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a b s t r a c t Objective: The aim of this study was to compare the predictive value of two clinical prognostic models, the Spanish score and the simplified Pulmonary Embolism Severity Index (sPESI), in an independent cohort of patients diagnosed of acute symptomatic pulmonary embolism (PE). Methods: We performed a retrospective analysis of a cohort composed of 1447 patients with acute symp- tomatic PE. The Spanish score and the sPESI were calculated for each patient according to different clinical variables. We assessed the predictive accuracy of these scores for 30-day mortality, and a composite of non fatal recurrent venous thromboembolism and non fatal major bleeding, using C statistic, which was obtained by means of logistic regression and ROC curves. Results: Overall, 138 patients died (9.5%) during the first month of follow-up. Both scores showed an excellent predictive value for 30-day all-cause mortality (C statistic, 0.72 and 0.74), but the performance was poor for the secondary endpoint (C statistic, 0.60 and 0.59). The sPESI classified fewer patients as low risk (32% versus 62%; P

Objetivo El objetivo de este estudio fue validar y comparar 2 escalas pronosticas, la escala espanola y la escala Pulmonary Embolism Severity Index simplificada (PESIs), en una cohorte de pacientes diagnosticados de tromboembolia de pulmon (TEP) aguda sintomatica. Metodos Se realizo un analisis retrospectivo de una cohorte de 1.447 pacientes diagnosticados consecutivamente de TEP aguda sintomatica. Evaluamos el valor predictivo de las 2 escalas para muerte a 30 dias y para un episodio compuesto de recurrencia tromboembolica no mortal y hemorragia mayor no mortal mediante el estadistico C, empleando para su calculo regresion logistica y curvas ROC. Resultados Durante los primeros 30 dias de seguimiento fallecieron 138 pacientes (9,5%). Las 2 escalas mostraron un valor predictivo bueno para mortalidad a 30 dias (estadistico C, 0,72 y 0,74) y pobre para la prediccion del episodio secundario (estadisticos C, 0,60 y 0,59). La escala PESIs clasifico una proporcion significativamente menor de pacientes como de bajo riesgo, comparada con la escala espanola (32% versus 62%; p < 0,001). La mortalidad del grupo de bajo riesgo segun la escala PESIs fue menor que la de la escala espanola (1,1% versus 4,2%). La proporcion de episodios no mortales fue similar en el grupo de bajo riesgo de ambos modelos (2,2% versus 2,3%). Conclusiones La escala espanola y la escala PESIs presentaron excelente capacidad discriminatoria para la mortalidad a 30 dias. La escala PESIs fue mas segura para identificar a los pacientes con TEP y bajo riesgo de complicaciones precoces.

The aim of this study was to analyse the normalization rate of compression ultrasonography after a first episode of proximal deep venous thrombosis (DVT). Patients underwent compressive ultrasound (C-US) examinations during the 3-6 months following the first proximal DVT episode. Normalization rate of compressive ultrasound (C-US) during the follow-up period was 26.4% [95% confidence interval, 16.3-37.3]. Allelic variation in factor XIII gene (Val34Leu) significantly affected the improvement of popliteal residual thrombi (P = 0.019). We also observed a significant negative correlation between D-dimer levels at 3 months and improvement of popliteal residual thrombi (P = 0.016). There was a significant positive correlation between baseline lumen diameter of the femoral thrombi and IL-8 cytokine (P = 0.015). A significant difference was also found between 1 month-tumor necrosis factor (TNF)-α levels and improvement of residual thrombi (P = 0.047). Our results show that normalization after a standard period of anticoagulation is not frequent and procoagulant and inflammatory biomarkers and also some genetic variations might be related to the resolution of thrombosis.

Chronic pulmonary thromboembolic hypertension is a physiopathological state resulting from failing to resolve an episode of acute pulmonary embolism (PE), single or recurrent, whether symptomatic or not, after correct treatment with anti-coagulants. This review presents the risk factors, the pathophysiology is discussed and the diagnostic and therapeutic protocol currently used is updated.

To determine biomarker9s predictive value in VTD recurrence in oncologic patients at different times during the follow-up after withdrawal anticoagulation. Methods: Prospective,observational,multicenter study.After removing treatment,a blood sample was taken in all patients at three different moments(basal,at 3weeks and 3months)for determination of D-dimer(DD),C-reactive protein(CRP),P-selectin(PS) and activity procoagulant phospholipids(PPL).Patients were followed up for 6months after suspension anticoagulant therapy.Outcomes were recurrences,deaths and reintroduction of anticoagulation. Results: 104 patients were included.All of them accepted anticoagulant treatment suspension.87patients completed 6months of follow up(median=7months,range=0-18)with a mean age of 63±13years and 53%were men.The most frequent types of cancer were colorectal cancer19.5%,breast17%,hematologic13.8% and lung10.3%.38%of patients had metastatic cancer.97%of patients had an ECOG0-1.Central Venous Catheter-Associated Thrombosis was 11%.7patients died(8%),one for recurrence of VTD.There were 10recurrences(11.5%):5were between 3weeks and 3months and another 5recurrences after 3months.Determinations with best AUC in relation to recurrences were made at 3weeks,and cutoff points were:DD1000mg/ml,RCP5,75mg/L and PS49,27ng/ml.The hazard ratios of these variables were: HR=4.98[(95%IC:1.28-19.32)p=0.020],HR=7.43[(95%IC:1.53-36.02)p=0.013],and HR=10[(95%IC:2.01-49.84)p=0.005],respectively. Conclusions: Determinations of D-dimer,CRP and P-selectin at 3weeks after anticoagulation suspension may be useful to decide the reintroduction of treatment at high risk of recurrences.

Objective: Determine clinical characteristics, bleedings, thrombotic events and mortality in splanchnic venous thrombosis (SVT) in non-cirrhotic patients. Material and methods: Retrospective cohort (2008-2015) of non-cirrhotic (single center). We evaluated: risk factors; symptoms, location, chronicity, and anticoagulant treatment. During the follow up: evaluated all-causes mortality, thrombotic and bleedings events. Results: 70 patients. Most frequent risk factors: Infectious-inflammatory abdominal conditions (54%) and solid cancer (40%). Affected veins: portal, splenic, mesenteric or multiple. Of all, 54 patients received anticoagulant treatment (average 6.7 months). They were treated with low molecular weight heparin (LMWH) (85%) or vitamin K antagonist (VKA) (15%). Median follow-up was 12 months. Complications: 21 patients (30%) had thrombosis and 18 (26%) major bleeding. The incidence rates were 8.6 per 100 patient-years for major bleeding, 13.9 per 100 patient-years for thrombotic events and 11.9 per 100 patient-years for all-cause mortality. Major bleeding rates were 7.1 per 100 patient-years and 9.6 per 100 patient-years with or without anticoagulant treatment, respectively. Thrombotic events rates were 14.1 per 100 patient-years and 13.9 per 100 patient-years with or without anticoagulant treatment, respectively. Highest rates of major bleeding and thrombotic events were in solid cancer (15.7 per 100 patient-years and 31.4 per 100 patient-years, respectively). Conclusions: SVT has high baseline bleeding risk, although thrombotic events are also high. It9s important balance risk benefit of anticoagulant therapy.

