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Young adults — Under threat of venous thromboembolism
Abstracts
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and 52.3% of seniors, difference is statistically significant (P = 0.018). 42.2% of young adults and 28.4% of seniors in our study group had more important thrombophilia mutations, difference is not statistically significant (P = 0.336). 22.2% of young adults and 11.4% of seniors reported VTE in relatives, difference is not statistically significant (P = 0.113). Only 4.4% of young adults had malignant disease but in seniors it was 34.1%, difference is statistically significant (P b 0.000). 24.4% of young adults and 17.0% of seniors underwent VTE in the context with trauma (we did not discriminate the kind of trauma), difference is not statistically significant (P = 0.589). 8.9% of young adults and 11.4% of seniors underwent perioperative VTE, difference is not statistically significant (P = 0.575). 31.1% of young adults and 4.5% of seniors underwent VTE regarding to use of hormones, difference is statistically significant (P b 0.000). 4.4% of young adults and 4.5% of seniors underwent VTE regarding to travelling, difference is not statistically significant (P = 0.426). Young adults achieved higher education than seniors. 53.3% of young adults achieved secondary education, 37.8 % of young adults achieved higher education as compared with 34.1% and 22.7% of seniors, difference is statistically significant (P b 0.000). Patient knowledge about principle of VTE and about risk factors was studied by questionnaire. We expected better knowledge of young adults of the principle of the disease. 93.3% of young adults and 79.5% of seniors were able to explain the principle of venous thrombosis, difference is statistically significant (P = 0.057). We had same assumption for patient knowledge of the principle of pulmonary embolism, it was confirmed (P b 0.000). 48.9% of young adults and 28.4% of seniors could explain the principle of pulmonary embolism. 17.8% of young adults and 48.9% of seniors were unable to specify neither risk factor of VTE. Young adults named in most cases two risk factors (40%). 82.2% of young adults and 51.1% of seniors named at least one risk factor of VTE. This difference was statistically significant (P = 0.008). Conclusions: Excessively optimistic view on young adults considered usually healthy and unthreatened may lead to underestimation of risk of VTE. Young adults create important target risk group for proper medical education.
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old woman, who appealed to the Emergency Department of our hospital with low back pain beginning three days ago, which was progressively worsening, associated with nonspecific malaise and vomiting. The patient had a history of coronary bypass surgery (CABG) in 2004 for ischemic heart disease, heart failure class II/III NYHA, hypertension, dyslipidemia, obesity and chronic renal failure. On examination, the patient was agitated, pale, sweaty and had a high respiratory frequency. The blood pressure was not measurable, there were no heart murmurs, the lungs were clear and the abdomen revealed a large, non-painful, pulsatile, palpable mass at the level of epigastrium/periumbilical region. The Murphy's sign was positive on the left. The extremities were cold and the foot pulses were diminished. The analytical study pointed out normocytic hypochromic anemia (Hb 8.5 g/dl), metabolic acidemia with hyperlactacidemia (8.32 mmol/l), creatinine 1.9 mg/dl and urea 85 mg/dl. Chest radiography and electrocardiogram showed no changes. Having in mind the hypothesis of aortic aneurysm, the patient underwent thoracic-abdominal-pelvic computed tomography, which revealed a large abdominal aortic aneurysm, reaching 14.24 cm in anteroposterior diameter, excluding the left kidney. The left renal artery was leaving the aneurysm, which was in rupture and there was a massive retroperitoneal hematoma on the left. She maintained progressive hemodynamic instability and it was verified a decrease of haemoglobin from 8.5 g/dl to 5.7 g/dl, besides medical treatment. A vascular surgeon observed the patient and taking in account the hemodynamic instability and the patient's comorbidities, considered it an irreversible situation, without benefit of surgical treatment. The patient died hours later. The aortic aneurysm rupture is a rare cause of haemorrhagic shock, which is highly catastrophic. Mortality increases by 1% to 2% each hour after the onset of symptoms. Because every minute counts, early diagnosis is crucial for urgent surgical intervention. Once the prognosis is closely related to the size of the aneurysm and patient comorbidities, there are situations where even diagnosed in a short time, the outcome is fatal.
