Pub Date : 2025-12-01DOI: 10.1016/j.medcle.2025.107180
Antonio Alcántara Montero
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Pub Date : 2025-12-01DOI: 10.1016/j.medcle.2025.107199
Vicente Giner-Galvañ , Raúl Quirós-López , Javier Abellán-Martínez , Fernando Caballero-Martínez , Diana Monge-Martín , Fernando Neria , Miguel Camafort-Babkowski
Background
Patients with atrial fibrillation (AF) attending Spanish Internal Medicine outpatient clinics (SIMOs) are frequently older, and DOACs are underused.
Objective
To assess how anticoagulation and DOACs (direct oral anticoagulants) are applied in patients with AF in the SIMOs.
Methods
Analysis of the use and opinions about anticoagulants in patients with AF attending the SIMOs in a multicenter, nationwide, retrospective study including 900 patients and 183 physicians.
Results
96.1% of the patients were anticoagulated, 55% with DOACs. One-third on vitamin K antagonists (VKA) were not within the therapeutic range. DOAC use was higher in patients with shorter duration of AF (p < 0.001), better kidney function (p < 0.001), and short-term persistent (p = 0.035) or paroxysmal AF (p = 0.012). DOAC switch indication was met by 32.1% of those on VKA (72% because of out of control range). Although “administrative barriers” (38%), “frailty” (21%); “polypharmacy” (19%) and “very advanced age” (18%) were the main limitations to DOAC prescription in opinion of the physicians, validated scales were seldom used to assess basal functional status.
Conclusions
More than one-third of patients with AF on VKA treated in the SIMOs should be switched to DOACs. Administrative limitations and poor functional status are the main difficulties for it. Validated scales are rarely used to measure functional basal status.
{"title":"Management of anticoagulation and direct oral ancticoagulants in patients with atrial fibrillation treated in Spanish Internal Medicine outpatient clinics","authors":"Vicente Giner-Galvañ , Raúl Quirós-López , Javier Abellán-Martínez , Fernando Caballero-Martínez , Diana Monge-Martín , Fernando Neria , Miguel Camafort-Babkowski","doi":"10.1016/j.medcle.2025.107199","DOIUrl":"10.1016/j.medcle.2025.107199","url":null,"abstract":"<div><h3>Background</h3><div>Patients with atrial fibrillation (AF) attending Spanish Internal Medicine outpatient clinics (SIMOs) are frequently older, and DOACs are underused.</div></div><div><h3>Objective</h3><div>To assess how anticoagulation and DOACs (direct oral anticoagulants) are applied in patients with AF in the SIMOs.</div></div><div><h3>Methods</h3><div>Analysis of the use and opinions about anticoagulants in patients with AF attending the SIMOs in a multicenter, nationwide, retrospective study including 900 patients and 183 physicians.</div></div><div><h3>Results</h3><div>96.1% of the patients were anticoagulated, 55% with DOACs. One-third on vitamin K antagonists (VKA) were not within the therapeutic range. DOAC use was higher in patients with shorter duration of AF (<em>p</em> <!--><<!--> <!-->0.001), better kidney function (<em>p</em> <!--><<!--> <!-->0.001), and short-term persistent (<em>p</em> <!-->=<!--> <!-->0.035) or paroxysmal AF (<em>p</em> <!-->=<!--> <!-->0.012). DOAC switch indication was met by 32.1% of those on VKA (72% because of out of control range). Although “administrative barriers” (38%), “frailty” (21%); “polypharmacy” (19%) and “very advanced age” (18%) were the main limitations to DOAC prescription in opinion of the physicians, validated scales were seldom used to assess basal functional status.</div></div><div><h3>Conclusions</h3><div>More than one-third of patients with AF on VKA treated in the SIMOs should be switched to DOACs. Administrative limitations and poor functional status are the main difficulties for it. Validated scales are rarely used to measure functional basal status.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 6","pages":"Article 107199"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.medcle.2025.107144
Sefa Tatar, Yunus Emre Yavuz, Hakan Akilli
Introduction
Massive pulmonary embolism (MPE) is associated with high mortality, particularly in cancer patients aged 65 years and older. Thrombolytic therapy (TT) is a life-saving intervention in pulmonary embolism, yet its efficacy and safety in this vulnerable population remain uncertain. This study aimed to evaluate the impact of thrombolytic therapy on mortality in elderly cancer patients diagnosed with MPE.
