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1. Symptomatic subsegmental versus more central pulmonary embolism: Clinical outcomes during anticoagulation

Author

Carmen Fernández‐Capitán, Ana Rodriguez Cobo, David Jiménez, Olga Madridano, Maurizio Ciammaichella, Esther Usandizaga, Remedios Otero, Pierpaolo Di Micco, Farès Moustafa, Manuel Monreal, M.D. Adarraga, M.A. Aibar, M. Alfonsa, J.I. Arcelus, P. Azcarate‐Agüero, A. Ballaz, P. Baños, R. Barba, M. Barrón, B. Barrón‐Andrés, J. Bascuñana, A. Blanco‐Molina, A.M. Camón, L. Chasco, A.J. Cruz, R. del Pozo, J. de Miguel, J. del Toro, M.C. Díaz‐Pedroche, J.A. Díaz‐Peromingo, J.C. Escribano, C. Falgá, C. Fernández‐Aracil, M.A. Fidalgo, C. Font, L. Font, M.A. García, F. García‐Bragado, M. García‐Morillo, A. García‐Raso, A.I. García‐Sánchez, O. Gavín, I. Gaya, C. Gómez, V. Gómez, J. González, E. Grau, R. Guijarro, J. Gutiérrez, G. Hernández‐Comes, L. Hernández‐Blasco, E. Hernando, L. Jara‐Palomares, M.J. Jaras, D. Jiménez, M.D. Joya, J. Lima, P. Llamas, J.L. Lobo, R. López‐Reyes, J.B. López‐Sáez, M.A. Lorente, A. Lorenzo, M. Lumbierres, A. Maestre, P.J. Marchena, F. Martín‐Martos, M. Martín‐Romero, M.V. Morales, J.A. Nieto, S. Nieto, A. Núñez, M.J. Núñez, M. Odriozola, M.C. Olivares, S. Otalora, J.M. Pedrajas, G. Pellejero, C. Pérez‐Ductor, M.L. Peris, I. Pons, J.A. Porras, L. Ramírez, O. Reig, A. Riera‐Mestre, D. Riesco, A. Rivas, M.A. Rodríguez‐Dávila, V. Rosa, P. Ruiz‐Artacho, J.C. Sahuquillo, M.C. Sala‐Sainz, A. Sampériz, R. Sánchez‐Martínez, S. Soler, B. Sopeña, J.M. Suriñach, C. Tolosa, M.I. Torres, J. Troya, J. Trujillo‐Santos, F. Uresandi, B. Valero, R. Valle, J. Vela, L. Vela, G. Vidal, A. Villalobos, T. Vanassche, C. Vandenbriele, P. Verhamme, H.H.B. Yoo, P. Wells, J. Hirmerova, R. Malý, E. Salgado, L. Bertoletti, A. Bura‐Riviere, N. Falvo, D. Farge‐Bancel, A. Hij, I. Mahé, I. Quere, A. Braester, B. Brenner, M. Ellis, I. Tzoran, G. Antonucci, G. Barillari, F. Bilora, C. Bortoluzzi, E. Bucherini, A. Camerota, C. Cattabiani, F. Dentali, R. Duce, M. Giorgi‐Pierfranceschi, E. Grandone, E. Imbalzano, G. Lessiani, R. Maida, D. Mastroiacovo, F. Pace, R. Pesavento, M. Pesavento, R. Poggio, P. Prandoni, R. Quintavalla, A. Rocci, C. Siniscalchi, E. Tiraferri, D. Tonello, A. Visonà, B. Zalunardo, V. Gibietis, A. Skride, B. Vitola, A. Alatri, H. Bounameaux, L. Calanca, and L. Mazzolai

Subjects
Subsegmental, medicine.medical_specialty, anticoagulant, deep vein thrombosis, outcomes, pulmonary embolism, subsegmental, medicine.drug_class, Deep vein, Outcomes, Deep vein thrombosis, Internal medicine, medicine, First episode, lcsh:RC633-647.5, business.industry, Pulmonary embolism, Hazard ratio, Anticoagulant, Anticoagulants, lcsh:Diseases of the blood and blood-forming organs, Hematology, Heparin, Original Articles ‐ Thrombosis, medicine.disease, Thrombosis, Confidence interval, medicine.anatomical_structure, Cardiology, Original Article, business, medicine.drug
Abstract

The RIETE Investigators., [Background] The optimal therapy of patients with acute subsegmental pulmonary embolism (PE) is controversial., [Methods] We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to compare the rate of symptomatic PE recurrences during anticoagulation in patients with subsegmental, segmental, or more central PEs. [Results] Among 15 963 patients with a first episode of symptomatic PE, 834 (5.2%) had subsegmental PE, 3797 (24%) segmental, and 11 332 (71%) more central PE. Most patients in all subgroups received initial therapy with low‐molecular‐weight heparin, and then most switched to vitamin K antagonists. Median duration of therapy was 179, 185, and 204 days, respectively. During anticoagulation, 183 patients developed PE recurrences, 131 developed deep vein thrombosis (DVT), 543 bled, and 1718 died (fatal PE, 135). The rate of PE recurrences was twofold higher in patients with subsegmental PE than in those with segmental (hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.16‐3.85) or more central PE (HR, 1.89; 95% CI, 1.12‐3.13). On multivariable analysis, patients with subsegmental PE had a higher risk for PE recurrences than those with central PE (adjusted HR, 1.75; 95% CI, 1.02‐3.03). After stratifying patients with subsegmental PE according to ultrasound imaging in the lower limbs, the rate of PE recurrences was similar in patients with DVT, in patients without DVT, and in those with no ultrasound imaging. [Conclusions] Our study reveals that the risk for PE recurrences in patients with segmental PE is not lower than in those with more central PE, thus suggesting that the risk of PE recurrences is not influenced by the anatomic location of PE.

