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Cancer patients are at risk of venous thromboembolism (VTE), its recurrence, but also at risk of bleeding while anticoagulated. In addition, cancer therapies have been associated to increased VTE risk. Guidelines for VTE treatment in cancer patients recommend low molecular weight heparins (LMWH) or direct oral anticoagulants (DOAC) for the initial treatment, DOAC for VTE short-term treatment, and LMWH or DOAC for VTE long-term treatment. This consensus article arises from a collaboration between different Spanish experts on cancer-associated thrombosis. It aims to reach an agreement on a practical document of recommendations for action allowing the healthcare homogenization of cancer-associated thrombosis (CAT) patients in Spain considering not only what is known about VTE management in cancer patients but also what is done in Spanish hospitals in the clinical practice. The text summarizes the current knowledge and available evidence on the subject in Spain and provides a series of practical recommendations for CAT management and treatment algorithms to help clinicians to manage CAT over time., (© 2024. The Author(s).)

Background: Electroanatomical mapping systems (EMS) reduce fluoroscopy dose for the ablation. Higher costs and longer procedure times are the drawbacks associated with EMS. Our objective was to validate the efficiency of the EMS., Objective: To demonstrate that using EMS is more efficient and as secure as the traditional system of ablation., Methods: From April 2013 to June 2018, all patients were included into two groups, according to the intention of ablation with or without fluoroscopy. Right, left, supraventricular and ventricular ablation were included. We compared procedure variables (fluoroscopy, radiofrequency and procedure times, ablation results, complication rates and costs of the procedure) that included material and detrimental effect of fluoroscopy., Results: A total of 105 were included in the fluoroscopy group and 287 in the without fluoroscopy group. We found an important reduction in time and radiation dose in all the ablation procedures studied, without increasing the procedure time. No differences in ablation results nor complications rate were found. We found lower costs in the flutter ablation without fluoroscopy, similar costs in the right focal tachycardia ablation group and higher costs in the without fluoroscopy group for the AVNRT and left accessory pathway. When detrimental effect of fluoroscopy was added, all procedures without fluoroscopy were significantly more efficient than the ones performed with it., Conclusions: Ablation without fluoroscopy is a technique as safe and effective as the conventional technique. Our study suggests that the radiation dose delivered to the patient and staff might be reduced, without increasing the total procedure time, being even more efficient.

Deep vein thrombosis of the lower extremities is a common condition that should be treated appropriately given the possibility that it could lead to an ultimately fatal complication, as well as to a post-thrombotic syndrome that is in some cases disabling. The current treatment for this condition is differentiated into an acute phase, a long-term therapy and occasionally an extended therapy, which not only has defined objectives but also uses various drugs and even varying dosages for each drug. We describe the therapeutic anticoagulation options in each of these treatment phases and some of the treatments (thrombolysis, insertion of an inferior vena cava filter, surgery) that can play a role in certain conditions., (Copyright © 2020 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

Venous thromboembolism is a frequent complication in cancer patients and affects their morbidity and mortality. The risk of this event differs according to the characteristics of the tumor, the patient's circumstances, and the treatments provided. Although the benefits of thromboprophylaxis in certain subgroups of patients with cancer have been demonstrated, currently generic prescription is not recommended unless other risk factors are present, or the patient has multiple myeloma and has been treated with thalidomide or lenalidomide. The insertion of a central venous catheter in these patients does not imply prescription of thromboprophylaxis, although the risk factors for catheter thrombosis are known. Finally, a risk scoring model for the prediction of venous thromboembolism has been defined in outpatients with cancer starting chemotherapy, which has been externally validated and supplemented with the addition of two biomarkers., (Copyright © 2013 Elsevier España, S.L. All rights reserved.)

The term "economy-class syndrome" defines an infrequent episode of venous thromboembolism (VTED) related to a long travel, namely by plane. However, this relation has not clearly been demonstrated by investigators. We carried out a systematic review and a meta-analysis of cases-control studies that had studied this topic. We realised a systematic review of the literature and selected all the case-control studies published. Two authors carried out a methodological evaluation according to the Scottish Intercollegiate Guidelines Network items (concordance was analysed by weighted kappa index), and a systematic analysis of the potential biases of each study was assessed. We carried out the meta-analysis with the data extracted from the studies. We recovered eight cases-control studies. The relation between the antecedent of a long travel and subsequent VTED varied from OR = 1.1 to OR = 4.0 and was found to be significant in four studies. The studies were highly heterogeneous in methodology and so the results obtained about the relation between the long travel and the VTED and the score at SIGN50. Two meta-analysis were carried out: only with travels by plane in which the relation was not significant (OR = 1.21; CI 95%, 0.95-1.55) and with all types of transport, with a slightly significant relation (OR = 1.46; CI95%, 1.24-1.72). We may deduce from this systematic review that there does exist a weak association between episodes of VTED and a long travel, but not by plane specifically. The heterogeneity and the methodological quality of the studies published preclude of more robust conclusions.