Materials and methods
This retrospective study included 90 patients aged ≥ 65 years diagnosed with MPE. Patients were categorized based on malignancy status and administration of TT. Clinical, laboratory, and echocardiographic parameters were compared. One-month all-cause mortality was recorded for each patient.
Results
Patients with malignancy exhibited higher mortality rates compared to non-malignant cases (63.3% vs. 46.7%, p = 0.1), though bleeding rates were similar between the two groups. Among cancer patients, the administration of TT did not significantly affect mortality (60% vs. 65%, p = 0.7). Right ventricular function, assessed by RV systolic motion and TAPSE, was more severely impaired in cancer patients, and TT did not lead to significant improvement in these parameters.
Conclusion
Thrombolytic therapy in elderly cancer patients with massive pulmonary embolism does not significantly reduce 1-month mortality. However, it does not increase bleeding complications, suggesting that it may be a viable option for selected patients. The similar mortality rates between thrombolytic therapy and non-thrombolytic therapy groups highlight the complex interplay between malignancy, coagulation, and cardiovascular risk. These findings emphasize the need for individualized risk assessment and treatment decisions.
{"title":"Effect of thrombolytic therapy in mortality of elderly patients with cancer and massive pulmonary embolism","authors":"Sefa Tatar, Yunus Emre Yavuz, Hakan Akilli","doi":"10.1016/j.medcle.2025.107144","DOIUrl":"10.1016/j.medcle.2025.107144","url":null,"abstract":"<div><h3>Introduction</h3><div>Massive pulmonary embolism (MPE) is associated with high mortality, particularly in cancer patients aged 65 years and older. Thrombolytic therapy (TT) is a life-saving intervention in pulmonary embolism, yet its efficacy and safety in this vulnerable population remain uncertain. This study aimed to evaluate the impact of thrombolytic therapy on mortality in elderly cancer patients diagnosed with MPE.</div></div><div><h3>Materials and methods</h3><div>This retrospective study included 90 patients aged<!--> <!-->≥<!--> <!-->65 years diagnosed with MPE. Patients were categorized based on malignancy status and administration of TT. Clinical, laboratory, and echocardiographic parameters were compared. One-month all-cause mortality was recorded for each patient.</div></div><div><h3>Results</h3><div>Patients with malignancy exhibited higher mortality rates compared to non-malignant cases (63.3% vs. 46.7%, <em>p</em> <!-->=<!--> <!-->0.1), though bleeding rates were similar between the two groups. Among cancer patients, the administration of TT did not significantly affect mortality (60% vs. 65%, <em>p</em> <!-->=<!--> <!-->0.7). Right ventricular function, assessed by RV systolic motion and TAPSE, was more severely impaired in cancer patients, and TT did not lead to significant improvement in these parameters.</div></div><div><h3>Conclusion</h3><div>Thrombolytic therapy in elderly cancer patients with massive pulmonary embolism does not significantly reduce 1-month mortality. However, it does not increase bleeding complications, suggesting that it may be a viable option for selected patients. The similar mortality rates between thrombolytic therapy and non-thrombolytic therapy groups highlight the complex interplay between malignancy, coagulation, and cardiovascular risk. These findings emphasize the need for individualized risk assessment and treatment decisions.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 6","pages":"Article 107144"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.medcle.2025.107179
Jorge Gabriel Ruiz-Sánchez , Roberto Miguel Sierra Poyatos , Bogdana Luiza Luca , Begoña Sánchez-Lechuga , Naiara Modroño Móstoles , Teresa Montoya Álvarez , Diego Meneses , Raquel Sánchez-Lopez , Carlos Casado Cases , Víctor Pérez de Arenaza Pozo , Clotilde Vázquez , Jersy Jair Cárdenas-Salas
Introduction
Type 2 diabetes mellitus (T2DM), a major cardiovascular risk, is often associated with obesity and hypertension. Once-weekly subcutaneous semaglutide (OWS-Sema) can improve these conditions, but factors influencing blood pressure (BP) effects are not well studied. This study aimed to assess the impact of OWS-Sema on systolic BP (SBP) and identify clinical factors associated with its reduction in patients with T2DM.
