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

Felipe Aníbal Gregalio; Camila Juana; Gian Manattini Palmili; Bernardo Julio Martínez; Ignacio Martin Bluro; Fernando Javier Vázquez; María Florencia Grande Ratti

doi:10.47487/apcyccv.v5i1.334

Authors

Felipe Aníbal Gregalio Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. https://orcid.org/0000-0003-3189-2382
Camila Juana Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. https://orcid.org/0000-0003-4023-6563
Gian Manattini Palmili Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. https://orcid.org/0009-0005-8609-999X
Bernardo Julio Martínez Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Central de Emergencias de Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. https://orcid.org/0000-0002-0270-6520
Ignacio Martin Bluro Servicio de Cardiología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. https://orcid.org/0000-0003-1833-6090
Fernando Javier Vázquez Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; CONICET-IMTIB, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. https://orcid.org/0000-0003-1480-5101
María Florencia Grande Ratti Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Área de Investigación en Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; CONICET-HIBA, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. https://orcid.org/0000-0001-8622-8230

DOI:

https://doi.org/10.47487/apcyccv.v5i1.334

Keywords:

Emergency Service, Hospital, Venous thromboembolism, Pulmonary embolism, Argentina, Ambulatory care

Abstract

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.

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