25 results on '"Beckers, E."'
Search Results
2. MRI-assessed locus coeruleus integrity linked to responsiveness to vagus nerve stimulation in patients with drug-resistant epilepsy
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Berger, A., Danthine, V., Vespa, S., Dumoulin, M., Stumpp, L., Beckers, E., Duchene, G., Dricot, L., Vandewalle, G., El Tahry, R., QE Operations research, RS: GSBE other - not theme-related research, RS: FSE DACS Mathematics Centre Maastricht, RS: CAPHRI - R3 - Functioning, Participating and Rehabilitation, and Interne Geneeskunde
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- 2022
3. Somatic mutations in hematological tumors can interfere with accurate HLA and chimerism diagnostics
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Olieslagers, T., van Gorkom, G., Beckers, E., Wieten, L., Voorter, C., RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Transplant. Immunology/Tissue Typing lab, Interne Geneeskunde, MUMC+: MA Hematologie (9), RS: CAPHRI - R3 - Functioning, Participating and Rehabilitation, and MUMC+: DA TI Staf (9)
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- 2022
4. Prevalence, burden and treatment effects of vaginal bleeding in women with (suspected) congenital platelet disorders throughout life: a cross-sectional study
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Punt, Marieke C., Ruigrok, Nienke D., Bloemenkamp, Kitty W.M., Uitslager, Nanda, Urbanus, Rolf T., Groot, Evelyn, Kremer Hovinga, Idske C.L., Schutgens, R. E.G., van Galen, K. P.M., Kruip, M. J.H.A., Beckers, E. A.M., Coppens, M., Eikenboom, J., Tamminga, R. Y.J., Hematology, and Pediatrics
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Adult ,medicine.medical_specialty ,Platelet disorder ,Miscarriage ,Menstruation ,Quality of life ,Cost of Illness ,Surveys and Questionnaires ,medicine ,Prevalence ,Humans ,Vaginal bleeding ,Public Health Surveillance ,Age of Onset ,Menorrhagia ,Netherlands ,Pregnancy ,business.industry ,Obstetrics ,Disease Management ,Hematology ,Middle Aged ,medicine.disease ,Cross-Sectional Studies ,Treatment Outcome ,Cohort ,Menarche ,Quality of Life ,Female ,Blood Platelet Disorders ,Disease Susceptibility ,Uterine Hemorrhage ,medicine.symptom ,business - Abstract
Congenital platelet disorders (CPDs) are rare bleeding disorders that are associated with mucocutaneous bleeds. However, data on vaginal bleeding in women with CPDs are scarce. A set of generic and bleeding-specific questionnaires were used to evaluate the prevalence of vaginal bleeding, its impact on quality of life (QoL) and sexual functioning and the consequences for pregnancy, miscarriage and delivery in a cohort of women who were referred for diagnostic evaluation for CPDs. A total of 78 women included in the study were either diagnosed with a CPD (n = 35) or were clinically suspected of a CPD (n = 43). Heavy menstrual bleeding (HMB) was reported by a large proportion of women, which mainly started at menarche. In all, 76% of women received any kind of HMB treatment, often leading to surgical prodecures. HMB was shown to have a high impact on QoL, which improved upon treatment. Even though women reported that vaginal bleeding affects sexuality, this topic is not frequently discussed with physicians. Heavy blood loss frequently occurred after miscarriage/delivery, often requiring treatment. Women with (suspected) CPDs frequently encounter HMB, negatively impacting daily life and sexual functioning. Together with peripartum bleeding, these data highlight the burden of vaginal bleeding in CPDs and importance of adequate treatment.