Background: There is controversy about what patients with acute venous thromboembolism (VTE) should be investigated for occult cancer. Patients and Methods: We used data from the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry to perform a nested case control study. VTE patients diagnosed with cancer beyond the first 30 days were identified as cases, and compared with those followed-up for 24 months and without cancer. Results: Of 5,863 eligible patients, 444 (7.6%) were diagnosed with occult cancer. Its proportion progressively increased with the patient9s age, from 3.5% (in men) and 2.4% (in women) among those aged 70 years.The most common sites of cancer were the lung (26%), prostate (17%) and colorectal (12%) in men; colorectal (19%) and breast (12%) in women. On multivariable analysis, male gender, age >70 years, chronic lung disease, raised platelet count, anaemia, prior VTE and recent surgery independently predicted the risk for occult cancer. The proportion of cancer in patients scoring ≤ 2 points was 5.8%, and 12% in those scoring >2 points. C-statistic was 0.636 (95% CI, 0.61-0.66). Their rate of VTE recurrences (odds ratio: 13.8; 95%CI: 0.77-249; p=0.07)) was higher than in patients with no cancer. Conclusions: Our prognostic score identified VTE patients at increased risk for occult cancer. We also identified the most common sites of cancer according to sex and age.

OBJECTIVE: To analyze the prognostic value of pulmonary artery obstruction versus right-ventricle (RV) dysfunction radiologic indices in cancer-related pulmonary embolism (PE). METHODS: We enrolled 303 consecutive patients with paraneoplastic PE, evaluated by computed tomography pulmonary angiography (CTPA) between 2013 and 2014. The primary outcome measure was serious complications at 15days. Multivariate analyses were conducted by using binary logistic and robust regressions. Radiological features such as the Qanadli index (QI) and RV dysfunction signs were analyzed with Spearman's partial rank correlations. RESULTS: RV diameter was the only radiological variable associated with an adverse outcome. Subjects with enlarged RV (diameter>45mm) had more 15-day complications (58% versus 40%, p=0.001). The QI correlated with the RV diameter (r=0.28, p

Background The benefits of a diagnostic workup for occult cancer in patients with VTE are controversial. Our aim was to provide and validate a risk score for occult cancer in patients with VTE. Methods We designed a nested case-control study in a cohort of patients with VTE included in the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry from 2001 to 2014. Cases included cancer detected beyond the first 30 days and up to 24 months after VTE. Control subjects were defined as patients with VTE with no cancer in the same period. Results Of 5,863 eligible patients, 444 (7.6%; 95% CI, 6.8%-8.2%) were diagnosed with occult cancer. On multivariable analysis, variables selected were male sex, age > 70 years, chronic lung disease, anemia, elevated platelet count, prior VTE, and recent surgery. We built a risk score assigning points to each variable. Internal validity was confirmed using bootstrap analysis. The proportion of patients with cancer who scored ≤ 2 points was 5.8% (241 of 4,150) and that proportion in those who scored ≥ 3 points was 12% (203 of 1,713). We also identified scores divided by sex and age subgroups. Conclusions This is the first risk score that has identified patients with VTE who are at increased risk for occult cancer. Our score needs to be externally validated.

Background Acute symptomatic pulmonary embolism (PE) varies in its clinical manifestations in patients with cancer and entails specific issues. The objective is to assess the performance of five scores (PESI, sPESI, GPS, POMPE, and RIETE) and a clinical decision rule to predict 30-day mortality. Methods This is an ambispective, observational, multicenter study that collected episodes of PE in patients with cancer from 13 Spanish centers. The main criterion for comparing scales was the c-indices and 95% confidence intervals (CIs) of the models for predicting 30-day mortality. Results 585 patients with acute symptomatic PE were recruited. The 30-day mortality rate was 21.3 (95% CI; 18.2–24.8%). The specific scales (POMPE-C and RIETE) were equally effective in discriminating prognosis (c-index of 0.775 and 0.757, respectively). None of these best performing scales was superior to the ECOG-PS with a c-index of 0.724. The remaining scores (PESI, sPESI, and GPS) performed worse, with c-indexes of 0.719, 0.705, and 0.722, respectively. The dichotomic “clinical decision rule” for ambulatory therapy was at least equally reliable in defining a low risk group: in the absence of all exclusion criteria, 30-day mortality was 2%, compared to 5% and 4% in the POMPE-C and RIETE low-risk categories, respectively. Conclusion The accuracy of the five scales examined was not high enough to rely on to predict 30-day mortality and none of them contribute significantly to qualitative clinical judgment.

Resumen Fundamento y objetivo Realizamos un estudio sobre seguridad, costes comparados y analisis de impacto presupuestario del tratamiento ambulatorio de pacientes con cancer y trombosis venosa profunda (TVP) frente al tratamiento hospitalario. Material y metodos Estudio observacional y prospectivo de pacientes con neoplasia conocida y diagnosticados de TVP desde 2003 hasta 2007. Las variables de resultados fueron mortalidad, recidivas y hemorragias a un mes. Realizamos un analisis economico para evaluar el coste comparado de los pacientes tratados ambulatoriamente frente al procedimiento habitual. Resultados Se incluyeron 317 pacientes, 55 (17%) con cancer. La edad media (DE) de los pacientes fue de 63 (11) anos. Las complicaciones a un mes fueron: 2 sangrados, 2 recidivas y 6 muertes. De todos los pacientes, solo 7 (13,7%) necesitaron ingreso hospitalario. Todas las muertes excepto una fueron debidas a la progresion de su enfermedad de base. Cuando realizamos el analisis economico observamos que el tratamiento ambulatorio es 6 veces menos costoso que el hospitalario, lo que implicaria una reduccion de costes de un 85%. Conclusiones El tratamiento ambulatorio a traves de una consulta monografica de los pacientes con cancer y TVP es seguro y podria ahorrar importantes recursos economicos.

