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

• Autores: Gregalio, Felipe Aníbal, Juana, Camila, Manattini Palmili, Gian, Martínez, Bernardo Julio, Bluro, Ignacio Martin, Vázquez, Fernando Javier, Grande Ratti, María Florencia
• Formato: artículo
• Fecha de Publicación: 2024
• Institución: Instituto Nacional Cardiovascular
• Repositorio: Archivos peruanos de cardiología y cirugía cardiovascular
• Lenguaje: inglés; español
• OAI Identifier: oai:apcyccv.org.pe:article/334
• Enlace del recurso: https://apcyccv.org.pe/index.php/apccc/article/view/334
• Nivel de acceso: acceso abierto
• Materia: Urgencias Médicas; Trombosis; Embolia Pulmonar; Argentina; Servicio Ambulatorio en Hospital; Emergency Service, Hospital; Venous thromboembolism; Pulmonary embolism; Ambulatory care

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.