Comparación de resultados clínicos de enfermedad tromboembólica venosa según manejo ambulatorio versus hospitalario

Objectives. To compare the occurrence of death, bleeding, and recurrence according to inpatient or outpatient management of venous thromboembolic disease (VTE). Materials and methods. Retrospective cohort that included a consecutive sampling of VTE consultations between 2016 and 2019 diagnosed in th...

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Published in:Archivos peruanos de cardiología y cirugía cardiovascular 2024-02, Vol.5 (1), p.13-21
Main Authors: Gregalio, Felipe Aníbal, Juana, Camila, Manattini Palmili, Gian, Martínez, Bernardo Julio, Bluro, Ignacio Martin, Vázquez, Fernando Javier, Grande Ratti, María Florencia
Format: Article
Language:Spanish
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Summary:Objectives. To compare the occurrence of death, bleeding, and recurrence according to inpatient or outpatient management of venous thromboembolic disease (VTE). Materials and methods. Retrospective cohort that included a consecutive sampling of VTE consultations between 2016 and 2019 diagnosed in the Emergency Center of a private hospital in Argentina. Results. There were 1202 cases, 908 with isolated deep vein thrombosis (DVT), 205 with isolated pulmonary embolism (PE), and 89 cases of combined DVT - PE. 66% were women, with a median age of 77 years; 72% of cases were managed on an outpatient basis (n= 862). Comorbidities associated with hospitalization were obesity (p=0.03), chronic obstructive pulmonary disease (COPD) (p=0.01), heart failure (CHF) (p=0.01), chronic renal failure (CKD) (p=0.01), and cancer (p=0.01). At 90 days, the cumulative incidence of bleeding was 2.6% in inpatient compared to 2.9% in outpatient management (p=0.81); recurrence was 0% versus 0.9% (p=0.07), and mortality was 42.9% versus 18.9%, respectively (p=0.01). The HR for 90-day mortality in hospitalized patients adjusted for confounders (sex, age, type of VTE, obesity, CKD, CHF, COPD, and cancer) was 1.99 (95% CI 1.49-2.64; p=0.01). Conclusions. In this elderly, and predominantly female Argentine population, the 90-day mortality in patients hospitalized for VTE was higher than mortality in patients with outpatient management, without differences in recurrence or major bleeding. Objetivo. Comparar la ocurrencia de muerte, sangrado y recurrencia según el manejo hospitalizado o ambulatorio de la enfermedad tromboembólica venosa (ETV). Materiales y métodos. Cohorte retrospectiva que incluyó muestreo consecutivo de consultas por ETV entre los años 2016 y 2019 diagnosticadas en la Central de Emergencias de un hospital privado de Argentina. Resultados. Hubo 1202 casos, 908 con trombosis venosa profunda (TVP) aislada; 205 con embolia pulmonar (EP) aislada y 89 casos de TVP - EP combinadas. El 66% fueron mujeres, con mediana de edad de 77 años; el 72% de casos tuvo manejo ambulatorio (n= 862). Las comorbilidades asociadas a hospitalización fueron la obesidad (p=0,03); enfermedad pulmonar obstructiva crónica (EPOC) (p=0,01); insuficiencia cardíaca (ICC) (p=0,01); insuficiencia renal crónica (IRC) (p=0,01) y cáncer (p=0,01). A 90 días, la incidencia acumulada de sangrado fue 2,6% en hospitalizados comparado con 2,9% en ambulatorio (p=0,81); la recurrencia fue de 0% versus 0,9%
ISSN:2708-7212
2708-7212
DOI:10.47487/apcyccv.v5i1.334