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1. Noninvasive diagnostic work-up for suspected acute pulmonary embolism during pregnancy: a systematic review and meta-analysis of individual patient data.

Author

Stals, M.A.M., Moumneh, T., Ainle, F.N., Aujesky, D., Bemmel, T. van, Bertoletti, L., Bistervels, I.M., Chauleur, C., Couturaud, F., Dooren, Y.P.A. van, Elias, A., Faber, L.M., Gall, C., Hofstee, H.M.A., Hulle, T. van der, Kruip, M.J.H.A., Maignan, M., Mairuhu, A.T.A., Middeldorp, S., Moigne, E. Le, Nijkeuter, M., Pol, L. van de, Robert-Ebadi, H., Roy, P.M., Sanchez, O., Schmidt, J., Smeden, M. van, Tromeur, C., Wolde, M.T., Righini, M., Gal, G. Le, Huisman, M.V., Klok, F.A., Stals, M.A.M., Moumneh, T., Ainle, F.N., Aujesky, D., Bemmel, T. van, Bertoletti, L., Bistervels, I.M., Chauleur, C., Couturaud, F., Dooren, Y.P.A. van, Elias, A., Faber, L.M., Gall, C., Hofstee, H.M.A., Hulle, T. van der, Kruip, M.J.H.A., Maignan, M., Mairuhu, A.T.A., Middeldorp, S., Moigne, E. Le, Nijkeuter, M., Pol, L. van de, Robert-Ebadi, H., Roy, P.M., Sanchez, O., Schmidt, J., Smeden, M. van, Tromeur, C., Wolde, M.T., Righini, M., Gal, G. Le, Huisman, M.V., and Klok, F.A.

Abstract

Item does not contain fulltext, BACKGROUND: Few studies evaluated the performance of noninvasive diagnostic strategies for suspected acute pulmonary embolism (PE) in pregnant women. OBJECTIVES: The aim of this study was to establish the safety and efficiency of the Wells rule with fixed and adapted D-dimer threshold, and the YEARS algorithm, combined with compression ultrasonography (CUS), in pregnant women with suspected PE in an individual patient data meta-analysis. METHODS: We performed a systematic review to identify prospective diagnostic management studies in pregnant women with suspected PE. Primary outcomes were safety, defined as the failure rate, ie, the 3-month venous thromboembolism (VTE) incidence after excluding PE without chest imaging, and efficiency, defined as the proportion of patients in whom chest imaging could be avoided. RESULTS: We identified 2 relevant studies, of which individual patient-level data were analyzed in a fixed-effect meta-analysis, totaling 893 pregnant women. The Wells rule with fixed and adapted D-dimer threshold as well as the YEARS algorithm could safely rule out acute PE (failure rate, 0·37%-1·4%), but efficiency improved considerably when applying pretest probability-adapted D-dimer thresholds. The efficiency of bilateral CUS was limited (2·3% overall; number needed to test 43), especially in patients without symptoms of deep-vein thrombosis (efficiency 0·79%; number needed to test 127). CONCLUSION: This study supports the latest guideline recommendations (European Society of Cardiology 2019) to apply pretest probability assessment and D-dimer tests to rule out PE in pregnant women. From an efficiency perspective, the use of a strategy with pretest probability-adapted D-dimer threshold is preferred. The yield of CUS was very limited in patients without concomitant symptoms of deep-vein thrombosis.

Published
2023

2. Noninvasive diagnostic work-up for suspected acute pulmonary embolism during pregnancy: a systematic review and meta-analysis of individual patient data.

Author

Stals, M.A.M., Moumneh, T., Ainle, F.N., Aujesky, D., Bemmel, T. van, Bertoletti, L., Bistervels, I.M., Chauleur, C., Couturaud, F., Dooren, Y.P.A. van, Elias, A., Faber, L.M., Gall, C., Hofstee, H.M.A., Hulle, T. van der, Kruip, M.J.H.A., Maignan, M., Mairuhu, A.T.A., Middeldorp, S., Moigne, E. Le, Nijkeuter, M., Pol, L. van de, Robert-Ebadi, H., Roy, P.M., Sanchez, O., Schmidt, J., Smeden, M. van, Tromeur, C., Wolde, M.T., Righini, M., Gal, G. Le, Huisman, M.V., Klok, F.A., Stals, M.A.M., Moumneh, T., Ainle, F.N., Aujesky, D., Bemmel, T. van, Bertoletti, L., Bistervels, I.M., Chauleur, C., Couturaud, F., Dooren, Y.P.A. van, Elias, A., Faber, L.M., Gall, C., Hofstee, H.M.A., Hulle, T. van der, Kruip, M.J.H.A., Maignan, M., Mairuhu, A.T.A., Middeldorp, S., Moigne, E. Le, Nijkeuter, M., Pol, L. van de, Robert-Ebadi, H., Roy, P.M., Sanchez, O., Schmidt, J., Smeden, M. van, Tromeur, C., Wolde, M.T., Righini, M., Gal, G. Le, Huisman, M.V., and Klok, F.A.

Abstract

Item does not contain fulltext, BACKGROUND: Few studies evaluated the performance of noninvasive diagnostic strategies for suspected acute pulmonary embolism (PE) in pregnant women. OBJECTIVES: The aim of this study was to establish the safety and efficiency of the Wells rule with fixed and adapted D-dimer threshold, and the YEARS algorithm, combined with compression ultrasonography (CUS), in pregnant women with suspected PE in an individual patient data meta-analysis. METHODS: We performed a systematic review to identify prospective diagnostic management studies in pregnant women with suspected PE. Primary outcomes were safety, defined as the failure rate, ie, the 3-month venous thromboembolism (VTE) incidence after excluding PE without chest imaging, and efficiency, defined as the proportion of patients in whom chest imaging could be avoided. RESULTS: We identified 2 relevant studies, of which individual patient-level data were analyzed in a fixed-effect meta-analysis, totaling 893 pregnant women. The Wells rule with fixed and adapted D-dimer threshold as well as the YEARS algorithm could safely rule out acute PE (failure rate, 0·37%-1·4%), but efficiency improved considerably when applying pretest probability-adapted D-dimer thresholds. The efficiency of bilateral CUS was limited (2·3% overall; number needed to test 43), especially in patients without symptoms of deep-vein thrombosis (efficiency 0·79%; number needed to test 127). CONCLUSION: This study supports the latest guideline recommendations (European Society of Cardiology 2019) to apply pretest probability assessment and D-dimer tests to rule out PE in pregnant women. From an efficiency perspective, the use of a strategy with pretest probability-adapted D-dimer threshold is preferred. The yield of CUS was very limited in patients without concomitant symptoms of deep-vein thrombosis.

