pacientes con enfermedad aguda internados en urgencias. Pacientes y método: estudio retrospectivo efectuado en pacientes ingresados en urgencias adultos durante los meses de enero y febrero del 2009 evaluados según el número y características de factores de riesgo para enfermedad tromboembólica venosa definidos por las guías del ACCP. Con base en la cantidad de factores de riesgo se determinó la posibilidad de llegar a padecer enfermedad tromboem-bólica venosa. resultados: durante el periodo de estudio ingresaron a la sala de observación de urgencias adultos 2,050 pacientes, de los que se consideraron 1,980 susceptibles de estudio. El promedio de edad fue de 58.5 años. 920 hombres y 1,060 mujeres. 970 pacientes tenían más de 60 años de edad. Obesidad e insuficiencia venosa periférica se reportaron en 26% de los casos, insuficiencia renal crónica se encontró en 376 pacientes. 257 tenían inmovilización prolongada y en 158 se estableció diagnóstico de algún tipo de neoplasia. Más de 80% de los pacientes tienen por lo menos dos factores de riesgo para enfermedad tromboembólica venosa y más de 70% tienen riesgo alto de enfermedad tromboembólica venosa (más de tres factores de riesgo). Conclusión: la mayoría de los pacientes ingresados a urgencias tienen riesgo alto o muy alto de enfermedad tromboembólica venosa. Se debe realizar un análisis del número de factores de riesgo y establecer medidas profilácticas efectivas que permitan reducir la morbilidad y mortalidad de esta enfermedad. Palabras clave: factores de riesgo, tromboembolismo venoso. aBStraC Background: Venous thromboembolic disease is a serious public health problem throughout the world and a major cause of potentially preventable deaths in hospitals. It is necessary to know the risk factors for venous thromboembolic from the emergency services.

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    ABSTRACT: The appropriate duration of oral anticoagulation after a first episode of venous thromboembolism (VTE) is uncertain and depends upon VTE recurrence rates. To estimate VTE recurrence rates and determine predictors of recurrence. Patients in Olmsted County, Minnesota, with a first lifetime deep vein thrombosis or pulmonary embolism diagnosed during the 25-year period from 1966 through 1990 (N = 1,719) were followed forward in time through their complete medical records in the community for first VTE recurrence. Four hundred four patients developed recurrent VTE during 10,198 person-years of follow-up. The overall (probable/definite) cumulative percentages of VTE recurrence at 7, 30, and 180 days and 1 and 10 years were 1.6% (0.2%), 5.2% (1.4%), 10.1% (4.1%), 12.9% (5.6%), and 30.4% (17.6%), respectively. The risk of recurrence was greatest in the first 6 to 12 months after the initial event but never fell to zero. Independent predictors of first overall VTE recurrence included increasing age and body mass index, neurologic disease with paresis, malignant neoplasm, and neurosurgery during the period from 1966 through 1980. Independent predictors of first probable/definite recurrence included diagnostic certainty of the incident event and neurologic disease in patients with hospital-acquired VTE. Recurrence risk was increased by malignant neoplasm but varied with concomitant chemotherapy, patient age and sex, and study year. Venous thromboembolism recurs frequently, especially within the first 6 to 12 months, and continues to recur for at least 10 years after the initial VTE. Patients with VTE with neurologic disease and paresis or with malignant neoplasm are at increased risk for recurrence, while VTE patients with transient or reversible risk factors are at less risk.
    Archives of Internal Medicine 04/2000; 160(6):761-8. DOI:10.1001/archinte.160.6.761 · 17.33 Impact Factor
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    ABSTRACT: Most hospitalized patients have one or more risk factors to develop venous thromboembolic disease (VTD), an important cause of in- hospital morbidity and mortality. Therefore, thromboprophylaxis must be indicated in all patients with risk factors. Low molecular weight heparins are the main drugs for pharmacological thromboprophylaxis. Possibility of VTD in hospitalized non-surgical patients is estimated by the level of risk associated (low, moderate, high and very high). In this section, some important recommendations are made for the prevention of VTD in hospitalized patients with non-surgical diseases. Antiphospholipid antibody syndrome is associated with both, venous and arterial thrombosis and adverse obstetric history. The relative risk of thrombosis is between 2 and 4 and the recurrence rises up to 18.7%/ year. Pregnancy and puerperium are thrombophilic states because they elevate the plasma concentration of hemostatic factors and the platelet count and diminish antithrombin and protein S plasma levels. Thromboprophylaxis is recommended in case of antecedent or current presence of VTD. Since estrogens raise the possibility of VTD each patient must be evaluated in terms of her thrombotic risk before starting this kind of therapy. Cancer patients represent 15 to 20% of total cases of VTD. Ten per cent of patients with idiopathic deep vein thrombosis (DVT) develop cancer in the following 12 to 24 months. Cancer represents a special thrombophilia associated to very specific prothrombotic risk factors. In intensive care units DVT reaches an 80% incidence because these patients have accumulative risk factors for VTD. Some general recommendations are done for different types of patients in these units. Patients with neurological diseases are also candidates for thrombo- prophylaxis. We suggest some thromboprophylactic strategies for the most common entities such as stroke and cerebral hemorrhage as well as for cerebral vein thrombosis.
    Gaceta medica de Mexico 01/2007; 143(1):29. · 0.27 Impact Factor
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    ABSTRACT: Little information is available concerning risk factors for venous thromboembolism (VTE) in nonhospitalized patients. An epidemiologic case-control study of deep vein thrombosis (DVT) risk factors was conducted in 1272 outpatients by general practitioners. The case population (636 patients presenting with DVT) was paired with the control population (636 patients presenting with influenzal or rhinopharyngeal syndrome) according to sex and age. Deep vein thrombosis was to be documented by at least 1 objective test. Risk factors were classified into "intrinsic" ("permanent") and "triggering" ("transient") factors and were evidenced using univariate analysis. In the medical population, defined as patients who had not undergone surgery or application of a plaster cast to the lower extremities within the 3 weeks preceding inclusion (494 cases and 494 controls), intrinsic factors such as history of VTE, venous insufficiency, chronic heart failure, obesity, immobile standing position, history of more than 3 pregnancies, and triggering factors such as pregnancy, violent effort, or muscular trauma, deterioration of general condition, immobilization, long-distance travel, and infectious disease were significantly more frequent in the case patients than in the controls (odds ratio, >1; P<.05). In the overall population, additional risk factors were cancer, blood group A, plaster cast of the lower extremities, and surgery. In both populations, the number of risk factors per patient was greater in the case patients than in the controls. Several risk factors for DVT were identified in medical outpatients presenting with DVT, and their comprehension may improve appropriateness and efficiency of the different methods available for thromboprophylaxis. Arch Intern Med. 2000;160:3415-3420.
    Archives of Internal Medicine 12/2000; 160(22):3415-20. DOI:10.1001/archinte.160.22.3415 · 17.33 Impact Factor


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