title: Natural history of venous thromboembolism in patients from the Mediterranean region. A systematic review.
abstract: BACKGROUND
  Patients with cardiovascular diseases living in the Mediterranean area have a better outcome than those in other parts of the world, but it is not known whether these differences also occur with venous thromboembolism (VTE).
  
  
  METHODS
  We searched the Medline and EMBASE databases to identify clinical trials and cohort studies of patients with VTE who had been treated with anticoagulant therapy for 3 months. Two reviewers independently extracted the data in a standardized manner. A total of 24 studies that included 7,225 patients (2,414 from the Mediterranean region and 4,811 from other regions) were analyzed.
  
  
  RESULTS
  The patients from the Mediterranean area were predominately women and older, and the idiopathic VTE was less frequent than in other regions. Compared with patients from other regions, patients from the Mediterranean region had an increased rate of recurrent deep vein thrombosis (4.35% vs. 2.68%; odds ratio [OR], 1.65; 95% confidence interval [95% CI] 1.27-2.15), fatal recurrent VTE (0.75% vs. 0.35%; OR, 2.11; 95% CI 1.09-4.12) and fatal bleeding (0.25% vs. 0.06%; odds ratio: 3.99; 95% CI 1.00-16.0). The case-fatality rate (CFR) for recurrent VTE was 12.8% (95% CI 7.99-19.1) in the Mediterranean region and 8.41% (5.15-12.9) in other areas. The CFR for major bleeding was 11.3% (95% CI 4.72-22.1) and 3.22% (95% CI 0.83-8.53), respectively.
  
  
  CONCLUSIONS
  Compared to other regions, patients with VTE from the Mediterranean region have greater mortality during the first 3 months of treatment due to a greater incidence of recurrent VTE and severe hemorrhaging.
authors.affiliation: Servicio de Medicina Interna, Hospital San Pedro de Alcántara, Cáceres, España. Electronic address: juanf.sanchezm@gmail.com.
authors.forename: J F
authors.initials: JF
authors.lastname: Sánchez Muñoz-Torrero
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: Lorenzo-Hernández
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario de Santa Lucía, Cartagena, Murcia, España.
authors.forename: J
authors.initials: J
authors.lastname: Trujillo-Santos
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España.
authors.forename: C
authors.initials: C
authors.lastname: Fernández-Capitán
authors.affiliation: Unidad Investigación, Hospital San Pedro de Alcántara, Cáceres, España.
authors.forename: J
authors.initials: J
authors.lastname: Zamorano
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Germans Trias y Pujol, Badalona, Barcelona, España.
authors.forename: M
authors.initials: M
authors.lastname: Monreal
mesh_terms: D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D008297:Male; D019083:Mediterranean Region / Q000453:epidemiology; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D012737:Sex Factors; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000453:epidemiology*; D020246:Venous Thrombosis / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000925:Anticoagulants
keywords: Anticoagulantes; Anticoagulants; Mediterranean region; Prognosis; Pronóstico; Región mediterránea; Tromboembolismo venoso; Venous thromboembolism