- Email: [email protected]
P0124 VENOUS THROMBOEMBOLISM RISK ASSESSMENT AND PROPHYLAXIS IN HOSPITALISED MEDICAL PATIENTS
S46
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
reveal any possible etiology for the arterial thrombosis in a hyperthroidism patient without the atrial fibrilation. Results: Hyperthroidism may affect the coagulation system by mostly causing hypercoagulation and thromboembolic events. The studies about thrombosis in hyperthroidism usually demonstrated that hyperthyroidism and arterial thrombosis are usually seen in patients complicated with atrial fibrillation. It is a rare case of arterial and venous thrombosis accompanying hyperthroidism without atrial fibriallation. In our case we could not find any predisposing factors causing both venous and arterial thrombosis else than hyperthroidism. We suggest that there may be a relationship between thrombosis and hyperthroidism and recommend to the clinicians to keep in mind that arterial thrombosis may be seen without atrial fibrilation at hyperthroidism patients.
P0123 SWEET SYNDROME (ACUTE FEBRILE NEUTROPHILIC DERMATOSIS)
Fatma Alıbaz Öner, Nesrın Ünalan, Mehmet Emın Pı¸skınpa¸sa, Mecdı Ergüney. Istanbul Education and Research Hospital Introduction: Sweet syndrome is a rare dermatological disease characterized fever, leukocytosis, well-demarcated, erythematous papüles and plaques which show dense neutrophilic infiltration.Sweet syndrome presents in three clinical groups; classic or idiopathic form, a malignancy associated or paraneoplastic form, drug-induced form. Case report: A 71-year-old woman presents with painful and erythematous rashes in her hands and distal part of legs.On the physical examination; She had erythematous, edematous plaques in her hands and distals of legs. The other system examinations were normal. Hb: 11,5 gr/dl, Hct: 34, plt: 251000, WBC: 18400, kidney and hepatic function tests,electrolyte levels were normal. Erytrocyte sedimantation rate: 105 mm/hour, CRP:12,1 m IU/ML, ASO:315 m IU/ML.After dermatology consultation, A punch biopsy was performed on her left leg. The patient was started on oral antihistaminic and topical cortocosteroid.On biopsy; focal dermal neutrophilic infiltrations were found. Classical sweet syndrome was diognosed with both major criterias and three minor citerias. Discussion & conclusion: Acute febrile neutrophilic dermatosis was first described by Sweet in 1964. There is a broad incidence peak in the fourth to seventh decades; women average age 50 and men age 65.The etiology is unknown but is thought to be a hypersensitivity reaction that leads to cytokine stimulation and subsequent neutrophil activation and infiltration. Plaques usually appear on your back, neck, arms and face. These tender and painful eruptions may develop blisters, pustules or ulcers, causing your skin to burn or itch. The diagnostic criteria are summarized in table 1. Criteria
Classic/Malignancy-associated
Drug-induced
1
Abrupt onset of painful erythematous plaques/nodules
2
Histopathologic evidence of a dense neutrophilic infiltrate without evidence of leukocytoclastic vasculitis. Fever > 38°C
3 4
Association: underlying malignancy, inflammatory disease, pregnancy; OR preceded by upper respiratory or gastrointestinal infection or vaccination.
Temporal relationship: between drug ingestion and clinical presentation; OR recurrence after oral challenge
5
Excellent response to treatment with systemic glucocorticoids or potassium iodide.
Temporally related resolution of lesions after drug withdrawal or treatment with systemic glucocorticoids.
6
Abnormal labs at presentation (3 of 4): ESR > 20mm/hr, (+) C reactive protein, WBC > 8000, neutrophils > 70 percent
Diagnosis
Both major criteria (1 and 2), and 2 of 4 minor criteria (3-6).