Published
2021
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2. Incidence of major adverse cardiovascular events among patients with provoked and unprovoked venous thromboembolism: Findings from the Registro Informatizado de Enfermedad Tromboembólica Registry

Author

Fernando J. Vazquez, Hanh My Bui, R. Maida, Alicia Lorenzo, Iva Golemi, Remedios Otero, R. Otero, G. Pellejero, Pilar Llamas, M.J. Soto, J. del Toro, Inna Tzoran, K. Sablinskis, Carmine Siniscalchi, E. Bucherini, G. Vidal, Juan J. López-Núñez, N. Mumoli, J.M. Suriñach, S. Ruiz-Alcaraz, H. Bounameaux, Jose Gutierrez, E. Salgado, C. Carrasco, I. Gaya, R. Parisi, M.D. Adarraga, Peter Verhamme, Meritxell Mellado, N. Vo Hong, I. Jou, M.C. Gayol, M. García-Morillo, Marco Fresa, Luis Jara-Palomares, Daniela Mastroiacovo, M. Sablinskis, A. Rodríguez-Hernández, R. Díaz-Simón, Miguel Ángel Aibar, David Jiménez, Ángel Sampériz, Raquel López-Reyes, Isabelle Mahé, P. Ruiz-Sada, Martin Ellis, J.A. Porras, Omer Iftikhar, Ángeles Blanco-Molina, J. Aibar, R. Malý, M. Pérez-Pinar, Adriana Visonà, L. Guirado, Carme Font, M. Encabo, M.A. Lorente, María del Carmen Díaz-Pedroche, F. García-Bragado, Gianfranco Lessiani, P. Prandoni, T. Sancho, I. Sanoja, A. Tafur, Manuel Monreal, M.J. Jaras, Alessandra Bura-Rivière, Javier Trujillo-Santos, E. Grau, J. Castro, E. Imbalzano, P. Demelo, A.M. Camon, P. López-Miguel, R. Quintavalla, Alfonso Tafur, Laurent Bertoletti, N. Falvo, J. Ruiz-Ruiz, M. Pinelli, M.A. Fidalgo, Pablo Javier Marchena, Anna Rocci, Aitor Ballaz, José González-Martínez, Andrei Braester, J.F. Sánchez-Muñoz-Torrero, J. Bascuñana, Philippe Debourdeau, J.M. Pedrajas, Giovanni Barillari, C. Vandenbriele, H.M. Bui, M. Iglesias, M. Bosevski, Raffaele Pesavento, Barry M. Brenner, Antonella Tufano, Silvia Soler, F. Pace, Paolo Prandoni, L. Font, L. Bertoletti, A. García-Raso, G. Pérez-Rus, V. Salazar, Juan I. Arcelus, Barbara Ney, Lauren Cote, Raquel Barba, B. Brandolin, Luciano López-Jiménez, Pierpaolo Di Micco, C. Fernández-Capitán, M. Martín Fernández, M.A. García, R. Barba, R. Valle, Carmen Fernández-Capitán, M.L. Pesce, J.M. Martín-Guerra, D. Farge-Bancel, Conxita Falga, M. Lumbierres, Fernando Uresandi, Benjamin Brenner, Elvira Grandone, Mónica Loring, Dominique Farge-Bancel, A. Lalueza, Cristiano Bortoluzzi, M.J. Núñez, M.C. Olivares, Maurizio Ciammaichella, M.D. Joya, Agustina Rivas, Joan Carles Sahuquillo, C.M. Rubio, Abílio Reis, A. Vilaseca, P. Di Micco, Jana Hirmerova, M. Monreal, José María Pedrajas, M.L. Peris, M.A. Rodríguez-Dávila, S. Otalora, F. Bilora, E. Usandizaga, C. Amado, Pedro Ruiz-Artacho, Roberto Quintavalla, B. Barrón-Andrés, P.M. Azcarate, I. Benzidia, Lucia Mazzolai, P. Gutiérrez, Jorge Lima, O. Gavín, Thomas Vanassche, Farès Moustafa, V. Gómez, Andris Skride, Joseph A. Caprini, A. Gil-Díaz, Behnood Bikdeli, A. Hij, L. Rodríguez-Fernández, Olga Madridano, C. Rodríguez-Martín, C. de Ancos, Ana Maestre, M.C. Fernández-Criado, Henri Bounameaux, M.I. Torres, Radovan Malý, A.I. Farfán, I. Tzoran, J.A. Díaz-Peromingo, J.B. López-Sáez, M. Barrón, C. Tolosa, José Luis Lobo, Francesco Dentali, M. Zdraveska, Marijan Bosevski, L.M. Hernández Blasco, J.A. Nieto, Ma Morales, J. Caprini, Golemi, I., Cote, L., Iftikhar, O., Brenner, B., Tafur, A., Bikdeli, B., Fernandez-Capitan, C., Pedrajas, J. M., Otero, R., Quintavalla, R., Monreal, M., Prandoni, P., Farge-Bancel, D., Barba, R., Di Micco, P., Bertoletti, L., Tzoran, I., Reis, A., Bounameaux, H., Maly, R., Verhamme, P., Bosevski, M., Caprini, J. A., Bui, H. M., Adarraga, M. D., Aibar, M. A., Aibar, J., Amado, C., Arcelus, J. I., Azcarate, P. M., Ballaz, A., Barron, M., Barron-Andres, B., Bascunana, J., Blanco-Molina, A., Camon, A. M., Carrasco, C., Castro, J., de Ancos, C., del Toro, J., Demelo, P., Diaz-Pedroche, M. C., Diaz-Peromingo, J. A., Diaz-Simon, R., Encabo, M., Falga, C., Farfan, A. I., Fernandez-Criado, M. C., Fidalgo, M. A., Font, C., Font, L., Garcia, M. A., Garcia-Bragado, F., Garcia-Morillo, M., Garcia-Raso, A., Gavin, O., Gaya, I., Gayol, M. C., Gil-Diaz, A., Guirado, L., Gomez, V., Gonzalez-Martinez, J., Grau, E., Gutierrez, J., Hernandez Blasco, L. M., Iglesias, M., Jara-Palomares, L., Jaras, M. J., Jimenez, D., Jou, I., Joya, M. D., Lalueza, A., Lima, J., Llamas, P., Lobo, J. L., Lopez-Jimenez, L., Lopez-Miguel, P., Lopez-Nunez, J. J., Lopez-Reyes, R., Lopez-Saez, J. B., Lorente, M. A., Lorenzo, A., Loring, M., Lumbierres, M., Madridano, O., Maestre, A., Marchena, P. J., Martin-Guerra, J. M., Martin Fernandez, M., Mellado, M., Morales, M. V., Nieto, J. A., Nunez, M. J., Olivares, M. C., Otalora, S., Pellejero, G., Perez-Pinar, M., Perez-Rus, G., Peris, M. L., Pesce, M. L., Porras, J. A., Rivas, A., Rodriguez-Davila, M. A., Rodriguez-Fernandez, L., Rodriguez-Hernandez, A., Rodriguez-Martin, C., Rubio, C. M., Ruiz-Alcaraz, S., Ruiz-Artacho, P., Ruiz-Ruiz, J., Ruiz-Sada, P., Sahuquillo, J. C., Salazar, V., Samperiz, A., Sanchez-Munoz-Torrero, J. F., Sancho, T., Sanoja, I., Soler, S., Soto, M. J., Surinach, J. M., Tolosa, C., Torres, M. I., Trujillo-Santos, J., Uresandi, F., Usandizaga, E., Valle, R., Vidal, G., Gutierrez, P., Vazquez, F. J., Vilaseca, A., Vanassche, T., Vandenbriele, C., Hirmerova, J., Salgado, E., Benzidia, I., Bura-Riviere, A., Debourdeau, P., Falvo, N., Hij, A., Mahe, I., Moustafa, F., Braester, A., Ellis, M., Barillari, G., Bilora, F., Bortoluzzi, C., Brandolin, B., Bucherini, E., Ciammaichella, M., Dentali, F., Grandone, E., Imbalzano, E., Lessiani, G., Maida, R., Mastroiacovo, D., Mumoli, N., Vo Hong, N., Pace, F., Parisi, R., Pesavento, R., Pinelli, M., Rocci, A., Siniscalchi, C., Tufano, A., Visona, A., Skride, A., Sablinskis, K., Sablinskis, M., Zdraveska, M., Fresa, M., Ney, B., Mazzolai, L., and Caprini, J.

