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Vol. 214. Issue 7.
Pages 357-364 (October 2014)
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Vol. 214. Issue 7.
Pages 357-364 (October 2014)
Original article
Idiopathic versus secondary venous thromboembolism. Findings of the RIETE registry
Enfermedad tromboembólica venosa idiopática versus secundaria. Hallazgos del registro RIETE
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J.M. Pedrajasa,
Corresponding author
jmaria1963@yahoo.es

Corresponding author.
, C. Garmendiab, J. Portilloc, F. Gabrield, C. Maineze, C. Yeraf, M. Monrealg
a Servicio de Medicina Interna, Hospital Clínico San Carlos, Madrid, Spain
b Servicio de Medicina Interna, Fundación Hospital Alcorcón, Alcorcón, Madrid, Spain
c Servicio de Medicina Interna, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
d Servicio de Medicina Interna, Hospital Clínico de Valencia, Valencia, Spain
e Servicio de Medicina Interna, Hospital Universitario Puerta Hierro, Majadahonda, Madrid, Spain
f Servicio de Medicina Interna, Hospital Virgen de la Salud, Toledo, Spain
g Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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Tables (7)
Table 1. Risk factors in patients with secondary thromboembolism venous (SVTE).
Table 2. Characteristics of patients with idiopathic or secondary venous thromboembolism (VTE).
Table 3. Characteristics of patients who presented with a pulmonary embolism and who had idiopathic or secondary venous thromboembolism (VTE).
Table 4. Characteristics of patients who presented with deep vein thrombosis and who had idiopathic or secondary venous thromboembolism (VTE).
Table 5. Probability of episodes at 90 days in patients with venous thromboembolism (VTE), idiopathic (IVTE) versus secondary (SVTE).
Table 6. Probability of episodes at 90 days in patients with venous thromboembolism (VTE), idiopathic (IVTE) versus secondary (SVTE) who presented with idiopathic pulmonary embolism (IPE) versus secondary pulmonary embolism (SPE).
Table 7. Probability of events at 90 days in patients with venous thromboembolism (VTE) who presented initially with idiopathic deep vein thrombosis (IDVT) versus secondary deep vein thrombosis (SDVT).
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Abstract
Background and objectives

The Computerized Registry of Patients with Venous Thromboembolism (RIETE) is a prospective registry that consecutively includes patients diagnosed with venous thromboembolism. We compared the clinical presentation and response to anticoagulant treatment in patients with idiopathic venous thromboembolism (IVT) versus secondary venous thromboembolism (SVT, associated with a risk factor).

Patients and methods

We analyzed the differences in clinical characteristics, comorbidity, treatment and events during the first 3 months after the diagnosis of venous thromboembolism in patients with IVT or SVT and according to their initial clinical presentation.

Results

A total of 39,921 patients with IVT (n=18,029; 45.1%) or SVT (n=21,892; 54.9%) were enrolled. The patients with IVT had a greater history of venous thromboembolism than those diagnosed with SVT (p<.001). The initial treatment was similar for the 2 groups, but more inferior vena cava filters were placed in the SVT group (p<.001). In the long term, low-molecular-weight heparin was used more often in the SVT group than in the IVT group. At 90 days, bleeding, death and the recurrence of venous thromboembolism were significantly more frequent in the SVT group. The multivariate analysis confirmed that IVT was associated with fewer major (OR, 0.60; 95% CI, 0.50–0.61; p<.001) and fatal (OR, 0.41; 95% CI, 0.29–0.62; p<.001) bleedings, fewer relapses (OR, 0.58; 95% CI, 0.39–0.78; p<.001) and fewer fatal pulmonary embolisms (OR, 0.29; 95% CI, 0.12–0.52; p<.001). These differences were maintained in patients whose venous thromboembolism started with a pulmonary embolism or with deep vein thrombosis.

Conclusions

IVT has a better prognosis than SVT at 90 days of the diagnosis.

Keywords:
Deep vein thrombosis
Duration of anticoagulant treatment
Pulmonary embolism
Venous thromboembolism
Heparin
Vitamin K antagonists
Resumen
Antecedentes y objetivos

El Registro Informatizado de Enfermedad Tromboembólica (RIETE) es un registro prospectivo que incluye de forma consecutiva pacientes diagnosticados de enfermedad tromboembólica venosa. Hemos comparado la presentación clínica y la respuesta al tratamiento anticoagulante en pacientes con enfermedad tromboembólica venosa idiopática (ETEVI) versus secundaria (ETEVS, asociada a algún factor de riesgo).

Pacientes y métodos

Se analizaron las diferencias en las características clínicas, comorbilidad, tratamiento y episodios durante los primeros 3meses tras el diagnóstico de ETEV en los pacientes con ETEVI o ETEVS y según su presentación clínica inicial.

Resultados

Se incluyeron 39.921 pacientes, con ETEVI (n=18.029; 45,1%) o ETEVS (n=21.892; 54,9%). Los pacientes con ETEVI mostraron más antecedentes de ETEV que los diagnosticados de ETEVS (p<0,001). El tratamiento inicial fue similar en ambos grupos, pero se colocaron más filtros de vena cava inferior en el grupo de ETEVS (p<0,001). A largo plazo se utilizó con mayor frecuencia heparina de bajo peso molecular en el grupo de ETEVS que en el de ETEVI. A los 90días, la recidiva de ETEV, el sangrado y la muerte fueron significativamente más frecuentes en el grupo con ETEVS. El análisis multivariante confirmó que la ETEVI se asoció a un menor número de sangrados mayores (OR, 0,60; IC95%, 0,50-0,61; p<0,001) y mortales (OR, 0,41; IC95%, 0,29-0,62; p<0,001), menor número de recidivas (OR, 0,58; IC95%, 0,39-0,78; p<0,001) y de embolismo pulmonar mortal (OR, 0,29; IC95%, 0,12-0,52; p<0,001). Estas diferencias se mantuvieron en los pacientes cuya ETEV se inició con un embolismo pulmonar o con una trombosis venosa profunda.

Conclusiones

La ETEVI tiene mejor pronóstico que la ETEVS a los 90días del diagnóstico.

Palabras clave:
Trombosis venosa profunda
Duración del tratamiento anticoagulante
Embolismo pulmonar
Enfermedad tromboembólica venosa
Heparina
Antagonistas de la vitamina K

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