P0124 VENOUS THROMBOEMBOLISM RISK ASSESSMENT AND PROPHYLAXIS IN HOSPITALISED MEDICAL PATIENTS
Rakesh Kishore Panchal, Syed Fayyaz Hussain. Kettering General Hospital, Rothwell Road, Kettering, Northants, United Kingdom Nn16 8uz Introduction: Hospitalisation for acute medical illness is associated with an eightfold increased relative risk for venous thromboembolism (VTE). Pulmonary embolism accounts for 5-10% of deaths in hospitalised patients. Despite their existence, risk assessment strategies and thromboprophylaxis recommendations are not well implemented in hospitalised patients internationally. Objectives: To assess the risk of VTE and use of thromboprophylaxis strategies in adult internal medicine patients admitted to a district general hospital in the United Kingdom. Materials & methods: On a single day all adult internal medical inpatients were assessed for risk of VTE based on a review of medical notes and prescription charts. An evidence-based risk assessment tool was used to evaluate VTE risk and determine whether patients were receiving recommended thromboprophylaxis. Results: Of 193 internal medicine inpatients (53% male), 190 (98%) were aged ≥40 years. Survey demonstrated 142 (74%) medical patients at risk of VTE. Some form of thromboprophylaxis was prescribed to 74 (52%) at-risk patients (35% low molecular weight heparin and 18% thromboembolic
Characteristics and reasons for hospitalisation of assessed medical patients (193) Sex Age (years) Length of Hospitalisation (days) Reason for hospitalisation Respiratory Cardiology Infection (non-respiratory) Stroke Neurology (non-stroke) Oncology Gastroenterology Renal disease Haematology Endocrine/Metabolic Rheumatology Dermatology Other
102 (53%) Male, 91 (47%) Female 190 (98%) > 40yrs [51% > 75years] 6.0 [1-50]
Risk factors for venous thromboembolism Before admission Age >75 years Chronic Respiratory failure Chronic Heart failure Body mass Index > 30 (kg/m2 ) Previous venous thromboembolism Varicose veins or venous insufficiency Contraceptive/Hormone Replacement/Chemotherapy Admission Category Risk Factor Acute Heart Failure Acute Respiratory Failure Active Cancer/Inflammatory Disease (including infection) Other medical condition
All 5 criteria Prevalence of VTE in Internal Medicine
Localized lesions may be successfully treated with intralesional or topical glucocorticoids. Alternative treatments include doxycycline, potassium iodide, colchicine, indomethacin, dapsone, cyclosporine, cyclophosphamide, chlorambucil, and clofazamine Lesions are generally on upper extremities and face.Leg lesions are rare. Our case is interesting because of both the syndrome or the leg lesions are rare. Key words: Febrile neutrophilic dermetosis
Method of Thromboprophylaxis
54 (28%) 34 (18%) 23 (12%) 19 (10%) 18 (9%) 15 (8%) 14 (7%) 6 (3%) 4 (2%) 2 (1%) 2 (1%) 1 (0.5%) 1 (0.5%)
98 (51%) 32 (17%) 32 (17%) 14 (7%) 11 (6%) 3 (1%) 3(1%) 18 (9%) 42 (22%) 58 (30%) 75 (39%)
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
S47
and about 60% of our patients with a CHADS2 score of 2 or superior were discharged with warfarin. Physical and/or mental deterioration were important reasons not to start oral anticoagulation.
P0126 RECURRENCE IN MAJOR BLEEDING DURING ANTICOAGULANT TREATMENT IN PATIENTS WITH PULMONARY EMBOLISM. EXPERIENCES TO COMPARISON: "MAJBLEEDR-VTE" STUDY VERSUS “RIETE” DATABASE
Maurizio Maria Ciammaichella, Rosa Maida, Carla Patrizi, Giannantonio Cerqua. St. John Hospital, Emergency Medicine, Rome, Italy Contraindications to anticoagulation
stockings (TEDs). TED stocking was mainly used in stroke patients. No thromboprophylaxis was prescribed to 68 (48%) patients at risk of VTE. Discussion & conclusion: We have shown that nearly half of all hospitalised internal medicine patients at high risk of VTE did not receive thromboprophylaxis, a finding comparable to previous studies. VTE is a major public health issue and is easily preventable. We have incorporated a VTE risk assessment tool into our medical admissions proforma to ensure thromboprophylaxis is appropriately prescribed. We recommend that all hospitals admitting acutely ill patients in internal medicine should implement similar strategies. Keywords: venous thromboembolism, thromboprophylaxis
P0125 ATRIAL FIBRILLATION: A COMMON ARRHYTHMIA IN INTERNAL MEDICINE