Subjects
Registrie, Male, Time Factors, Databases, Factual, Major adverse cardiovascular event, 030204 cardiovascular system & hematology, Coronary artery disease, 0302 clinical medicine, Retrospective Studie, Cardiovascular Disease, Major adverse limb events, Medicine, Registries, 030212 general & internal medicine, Myocardial infarction, Stroke, Incidence, Incidence (epidemiology), Hazard ratio, Major adverse limb event, Heart Disease Risk Factor, Middle Aged, Prognosis, Cardiovascular Diseases, Major adverse cardiovascular events, Female, VTE, Cardiology and Cardiovascular Medicine, Human, Provoked, Venous thromboembolism, medicine.medical_specialty, Time Factor, Prognosi, Risk Assessment, 03 medical and health sciences, Internal medicine, Humans, cardiovascular diseases, Aged, Retrospective Studies, business.industry, Unstable angina, medicine.disease, equipment and supplies, Confidence interval, Heart Disease Risk Factors, Surgery, business, Mace
Abstract

Registro Informatizado de Enfermedad Tromboembólica Investigators., [Objective] Overlap exists between the risk factors for coronary artery disease and venous thromboembolism (VTE). However, a paucity of data is available on the incidence of major acute cardiovascular events (MACE) and major adverse limb events (MALE) among patients presenting with VTE. Moreover, it is unknown whether the rate of cardiovascular outcomes differs among patients with unprovoked vs provoked VTE., [Methods] We analyzed the data from 2009 to 2017 in the Registro Informatizado de Enfermedad Tromboembólica registry, an ongoing, multicenter, international registry of consecutive patients with a diagnosis of objectively confirmed VTE. The query was restricted it to patients with data entry for the arterial outcomes. The baseline prevalence of coronary artery disease risk factors was compared between patients with provoked (ie, immobility, cancer, surgery, travel >6 hours, hormonal causes) and unprovoked VTE. After the initial VTE event, we followed up patients for the composite primary outcome of incident MACE (ie, stroke, myocardial infarction, unstable angina) and/or MALE (ie, major limb events). We used the χ2 test for baseline associations and a Cox proportional hazard for multivariate analysis. We used IBM SPSS, version 24 (IBM Corp, Armonk, NY) for statistical analysis. A P value of, [Results] We analyzed the data from 41,259 patients with VTE, of whom 22,633 (55.6%) had experienced a provoked VTE. During follow-up, the patients with provoked VTE were more likely to develop MACE or MALE than were patients with unprovoked VTE (hazard ratio [HR], 1.3; 95% confidence interval [CI], 1.1-1.5). The association of arterial events with recent immobility (HR, 1.4; 95% CI, 1.5-12.1) and cancer (HR, 1.7; 95% CI, 1.4-1.9) was strong. After adjusting for multiple conventional cardiovascular risk factors, provoked VTE, compared with unprovoked VTE, was significantly associated with an increased hazard for MACE (HR, 1.4; 95% CI, 1.1-1.7). Cancer remained a significant adjusted predictor for both MACE (HR, 1.7; 95% CI, 1.4-2.1) and MALE (HR, 2.1; 95% CI 1.01-4.6) in those with provoked VTE., [Conclusions] Among patients with VTE, provoked cases, specifically those with cancer-associated VTE, have an increased risk of major arterial events.

Published
2020

3. Age‐adjusted D‐dimer to rule out deep vein thrombosis: findings from the PALLADIO algorithm

Author

N. Riva, G. Camporese, M. Iotti, E. Bucherini, M. Righini, P.W. Kamphuisen, P. Verhamme, J.D. Douketis, C. Tonello, P. Prandoni, W. Ageno, A. Ghirarduzzi, M.R. Veropalumbo, M. Donadini, and Cardiovascular Centre (CVC)

Subjects
Male, Databases, Factual, diagnosis, Deep vein, MULTICENTER, 030204 cardiovascular system & hematology, 0302 clinical medicine, Risk Factors, EXCLUSION, Prevalence, 030212 general & internal medicine, Ultrasonography, Aged, 80 and over, Venous Thrombosis, ddc:616, Incidence, Incidence (epidemiology), Age Factors, Venous Thromboembolism, Hematology, Middle Aged, Thrombosis, Pulmonary embolism, Venous thrombosis, medicine.anatomical_structure, Female, Algorithm, Algorithms, Adult, PULMONARY-EMBOLISM, Clinical Decision-Making, Age adjustment, Unnecessary Procedures, Decision Support Techniques, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, Predictive Value of Tests, D-dimer, MANAGEMENT, medicine, Humans, INDIVIDUAL-PATIENT DATA, Aged, WELLS RULE, business.industry, Reproducibility of Results, Emergency department, PERFORMANCE, algorithms, outpatients, ultrasonography, venous thrombosis, medicine.disease, EMERGENCY-DEPARTMENT, business, Biomarkers
Abstract