Published
2023

3. Towards optimal use of antithrombotic therapy of people with cancer at the end of life:A research protocol for the development and implementation of the SERENITY shared decision support tool

Author

Goedegebuur, J., Abbel, D., Accassat, S., Achterberg, W. P., Akbari, A., Arfuch, V. M., Baddeley, E., Bax, J. J., Becker, D., Bergmeijer, B., Bertoletti, L., Blom, J. W., Calvetti, A., Cannegieter, S. C., Castro, L., Chavannes, N. H., Coma-Auli, N., Couffignal, C., Edwards, A., Edwards, M., Enggaard, H., Font, C., Gava, A., Geersing, G. J., Geijteman, E. C.T., Greenley, S., Gregory, C., Gussekloo, J., Hoffmann, I., Højen, A. A., van den Hout, W. B., Huisman, M. V., Jacobsen, S., Jagosh, J., Johnson, M. J., Jørgensen, L., Juffermans, C. C.M., Kempers, E. K., Konstantinides, S., Kroder, A. F., Kruip, M. J.H.A., Lafaie, L., Langendoen, J. W., Larsen, T. B., Lifford, K., van der Linden, Y. M., Mahé, I., Maiorana, L., Maraveyas, A., Martens, E. S.L., Mayeur, D., van Mens, T. E., Mohr, K., Mooijaart, S. P., Murtagh, F. E.M., Nelson, A., Nielsen, P. B., Ording, A. G., Ørskov, M., Pearson, M., Poenou, G., Portielje, J. E.A., Raczkiewicz, D., Rasmussen, K., Trinks-Roerdink, E., Schippers, I., Seddon, K., Sexton, K., Sivell, S., Skjøth, F., Søgaard, M., Szmit, S., Trompet, S., Vassal, P., Visser, C., van Vliet, L. M., Wilson, E., Klok, F. A., Noble, S. I.R., Goedegebuur, J., Abbel, D., Accassat, S., Achterberg, W. P., Akbari, A., Arfuch, V. M., Baddeley, E., Bax, J. J., Becker, D., Bergmeijer, B., Bertoletti, L., Blom, J. W., Calvetti, A., Cannegieter, S. C., Castro, L., Chavannes, N. H., Coma-Auli, N., Couffignal, C., Edwards, A., Edwards, M., Enggaard, H., Font, C., Gava, A., Geersing, G. J., Geijteman, E. C.T., Greenley, S., Gregory, C., Gussekloo, J., Hoffmann, I., Højen, A. A., van den Hout, W. B., Huisman, M. V., Jacobsen, S., Jagosh, J., Johnson, M. J., Jørgensen, L., Juffermans, C. C.M., Kempers, E. K., Konstantinides, S., Kroder, A. F., Kruip, M. J.H.A., Lafaie, L., Langendoen, J. W., Larsen, T. B., Lifford, K., van der Linden, Y. M., Mahé, I., Maiorana, L., Maraveyas, A., Martens, E. S.L., Mayeur, D., van Mens, T. E., Mohr, K., Mooijaart, S. P., Murtagh, F. E.M., Nelson, A., Nielsen, P. B., Ording, A. G., Ørskov, M., Pearson, M., Poenou, G., Portielje, J. E.A., Raczkiewicz, D., Rasmussen, K., Trinks-Roerdink, E., Schippers, I., Seddon, K., Sexton, K., Sivell, S., Skjøth, F., Søgaard, M., Szmit, S., Trompet, S., Vassal, P., Visser, C., van Vliet, L. M., Wilson, E., Klok, F. A., and Noble, S. I.R.

Abstract

Background: Even though antithrombotic therapy has probably little or even negative effects on the well-being of people with cancer during their last year of life, deprescribing antithrombotic therapy at the end of life is rare in practice. It is often continued until death, possibly resulting in excess bleeding, an increased disease burden and higher healthcare costs. Methods: The SERENITY consortium comprises researchers and clinicians from eight European countries with specialties in different clinical fields, epidemiology and psychology. SERENITY will use a comprehensive approach combining a realist review, flash mob research, epidemiological studies, and qualitative interviews. The results of these studies will be used in a Delphi process to reach a consensus on the optimal design of the shared decision support tool. Next, the shared decision support tool will be tested in a randomised controlled trial. A targeted implementation and dissemination plan will be developed to enable the use of the SERENITY tool across Europe, as well as its incorporation in clinical guidelines and policies. The entire project is funded by Horizon Europe. Results: SERENITY will develop an information-driven shared decision support tool that will facilitate treatment decisions regarding the appropriate use of antithrombotic therapy in people with cancer at the end of life. Conclusions: We aim to develop an intervention that guides the appropriate use of antithrombotic therapy, prevents bleeding complications, and saves healthcare costs. Hopefully, usage of the tool leads to enhanced empowerment and improved quality of life and treatment satisfaction of people with advanced cancer and their care givers.

Published
2023

4. Three-Month Outcomes in Cancer Patients with Superficial or Deep Vein Thrombosis in the Lower Limbs: Results from the RIETE Registry

Author

Universitat Rovira i Virgili, Debourdeau, P; Bertoletti, L; Font, C; López-Núñez, JJ; Gómez-Cuervo, C; Mahe, I; Otero-Candelera, R; Adarraga, MD; López-Miguel, P; Monreal, M, Universitat Rovira i Virgili, and Debourdeau, P; Bertoletti, L; Font, C; López-Núñez, JJ; Gómez-Cuervo, C; Mahe, I; Otero-Candelera, R; Adarraga, MD; López-Miguel, P; Monreal, M

Abstract

Background: The clinical characteristics and outcomes of cancer patients with lower-limb isolated superficial vein thrombosis (SVT) have not been consistently evaluated. Methods: We used data in the RIETE registry to compare the clinical characteristics and 90-day outcomes for patients with: (1) active cancer and lower-limb SVT; (2) active cancer and lower-limb deep vein thrombosis (DVT); (3) lower-limb SVT without cancer. The primary outcomes included subsequent symptomatic SVT, DVT or pulmonary embolism (PE). Secondary outcomes were major bleeding and death. Results: From March 2015 to April 2021, there were 110 patients with cancer and SVT, 1695 with cancer and DVT, and 1030 with SVT but no cancer. Most patients in all subgroups (93%, 99% and 96%, respectively) received anticoagulants, while those with SVT received lower daily doses of low-molecular-weight heparin (114 +/- 58, 163 +/- 44, and 106 +/- 50 IU/kg, respectively). During the first 90 days, 101 patients (3.6%) developed subsequent VTE (PE 47, DVT 41, SVT 13), whereas 72 (2.5%) had major bleeding and 282 (9.9%) died. Among the three groups, 90-day events were, respectively: VTE at rates of 7.3%, 4.0% and 2.4%; major bleeding at rates of 2.7%, 3.9% and 0.3%; mortality at rates of 8.2%, 16% and 0.3%. Between D90 and D180, only one SVT recurrence and one death occurred in SVT cancer patients. In multivariable analysis, cancer was associated with subsequent VTE (HR = 2.04; 1.15-3.62), while initial presentation as SVT or DVT were not associated with a different risk. Conclusions: The risk for subsequent VTE (including symptomatic SVT, DVT or PE) was similar in cancer patients with isolated SVT than in those with isolated DVT.

