Jara-Palomares, L. (Luis)
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- Hospital volume and outcomes for acute pulmonary embolism: multinational population based cohort study(BMJ, 2019) Quezada, A. (Andrés); Bikdeli, B. (Behnood); Monreal, M. (Manuel); Muriel, A. (Alfonso); Ruiz-Artacho, P. (Pedro); Jiménez, D. (David); Yusen, R.D. (Roger D.); Miguel-Diez, J. (Javier) de; Jara-Palomares, L. (Luis); Lobo, J.L. (José Luis)Objectives To evaluate the association between experience in the management of acute pulmonary embolism, reflected by hospital case volume, and mortality. Design Multinational population based cohort study using data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry between 1 January 2001 and 31 August 2018. Setting 353 hospitals in 16 countries. Participants 39 257 consecutive patients with confirmed diagnosis of acute symptomatic pulmonary embolism. Main outcome measure Pulmonary embolism related mortality within 30 days after diagnosis of the condition. Results Patients with acute symptomatic pulmonary embolism admitted to high volume hospitals (>40 pulmonary embolisms per year) had a higher burden of comorbidities. A significant inverse association was seen between annual hospital volume and pulmonary embolism related mortality. Admission to hospitals in the highest quarter (that is, >40 pulmonary embolisms per year) was associated with a 44% reduction in the adjusted odds of pulmonary embolism related mortality at 30 days compared with admission to hospitals in the lowest quarter (<15 pulmonary embolisms per year; adjusted risk 1.3% v 2.3%; adjusted odds ratio 0.56 (95% confidence interval 0.33 to 0.95); P=0.03). Results were consistent in all sensitivity analyses. All cause mortality at 30 days was not significantly reduced between the two quarters (adjusted odds ratio 0.78 (0.50 to 1.22); P=0.28). Survivors showed little change in the odds of recurrent venous thromboembolism (odds ratio 0.76 (0.49 to 1.19)) or major bleeding (1.07 (0.77 to 1.47)) between the low and high volume hospitals. Conclusions In patients with acute symptomatic pulmonary embolism, admission to high volume hospitals was associated with significant reductions in adjusted pulmonary embolism related mortality at 30 days. These findings could have implications for management strategies.
- PICO questions and DELPHI methodology for the management of venous thromboembolism associated with COVID-19(MDPI, 2021) Riera-Mestre, A. (Antonio); Jara-Palomares, L. (Luis); Lecumberri-Villamediana, R. (Ramón); Trujillo-Santos, J. (Javier); Grau, E. (Enric); Blanco-Molina, A. (Angeles); Piera-Carbonell, A. (Ana); Jiménez-Hortelano, S. (Sonia); Frías-Vargas, M. (Manuel); Fuset, M.P. (Mari Paz); Bellmunt-Montoya, S. (Sergi); Monreal, M. (Manuel); Jiménez, D. (David)Patients with coronavirus disease 2019 (COVID-19) have a higher risk of venous thromboembolic disease (VTE) than patients with other infectious or inflammatory diseases, both as macrothrombosis (pulmonar embolism and deep vein thrombosis) or microthrombosis. However, the use of anticoagulation in this scenario remains controversial. This is a project that used DELPHI methodology to answer PICO questions related to anticoagulation in patients with COVID-19. The objective was to reach a consensus among multidisciplinary VTE experts providing answers to those PICO questions. Seven PICO questions regarding patients with COVID-19 responded with a broad consensus: 1. It is recommended to avoid pharmacological thromboprophylaxis in most COVID-19 patients not requiring hospital admission; 2. In most hospitalized patients for COVID-19 who are receiving oral anticoagulants before admission, it is recommended to replace them by low molecular weight heparin (LMWH) at therapeutic doses; 3. Thromboprophylaxis with LMWH at standard doses is suggested for COVID-19 patients admitted to a conventional hospital ward; 4. Standard-doses thromboprophylaxis with LMWH is recommended for COVID-19 patients requiring admission to Intensive Care Unit; 5. It is recommended not to determine D-Dimer levels routinely in COVID-19 hospitalized patients to select those in whom VTE should be suspected, or as a part of the diagnostic algorithm to rule out or confirm a VTE event; 6. It is recommended to discontinue pharmacological thromboprophylaxis at discharge in most patients hospitalized for COVID-19; 7. It is recommended to withdraw anticoagulant treatment after 3 months in most patients with a VTE event associated with COVID-19. The combination of PICO questions and DELPHI methodology provides a consensus on different recommendations for anticoagulation management in patients with COVID-19.
- Venous thromboembolism in cancer patients: ESMO Clinical Practice Guideline(Elsevier, 2023) Falanga, A. (Anna); Ay, C. (Cihan); Di-Nisio, M.; Gerotziafas, G.; Jara-Palomares, L. (Luis); Langer, F.; Lecumberri, R. (Ramón); Mandala, M.; Maraveyas, A.; Pabinger, I. (Ingrid); Sinn, M.; Syrigos, K.; Young, A.; Jordan, K.