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- 2022
5. Desmopressin in moderate hemophilia A patients: a treatment worth considering
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Loomans, J.I., Kruip, M.J.H.A., Carcao, M., Jackson, S., Velzen, A.S. van, Peters, M., Santagostino, E., Platokouki, H., Beckers, E., Voorberg, J., Bom, J.G. van der, Fijnvandraat, K., RISE Consortium, Graduate School, ARD - Amsterdam Reproduction and Development, ACS - Amsterdam Cardiovascular Sciences, General Paediatrics, Paediatric Infectious Diseases / Rheumatology / Immunology, Other departments, ACS - Microcirculation, ACS - Pulmonary hypertension & thrombosis, Hematology, MUMC+: MA Hematologie (9), and RS: CARIM - R1.01 - Blood proteins & engineering
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Adult ,medicine.medical_specialty ,Adolescent ,VONWILLEBRANDS-DISEASE ,medicine.medical_treatment ,VON-WILLEBRANDS DISEASE ,030204 cardiovascular system & hematology ,Hemophilia A ,Gastroenterology ,Young Adult ,03 medical and health sciences ,BLEEDING DISORDERS ,0302 clinical medicine ,Predictive Value of Tests ,hemic and lymphatic diseases ,Internal medicine ,von Willebrand Factor ,medicine ,Humans ,Deamino Arginine Vasopressin ,Young adult ,Child ,Desmopressin ,INTRANASAL SPRAY ,DDAVP ,Factor VIII ,FACTOR-VIII ,TRANSPLANTATION ,business.industry ,Moderate hemophilia A ,Hematology ,Middle Aged ,MILD ,Prognosis ,ENDOTHELIAL-CELLS ,Transplantation ,Treatment Outcome ,Editorial ,Nasal spray ,Predictive value of tests ,Mutation ,Factor VIII level ,business ,NASAL SPRAY ,hormones, hormone substitutes, and hormone antagonists ,030215 immunology ,medicine.drug ,Cohort study - Abstract
Desmopressin increases endogenous factor VIII levels in hemophilia A. Large inter-individual variation in the response to desmopressin is observed. Patients with a lower baseline factor VIII activity tend to show a reduced response, therefore, desmopressin is less frequently used in moderate hemophilia A patients (baseline factor VIII activity 1-5 international units/deciliter), even though factor VIII levels may rise substantially in some of them. We aim to describe the response to desmopressin in moderate hemophilia A patients and to identify predictors. We selected data on 169 patients with moderate hemophilia from the multicenter Response to DDAVP In non-severe hemophilia A patients: in Search for dEterminants (RISE) cohort study. Adequate response to desmopressin was defined as a peak factor VIII level ≥ 30, and excellent response as ≥ 50 international units/deciliter after desmopressin administration. We used univariate and multiple linear regression techniques to analyze predictors of the peak factor VIII level. Response was considered adequate in 68 patients (40%), of whom 25 showed excellent response (15%). Intravenous administration, age, pre-desmopressin factor VIII activity and von Willebrand factor antigen, peak von Willebrand factor activity and desmopressin-induced rise in von Willebrand factor antigen were significant predictors of peak factor VIII level and explained 65% of the inter-individual variation. In 40% of moderate hemophilia A patients, desmopressin response was adequate, thus it is important not to with-hold this group of patients from desmopressin responsiveness. Among the six predictors that we identified for desmopressin-induced factor VIII rise, factor VIII activity and desmopressin-induced rise in von Willebrand factor antigen had the strongest effect.
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- 2018
6. Dosis-Harmonisierung für die Leber-SBRT
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Moustakis, Christos, Wilke, L, Chan, Mark, Schmitt, Daniela, Andratschke, Nicolaus, Boda-Heggemann, Judith, Tanadini-Lang, Stephanie, Albers, D, Alraun, M, Bäumer, Christian, Beckers, E, Brunner, Thomas, Dierl, M, Droege, S, Duma, M-N, Ebrahimi Tazeh Maha, F, Eich, H.T.T., Fleckenstein, J, Ganswindt, U, Gauer, Tobias, Gikka, E, Hafner, M., Haverkamp, U, Heinz, C, Henkenberens, C, Köhn, J, Krieger, T, Hennig, A, Kornhuber, C, Loufti-Kraus, Britta, Mayr, M, Pfeiler, Tina, Pollul, G, Ramm, U, Roeder, F, Salz, H, Schmidhalter, D, Schöffler, J, Schubert, K., Ulm, C, Walke, M, Weigel, R, Wiehle, R, Wiezorek, T, Wolf, U, Zimmer, J, Baus, Wolfgang, Guckenberger, Matthias, and Blanck, Oliver
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- 2019
7. Referenz Planvergleichsstudie für Leber-SBRT – Ergebnisse DEGRO AG/DGMP AK Stereotaxie
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Moustakis, Christos, Blanck, Oliver, Andratschke, Nicolaus, Boda-Heggemann, Judith, Wilke, J, Tanadini-Lang, Stephanie, Albers, D, Alraun, M, Bäumer, Christian, Beckers, E, Blaschek, M, Brunner, Thomas, Chan, Mark, Dierl, M, Droege, S, Duma, M-N, Ebrahimi Tazeh Maha, F, Eich, H.T.T., Fleckenstein, J, Ganswindt, U, Garbe, S, Gikka, E, Heinz, C, Henkenberens, C, Hennig, A, Köhn, J, Kornhuber, C, Kretschmer, M, Krieger, T, Loufti-Kraus, Britta, Mayr, M, Mensing, T, Pfeiler, Tina, Pollul, G, Reiken, S, Roeder, F, Schmidthalter, D, Schmitt, Daniela, Schöffler, J, Ulm, C, Baus, Wolfgang, and Guckenberger, Matthias