Published
2023

5. Pharmacological Agents Targeting Thromboinflammation in COVID-19: Review and Implications for Future Research

Author

Bikdeli, B, Madhavan, M, Gupta, A, Jimenez, D, Burton, J, Der Nigoghossian, C, Chuich, T, Nouri, S, Dreyfus, I, Driggin, E, Sethi, S, Sehgal, K, Chatterjee, S, Ageno, W, Madjid, M, Guo, Y, Tang, L, Hu, Y, Bertoletti, L, Giri, J, Cushman, M, Quéré, I, Dimakakos, E, Gibson, C, Lippi, G, Favaloro, E, Fareed, J, Tafur, A, Francese, D, Batra, J, Falanga, A, Clerkin, K, Uriel, N, Kirtane, A, Mclintock, C, Hunt, B, Spyropoulos, A, Barnes, G, Eikelboom, J, Weinberg, I, Schulman, S, Carrier, M, Piazza, G, Beckman, J, Leon, M, Stone, G, Rosenkranz, S, Goldhaber, S, Parikh, S, Monreal, M, Krumholz, H, Konstantinides, S, Weitz, J, Lip, G, Global COVID-19 Thrombosis Collaborative, G, Bikdeli B, Madhavan MV, Gupta A, Jimenez D, Burton JR, Der Nigoghossian C, Chuich T, Nouri SN, Dreyfus I, Driggin E, Sethi S, Sehgal K, Chatterjee S, Ageno W, Madjid M, Guo Y, Tang LV, Hu Y, Bertoletti L, Giri J, Cushman M, Quéré I, Dimakakos EP, Gibson CM, Lippi G, Favaloro EJ, Fareed J, Tafur AJ, Francese DP, Batra J, Falanga A, Clerkin KJ, Uriel N, Kirtane A, McLintock C, Hunt BJ, Spyropoulos AC, Barnes GD, Eikelboom JW, Weinberg I, Schulman S, Carrier M, Piazza G, Beckman JA, Leon MB, Stone GW, Rosenkranz S, Goldhaber SZ, Parikh SA, Monreal M, Krumholz HM, Konstantinides SV, Weitz JI, Lip GYH, Global COVID-19 Thrombosis Collaborative Group., Bikdeli, B, Madhavan, M, Gupta, A, Jimenez, D, Burton, J, Der Nigoghossian, C, Chuich, T, Nouri, S, Dreyfus, I, Driggin, E, Sethi, S, Sehgal, K, Chatterjee, S, Ageno, W, Madjid, M, Guo, Y, Tang, L, Hu, Y, Bertoletti, L, Giri, J, Cushman, M, Quéré, I, Dimakakos, E, Gibson, C, Lippi, G, Favaloro, E, Fareed, J, Tafur, A, Francese, D, Batra, J, Falanga, A, Clerkin, K, Uriel, N, Kirtane, A, Mclintock, C, Hunt, B, Spyropoulos, A, Barnes, G, Eikelboom, J, Weinberg, I, Schulman, S, Carrier, M, Piazza, G, Beckman, J, Leon, M, Stone, G, Rosenkranz, S, Goldhaber, S, Parikh, S, Monreal, M, Krumholz, H, Konstantinides, S, Weitz, J, Lip, G, Global COVID-19 Thrombosis Collaborative, G, Bikdeli B, Madhavan MV, Gupta A, Jimenez D, Burton JR, Der Nigoghossian C, Chuich T, Nouri SN, Dreyfus I, Driggin E, Sethi S, Sehgal K, Chatterjee S, Ageno W, Madjid M, Guo Y, Tang LV, Hu Y, Bertoletti L, Giri J, Cushman M, Quéré I, Dimakakos EP, Gibson CM, Lippi G, Favaloro EJ, Fareed J, Tafur AJ, Francese DP, Batra J, Falanga A, Clerkin KJ, Uriel N, Kirtane A, McLintock C, Hunt BJ, Spyropoulos AC, Barnes GD, Eikelboom JW, Weinberg I, Schulman S, Carrier M, Piazza G, Beckman JA, Leon MB, Stone GW, Rosenkranz S, Goldhaber SZ, Parikh SA, Monreal M, Krumholz HM, Konstantinides SV, Weitz JI, Lip GYH, and Global COVID-19 Thrombosis Collaborative Group.

Abstract

Coronavirus disease 2019 (COVID-19), currently a worldwide pandemic, is a viral illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The suspected contribution of thrombotic events to morbidity and mortality in COVID-19 patients has prompted a search for novel potential options for preventing COVID-19-associated thrombotic disease. In this article by the Global COVID-19 Thrombosis Collaborative Group, we describe novel dosing approaches for commonly used antithrombotic agents (especially heparin-based regimens) and the potential use of less widely used antithrombotic drugs in the absence of confirmed thrombosis. Although these therapies may have direct antithrombotic effects, other mechanisms of action, including anti-inflammatory or antiviral effects, have been postulated. Based on survey results from this group of authors, we suggest research priorities for specific agents and subgroups of patients with COVID-19. Further, we review other agents, including immunomodulators, that may have antithrombotic properties. It is our hope that the present document will encourage and stimulate future prospective studies and randomized trials to study the safety, efficacy, and optimal use of these agents for prevention or management of thrombosis in COVID-19.

Published
2020

6. Establishing diagnostic criteria and treatment of subsegmental pulmonary embolism: A Delphi analysis of experts

Author

Exter, P.L. den, Kroft, L.J., Gonsalves, C., Gal, G. Le, Schaefer-Prokop, C.M., Carrier, M., Huisman, M.V., Klok, F.A., Meijboom, L., Beenen, L.F., Roos, A, Hartmann, I., Dennie, C., Revel, M.P., Haramati, L., Beek, E. van, Screaton, N., Ferretti, G., Ghaye, B., Das, M., White, C., Fernandez, E. Pena, Paul, N., Vlahos, I., Renapurkar, R.D., Ravenel, J., Kanne, J., Abbara, S., Remy-Jardin, M., Geurts, B., Frauenfelder, T., Sverzellati, N., Prosch, H., Goo, J.M., Vogel-Claussen, J., MacMahon, P.J., Bhalla, S., Kahn, S., Shivakumar, S., Wells, P., Rodger, M., Castellucci, L., Duffett, L., Delluc, A., Siegal, D., Lazo-Langner, A., Wu, C., Lee, A, Garcia, D., Zwicker, J., Aujesky, D., Jimenez, D., Righini, M., Blondon, M., Ay, C., Barco, S., Kamphuisen, P.W., Ferreira, M., Sanchez, O., Moores, L.K., Tromeur, C., Ageno, W., Hunt, B., Prandoni, P., Monreal, M., Crowther, M., Roy, P.M., Pabinger, I., Donadini, M.P., Moustafa, F., Jara-Palomares, L., Pedroc, R., Bertoletti, L., Verhamme, P., Eikenboom, H., Meer, F. van der, Buller, H.R., Es, N. van, Exter, P.L. den, Kroft, L.J., Gonsalves, C., Gal, G. Le, Schaefer-Prokop, C.M., Carrier, M., Huisman, M.V., Klok, F.A., Meijboom, L., Beenen, L.F., Roos, A, Hartmann, I., Dennie, C., Revel, M.P., Haramati, L., Beek, E. van, Screaton, N., Ferretti, G., Ghaye, B., Das, M., White, C., Fernandez, E. Pena, Paul, N., Vlahos, I., Renapurkar, R.D., Ravenel, J., Kanne, J., Abbara, S., Remy-Jardin, M., Geurts, B., Frauenfelder, T., Sverzellati, N., Prosch, H., Goo, J.M., Vogel-Claussen, J., MacMahon, P.J., Bhalla, S., Kahn, S., Shivakumar, S., Wells, P., Rodger, M., Castellucci, L., Duffett, L., Delluc, A., Siegal, D., Lazo-Langner, A., Wu, C., Lee, A, Garcia, D., Zwicker, J., Aujesky, D., Jimenez, D., Righini, M., Blondon, M., Ay, C., Barco, S., Kamphuisen, P.W., Ferreira, M., Sanchez, O., Moores, L.K., Tromeur, C., Ageno, W., Hunt, B., Prandoni, P., Monreal, M., Crowther, M., Roy, P.M., Pabinger, I., Donadini, M.P., Moustafa, F., Jara-Palomares, L., Pedroc, R., Bertoletti, L., Verhamme, P., Eikenboom, H., Meer, F. van der, Buller, H.R., and Es, N. van