Background Age-adjusted D-dimer has been proposed to increase specificity for the diagnosis of venous thromboembolism (VTE). However, the accuracy of this threshold has been recently questioned. Objectives To assess the diagnostic performance of age-adjusted D-dimer combined with clinical pre-test probability (PTP) in patients with suspected deep vein thrombosis (DVT). Methods PALLADIO (NCT01412242) was a multicentre management study that validated a new diagnostic algorithm, incorporating PTP, D-dimer (using manufacturers’ cut-off), and limited or extended compression ultrasonography (CUS) in outpatients with clinically suspected DVT. Patients with unlikely PTP and negative D-dimer had DVT ruled out without further testing (group 1); patients with likely PTP or positive D-dimer underwent limited-CUS (group 2); patients with likely PTP and positive D-dimer underwent extended-CUS (group 3). Patients with DVT ruled out at baseline had a 3-month follow-up. In this post-hoc analysis we evaluated age-adjusted D-dimer cut-off (defined as age times 10μg/L, or age times 5μg/L for D-dimers with lower manufacturers’ cut-off, in patients >50 years). Results 1162 patients were enrolled. At initial visit, DVT were detected in 4.0% of patients in group 2 and 53.0% in group 3. The age-adjusted D-dimer, compared to the fixed cut-off, resulted in 5.1% (95%CI, 4.0-6.5%) reduction of CUS. The incidence of symptomatic VTE during follow-up was: 0.24% (95%CI, 0.04-1.37) in group 1; 1.12% (95%CI, 0.44-2.85) in group 2; 1.89% (95%CI, 0.64-5.40) in group 3. Conclusions The PALLADIO algorithm using age-adjusted D-dimer slightly decreased the number of required imaging tests, but this approach should be confirmed in large management studies. This article is protected by copyright. All rights reserved.

Published
2018
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4. Timing and characteristics of venous thromboembolism after noncancer surgery

Author

Manuela Expósito-Ruiz, Juan Ignacio Arcelus, Joseph A. Caprini, Cristina López-Espada, Alessandra Bura-Riviere, Cristina Amado, Mónica Loring, Daniela Mastroiacovo, Manuel Monreal, Paolo Prandoni, Benjamin Brenner, Dominique Farge-Bancel, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Sebastian Schellong, Inna Tzoran, Abilio Reis, Marijan Bosevski, Henri Bounameaux, Radovan Malý, Peter Verhamme, Hanh My Bui, M.D. Adarraga, M. Agud, J. Aibar, M.A. Aibar, C. Amado, J.I. Arcelus, C. Baeza, A. Ballaz, R. Barba, C. Barbagelata, M. Barrón, B. Barrón-Andrés, A. Blanco-Molina, E. Botella, A.M. Camon, S. Campos, I. Cañas, I. Casado, J. Castro, J. Criado, C. de Ancos, J. de Miguel, J. del Toro, P. Demelo-Rodríguez, C. Díaz-Pedroche, J.A. Díaz-Peromingo, J. Díez-Sierra, I.M. Domínguez, J.C. Escribano, C. Falgá, A.I. Farfán, K. Fernández de Roitegui, C. Fernández-Aracil, C. Fernández-Capitán, J.L. Fernández-Reyes, M.A. Fidalgo, K. Flores, C. Font, L. Font, I. Francisco, I. Furest, C. Gabara, F. Galeano-Valle, M.A. García, F. García-Bragado, R. García-Hernáez, A. García-Raso, O. Gavín-Sebastián, A. Gil-Díaz, C. Gómez-Cuervo, J. González-Martínez, E. Grau, M. Giménez-Suau, L. Guirado, J. Gutiérrez, L. Hernández-Blasco, E. Hernando, M. Herreros, L. Jara-Palomares, M.J. Jaras, D. Jiménez, R. Jiménez, M.D. Joya, I. Jou, A. Lalueza, R. Lecumberri, J. Lima, P. Llamas, J.L. Lobo, L. López-Jiménez, P. López-Miguel, J.J. López-Núñez, R. López-Reyes, J.B. López-Sáez, A. Lorenzo, M. Loring, O. Madridano, A. Maestre, P.J. Marchena, M. Martín del Pozo, F. Martín-Martos, C. Mella, M. Mellado, M.I. Mercado, J. Moisés, M. Monreal, M.V. Morales, A. Muñoz-Blanco, D. Muñoz-Guglielmetti, N. Muñoz-Rivas, J.A. Nieto, A. Núñez-Ares, M.J. Núñez-Fernández, B. Obispo, M.C. Olivares, J.L. Orcastegui, M.D. Ortega-Recio, J. Osorio, S. Otalora, R. Otero, D. Paredes, P. Parra, V. Parra, J.M. Pedrajas, G. Pellejero, D. Pesántez, J.A. Porras, J. Portillo, A. Riera-Mestre, A. Rivas, F. Rivera, A. Rodríguez-Cobo, C. Rodríguez-Matute, J. Rogado, V. Rosa, C.M. Rubio, P. Ruiz-Artacho, N. Ruiz-Giménez, J. Ruiz-Ruiz, P. Ruiz-Sada, J.C. Sahuquillo, G. Salgueiro, A. Sampériz, J.F. Sánchez-Muñoz-Torrero, T. Sancho, P. Sigüenza, S. Soler, J.M. Suriñach, M.I. Torres, C. Tolosa, J. Trujillo-Santos, F. Uresandi, R. Valle, J.R. Vela, G. Vidal, P. Villares, C. Zamora, P. Gutiérrez, F.J. Vázquez, T. Vanassche, C. Vandenbriele, P. Verhamme, J. Hirmerova, R. Malý, I. Benzidia, L. Bertoletti, A. Bura-Riviere, B. Crichi, P. Debourdeau, O. Espitia, D. Farge-Bancel, H. Helfer, I. Mahé, F. Moustafa, G. Poenou, S. Schellong, A. Braester, B. Brenner, I. Tzoran, F. Bilora, B. Brandolin, E. Bucherini, M. Ciammaichella, D. Colaizzo, P. Di Micco, E. Grandone, D. Marchi, D. Mastroiacovo, R. Maida, F. Pace, R. Pesavento, P. Prandoni, R. Quintavalla, N. Rinzivillo, A. Rocci, C. Siniscalchi, A. Tufano, A. Visonà, B. Zalunardo, V. Gibietis, D. Kigitovica, A. Skride, M. Ferreira, S. Fonseca, F. Martins, J. Meireles, M. Bosevski, G. Krstevski, H. Bounameaux, L. Mazzolai, J.A. Caprini, A.J. Tafur, I. Weinberg, H. Wilkins, H.M. Bui, Exposito-Ruiz, M., Arcelus, J. I., Caprini, J. A., Lopez-Espada, C., Bura-Riviere, A., Amado, C., Loring, M., Mastroiacovo, D., Monreal, M., Prandoni, P., Brenner, B., Farge-Bancel, D., Barba, R., Di Micco, P., Bertoletti, L., Schellong, S., Tzoran, I., Reis, A., Bosevski, M., Bounameaux, H., Maly, R., Verhamme, P., Bui, H. M., Adarraga, M. D., Agud, M., Aibar, J., Aibar, M. A., Baeza, C., Ballaz, A., Barbagelata, C., Barron, M., Barron-Andres, B., Blanco-Molina, A., Botella, E., Camon, A. M., Campos, S., Canas, I., Casado, I., Castro, J., Criado, J., de Ancos, C., de Miguel, J., Toro, J. D., Demelo-Rodriguez, P., Diaz-Pedroche, C., Diaz-Peromingo, J. A., Diez-Sierra, J., Dominguez, I. M., Escribano, J. C., Falga, C., Farfan, A. I., Fernandez de Roitegui, K., Fernandez-Aracil, C., Fernandez-Capitan, C., Fernandez-Reyes, J. L., Fidalgo, M. A., Flores, K., Font, C., Font, L., Francisco, I., Furest, I., Gabara, C., Galeano-Valle, F., Garcia, M. A., Garcia-Bragado, F., Garcia-Hernaez, R., Garcia-Raso, A., Gavin-Sebastian, O., Gil-Diaz, A., Gomez-Cuervo, C., Gonzalez-Martinez, J., Grau, E., Gimenez-Suau, M., Guirado, L., Gutierrez, J., Hernandez-Blasco, L., Hernando, E., Herreros, M., Jara-Palomares, L., Jaras, M. J., Jimenez, D., Jimenez, R., Joya, M. D., Jou, I., Lalueza, A., Lecumberri, R., Lima, J., Llamas, P., Lobo, J. L., Lopez-Jimenez, L., Lopez-Miguel, P., Lopez-Nunez, J. J., Lopez-Reyes, R., Lopez-Saez, J. B., Lorenzo, A., Madridano, O., Maestre, A., Marchena, P. J., Martin del Pozo, M., Martin-Martos, F., Mella, C., Mellado, M., Mercado, M. I., Moises, J., Morales, M. V., Munoz-Blanco, A., Munoz-Guglielmetti, D., Munoz-Rivas, N., Nieto, J. A., Nunez-Ares, A., Nunez-Fernandez, M. J., Obispo, B., Olivares, M. C., Orcastegui, J. L., Ortega-Recio, M. D., Osorio, J., Otalora, S., Otero, R., Paredes, D., Parra, P., Parra, V., Pedrajas, J. M., Pellejero, G., Pesantez, D., Porras, J. A., Portillo, J., Riera-Mestre, A., Rivas, A., Rivera, F., Rodriguez-Cobo, A., Rodriguez-Matute, C., Rogado, J., Rosa, V., Rubio, C. M., Ruiz-Artacho, P., Ruiz-Gimenez, N., Ruiz-Ruiz, J., Ruiz-Sada, P., Sahuquillo, J. C., Salgueiro, G., Samperiz, A., Sanchez-Munoz-Torrero, J. F., Sancho, T., Siguenza, P., Soler, S., Surinach, J. M., Torres, M. I., Tolosa, C., Trujillo-Santos, J., Uresandi, F., Valle, R., Vela, J. R., Vidal, G., Villares, P., Zamora, C., Gutierrez, P., Vazquez, F. J., Vanassche, T., Vandenbriele, C., Hirmerova, J., Benzidia, I., Crichi, B., Debourdeau, P., Espitia, O., Helfer, H., Mahe, I., Moustafa, F., Poenou, G., Braester, A., Bilora, F., Brandolin, B., Bucherini, E., Ciammaichella, M., Colaizzo, D., Grandone, E., Marchi, D., Maida, R., Pace, F., Pesavento, R., Quintavalla, R., Rinzivillo, N., Rocci, A., Siniscalchi, C., Tufano, A., Visona, A., Zalunardo, B., Gibietis, V., Kigitovica, D., Skride, A., Ferreira, M., Fonseca, S., Martins, F., Meireles, J., Krstevski, G., Mazzolai, L., Tafur, A. J., Weinberg, I., and Wilkins, H.

