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Introduction COVID‐19 predisposes patients to a higher risk of venous thromboembolism (VTE), although the extent of these implications is unclear and the risk of bleeding has been poorly evaluated. To date, no studies have reported long‐term outcomes of patients with COVID‐19 and VTE. Method Prospective observational study to evaluate long‐term (90 days or more) outcomes of patients diagnosed with VTE (PE, DVT of the extremities, or both) in the setting of COVID‐19. The main outcome of the study was a compound of major bleeding and death. Results The study comprised 100 patients (mean age 65 ± 13.9 years). At the time of VTE diagnosis, 66% patients were hospitalized, 34.8% of them in the ICU. Mean follow‐up was 97.9 ± 23.3 days. During the study period, 24% patients died and median time to death was 12 (IQR: 2.25‐20.75) days, 11% patients had major bleeding and median time to event was 12 (IQR: 5‐16) days. The cause of death was PE in 5% and bleeding in 2% of patients. There were no VTE recurrences. The main study outcome occurred in 29% patients. Risk of death or major bleeding was independently associated with ICU admission (HR 12.2; 95% CI 3.0‐48.3), thrombocytopenia (HR 4.5; 95% CI 1.2‐16.5), and cancer (HR 21.6; 95% CI 1.8‐259). Conclusion In patients with COVID‐19 and VTE, mortality and major bleeding were high and almost a third of deaths were VTE‐related. The majority of complications occurred in the first 30 days. ICU admission, thrombocytopenia, and cancer are risk factors for poor prognosis.

Aims The association of on-admission CRP and early adverse outcomes in acute venous thromboembolism (VTE) has not been investigated. We hypothesized that increased on-admission CRP levels would correlate with adverse outcomes in patients with acute VTE. Method In this prospective observational study, consecutive patients with acute VTE were enrolled and CRP levels were measured within the first 24 h after diagnosis. Mortality, bleeding and recurrence were recorded during a 30-day follow-up. Results 586 patients were included. Higher CRP levels were found in patients with mortality (7.5 vs 4.0 mg/dL; p = 0.01) and bleeding (7.8 vs 3.9 mg/dL; p = 0.03). Multivariable logistic regression showed that CRP levels >5 mg/dL were associated with higher mortality (OR 6.25; 95% CI, 2.1–18.6) and bleeding (OR 2.7; CI 95% 1.3–5.7). These results were independent to ESC risk score and simplified PESI score for mortality prediction. The predictive capacity of CRP showed an area under the ROC curve – AUC – of .7 (CI 95% .56–.85) for mortality and .65 (CI 95% .54–.75) for bleeding. The prognostic capacity of the ESC risk score and simplified PESI score was improved after adding the CRP cutoff of 5 mg/dL (AUC of .87 CI 95% .79–.95). Conclusion Our findings suggest that on-admission CRP level may be a simple, widely available and valuable biomarker to identify high-risk VTE patients for early mortality and bleeding. CRP ≥5 mg/dL was independently associated with 30-day VTE related death and bleeding.

The relationship between inflammation and venous thrombosis is not well understood. An inflammatory response may be both the cause and consequence of venous thromboembolism (VTE). In fact, several risk factors of VTE modulate thrombosis through inflammatory markers. Acute pulmonary embolism (PE) is burdened by a remarkable mortality rate, up to 34% in severely ill patients presenting with hemodynamic instability. Initial mortality risk stratification is based on hemodynamic instability. Patients with a situation of hemodynamic stability require immediate further risk assessment based on clinical, imaging, and circulating biomarkers, as well as the presence of comorbidities. Some inflammatory biomarkers have shown potential usefulness in the risk stratification of patients with VTE, especially acute PE. C-reactive protein on admission is associated with 30-day mortality and bleeding in VTE patients. P-selectin is associated with right ventricle dysfunction in PE patients and might be associated with VTE recurrences and the extension of thrombosis. Tissue factor microparticles are associated with VTE recurrence in cancer-associated thrombosis. Other inflammatory biomarkers present scarce evidence (inflammatory cytokines, erythrocyte sedimentation rate, fibrinogen, leukocyte count). In this manuscript, we will review the prognostic role of different inflammatory biomarkers available both for clinical practice and research in VTE patients.