International audience; BACKGROUND:There is uncertainty about the optimal therapy of venous thromboembolism (VTE) in patients with glioblastoma multiforme (GBM).METHODS:We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to compare the rate of VTE recurrences and major bleeding during the course of anticoagulation in patients with GBM, other cancers and in patients without cancer.RESULTS:As of September 2014, 53,546 patients have been recruited in RIETE. Of these, 72 (0.13%) had GBM and 11,811 (22%) had other cancers. Most patients in all 3 subgroups received initial therapy with low-molecular-weight heparin (LMWH), but those with GBM received slightly lower doses than those with other cancers or without cancer. Then, most patients with GBM continued on LMWH for long-term therapy, at similar doses than those in the other subgroups. During the course of anticoagulation (mean, 202 days), 3 patients with GBM presented VTE recurrences (10.9 per 100 patient-years; 95% CI: 2.76-29.5) and 4 suffered major bleeding (one intracranial) (14.5 bleeds per 100 patient-years; 95%CI: 4.60-34.9). Compared with patients with other cancers, those with GBM had a similar rate of VTE recurrences and major bleeds, but had a higher rate of extracranial hematoma (p

Death rates from lung cancer in men are higher in Andalusia than in other Spanish regions. This study describes lung cancer mortality rates and their trends in Andalusia from 1975 through 2008. Data on lung cancer mortality were obtained from the Death Registry of Andalusia. For each gender, age group-specific and standardized (overall and truncated) rates were calculated by the direct method using the world standard population. Joinpoint regression analysis was used to identify points where a significant change in trends occurred. In men, short-term trends for age-standardized mortality rates (ASMRs) declined significantly from 2004 through 2008 for each age group

a b s t r a c t Although patent foramen ovale is a relatively common disease, the presence of paradoxical embolism is a rare clinical condition, representing less than 2% of arterial ischemias. We report the case of a 55- year-old male diagnosed with massive pulmonary embolism and paradoxical embolism in the right arm, secondary to patent foramen ovale. We also highlight some uncertainties in the diagnosis and treatment of patients with paradoxical embolism.

International audience; BACKGROUND: The clinical characteristics of patients with factor V Leiden or prothrombin G20210A presenting with a first episode of venous thromboembolism (VTE) have not been thoroughly studied. METHODS: RIETE is an ongoing registry of consecutive patients with acute VTE. We compared the clinical characteristics of patients with factor V Leiden, prothrombin G20210A, or no thrombophilia, at presentation with a first episode of VTE. RESULTS: As of May 2009, 22428 patients had been enrolled with a first episode of VTE. Of these, 345 had factor V Leiden, 261 had prothrombin G20210A, and 2399 tested negative. Sixty-two percent of the VTE episodes in women with factor V Leiden or prothrombin G20210A (40% in men) were associated with an acquired risk factor. Among women, pregnancy or contraceptive use accounted for 63% and 67% of such risk factors. Patients with factor V Leiden presented with pulmonary embolism (PE) less likely than those with prothrombin G20210A (31% vs. 51%; p

Concomitant deep vein thrombosis (DVT) in patients with acute pulmonary embolism (PE) has an uncertain prognostic significance.In a cohort of patients with PE, this study compared the risk of death in those with and those without concomitant DVT.We conducted a prospective cohort study of outpatients diagnosed with a first episode of acute symptomatic PE. Patients underwent bilateral lower extremity venous compression ultrasonography to assess for concomitant DVT.The primary study outcome, all-cause mortality, and the secondary outcome of PE-specific mortality were assessed during the 3 months of follow-up after PE diagnosis. Multivariate Cox proportional hazards regression was done to adjust for significant covariates. Of 707 patients diagnosed with PE, 51.2% (362 of 707) had concomitant DVT and 10.9% (77 of 707) died during follow-up. Patients with concomitant DVT had an increased all-cause mortality (adjusted hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.24 to 3.38; P = 0.005) and PE-specific mortality (adjusted HR, 4.25; 95% CI, 1.61 to 11.25; P = 0.04) compared with those without concomitant DVT. In an external validation cohort of 4,476 patients with acute PE enrolled in the international multicenter RIETE Registry, concomitant DVT remained a significant predictor of all-cause (adjusted HR, 1.66; 95% CI, 1.28 to 2.15; P0.001) and PE-specific mortality (adjusted HR, 2.01; 95% CI, 1.18 to 3.44; P = 0.01).In patients with a first episode of acute symptomatic PE, the presence of concomitant DVT is an independent predictor of death in the ensuing 3 months after diagnosis. Assessment of the thrombotic burden should assist with risk stratification of patients with acute PE.

BACKGROUND Survivin is a well-known member of the inhibitor of apoptosis family, and has been related to increased tumour aggressivity, both in tissue and in pleural fluid. OBJECTIVES In patients with malignant pleural effusion, we sought to investigate the changes in pleural fluid survivin concentrations induced by talc instillation into the pleural space. Those changes were also examined in relation to pleurodesis outcome and patient survival. METHODS We investigated 84 patients with malignant pleural effusion who underwent talc pleurodesis. Of them, 32 had breast cancer, 25 lung cancer and 27 had mesothelioma. Serial samples of pleural fluid were obtained before thoracoscopy (baseline) and 24 hours thereafter. RESULTS Survivin levels were successfully quantified in all pleural fluid samples, and they were significantly higher in samples obtained after thoracoscopic talc poudrage compared with baseline (P < .001). Patients with higher pleural fluid survivin levels at baseline had a significantly poorer pleurodesis outcome (P = .004). A 30 pg/mL cut-off for baseline survivin in pleural fluid predicted failure of pleurodesis with a 54% sensitivity and 79% specificity (P = .009). Moreover, median postpleurodesis survival of patients with baseline survivin levels ≥30 pg/mL was 4 months (range: 0.1-38), compared with 13 months (range: 0.1-259) in patients below that cut-off (P < .001). CONCLUSION Elevated pleural fluid survivin concentrations are useful to predict failure of pleurodesis and are associated with shorter survival in patients with malignant pleural effusion.

Introduction An association between pulmonary embolism (PE) and a subsequent diagnosis of cancer has been repeatedly reported. Although screening and early detection might play a pivotal part in reducing mortality from cancer, there are currently no definite data to suggest that cancer screening may improve survival rates in patients with PE. We hereby present the results of a screening program and a two-year follow-up survey for detecting occult cancer in this patient population. Materials and methods A total of 107 patients with PE were consecutively enrolled. All subjects underwent an initial screening program followed by a two-year follow-up survey. We calculated the sensitivity of our screening program, and identified risk factors associated with occult cancer by means of logistic regression. Results The initial screening program yielded positive results in five patients (4.7%), and four additional cases were identified during the 2-year follow-up. The overall sensitivity of our screening program in idiopathic PE was 55.5%. In the entire study cohort, the number necessary for screening was 12.1 (6.1 in idiopathic PE, and 58 in secondary PE). Logistic regression analysis revealed that a shock index ≥ 1 (odds ratio: 5.467; p = 0.007) and idiopathic PE (odds ratio: 12.82; p = 0.03) were independent risk factors for occult cancer in our PE patients. Conclusions A simple and noninvasive screening program yields an acceptable sensitivity for detecting occult cancer in idiopathic PE patients. These results highlight the importance of screening for occult cancer in patients diagnosed with PE, especially in idiopathic forms.