Subjects
Adult, Male, Registrie, medicine.medical_specialty, Time Factors, Time Factor, Duration of risk, 030204 cardiovascular system & hematology, Drug Administration Schedule, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, Deep vein thrombosi, Interquartile range, medicine, Humans, Registries, cardiovascular diseases, 030212 general & internal medicine, Aged, Venous Thrombosis, Benign disease, business.industry, Risk Factor, Incidence (epidemiology), Pulmonary embolism, Anticoagulant, Anticoagulants, Venous Thromboembolism, Heparin, Low-Molecular-Weight, Middle Aged, equipment and supplies, medicine.disease, Thrombosis, Surgery, Time course, Thromboprophylaxi, Female, Postoperative Complication, Cardiology and Cardiovascular Medicine, business, Venous thromboembolism, Human, Surgical patients
Abstract

Background Venous thromboembolism (VTE) is a major cause of morbidity and mortality postoperatively. The use of pharmacologic prophylaxis is effective in reducing the incidence of VTE. However, the prophylaxis is often discontinued at hospital discharge, especially for those with benign disease. The implications of this practice are not known. We assessed the data from a large, ongoing registry regarding the time course of VTE and outcomes after noncancer surgery. Methods We analyzed the RIETE (Computerized Registry on Venous Thromboembolism) registry, which includes data from consecutive patients with symptomatic confirmed VTE. In the present study, we focused on general surgical patients who had developed symptomatic postoperative VTE in the first 8 weeks after noncancer surgery. The main objective was to assess the interval between surgery and the occurrence of VTE. Additional variables included the clinical presentation associated with the event, the use of thrombosis prophylaxis, and unfavorable outcomes. Results The data from 3296 patients were analyzed. The median time from surgery to the detection of VTE was 16 days (interquartile range, 8-30 days). Of the VTE events, 77% were detected after the first postoperative week and 27% after 4 weeks. Overall, 43.9% of the patients with VTE had received pharmacologic prophylaxis after surgery for a median of 8 days (interquartile range, 5-14 days), and three quarters of the VTE events were detected after pharmacologic prophylaxis had been discontinued. Overall, 54% of the patients with VTE had presented with pulmonary embolism. For 15% of the patients, the clinical outcome was unfavorable, including 4% who had died within 90 days. Conclusions The risk of VTE after noncancer general surgery remains high for ≤2 months. More than one half of the patients had presented with symptomatic PE as the VTE event, and 15% had had unfavorable outcomes. Only 44% of these patients had received pharmacologic prophylaxis for around 1 week.