Aim An increased risk of venous thromboembolism (VTE) in patients with COVID-19 pneumonia admitted to intensive care unit (ICU) has been reported. Whether COVID-19 increases the risk of VTE in non-ICU wards remains unknown. We aimed to evaluate the burden of asymptomatic deep vein thrombosis (DVT) in COVID-19 patients with elevated D-dimer levels. Method In this prospective study consecutive patients hospitalized in non-intensive care units with diagnosis of COVID-19 pneumonia and D-dimer > 1000 ng/mL were screened for asymptomatic DVT with complete compression doppler ultrasound (CCUS). The study was approved by the Institutional Ethics Committee. Results The study comprised 156 patients (65.4% male). All but three patients received standard doses of thromboprophylaxis. Median days of hospitalization until CCUS was 9 (IQR 5–17). CCUS was positive for DVT in 23 patients (14.7%), of whom only one was proximal DVT. Seven patients (4.5%) had bilateral distal DVT. Patients with DVT had higher median D-dimer levels: 4527 (IQR 1925-9144) ng/ml vs 2050 (IQR 1428-3235) ng/ml; p 1570 ng/mL were associated with asymptomatic DVT (OR 9.1; CI 95% 1.1–70.1). D-dimer showed an acceptable discriminative capacity (area under the ROC curve 0.72, 95% CI 0.61–0.84). Conclusion In patients admitted with COVID-19 pneumonia and elevated D-dimer levels, the incidence of asymptomatic DVT is similar to that described in other series. Higher cut-off levels for D-dimer might be necessary for the diagnosis of DVT in COVID-19 patients., Highlights • An increased risk of VTE in patients with COVID-19 pneumonia admitted to intensive care unit. • The most consistent hemostatic abnormalities with COVID-19 include mild thrombocytopenia and increased D-dimer levels. • In patients admitted with COVID-19 pneumonia and elevated D-dimer levels, the incidence of asymptomatic DVT is similar to that described in other series • Systematic screening for DVT in the absence of clinical signs does not seem justified in these patients. • Higher cut-off levels for D-dimer might be necessary for the diagnosis of DVT in COVID-19 patients.

Background: In recent years, mobile health (mHealth)-related apps have been developed to help manage chronic diseases. Apps may allow patients with a chronic disease characterized by exacerbations, such as chronic obstructive pulmonary disease (COPD), to track and even suspect disease exacerbations, thereby facilitating self-management and prompt intervention. Nevertheless, there is insufficient evidence regarding patient compliance in the daily use of mHealth apps for chronic disease monitoring. Objective: This study aimed to provide further evidence in support of prospectively recording daily symptoms as a useful strategy to detect COPD exacerbations through the smartphone app, Prevexair. It also aimed to analyze daily compliance and the frequency and characteristics of acute exacerbations of COPD recorded using Prevexair. Methods: This is a multicenter cohort study with prospective case recruitment including 116 patients with COPD who had a documented history of frequent exacerbations and were monitored over the course of 6 months. At recruitment, the Prevexair app was installed on their smartphones, and patients were instructed on how to use the app. The information recorded in the app included symptom changes, use of medication, and use of health care resources. The patients received messages on healthy lifestyle behaviors and a record of their cumulative symptoms in the app. There was no regular contact with the research team and no mentoring process. An exacerbation was considered reported if medical attention was sought and considered unreported if it was not reported to a health care professional. Results: Overall, compliance with daily records in the app was 66.6% (120/180), with a duration compliance of 78.8%, which was similar across disease severity, age, and comorbidity variables. However, patients who were active smokers, with greater dyspnea and a diagnosis of depression and obesity had lower compliance (P, The authors thank the investigators, Francisco Javier Agustin Martinez, Pulmonology Department, Complejo Hospitalario U de Albacete, and Walther Ivan Giron Matute, Pulmonology Department, Hospital U Gregorio Maranon Madrid, Spain, who participated in the Prevexair study. The authors also thank Astra Zeneca for its financial support to carry out the study. This study has been promoted and sponsored by the Spanish Society of Pneumology and Thoracic Surgery. The financers had no role in study design, data collection, analysis, and decision to publish or in the preparation of this manuscript. This does not alter our adherence to the policies of the Journal of Medical Internet Research on sharing data and materials.

