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Assessment of myocardial injury in low-risk acute pulmonary embolism 低危急性肺栓塞心肌损伤的评价
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa3642
D. J. Castro, A. Quezada, J. Lobo, R. Morillo, E. Barbero, D. Chiluiza, E. Mercedes, F. León, D. Barrios, R. Yusen
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引用次数: 0
Anti-Factor Xa levels correlate with recurrent venous thromboembolism and clinically relevant bleeding in patients receiving low-molecular-weight heparin 在接受低分子肝素治疗的患者中,抗Xa因子水平与静脉血栓栓塞复发和临床相关出血相关
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa1460
L. Jara-Palomares, S. Marin-Romero, M. Asensio-Cruz, T. Elías-Hernández, Rocío Ortega-Rivera, R. Otero-Candelera, E. Montero-Romero, Rodrigo Tallon-Aguilar, Maria Dolores Ucero-Leon, Manuel Arellano-Ceballos, M. Espada, C. Fernandez-Garcia, J. Sánchez-Díaz, V. Sánchez-López, E. Arellano-Orden, M. Ferrer-Galván, Stefano Barco
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引用次数: 0
Pulmonary Embolism Registry of a South American Hospital 南美一家医院肺栓塞登记
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa1458
P. R. G. Torres, Claudio Villaquiran Torres, C. Preciado, A. Arboleda, Javier Ivan Lasso Apraez
Pulmonary thromboembolism (PE) causes high morbidity and mortality. Due to limited information about the disease in our country, information from others must often be used. That is why we conducted a prospective observational study on the epidemiology of PE treated in a high complexity hospital from Colombia. A search of the scientific literature was carried out finding several initiatives and only two previous local ones. A review of the risk factors, clinical presentation, diagnostic process, treatment, complications and prognosis of the disease was used to construct the tool for data collection in the RedCap program. Between November 2017 and 2018, 122 reports were obtained and after the review, 113 patients were included. A diagnosis of PE was obtained every 3.2 days, being a pathology that mainly affects women older than 60 years. The most frequent risk factors were cancer, limitation for mobilization and history of deep vein thrombosis (DVT). The most frequent symptoms were dyspnea, chest pain and cough. DVT was present in a third of the cases, being mostly distal. The diagnostic methods most used in our hospital are those described in the literature. In spite that a quarter of the patients had dysfunction of the right ventricle, mortality was only 3.5%. When classifying the risk according to PESI, most patients had intermediate risk. This score had a better performance than the shock index for stratifying patients with a high risk of mortality. No relationship was found between biomarkers or dysfunction of the right ventricle and mortality. A 10% of patients had a high risk of developing CTEPH. Our registry allows to know in a greater depth the characteristics of this pathology in a South American Hospital.
肺血栓栓塞(PE)引起高发病率和死亡率。由于我国对该病的信息有限,必须经常使用来自他人的信息。这就是为什么我们对哥伦比亚一家高复杂性医院治疗的PE流行病学进行了前瞻性观察研究。对科学文献进行了搜索,发现了几项倡议,但只有两项是以前的地方倡议。通过对危险因素、临床表现、诊断过程、治疗、并发症和预后的回顾,构建了RedCap项目数据收集工具。在2017年11月至2018年期间,获得122份报告,经过审查,纳入113名患者。每3.2天诊断一次PE,这是一种主要影响60岁以上女性的病理。最常见的危险因素是癌症、活动受限和深静脉血栓(DVT)史。最常见的症状是呼吸困难、胸痛和咳嗽。三分之一的病例存在深静脉血栓,大多位于远端。本院最常用的诊断方法为文献所述的诊断方法。尽管四分之一的患者有右心室功能障碍,但死亡率仅为3.5%。根据PESI进行风险分级时,多数患者为中度风险。该评分比休克指数对死亡率高的患者有更好的分层效果。没有发现生物标志物或右心室功能障碍与死亡率之间的关系。10%的患者有发生CTEPH的高风险。我们的登记可以更深入地了解南美医院这种病理的特点。