Published
2021
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5. A prospective validation of the Bova score in normotensive patients with acute pulmonary embolism

Author

Loris Roncon, Enrico Bernardi, Alice Spinazzè, Deisy Barrios, Francesco Dentali, Fulvio Morello, Gabriele Viviani, Claudio Poggioni, Iolanda Enea, Sara Giatti, E. Bucherini, Fabrizio Bottino, Peiman Nazerian, Andrés Quezada, M. Vastola, Simone Vanni, L. Sardo, Sofia Barbar, Francesco Crocco, S. Barbar, G. De Morelli, A. Dall' Arche, S. Brescianini, F. Morello, Claudio Picariello, Nicola Mumoli, Raffaele Pesavento, Paolo Prandoni, Eugenio Bucherini, F. Stea, David Jiménez, Massimo Puato, I. Enea, and Carlo Bova

Subjects
Male, medicine.medical_specialty, Hemodynamics, 030204 cardiovascular system & hematology, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Clinical endpoint, Humans, Female, Prognosis, Prospective Studies, Pulmonary Embolism, Hematology, Stage (cooking), Prospective cohort study, business.industry, medicine.disease, Confidence interval, Pulmonary embolism, Increased risk, 030228 respiratory system, Risk assessment, business
Abstract

The Bova score has shown usefulness in the identification of intermediate-high risk patients with acute pulmonary embolism (PE), but lacks prospective validation. The aim of this study was to prospectively validate the Bova score in different settings from the original derivation cohort.Consecutive, normotensive patients with acute PE recruited at 13 academic or general hospitals were stratified, using their baseline data, into the three Bova risk stages (I-III). The primary outcome was the 30-day composite of PE-related mortality, hemodynamic collapse and non-fatal PE recurrences in the three risk categories.In the study period, 639 patients were enrolled. The primary end point occurred in 45 patients (7.0%; 95% Confidence Intervals, 5.2%-9.3%). Risk stage correlated with the PE-related complication rate (stage I, 2.9%; stage II, 17%; stage III, 27%). Patients classified as stage III by the Bova score had a 6.5-fold increased risk for adverse outcomes (3.1-13.5, p 0.001) compared with stages I and II combined. Rescue thrombolysis increased from stage I to stage III (0.6%, 12% and 15% respectively). All-cause mortality (5.3%) did not substantially differ among the stages.The Bova score accurately stratifies normotensive patients with acute PE into stages of increasing risk of 30-day PE-related complications.

Published
2018

6. Vitamin K Antagonists After 6 Months of Low-Molecular-Weight Heparin in Cancer Patients with Venous Thromboembolism

Author

Chatree Chai-Adisaksopha, Alfonso Iorio, Mark A. Crowther, Javier de Miguel, Estuardo Salgado, Marija Zdraveska, Carmen Fernández-Capitán, José Antonio Nieto, Giovanni Barillari, Laurent Bertoletti, Manuel Monreal, M.A. Aibar, J.I. Arcelus, A. Ballaz, R. Barba, M. Barrón, B. Barrón-Andrés, J. Bascuñana, A. Blanco-Molina, T. Bueso, B. Calvo, G. Cañada, I. Cañas, I. Casado, A. Culla, J. de Miguel, J. del Toro, J.A. Díaz-Peromingo, C. Falgá, C. Fernández-Capitán, C. Font, L. Font, P. Gallego, F. García-Bragado, V. Gómez, J. González, E. Grau, M. Guil, L. Guirado, J. Gutiérrez, G. Hernández, L. Hernández-Blasco, V. Isern, L. Jara-Palomares, M.J. Jaras, D. Jiménez, B. Lacruz, R. Lecumberri, J.L. Lobo, L. López-Jiménez, R. López-Reyes, J.B. López-Sáez, M.A. Lorente, A. Lorenzo, O. Madridano, A. Maestre, I. Manrique-Abos, P.J. Marchena, J.M. Martín-Antorán, F. Martín-Martos, M. Monreal, M.V. Morales, R. Morillo, D. Nauffal, J.A. Nieto, S. Nieto, M.J. Núñez, M. Odriozola, S. Otalora, R. Otero, B. Pagán, J.M. Pedrajas, C. Pérez, M.L. Peris, I. Pons, J.A. Porras, L. Ramirez, A. Riera, A. Rivas, C. Rodríguez, M.A. Rodríguez-Dávila, V. Rosa, N. Ruiz-Giménez, A. Sampériz, R. Sánchez, M.C. Sala, J.C. Sahuquillo, O. Sanz, S. Soler, I. Suárez-González, J.M. Suriñach, G. Tiberio, C. Tolosa, J. Trujillo-Santos, F. Uresandi, B. Valero, R. Valle, J. Vela, M.P. Vicente, G. Vidal, V. Vilella-Tomás, J. Villalta, P.C. Malfante, T. Vanassche, P. Verhamme, P. Wells, J. Hirmerova, R. Malý, T. Tomko, G. Celis, E. Salgado, G.T. Sánchez, L. Bertoletti, A. Bura-Riviere, D. Farge-Bancel, A. Hij, I. Mahé, A. Merah, I. Quere, M. Papadakis, A. Braester, B. Brenner, I. Tzoran, A. Apollonio, G. Barillari, A. Bertone, F. Bilora, E. Bucherini, G. Candelero, M. Ciammaichella, P. Di Micco, P. Ferrazzi, E. Grandone, G. Lessiani, C. Lodigiani, D. Mastroiacovo, F. Pace, R. Pesavento, M. Pinelli, P. Prandoni, M. Rosa, L. Rota, E. Tiraferri, D. Tonello, A. Tufano, U. Venturelli, A. Visonà, B. Zalunardo, E. Drucka, D. Kigitovica, A. Skride, M.S. Sousa, M. Bosevski, M. Zdraveska, H. Bounameaux, L. Mazzolai, and J.C. Serrano