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- 2018
8. Disseminated mucormycosis: (almost) fatal!
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van Lieshout, M., Janssen, A. H. J. W., Linssen, C. F. M., Beckers, E. A. M., van Mook, W. N. K. A., Bergmans, D. C. J. J., MUMC+: MA Hematologie (9), RS: CARIM - R1.01 - Blood proteins & engineering, MUMC+: MA Medische Staf IC (9), Intensive Care, and MUMC+: MA Arts Assistenten IC (9)
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IDENTIFICATION ,ZYGOMYCOSIS ,INFECTIONS ,ANTIFUNGAL THERAPY ,MANAGEMENT ,neutropenia ,ASPERGILLUS ,EPIDEMIOLOGY ,acute myeloid leukaemia ,HEMATOLOGICAL MALIGNANCIES ,DIAGNOSIS ,GUIDELINES ,disseminated mucormycosis - Abstract
Mucormycosis is an invasive mould infection, which is associated with haematological malignancies and is often fatal. The keys for successful treatment are focus on early diagnosis, surgical debridement when possible and appropriate administration of appropriate antifungal agents. We report a case of disseminated mucormycosis in a patient with acute myeloid leukaemia diagnosed and identified by polymerase chain reaction analysis. After surgical debulking, the patient was successfully treated with antifungal therapy.
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- 2017
9. Revue bibliographique : la prise en compte des transferts horizontaux dans les modèles hydrologiques
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Beckers, E. and Degré, A.
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lcsh:GE1-350 ,subsurface flow ,horizontal hydraulic conductivity ,lcsh:Biotechnology ,lcsh:TP248.13-248.65 ,hydrological model ,Darcy coefficient ,Interflow ,lcsh:Environmental sciences - Abstract
Modelling of interflows in soils: a review. This review sums up the different schemes in hydrological modelling. Moreover, it underlines how the interflows are taken into account and draws the first lines to improve their physically based representation. In the mood of the change in agricultural practices, especially concerning the conventional tillage reduction in support of conservational tillage, it seems to be necessary to propose a better description of decisive parameters like horizontal hydraulic conductivity. More precisely, the dependence of this parameter with the water retention curve has to be described in order to represent fluxes at the plot scale and at the watershed scale. Under these circumstances, an approach with in situ measurements and physically based modelling is suggested.
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- 2011
10. L'hydrologie, une partenaire de la géomorphopédologie pour une gestion transéchelle des grands enjeux environnementaux
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Colard, F., Sohier, C., Degré, A., Rauw, J., Bauwens, A., Kummert, N., and Beckers, E.
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soil sciences ,lcsh:GE1-350 ,Belgium ,nitrate ,lcsh:Biotechnology ,lcsh:TP248.13-248.65 ,géomorphology ,simulation models ,Hydrology ,water-soil-plant relationships ,erosion ,lcsh:Environmental sciences - Abstract
Hydrology: a partner of geomorphopedology in the scope of a scale-through environmental management. Unsaturated soil and subsoil are often called "critical zone" considering their major interfacing role in our environment. Dealing with solute transfer or water and soil conservation, hydrologic research relies on pedologic descriptions. It is the case from micro to macro scale analysis. Hydrodynamic parameters are derived from pedologic information on soil. They allow hydrologists to quantify and spatially describe the dynamic exchanges between water, soil, crops and atmosphere. The modelling of water and solute transfer through soil and vadose zone also needs them. The paper presents some research highlights on soil behaviour, hydrological modelling and forecasting under climate change. Erosion is another major topic. Soil is a poorly renewable resource. Soil conservation and soft hydraulic management in watersheds deserve more attention. They can help limiting nutrient and sediment transfer to surface water. Again, pedologic information is the starting point of conceptualization and modelling. Furthermore, the Soil Map of Belgium includes information on geomorphology and landscape descriptions which date from decades. They are of first importance to calibrate and validate detachment, transport and sedimentation models. In the current context of high environmental concern, it is demonstrated how hydrology and pedology have to be partners in order to deal with such major issues.