Resumen Fundamento y objetivo El modelo predictivo de Khorana se desarrollo para estratificar el riesgo de enfermedad tromboembolica en pacientes con cancer y en tratamiento con quimioterapia y, por tanto, identificar a aquellos que podrian beneficiarse de tromboprofilaxis. Analizar los resultados de la aplicacion del modelo predictivo de Khorana en una cohorte de pacientes con cancer y que fueron diagnosticados de trombosis venosa profunda (TVP). Pacientes y metodos Analisis retrospectivo de las caracteristicas pronosticas del modelo de Khorana en 122 pacientes con cancer y TVP, basado en una recogida prospectiva de datos. Resultados Se catalogo al 79% como pacientes de riesgo bajo e intermedio, y al 21% como de alto riesgo. La escala de Khorana tuvo una sensibilidad y exactitud pronostica del 20,8% (intervalo de confianza del 95% [IC 95%]: 14,6-28,7) y una proporcion de falsos negativos de 79,2% (IC 95%: 1,3-85,4). Conclusiones: La aplicacion de este modelo en nuestros pacientes resultaria insuficiente como unica herramienta para identificar a los enfermos con cancer que deberian ser tratados con tromboprofilaxis. El uso de biomarcadores junto a modelos clinicos parece ser la mejor estrategia costo-efectivas para identificar a pacientes candidatos al tratamiento profilactico. Estudios amplios, prospectivos, randomizados y con placebo deberian decidir si esta estrategia es la mas valida.

Background Controversy exists regarding the usefulness of troponin testing for the risk stratification of patients with acute pulmonary embolism (PE). We conducted an updated systematic review and a metaanalysis of troponin-based risk stratification of normotensive patients with acute symptomatic PE. The sources of our data were publications listed in Medline and Embase from 1980 through April 2008 and a review of cited references in those publications. Methods We included all studies that estimated the relation between troponin levels and the incidence of all-cause mortality in normotensive patients with acute symptomatic PE. Two reviewers independently abstracted data and assessed study quality. From the literature search, 596 publications were screened. Nine studies that consisted of 1,366 normotensive patients with acute symptomatic PE were deemed eligible. Pooled results showed that elevated troponin levels were associated with a 4.26-fold increased odds of overall mortality (95% CI, 2.13 to 8.50; heterogeneity χ 2 = 12.64; degrees of freedom=8; p=0.125). Summary receiver operating characteristic curve analysis showed a relationship between the sensitivity and specificity of troponin levels to predict overall mortality (Spearman rank correlation coefficient=0.68; p=0.046). Pooled likelihood ratios (LRs) were not extreme (negative LR, 0.59 [95% CI, 0.39 to 0.88]; positive LR, 2.26 [95% CI, 1.66 to 3.07]). The Begg rank correlation method did not detect evidence of publication bias. Conclusions The results of this metaanalysis indicate that elevated troponin levels do not adequately discern normotensive patients with acute symptomatic PE who are at high risk for death from those who are at low risk for death.

The advent of subcutaneous treatment with low -molecular-weight heparins (LMWH) and less intensive monitoring has made it possible for patients the treatment at home. Large, randomised, controlled trials have demonstrated that outpatient treatment of deep vein thrombosis (DVT) with LMWH is as safe as the hospital-based treatment with intravenous unfractionated heparin (UFH). However, the risk of death in patients with treatment at home is higher for pulmonary embolism (PE) than for DVT, and additional evidence is required before the results of outpatient treatment for DVT can be extrapolated to PE. The prognostic stratification of patients with acute PE has important management implications for the outpatient treatment.

Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by the organization of thrombotic material within the pulmonary arteries. The lack of correlation between the proportion of obliterated pulmonary arteries and pulmonary hypertension values suggest that an exclusively mechanical theory could be too simplistic. Acute pulmonary embolism could be the initial event, but disease progression probably results from progressive vascular remodelling of the small vessels. Unresolved pulmonary arterial thrombosis may be a decisive factor in initiating endothelial-to-mesenchymal transition. The present article analyzes the genetic features, inflammatory mechanisms and clinical factors influencing the physiopathological mosaic of this complex entity.

Un equipo multidisciplinario ha realizado una actualizacion de recomendaciones en la profilaxis de la enfermedad tromboembolica venosa basandose en las evidencias disponibles actualmente. Se ha abordado la problematica tanto del paciente medico como quirurgico. Hay que puntualizar que esta Normativa esta planteada para su utilizacion en el ambito de Espana y, por lo tanto, debe aplicarse con los farmacos autorizados y las practicas terapeuticas mas aceptadas en este pais.

Objetivo Describir la evolucion de la mortalidad por cancer de pulmon en Espana durante el periodo 1980-2005. Material y metodos Las defunciones por cancer de pulmon durante el periodo de estudio se obtuvieron del Instituto Nacional de Estadistica. Se calcularon las tasas especificas globales y truncadas (35-64 anos) por grupos de edad y sexo, que se expresan como tasas por 100.000 personas-ano. Para el analisis de tendencias de las tasas se utilizaron modelos de regresion joinpoint. Resultados En 2005 se produjeron en Espana 16.647 defunciones por cancer de pulmon en varones y 2.471 en mujeres, lo que represento el 26,6 y el 6,6% de la mortalidad por tumores, respectivamente. En los varones las tasas truncadas, tras un periodo de incremento (1980-1992, un 3,1% anual; p Conclusiones Mientras que la tendencia de mortalidad por cancer de pulmon en los varones espanoles comenzo a descender ligeramente hace 15 anos, en las mujeres se observa un aumento llamativo durante el mismo periodo.

The recommendations on venous thromboprophylaxis have been updated on the basis of current evidence reviewed by a multidisciplinary team. The problem has been approached with regard to its relevance in both surgical and nonsurgical patients. It should be noted that these recommendations were drawn up for use in Spain and, therefore, should be implemented with the drugs and therapeutic practices authorized and generally accepted in this country.

To describe trends in lung cancer mortality in Spain between 1980 and 2005.Data on deaths from lung cancer during the study period were obtained from the Spanish National Institute of Statistics. Global and truncated (35 to 64 years) age-specific and gender-specific mortality rates were calculated and expressed as rates per 100,000 person-years. Trends were analyzed using joinpoint regression models.In 2005 in Spain, 16 647 men and 2471 women died from lung cancer, accounting for 26.6% and 6.6%, respectively, of all cancer deaths. In men, truncated mortality rates initially increased in the 1980-1992 period (3.1% per year; P.05) but began to decrease in the 1992-2005 period (-0.8% per year, P.05). Starting in the 1990s, age-specific mortality rates showed a statistically significant decrease in patients aged less than 85 years. For women, after an initial stable period, truncated mortality rates increased significantly from 1992 onward by 6.3% per year. The analysis by age groups showed that the rates increased in all age groups, except for patients aged 25 to 34 years and patients aged 75 to 84 years, in whom they remained stable.While lung cancer mortality began to decrease slightly among Spanish men 15 years ago, it increased significantly among women during the same period.