Abstract

Contains fulltext : 229597.pdf (publisher's version ) (Open Access), Background: Improved imaging techniques have increased the incidence of subsegmental pulmonary embolism (ssPE). Indirect evidence is suggesting that ssPE may represent a more benign presentation of venous thromboembolism not necessarily requiring anticoagulant treatment. However, correctly diagnosing ssPE is challenging with reported low interobserver agreement, partly due to the lack of widely accepted diagnostic criteria. Objectives: We sought to derive uniform diagnostic criteria for ssPE, guided by expert consensus. Methods: Based on an extensive literature review and expert opinion of a Delphi steering committee, two surveys including statements regarding diagnostic criteria and management options for ssPE were established. These surveys were conducted electronically among two panels, respectively: expert thoracic radiologists and clinical venous thromboembolism specialists. The Delphi method was used to achieve consensus after multiple survey rounds. Consensus was defined as a level of agreement >70%. Results: Twenty-nine of 40 invited radiologists (73%) and 40 of 51 clinicians (78%) participated. Following two survey rounds by the expert radiologists, consensus was achieved on 15 of 16 statements, including on the established diagnostic criteria for ssPE (96% agreement): a contrast defect in a subsegmental artery, that is, the first arterial branch division of any segmental artery independent of artery diameter, visible in at least two subsequent axial slices, using a computed tomography scanner with a desired maximum collimator width of

Published
2020

7. Establishing diagnostic criteria and treatment of subsegmental pulmonary embolism: A Delphi analysis of experts

Author

Exter, P.L. den, Kroft, L.J., Gonsalves, C., Gal, G. Le, Schaefer-Prokop, C.M., Carrier, M., Huisman, M.V., Klok, F.A., Meijboom, L., Beenen, L.F., Roos, A, Hartmann, I., Dennie, C., Revel, M.P., Haramati, L., Beek, E. van, Screaton, N., Ferretti, G., Ghaye, B., Das, M., White, C., Fernandez, E. Pena, Paul, N., Vlahos, I., Renapurkar, R.D., Ravenel, J., Kanne, J., Abbara, S., Remy-Jardin, M., Geurts, B., Frauenfelder, T., Sverzellati, N., Prosch, H., Goo, J.M., Vogel-Claussen, J., MacMahon, P.J., Bhalla, S., Kahn, S., Shivakumar, S., Wells, P., Rodger, M., Castellucci, L., Duffett, L., Delluc, A., Siegal, D., Lazo-Langner, A., Wu, C., Lee, A, Garcia, D., Zwicker, J., Aujesky, D., Jimenez, D., Righini, M., Blondon, M., Ay, C., Barco, S., Kamphuisen, P.W., Ferreira, M., Sanchez, O., Moores, L.K., Tromeur, C., Ageno, W., Hunt, B., Prandoni, P., Monreal, M., Crowther, M., Roy, P.M., Pabinger, I., Donadini, M.P., Moustafa, F., Jara-Palomares, L., Pedroc, R., Bertoletti, L., Verhamme, P., Eikenboom, H., Meer, F. van der, Buller, H.R., Es, N. van, Exter, P.L. den, Kroft, L.J., Gonsalves, C., Gal, G. Le, Schaefer-Prokop, C.M., Carrier, M., Huisman, M.V., Klok, F.A., Meijboom, L., Beenen, L.F., Roos, A, Hartmann, I., Dennie, C., Revel, M.P., Haramati, L., Beek, E. van, Screaton, N., Ferretti, G., Ghaye, B., Das, M., White, C., Fernandez, E. Pena, Paul, N., Vlahos, I., Renapurkar, R.D., Ravenel, J., Kanne, J., Abbara, S., Remy-Jardin, M., Geurts, B., Frauenfelder, T., Sverzellati, N., Prosch, H., Goo, J.M., Vogel-Claussen, J., MacMahon, P.J., Bhalla, S., Kahn, S., Shivakumar, S., Wells, P., Rodger, M., Castellucci, L., Duffett, L., Delluc, A., Siegal, D., Lazo-Langner, A., Wu, C., Lee, A, Garcia, D., Zwicker, J., Aujesky, D., Jimenez, D., Righini, M., Blondon, M., Ay, C., Barco, S., Kamphuisen, P.W., Ferreira, M., Sanchez, O., Moores, L.K., Tromeur, C., Ageno, W., Hunt, B., Prandoni, P., Monreal, M., Crowther, M., Roy, P.M., Pabinger, I., Donadini, M.P., Moustafa, F., Jara-Palomares, L., Pedroc, R., Bertoletti, L., Verhamme, P., Eikenboom, H., Meer, F. van der, Buller, H.R., and Es, N. van

Abstract

Contains fulltext : 229597.pdf (publisher's version ) (Open Access), Background: Improved imaging techniques have increased the incidence of subsegmental pulmonary embolism (ssPE). Indirect evidence is suggesting that ssPE may represent a more benign presentation of venous thromboembolism not necessarily requiring anticoagulant treatment. However, correctly diagnosing ssPE is challenging with reported low interobserver agreement, partly due to the lack of widely accepted diagnostic criteria. Objectives: We sought to derive uniform diagnostic criteria for ssPE, guided by expert consensus. Methods: Based on an extensive literature review and expert opinion of a Delphi steering committee, two surveys including statements regarding diagnostic criteria and management options for ssPE were established. These surveys were conducted electronically among two panels, respectively: expert thoracic radiologists and clinical venous thromboembolism specialists. The Delphi method was used to achieve consensus after multiple survey rounds. Consensus was defined as a level of agreement >70%. Results: Twenty-nine of 40 invited radiologists (73%) and 40 of 51 clinicians (78%) participated. Following two survey rounds by the expert radiologists, consensus was achieved on 15 of 16 statements, including on the established diagnostic criteria for ssPE (96% agreement): a contrast defect in a subsegmental artery, that is, the first arterial branch division of any segmental artery independent of artery diameter, visible in at least two subsequent axial slices, using a computed tomography scanner with a desired maximum collimator width of