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- 2011
11. Vijf jaar ervaring met een op ROTEM gebaseerd algoritme voor de diagnose en behandeling van bloedverlies bij cardiothoracale chirurgie
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Henskens, Yvonne, van Noord, P., Beckers, E., Lance, Markus, Medische Microbiologie, MUMC+: DA CDL Algemeen (9), MUMC+: MA Anesthesiologie (9), Intensive Care, Biochemie, RS: CARIM - R1 - Thrombosis and haemostasis, RS: GROW - Oncology, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, and Interne Geneeskunde
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- 2015
12. ROTEM de nieuwe globale hemostase test: hoe werkt het in de praktijk?
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Henskens, Y., van Noord, P., Beckers, E., Lance, M., Interne Geneeskunde, Intensive Care, RS: GROW - Oncology, and RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy
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- 2015
13. Extrakranielle stereotaktische Radiotherapie (ESRT) - eine Übersicht unter besonderer Berücksichtigung von ESRT und LITT in der Behandlung von Lebermetastasen
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Fiedler Vu, Schwarzmaier Hj, Eickmeyer F, Roth A, Schneid S, Lücking Ps, Beckers E, Schulz U, and Ernst I
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Oncology ,Chemotherapy ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Radiation dose ,Normal tissue ,Obstetrics and Gynecology ,medicine.disease ,Primary tumor ,Resection ,Radiation therapy ,Internal medicine ,medicine ,Overall survival ,business ,Nuclear medicine ,Stereotactic body radiotherapy - Abstract
Stereotactic body radiotherapy (SBRT) is a high dose radiotherapy, the radiation dose is applicated one-time or in a few fractions exactly to the tumor or metastases under maximal separation from the normal tissue. Because of this a major expenditure of medical and technical efforts are necessary, a detailed description of the proceedings is following in the methodic part of this article. Indications of SBRT are especially medical irresectable lung tumors of early stages, primary liver/biliary tumors and pulmonary or liver metastases if there is an oncological benefit for the patients. The side effects are moderate, the local tumor control rate is between 78 to 100 %. Depending on the primary tumor the overall survival is prolonged statistically significant. In the Klinikum Krefeld indications of SBRT vs chemotherapy, LITT or resection are discussed by an interdisciplinary conference of gastroenterologists/oncologists, radiologists, radiooncologists and surgeons. An example of LITT will be shown also.
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- 2006
14. Atmospheric Deposition of Zinc Oxide Front Electrode for Cu(In,Ga)Se2 and Si Thin Films Solar Cells
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Illiberi, A., Grob, F., Kniknie, B., Poodt, P., Van Deelen, J., Ramachandra, R., Winands, G.J.J., Simor, M., Theelen, M., Beckers, E., and Bolt, P.J.
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THIN FILM SOLAR CELLS ,CdTe, CIS and Related Ternary and Quaternary Thin Film Solar Cells - Abstract
28th European Photovoltaic Solar Energy Conference and Exhibition; 2414-2417, ZnO films have been grown on a moving glass substrate by high temperature (480 0C) chemical vapour deposition (CVD) and low temperature (200 0C) plasma enhanced CVD (PE-CVD) process at atmospheric pressure. Deposition rates above 7 nm/s have been achieved for substrate speeds from 20 to 500 mm/min. The conductivity of the films is enhanced by Al doping of CVD ZnO or by exposure to near-UV radiation of PE-CVD ZnO. Both CVD ZnO:Al and UV-exposed PE-CVD i-ZnO films are highly transparent (> 85% in the visible range) and conductive (< 15 Ohm/sq for a thickness above 1200 nm). ZnO:Al has been used as front electrode in amorphous silicon (a-Si:H) solar cells while i-ZnO has been applied as electrode in CIGS solar cells, achieving an efficiency of 8% and 15.4%, respectively.
