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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.

Funding Acknowledgements Type of funding sources: None. Background To stop Coronavirus-19 pandemic, Spanish government ordained home confinement in Basque Country from 13th March to 11th May, although some people had previously confined themselves. In this period, a decrease in cardiovascular admissions, except pulmonary embolism has been reported, speculating about viral activation of coagulation. As patients could not receive the standard care, augmented mortality of non-Covid pathologies could happen. Methods We, selected patients admitted with intermediate-high and high risk from 1st March to 30th June. Other risks or those occurred during a hospitalization were excluded. Several characteristics were reported. Results Among 21 cases (13 women), there were 3 Covid-positive (2 women). All presented an intermediate-high risk, except 2. 16 cases happened in March and April. Mean age was 72,5 years (range 30-94). Mean total stay length was 7,24 days (range 3-12). 14 patients presented original Pulmonary Embolism Severity Index (PESI) class ≥ III and mean simplified PESI (sPESI) was 1.43 points (range 0-4). On average, patients presented 1,95 risk factors for pulmonary embolism (range 0-6), mainly weak ones. Average Troponin T was 130.15 ng/L (range 15-1099, one case unknown). Average NT-proBNP was 6690.42 pg/ml (range 267-35000, 2 cases unknown). Fibrinolytic therapy and vasopressors were only used in intensive care unit (ICU), in 2 and 1 patients respectively. 2 patients were on Unfractionated Heparin, the rest received low-molecular-weight heparin. All patients admitted in ICU were transferred later to ward, except 1 that was transfer to Intermediate respiratory care unit (IRCU). There were no mortality during hospitalization. There were 3 complications that not required intensive therapy. 8 were admitted in ICU (50% women, mean age 61,2 years (range 30-78), average sPESI 1,4 (range 0-4), 6 patients PESI class ≥ III, average troponin 109,25 ng/L (19-259) and NT-proBNP 7219.86 pg/ml (446-15787), 1,88 risk factors on average, stay length 8,25 days (6-11)). The rest were admitted in ward (4 in IRCU) (62% women, mean age 79.46 years (66-94), average sPESI 1,46 (0-4), 8 patients PESI class ≥ III, average troponin 144,08 ng/L (15-1099) and NT-proBNP 6351.58 pg/ml (439-35000), 2 risk factors on average, stay length 6,62 days (3-12)). Conclusions Probably coronavirus-19 is not a risk factor for admission due to severe pulmonary embolism. Home confinement may be a risk factor, and if it happened again, advice against sedentary lifestyle should be given to population. Despite a possible delay in diagnosis or treatment, there were no mortality or severe complications, irrespectively of age or site of admission, although patients in intensive care tend to be younger, presented more frequently PESI class > III and stay more time in hospital. Studies are needed to determine which patients would benefit from admission in intensive care units, especially if resources are limited again. Abstract Figure. Number of cases per month

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.

SummaryVenous thromboembolism (VTE) is a significant cause of morbidity and mortality in Europe. Data from real-world registries are necessary, as clinical trials do not represent the full spectrum of VTE patients seen in clinical practice. We aimed to document the epidemiology, management and outcomes of VTE using data from a large, observational database. PREFER in VTE was an international, non-interventional disease registry conducted between January 2013 and July 2015 in primary and secondary care across seven European countries. Consecutive patients with acute VTE were documented and followed up over 12 months. PREFER in VTE included 3,455 patients with a mean age of 60.8 ± 17.0 years. Overall, 53.0% were male. The majority of patients were assessed in the hospital setting as inpatients or outpatients (78.5%). The diagnosis was deep-vein thrombosis (DVT) in 59.5% and pulmonary embolism (PE) in 40.5%. The most common comorbidities were the various types of cardiovascular disease (excluding hypertension; 45.5%), hypertension (42.3%) and dyslipidaemia (21.1%). Following the index VTE, a large proportion of patients received initial therapy with heparin (73.2%), almost half received a vitamin K antagonist (48.7%) and nearly a quarter received a DOAC (24.5%). Almost a quarter of all presentations were for recurrent VTE, with >80% of previous episodes having occurred more than 12 months prior to baseline. In conclusion, PREFER in VTE has provided contemporary insights into VTE patients and their real-world management, including their baseline characteristics, risk factors, disease history, symptoms and signs, initial therapy and outcomes.

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.

El quilotorax se define como la presencia de linfa en la cavidad pleural constituyendo una complicacion que ocurre en la mayoria de los casos en el contexto de un tumor, una intervencion quirurgica, o un traumatismo sobre el conducto toracico. La asociacion entre el quilotorax y la ascitis quilosa resulta infrecuente, normalmente en el contexto de un traumatismo, una enfermedad tumoral o complicaciones posquirurgicas, pudiendo deberse ocasionalmente a cirrosis hepatica, insuficiencia cardiaca o sindrome nefrotico. Exponemos un caso clinico en el que tal asociacion se encuentra presente.

Background: There is limited information on the causes of death in asthma patients. To determine the causes of death in hospitalized asthmatic patients and to compare with those observed in COPD patients and non-respiratory individuals, with a particular interest in associations with previous cardiovascular disease. Methods: Retrospective case-control study which analyzed the deaths of all hospitalized patients admitted for any reason during January, April, July and October of 2008 in 13 Spanish centers. Medical records of deceased patients were reviewed, and demographic and clinical data were collected. Results: A total of 2,826 deaths (mean age 75 years, 56% men) were included in the analysis, of which 82 (2.9%) were of patients with asthma and 283 (10%) with COPD. The most common causes of death in asthma patients were cardiovascular diseases (29.3%), malignancies (20.7%) and infections (14.6%); in COPD patients they were malignancies (26.5%), acute respiratory failure (25.8%) and cardiovascular diseases (21.6%). Asthma, compared to COPD patients, died significantly less frequently from acute respiratory failure and lung cancer. A multivariate logistic regression analysis failed to associate asthma with cardiovascular deaths. Conclusions: Cardiovascular disease is the most frequent cause of death among hospitalized asthma patients. The specific causes of death differ between asthma and COPD patients., The study received a Research Grant in 2009 from SEPAR.

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.