Objetivo Identificar a pacientes con riesgo bajo de complicaciones a corto plazo tras un episodio agudo de trombo-embolia pulmonar (TEP). Pacientes y metodos Se trata de un estudio multicentrico y prospectivo, realizado en 8 hospitales espanoles, en el que se incluyo a un total de 681 pacientes ambulatorios consecutivos con diagnostico de TEP. Las variables con significacion clinica se ponderaron a partir de los coeficientes del modelo logis-tico, con el objetivo de maximizar las caracteristicas diagnosticas de la escala clinica de prediccion de eventos a corto plazo: muertes, recidivas tromboembolicas o complicaciones hemorragicas graves y no graves en los 10 primeros dias. Resultados Hubo 51 complicaciones en 43 pacientes (6,3%): un total de 33 fallecimientos, 12 hemorragias graves y 6 no graves. La puntuacion clinica asignada a las variables de la escala de prediccion fue la siguiente: hemorragia grave reciente y cancer con metastasis, 4 puntos cada una; valores de creatinina mayores de 2 mg/dl, 3 puntos; cancer sin metastasis e inmovilizacion por enfermedad medica reciente, 2 puntos cada una, y ausencia de cirugia en los ultimos 2 meses y edad superior a 60 anos, 1 punto cada una. Una puntuacion de 2 o menor, que obtuvo el 47,8% de nuestros pacientes, indica un riesgo bajo de presentar complicaciones a corto plazo tras la TEP. El area bajo la curva de eficacia diagnostica de la escala es de 0,75 (intervalo de confianza [IC] del 95%, 0,67-0,83). Para ese punto de corte la sensibilidad es del 82,9% (IC del 95%, 68,7-91,5), el cociente de probabilidad positiva del 1,63 (IC del 95%, 1,39-1,92) y el cociente de probabilidad negativa de 0,35 (IC del 95%, 0,18-0,69). Conclusiones Nuestra escala clinica de puntuacion podria ser util para identificar a pacientes con riesgo bajo de presentar complicaciones durante los 10 primeros dias tras un episodio de TEP aguda. Estos pacientes serian los candidatos sobre los que plantear un estudio que avale el tratamiento domiciliario de la TEP.

Patients with acute pulmonary embolism (PE) presenting with haemodynamic instability have the worst prognosis. However, what is understood by haemodynamic instability has not been clearly defined. The Registro Informatizado de la Enfermedad Tromboembolica (RIETE) is an ongoing registry of consecutive patients with symptomatic, objectively confirmed, acute deep vein thrombosis or PE. The present authors compared the predictive value of a systolic blood pressure (SBP) value of

To assess the performance of two prognostic models in predicting short-term mortality in patients with pulmonary embolism (PE).We compared the test characteristics of two prognostic models for predicting 30-day outcomes (mortality, thromboembolic recurrences, and major bleeding) in a cohort of 599 patients with objectively confirmed PE. Patients were stratified into the PE severity index (PESI) risk classes I-V and the Geneva low-risk and high-risk strata. We compared the discriminatory power of both prognostic models.The PESI classified fewer patients as low risk (strata I and II) [36%; 216 of 599 patients; 95% confidence interval (CI), 32 to 40%] compared to the Geneva prediction rule (84%; 502 of 599 patients; 95% CI, 81 to 87%) [p0.0001]. Using either prediction rule, the low-risk groups showed statistically relevant 30-day mortality difference (PESI, 0.9%; 95% CI, 0.3 to 2.2; vs Geneva, 5.6%; 95% CI, 3.6 to 7.6) [p0.0001], although nonfatal recurrent venous thromboembolism or major bleeding rates were statistically similar (PESI, 2.8%; 95% CI, 0.6 to 5.0%; vs Geneva, 4.2%; 95% CI, 2.4 to 5.9%). The area under the receiver operating characteristic curve was higher for the PESI (0.76; 95% CI, 0.69 to 0.83) than for the Geneva score (0.61; 95% CI, 0.51 to 0.71) [p = 0.002].The PESI quantified the prognosis of patients with PE better than the Geneva score. This study demonstrated that PESI can select patients with very low adverse event rates during the initial days of acute PE therapy and assist in selecting patients for treatment in the outpatient setting.

OBJECTIVE: To identify patients with a low short-term risk of complications following acute pulmonary thromboembolism. PATIENTS AND METHODS: A prospective multicenter study was conducted in 8 Spanish hospitals; 681 consecutive outpatients diagnosed with pulmonary thromboembolism were enrolled. Clinically significant variables were weighted using coefficients derived from a logistic regression model in order to optimize the diagnostic performance of a clinical prediction rule to predict the following complications within 10 days of acute pulmonary thromboembolism: death, recurrent thromboembolism, and major or minor bleeding. RESULTS: Forty-three patients (6.3%) had 51 complications. These included 33 deaths, 12 major bleeding episodes, and 6 minor bleeding episodes. The clinical variables used in the prediction rule were assigned the following scores: recent major bleeding episode and cancer with metastasis, 4 points each; creatinine levels of over 2 mg/dL, 3 points; cancer without metastasis and immobility due to a recent medical condition, 2 points each; and absence of surgery in the past 2 months and an age of over 60 years, 1 point each. A risk score of 2 or less, obtained by 47.8% of patients, indicated a low short-term risk of developing complications following pulmonary thromboembolism. The area under the receiver operating characteristic curve for the prediction rule was 0.75 (95% confidence interval [CI], 0.67-0.83). For this cutoff point, sensitivity was 82.9% (95% CI, 68.7-91.5) and the likelihood ratios for a positive and negative test result were 1.63 (95% CI, 1.39-1.92), and 0.35 (95% CI, 0.18-0.69), respectively. CONCLUSIONS: Our clinical prediction rule could be useful for identifying patients with a low risk of complications in the 10 days following acute pulmonary thromboembolism. Those patients would be eligible for consideration for outpatient treatment.