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- 2013
- Full Text
- View/download PDF
15. ALLO-EXPOSED BLOOD DONORS AND TRANSFUSION-RELATED ACUTE LUNG INJURY
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Middelburg, R.A., Stein, D. van, Atsma, F., Wiersum-Osselton, J.C., Porcelijn, L., Beckers, E., Briet, E., and Bom, J.G. van der
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- 2010
16. Onderzoek Programmabegroting gemeente Bergen op Zoom
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van den Dool, L.T., Beckers, E., and Public Law & Governance
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- 2009
17. Transfusiegerelateerde acute longbeschadiging (TRALI) in Nederland in 2002-2005
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Wiersum-Osselton, J. C., Porcelijn, L., van Stein, D., Vlaar, A. P. J., Beckers, E. A. M., Schipperus, M. R., and Intensive Care Medicine
- Abstract
To determine the number of reported cases of transfusion-related acute lung injury (TRALI) in the Netherlands in 2002-2005 and to determine how many cases were associated with incompatibility between leukocyte-reactive antibodies in the donor plasma and leukocytes or antigens in the recipient. Retrospective national case review. Cases of TRALI reported in 2002-2005 were assessed according to the national clinical definition of TRALI, and the relationship between TRALI and transfusion was assessed. Additional clinical details were requested from the treating hospital as necessary. The results of leukocyte serological tests from donors and recipients were linked to clinical cases. For cases with positive leukocyte serological tests, the relevant blood components and the sex of the donor were recorded. Of the 46 cases reported, 6 had insufficient information. 8 cases did not meet the definition or had another more likely diagnosis. There was a trend toward an increase in the number of reports: 12 cases were reported in 2005, corresponding with 1:60,000 blood components. Of the 40 evaluable cases, 32 (80%) met the definition of TRALI and were deemed to be definitely (n = 16), probably (n = 5) or possibly (n = 11) related to transfusion. Severity ranged from moderate to life-threatening, and there was one TRALI-related death. Leukocyte serology was fully investigated in 18 cases: 13 (72%) had leukocyte incompatibility and in 5 cases exclusively fresh frozen plasma from a female donor was implicated
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- 2008
18. Sportunterricht als Forschungsfeld
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Bernd Gröben, Beckers, E., and Schmidt-Millard, T.
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- 2004
19. Quality of life measurement in patients with transfusion-dependent myelodysplastic syndromes
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Jansen, A. J. G., Essink-Bot, M.-L., Beckers, E. A. M., Hop, W. C. J., Schipperus, M. R., van Rhenen, D. J., and Public and occupational health
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hemic and lymphatic diseases ,humanities - Abstract
The myelodysplastic syndromes (MDS) are clonal disorders characterized by dysplasia in at least two myeloid cell lines. Fatigue is one of the most significant symptoms. MDS patients are treated with blood transfusions to improve their health-related quality of life (HRQoL). A cross-sectional pilot study was performed for psychometric evaluation of three internationally established HRQoL measures in MDS patients, and for investigation of the association between the severity of chronic anaemia and HRQoL. Fifty consecutive MDS patients completed the Short Form 36, the Multidimensional Fatigue Inventory and the EuroQoL-5D Visual Analogue Scale. Hb level was measured during the same visit. Psychometric analysis focused on feasibility, construct validity and reliability. The questionnaires showed a high feasibility, reliability and validity. MDS patients had worse HRQoL scores than the age- and sex-matched general population. We found a positive correlation between haemoglobin (Hb) level and HRQoL. This study provides insights into the suitability of established HRQoL measures for the evaluation of interventions in MDS patients. Hb value and HRQoL are complementary variables for evaluation of the severity of chronic anaemia in patients with MDS
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- 2003
20. Erziehender Sportunterricht: Wie kann die Hochschule darauf vorbereiten
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Kurz, Dietrich, Beckers, E., Hercher, J., and Neuber, N.
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- 2000
21. Performance of the ISTH bleeding assessment tool in predicting the presence of inherited platelet function disorders
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Blaauwgeers, M., van Asten, I., Korporaal, S., Huisman, A., Beckers, E., Kruip, M., Coppens, M., Eikenboom, J., Tamminga, R., Urbanus, R., and Schutgens, R.