Methods
Sub-analysis of the REALSEM-SP study involving OWS-Sema-naïve patients with T2DM. Changes in SBP and diastolic BP (DBP) and influencing factors were analyzed over 12 months.
Results
One hundred seventy-eight patients were included (mean age 61 ± 10 years, 43.8% female, 79.2% with hypertension). Median baseline SBP and DBP were 132 [122–145] and 80 [72–88] mmHg, respectively. SBP decreased by −4 mmHg at 6 months and −2 mmHg at 12 months (p = 0.014), while DBP showed no significant change (p = 0.395). Factors independently associated with SBP reduction at 6 months included uncontrolled BP and a glomerular filtration rate ≥60 mL/min/1.73 m2, while at 12 months, only uncontrolled BP remained significant. A SBP ≥10 mmHg reduction was associated with uncontrolled BP, dyslipidemia and renal function at 6-month, and only with uncontrolled BP at 12-month.
Conclusion
OWS-Sema was associated with significant reductions in office SBP in T2DM patients, especially those with uncontrolled baseline BP, independent of BMI changes or dose. Patients with baseline uncontrolled BP appear to benefit the most.
{"title":"Clinical factors influencing the systolic blood pressure benefits of once-weekly semaglutide in patients with type 2 diabetes","authors":"Jorge Gabriel Ruiz-Sánchez , Roberto Miguel Sierra Poyatos , Bogdana Luiza Luca , Begoña Sánchez-Lechuga , Naiara Modroño Móstoles , Teresa Montoya Álvarez , Diego Meneses , Raquel Sánchez-Lopez , Carlos Casado Cases , Víctor Pérez de Arenaza Pozo , Clotilde Vázquez , Jersy Jair Cárdenas-Salas","doi":"10.1016/j.medcle.2025.107179","DOIUrl":"10.1016/j.medcle.2025.107179","url":null,"abstract":"<div><h3>Introduction</h3><div>Type 2 diabetes mellitus (T2DM), a major cardiovascular risk, is often associated with obesity and hypertension. Once-weekly subcutaneous semaglutide (OWS-Sema) can improve these conditions, but factors influencing blood pressure (BP) effects are not well studied. This study aimed to assess the impact of OWS-Sema on systolic BP (SBP) and identify clinical factors associated with its reduction in patients with T2DM.</div></div><div><h3>Methods</h3><div>Sub-analysis of the REALSEM-SP study involving OWS-Sema-naïve patients with T2DM. Changes in SBP and diastolic BP (DBP) and influencing factors were analyzed over 12 months.</div></div><div><h3>Results</h3><div>One hundred seventy-eight patients were included (mean age 61<!--> <!-->±<!--> <!-->10 years, 43.8% female, 79.2% with hypertension). Median baseline SBP and DBP were 132 [122–145] and 80 [72–88]<!--> <!-->mmHg, respectively. SBP decreased by −4<!--> <!-->mmHg at 6 months and −2<!--> <!-->mmHg at 12 months (<em>p</em> <!-->=<!--> <!-->0.014), while DBP showed no significant change (<em>p</em> <!-->=<!--> <!-->0.395). Factors independently associated with SBP reduction at 6 months included uncontrolled BP and a glomerular filtration rate ≥60<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>, while at 12 months, only uncontrolled BP remained significant. A SBP ≥10<!--> <!-->mmHg reduction was associated with uncontrolled BP, dyslipidemia and renal function at 6-month, and only with uncontrolled BP at 12-month.</div></div><div><h3>Conclusion</h3><div>OWS-Sema was associated with significant reductions in office SBP in T2DM patients, especially those with uncontrolled baseline BP, independent of BMI changes or dose. Patients with baseline uncontrolled BP appear to benefit the most.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 6","pages":"Article 107179"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Mpox infections in vaccinated persons. Is now the moment to reconsider a booster dose?","authors":"Jorge Nestor García-Pérez , Blanca Borras-Bermejo , Maider Arando","doi":"10.1016/j.medcle.2025.107108","DOIUrl":"10.1016/j.medcle.2025.107108","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 6","pages":"Article 107108"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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