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引用次数: 0
Factors related to hospital stay of patients with pulmonary thromboembolism 肺血栓栓塞患者住院时间的相关因素
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa3650
J. Hernández Borge, Luis Miguel Sierra Murillo, Kaoutar El Boutaibi Faiz, P. Cordero Montero, A. Castañar Jover, María Teresa Gómez Vizcaino, Amparo Sanz Cabrera, F. L. Márquez Pérez
Pulmonary thromboembolism (PTE) has important economic burden related, fundamentally, to the costs of hospital admission. Our objective were to analyze what factors can influence the hospital stay of patients with PTE. Retrospective cohort study of patients with PTE (January 2007 - May 2016). A descriptive and comparative analysis was performed according to the hospital stay and a multivariate analysis of the factors related to it. We included 430 patients (mean age: 63.7 ± 16.5 years, 55.3% men). Median hospital stay: 12 days (IQR: 3-80). In the univariate analysis the stay was longer in: Older patients, higher score of the PESI scale, Obese (BMI> 30), with surgery as a risk factor, with absence of previous PTE, presence of syncope, lower PaO2, higher levels of glycemia, presence of pahological EKG or thorax X-Ray (XR), severity in the affectation of angioCT, pathological echocardiography, appearance of hemorrhagic and non-hemorrhagic complications during admission, need for transfusion or admission to the ICU. Variables that were associated, independently, with a longer hospital stay were: age (OR: 1.01, 95% CI: 1-1.02), obesity (OR: 1.88: 95% CI: 1.12-3, 14), absence of previous PET (OR: 3.09, 95% CI: 1.17-8.16), PaO2 (OR: 0.98, 95% CI: 0.97-1), presence of pathological XR (OR: 1.49, 95% CI: 0.98-2.27), admission to the ICU (OR: 1.68, 95% CI: 1.03-2.73) and, presence of complications, both, haemorrhagic (OR: 2.20, 95% CI: 1.09-4.43) and non-haemorrhagic (OR: 2.80, 95% CI: 1.70-4.62), during hospitalization. In patients with PTE, several epidemiological characteristics, severity at presentation variables and, above all, evolution variables were associated with longer stays.
肺血栓栓塞(PTE)具有重要的经济负担,从根本上说,与住院费用相关。我们的目的是分析哪些因素会影响PTE患者的住院时间。回顾性队列研究PTE患者(2007年1月- 2016年5月)。根据住院时间进行描述性和比较分析,并对相关因素进行多变量分析。我们纳入430例患者(平均年龄:63.7±16.5岁,男性55.3%)。中位住院时间:12天(IQR: 3-80)。在单因素分析中,住院时间较长的患者有:年龄较大,PESI评分较高,肥胖(BMI> 30),手术为危险因素,既往无PTE,存在晕厥,PaO2较低,血糖水平较高,存在病理心电图或胸部x光片(XR),血管oct影响的严重程度,病理超声心动图,入院时出现出血性和非出血性并发症,需要输血或入住ICU。与较长住院时间独立相关的变量有:年龄(OR: 1.01, 95% CI: 1-1.02)、肥胖(OR: 1.88, 95% CI: 1.12- 3,14)、既往未见PET (OR: 3.09, 95% CI: 1.17-8.16)、PaO2 (OR: 0.98, 95% CI: 0.97-1)、病理性XR (OR: 1.49, 95% CI: 0.98-2.27)、入住ICU (OR: 1.68, 95% CI: 1.03-2.73)以及并发症的存在,出血(OR: 2.20, 95% CI: 1.09-4.43)和非出血(OR: 2.80, 95% CI: 1.02 -1.02)。1.70-4.62),住院期间。在PTE患者中,一些流行病学特征、出现时的严重程度变量以及最重要的进化变量与更长的住院时间有关。
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引用次数: 0
Pulmonary thrombosis occurring in hypobaric hypoxia among previously healthy young adult males 先前健康的年轻成年男性在低压缺氧时发生肺血栓
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa1466
M. Prasad, Y. Uday