22. Prevalence and 6-month recovery of olfactory dysfunction: a multicentre study of 1363 COVID-19 patients
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Morgane Ducarme, Vincent Mustin, Stéphane Hans, Giovanni Cammaroto, Maria Rosaria Barillari, Marta P. Circiu, Jerome R. Lechien, Arnaud Marchant, Eline Beckers, Sven Saussez, Carlos M. Chiesa-Estomba, Lionel Jouffe, Fabrice Journe, Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Lechien, J. R., Chiesa-Estomba, C. M., Beckers, E., Mustin, V., Ducarme, M., Journe, F., Marchant, A., Jouffe, L., Barillari, M. R., Cammaroto, G., Circiu, M. P., Hans, S., and Saussez, S.
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0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,[SDV]Life Sciences [q-bio] ,Anosmia ,Olfaction ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Olfaction Disorders ,03 medical and health sciences ,recovery ,0302 clinical medicine ,Disease severity ,Hyposmia ,Olfaction Disorder ,Internal medicine ,Epidemiology ,Prevalence ,Internal Medicine ,smell ,Humans ,Medicine ,Mild form ,Aged ,business.industry ,SARS-CoV-2 ,COVID-19 ,Recovery of Function ,Middle Aged ,olfactory ,Europe ,Médecine interne ,030104 developmental biology ,Female ,medicine.symptom ,business ,anosmia ,Human - Abstract
Objective: To investigate prevalence and recovery of olfactory dysfunction (OD) in COVID-19 patients according to the disease severity. Methods: From 22 March to 3 June 2020, 2581 COVID-19 patients were identified from 18 European hospitals. Epidemiological and clinical data were extracted at baseline and within the 2-month post-infection. Results: The prevalence of OD was significantly higher in mild form (85.9%) compared with moderate-to-critical forms (4.5–6.9%; P = 0.001). Of the 1916 patients with OD, 1363 completed the evaluations (71.1%). A total of 328 patients (24.1%) did not subjectively recover olfaction 60 days after the onset of the dysfunction. The mean duration of self-reported OD was 21.6 ± 17.9 days. Objective olfactory evaluations identified hyposmia/anosmia in 54.7% and 36.6% of mild and moderate-to-critical forms, respectively (P = 0.001). At 60 days and 6 months, 15.3% and 4.7% of anosmic/hyposmic patients did not objectively recover olfaction, respectively. The higher baseline severity of objective olfactory evaluations was strongly predictive of persistent OD (P, SCOPUS: ar.j, info:eu-repo/semantics/published
- Published
- 2021
23. Anticoagulation in thrombocytopenic patients with hematological malignancy: A multinational clinical vignette-based experiment
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Harry C. Schouten, Avi Leader, Arina J. ten Cate-Hoek, Galia Spectre, Anna Gurevich-Shapiro, Erik A M Beckers, Hugo ten Cate, Cinzia Giaccherini, Pia Raanani, Eilon Krashin, Vincent ten Cate, Anna Falanga, Leader, A, Ten Cate, V, Ten Cate-Hoek, A, Beckers, E, Spectre, G, Giaccherini, C, Gurevich-Shapiro, A, Krashin, E, Raanani, P, Schouten, H, Falanga, A, Ten Cate, H, RS: Carim - B04 Clinical thrombosis and Haemostasis, Interne Geneeskunde, RS: CAPHRI - R5 - Optimising Patient Care, Epidemiologie, MUMC+: HVC Pieken Trombose (9), MUMC+: MA Hematologie (9), RS: Carim - B01 Blood proteins & engineering, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, MUMC+: HVC Trombosezorg (8), MUMC+: MA Alg Interne Geneeskunde (9), and Biochemie
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medicine.medical_specialty ,Hemorrhage ,Disease ,030204 cardiovascular system & hematology ,Disease cluster ,Risk Assessment ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Risk Factors ,Neoplasms ,Atrial Fibrillation ,Internal Medicine ,medicine ,MANAGEMENT ,Humans ,030212 general & internal medicine ,Poisson regression ,Intensive care medicine ,Blood Coagulation ,RISK ,business.industry ,Anticoagulant ,Anticoagulants ,Atrial fibrillation ,medicine.disease ,Thrombosis ,CANCER ,Thrombocytopenia ,Stroke ,Platelet transfusion ,Hematological malignancy ,Relative risk ,Hematologic Neoplasms ,symbols ,Neoplasm ,business ,Venous thromboembolism - Abstract
