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[Background]: The relationship between cancer and venous thromboembolic disease (VTD) are complex because the activated coagulation factors are not only involved in thrombosis but also in malignant processes, such as angiogenesis and metastasis., [Objective]: To compare phenotypes of extracellular vesicles (EVs), and levels of D-dimer, soluble P-selectin (sP-selectin) and antigenic tissue factor (TF) between unprovoked VTD patients, who did not develop cancer during one-year follow-up, and those with advanced stage of cancer but not associated with VTD., [Methods]: A prospective study in which we included 138 unprovoked VTD patients and 67 advanced cancer patients, who did not develop thrombosis. Levels of EVs of different cellular origin (platelet, endothelium and leukocyte), EVs positive for tissue factor (TF) and P-selectin glycoprotein ligand 1 were quantified by flow cytometry. D-dimer, soluble P-selectin (sP-selectin) and antigenic TF were determined by ELISA., [Results]: TF-positive EVs, D-dimer, and sP-selectin were markedly elevated in unprovoked VTD patients compared to cancer patients without association with thrombosis., [Conclusions]: Levels of TF-positive EVs, D-dimer and sP-selectin are able to discriminate between unprovoked VTD patients not related to cancer and cancer patients not associated with VTD. These results could lead to the application of EVs as biomarkers of both diseases., This work was supported by research grants from the Plan Nacional de Investigacion Cient ıfica, Desarrollo e Innovacion Tecnologica (Instituto de Salud Carlos III, Fondo de Investigacion Sanitaria [PI11/02308], Red RIC [RD12/0042/ 0029], Junta de Andalucıa [CVI-6654] and by the Fundacion Investigacion Hospital La Fe, Spain.

Anemia is a common condition in cancer patients and is associated with a wide variety of symptoms that impair quality of life (QoL). However, exactly how anemia affects QoL in cancer patients is unclear because of the inconsistencies in its definition in previous reports. We aimed to examine the clinical impact of anemia on the QoL of cancer patients using specific questionnaires. We performed a post-hoc analysis of a multicenter, prospective, case-control study. We included patients with cancer with (cases) or without (controls) anemia. Participants completed the European Organization for Research and Treatment of Cancer Quality of Life questionnaire version 3.0 (EORTC QLQ-C30) and Euro QoL 5-dimension 3-level (EQ−5D−3L) questionnaire. Statistically significant and clinically relevant differences in the global health status were examined. From 2015 to 2018, 365 patients were included (90 cases and 275 controls). We found minimally important differences in global health status according to the EORTC QLQ-C30 questionnaire (case vs. controls: 45.6 vs. 58%, respectively, mean difference: −12.4, p &lt, 0.001). Regarding symptoms, cancer patients with anemia had more pronounced symptoms in six out of nine scales in comparison with those without anemia. In conclusion, cancer patients with anemia had a worse QoL both clinically and statistically.

Although there is published research on the impact of venous thromboembolism (VTE) on quality of life (QoL), this issue has not been thoroughly investigated in patients with cancer&mdash, particularly using specific questionnaires. We aimed to examine the impact of acute symptomatic VTE on QoL of patients with malignancies. This was a multicenter, prospective, case-control study conducted in patients with cancer either with (cases) or without (controls) acute symptomatic VTE. Participants completed the EORTC QLQ-C30, EQ-5D-3L, PEmb-QoL, and VEINES-QOL/Sym questionnaires. Statistically significant and clinically relevant differences in terms of global health status were examined. Between 2015 and 2018, we enrolled 425 patients (128 cases and 297 controls, mean age: 60.2 &plusmn, 18.4 years). The most common malignancies were gastrointestinal (23.5%) and lung (19.8%) tumors. We found minimally important differences in global health status on the EQ-5D-3L (cases versus controls: 0.55 versus 0.77, mean difference: &minus, 0.22) and EORTC QLQ-C30 (47.7 versus 58.4, 10.3) questionnaires. There were minimally important differences on the PEmb-QoL questionnaire (44.4 versus 23, 21.4) and a significantly worse QoL on the VEINES-QOL/Sym questionnaire (42.7 versus 51.7, 9). In conclusion, we showed that acute symptomatic VTE adversely affects the QoL of patients with malignancies.

