DVT Management and Outcome Trends, 2001 to 2014
2016; Elsevier BV; Volume: 150; Issue: 2 Linguagem: Inglês
10.1016/j.chest.2016.03.046
ISSN1931-3543
AutoresRaquel Morillo, David Jiménez, Miguel Ángel Aibar Arregui, Daniela Mastroiacovo, Philip S. Wells, A. Sampériz, Marta Sousa, Alfonso Muriel, Roger D. Yusen, Manuel Monréal, Manuel Monréal, Hervé Decousus, Paolo Prandoni, Benjamin Brenner, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Sebastian Schellong, Inna Tzoran, Abílio Reis, Marijan Bosevski, Henri Bounameaux, Radován Malý, Philip Wells, Manolis Papadakis, Pilar Agudo, Miguel Ángel Aibar Arregui, Miriam Akasbi, M. Alcalde-Manero, V. Andújar, J.I. Arcelus, Aitor Ballaz, Raquel Barba, M. Barrón, B. Barrón‐Andrés, José Bascuñana, Á. Blanco-Molina, I. Cañas, I. Casado, Javier de Miguel‐Díez, J. del Toro, Sonia Pértega‐Díaz, J.A. Díaz-Peromingo, C. Falgá, Carmen Fernández‐Capitán, Carme Font, Llorenç Font, P. Gallego, F. García‐Bragado, M. García-Rodenas, Vicente Gómez del Olmo, C.J. González, E Grau, L. Guirado, Javier Cuesta, Giselle Riquelme Hernández, Luis Blasco, V. Isern, Luis Jara‐Palomares, M.J. Jaras, David Jiménez, José Luís Lobo, Luciano López‐Jiménez, Raquel López-Reyes, J.B. López‐Sáez, M.A. Lorente, A. Lorenzo, Olga Madridano, Ana M. Maestre, Pablo Javier Marchena, M. Martín, J.M. Martín‐Antorán, F. Martín‐Martos, Manuel Monréal, M.V. Morales, D. Nauffal, J.A. Nieto, Santiago Nieto, M.J. Núñez, Cecilia Orbegoso, S. Otálora, Remedios Otero, B. Pagán, José María Pedrajas, Cecilia E González Pérez, Gustavo Pérez, M.L. Peris, Isabel Estruch Pons, José Antonio Porras, Òscar Reig, A. Riera-Mestre, A. Rivas, Carmen Rodríguez, M.A. Rodríguez‐Dávila, V. Rosa, A.S. Rosa-Murillo, N. Ruiz‐Giménez, Joan Carles Sahuquillo, M.C. Sala, A. Sampériz, Rosario Sánchez‐Martínez, O. Sanz, S. Soler, José María Suriñach, Carlos Tolosa, Javier Trujillo‐Santos, Fernando Uresandi, B. Valero, R. Valle, J. Vela, G. Vidal, Carlos Vilar, J Villalta, Belen Xifré, Thomas Vanassche, Peter Verhamme, P.S. Wells, Jana Hirmerová, Radován Malý, T. Tomko, Geert Celis, E. Salgado, G.T. Sánchez, Laurent Bertoletti, A. Bura-Rivière, Dominique Farge, A. Hij, Isabelle Mahé, A. Merah, I. Quéré, Marios Papadakis, Andrei Braester, Benjamin Brenner, Inna Tzoran, A. Apollonio, Giovanni Barillari, A. Bertone, Franca Bilora, Eugenio Bucherini, Maurizio Ciammaichella, P. De Ciantis, Francesco Dentali, P. Di Micco, R. Duce, Paola Ferrazzi, Elvira Grandone, Gianfranco Lessiani, Corrado Lodigiani, Daniela Mastroiacovo, F. Pace, Raffaele Pesavento, Massimiliano Pinelli, Renzo Poggio, Paolo Prandoni, M. Rosa, L. Rota, Eros Tiraferri, D. Tonello, Antonella Tufano, U. Venturelli, A. Visonà, Beniamino Zalunardo, E. Drucka, Dana Kigitoviča, Andris Skride, A. Mafalda, José Luís Pais Ribeiro, M. Silva e Sousa, Marijan Bosevski, Marija Zdraveska, H Bounameaux, Lucia Mazzolai,
Tópico(s)Blood Coagulation and Thrombosis Mechanisms
ResumoBackground A comprehensive evaluation of temporal trends in the treatment of patients who have DVT may assist with identification of modifiable factors that contribute to short-term outcomes. Methods We assessed temporal trends in length of hospital stay and use of pharmacological and interventional therapies among 26,695 adults with DVT enrolled in the Registro Informatizado de la Enfermedad TromboEmbólica registry between 2001 and 2014. We also examined temporal trends in risk-adjusted rates of all-cause, pulmonary embolism-related, and bleeding-related death to 30 days after diagnosis. Results The mean length of hospital stay decreased from 9.0 days in 2001 to 2005 to 7.6 days in 2010 to 2014 (P < .01). For initial DVT treatment, the use of low-molecular-weight heparin decreased from 98% to 90% (P < .01). Direct oral anticoagulants use increased from 0.5% in 2010 to 13.4% in 2014 (P < .001). Risk-adjusted rates of 30-day all-cause mortality decreased from 3.9% in 2001 to 2005 to 2.7% in 2010 to 2014 (adjusted rate ratio per year, 0.84; 95% CI, 0.74-0.96; P < .01). VTE-related mortality showed a nonstatistically significant downward trend (adjusted rate ratio per year, 0.70; 95% CI, 0.44-1.10; P = .13), whereas 30-day bleeding-related mortality significantly decreased from 0.5% in 2001 to 2005 to 0.1% in 2010-2014 (adjusted rate ratio per year, 0.55; 95% CI, 0.40-0.77; P < .01). Conclusions This international registry-based temporal analysis identified reductions in length of stay for adults hospitalized for DVT. The study also found a decreasing trend in adjusted rates of all-cause and bleeding-related mortality. A comprehensive evaluation of temporal trends in the treatment of patients who have DVT may assist with identification of modifiable factors that contribute to short-term outcomes. We assessed temporal trends in length of hospital stay and use of pharmacological and interventional therapies among 26,695 adults with DVT enrolled in the Registro Informatizado de la Enfermedad TromboEmbólica registry between 2001 and 2014. We also examined temporal trends in risk-adjusted rates of all-cause, pulmonary embolism-related, and bleeding-related death to 30 days after diagnosis. The mean length of hospital stay decreased from 9.0 days in 2001 to 2005 to 7.6 days in 2010 to 2014 (P < .01). For initial DVT treatment, the use of low-molecular-weight heparin decreased from 98% to 90% (P < .01). Direct oral anticoagulants use increased from 0.5% in 2010 to 13.4% in 2014 (P < .001). Risk-adjusted rates of 30-day all-cause mortality decreased from 3.9% in 2001 to 2005 to 2.7% in 2010 to 2014 (adjusted rate ratio per year, 0.84; 95% CI, 0.74-0.96; P < .01). VTE-related mortality showed a nonstatistically significant downward trend (adjusted rate ratio per year, 0.70; 95% CI, 0.44-1.10; P = .13), whereas 30-day bleeding-related mortality significantly decreased from 0.5% in 2001 to 2005 to 0.1% in 2010-2014 (adjusted rate ratio per year, 0.55; 95% CI, 0.40-0.77; P < .01). This international registry-based temporal analysis identified reductions in length of stay for adults hospitalized for DVT. The study also found a decreasing trend in adjusted rates of all-cause and bleeding-related mortality.
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