Background: Thrombocytopenia in cancer patients with an indication for anticoagulation poses a unique clinical challenge. There are guidelines for the setting of venous thromboembolism but not atrial fibrillation (AF). Evidence is lacking and current practice is unclear.Objective: To identify patient and physician characteristics associated with anticoagulation management in hematological malignancy and thrombocytopenia.Methods: A clinical vignette-based experiment was designed. Eleven hematologists were interviewed, identifying 5 relevant variable categories with 2-5 options each. Thirty hypothetical vignettes were generated. Each physician received 5 vignettes and selected a management strategy (hold anticoagulation; no change; transfuse platelets; modify type/dose). The survey was distributed to hematologists and thrombosis specialists in 3 countries. Poisson regression models with cluster robust variance estimates were used to calculate relative risks for using one management option over the other, for each variable in comparison to a reference variable.Results: 168 physicians answered 774 cases and reported continuing anticoagulation for venous thromboembolism or AF in 607 (78%) cases, usually with dose reduction or platelet transfusion support. Overall, management was affected by platelet count, anticoagulation indication, time since indication, type of hematological disease and treatment, and prior major bleeding, as well as physician demographics and practice setting. The CHA(2)DS(2)-VASc score and time since AF diagnosis affected anticoagulation management in AF.Conclusion: This study indicates what the widely accepted management strategies are. These strategies, and possibly others, should be assessed prospectively to ascertain effectiveness. The decision process is intricate and compatible with current venous thromboembolism guidelines.
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- 2020
24. Managing Anti-Platelet Therapy in Thrombocytopaenic Patients with Haematological Malignancy: A Multinational Clinical Vignette-Based Experiment
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Erik A M Beckers, Arina J. ten Cate-Hoek, Avi Leader, Anna Falanga, Cinzia Giaccherini, Galia Spectre, Pia Raanani, Vincent ten Cate, Hugo ten Cate, David Pereg, Harry C. Schouten, Leader, A, Ten Cate, V, Ten Cate-Hoek, A, Spectre, G, Beckers, E, Raanani, P, Giaccherini, C, Pereg, D, Schouten, H, Falanga, A, Ten Cate, H, RS: Carim - B04 Clinical thrombosis and Haemostasis, RS: CARIM - R1.04 - Clinical thrombosis and haemostasis, Interne Geneeskunde, RS: CAPHRI - R5 - Optimising Patient Care, Epidemiologie, Biochemie, MUMC+: MA Hematologie (9), RS: Carim - B01 Blood proteins & engineering, RS: CARIM - R1.01 - Blood proteins & engineering, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, MUMC+: MA Alg Interne Geneeskunde (9), and MUMC+: HVC Pieken Trombose (9)
- Subjects
0301 basic medicine ,2013 ACCF/AHA GUIDELINE ,Myocardial Infarction ,arterial thrombosis ,SECONDARY PREVENTION ,030204 cardiovascular system & hematology ,anti-platelet agents, arterial thrombosis, cancer , thrombocytopaenia ,Random Allocation ,0302 clinical medicine ,Surveys and Questionnaires ,Medicine ,Poisson Distribution ,Israel ,thrombocytopaenia ,Netherlands ,Hematology ,Thrombosis ,Community hospital ,Italy ,Hematologic Neoplasms ,symbols ,Blood Platelets ,medicine.medical_specialty ,Gastrointestinal bleeding ,Decision Making ,Cardiology ,Hemorrhage ,CANCER-PATIENTS ,Platelet Transfusion ,AMERICAN-COLLEGE ,anti-platelet agents ,03 medical and health sciences ,symbols.namesake ,Internal medicine ,cancer ,PLATELET TRANSFUSIONS ,Humans ,ASSOCIATION TASK-FORCE ,Poisson regression ,CARDIOVASCULAR EVENTS ,VENOUS THROMBOEMBOLISM ,business.industry ,Unstable angina ,ACUTE CORONARY SYNDROMES ,ELEVATION MYOCARDIAL-INFARCTION ,medicine.disease ,Thrombocytopenia ,Confidence interval ,030104 developmental biology ,Platelet transfusion ,Relative risk ,business ,Platelet Aggregation Inhibitors - Abstract
