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    Factores asociados a la recurrencia y supervivencia en el Tromboembolismo pulmonar

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    21 TesisAnnicherico.pdf (1.911Mb)
    Date
    2020
    Author
    Anniccherico Sánchez, Francisco Javier Upna Orcid
    Advisor
    Casas Fernández de Tejerina, Juan Manuel Upna Orcid
    Alonso Martínez, José Luis 
    Version
    Acceso abierto / Sarbide irekia
    Type
    Tesis doctoral / Doktoretza tesia
    Impact
     
     nodoi-noplumx
     
     
     
     
     
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    Abstract
    Background: Venous thromboemboli tend to recur. However, the causative factors underlying pulmonary embolism recurrence are not well defined. Aims: To explore the factors associated with pulmonary embolism recurrence. Patients and methods: Patients diagnosed with pulmonary emboli between 2004 and 2013 at our institution were enrolled. Duration of anticoagulant therapy, new episodes of venous thro ... [++]
    Background: Venous thromboemboli tend to recur. However, the causative factors underlying pulmonary embolism recurrence are not well defined. Aims: To explore the factors associated with pulmonary embolism recurrence. Patients and methods: Patients diagnosed with pulmonary emboli between 2004 and 2013 at our institution were enrolled. Duration of anticoagulant therapy, new episodes of venous thromboembolism, and deaths were recorded. Results: Pulmonary embolism was diagnosed in 528 patients (median age: 76 years, interquartile range [IQR]: 16; male: 45%). The median follow-up time was 34 months (IQR: 52). In total, 477 patients completed ≥3 months of anticoagulation therapy. Permanent anticoagulation was indicated in 217 (45%) patients, and therapy was discontinued in 260 (55%) patients. Overall, 79 patients experienced a recurrence (5.6 per patient-year). Recurrence was significantly associated with anticoagulation discontinuation (4% vs. 27% of patients who maintained or discontinued therapy, respectively; P<0.001; 95% confidence interval -0.95, -0.86). The median duration between anticoagulation withdrawal and recurrence was 6.5 months (IQR: 23.25). Factors associated with recurrence were unprovoked pulmonary embolism (odds ratio [OR]: 0.45), a greater degree of pulmonary arterial obstruction (OR: 2.5), a delay in initiation of anticoagulation (OR: 3), and higher plasma D-dimer levels during treatment (OR: 2.3). Survival rates were improved for patients who maintained anticoagulation therapy relative to those who discontinued. Conclusion: Pulmonary embolism has a high recurrence rate. Permanent anticoagulant therapy should be considered for patients with idiopathic pulmonary embolism, a high thrombotic burden, and persistently elevated D-dimer levels during treatment, and for patients where therapy was initially delayed. [--]
    Subject
    Tromboembolismo pulmonar, Hipertensión pulmonar, Síndrome post-trombótico, Anticoagulantsnts, D-dimer, Pulmonary arterial obstruction, Pulmonary embolism, Recurrence, Venous thromboses
     
    Departament
    Universidad Pública de Navarra. Departamento de Ciencias de la Salud / Nafarroako Unibertsitate Publikoa. Osasun Zientziak Saila
     
    PhD Program
    Programa de Doctorado en Ciencias de la Salud (RD 99/2011) / Osasun Zientzietako Doktoretza Programa (ED 99/2011)
     
    URI
    https://hdl.handle.net/2454/38902
    Appears in Collections
    • Tesis doctorales DCS - OZS Doktoretza tesiak [136]
    • Tesis doctorales - Doktoretza tesiak [570]
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