An optimal duration of LMWH in cancer associated venous thromboembolism(CAT)patients is unknown. Objective: To analyze the required duration of LMWH according clinical criteria in CAT patients. Methods: CAT patients were referred to outpatients venous thromboembolic diseases (VTD) unit for suspection of deep venous thrombosis (DVT) or for follow-up of symptomatic or incidental Pulmonary Emobolism (PE).Demographic, related to VTD or cancer variables and events during the follow up patientswere collected.The comparison between groups was performed using Chi-squared test and Student9s t-test.Bleeding risk was weighted using Cox regression. Results: 121 patients were included.69% were in a metastatic stage.DVT of lower limbs as diagnosed in 56% of patients, of which 27% were asymptomatic;11% were diagnosed with DVT of higher limbs.Up to 87% were treated with Tinzaparin and 50% were anticoagulated more than 6 months.Anticoagulant treatment was maintained when there was active malignancy(56%),persistent residual thrombosis(31%)and use of chemotherapy 7.4%). 25% of patients died, although not related to VTD.Half of the deaths occurred in the first six months after diagnosing VTD(p=0.01).There were 12 episodes of recurrence(10%)of which 30% happened despite anticoagulation.18 patients(15%)suffered bleeding,and 5% of them were severe.The bleeding risk after the first 6 months descended significantly [HR:0.089(95% CI: 0.017 to 0.462),p=0.004]. Conclusions: Most of CAT patients needed anticoagulation with LMWH treatment for more than 6 months. There was higher incidence than expected in VTD recurrences The bleeding risk decreased after 6 months of LMWH treatment.

Despite advances in hospital management in recent years, it is not clear whether mortality after acute pulmonary embolism (PE) has decreased over time.This study describes the trends in the management and outcomes of acute symptomatic PE.We identified adults with acute PE enrolled in the registry between 2001 and 2013. We assessed temporal trends in length of hospital stay and use of pharmacological and interventional therapies. Using multivariable regression, we examined temporal trends in risk-adjusted rates of all-cause and PE-related death to 30 days after diagnosis.Among 23,858 patients with PE, mean length of stay decreased from 13.6 to 9.3 days over time (32% relative reduction, p 0.001). For initial treatment, use of low-molecular-weight heparin increased from 77% to 84%, whereas the use of unfractionated heparin decreased from 22% to 8.4% (p 0.001 for trend for all comparisons). Thrombolytic therapy use increased from 0.7% to 1.0% (p = 0.07 for trend) and surgical embolectomy use doubled from 0.3% to 0.6% (p 0.01 for trend). Risk-adjusted rates of all-cause mortality decreased from 6.6% in the first period (2001 to 2005) to 4.9% in the last period (2010 to 2013) (p = 0.02 for trend). Rates of PE-related mortality decreased over time, with a risk-adjusted rate of 3.3% in 2001 to 2005 and 1.8% in 2010 to 2013 (p 0.01 for trend).In a large international registry of patients with PE, improvements in length of stay and changes in the initial treatment were accompanied by a reduction in short-term all-cause and PE-specific mortality.

Background Venous and arterial thrombosis share a number of pathogenic mechanisms, but the burden of pulmonary embolism (PE) has not been consistently compared with that in other arterial diseases. Methods We used the Spanish National Discharge Database to compare the frequency, clinical characteristics and mortality rate of all patients with PE, acute coronary syndrome (ACS) or ischemic stroke admitted from 2001 to 2010. Patients were classified as having primary diagnosis (the process leading to hospital admission) or secondary diagnosis (it appeared during hospital stay for other reasons) Results During the study period, 31,949,739 patients were discharged. Of these, 165,229 (0.52%) were diagnosed with PE, 562,837 (1.76%) with ACS and 495,427 (1.55%) with ischemic stroke. Overall, 31% of patients with PE, 8.4% with ACS and 13% with ischemic stroke had secondary diagnoses. The most common reasons for admission in patients with secondary PE were: cancer (21%), acute respiratory failure (11%), acute heart failure (6.4%) and stroke (5.5%). Mean hospital stay was: 14 ± 13 days in PE patients, 9.7 ± 9.7 in those with ACS and 13 ± 14 days in those with stroke. In-hospital mortality rate was: 10.5%, 10.1% and 12.3% respectively in patients with primary diagnosis, and 36%, 34% and 29% in those with secondary diagnosis. Conclusions Patients hospitalized with PE were 3–4 times less frequent than those with ACS or stroke, but had a higher mortality. One in every 3 patients with PE (but only one in every 10 with ACS or stroke) had secondary diagnosis, and these patients had the highest mortality.

Pulmonary thromboembolism (PE) is a common cause of morbidity and mortality in patients with cancer. Having cancer is an independent risk factor for death in the general series of patients with PE and is included as a variable in the prognostic scales of acute symptomatic PE. This fact limits the discriminatory power of these general scales for patients with cancer and has prompted the development of specific prognostic tools: POMPE-C and a scale derived from the RIETE registry. Whether the increased risk of death by PE in patients with cancer is due to complications related to the neoplasm or to a greater severity of the thromboembolic episode in this population has not been well studied. Moreover, the introduction of computed multidetector tomography in recent years has led to a growing diagnosis of incidental PE, which currently represents up to half of pulmonary embolisms in patients with cancer. The EPIPHANY study attempts to further the understanding of the characteristics of pulmonary embolisms in patients with cancer by including incidental and symptomatic events. Its primary objectives are a) to understand the clinical and epidemiological patterns of pulmonary embolism associated with cancer and b) to develop and validate a specific prognosis model for PE in this population. The registry includes variables of interest to oncology (cancer type and extent, oncospecific treatments, patient's functional condition, cancer progression), radiological variables (thrombotic burden, signs of ventricular overload and other findings), location of treatment (hospital or outpatient), acute complications and causes of death in patients with PE associated with cancer.

Objective To describe trends in lung cancer mortality rates in the different provinces of Andalusia, Spain, from 1975 through 2002. Material and methods Deaths from lung cancer during the period 1975 through 2002 were obtained from the Spanish national institute of statistics. Crude rates and age-adjusted rates (overall and truncated 35-64 year rates) were calculated. Results In Andalusia in 2002 there were 2802 deaths from lung cancer in men and 254 in women, representing 28.4% and 4.5%, respectively, of the mortality rate from tumors. Joinpoint regression analysis distinguished 3 recent trends in truncated (range, 35-64 years) lung cancer mortality rates in men: decrease in Sevilla, increase in Huelva and Jaen, and stability in the other provinces. For women there was a marked increase (5.2% annually) during the period 1988 through 2002 in Malaga. Conclusions From a strategic point of view, antismoking strategies should target women in the province of Malaga in particular, with the aim of detaining their increasing risk for this type of cancer and of preventing avoidable and premature deaths among future generations of women.