Published
2020

8. Treatment of Right Heart Thrombi Associated with Acute Pulmonary Embolism

Author

Medicina i Cirurgia, Universitat Rovira i Virgili, Barrios D., Chavant J., Jiménez D., Bertoletti L., Rosa-Salazar V., Muriel A., Viallon A., Fernández-Capitán C., Yusen R.D., Monreal M., Decousus H., Prandoni P., Brenner B., Barba R., Di Micco P., Tzoran I., Reis A., Bosevski M., Bounameaux H., Malý R., Wells P., Verhamme P., Adarraga M.D., Aibar M.A., Alfonso M., Arcelus J.I., Azcarate-Agüero P.M., Ballaz A., Barrón M., Barrón-Andrés B., Bascuñana J., Blanco-Molina A., Cañada G., Cañas I., Casado I., Chic N., del Pozo R., del Toro J., Díaz-Pedroche M.C., Díaz-Peromingo J.A., Barrios D., Chavant J., Jiménez D., Bertoletti L., Rosa-Salazar V., Muriel A., Viallon A., Fernández-Capitán C., Yusen R.D., Monreal M., Decousus H., Prandoni P., Brenner B., Barba R., Di Micco P., Tzoran I., Reis A., Bosevski M., Bounameaux H., Malý R., Wells P., Verhamme P., Adarraga M.D., Aibar M.A., Alfonso M., Arcelus J.I., Azcarate-Agüero P.M., Ballaz A., Barrón M., Barrón-Andrés B., Bascuñana J., Blanco-Molina A., Cañada G., Cañas I., Casado I., Chic N., del Pozo R., del Toro J., Díaz-Pedroche M.C., Díaz-Peromingo J.A., Barrios D., Chavant J., Jiménez D., Bertoletti L., Rosa-Salazar V., Muriel A., Viallon A., Fernández-Capitán C., Yusen R.D., Monreal M., Decousus H., Prandoni P., Brenner B., Barba R., Di Micco P., Tzoran I., Reis A., Bosevski M., Bounameaux H., Malý R., Medicina i Cirurgia, Universitat Rovira i Virgili, and Barrios D., Chavant J., Jiménez D., Bertoletti L., Rosa-Salazar V., Muriel A., Viallon A., Fernández-Capitán C., Yusen R.D., Monreal M., Decousus H., Prandoni P., Brenner B., Barba R., Di Micco P., Tzoran I., Reis A., Bosevski M., Bounameaux H., Malý R., Wells P., Verhamme P., Adarraga M.D., Aibar M.A., Alfonso M., Arcelus J.I., Azcarate-Agüero P.M., Ballaz A., Barrón M., Barrón-Andrés B., Bascuñana J., Blanco-Molina A., Cañada G., Cañas I., Casado I., Chic N., del Pozo R., del Toro J., Díaz-Pedroche M.C., Díaz-Peromingo J.A., Barrios D., Chavant J., Jiménez D., Bertoletti L., Rosa-Salazar V., Muriel A., Viallon A., Fernández-Capitán C., Yusen R.D., Monreal M., Decousus H., Prandoni P., Brenner B., Barba R., Di Micco P., Tzoran I., Reis A., Bosevski M., Bounameaux H., Malý R., Wells P., Verhamme P., Adarraga M.D., Aibar M.A., Alfonso M., Arcelus J.I., Azcarate-Agüero P.M., Ballaz A., Barrón M., Barrón-Andrés B., Bascuñana J., Blanco-Molina A., Cañada G., Cañas I., Casado I., Chic N., del Pozo R., del Toro J., Díaz-Pedroche M.C., Díaz-Peromingo J.A., Barrios D., Chavant J., Jiménez D., Bertoletti L., Rosa-Salazar V., Muriel A., Viallon A., Fernández-Capitán C., Yusen R.D., Monreal M., Decousus H., Prandoni P., Brenner B., Barba R., Di Micco P., Tzoran I., Reis A., Bosevski M., Bounameaux H., Malý R.

Abstract

Background Evidence-based recommendations do not adequately address the treatment of right heart thrombi in patients who present with acute symptomatic pulmonary embolism. Methods This study included patients who had acute pulmonary embolism associated with right heart thrombi and participated in the Registro Informatizado de la Enfermedad TromboEmbólica registry. We assessed the effectiveness of anticoagulation versus reperfusion treatment for the outcomes of all-cause mortality, pulmonary embolism-related mortality, recurrent venous thromboembolism, and major bleeding rates through 30 days after initiation of pulmonary embolism treatment. We used propensity score matching to adjust for the likelihood of receiving reperfusion treatment. Results Of 325 patients with pulmonary embolism and right heart thrombi, 255 (78%; 95% confidence interval, 74-83) received anticoagulation and 70 (22%; 95% confidence interval, 17-26) also received reperfusion treatment. Propensity score-matched pairs analyses did not detect a statistically lower risk of all-cause death (6.2% vs 14%, P = .15) or pulmonary embolism-related mortality (4.7% vs 7.8%; P = .47) for reperfusion compared with anticoagulation. Of the patients who received reperfusion treatment, 6.2% had a recurrence during the study follow-up period, compared with 0% of those who received anticoagulation (P = .049). The incidence of major bleeding events was not statistically different between the 2 treatment groups (3.1% vs 3.1%; P = 1.00). Conclusions In patients with pulmonary embolism and right heart thrombi, no significant difference was found between reperfusion therapy and anticoagulant therapy for mortality and bleeding. The risk of recurrences was significantly higher for reperfusion therapy compared with anticoagulati

Published
2017

9. Outcome of Patients with Venous Thromboembolism and Factor V Leiden or Prothrombin 20210 Carrier Mutations During the Course of Anticoagulation