Background and Objective: To determine wether the quality of care criteria applied and the treatment provided to patients hospitalized after congestive heart failure were appropriate to reduce rates of premature readmission and death., Patients and Method: We analyzed the epidemiologic, clinical and quality of care data proposed by 3 international organizations: JCAHO, AHA/ACC and ACOVE Project. The dependent variable was defined as readmission or death during the 30 days after discharge. A multivariate analysis was made using multiple binary logistic regression of the parameters of quality of care and treatment appropriateness., Results: 225 hospital discharge records were analyzed. There were 21 readmissions and 3 deaths (i.e., 24 cases [10.7%] with a positive dependent variable). 162 records (72%) corresponded to patients aged 65 years and over, who presented a total of 18 (8%) readmissions or premature deaths. A positive association between readmission or premature death was found with regard to 2 variables: appropriate treatment with beta-blockers (odds ratio [OR] = 0.34) and the Charlson index (OR = 3,79 for score of 3 or more vs. score of 2 or less). In the case of patients aged 65 years and over the same 2 variables were positively associated, with OR similar to those cited (OR = 0.31 and 3.21, respectively). No association was found between premature readmission or death and the overall evaluation of the criteria referred to by AHA/ACC, JCAHO or the ACOVE Project., Conclusions: Premature readmission or death of patients with heart failure is more determined by the characteristics of the clinical state of patients (the Charlson comorbidity index) and by the appropriateness of the treatment applied (treatment with beta-blockers) than by the accomplishment of quality of care criteria as proposed by the cited scientific organizations.

Background and Objective: We aimed to know if treatment of deep vein thrombosis (DVT) with early mobilisation is as safe and effective as bed rest., Material and Method: MEDLINE, EMBASE, Cochrane library (CCTR), Spanish Medical Index, and MD-Consult Virtual Library databases were searched. We also cross-checked bibliographies of the retrieved articles. The TESEO database of doctoral theses in Spain was also revised. We only searched for clinical trial articles comparing bed rest with early mobilization with respect to the incidence of objectively diagnosed pulmonary embolism (PE) in patients treated for DVT of lower limbs. The concordance coefficient was evaluated by statistical methods. We used relative risk and 95% confidence intervals. Selection bias was evaluated using funnel plot., Results: Only three articles were included in the metaanalysis, with 296 patients randomized from 773 patients initially evaluated, with a follow-up of 9 days to 3 months. Quality rating ranged from 61.4 to 90% and the kappa index of concordance ranged from 0.78 to 0.93. The relative risks of PE between the two groups of treatment (early mobilization versus bed rest) were 1.31 (0.63-2.72), 1.50 (0.17-13.23), and 1.45 (0.56-3.75), respectively, and the global RR was 1.37 (0.78-2.40)., Conclusions: The analyzed studies reveal that the treatment of DVT with early mobilization rather than bed rest neither increases the rate of PE nor increases the complication rate. New well designed, controlled clinical trials are needed to confirm the conclusions of this review.

Objective: To systematically review all the reported cases of diabetic muscle infarction (DMI) and its pathogenesis, clinical features, prognostic implications, and management., Research Design and Methods: We searched databases (MEDLINE and EMBASE) from their inception to August 2001 and reviewed bibliographies in reports retrieved. Data were extracted in a standardized form., Results: A total of 47 references were retrieved; 115 patients and 166 episodes were included. DMI was more frequent in women (61.5%, mean age at presentation 42.6 years). Of the cases, 59% had type 1 diabetes; the mean duration of disease was 14.3 years, and multiple diabetic end-organ complications were noted. DMI affects the lower limbs with abrupt onset of pain and local swelling. Diagnosis is made by biopsy, but the characteristic features in magnetic resonance imaging are very typical. Treatment includes bed rest and administration of analgesics, but recurrence is common., Conclusions: DMI is a very uncommon complication of long-standing diabetes; presentation is well characterized and management is simple.

Subclavian artery aneurysm is an uncommon condition. Usually is arteriosclerotic in origin. Its clinical features are scarce and generally are due to compression of the neighbourhood structures or ischemic, embolic or, less frequently, rupture of it. Diagnosis is performed by an arteriography or a computed tomography scan. Treatment includes the surgical reaction or the embolization. We report the case of a patient with a left subclavian artery aneurysm and review the most important clinical features of this entity.

Background: Diagnosis of deep-vein thrombosis (DVT) of lower limbs has changed in recent years. The objective of our study was to analyze the diagnostic accuracy of a combination of clinical and epidemiological data and the D-Dimer plasma levels in this entity., Patients and Methods: Clinical (symptoms and signs) and epidemiological data, personal and family history, and D-dimer plasma levels or positivity were reviewed, on the admittance, in 108 patients to whom a phlebography was performed due to a suspected DVT., Results: Phlebography was positive in 76 cases (70.37%). Logistic regression analysis determined a prediction model of the diagnostic of DVI including a combination of both D-dimer plasma levels or positivity and pain along the deep venous involved area., Conclusion: Combination of D-dimer testing and pain along the distribution of the deep venous area is useful as an initial diagnostic approach to the DVI of the lower limbs.