Objetivo Describir la evolucion de la mortalidad por cancer de pulmon en Andalucia durante el periodo 1975- 2002 a nivel provincial. Material y metodos Las defunciones por cancer de pulmon durante el periodo 1975-2002 se obtuvieron del Instituto Nacional de Estadistica. Se han calculado los siguientes indicadores: tasas brutas y tasas ajustadas por edad (globales y truncadas 35-64 anos). Resultados En 2002 se produjeron en Andalucia 2.802 defunciones por cancer de pulmon en varones y 254 en mujeres, lo que represento el 28,4 y el 4,5% de la mortalidad por tumores, respectivamente. El analisis joinpoint permitio delimitar 3 tendencias diferenciadas en los ultimos anos (descenso en Sevilla, incremento en Huelva y Jaen, y estabilizacion en el resto de provincias) en las tasas truncadas (35-64 anos) de mortalidad por cancer de pulmon en varones. En las mujeres destaco el fuerte incremento (un 5,2% anual) observado en el periodo 1988-2002 en Malaga. Conclusiones Desde el punto de vista estrategico es recommendable que las medidas antitabaco se dirijan especialmente a las mujeres de la provincia de Malaga, con el fin de detener el creciente incremento del riesgo de padecer este tipo de cancer e impedir muertes evitables y prematuras entre las generaciones futuras de mujeres.

Fundamento y objetivo: Las complicaciones precoces mas graves de la embolia pulmonar (EP) son la mortalidad, las recidivas y las hemorragias. Los objetivos de este estudio fueron conocer cuales son las complicaciones mas frecuentes y los factores a ellas asociados en los primeros 10 dias siguientes al diagnostico de EP. Pacientes y metodo: Se incluyo prospectivamente en el estudio a todos los pacientes ingresados por sospecha de EP entre diciembre de 2003 y agosto de 2004, procedentes de 8 hospitales. Se evaluo la aparicion de complicaciones durante los primeros 10 dias. Las variables clinicas recogidas se incluyeron en el Registro Informatizado de la Enfermedad Tromboembolica en Espana (RIETE). El analisis estadistico se realizo mediante las pruebas de la *2 y de la t de Student para la comparacion de los grupos segun presentaran o no complicaciones; se efectuo un analisis multivariado para averiguar que factores estaban relacionados con la aparicion de complicaciones. Resultados: El numero de pacientes fue de 681, 336 hombres y 345 mujeres, edad media 66 y 70 anos, respectivamente. En los primeros 10 dias, 33 (4,8%) fallecieron y 22 (3,2%) presentaron alguna hemorragia. No hubo ninguna recidiva de la EP. El antecedente de inmovilizacion y la presencia de insuficiencia respiratoria, de un cancer o de insuficiencia renal fueron las variables asociadas con mas frecuencia a la aparicion de complicaciones. La cirugia y el dolor toracico fueron las asociadas a menos complicaciones. Conclusiones: La frecuencia de presentacion de complicaciones precoces de la EP y una parte de los factores asociados a ellas coinciden con los ya conocidos. Sin embargo, este estudio demuestra que otros factores como la cirugia previa o el dolor toracico protegen a los pacientes frente a su aparicion.

This study aimed to determine the effect of an evidence-based clinical decision support (CDS) algorithm on the use and yield of CT pulmonary angiography (CTPA) and on outcomes of patients evaluated in the emergency department (ED) for suspected PE. The study included 1363 consecutive patients evaluated for suspected PE in an ED during 12 months before and 12 months after initiation of CDS use. Introduction of CDS was associated with decreased CTPA use (55% vs 49%; absolute difference (AD), 6.3%; 95% CI 1.0% to 11.6%; p=0.02). The use of CDS was associated with fewer symptomatic venous thromboembolic events during follow-up in patients with an initial negative diagnostic evaluation for PE (0.7% vs 3.2%; AD 2.5%; 95% CI 0.9% to 4.6%; p0.01).

Summary. Background: The history of venous thromboembolism (VTE), and the rationale for thromboprophylaxis in surgical patients are well understood. The situation is less clear for acutely ill medical patients. Objectives: To compare the clinical presentation of VTE and clinical outcomes of immobile acutely ill medical patients with surgical patients. Patients: RIETE (Registro Informatizado de la Enfermedad TromboEmbolica) is a Spanish registry of consecutively enrolled patients with objectively confirmed, symptomatic acute VTE. In this analysis, clinical characteristics of patients, details of anticoagulant therapy, and outcomes of all enrolled acutely ill medical patients with immobility ≥ 4 days, and surgical patients are included. Results: Of 6160 patients enrolled up to December 2003, 756 (12%) were acutely ill medical patients with immobility ≥ 4 days, and 884 (14%) were surgical patients who developed VTE within 2 months of surgical intervention. Only 28% of acutely ill medical patients had received thromboprophylaxis, compared with 67% of surgical patients. During the 3-month follow-up period, both fatal pulmonary embolism (PE) and fatal bleeding occurred more frequently in acutely ill medical patients. Immobility in acutely ill medical patients, cancer, and PE were associated with a significantly higher risk of fatal PE or bleeding. Conclusions: In patients treated for VTE, the incidences of fatal PE, fatal bleeding, and major bleeding were significantly higher in acutely ill medical patients compared with surgical patients. Given the low percentage of acutely ill medical patients who had received thromboprophylaxis, increasing its use appropriately may reduce the incidence of VTE and associated complications.

Fundamento y objetivo En pacientes con enfermedad pulmonar obstructiva cronica (EPOC) eninsuficiencia respiratoria aguda hipercapnica se ha demostrado que la ventilacion mecanica noinvasiva (VMNI) con soporte de presion (mediante el dispositivo BiPAP) puede mejorar los parametrosclinicos y fisiologicos. El objetivo de nuestro estudio ha sido evaluar, en un trabajo prospectivoy aleatorizado, los beneficios del tratamiento con VMNI aplicada a los pacientes ingresadosen una planta de neumologia por descompensacion hipercapnica de su EPOC frente altratamiento estandar en un hospital de tercer nivel. Pacientes y metodo Se incluyo en el estudio a 41 pacientes que se asignaron de forma aleatoria algrupo de tratamiento medico convencional (grupo control) o la VMNI con soporte de presion (Bi-PAP ST, Respironics Inc., Murrysville, PA, EE.UU.) ademas del tratamiento estandar. No hubo diferenciasentre los dos grupos en los parametros clinicos o fisiologicos en el momento del ingreso. Resultados En el grupo de tratamiento con VMNI se observo una reduccion de la frecuencia respiratoriay mejoria del nivel de conciencia en las primeras 2 h respecto al grupo control (p Conclusiones La aplicacion temprana de VMNI en los pacientes con descompensacion hipercapnicade su EPOC consigue una mejoria clinica y fisiologica mas rapida frente al tratamiento estandar.El uso de esta modalidad terapeutica en una planta convencional de neumologia es factible.