Author

Medicina i Cirurgia, Universitat Rovira i Virgili, Tzoran I., Papadakis M., Brenner B., Fidalgo Á., Rivas A., Wells P.S., Gavín O., Adarraga M.D., Moustafa F., Monreal M., Decousus H., Prandoni P., Barba R., Di Micco P., Bertoletti L., Reis A., Bosevski M., Bounameaux H., Malý R., Wells P., Aibar M.A., Alfonso M., Arcelus J.I., Barrón M., Barrón-Andrés B., Bascuñana J., Blanco-Molina A., Bueso T., Cañada G., Cañas I., Chic N., del Pozo R., del Toro J., Díaz-Pedroche M.C., Díaz-Peromingo J.A., Falgá C., Fernández-Capitán C., Fidalgo M.A., Font C., Font L., Tzoran I., Papadakis M., Brenner B., Fidalgo Á., Rivas A., Wells P.S., Gavín O., Adarraga M.D., Moustafa F., Monreal M., Decousus H., Prandoni P., Barba R., Di Micco P., Bertoletti L., Reis A., Bosevski M., Bounameaux H., Malý R., Wells P., Aibar M.A., Alfonso M., Arcelus J.I., Barrón M., Barrón-Andrés B., Bascuñana J., Blanco-Molina A., Bueso T., Cañada G., Cañas I., Chic N., del Pozo R., del Toro J., Díaz-Pedroche M.C., Díaz-Peromingo J.A., Falgá C., Fernández-Capitán C., Fidalgo M.A., Font C., Font L., Tzoran I., Papadakis M., Brenner B., Fidalgo Á., Rivas A., Wells P.S., Gavín O., Adarraga M.D., Moustafa F., Monreal M., Decousus H., Prandoni P., Barba R., Di Micco P., Bertoletti L., Reis A., Bosevski M., Bounameaux H., Malý R., Wells P., Medicina i Cirurgia, Universitat Rovira i Virgili, and Tzoran I., Papadakis M., Brenner B., Fidalgo Á., Rivas A., Wells P.S., Gavín O., Adarraga M.D., Moustafa F., Monreal M., Decousus H., Prandoni P., Barba R., Di Micco P., Bertoletti L., Reis A., Bosevski M., Bounameaux H., Malý R., Wells P., Aibar M.A., Alfonso M., Arcelus J.I., Barrón M., Barrón-Andrés B., Bascuñana J., Blanco-Molina A., Bueso T., Cañada G., Cañas I., Chic N., del Pozo R., del Toro J., Díaz-Pedroche M.C., Díaz-Peromingo J.A., Falgá C., Fernández-Capitán C., Fidalgo M.A., Font C., Font L., Tzoran I., Papadakis M., Brenner B., Fidalgo Á., Rivas A., Wells P.S., Gavín O., Adarraga M.D., Moustafa F., Monreal M., Decousus H., Prandoni P., Barba R., Di Micco P., Bertoletti L., Reis A., Bosevski M., Bounameaux H., Malý R., Wells P., Aibar M.A., Alfonso M., Arcelus J.I., Barrón M., Barrón-Andrés B., Bascuñana J., Blanco-Molina A., Bueso T., Cañada G., Cañas I., Chic N., del Pozo R., del Toro J., Díaz-Pedroche M.C., Díaz-Peromingo J.A., Falgá C., Fernández-Capitán C., Fidalgo M.A., Font C., Font L., Tzoran I., Papadakis M., Brenner B., Fidalgo Á., Rivas A., Wells P.S., Gavín O., Adarraga M.D., Moustafa F., Monreal M., Decousus H., Prandoni P., Barba R., Di Micco P., Bertoletti L., Reis A., Bosevski M., Bounameaux H., Malý R., Wells P.

Abstract

Background Individuals with factor V Leiden or prothrombin G20210A mutations are at a higher risk to develop venous thromboembolism. However, the influence of these polymorphisms on patient outcome during anticoagulant therapy has not been consistently explored. Methods We used the Registro Informatizado de Enfermedad TromboEmbólica database to compare rates of venous thromboembolism recurrence and bleeding events occurring during the anticoagulation course in factor V Leiden carriers, prothrombin mutation carriers, and noncarriers. Results Between March 2001 and December 2015, 10,139 patients underwent thrombophilia testing. Of these, 1384 were factor V Leiden carriers, 1115 were prothrombin mutation carriers, and 7640 were noncarriers. During the anticoagulation course, 160 patients developed recurrent deep vein thrombosis and 94 patients developed pulmonary embolism (16 died); 154 patients had major bleeding (10 died), and 291 patients had nonmajor bleeding. On multivariable analysis, factor V Leiden carriers had a similar rate of venous thromboembolism recurrence (adjusted hazard ratio [HR], 1.16; 95% confidence interval [CI], 0.82-1.64), half the rate of major bleeding (adjusted HR, 0.50; 95% CI, 0.25-0.99) and a nonsignificantly lower rate of nonmajor bleeding (adjusted HR, 0.66; 95% CI, 0.43-1.01) than noncarriers. Prothrombin mutation carriers and noncarriers had a comparable rate of venous thromboembolism recurrence (adjusted HR, 1.00; 95% CI, 0.68-1.48), major bleeding (adjusted HR, 0.75; 95% CI, 0.42-1.34), and nonmajor bleeding events (adjusted HR, 1.10; 95% CI, 0.77-1.57). Conclusions During the anticoagulation course, factor V Leiden carriers had a similar risk for venous thromboembolism recurrence and half the risk for major bleeding compared with noncarr

Published
2017

10. Treatment of Right Heart Thrombi Associated with Acute Pulmonary Embolism

Author

Universitat Rovira i Virgili, Barrios D., Chavant J., Jiménez D., Bertoletti L., Rosa-Salazar V., Muriel A., Viallon A., Fernández-Capitán C., Yusen R.D., Monreal M., Decousus H., Prandoni P., Brenner B., Barba R., Di Micco P., Tzoran I., Reis A., Bosevski M., Bounameaux H., Malý R., Wells P., Verhamme P., Adarraga M.D., Aibar M.A., Alfonso M., Arcelus J.I., Azcarate-Agüero P.M., Ballaz A., Barrón M., Barrón-Andrés B., Bascuñana J., Blanco-Molina A., Cañada G., Cañas I., Casado I., Chic N., del Pozo R., del Toro J., Díaz-Pedroche M.C., Díaz-Peromingo J.A., Barrios D., Chavant J., Jiménez D., Bertoletti L., Rosa-Salazar V., Muriel A., Viallon A., Fernández-Capitán C., Yusen R.D., Monreal M., Decousus H., Prandoni P., Brenner B., Barba R., Di Micco P., Tzoran I., Reis A., Bosevski M., Bounameaux H., Malý R., Wells P., Verhamme P., Adarraga M.D., Aibar M.A., Alfonso M., Arcelus J.I., Azcarate-Agüero P.M., Ballaz A., Barrón M., Barrón-Andrés B., Bascuñana J., Blanco-Molina A., Cañada G., Cañas I., Casado I., Chic N., del Pozo R., del Toro J., Díaz-Pedroche M.C., Díaz-Peromingo J.A., Barrios D., Chavant J., Jiménez D., Bertoletti L., Rosa-Salazar V., Muriel A., Viallon A., Fernández-Capitán C., Yusen R.D., Monreal M., Decousus H., Prandoni P., Brenner B., Barba R., Di Micco P., Tzoran I., Reis A., Bosevski M., Bounameaux H., Malý R., Universitat Rovira i Virgili, and Barrios D., Chavant J., Jiménez D., Bertoletti L., Rosa-Salazar V., Muriel A., Viallon A., Fernández-Capitán C., Yusen R.D., Monreal M., Decousus H., Prandoni P., Brenner B., Barba R., Di Micco P., Tzoran I., Reis A., Bosevski M., Bounameaux H., Malý R., Wells P., Verhamme P., Adarraga M.D., Aibar M.A., Alfonso M., Arcelus J.I., Azcarate-Agüero P.M., Ballaz A., Barrón M., Barrón-Andrés B., Bascuñana J., Blanco-Molina A., Cañada G., Cañas I., Casado I., Chic N., del Pozo R., del Toro J., Díaz-Pedroche M.C., Díaz-Peromingo J.A., Barrios D., Chavant J., Jiménez D., Bertoletti L., Rosa-Salazar V., Muriel A., Viallon A., Fernández-Capitán C., Yusen R.D., Monreal M., Decousus H., Prandoni P., Brenner B., Barba R., Di Micco P., Tzoran I., Reis A., Bosevski M., Bounameaux H., Malý R., Wells P., Verhamme P., Adarraga M.D., Aibar M.A., Alfonso M., Arcelus J.I., Azcarate-Agüero P.M., Ballaz A., Barrón M., Barrón-Andrés B., Bascuñana J., Blanco-Molina A., Cañada G., Cañas I., Casado I., Chic N., del Pozo R., del Toro J., Díaz-Pedroche M.C., Díaz-Peromingo J.A., Barrios D., Chavant J., Jiménez D., Bertoletti L., Rosa-Salazar V., Muriel A., Viallon A., Fernández-Capitán C., Yusen R.D., Monreal M., Decousus H., Prandoni P., Brenner B., Barba R., Di Micco P., Tzoran I., Reis A., Bosevski M., Bounameaux H., Malý R.

