'Pulmonary thrombosis in situ': risk factors, clinic characteristics and long-term evolution.

: Pulmonary embolism typically occurs from deep venous thrombosis (DVT). However, not always a DVT can be identified, and 'in situ' generation of pulmonary embolism has been considered, referred to in the literature as 'De novo pulmonary embolism' (DNPE). The objective of the study is to assess risk factors, comorbidities, clinic characteristics and long-term evolution of patients with pulmonary embolism in the absence of an identified source. Retrospective study of 280 patients with pulmonary embolism, 190 pulmonary embolisms with DVT group and 90 (32%) pulmonary embolism without DVT (DNPE group), admitted to an Internal Medicine Department of a tertiary hospital from January 2012 to December 2015. In the DNPE group, segmental and subsegmental arteries were more frequently affected (P = 0.01). As compared with pulmonary embolisms with DVT group: older age, female sex, sedentary lifestyle, diabetes mellitus, arterial hypertension, heart failure, respiratory infections and chronic obstructive pulmonary disease (COPD) were significantly more frequent in DNPE. In multivariate analysis, respiratory infection [odds ratio (OR) 12.2, P < 0.0001], COPD (OR 8.7, P < 0.0001) and female sex (OR 3.0, P = 0.003) were independently associated risk factors. Long-term mortality (median follow-up 15 months) was also higher in DNPE group (34 vs. 16%, P = 0.01). De novo pulmonary embolism occurred in 32% of cases of pulmonary embolisms and was more frequent in female and COPD patients or those with respiratory infections as compared with pulmonary embolisms in which DVT was identified as a source of embolism.

Telitromicina, un posible nuevo potenciador del acenocumarol / Potential interaction between telitromicin and acenocumarol

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[Inferior vena cava malformations and deep venous thrombosis]. / Anomalías de la vena cava y trombosis venosa profunda.

We carried out a prospective study of 116 patients under 50 years of age who had deep venous thrombosis of the lower extremities to determine whether the presence of congenital anomaly of the inferior vena cava (IVC) was a risk factor for the disease. All patients were investigated by Doppler echography. Some 37 patients who had iliac vein occlusion also underwent phlebography. In 10 patients in whom the IVC was difficult to image, magnetic resonance angiography or computerized axial tomography was carried out. In all patients, studies of antithrombin, protein C and protein S deficiency, factor V Leiden, prothrombin G20210A, antiphospholipid antibodies, and acquired risk factors were also performed. Of the 37 patients who had iliac vein occlusion, six had an IVC anomaly. Two of these patients had antiphospholipid antibodies, while another had prothrombin G20210A. Two patients with an anomaly had recurrent thrombotic occlusion. In conclusion, congenital IVC anomalies were present in 16.2% (95% confidence interval, 6.2-32%) of young patients with iliac thrombosis.

Anomalías de la vena cava y trombosis venosa profunda / Inferior vena cava malformations and deep venous thrombosis

Estudio prospectivo de 116 pacientes menores de 50 años con trombosis venosa profunda (TVP) de los miembros inferiores, en el que se valora la presencia de anomalías de la vena cava inferior (VCI) como factor de riesgo de la TVP. Se practicó a todos una eco-Doppler; cuando tenían afección ilíaca se realizaba también flebografía, y cuando el drenaje a la VCI era deficiente, se completaba el estudio con resonancia magnética o tomografía computarizada. En todos los pacientes también se realizaron las siguientes determinaciones: antitrombina, déficit de proteína C y S, factor V Leiden, protrombina G20210A y anticuerpos antifosfolipídicos. También se valoraron los factores de riesgo adquiridos. De los 37 pacientes con afección ilíaca, 6 presentaron anomalías de VCI: 4 hipoplasias y 2 duplicaciones. Todos ellos eran menores de 30 años, 2 tenían anticuerpos antifosfolipídicos y 1 protrombina G20210A. Dos presentaron recidiva trombótica tras la suspensión de la anticoagulación. En conclusión, el 16,2% (intervalo de confianza [IC] del 95%, 6,2-32) de los pacientes con trombosis ilíaca presentaba anomalía de la VCI

We carried out a prospective study of 116 patients under 50 years of age who had deep venous thrombosis of the lower extremities to determine whether the presence of congenital anomaly of the inferior vena cava (IVC) was a risk factor for the disease. All patients were investigated by Doppler echography. Some 37 patients who had iliac vein occlusion also underwent phlebography. In 10 patients in whom the IVC was difficult to image, magnetic resonance angiography or computerized axial tomography was carried out. In all patients, studies of antithrombin, protein C and protein S deficiency, factor V Leiden, prothrombin G20210A, antiphospholipid antibodies, and acquired risk factors were also performed. Of the 37 patients who had iliac vein occlusion, six had an IVC anomaly. Two of these patients had antiphospholipid antibodies, while another had prothrombin G20210A. Two patients with an anomaly had recurrent thrombotic occlusion. In conclusion, congenital IVC anomalies were present in 16.2% (95% confidence interval, 6.2-32%) of young patients with iliac thrombosis