Behçet's Disease (BD) is a rare multi-systemic inflammatory disorder classified as a systemic vasculitis of unknown aetiology. Vascular involvement occurs in approximately 5–51.6% cases, affecting venous and arterial vessels. Cardiac involvement is rare in BD (6%). There have been published approximately 93 cases of BD associated with intracardiac thrombosis, with different treatments and courses. We present a case of a 35-year-old spanish male that, after a percutaneous pharmacomechanical thrombectomy with venous stent placement, developed high fever and extensive venous thrombosis despite anticoagulation including intracardiac thrombosis (ICT) in the right ventricle and pulmonary embolism that leaded to the diagnosis of BD. The patient was successfully treated with immunosuppressants, achieving the complete resolution of ICT. We hypotesize that the endovenous procedure could have acted as a trigger for the posterior acute attack of the disease, representing a ‘vascular pathergy phenomenon’. Vascular BD has to be suspected in cases of thrombosis recurrence despite correct anticoagulation, and intense immunosuppressive treatment should be considered.

To analyze the relationship between therapeutic (weight-adjusted) dose of bemiparin and anti-Xa activity in patients with venous thromboembolism (VTE) and cancer in comparison with a cohort of patients with VTE without cancer, and its relationship with outcomes. This is a prospective cohort study that comprised a cohort of patients with cancer-associated VTE and a cohort of non-cancer patients with VTE, all of them treated with bemiparin. The ethics committee approved the study and informed consent was obtained from the patients. One hundred patients were included (52 with cancer and 48 without cancer), with a median follow-up of 9.8 months. Mean anti-Xa activity was 0.89 (± 0.33) UI/mL in oncological patients and 0.83 (± 0.30) UI/mL in non-cancer patients (mean difference − 0.05 95% CI − 0.18; 0.06). A multiple linear regression model showed that anti-Xa peak was associated with the dose/kg independently of possible confounding variables (presence of cancer, age, sex and eGFR—estimated Glomerular Filtration Rate), in a way that for every 1 UI of dose/kg increase, the anti-Xa peak activity increased 0.006 UI/mL (95% CI 0.003; 0.009) (p

Resumen Introduccion La neumonia adquirida en la comunidad (NAC) es una afeccion comun y potencialmente grave. En los ultimos anos ha empezado a tenerse en cuenta el control de la respuesta inflamatoria como un nuevo objetivo terapeutico en esta enfermedad. El objetivo de este estudio fue analizar la influencia de la administracion de corticoides sistemicos sobre la mortalidad de los pacientes ingresados con NAC en condiciones de practica clinica habitual. Pacientes y metodos Estudio prospectivo observacional en el que se recogieron casos de NAC en pacientes ingresados en los servicios de Medicina Interna y Neumologia de un hospital terciario a lo largo del ano 2007. Se registro el tratamiento administrado durante su ingreso y se determino la mortalidad hospitalaria, asi como a los 30 y 90 dias del alta hospitalaria. Resultados Se analizaron 257 pacientes, 179 varones (69,6%) y 78 mujeres (30,4%). La edad media fue de 72 ± 15 anos. Tanto la mortalidad hospitalaria como a los 30 dias del alta fue del 10,2%, mientras que la mortalidad global a los 90 dias fue del 14,8%. No se encontro relacion entre el empleo de corticoides y la mortalidad . El uso de corticoides tampoco modifico los dias de estancia hospitalaria ni la tasa de reingresos. Conclusiones En este estudio se ha observado que el tratamiento con corticoides sistemicos en la NAC no se asocia con una menor mortalidad ni influye en la tasa de reingresos. Tampoco modifica la duracion de la estancia hospitalaria.

