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

ABSTRACT 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 · 13.25 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 · 13.25 Impact Factor
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    ABSTRACT: Cancer and its treatments are well-recognized risk factors for venous thromboembolism (VTE). Evidence suggests that the absolute risk depends on the tumor type, the stage or extent of the cancer, and treatment with antineoplastic agents. Furthermore, age, surgery, immobilization, and other comorbid features will also influence the overall likelihood of thrombotic complications, as they do in patients without cancer. The role of hereditary thrombophilia in patients with cancer and thrombosis is still unclear, and screening for this condition in cancer patients is not indicated. The most common malignancies associated with thrombosis are those of the breast, colon, and lung, reflecting the prevalence of these malignancies in the general population. When adjusted for disease prevalence, the cancers most strongly associated with thrombotic complications are those of the pancreas, ovary, and brain. Idiopathic thrombosis can be the first manifestation of an occult malignancy. However, intensive screening for cancer in patients with VTE often does not improve survival and is not generally warranted. Independently of the timing of cancer diagnosis (before or after the VTE), the life expectancy of cancer patients with VTE is relatively short, because of both deaths from recurrent VTE and the cancer itself. Patients with cancer and acute VTE who take anticoagulants for an extended period are at increased risk of recurrent VTE and bleeding. A recent randomized trial, the Randomized Comparison of Low Molecular Weight Heparin versus Oral Anticoagulant Therapy for Long-Term Anticoagulation in Cancer Patients with Venous Thromboembolism (CLOT) study, showed that low molecular weight heparin may be a better treatment option for this group of patients. The antineoplastic effects of anticoagulants are being actively investigated with promising preliminary results.
    Circulation 07/2003; 107(23 Suppl 1):I17-21. DOI:10.1161/01.CIR.0000078466.72504.AC · 14.95 Impact Factor


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