Can Home Prophylaxis for Venous Thromboembolism Reduce Mortality Rates in Patients With Chronic Obstructive Pulmonary Disease?

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"tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "130" "paginaFinal" => "134" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Modesto-Alapont, D. Nauffal-Manzur, E. Ansótegui-Barrera, R. Menéndez-Villanueva, A. Ballesta, R. Touza, M. Perpiñá-Tordera" "autores" => array:7 [ 0 => array:5 [ "preGrado" => "Dr." "nombre" => "M." "apellidos" => "Modesto-Alapont" "email" => array:1 [ 0 => "manumalap@ono.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "D." "apellidos" => "Nauffal-Manzur" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff1" ] ] ] 2 => array:3 [ "nombre" => "E." "apellidos" => "Ansótegui-Barrera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff1" ] ] ] 3 => array:3 [ "nombre" => "R." "apellidos" => "Menéndez-Villanueva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff1" ] ] ] 4 => array:3 [ "nombre" => "A." "apellidos" => "Ballesta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff2" ] ] ] 5 => array:3 [ "nombre" => "R." "apellidos" => "Touza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff2" ] ] ] 6 => array:3 [ "nombre" => "M." "apellidos" => "Perpiñá-Tordera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff1" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario La Fe, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Servicio de Radiología, Hospital Universitario La Fe, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dr. M. Modesto-Alapont. Servicio de Neumología. Hospital Universitario La Fe. Avda. Campanar, 21. 46009 Valencia. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-04-19" "fechaAceptado" => "2005-09-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec154272" "palabras" => array:4 [ 0 => "COPD" 1 => "Pulmonary embolism" 2 => "Deep vein thrombosis" 3 => "Venous thromboembolism prophylaxis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154271" "palabras" => array:4 [ 0 => "EPOC" 1 => "Embolia pulmonar" 2 => "Trombosis venosa profunda" 3 => "Profilaxis de la tromboembolia venosa" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "ObjectiveThe incidence of venous thromboembolism (VTE) in patients with chronic obstructive pulmonary disease (COPD) ranges from 20% to 60% in different studies and the mortality rates are higher for patients with both conditions. Heparin prophylaxis is therefore usually prescribed for COPD patients who are hospitalized for exacerbation. Once their situation becomes stable, however, they are discharged to home without prophylaxis even though the low level of physical activity their disease allows continues to put them at risk for VTE.The aim of this study was to test the efficacy of home heparin prophylaxis on reducing the incidence of VTE and on the overall mortality rate in patients with severe COPD. Patients and methodsWe conducted a prospective, randomized controlled trial of 87 patients with severe COPD who required home oxygen therapy (≥18 h/d) and whose physical activity was highly restricted. A total of 44 patients received low molecular weight heparin (3500 IU/d of bemiparin) subcutaneously for 6 months. The outcome measures were incidence of VTE and mortality at 3 and 6 months. ResultsFour patients (9.1%) died in the heparin group and 9 (20.4%) died in the control group; the difference was not statistically significant (P =.23). VTE without pulmonary embolism developed in 1 patient (2%) in each group. Slight bleeding complications appeared in 9 patients (20.4%) in the heparin group and 1 patient (2.3%) in the control group, a difference that was statistically significant (P =.015). ConclusionsHome prophylaxis with heparin does not reduce the incidence of VTE or overall mortality in patients with severe COPD." ] "es" => array:1 [ "resumen" => "ObjetivoLa incidencia de enfermedad tromboembólica venosa (ETV) en pacientes con enfermedad pulmonar obs-tructiva crónica (EPOC) oscila entre el 20 y el 60% según las series, y la mortalidad por ETV es superior en estos enfer-mos. Por ello suele prescribirse profilaxis con heparina a los pacientes con EPOC hospitalizados por una agudización. Sin embargo, una vez que se estabiliza su situación, se les remite a su domicilio sin dicha profilaxis, a pesar de que la escasa actividad física que les permite su enfermedad sigue constituyendo un factor de riesgo para la aparición de ETV. El objetivo de este estudio ha sido analizar si la profilaxis domiciliaria con heparina reduce la aparición de ETV y la mortalidad global en los enfermos con EPOC evolucionada. Pacientes y métodosSe ha realizado un ensayo clínico prospectivo aleatorizado con 87 pacientes afectados de EPOC grave que precisaban oxigenoterapia domiciliaria (18 h o más al día), con una alta limitación de la actividad física. Un total de 44 sujetos recibió heparina de bajo peso molecular (HBPM; 3.500 U/día de bemiparina) por vía subcutánea durante 6 meses. Las variables estudiadas fueron la incidencia de ETV y la mortalidad a los 3 y 6 meses. ResultadosDurante el estudio fallecieron 4 pacientes del grupo que recibió HBPM (9,1%) y 9 del grupo control (20,4%); las diferencias entre ambos grupos no fueron esta-dísticamente significativas (p = 0,23). Presentó trombosis venosa profunda sin embolia pulmonar un paciente de cada grupo (2%). Aparecieron complicaciones hemorrágicas leves en 9 pacientes del grupo con HBPM (20,4%), frente a una en el grupo control (2,3%), diferencia que fue estadísti-camente significativa (p = 0,015). ConclusionesLa profilaxis domiciliaria con heparina no reduce la aparición de ETV ni la mortalidad global en los pacientes con EPOC avanzada." ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:33 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Low-dose heparin prophylaxis against fatal pulmonary embolism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S Sagar" 1 => "J Massey" 2 => "JM Sanderson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br Med J" "fecha" => "1975" "volumen" => "4" "paginaInicial" => "257" "paginaFinal" => "259" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1104060" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reduction of mortality in general medical patients by low-dose heparin prophylaxis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H Halkin" 1 => "J Goldberg" 2 => "M Modan" 3 => "B Modan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "1982" "volumen" => "96" "paginaInicial" => "561" "paginaFinal" => "565" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7073148" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heparin prophylaxis in bedridden patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "JF Bergmann" 1 => "C Caulin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1996" "volumen" => "348" "paginaInicial" => "205" "paginaFinal" => "206" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8684189" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Randomised, controlled trial of low-dose heparin prophylaxis for prevention of fatal pulmonary embolism in patients with Infectious diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B Gardlun" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1996" "volumen" => "347" "paginaInicial" => "1357" "paginaFinal" => "1361" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8637340" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mortality after hospitalization for COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P Almagro" 1 => "E Calbo" 2 => "A Ochoa de Echagüen" 3 => "B Barreiroi" 4 => "S Quintana" 5 => "JL Heredia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2002" "volumen" => "121" "paginaInicial" => "1441" "paginaFinal" => "1448" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12006426" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "for The Prophylaxis in Medical Patients with Enoxaparin Study Group" "etal" => true "autores" => array:6 [ 0 => "MM Samama" 1 => "AT Cohen" 2 => "JY Darmon" 3 => "L Desjardins" 4 => "A Eldor" 5 => "C Janbon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199909093411103" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1999" "volumen" => "341" "paginaInicial" => "793" "paginaFinal" => "800" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10477777" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "GOLD Scientific Committee. 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