Abstract

Background Evidence-based recommendations do not adequately address the treatment of right heart thrombi in patients who present with acute symptomatic pulmonary embolism. Methods This study included patients who had acute pulmonary embolism associated with right heart thrombi and participated in the Registro Informatizado de la Enfermedad TromboEmbólica registry. We assessed the effectiveness of anticoagulation versus reperfusion treatment for the outcomes of all-cause mortality, pulmonary embolism-related mortality, recurrent venous thromboembolism, and major bleeding rates through 30 days after initiation of pulmonary embolism treatment. We used propensity score matching to adjust for the likelihood of receiving reperfusion treatment. Results Of 325 patients with pulmonary embolism and right heart thrombi, 255 (78%; 95% confidence interval, 74-83) received anticoagulation and 70 (22%; 95% confidence interval, 17-26) also received reperfusion treatment. Propensity score-matched pairs analyses did not detect a statistically lower risk of all-cause death (6.2% vs 14%, P = .15) or pulmonary embolism-related mortality (4.7% vs 7.8%; P = .47) for reperfusion compared with anticoagulation. Of the patients who received reperfusion treatment, 6.2% had a recurrence during the study follow-up period, compared with 0% of those who received anticoagulation (P = .049). The incidence of major bleeding events was not statistically different between the 2 treatment groups (3.1% vs 3.1%; P = 1.00). Conclusions In patients with pulmonary embolism and right heart thrombi, no significant difference was found between reperfusion therapy and anticoagulant therapy for mortality and bleeding. The risk of recurrences was significantly higher for reperfusion therapy compared with anticoagulati

Published
2017

11. Development of a Risk Prediction Score for Occult Cancer in Patients With VTE

Author

Universitat Rovira i Virgili, Jara-Palomares L., Otero R., Jimenez D., Carrier M., Tzoran I., Brenner B., Margeli M., Praena-Fernandez J.M., Grandone E., Monreal M., Decousus H., Prandoni P., Barba R., Di Micco P., Bertoletti L., Reis A., Bosevski M., Bounameaux H., Malý R., Wells P., Papadakis M., Aibar M.A., Alfonso M., Asensio-Cruz M.I., Auguet T., Arcelus J.I., Barrón M., Barrón-Andrés B., Bascuñana J., Blanco-Molina A., Bueso T., Cañas I., Ceausu A., Chic N., Culla A., del Pozo R., del Toro J., Díaz-Pedroche M.C., Díaz-Peromingo J.A., Duffort M., Jara-Palomares L., Otero R., Jimenez D., Carrier M., Tzoran I., Brenner B., Margeli M., Praena-Fernandez J.M., Grandone E., Monreal M., Decousus H., Prandoni P., Barba R., Di Micco P., Bertoletti L., Reis A., Bosevski M., Bounameaux H., Malý R., Wells P., Papadakis M., Aibar M.A., Alfonso M., Asensio-Cruz M.I., Auguet T., Arcelus J.I., Barrón M., Barrón-Andrés B., Bascuñana J., Blanco-Molina A., Bueso T., Cañas I., Ceausu A., Chic N., Culla A., del Pozo R., del Toro J., Díaz-Pedroche M.C., Díaz-Peromingo J.A., Duffort M., Jara-Palomares L., Otero R., Jimenez D., Carrier M., Tzoran I., Brenner B., Margeli M., Praena-Fernandez J.M., Grandone E., Monreal M., Decousus H., Prandoni P., Barba R., Di Micco P., Bertoletti L., Reis A., Bosevski M., Bounameaux H., Malý R., Universitat Rovira i Virgili, and Jara-Palomares L., Otero R., Jimenez D., Carrier M., Tzoran I., Brenner B., Margeli M., Praena-Fernandez J.M., Grandone E., Monreal M., Decousus H., Prandoni P., Barba R., Di Micco P., Bertoletti L., Reis A., Bosevski M., Bounameaux H., Malý R., Wells P., Papadakis M., Aibar M.A., Alfonso M., Asensio-Cruz M.I., Auguet T., Arcelus J.I., Barrón M., Barrón-Andrés B., Bascuñana J., Blanco-Molina A., Bueso T., Cañas I., Ceausu A., Chic N., Culla A., del Pozo R., del Toro J., Díaz-Pedroche M.C., Díaz-Peromingo J.A., Duffort M., Jara-Palomares L., Otero R., Jimenez D., Carrier M., Tzoran I., Brenner B., Margeli M., Praena-Fernandez J.M., Grandone E., Monreal M., Decousus H., Prandoni P., Barba R., Di Micco P., Bertoletti L., Reis A., Bosevski M., Bounameaux H., Malý R., Wells P., Papadakis M., Aibar M.A., Alfonso M., Asensio-Cruz M.I., Auguet T., Arcelus J.I., Barrón M., Barrón-Andrés B., Bascuñana J., Blanco-Molina A., Bueso T., Cañas I., Ceausu A., Chic N., Culla A., del Pozo R., del Toro J., Díaz-Pedroche M.C., Díaz-Peromingo J.A., Duffort M., Jara-Palomares L., Otero R., Jimenez D., Carrier M., Tzoran I., Brenner B., Margeli M., Praena-Fernandez J.M., Grandone E., Monreal M., Decousus H., Prandoni P., Barba R., Di Micco P., Bertoletti L., Reis A., Bosevski M., Bounameaux H., Malý R.