e45
doi:10.1016/j.ejim.2013.08.108
EC
doi:10.1016/j.ejim.2013.08.109
ID: 420 Young adults — Under threat of venous thromboembolism K. Dostalovaa, S. Moricovaa, L. Kukuckovab, V. Stvrtinovac, J. Luhad a
CO
RR
Department of Preventive and Clinical Medicine, Faculty of Public Health, Slovak Medical University, Bratislava, Slovakia b Long Term Ill Department, Derer's Hospital, University Hospital, Bratislava, Slovakia c 2nd Clinic of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia d Department of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, Bratislava, Slovakia
UN
Objective: By comparison of epidemiological data we find out that in young adults (25–39 years) the incidence of venous thromboembolism (VTE) is 6-fold higher than cerebral infarction and 2-fold higher than acute myocardial infarction. Life circumstances and activities typical for young adults may cause that this group of individuals is exposed to more risk factors of VTE: 1. congenital thrombophilia, 2. using of oral contraceptives, 3. pregnancy and puerperium, 4. cancer typical for young adults, 5. drug abuse and 6. sport activity. Methods: 219 patients with VTE were followed during last 6 years by the Outpatient Department of Angiology. 100 (45.7%) of them were men and 119 women (54.3%), from 21 to 90 years. Results: 13.3% of young adults and 21.6% of seniors underwent pulmonary embolism, difference is not statistically significant (Fisher's exact test with P = 0.476). We identified recurrence of VTE in 28.9% of young adults
ID: 529 Thromboprophylaxis in acute medical ill patients: A survey among a large cohort of Italian physicians F. Dentalia, F. Pomerob, M. La Reginac, F. Orlandinic, S. Turatoa, A. Mazzoned, A. Nozzolie, A. Fontanellaf, W. Agenoa, M. Campaninig a
Clinical Medicine, Insubria University, Varese, Italy Clinical Medicine, Santa Croce and Carle General Hospital, Cuneo, Italy c Internal Medicine, Ligurian East Hospital, La Spezia, Italy d Internal Medicine, Ospedale Civile, Legnano, Italy e Clinical Medicine, A.O. Careggi, Firenze, Italy f Internal Medicine, Buonconsiglio Fatebenefratelli Hospital, Naples, Italy g Internal Medicine, A.S.O.U. “Maggiore della Carità”, Novara, Italy b
Aims: acute medical ill patients with reduced mobility are at increased risk of venous thromboembolism (VTE), but to identify patients who could benefit from an appropriate prophylaxis may be difficult due to the heterogeneity of the medical population. We conducted a survey among a large cohort of Italian physicians to assess their approach to some important grey areas of thromboprophylaxis in this setting. Methods: a questionnaire was distributed during the national FADOI society (Italian Federation of Internal Medicine) meeting, held in May, 2013. In this questionnaire information on the training and the experience of the participants (including specialty, workplace and experience in thrombosis and
RO
OF
and 52.3% of seniors, difference is statistically significant (P = 0.018). 42.2% of young adults and 28.4% of seniors in our study group had more important thrombophilia mutations, difference is not statistically significant (P = 0.336). 22.2% of young adults and 11.4% of seniors reported VTE in relatives, difference is not statistically significant (P = 0.113). Only 4.4% of young adults had malignant disease but in seniors it was 34.1%, difference is statistically significant (P b 0.000). 24.4% of young adults and 17.0% of seniors underwent VTE in the context with trauma (we did not discriminate the kind of trauma), difference is not statistically significant (P = 0.589). 8.9% of young adults and 11.4% of seniors underwent perioperative VTE, difference is not statistically significant (P = 0.575). 31.1% of young adults and 4.5% of seniors underwent VTE regarding to use of hormones, difference is statistically significant (P b 0.000). 4.4% of young adults and 4.5% of seniors underwent VTE regarding to travelling, difference is not statistically significant (P = 0.426). Young adults achieved higher education than seniors. 53.3% of young adults achieved secondary education, 37.8 % of young adults achieved higher education as compared with 34.1% and 22.7% of seniors, difference is statistically significant (P b 0.000). Patient knowledge about principle of VTE and about risk factors was studied by questionnaire. We expected better knowledge of young adults of the principle of the disease. 93.3% of young adults and 79.5% of seniors were able to explain the principle of venous thrombosis, difference is statistically significant (P = 0.057). We had same assumption for patient knowledge of the principle of pulmonary embolism, it was confirmed (P b 0.000). 48.9% of young adults and 28.4% of seniors could explain the principle of pulmonary embolism. 17.8% of young adults and 48.9% of seniors were unable to specify neither risk factor of VTE. Young adults named in most cases two risk factors (40%). 82.2% of young adults and 51.1% of seniors named at least one risk factor of VTE. This difference was statistically significant (P = 0.008). Conclusions: Excessively optimistic view on young adults considered usually healthy and unthreatened may lead to underestimation of risk of VTE. Young adults create important target risk group for proper medical education.
