Examinando por Autor "MONREAL, MANUEL"

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The influence of extreme body weight on clinical outcome of patients with venous thromboembolism: findings from a prospective registry (RIETE)
(Science direct, 2005-05) BARBA, RAQUEL; MARCO, JAVIER; MARTIN-ALVAREZ, HELENA; RONDON, PILAR; FERNANDEZ-CAPITAN, CARMEN; GARCIA-BRAGADO, FERRAN; MONREAL, MANUEL
Background: Data evaluating the safety of using weight‐based dosing of low‐molecular‐weight heparin (LMWH) in either underweight or obese patients with venous thromboembolism (VTE) are limited. Thus, recommendations based on evidence from clinical trials might not be suitable for patients with extreme body weight. Patients and Methods: Patients with objectively confirmed, symptomatic acute VTE are consecutively enrolled into the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry. For this analysis, data from patients in the following ranges of body weight were examined: <50, 50–100, and >100 kg. Patient characteristics, underlying conditions, treatment schedules and clinical outcomes during the first 15 days of treatment were compared. Results: As of August 2004, 8845 patients with acute VTE were enrolled from 94 participating centers. Of these, 169 (1.9%) weighed <50 kg, 8382 (95%) weighed 50–100 kg and 294 (3.3%) weighed >100 kg. Patients weighing <50 kg were more commonly females, were taking non‐steriodal antiinflammatory drugs (NSAIDs), and had severe underlying diseases more often than patients weighing 50–100 kg. Their incidence of overall bleeding complications was significantly higher than in patients weighing 50–100 kg (odds ratio 2.2; 95% CI: 1.2–4.0). Patients weighing >100 kg were younger, most commonly males, and had cancer less often than those weighing 50–100 kg. Incidences of recurrent VTE, fatal pulmonary embolism or major bleeding complications were similar in both groups. Conclusions: Patients with VTE weighing <50 kg have a significantly higher rate of bleeding complications. The clinical outcome of patients weighing over 100 kg was not significantly different from that in patients weighing 50–100 kg.
The outcome after treatment of venous thromboembolism is different in surgical and acutely ill medical patients. Findings from the RIETE registry
(ELSEVIER, 2004-11) MONREAL, MANUEL; KAKKAR, AK; CAPRINI, JA; BARBA, RAQUEL; URESANDI, FERNANDO; VALLE, REINA; SUAREZ, CARMEN; OTERO, REMEDIOS
Background:The history of venous thromboembolism (VTE), and the rationale for thromboprophylaxis in surgical patients are well understood. The situation is less clear for acutely ill medical patients. Objectives:To compare the clinical presentation of VTE and clinical outcomes of immobile acutely ill medical patients with surgical patients. Patients: RIETE (Registro Informatizado de la Enfermedad TromboEmbólica) is a Spanish registry of consecutively enrolled patients with objectively confirmed, symptomatic acute VTE. In this analysis, clinical characteristics of patients, details of anticoagulant therapy, and outcomes of all enrolled acutely ill medical patients with immobility ≥ 4 days, and surgical patients are included. Results:Of 6160 patients enrolled up to December 2003, 756 (12%) were acutely ill medical patients with immobility ≥ 4 days, and 884 (14%) were surgical patients who developed VTE within 2 months of surgical intervention. Only 28% of acutely ill medical patients had received thromboprophylaxis, compared with 67% of surgical patients. During the 3‐month follow‐up period, both fatal pulmonary embolism (PE) and fatal bleeding occurred more frequently in acutely ill medical patients. Immobility in acutely ill medical patients, cancer, and PE were associated with a significantly higher risk of fatal PE or bleeding. Conclusions:In patients treated for VTE, the incidences of fatal PE, fatal bleeding, and major bleeding were significantly higher in acutely ill medical patients compared with surgical patients. Given the low percentage of acutely ill medical patients who had received thromboprophylaxis, increasing its use appropriately may reduce the incidence of VTE and associated complications.
Venous thromboembolism in patients with renal insufficiency: findings from the RIETE Registry
(ELSEVIER, 2006-12-01) MONREAL, MANUEL; FALGA, CONTXITA; VALLE, REINA; BARBA, RAQUEL; BOSCO, JUAN; BEATO, JOSE LUIS; MAESTRE, ANA
Background: Current guidelines make no specific recommendations for venous thromboembolism (VTE) treatment in patients with renal insufficiency, but some experts recommend some reduction in heparin dose. Methods: Registro Informatizado de Enfermedad TromboEmbólica (RIETE) is an ongoing, prospective registry of consecutively enrolled patients with objectively confirmed, symptomatic, acute VTE. In this analysis we retrospectively analyzed the effect of renal insufficiency on the incidence of fatal pulmonary embolism (PE) and fatal bleeding within 15 days of diagnosis. Results: Up to March 2005, 10,526 patients with acute VTE were enrolled in RIETE, of whom 9234 (88%) had a creatinine clearance (CrCl) greater than 60 mL/min, 704 (6.7%) had a CrCl 30 to 60 mL/min, and 588 (5.6%) had a CrCl less than 30 mL/min. The incidence of fatal PE during the study period was 1.0%, 2.6%, and 6.6%, respectively. Fatal bleeding occurred in 0.2%, 0.3%, and 1.2% of the patients, respectively. On multivariate analysis, patients with a CrCl less than 30 mL/min were independently associated with an increased risk for fatal PE and fatal bleeding. In addition, initial diagnosis of PE, immobility for 4 days or more, cancer, and initial therapy with unfractionated heparin were independent predictors of fatal PE; whereas immobility for 4 days or more and cancer were independent predictors of fatal bleeding. Conclusions: 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. Our data support the use of full-dose anticoagulant therapy, even in patients with a CrCl less than 30 mL/min.