José Tiago Sequeira Lopes Da Silva, Nicolas Bureo Gutierrez, Veronica Fernandez Auzmendi, Olga Gonzalez Casas, Fermin Olgado Ferrero, Dolores Magro Ledesma. Internal Medicine Department, Hospital Infanta Cristina, Badajoz, Spain Background: Atrial Fibrillation (A. Fib.) is the most common arrhythmia and one very important cause of admittance in Internal Medicine. It consumes many important resources and is a cause of serious complications. Aims: To study the characteristics of patients diagnosed of A. Fib. and the reason of their admittance in a Department of Internal Medicine, type of A. Fib. commonly seen, studies requested during their stay, treatment chosen, CHADS2 score and if anticoagulation was prescribed, and if not, why not. Methods: We performed a descriptive retrospective study of all patients discharged of our Department during February of 2.005 and August of 2.008 in which A. Fib. was considered one of the principal diagnosis. Results: During this 3 and half years, 158 patients with diagnosis of A. Fib. were admitted. 39 patients died, thus making that 119 were discharged during this period of time. 45 of them were men and 65 were women, with a mean age of 76 years. First detected A. Fib. (54 cases) and Permanent A. Fib. (46 cases) were more commonly diagnosed. Persistent and Paroxysmal A. Fib. corresponded to 10 and 9 cases, respectively. Studying their medical background, we noticed that 82 patients had been previously diagnosed of Hypertension, 45 were Diabetic, 18 had had Strokes and 23 suffered from Ischemic Heart Disease. Pulmonary Diseases (Chronic Obstructive Pulmonary Disease, Pulmonary Hypertension and Obstructive Sleep Apnea Syndrome) were also frequent in our patients. The primary reason of admittance was Congestive Heart Failure (61 patients), followed by Respiratory Infections (16 cases) and Stroke (15 admittances). All performed a thoracic radiography and an electrocardiogram. To 72 patients an echocardiogram was also requested, and 64 had their thyroid hormone levels studied. In 86 patients a rate control therapy was chosen with digoxin, beta-blockers or calcium channel blockers, while in 11 patients an antiarrhythmic drug, especially amiodarone, was prescribed. According to the CHADS2 score, in 105 patients anticoagulation was obliged, since the score was 2 or superior, but of these only 63 patients were discharged with warfarin. The primary reason not to use anticoagulants was old age/physical deterioration (16 patients) and dementia (8 patients). Anemia and current alcoholism were also important reasons. Antiplatelet therapy was decided in 31 patients. Summary: Patients admitted in Internal Medicine with A. Fib. are usually people of old age, frequently women, with a background of Hypertension, Diabetes, Cardiac Ischemia or Pulmonary Disease. Most of them were admitted due to Heart Failure secondary to A. Fib. not previously diagnosed. Digoxin and beta-blockers were more frequently prescribed than antiarrhytmic drugs
Background: The Authors have introduced the study "MAJBLEEDrVTE",from name "MAJOR BLEEDING recurrence-VENOUS THROMBOEMBOLISM" turned to 140 patients admitted to the unit “Degenza Breve/Sub-Intensiva C" in the period January 2005-December 2008 with pulmonary embolism and subjected to treatment with anticoagulant drugs: unfractionated heparin (UFH)+antivitamin K (AVK). Aims: Aims of the study are following:to verify the cases of recurrence in major bleeding in the 140 patients enlisted and treated with anticoagulant drugs (UFH+AVK); to confront study "MAJBLEEDr-VTE" with RIETE data on patients treated with anticoagulant drugs (UFH+AVK). Methods: The study "MAJBLEEDr-VTE" has enlisted 140 patients with pulmonary embolism who have been subordinated to anticoagulant treatment with UFH+AVK. Therefore,we have brought back in Table 1 the data extrapolated from the RIETE database inherent 24932 patients,updated to November 2008.In the database we have searched the following analytical profile:Treatment prior to Major Bleeding: UFH + Anti-vitamin K drugs, Symptoms:Any symptoms,Treatment Phase in which bleeding occurred:Any treatment,Severity:Any,Site:Any.In Table 2 we have brought back,instead,the coming from data from MAJBLEEDr-VTE Study on 140 patients enlisted.We have searched the same analytical profile of RIETE database. Results: The coming from data from Registry RIETE and the MAJBLEEDrVTE Study have documented,according to the following analytical profile "treatment prior to bleeding:UFH+AVK drugs",0 cases of recurrence in major bleeding during associated treatment with unfractionated heparin to antivitamin K drugs.In the RIETE Registry five cases with Good Outcome have been analyzed: in one patient the therapy has been transiently suspended for 2 days,in two patients has been maintained the same therapy with 26450 IU to the dose of 434 IU/kg,in one patient the therapy has been switched to UFH (dose 24000 IU/die,414 IU/kg),in one patient the therapy has been switched to AVK drugs.The coming from data from the MAJBLEEDr-VTE Study have documented as in no case it has been necessary definitely to suspend the therapy with UFH+AVK,in two cases the therapy with UFH+AVK has been transiently suspended for 2 days,in two cases it has been switched to LMWH (dose 12000 IU/die,100 IU/kg), in two cases has been chosen the strategy with LMWH (dose 12000 IU/die,100 IU/kg) and caval filter system,in one case the therapy has been switched to AVK.Five patients with major bleeding have been afflicted with digestive haemorrhage (4 cases), haemoptysis (1 case).As for the data of the RIETE Registry also ours five patients have had a Good Outcome. Conclusions: The comparative analysis of the coming from data from the database of the RIETE Registry and from the MAJBLEEDr-VTE Study demonstrated as it has not been evidence of recurrence in major bleeding in no case as a result of treatment with UFH+AVK.