Data on anti-platelet therapy (APT) for prevention of atherothrombotic events in thrombocytopaenic cancer patients is lacking. We aimed to identify patient and physician characteristics associated with APT management in thrombocytopaenic patients with haematological malignancy. A clinical vignette-based experiment was designed. Eleven haematologists were interviewed, identifying five variable categories. Next, 18 hypothetical vignettes were generated. Each physician received three vignettes and chose to: hold all APT; continue APT without platelet transfusion support; or continue APT with platelet transfusion support. The survey was distributed to haematologists and thrombosis specialists in three countries. Multivariate cluster robust Poisson regression models were used to calculate relative risks (RRs) of using one management option (over the other) for each variable in comparison to a reference variable. A total of 145 physicians answered 434 cases. Clinicians were more likely to hold APT in case of 20,000/µL platelets (vs. 40,000/µL; RR for continuing: 0.82 [95% confidence interval: 0.75–0.91]), recent major gastrointestinal bleeding (vs. none; RR 0.81 [0.72–0.92]) and when the physician worked at a university-affiliated community hospital (vs. non-academic community hospital; RR 0.84 [0.72–0.98]). Clinicians were more likely to continue APT in ST elevation myocardial infarction with dual APT (vs. unstable angina with single APT; RR 1.31 [1.18–1.45]) and when there were institutional protocols guiding management (vs. none; RR 1.15 [1.03–1.27]). When APT was continued, increased platelet transfusion targets were used in 34%. In summary, the decision process is complex and affected by multiple patient and physician characteristics. Platelet transfusions were frequently chosen to support APT, although no evidence supports this practice.
- Published
- 2019
25. Antithrombotic medication in cancer-associated thrombocytopenia: Current evidence and knowledge gaps
- Author
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H. ten Cate, Anna Falanga, Avi Leader, Galia Spectre, Erik A M Beckers, Leader, A, Ten Cate, H, Spectre, G, Beckers, E, and Falanga, A
- Subjects
medicine.medical_specialty ,Acute coronary syndrome ,030204 cardiovascular system & hematology ,ACUTE CORONARY SYNDROME ,HEMATOLOGIC MALIGNANCIES ,RECURRENT VENOUS THROMBOEMBOLISM ,03 medical and health sciences ,0302 clinical medicine ,Fibrinolytic Agents ,Neoplasms ,Antithrombotic ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Platelet transfusion ,Aspirin ,business.industry ,Arterial thrombosi ,Bleeding ,Anticoagulant ,Arterial thrombosis ,ELEVATION MYOCARDIAL-INFARCTION ,LOW-DOSE ASPIRIN ,Anticoagulants ,Hematology ,MOLECULAR-WEIGHT HEPARIN ,medicine.disease ,STEM-CELL-TRANSPLANTATION ,Thrombosis ,Thrombocytopenia ,PROPHYLACTIC PLATELET TRANSFUSIONS ,Regimen ,Platelet aggregation inhibitor ,Oncology ,ATRIAL-FIBRILLATION ,RISK-FACTORS ,Neoplasm ,business ,Fibrinolytic agent ,Platelet Aggregation Inhibitors ,medicine.drug ,Venous thromboembolism - Abstract
In cancer patients, antithrombotic medications (i.e. anticoagulation or antiplatelet therapy) are frequently prescribed for prior or new indications such as venous thromboembolism or stoke prevention in atrial fibrillation. Balancing the risks of bleeding and thrombosis during periods of thrombocytopenia represents a significant challenge. Management is informed mainly by expert opinion and several recent retrospective studies on venous thromboembolism. The main management options include no change, temporarily withholding antithrombotic therapy, reducing dose, changing the regimen, and increasing the platelet transfusion threshold. Important recent advances in knowledge include the prognostic importance and apparent safety of aspirin in acute myocardial infarction and thrombocytopenia and data suggesting a low risk of recurrent venous thromboembolism in autologous stem cell transplantation patients who had anticoagulation withheld. This paper will review the literature on antithrombotic medication in thrombocytopenic patients with cancer. The significant knowledge gaps will be summarized and considerations for practice and research will be provided.
- Published
- 2018
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