Resumen Se presenta el caso de una mujer de 20 anos diagnosticada de tromboembolismo pulmonar (EP) y trombosis de la vena subclavia derecha atribuible a la estasis provocada por la prominencia clavicular derecha. En el seguimiento a los 10 meses la paciente desarrollo una hipertension pulmonar tromboembolica cronica (HPTEC), instaurandose tratamiento con un antagonista dual del receptor de endotelina. Se han descrito muy pocos casos de trombosis venosa profunda de miembro superior debidos a alteraciones anatomicas. Lo excepcional del caso es que, ademas, la paciente desarrollo una hipertension pulmonar postembolica cronica, cuya incidencia se estima del 0,5% del total de los EP sintomaticos.

We report on a 20 year-old woman diagnosed with pulmonary embolism (PE) and right subclavian vein thrombosis attributable to stasis caused by right clavicular prominence. At the 10-months follow-up, the patient had developed chronic thromboembolic pulmonary hypertension (CTEPH), and treatment was begun with a dual endothelin receptor antagonist. Very few cases of deep venous thrombosis of upper limb have been reported in relation to anatomical abnormalities. This case is also exceptional because the patient developed a chronic thromboembolic pulmonary hypertension, whose incidence is estimated at 0.5% of all symptomatic PE.

International audience; OBJECTIVE:Patients with acute venous thromboembolism (VTE) are at increased risk for the development of subsequent arterial ischemic events unrelated to the diagnosis of VTE. Accurate identification of VTE patients at increased risk for ischemic events during the course of anticoagulation may help to select those who would potentially benefit from concomitant therapy with anticoagulants and antiplatelets.METHODS:We used the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) Registry to assess the rate and severity of subsequent ischemic events (ie, stroke, myocardial infarction, lower limb amputation, or mesenteric ischemia) appearing during the course of anticoagulant therapy and tried to identify risk factors for these events.RESULTS:From February 2009 to March 2014, 23,370 patients were recruited: 12,397 initially presenting with pulmonary embolism (PE) and 10,973 with deep venous thrombosis. During the course of anticoagulation (mean, 9.2 months), 597 patients developed recurrent VTE, 652 bled, 162 had ischemic events (stroke, 86; myocardial infarction, 53; limb amputation, 13; mesenteric ischemia, 11), and 2063 died. Of these, 29 patients died of recurrent PE, 83 of bleeding, and 53 of the ischemic events. On multivariable analysis, cancer (hazard ratio [HR], 1.77; 95% confidence interval [CI], 1.21-2.61), chronic lung disease (HR, 1.54; 95% CI, 1.05-2.26), renal insufficiency (HR, 1.72; 95% CI, 1.25-2.36), anemia (HR, 1.54; 95% CI, 1.11-2.14), prior artery disease (HR, 1.84; 95% CI, 1.29-2.64), and diabetes (HR, 1.58; 95% CI, 1.10-2.27) independently predicted the risk for ischemic events. Most of these variables also predicted major bleeding (cancer, chronic lung disease, renal insufficiency, anemia, and prior artery disease) or recurrent PE (cancer, chronic lung disease, anemia, and prior artery disease).CONCLUSIONS:In patients receiving anticoagulation for VTE, the mortality due to PE recurrences was lower than the mortality due to ischemic events. Most independent predictors for ischemic events were also predictors for major bleeding and for recurrent PE.

International audience; BACKGROUND:No prior studies have identified which patients with deep vein thrombosis in the lower limbs are at a low risk for adverse events within the first week of therapy.METHODS:We used data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) to identify patients at low risk for the composite outcome of pulmonary embolism, major bleeding, or death within the first week. We built a prognostic score and compared it with the decision to treat patients at home.RESULTS:As of December 2013, 15,280 outpatients with deep vein thrombosis had been enrolled. Overall, 5164 patients (34%) were treated at home. Of these, 12 (0.23%) had pulmonary embolism, 8 (0.15%) bled, and 4 (0.08%) died. On multivariable analysis, chronic heart failure, recent immobility, recent bleeding, cancer, renal insufficiency, and abnormal platelet count independently predicted the risk for the composite outcome. Among 11,430 patients (75%) considered to be at low risk, 15 (0.13%) suffered pulmonary embolism, 22 (0.19%) bled, and 8 (0.07%) died. The C-statistic was 0.61 (95% confidence interval [CI], 0.57-0.65) for the decision to treat patients at home and 0.76 (95% CI, 0.72-0.79) for the score (P = .003). Net reclassification improvement was 41% (P < .001). Integrated discrimination improvement was 0.034 for the score and 0.015 for the clinical decision (P < .001).CONCLUSIONS:Using 6 easily available variables, we identified outpatients with deep vein thrombosis at low risk for adverse events within the first week. These data may help to safely treat more patients at home. This score, however, should be validated.

The aim of our study was to analyse changes in the incidence, diagnostic procedures, comorbidity, length of hospital stay, costs and in-hospital mortality of patients hospitalised for pulmonary embolism in Spain over a 10-year period.We included all patients who were hospitalised for pulmonary embolism (ICD-9-CM codes 415.11 and 415.19) as the primary diagnosis between 2002 and 2011. Data were collected from the National Hospital Discharge Database, covering the entire Spanish population.115 671 patients were admitted. The overall crude incidence increased from 20.44 per 100 000 inhabitants in 2002 to 32.69 in 2011 (p2, and in 2011 the prevalence increased to 20.8% (pOur results revealed an increase in the incidence of hospitalised pulmonary embolism patients from 2002 to 2011 with concomitant increase in comorbidities and cost. However, length of hospital stay and in-hospital mortality decreased.

Introduction Randomized clinical trials have demonstrated non-inferiority of rivaroxaban compared with vitamin K antagonists (VKAs) in the treatment of venous thromboembolism (VTE). Our objective was to analyze in real life, tolerance, recurrence, bleeding and adverse events of rivaroxaban in patients with acute symptomatic VTE. Material and Methods Open follow-up study of a cohort of patients aged 18 and over diagnosed with deep vein thrombosis (DVT) and/or pulmonary embolism (PE) treated with rivaroxaban from December 2011 to January 2014. Results The total number of patients treated with rivaroxaban was 103. The mean age was 58 +/-17 years. The most frequent co-morbidities were: hypertension (30.0%), dyslipidemia (23.3%) and respiratory disease (25.2%). The type of thromboembolic event treated was: DVT (64.1%), PE (18.4%), DVT + PE (17.5%). Of the rivaroxaban-treated patients, 30% did so from the initial anticoagulant therapy and the other 70% in long-term or extended anticoagulant therapy. The median time of treatment with rivaroxaban was 5 months. There was one recurrence and no deaths occurred. Six patients had bleeding, one of which was severe. Conclusions Rivaroxaban provides a therapeutic alternative in a group of patients with VTE with advantages over VKAs, because of the convenience in dosing, lack of requirements for periodic monitoring and limited interaction with other drugs.