P0127 KAWASAKI DISEASE AND ITS IMPACT IN THE ADULT: REPORT OF 2 CASES AND LITERATURE REVIEW
Sebastian Schröder, Marta Garcia Vidal, Enrique Saiz Hervas, Julio De Miguel Prieto. Department of Internal Medicine, Hospital Universitario Príncipe De Asturias, Alcalá De Henares, Spain Background: Kawasaki disease (KD) first described in 1967 is an acute multisystem vasculitis with still unknown etiology although both clinical and epidemiological features strongly support an infectious cause. Diagnosis is based on clinical criteria. KD is primarily affecting young children however occasionally cases in adults were described. Objectives: To describe 2 cases of adult KD and to review the medical literature to better define the epidemiological, clinical and therapeutic aspects of adult KD. Methods: Report of two cases and review of the literature using a Medline search from 1967 to October 2008.
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
reveal any possible etiology for the arterial thrombosis in a hyperthroidism patient without the atrial fibrilation. Results: Hyperthroidism may affect the coagulation system by mostly causing hypercoagulation and thromboembolic events. The studies about thrombosis in hyperthroidism usually demonstrated that hyperthyroidism and arterial thrombosis are usually seen in patients complicated with atrial fibrillation. It is a rare case of arterial and venous thrombosis accompanying hyperthroidism without atrial fibriallation. In our case we could not find any predisposing factors causing both venous and arterial thrombosis else than hyperthroidism. We suggest that there may be a relationship between thrombosis and hyperthroidism and recommend to the clinicians to keep in mind that arterial thrombosis may be seen without atrial fibrilation at hyperthroidism patients.
P0123 SWEET SYNDROME (ACUTE FEBRILE NEUTROPHILIC DERMATOSIS)
Fatma Alıbaz Öner, Nesrın Ünalan, Mehmet Emın Pı¸skınpa¸sa, Mecdı Ergüney. Istanbul Education and Research Hospital Introduction: Sweet syndrome is a rare dermatological disease characterized fever, leukocytosis, well-demarcated, erythematous papüles and plaques which show dense neutrophilic infiltration.Sweet syndrome presents in three clinical groups; classic or idiopathic form, a malignancy associated or paraneoplastic form, drug-induced form. Case report: A 71-year-old woman presents with painful and erythematous rashes in her hands and distal part of legs.On the physical examination; She had erythematous, edematous plaques in her hands and distals of legs. The other system examinations were normal. Hb: 11,5 gr/dl, Hct: 34, plt: 251000, WBC: 18400, kidney and hepatic function tests,electrolyte levels were normal. Erytrocyte sedimantation rate: 105 mm/hour, CRP:12,1 m IU/ML, ASO:315 m IU/ML.After dermatology consultation, A punch biopsy was performed on her left leg. The patient was started on oral antihistaminic and topical cortocosteroid.On biopsy; focal dermal neutrophilic infiltrations were found. Classical sweet syndrome was diognosed with both major criterias and three minor citerias. Discussion & conclusion: Acute febrile neutrophilic dermatosis was first described by Sweet in 1964. There is a broad incidence peak in the fourth to seventh decades; women average age 50 and men age 65.The etiology is unknown but is thought to be a hypersensitivity reaction that leads to cytokine stimulation and subsequent neutrophil activation and infiltration. Plaques usually appear on your back, neck, arms and face. These tender and painful eruptions may develop blisters, pustules or ulcers, causing your skin to burn or itch. The diagnostic criteria are summarized in table 1. Criteria
Classic/Malignancy-associated
Drug-induced
1
Abrupt onset of painful erythematous plaques/nodules
2
Histopathologic evidence of a dense neutrophilic infiltrate without evidence of leukocytoclastic vasculitis. Fever > 38°C
3 4
Association: underlying malignancy, inflammatory disease, pregnancy; OR preceded by upper respiratory or gastrointestinal infection or vaccination.