Abstract

The benefits of a diagnostic workup for occult cancer in patients with VTE are controversial. Our aim was to provide and validate a risk score for occult cancer in patients with VTE.We designed a nested case-control study in a cohort of patients with VTE included in the RIETE (Registro Informatizado Enfermedad TromboEmbólica) registry from 2001 to 2014. Cases included cancer detected beyond the first 30 days and up to 24 months after VTE. Control subjects were defined as patients with VTE with no cancer in the same period.Of 5,863 eligible patients, 444 (7.6%; 95% CI, 6.8%-8.2%) were diagnosed with occult cancer. On multivariable analysis, variables selected were male sex, age > 70 years, chronic lung disease, anemia, elevated platelet count, prior VTE, and recent surgery. We built a risk score assigning points to each variable. Internal validity was confirmed using bootstrap analysis. The proportion of patients with cancer who scored ? 2 points was 5.8% (241 of 4,150) and that proportion in those who scored ? 3 points was 12% (203 of 1,713). We also identified scores divided by sex and age subgroups.This is the first risk score that has identified patients with VTE who are at increased risk for occult cancer. Our score needs to be externally validated.Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Published
2017

12. Long-Term Anticoagulant Therapy of Patients with Venous Thromboembolism. What Are the Practices?

Author

Universitat Rovira i Virgili, Mahé I, Sterpu R, Bertoletti L, López-Jiménez L, Mellado Joan M, Trujillo-Santos J, Ballaz A, Hernández Blasco LM, Marchena PJ, Monreal M, RIETE Investigators., Universitat Rovira i Virgili, and Mahé I, Sterpu R, Bertoletti L, López-Jiménez L, Mellado Joan M, Trujillo-Santos J, Ballaz A, Hernández Blasco LM, Marchena PJ, Monreal M, RIETE Investigators.

Abstract

Current guidelines of antithrombotic therapy suggest early initiation of vitamin K antagonists (VKA) in non-cancer patients with venous thromboembolism (VTE), and long-term therapy with low-molecular weight heparin (LMWH) for those with cancer. We used data from RIETE (international registry of patients with VTE) to report the use of long-term anticoagulant therapy over time and to identify predictors of anticoagulant choice (regarding international guidelines) in patients with- and without cancer. Among 35,280 patients without cancer, 82% received long-term VKA (but 17% started after the first week). Among 4,378 patients with cancer, 66% received long term LMWH as monotherapy. In patients without cancer, recent bleeding (odds ratio [OR] 2.70, 95% CI 2.26-3.23), age >70 years (OR 1.15, 95% CI 1.06-1.24), immobility (OR 2.06, 95% CI 1.93-2.19), renal insufficiency (OR 2.42, 95% CI 2.15-2.71) and anemia (OR 1.75, 95% CI 1.65-1.87) predicted poor adherence to guidelines. In those with cancer, anemia (OR 1.83, 95% CI 1.64-2.06), immobility (OR 1.51, 95% CI 1.30-1.76) and metastases (OR 3.22, 95% CI 2.87-3.61) predicted long-term LMWH therapy. In conclusion, we report practices of VTE therapy in real life and found that a significant proportion of patients did not receive the recommended treatment. The perceived increased risk for bleeding has an impact on anticoagulant treatment decision.

Published
2015

13. Pulmonary embolism and 3-month outcomes in 4036 patients with venous thromboembolism and chronic obstructive pulmonary disease: data from the RIETE registry

Author

Universitat Rovira i Virgili, Bertoletti L, Quenet S, Laporte S, Sahuquillo JC, Conget F, Pedrajas JM, Martin M, Casado I, Riera-Mestre A, Monreal M, RIETE Investigators, Universitat Rovira i Virgili, and Bertoletti L, Quenet S, Laporte S, Sahuquillo JC, Conget F, Pedrajas JM, Martin M, Casado I, Riera-Mestre A, Monreal M, RIETE Investigators

Abstract

Patients with chronic obstructive pulmonary disease (COPD) have a modified clinical presentation of venous thromboembolism (VTE) but also a worse prognosis than non-COPD patients with VTE. As it may induce therapeutic modifications, we evaluated the influence of the initial VTE presentation on the 3-month outcomes in COPD patients.COPD patients included in the on-going world-wide RIETE Registry were studied. The rate of pulmonary embolism (PE), major bleeding and death during the first 3 months in COPD patients were compared according to their initial clinical presentation (acute PE or deep vein thrombosis (DVT)).Of the 4036 COPD patients included, 2452 (61%; 95% CI: 59.2-62.3) initially presented with PE. PE as the first VTE recurrence occurred in 116 patients, major bleeding in 101 patients and mortality in 443 patients (Fatal PE: first cause of death). Multivariate analysis confirmed that presenting with PE was associated with higher risk of VTE recurrence as PE (OR, 2.04; 95% CI: 1.11-3.72) and higher risk of fatal PE (OR, 7.77; 95% CI: 2.92-15.7).COPD patients presenting with PE have an increased risk for PE recurrences and fatal PE compared with those presenting with DVT alone. More efficient therapy is needed in this subtype of patients.

Published
2013

14. Prognostic value of the Geneva prediction rule in patients in whom pulmonary embolism is ruled out.

Author

UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (SLuc) Service des urgences, Bertoletti, L, Le Gal, G, Aujesky, D, Roy, P-M, Sanchez, O, Verschuren, F, Bounameaux, H, Perrier, A, Righini, M, UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (SLuc) Service des urgences, Bertoletti, L, Le Gal, G, Aujesky, D, Roy, P-M, Sanchez, O, Verschuren, F, Bounameaux, H, Perrier, A, and Righini, M

Abstract

The prognosis of patients in whom pulmonary embolism (PE) is suspected but ruled out is poorly understood. We evaluated whether the initial assessment of clinical probability of PE could help to predict the prognosis for these patients.

Published
2011

15. Diagnostic accuracy of bedside ultrasonography in the ICU: feasibility of detecting pulmonary effusion and lung contusion in patients on respiratory support after severe blunt thoracic trauma

Author

Rocco, M, Carbone, I, Morelli, A, Bertoletti, L, Rossi, S, Vitale, M, Montini, Luca, Passariello, R, Pietropaoli, P., Montini, Luca (ORCID:0000-0003-4602-5134), Rocco, M, Carbone, I, Morelli, A, Bertoletti, L, Rossi, S, Vitale, M, Montini, Luca, Passariello, R, Pietropaoli, P., and Montini, Luca (ORCID:0000-0003-4602-5134)

Abstract

BACKGROUND: Blunt thoracic trauma is a major concern in critically ill patients. Repeated lung diagnostic evaluations are needed in order to follow up the clinical situation and the results of the therapeutic strategies. The aim of this prospective clinical study was to evaluate the possible role of lung ultrasound (LU) compared with bedside radiography (CXR) and computed tomography (CT) used as the gold standard in the evaluation of trauma patients admitted to the intensive care unit with acute respiratory failure. METHOD: A total of 15 thoracic trauma patients were studied at intensive care unit (ICU) arrival (T1) and 48 h later (T2) with CT, CXR and LU. We evaluated the presence of pleural effusion (PE) and lung contusion (LC). For this purpose the lung parenchyma was divided into 12 regions so that we could compare 180 lung regions at T1 and T2, respectively. RESULTS: Sensitivity of ultrasound was 0.94 for PE and 0.86 for LC while specificity 0.99 and 0.97, respectively. The likelihood ratio was 94 (rho(+)) and 0.06 (rho(-)) for PE and 28.6 (rho(+)) and 0.14 (rho(-)) for LC. CONCLUSIONS: Ultrasound provides a reliable noninvasive, bedside method for the assessment of chest trauma patients with acute respiratory failure in the ICU.

Published
2008

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