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引用次数: 0
Rivaroxaban versus standard anticoagulation for the treatment of pulmonary embolism: a real-life study 利伐沙班与标准抗凝治疗肺栓塞:一项现实研究
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa3654
Clara Vigneron, A. Vivot, M. Jamme, A. Gibelin, G. Briend, J. Pastre, B. Planquette, G. Meyer, O. Sanchez
Introduction: In randomized controlled trials, direct oral anticoagulants are at least as effective and probably safer than standard anticoagulation in patients with venous thromboembolism (VTE). Real-life studies are of particular interest for the assessment of their efficacy and safety in unselected patients. Methods: We conducted a retrospective analysis of a prospective monocentric cohort including patients with symptomatic pulmonary embolism (PE) treated with VKA or rivaroxaban (riva) with a 6-month follow-up. We distinguished 2 periods: P1 (2010-2013) when only VKA was available; P2 (2014-2017) when VKA and riva were available. The primary outcome was the composite of all-cause mortality, major or clinically significant bleeding and symptomatic recurrent VTE under treatment. Outcomes and length of stay (LOS) were compared between riva and VKA groups using a propensity score analysis. Results: 706 patients were analysed: 271 during P1, 435 during P2 (VKA: n=143, Riva: n=292). No difference in the primary outcome was observed between P1 and P2 (respectively 8,1% vs 4,8%, p=0.1045). LOS was significantly reduced during P2 (5 [3,7] vs 6 days [4,10], p During P2, compared to VKA, patients treated with riva were younger (65 [49,75] vs 71 years [53,82], p=0.0044) and the proportion of patients with comorbidities was lower. In the propensity score adjustment sample, the primary outcome (OR 2.91 [95%CI, 1.03-8.26], p=0.044) was significantly higher in the VKA group compared to the riva group. LOS was significantly reduced in the riva group (4 vs 7 days, p Conclusion: Riva appears to be effective and safe to treat PE in a non-selected population with a shorter LOS.
在随机对照试验中,直接口服抗凝剂在静脉血栓栓塞(VTE)患者中至少与标准抗凝剂一样有效,而且可能更安全。现实生活中的研究对评估它们在未选择的患者中的有效性和安全性特别感兴趣。方法:我们对一项前瞻性单中心队列进行了回顾性分析,包括接受VKA或利伐沙班(riva)治疗的症状性肺栓塞(PE)患者,随访6个月。我们区分了两个时期:P1(2010-2013),只有VKA可用;P2(2014-2017),有VKA和riva。主要结局是全因死亡率、重大或临床显著出血和治疗期间静脉血栓栓塞复发症状的综合结果。使用倾向评分分析比较riva组和VKA组的预后和住院时间(LOS)。结果:分析706例患者:P1期271例,P2期435例(VKA: n=143, Riva: n=292)。P1组和P2组的主要转归无差异(分别为8.1% vs 4.8%, p=0.1045)。在P2期间,与VKA相比,riva治疗的患者更年轻(65岁[49,75]对71岁[53,82],p=0.0044),患者合共病的比例更低。在倾向评分调整样本中,VKA组的主要结局(OR 2.91 [95%CI, 1.03-8.26], p=0.044)明显高于riva组。riva组的LOS显著降低(4天vs 7天,p)。结论:riva在LOS较短的非选择人群中治疗PE似乎是有效和安全的。
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引用次数: 0
Categorising sub-massive pulmonary thromboembolism: no isolated role for shock index or its modified form 亚块状肺血栓栓塞的分类:休克指数或其修正形式没有孤立的作用
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa1469
Saleel Punnilath Abdulsamad, E. Crawford, A. Makan, N. Ahmad, K. Srinivasan, H. Moudgil
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引用次数: 0
Adherence to standard diagnostic algorithms for pulmonary embolus in a UK district general hospital 依从标准诊断算法肺栓塞在英国地区综合医院
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa1455
J. Heggie, Bilal Shoaib, M. Pagaria
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引用次数: 0