Temporal relationship: between drug ingestion and clinical presentation; OR recurrence after oral challenge
5
Excellent response to treatment with systemic glucocorticoids or potassium iodide.
Temporally related resolution of lesions after drug withdrawal or treatment with systemic glucocorticoids.
6
Abnormal labs at presentation (3 of 4): ESR > 20mm/hr, (+) C reactive protein, WBC > 8000, neutrophils > 70 percent
Diagnosis
Both major criteria (1 and 2), and 2 of 4 minor criteria (3-6).
P0124 VENOUS THROMBOEMBOLISM RISK ASSESSMENT AND PROPHYLAXIS IN HOSPITALISED MEDICAL PATIENTS
Rakesh Kishore Panchal, Syed Fayyaz Hussain. Kettering General Hospital, Rothwell Road, Kettering, Northants, United Kingdom Nn16 8uz Introduction: Hospitalisation for acute medical illness is associated with an eightfold increased relative risk for venous thromboembolism (VTE). Pulmonary embolism accounts for 5-10% of deaths in hospitalised patients. Despite their existence, risk assessment strategies and thromboprophylaxis recommendations are not well implemented in hospitalised patients internationally. Objectives: To assess the risk of VTE and use of thromboprophylaxis strategies in adult internal medicine patients admitted to a district general hospital in the United Kingdom. Materials & methods: On a single day all adult internal medical inpatients were assessed for risk of VTE based on a review of medical notes and prescription charts. An evidence-based risk assessment tool was used to evaluate VTE risk and determine whether patients were receiving recommended thromboprophylaxis. Results: Of 193 internal medicine inpatients (53% male), 190 (98%) were aged ≥40 years. Survey demonstrated 142 (74%) medical patients at risk of VTE. Some form of thromboprophylaxis was prescribed to 74 (52%) at-risk patients (35% low molecular weight heparin and 18% thromboembolic
Characteristics and reasons for hospitalisation of assessed medical patients (193) Sex Age (years) Length of Hospitalisation (days) Reason for hospitalisation Respiratory Cardiology Infection (non-respiratory) Stroke Neurology (non-stroke) Oncology Gastroenterology Renal disease Haematology Endocrine/Metabolic Rheumatology Dermatology Other
102 (53%) Male, 91 (47%) Female 190 (98%) > 40yrs [51% > 75years] 6.0 [1-50]
Risk factors for venous thromboembolism Before admission Age >75 years Chronic Respiratory failure Chronic Heart failure Body mass Index > 30 (kg/m2 ) Previous venous thromboembolism Varicose veins or venous insufficiency Contraceptive/Hormone Replacement/Chemotherapy Admission Category Risk Factor Acute Heart Failure Acute Respiratory Failure Active Cancer/Inflammatory Disease (including infection) Other medical condition
All 5 criteria Prevalence of VTE in Internal Medicine
Localized lesions may be successfully treated with intralesional or topical glucocorticoids. Alternative treatments include doxycycline, potassium iodide, colchicine, indomethacin, dapsone, cyclosporine, cyclophosphamide, chlorambucil, and clofazamine Lesions are generally on upper extremities and face.Leg lesions are rare. Our case is interesting because of both the syndrome or the leg lesions are rare. Key words: Febrile neutrophilic dermetosis
Method of Thromboprophylaxis
54 (28%) 34 (18%) 23 (12%) 19 (10%) 18 (9%) 15 (8%) 14 (7%) 6 (3%) 4 (2%) 2 (1%) 2 (1%) 1 (0.5%) 1 (0.5%)
98 (51%) 32 (17%) 32 (17%) 14 (7%) 11 (6%) 3 (1%) 3(1%) 18 (9%) 42 (22%) 58 (30%) 75 (39%)
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
S47
and about 60% of our patients with a CHADS2 score of 2 or superior were discharged with warfarin. Physical and/or mental deterioration were important reasons not to start oral anticoagulation.
