Use of direct oral anticoagulants and low molecular weight heparin in venous thromboembolism associated with cancer: real-world evidence in Argentina.

BACKGROUND: Venous thromboembolism (VTE) and major bleeding (MB) are common in cancer patients. Reduced-doses of antithrombotics as secondary prophylaxis have limited data. This work aims to describe and to compare treatments and outcomes for cancer-associated VTE. RESEARCH DESIGN AND METHODS: Retrospective study. Adults with cancer-associated VTE were included. After 3-6 months of full-doses of anticoagulants, three strategies were considered: A) lowering the doses; B) maintaining full-doses; C) stopping treatment. The strategy and medication used were shown in a descriptive analysis and the rate of bleeding and VTE-recurrence between those in a comparative analysis. RESULTS: A total of 420 patients were included, 56.2% received DOACs, 43.8% enoxaparin. Strategy was defined in 257 patients: A (50.2%), B (46.3%), and C (3.5%). Forty-one (9.8%) had VTE-recurrence and 15 (3.6%) had MB or clinically relevant non-major bleeding (CRNMB).According to strategy, recurrent-VTE was 8.5% (A), 4.2% (B), and 11.1 (C) (p = 0.22), MB or CRNMB was 0.8% (A), 1.7% (B), and 0% (C) (p = 0.64). CONCLUSIONS: DOACs and strategy A were the most frequently used agent and strategy, respectively. There were no differences between medications or strategies used. The results must be interpreted with caution, and it is a retrospective single-center study, probably with information and selection bias.

[Conservative management of premature membrane rupture in pregnancy of 28-34 weeks. Aleatory clinical trial]. / Manejo conservador de ruptura prematura de membranas en embarazos de 28 a 34 semanas. Ensayo clínico aleatorio.

A random clinical trial to compare two managements: a conservative one (experimental group) and an interventionist one (control group) in patients with PROM in pregnancy between 28 and 34 weeks, was carried out. A group of women with complicate pregnancies with PROM, with amniotic fluid index of 5 cm in four quadrants, and a negative amniotic fluid culture, by amniocenthesis; no antibiotics, were studied at Perinatology Department, Centro Médico Nacional, IMSS, Torreón, Coah. México, from November 1, 1992 to October 31, 1993. The latency period was longer in the experimental group, than the control group (7.9 and 3 days, p < 0.001). There were no difference in chorioamnioitis or endometritis in both groups (p > 0.1). There were five cases of mid RDS in the experimental group, and seven cases in the control group, and nine of severe RDS, all of them died; there was a highly significant difference in perinatal mortality, (p = 0.005). There were no differences in neonatal sepsis (p > 0.05). Adequate selection of patients for conservative management is safe for both, mother and newborn. Complications and death by sepsis were uncommon.