Effectiveness of the tromboembolic venous disease treatments estimated through clinical trials vs. observational studies 通过临床试验和观察性研究评估血栓栓塞性静脉疾病治疗的有效性
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa3651
Esther Barbero Herranz, C. Coscia, Ana Jaureguizar, C. A. Quezada, A. Muriel, M. Monreal, T. Villén, D. Chiluiza, Joger Yusen, D. Jiménez
It is unknown whether the efficacy of treatments for venous thromboembolic disease (VTE) estimated by observational studies with propensity analysis is similar to the one estimated by clinical trials (ECs). A systematic review of PubMed and Web of Science was conducted to identify observational studies with propensity analysis that would have evaluated the effect of VTE treatments on short term all-cause mortality. After identifying the treatment scenarios evaluated by the observational studies, a standardized algorithm was used to match them with at least one CE or a meta-analysis of ECs. The efficacy of the treatment (relative odds ratio [OR]) between the observational studies and the paired Ecs was compared. The global relative OR for all clinical scenarios was also calculated. Results: observational studies and CSs evaluated 7 treatment scenarios for VTE. There was no statistically significant difference in the effect on mortality obtained by observational studies compared to CSs (OR 0.89 [95%CI,0.32-1.46]). However, in 2 scenarios (thrombolysis vs. anticoagulation for lung thromboembolism, treatment with enoxaparin once or twice a day for VTE) there were statistically significant differences in the direction of effect, and there were no significant differences in the magnitude of the effect in 2 other scenarios (rivaroxaban vs. vitamin K antagonists for the treatment of VTE, home treatment vs. hospitalization for deep vein thrombosis). Conclusions: observational studies that use propensity analysis and CSs find similar results regarding the effect of VTE treatments, although there are occasionally differences in the direction/magnitude of this effect.
目前尚不清楚通过倾向分析的观察性研究估计的治疗静脉血栓栓塞性疾病(VTE)的疗效是否与临床试验(ECs)估计的疗效相似。对PubMed和Web of Science进行了系统回顾,以确定观察性研究,并进行倾向分析,以评估静脉血栓栓塞治疗对短期全因死亡率的影响。在确定观察性研究评估的治疗方案后,使用标准化算法将其与至少一个CE或ec的荟萃分析相匹配。比较观察性研究和配对Ecs之间的治疗效果(相对优势比[OR])。还计算了所有临床情况的全局相对OR。结果:观察性研究和CSs评估了静脉血栓栓塞的7种治疗方案。与CSs相比,观察性研究对死亡率的影响无统计学差异(OR 0.89 [95%CI,0.32-1.46])。然而,在2种情况下(溶栓vs抗凝治疗肺血栓栓塞,静脉血栓栓塞用依诺肝素治疗1 - 2天),效果的方向有统计学意义的差异,而在其他2种情况下(利伐沙班vs维生素K拮抗剂治疗静脉血栓,家庭治疗vs深静脉血栓住院治疗),效果的大小没有显著差异。结论:使用倾向分析和CSs的观察性研究发现关于静脉血栓栓塞治疗效果的相似结果,尽管这种效果的方向/幅度偶尔存在差异。
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引用次数: 0
Late Breaking Abstract - Frequency Pulmonary embolism (PE) in patients with an acute Exacerbation of chronic obstructive Pulmonary disease (COPD). PEP prospective trial 慢性阻塞性肺疾病(COPD)急性加重患者的频率肺栓塞(PE)。PEP前瞻性试验
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa3637
F. Couturaud, L. Bertoletti, O. Sanchez, R. Mao, P. Roy, F. Gagnadoux, N. Paleiron, Jeannot Schmidt, J. Pastre, E. Magalhaes, Y. Auffret, C. Hoffmann, L. Bressollette, M. Nonent, P. Salaun, P. Mismetti, P. Girard, K. Lacut, C. Lemarié, C. Tromeur, G. Meyer, C. Leroyer
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引用次数: 3
期刊
Pulmonary embolism
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