Subjects
Male, medicine.medical_specialty, Vitamin K, medicine.drug_class, Deep vein, Low molecular weight heparin, Anticoagulants, Cancer, Low-molecular-weight heparin, Thromboembolism, Warfarin, 030204 cardiovascular system & hematology, Recurrent deep vein thrombosis, 03 medical and health sciences, 0302 clinical medicine, Recurrence, Neoplasms, medicine, Humans, Registries, Propensity Score, Aged, Retrospective Studies, business.industry, Retrospective cohort study, General Medicine, Venous Thromboembolism, Heparin, Low-Molecular-Weight, medicine.disease, Thrombosis, Pulmonary embolism, Surgery, Venous thrombosis, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Female, business, medicine.drug
Abstract

BACKGROUND: Low-molecular-weight heparin (LMWH) is the treatment of choice in cancer patients with venous thromboembolism. However, data on continuing LMWH treatment beyond 6 months remain scanty. METHODS: We used the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry to compare the rate of venous thromboembolism recurrences and major bleeding appearing beyond the first 6 months of anticoagulant therapy in cancer patients with venous thromboembolism, according to therapy with LMWH or vitamin K antagonists (VKA). We performed a propensity score-matched cohort study. RESULTS: After propensity matching, 482 cancer patients continued to receive LMWH and 482 switched to VKA. During the course of anticoagulant therapy (mean 275.5 days), 57 patients developed venous thrombosis recurrences (recurrent pulmonary embolism 26, recurrent deep vein thrombosis 29, both 2), 28 had major bleeding, 38 had nonmajor bleeding, and 129 died. No patient died of recurrent venous thrombosis, and 5 patients died of bleeding (2 were on LMWH, 3 on VKA). Patients who continued with LMWH had a similar rate of deep vein thrombosis recurrences (relative risk [RR] 1.41; 95% confidence interval [CI], 0.68-2.93), pulmonary embolism recurrences (RR 0.73; 95% CI, 0.34-1.58), major bleeding (RR 0.96; 95% CI, 0.51-1.79), or nonmajor bleeding (RR 1.15; 95% CI, 0.55-2.40), compared with those who switched to VKA, but a higher mortality rate (RR 1.58; 95% CI, 1.13-2.20). CONCLUSIONS: In cancer patients with venous thromboembolism who completed 6 months of LMWH therapy, switching to VKA was associated with a similar risk of venous thrombosis recurrences or bleeding when compared with patients who continued LMWH. (C) 2018 Elsevier Inc. All rights reserved.

Published
2017

7. DVT Management and Outcome Trends, 2001 to 2014

Author

Raquel Morillo, David Jiménez, Miguel Ángel Aibar, Daniela Mastroiacovo, Philip S. Wells, Ángel Sampériz, Marta Saraiva de Sousa, Alfonso Muriel, Roger D. Yusen, Manuel Monreal, Hervè Decousus, Paolo Prandoni, Benjamin Brenner, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Sebastian Schellong, Inna Tzoran, Abilio Reis, Marijan Bosevski, Henri Bounameaux, Radovan Malý, Philip Wells, Manolis Papadakis, P. Agudo, M.A. Aibar, M. Akasbi, M. Alcalde-Manero, V. Andújar, J.I. Arcelus, A. Ballaz, R. Barba, M. Barrón, B. Barrón-Andrés, J. Bascuñana, A. Blanco-Molina, I. Cañas, I. Casado, J. de Miguel, J. del Toro, S. Díaz, J.A. Díaz-Peromingo, C. Falgá, C. Fernández-Capitán, C. Font, L. Font, P. Gallego, F. García-Bragado, M. García-Rodenas, V. Gómez, C.J. González, E. Grau, L. Guirado, J. Gutiérrez, G. Hernández, L. Hernández-Blasco, V. Isern, L. Jara-Palomares, M.J. Jaras, D. Jiménez, J.L. Lobo, L. López-Jiménez, R. López-Reyes, J.B. López-Sáez, M.A. Lorente, A. Lorenzo, O. Madridano, A. Maestre, P.J. Marchena, M. Martín, J.M. Martín-Antorán, F. Martín-Martos, M. Monreal, M.V. Morales, D. Nauffal, J.A. Nieto, S. Nieto, M.J. Núñez, C. Orbegoso, S. Otalora, R. Otero, B. Pagán, J.M. Pedrajas, C. Pérez, G. Pérez, M.L. Peris, I. Pons, J.A. Porras, O. Reig, A. Riera-Mestre, A. Rivas, C. Rodríguez, M.A. Rodríguez-Dávila, V. Rosa, A.S. Rosa-Murillo, N. Ruiz-Giménez, J.C. Sahuquillo, M.C. Sala, A. Sampériz, R. Sánchez, O. Sanz, S. Soler, J.M. Suriñach, C. Tolosa, J. Trujillo-Santos, F. Uresandi, B. Valero, R. Valle, J. Vela, G. Vidal, C. Vilar, J. Villalta, B. Xifre, T. Vanassche, P. Verhamme, P. Wells, J. Hirmerova, R. Malý, T. Tomko, G. Celis, E. Salgado, G.T. Sánchez, L. Bertoletti, A. Bura-Riviere, D. Farge-Bancel, A. Hij, I. Mahé, A. Merah, I. Quere, M. Papadakis, A. Braester, B. Brenner, I. Tzoran, A. Apollonio, G. Barillari, A. Bertone, F. Bilora, E. Bucherini, M. Ciammaichella, P. De Ciantis, F. Dentali, P. Di Micco, R. Duce, P. Ferrazzi, E. Grandone, G. Lessiani, C. Lodigiani, D. Mastroiacovo, F. Pace, R. Pesavento, M. Pinelli, R. Poggio, P. Prandoni, M. Rosa, L. Rota, E. Tiraferri, D. Tonello, A. Tufano, U. Venturelli, A. Visonà, B. Zalunardo, E. Drucka, D. Kigitovica, A. Skride, A. Mafalda, J.L. Ribeiro, M.S. Sousa, M. Bosevski, M. Zdraveska, H. Bounameaux, L. Mazzolai, Morillo, R., Jimenez, D., Aibar, M. A., Mastroiacovo, D., Wells, P. S., Samperiz, A., Saraiva de Sousa, M., Muriel, A., Yusen, R. D., Monreal, M., Decousus, H., Prandoni, P., Brenner, B., Barba, R., Di Micco, P., Bertoletti, L., Schellong, S., Tzoran, I., Reis, A., Bosevski, M., Bounameaux, H., Maly, R., Wells, P., Papadakis, M., Agudo, P., Akasbi, M., Alcalde-Manero, M., Andujar, V., Arcelus, J. I., Ballaz, A., Barron, M., Barron-Andres, B., Bascunana, J., Blanco-Molina, A., Canas, I., Casado, I., de Miguel, J., del Toro, J., Diaz, S., Diaz-Peromingo, J. A., Falga, C., Fernandez-Capitan, C., Font, C., Font, L., Gallego, P., Garcia-Bragado, F., Garcia-Rodenas, M., Gomez, V., Gonzalez, C. J., Grau, E., Guirado, L., Gutierrez, J., Hernandez, G., Hernandez-Blasco, L., Isern, V., Jara-Palomares, L., Jaras, M. J., Lobo, J. L., Lopez-Jimenez, L., Lopez-Reyes, R., Lopez-Saez, J. B., Lorente, M. A., Lorenzo, A., Madridano, O., Maestre, A., Marchena, P. J., Martin, M., Martin-Antoran, J. M., Martin-Martos, F., Morales, M. V., Nauffal, D., Nieto, J. A., Nieto, S., Nunez, M. J., Orbegoso, C., Otalora, S., Otero, R., Pagan, B., Pedrajas, J. M., Perez, C., Perez, G., Peris, M. L., Pons, I., Porras, J. A., Reig, O., Riera-Mestre, A., Rivas, A., Rodriguez, C., Rodriguez-Davila, M. A., Rosa, V., Rosa-Murillo, A. S., Ruiz-Gimenez, N., Sahuquillo, J. C., Sala, M. C., Sanchez, R., Sanz, O., Soler, S., Surinach, J. M., Tolosa, C., Trujillo-Santos, J., Uresandi, F., Valero, B., Valle, R., Vela, J., Vidal, G., Vilar, C., Villalta, J., Xifre, B., Vanassche, T., Verhamme, P., Hirmerova, J., Tomko, T., Celis, G., Salgado, E., Sanchez, G. T., Bura-Riviere, A., Farge-Bancel, D., Hij, A., Mahe, I., Merah, A., Quere, I., Braester, A., Apollonio, A., Barillari, G., Bertone, A., Bilora, F., Bucherini, E., Ciammaichella, M., De Ciantis, P., Dentali, F., Duce, R., Ferrazzi, P., Grandone, E., Lessiani, G., Lodigiani, C., Pace, F., Pesavento, R., Pinelli, M., Poggio, R., Rosa, M., Rota, L., Tiraferri, E., Tonello, D., Tufano, A., Venturelli, U., Visona, A., Zalunardo, B., Drucka, E., Kigitovica, D., Skride, A., Mafalda, A., Ribeiro, J. L., Sousa, M. S., Zdraveska, M., and Mazzolai, L.