Objective: To determine the correct indication of TP in admitted patients in Pulmonology department. To analyze secondary events during the admission, in 30 days and in 90 days; hemorrhages and venous thromboembolism (VTE). Methods: Retrospective study in which patients admitted in Pulmonology Department in December of 2017 were included. The Padua score was applied to calculate the thrombotic risk and IMPROVE for hemorrhagic risk. There were analyzed the necessity of TP and the events onsets during the admission, in 30 and in 90 days. Anticoagulated patients in therapeutic doses (atrial fibrillation, thromboembolism, etc) were excluded. Results: 218 of 322 patients included were analyzed, after excluding the anticoagulated patients. The mean age was 69 years, 57% were men and the mean stay was 5.23 days. The TP indication (Yes/No) was appropriate in 134 (61.6%) patients. There was done in 56 (67.5%) of the ones that was indicated and 78 (57.8%) did not receive it when it was not indicated. The inadequate TP was greater in women (37.7%), in patients under de age of 70 years (47.3%) and in stays over 5 days (45.2%). See Figure 1. There were 5 hemorrhages; none of them associated to a wrong indication of TP. There was no VTE. Conclusions: More than a 1/3 of the patients received an inappropriate TP. Nevertheless, they did not register any event. In spite of existing scores, the clinical practice in TP presents acceptable results in our cohort.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious disease with a very poor prognosis and extremely low survival in untreated patients or in those treated with anticoagulation alone. The true incidence and prevalence of CTEPH is currently unknown and the disease is probably underdiagnosed. Current data indicate that the incidence ranges from 0.1% to 3.8%. The latest research and reported studies reveal the need to determine not only the incidence of CTEPH in symptomatic patients but also in asymptomatic patients who subsequently develop the disease, as well as in the remaining patients with an asymptomatic venous thromboembolic event. Several risk factors are associated with a greater predisposition to CTEPH (advanced age, extensive obstruction, elevated systolic pulmonary pressure, and numerous clinical conditions). Due to advances made in the management of CTEPH in the last few years, the clinical course and prognosis and of this disease may be undergoing a major change and CTEPH may become a chronic, treatable disease.

La historia natural de la fibrosis pulmonar idiopatica es la lenta evolucion hacia la insuficiencia respiratoria y la muerte. Sin embargo, un pequeno porcentaje de casos evoluciona en semanas o pocos meses de forma fulminante con insuficiencia respiratoria, imagenes extensas de vidrio esmerilado y formacion de membranas hialinas en las muestras de biopsia; es lo que se denomina “fase acelerada” de la fibrosis pulmonar idiopatica, durante la cual se describen incrementos de las cifras de reactantes de fase aguda y marcadores tumorales. Hasta la fecha no se ha relacionado el marcador tumoral monoclonal CA 15/3 con dicha fase acelerada.

The natural history of idiopathic pulmonary fibrosis is characterized by a slow progression resulting in respiratory failure and death. The progression to the fulminant form is rapid in a small percentage of cases, however. Within weeks or months, patients develop respiratory distress, and extensive ground-glass patterns can be seen in computed tomography scans and hyaline membranes in biopsy samples. This is described as an accelerated phase of idiopathic pulmonary fibrosis, in which elevated levels of acute-phase reactants and tumor markers have been reported. To date, the monoclonal tumor marker, CA 15/3 has not been associated with the accelerated phase.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious disease with a very poor prognosis and extremely low survival in untreated patients or in those treated with anticoagulation alone. The true incidence and prevalence of CTEPH is currently unknown and the disease is probably underdiagnosed. Current data indicate that the incidence ranges from 0.1% to 3.8%. The latest research and reported studies reveal the need to determine not only the incidence of CTEPH in symptomatic patients but also in asymptomatic patients who subsequently develop the disease, as well as in the remaining patients with an asymptomatic venous thromboembolic event. Several risk factors are associated with a greater predisposition to CTEPH (advanced age, extensive obstruction, elevated systolic pulmonary pressure, and numerous clinical conditions). Due to advances made in the management of CTEPH in the last few years, the clinical course and prognosis and of this disease may be undergoing a major change and CTEPH may become a chronic, treatable disease.