Showing papers by "Manuel Monreal published in 2006"
TL;DR: In cancer patients, abnormal renal function, metastatic disease, recent major bleeding and recent immobility for ≥ 4 days are associated with an increased risk for both fatal PE and fatal bleeding.
208 citations
TL;DR: There seems to be more reason to be concerned about fatal PE than about bleeding in elderly patients with VTE, and those with recent bleeding, abnormal renal function, use of corticosteroids or long-term therapy with LMWH had an increased risk of major bleeding.
Abstract: BACKGROUND AND OBJECTIVES: Elderly patients with venous thromboembolism (VTE) have an increased rate of bleeding complications on therapeutic doses of anticoagulant therapy. DESIGN AND METHODS: Using data in RIETE, an international registry of consecutive patients with objectively confirmed, symptomatic acute VTE, we analyzed the clinical characteristics and outcome within 90 days of therapy of all enrolled patients aged > or = 80 years old. RESULTS: Of the 13,011 patients with VTE enrolled in RIETE up tp September 2005, 2890 (22%) were aged > or = 80 years old. During the study period 99 patients (3.4%) aged > or = 80 years, and 212 aged or = 80 years and 1.1% or = 80 years with symptomatic PE, heart failure, long-term therapy with low-molecular-weight heparin (LMWH) or a vena cava filter had an increased risk of recurrent VTE. Those with recent bleeding, abnormal renal function, use of corticosteroids or long-term therapy with LMWH had an increased risk of major bleeding. INTERPRETATION AND CONCLUSIONS: In patients aged > or = 80 years old the 3.4% incidence of major bleeding exceeded the 2.1% incidence of VTE recurrences. However, the 3.7% incidence of fatal PE outweighed the 0.8% of fatal bleeding. Thus, there seems to be more reason to be concerned about fatal PE than about bleeding in elderly patients with VTE.
155 citations
TL;DR: Patients with VTE who have renal insufficiency had an increased incidence of both fatal PE and fatal bleeding, but the risk of fatal PE far exceeded that of fatal bleeding.
136 citations
TL;DR: The influence of the clinical syndromes of pulmonary embolisms (PE) on clinical outcome has not been evaluated as mentioned in this paper, and all enrolled patients with acute PE without preexisting cardiac or pulmonary disease were classified into three clinical disorders: pulmonary infarction, isolated dyspnea, or circulatory collapse.
76 citations
TL;DR: The EXCLAIM study is designed to show the efficacy and safety of extended-duration thromboprophylaxis using enoxaparin in acutely ill medical patients with recent reduced mobility, which may potentially lead to a reduction in the incidence of late VTE events in these patients.
Abstract: Background: Venous thromboembolism (VTE) is a significant cause of mortality and morbidity in medical patients. Although thromboprophylaxis with enoxaparin reduces the risk of VTE in these patients, the optimal duration of therapy is not currently known. The EXCLAIM (EXtended CLinical prophylaxis in Acutely Ill Medical patients) study is designed to compare the efficacy and safety of extended-duration thromboprophylaxis using enoxaparin with the standard regimen of enoxaparin in acutely ill medical patients with recent reduced mobility.
75 citations
TL;DR: Significant differences exist in PE patients with and without underlying cardiopulmonary diseases.
74 citations
TL;DR: A simple risk score based on easily available variables can identify DVT outpatients at low risk for an adverse outcome, and may help clinicians to decide which DVT patients may be eligible for ambulatory treatment.
47 citations
TL;DR: The incidence of new bleeding or death depends on the site of prior bleeding and the time elapsed until VTE, and this information may help to identify the best therapeutic approach for these high‐risk patients.
45 citations
TL;DR: Patients with PE signs had a significantly higher incidence of major bleeding, recurrent PE, fatal PE and overall death than those with only DVT signs, but a lower incidence of recurrent DVT.
Abstract: The clinical characteristics and 3-month clinical outcome of 7,664 patients with acute deep vein thrombosis(DVT), 3,968 patients with pulmonary embolism(PE), and 2,287 with signs of both DVT and PE were compared. As compared to patients with DVT signs, PE patients were more commonly females, older and had less often cancer, prior VTE or recent surgery. By contrast, they had more often chronic lung disease,chronic heart failure or renal insufficiency. Patients with both DVT and PE signs were also more commonly females and older than those with only DVT signs, but they had more often a prior episode VTE, cancer, chronic lung disease, chronic heart failure or renal insufficiency. As for the 3-month clinical outcome,patients with PE signs had a significantly higher incidence of major bleeding, recurrent PE, fatal PE and overall death than those with only DVT signs,but a lower incidence of recurrent DVT. Besides, patients with DVT and PE signs had an even worse clinical outcome.
20 citations