ABSTRACT
Cancer patients are at risk of venous thromboembolism (VTE), its recurrence, but also at risk of bleeding while anticoagulated. In addition, cancer therapies have been associated to increased VTE risk. Guidelines for VTE treatment in cancer patients recommend low molecular weight heparins (LMWH) or direct oral anticoagulants (DOAC) for the initial treatment, DOAC for VTE short-term treatment, and LMWH or DOAC for VTE long-term treatment. This consensus article arises from a collaboration between different Spanish experts on cancer-associated thrombosis. It aims to reach an agreement on a practical document of recommendations for action allowing the healthcare homogenization of cancer-associated thrombosis (CAT) patients in Spain considering not only what is known about VTE management in cancer patients but also what is done in Spanish hospitals in the clinical practice. The text summarizes the current knowledge and available evidence on the subject in Spain and provides a series of practical recommendations for CAT management and treatment algorithms to help clinicians to manage CAT over time.
Subject(s)
Anticoagulants , Neoplasms , Thrombosis , Venous Thromboembolism , Humans , Neoplasms/complications , Spain , Anticoagulants/therapeutic use , Thrombosis/etiology , Thrombosis/prevention & control , Venous Thromboembolism/etiology , Venous Thromboembolism/prevention & control , Venous Thromboembolism/drug therapy , Consensus , Practice Guidelines as Topic , Heparin, Low-Molecular-Weight/therapeutic useABSTRACT
BACKGROUND: Electroanatomical mapping systems (EMS) reduce fluoroscopy dose for the ablation. Higher costs and longer procedure times are the drawbacks associated with EMS. Our objective was to validate the efficiency of the EMS. OBJECTIVE: To demonstrate that using EMS is more efficient and as secure as the traditional system of ablation. METHODS: From April 2013 to June 2018, all patients were included into two groups, according to the intention of ablation with or without fluoroscopy. Right, left, supraventricular and ventricular ablation were included. We compared procedure variables (fluoroscopy, radiofrequency and procedure times, ablation results, complication rates and costs of the procedure) that included material and detrimental effect of fluoroscopy. RESULTS: A total of 105 were included in the fluoroscopy group and 287 in the without fluoroscopy group. We found an important reduction in time and radiation dose in all the ablation procedures studied, without increasing the procedure time. No differences in ablation results nor complications rate were found. We found lower costs in the flutter ablation without fluoroscopy, similar costs in the right focal tachycardia ablation group and higher costs in the without fluoroscopy group for the AVNRT and left accessory pathway. When detrimental effect of fluoroscopy was added, all procedures without fluoroscopy were significantly more efficient than the ones performed with it. CONCLUSIONS: Ablation without fluoroscopy is a technique as safe and effective as the conventional technique. Our study suggests that the radiation dose delivered to the patient and staff might be reduced, without increasing the total procedure time, being even more efficient.
Subject(s)
Catheter Ablation/methods , Electrophysiology/methods , Fluoroscopy/methods , Female , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
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Subject(s)
Humans , Female , Adult , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/pathology , Chest Pain/complications , Chest Pain/diagnosis , Spirometry/methods , Methylprednisolone/therapeutic use , Azathioprine/therapeutic use , Tomography, Emission-Computed/methods , Diagnosis, Differential , Immunosuppression Therapy/methods , Thorax/pathology , Thorax , Chest Pain/etiology , Chest Pain , Immunosuppression Therapy/trends , Immunosuppression TherapyABSTRACT
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Subject(s)
Middle Aged , Male , Female , Humans , Status Asthmaticus , Valine , Time Factors , Tetrazoles , Urticaria , Churg-Strauss Syndrome , Anti-Asthmatic Agents , Loratadine , Anti-Allergic Agents , Quinolines , Leukotriene Antagonists , Antihypertensive Agents , Angioedema , Antipruritics , Drug Eruptions , Acetates , Histamine H1 Antagonists , Follow-Up StudiesABSTRACT
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Subject(s)
Humans , Venous Thrombosis , Antifibrinolytic Agents , Fibrin Fibrinogen Degradation Products , Enzyme-Linked Immunosorbent AssayABSTRACT
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Subject(s)
Middle Aged , Adult , Aged , Male , Female , Humans , Streptokinase , Rib Fractures , Radiography, Thoracic , Thorax , Disease Progression , Myocardial Ischemia , Cost-Benefit Analysis , Hemothorax , Hypertension , Injections, Intravenous , Exostoses, Multiple Hereditary , Eye Hemorrhage , Health Services , Bone NeoplasmsABSTRACT
Fundamento: El diagnóstico de la trombosis venosa profunda (TVP) de miembros inferiores ha variado en los últimos años. El objetivo del estudio fue analizar la capacidad diagnóstica de la combinación de datos clínicos y epidemiológicos y valores plasmáticos de dímero-D en dicha entidad. Pacientes y métodos: Se revisaron los datos epidemiológicos y clínicos (síntomas y signos), antecedentes personales y familiares y valores plasmáticos o positividad del dímero-D correspondientes al momento del ingreso, en las historias clínicas de 108 pacientes a los que se realizó una flebografía ante la sospecha de TVP de miembros inferiores. Resultados: La flebografía intravenosa fue positiva en 76 casos (70,37 por ciento). Mediante regresión logística se obtuvo un modelo predictivo del diagnóstico de TVP que combina datos clinicoepidemiológicos y el valor del dímero-D. Conclusiones: La combinación de la concentración plasmática del dímero-D y el dolor en el territorio del sistema venoso profundo es útil como aproximación diagnóstica inicial de la TVP de miembros inferiores. (AU)
