RT info:eu-repo/semantics/doctoralThesis
T1 Factores de riesgo, complicaciones y evaluación del manejo de los pacientes con trombosis venosa superficial de miembros inferiores atendidos en servicios de urgencias españoles
A1 Beddar Chaib, Fahd
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Trombosis
K1 Venous Thrombosis
K1 Trombosis venosa
K1 Emergency
K1 Urgencias
K1 Thromboembolic
K1 tromboembolismo
K1 32 Ciencias Médicas
AB Objectives: Three main objectives were evaluated: To describe the characteristics of patients diagnosed with isolated superficial venous thrombosis (SVT) of the lower limbs in hospital emergency departments (ED), and to evaluate adherence to clinical practice guidelines (first objective) in diagnostic (performance of venous ultrasound) and therapeutic management (initiation of anticoagulant therapy). To describe the therapeutic management of patients with isolated SVT of the lower limbs in the ED (second objective) and to evaluate the impact of the treatment established in the ED on the evolution (third objective), in terms of complications of venous thromboembolic disease (VTE), and to know the characteristics of the patients who suffer complications.Method: To respond to the first objective, a retrospective cohort study was conducted in 18 EDs. All patients seen in EDs with a final diagnosis of TVS in MMII, aged ≥18 years, from January 2016 to May 2017 were included. To assess non-adherence to clinical practice guideline recommendations, a backward stepwise multiple logistic regression model was fitted.To answer the second and third main objective, patients with an objective diagnosis of isolated SVT were selected. VTE complications [deep vein thrombosis (DVT), pulmonary thromboembolism (PE) and extension or recurrence of SVT)], clinically relevant bleeding and death at 180 days were collected. Variables associated with complications were assessed using Cox regression.Results:To meet the objectives of the study, two main sections were classified: a total patients (first main objective) and a subgroup of patients with an objective diagnosis of SVT (second and third main objectives). Regarding the total patients, 1166 patients were included. The mean age was 59.6 years, 67.9% were women. Twenty-four.4% had a history of VTE. 8.9% had some complication at 180 days. There were 17 patients (1.5%) with hemorrhage and 16 (1.4%) deaths. Venous ultrasound was performed in 703 (60.3%) patients. A total of 898 (77%) received anticoagulation treatment, with a median of 27.3 days. The variables associated with the decision to anticoagulate were: history of VTE (OR 1.60; 95% CI: 1.12-2.30), vari¬ces (OR 1.40; 95% CI: 1.12-2.30), limb pain (OR 1.44; 95% CI: 1.08-191), painful cord (OR 1.30; 95% CI: 0.97-1.73) and performance of venous ultrasound (OR 1.60; 95% CI: 1.94-3.45).As for the subgroup of patients with an objective diagnosis of SVT, 703 patients were included. A total of 84.1% received anticoagulation for 30 days (interquartile range 15-42), 81.3% with low-molecular-weight heparin (48% prophylactic doses, 52% intermediate-therapeutic). In 180 days, 64 patients (9.1%) had VTE complications, 12 (1.7%) had clinically relevant bleeding, and 4 died (0.6%). Patients in whom anticoagulation was instituted in the ED took longer to develop complications (66 vs. 11 days, p = 0.009). Of those who developed complications, 76.6% were not anticoagulated at the time. Previous VTE was independently associated with the development of complications (adjusted hazard ratio 2.20; 95% confidence interval: 1.34-3.62).Conclusions:Adherence to clinical practice guidelines for the diagnosis and treatment of isolated lower-limb SVT is low in Spanish emergency departments. Ultrasound imaging is not ordered for 1 out of every 2 to 3 patients, and anticoagulant treatment is not started in 1 out of 4 patients. There is great room for improvement. ED treatment of SVT varies and is often suboptimal. The incidence of thromboembolic complications after SVT is high. Starting anticoagulation in the ED delays the development of complications. Patients with a historyof thromboembolic disease are more at risk of complications.
YR 2023
FD 2023
LK https://uvadoc.uva.es/handle/10324/62644
UL https://uvadoc.uva.es/handle/10324/62644
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 28-dic-2024