TE
DP
old woman, who appealed to the Emergency Department of our hospital with low back pain beginning three days ago, which was progressively worsening, associated with nonspecific malaise and vomiting. The patient had a history of coronary bypass surgery (CABG) in 2004 for ischemic heart disease, heart failure class II/III NYHA, hypertension, dyslipidemia, obesity and chronic renal failure. On examination, the patient was agitated, pale, sweaty and had a high respiratory frequency. The blood pressure was not measurable, there were no heart murmurs, the lungs were clear and the abdomen revealed a large, non-painful, pulsatile, palpable mass at the level of epigastrium/periumbilical region. The Murphy's sign was positive on the left. The extremities were cold and the foot pulses were diminished. The analytical study pointed out normocytic hypochromic anemia (Hb 8.5 g/dl), metabolic acidemia with hyperlactacidemia (8.32 mmol/l), creatinine 1.9 mg/dl and urea 85 mg/dl. Chest radiography and electrocardiogram showed no changes. Having in mind the hypothesis of aortic aneurysm, the patient underwent thoracic-abdominal-pelvic computed tomography, which revealed a large abdominal aortic aneurysm, reaching 14.24 cm in anteroposterior diameter, excluding the left kidney. The left renal artery was leaving the aneurysm, which was in rupture and there was a massive retroperitoneal hematoma on the left. She maintained progressive hemodynamic instability and it was verified a decrease of haemoglobin from 8.5 g/dl to 5.7 g/dl, besides medical treatment. A vascular surgeon observed the patient and taking in account the hemodynamic instability and the patient's comorbidities, considered it an irreversible situation, without benefit of surgical treatment. The patient died hours later. The aortic aneurysm rupture is a rare cause of haemorrhagic shock, which is highly catastrophic. Mortality increases by 1% to 2% each hour after the onset of symptoms. Because every minute counts, early diagnosis is crucial for urgent surgical intervention. Once the prognosis is closely related to the size of the aneurysm and patient comorbidities, there are situations where even diagnosed in a short time, the outcome is fatal.
e45
doi:10.1016/j.ejim.2013.08.108
EC
doi:10.1016/j.ejim.2013.08.109
ID: 420 Young adults — Under threat of venous thromboembolism K. Dostalovaa, S. Moricovaa, L. Kukuckovab, V. Stvrtinovac, J. Luhad a
CO
RR
Department of Preventive and Clinical Medicine, Faculty of Public Health, Slovak Medical University, Bratislava, Slovakia b Long Term Ill Department, Derer's Hospital, University Hospital, Bratislava, Slovakia c 2nd Clinic of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia d Department of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, Bratislava, Slovakia
UN
Objective: By comparison of epidemiological data we find out that in young adults (25–39 years) the incidence of venous thromboembolism (VTE) is 6-fold higher than cerebral infarction and 2-fold higher than acute myocardial infarction. Life circumstances and activities typical for young adults may cause that this group of individuals is exposed to more risk factors of VTE: 1. congenital thrombophilia, 2. using of oral contraceptives, 3. pregnancy and puerperium, 4. cancer typical for young adults, 5. drug abuse and 6. sport activity. Methods: 219 patients with VTE were followed during last 6 years by the Outpatient Department of Angiology. 100 (45.7%) of them were men and 119 women (54.3%), from 21 to 90 years. Results: 13.3% of young adults and 21.6% of seniors underwent pulmonary embolism, difference is not statistically significant (Fisher's exact test with P = 0.476). We identified recurrence of VTE in 28.9% of young adults
ID: 529 Thromboprophylaxis in acute medical ill patients: A survey among a large cohort of Italian physicians F. Dentalia, F. Pomerob, M. La Reginac, F. Orlandinic, S. Turatoa, A. Mazzoned, A. Nozzolie, A. Fontanellaf, W. Agenoa, M. Campaninig a
Clinical Medicine, Insubria University, Varese, Italy Clinical Medicine, Santa Croce and Carle General Hospital, Cuneo, Italy c Internal Medicine, Ligurian East Hospital, La Spezia, Italy d Internal Medicine, Ospedale Civile, Legnano, Italy e Clinical Medicine, A.O. Careggi, Firenze, Italy f Internal Medicine, Buonconsiglio Fatebenefratelli Hospital, Naples, Italy g Internal Medicine, A.S.O.U. “Maggiore della Carità”, Novara, Italy b
Aims: acute medical ill patients with reduced mobility are at increased risk of venous thromboembolism (VTE), but to identify patients who could benefit from an appropriate prophylaxis may be difficult due to the heterogeneity of the medical population. We conducted a survey among a large cohort of Italian physicians to assess their approach to some important grey areas of thromboprophylaxis in this setting. Methods: a questionnaire was distributed during the national FADOI society (Italian Federation of Internal Medicine) meeting, held in May, 2013. In this questionnaire information on the training and the experience of the participants (including specialty, workplace and experience in thrombosis and