The clinical profile, evolution and complications of treatment with rivaroxaban in a cohort of patients presenting with venous thromboembolism (VTE) were analyzed in an observational, non-interventional and prospective study. A total of 111 patients were included in the study. Clinical data were collected from the medical history of the patients and recorded in a specific database. Mean age was 63.8 ± 17.4 years, 53.2% of patients were men, 55.9% had at least another concomitant condition, and 40.9% at least 1 VTE risk factor. 54.1% of patients presented with deep venous thrombosis, 32.4% with pulmonary embolism and 13.5% with both conditions simultaneously. The 61% of patients were admitted to hospital and mean hospital length-of-stay was 8.8 ± 9.9 days. After a mean follow-up 530 ± 464 days (median follow-up of 405 days), 3.9% of patients died and VTE recurrence occurred in 2.9% of patients. While receiving rivaroxaban, a first bleeding complication occurred in 8.1%; all events were minor bleeding. Our study supports the current literature data and confirms the similar results of real-life VTE patients with those enrolled in the rivaroxaban pivotal clinical trials. Rivaroxaban may facilitate outpatient treatment and might be considered as a first-line therapy for the management of VTE patients.

Chronic obstructive pulmonary disease (COPD) continues to be a disease of special importance due to its great social impact arising from its high prevalence, its high morbidity and mortality and the high health costs it incurs. This has led to a great number of articles on different aspects associated with COPD each year. There is increasingly greater emphasis made of the systemic repercussions of the diseases and its comorbidity. In that same sense, tools are being sought to be able to make a more accurate prognosis of the diseases and assess other different aspects of lung function. Some standards on the quality of healthcare in COPD have also been published during this year, as well as some recommendations of the care of these patients in the advanced phase. An attempt is made in this article to summarise the more outstanding COPD articles published in Archivos de Bronconeumologia during the past year.

The association of chronic obstructive pulmonary disease (COPD) and smoking is well established. However, an increasing number of studies have reported a not inconsiderable prevalence of COPD among nonsmokers. Therefore, other factors, both endogenous and exogenous, may influence the development of this disease. The present article reviews the influence of possible genetic factors, gender and other respiratory diseases (such as chronic asthma and tuberculosis), as well as environmental pollution and occupational exposure in the development of COPD.

Control is a priority treatment objective in asthma, and classification based on control is recommended in the follow-up of asthmatic patients. Different factors affect this control, and there are several regional differences, both in terms of prevalence and in terms of management and degree of control.To evaluate the factors associated with control of severe asthma in routine clinical practice.This was a prospective, cross-sectional, observational study of patients with severe asthma who were receiving treatment with a fixed combination of a corticosteroid (at least 800 microg/day of budesonide or equivalent) and an inhaled beta(2)-adrenergic agonist in respiratory medicine and allergology clinics throughout Spain. The authors collected demographic and socioeconomic data, as well as clinical data on asthma. The patients also completed a self-administered validated questionnaire-the Asthma Control Questionnaire (ACQ)-about the control of their asthma.The authors included 1471 patients, of whom 1224 (83%) were valid for the final analysis. Women accounted for 61%. Mean age was 51 +/- 16 years. The mean number of exacerbations during the previous year was 2.0 +/- 2.0. The global score on the ACQ was 1.8 +/- 1.1 (0 = no symptoms; 6 = maximum number of symptoms). Only 20.4% of patients were well controlled (ACQ0.75), and 55.7% of patients were poorly controlled (ACQ1.5). The multivariate analysis revealed that the variable with the greatest effect on control of asthma was the number of exacerbations during the previous year: when the number of exacerbations increased from 0 to 1 or more, the ACQ score increased by 0.56 points. Employed patients had a mean of 0.23 points less (better control) than unemployed and retired patients. Control of asthma was also significantly affected by adherence to treatment, patient knowledge of the disease, body mass index, gender, and number of visits to a physician in the previous 3 months.Many patients with severe asthma have poor control of their disease. The number of exacerbations is the variable with the greatest effect on control of asthma. Knowledge of the disease and adherence to treatment are associated with better control.