Once versus twice daily enoxaparin for the initial treatment of acute venous thromboembolism.

Essentials In venous thromboembolism (VTE), it is uncertain if enoxaparin should be given twice or once daily. We compared the 15- and 30-day outcomes in VTE patients on enoxaparin twice vs. once daily. Patients on enoxaparin once daily had fewer major bleeds and deaths than those on twice daily. The rate of VTE recurrences was similar in both subgroups. SUMMARY: Background In patients with acute venous thromboembolism (VTE), it is uncertain whether enoxaparin should be administered twice or once daily. Methods We used the RIETE Registry data to compare the 15- and 30-day rates of VTE recurrence, major bleeding and death between patients receiving enoxaparin twice daily and those receiving it once daily. We used propensity score matching to adjust for confounding variables. Results The study included 4730 patients: 3786 (80%) received enoxaparin twice daily and 944 once daily. During the first 15 days, patients on enoxaparin once daily had a trend towards more VTE recurrences (odds ratio [OR], 1.79; 95% confidence interval [CI], 0.55-5.88), fewer major bleeds (OR, 0.42; 95% CI, 0.17-1.08) and fewer deaths (OR, 0.32; 95% CI, 0.13-0.78) than those on enoxaparin twice daily. At day 30, patients on enoxaparin once daily had more VTE recurrences (OR, 2.5; 95% CI, 1.03-5.88), fewer major bleeds (OR, 0.40; 95% CI, 0.17-0.94) and fewer deaths (OR, 0.58; 95% CI, 0.33-1.00). On propensity analysis, patients on enoxaparin once daily had fewer major bleeds at 15 (hazard ratio [HR], 0.30; 95% CI, 0.10-0.88) and at 30 days (HR, 0.16; 95% CI, 0.04-0.68) and also fewer deaths at 15 (HR, 0.37; 95% CI, 0.14-0.99) and at 30 days (HR, 0.19; 95% CI, 0.07-0.54) than those on enoxaparin twice daily. Conclusions Our findings confirm that enoxaparin prescribed once daily results in fewer major bleeds than enoxaparin twice daily, as suggested in a meta-analysis of controlled clinical trials.

Los estudios prospectivos de pacientes consecutivos con enfermedad tromboembólica venosa no identifican a todos los pacientes en riesgo. Análisis multicéntrico ambispectivo del grupo Contaminatep / Prospective studies of consecutive patients with venous thromboembolic disease fail to identify all patients at risk. Multicenter, ambispective analysis of the Contaminatep Group

INTRODUCCIÓN: nuestro grupo ha comenzado un trabajo para estudiar la relación entre la incidencia de TEP y la contaminación ambiental. Para establecer una relación, es una condición metodológica fundamental contar con todos los casos incidentes en un periodo de tiempo. Por este motivo diseñamos este estudio, para valorar la eficacia de recogida de pacientes consecutivos con TEP. MATERIAL Y MÉTODOS: realizamos un estudio ambispectivo, multicéntrico, de un año de duración. En una primera fase se incluyeron prospectivamente todos los casos que ingresaron con diagnóstico de TEP y posteriormente, de forma retrospectiva, realizamos una revisión de los registros hospitalarios de cada uno de los centros participantes. Así, calculamos la eficacia dividiendo el número de casos incidentes en fase prospectiva por el número total de casos reclutados en ambas fases. RESULTADOS: desde febrero 2012 a febrero 2013 se reclutaron 839 pacientes (440 prospectivamente). El reclutamiento prospectivo presentó una eficacia de detección de TEP del 52,4%, mostrando variabilidad según el centro (29,3 - 100%). Cuando analizamos sólo a los pacientes con TEP agudo sintomático idiopático, la eficacia fue del 59,8 %, con variabilidad según centro (31,7 - 100%). La eficacia de reclutamiento de pacientes con TEP secundario o idiopático fue de 42,1% vs. 59,8%, respectivamente (p < 0,001). CONCLUSIONES: en los estudios prospectivos, el porcentaje de pacientes no diagnosticados no es desdeñable. Los resultados de este estudio nos deben hacer pensar en estrategias adicionales para reclutar pacientes consecutivos de forma correcta, principalmente en aquellos estudios donde la pérdida de pacientes supondría un sesgo a la hora de emitir conclusiones

INTRODUCTION: we are studying the relationship between the incidence of pulmonary embolism (PE) and air pollution, and all symptomatic PE were needed over a period of time to establish a relationship. For this reason we designed this study, to assess the efficacy of collection consecutive patients with PE. METHODS: ambispective, multicenter study, from February 2012 to February 2013. In the first phase, we included prospectively all cases admitted at the hospital with PE diagnosis, and in the second phase, we reviewed retrospectively, hospital records from each participating center. So, we calculate the efficacy by dividing the number of incident cases in prospective phase by the total number of cases recruited in both phases. RESULTS: during one year, 839 patients were recruited (440 prospectively). The prospective recruitment presented a PE efficacy detection of 52.4%, showing variability according to the center between 29.3 to 100%. When we analyzed only patients with idiopathic symptomatic PE, efficacy was 59.8%, with variability according to the center between 31.7 to 100%. The recruitment efficacy of patients with secondary or idiopathic PE was 42.1% vs. 59.8%, respectively (p < 0.001). CONCLUSIONS: A wide percentage of patients can pass up from prospectives studies. The results of this study try to make us think, that we need more strategies to get a good recruit of consecutive patients, especially in those studies where is essential collect all patients

[Duodenitis caused by Giardia lamblia]. / Duodenitis per Giardia lamblia.

Duodenitis produced by Giardia lamblia occurred in 4.5% of the patients hospitalized in our service. Often was associated with duodenal or gastric peptic ulcer, hiatus hernia and with some other parasitic diseases; particularly with ambiasis. Forty four patients were studied in whom the only cause to demonstrate or explain their symptomatology was the presence of Giardia lamblia in the duodenum. The complaints disappeared after the administration of specific treatment. The clinical manifestations remained an atypic ulcer syndrome without defined rhythm or periodicity; however, heartburn and regurgitation are frequently present. The physical exploration does not help to the diagnosis. Gastric acidity is normal. X-ray studies demonstrate irregular mucosa of the stomach and duodenum and some spastic waves. Duodenoscopy allows to watch inflammatory changes of the duodenal mucosa and rules out peptic ulcer. The diagnosis is confirmed by the demonstration of the parasite, present in the fluid aspirated from the duodenum during the endoscopy.

Duodenitis por Giardia lamblia. / Duodenitis due to Giardia lamblia

La duodenitis por Giardia lamblia (DGL) ocurrio en el 4,5% de los pacientes encamados en nuestro servicio. A menudo se asocia a padecimientos tales como: ulcera peptica, gastritis y hernia hiatal, asi como a otras parasitosis, en particular amibiasis. Se estudiaron 44 pacientes en los cuales la unica causa demostrada para explicar la sintomatologia fue la presecia de Giardia lamblia en el duodeno, molestias que cedieron al administrar el tratamiento especifico. El cuadro clinico simula a menudo un sindrome ulceroso que es atipico pues carece de ritmo y periodicidad definidos, son frecuentes la pirosis y las regurgitaciones. La exploracion no aporta datos al diagnostico. La acidez gastrica es normal. El estudio radiologico demuestra irregularidades en el patron mucoso del duodeno y espasmo. La duodenoscopia permite observar los cambios inflamatorios en la mucosa duodenal y elimina la posibilidad de ulcera. La confirmacion del diagnostico se hace mediante la demostracion del parasito en el sondeo duodenal y en el liquido del lavado duodenal durante la endoscopia