P0126 RECURRENCE IN MAJOR BLEEDING DURING ANTICOAGULANT TREATMENT IN PATIENTS WITH PULMONARY EMBOLISM. EXPERIENCES TO COMPARISON: "MAJBLEEDR-VTE" STUDY VERSUS “RIETE” DATABASE
Maurizio Maria Ciammaichella, Rosa Maida, Carla Patrizi, Giannantonio Cerqua. St. John Hospital, Emergency Medicine, Rome, Italy Contraindications to anticoagulation
stockings (TEDs). TED stocking was mainly used in stroke patients. No thromboprophylaxis was prescribed to 68 (48%) patients at risk of VTE. Discussion & conclusion: We have shown that nearly half of all hospitalised internal medicine patients at high risk of VTE did not receive thromboprophylaxis, a finding comparable to previous studies. VTE is a major public health issue and is easily preventable. We have incorporated a VTE risk assessment tool into our medical admissions proforma to ensure thromboprophylaxis is appropriately prescribed. We recommend that all hospitals admitting acutely ill patients in internal medicine should implement similar strategies. Keywords: venous thromboembolism, thromboprophylaxis
P0125 ATRIAL FIBRILLATION: A COMMON ARRHYTHMIA IN INTERNAL MEDICINE
José Tiago Sequeira Lopes Da Silva, Nicolas Bureo Gutierrez, Veronica Fernandez Auzmendi, Olga Gonzalez Casas, Fermin Olgado Ferrero, Dolores Magro Ledesma. Internal Medicine Department, Hospital Infanta Cristina, Badajoz, Spain Background: Atrial Fibrillation (A. Fib.) is the most common arrhythmia and one very important cause of admittance in Internal Medicine. It consumes many important resources and is a cause of serious complications. Aims: To study the characteristics of patients diagnosed of A. Fib. and the reason of their admittance in a Department of Internal Medicine, type of A. Fib. commonly seen, studies requested during their stay, treatment chosen, CHADS2 score and if anticoagulation was prescribed, and if not, why not. Methods: We performed a descriptive retrospective study of all patients discharged of our Department during February of 2.005 and August of 2.008 in which A. Fib. was considered one of the principal diagnosis. Results: During this 3 and half years, 158 patients with diagnosis of A. Fib. were admitted. 39 patients died, thus making that 119 were discharged during this period of time. 45 of them were men and 65 were women, with a mean age of 76 years. First detected A. Fib. (54 cases) and Permanent A. Fib. (46 cases) were more commonly diagnosed. Persistent and Paroxysmal A. Fib. corresponded to 10 and 9 cases, respectively. Studying their medical background, we noticed that 82 patients had been previously diagnosed of Hypertension, 45 were Diabetic, 18 had had Strokes and 23 suffered from Ischemic Heart Disease. Pulmonary Diseases (Chronic Obstructive Pulmonary Disease, Pulmonary Hypertension and Obstructive Sleep Apnea Syndrome) were also frequent in our patients. The primary reason of admittance was Congestive Heart Failure (61 patients), followed by Respiratory Infections (16 cases) and Stroke (15 admittances). All performed a thoracic radiography and an electrocardiogram. To 72 patients an echocardiogram was also requested, and 64 had their thyroid hormone levels studied. In 86 patients a rate control therapy was chosen with digoxin, beta-blockers or calcium channel blockers, while in 11 patients an antiarrhythmic drug, especially amiodarone, was prescribed. According to the CHADS2 score, in 105 patients anticoagulation was obliged, since the score was 2 or superior, but of these only 63 patients were discharged with warfarin. The primary reason not to use anticoagulants was old age/physical deterioration (16 patients) and dementia (8 patients). Anemia and current alcoholism were also important reasons. Antiplatelet therapy was decided in 31 patients. Summary: Patients admitted in Internal Medicine with A. Fib. are usually people of old age, frequently women, with a background of Hypertension, Diabetes, Cardiac Ischemia or Pulmonary Disease. Most of them were admitted due to Heart Failure secondary to A. Fib. not previously diagnosed. Digoxin and beta-blockers were more frequently prescribed than antiarrhytmic drugs
Background: The Authors have introduced the study "MAJBLEEDrVTE",from name "MAJOR BLEEDING recurrence-VENOUS THROMBOEMBOLISM" turned to 140 patients admitted to the unit “Degenza Breve/Sub-Intensiva C" in the period January 2005-December 2008 with pulmonary embolism and subjected to treatment with anticoagulant drugs: unfractionated heparin (UFH)+antivitamin K (AVK). Aims: Aims of the study are following:to verify the cases of recurrence in major bleeding in the 140 patients enlisted and treated with anticoagulant drugs (UFH+AVK); to confront study "MAJBLEEDr-VTE" with RIETE data on patients treated with anticoagulant drugs (UFH+AVK). Methods: The study "MAJBLEEDr-VTE" has enlisted 140 patients with pulmonary embolism who have been subordinated to anticoagulant treatment with UFH+AVK. Therefore,we have brought back in Table 1 the data extrapolated from the RIETE database inherent 24932 patients,updated to November 2008.In the database we have searched the following analytical profile:Treatment prior to Major Bleeding: UFH + Anti-vitamin K drugs, Symptoms:Any symptoms,Treatment Phase in which bleeding occurred:Any treatment,Severity:Any,Site:Any.In Table 2 we have brought back,instead,the coming from data from MAJBLEEDr-VTE Study on 140 patients enlisted.We have searched the same analytical profile of RIETE database. Results: The coming from data from Registry RIETE and the MAJBLEEDrVTE Study have documented,according to the following analytical profile "treatment prior to bleeding:UFH+AVK drugs",0 cases of recurrence in major bleeding during associated treatment with unfractionated heparin to antivitamin K drugs.In the RIETE Registry five cases with Good Outcome have been analyzed: in one patient the therapy has been transiently suspended for 2 days,in two patients has been maintained the same therapy with 26450 IU to the dose of 434 IU/kg,in one patient the therapy has been switched to UFH (dose 24000 IU/die,414 IU/kg),in one patient the therapy has been switched to AVK drugs.The coming from data from the MAJBLEEDr-VTE Study have documented as in no case it has been necessary definitely to suspend the therapy with UFH+AVK,in two cases the therapy with UFH+AVK has been transiently suspended for 2 days,in two cases it has been switched to LMWH (dose 12000 IU/die,100 IU/kg), in two cases has been chosen the strategy with LMWH (dose 12000 IU/die,100 IU/kg) and caval filter system,in one case the therapy has been switched to AVK.Five patients with major bleeding have been afflicted with digestive haemorrhage (4 cases), haemoptysis (1 case).As for the data of the RIETE Registry also ours five patients have had a Good Outcome. Conclusions: The comparative analysis of the coming from data from the database of the RIETE Registry and from the MAJBLEEDr-VTE Study demonstrated as it has not been evidence of recurrence in major bleeding in no case as a result of treatment with UFH+AVK.
P0127 KAWASAKI DISEASE AND ITS IMPACT IN THE ADULT: REPORT OF 2 CASES AND LITERATURE REVIEW
Sebastian Schröder, Marta Garcia Vidal, Enrique Saiz Hervas, Julio De Miguel Prieto. Department of Internal Medicine, Hospital Universitario Príncipe De Asturias, Alcalá De Henares, Spain Background: Kawasaki disease (KD) first described in 1967 is an acute multisystem vasculitis with still unknown etiology although both clinical and epidemiological features strongly support an infectious cause. Diagnosis is based on clinical criteria. KD is primarily affecting young children however occasionally cases in adults were described. Objectives: To describe 2 cases of adult KD and to review the medical literature to better define the epidemiological, clinical and therapeutic aspects of adult KD. Methods: Report of two cases and review of the literature using a Medline search from 1967 to October 2008.