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Vena Cava Filters, Hemorrhage, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Rate ratio, survival, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Cause of Death, medicine, Humans, Thrombolytic Therapy, Registries, 030212 general & internal medicine, Mortality, Population Growth, Intensive care medicine, Aged, Retrospective Studies, Aged, 80 and over, Venous Thrombosis, business.industry, Anticoagulants, Disease Management, Heparin, Low-Molecular-Weight, Length of Stay, Middle Aged, Prognosis, medicine.disease, Pulmonary embolism, Emergency medicine, Female, Cardiology and Cardiovascular Medicine, business, Venous thromboembolism, Hospital stay, DVT, prognosi
Abstract

Background A comprehensive evaluation of temporal trends in the treatment of patients who have DVT may assist with identification of modifiable factors that contribute to short-term outcomes. Methods We assessed temporal trends in length of hospital stay and use of pharmacological and interventional therapies among 26,695 adults with DVT enrolled in the Registro Informatizado de la Enfermedad TromboEmbólica registry between 2001 and 2014. We also examined temporal trends in risk-adjusted rates of all-cause, pulmonary embolism-related, and bleeding-related death to 30 days after diagnosis. Results The mean length of hospital stay decreased from 9.0 days in 2001 to 2005 to 7.6 days in 2010 to 2014 (P

Published
2016

8. A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the upper extremity

Author

V. Rosa‐Salazar, J. Trujillo‐Santos, J.A. Díaz Peromingo, A. Apollonio, O. Sanz, R. Malý, F.J. Muñoz‐Rodriguez, J.C. Serrano, S. Soler, M. Monreal, H. Decousus, P. Prandoni, B. Brenner, R. Barba, P. Di Micco, L. Bertoletti, S. Schellong, I. Tzoran, A. Reis, M. Bosevski, H. Bounameaux, P. Wells, M. Papadakis, M.D. Adarraga, A. Alibalic, A. Alvarado‐Faria, J.I. Arcelus, T. Auguet, A. Ballaz, M. Barrón, B. Barrón‐Andrés, J. Bascuñana, J.F. Benítez, A. Blanco‐Molina, T. Bueso, A. Cañas, A. Casado, N. Castejón‐Pina, E.L. Chaves, F del Molino, J del Toro, C. Falgá, C. Fernández‐Capitán, L. Font, P. Gallego, F. García‐Bragado, A. García‐Ortega, V. Gómez, J. González, D. González‐Marcano, E. Grau, R. Guijarro, M. Guil, L. Guirado, J. Gutiérrez‐Guisado, L. Hernández‐Blasco, L. Jara‐Palomares, M.J. Jaras, D. Jiménez, R. Jiménez, B. Lacruz, R. Lecumberri, J.L. Lobo, L. López‐Jiménez, L. López‐Montes, R. López‐Reyes, J.B. López‐Sáez, M.A. Lorente, A. Lorenzo, O. Madridano, A. Maestre, P.J. Marchena, J.M. Martín‐Antorán, F. Martín‐Martos, M.V. Morales, D. Nauffal, J.A. Nieto, M.J. Núñez, S. Otalora, R. Otero, B. Pagán, J.M. Pedrajas, M.L. Peris, I. Pons, J.A. Porras, A. Riera‐Mestre, A. Rivas, M.A. Rodríguez‐Dávila, N. Ruiz‐Giménez, P. Sabio, A. Sampériz, R. Sánchez, M.J. Soto, J.M. Suriñach, G. Tiberio, R. Tirado, C. Tolosa, F. Uresandi, B. Valero, R. Valle, J. Vela, A. Villalobos, J. Villalta, P. Malfante, P. Verhamme, T. Vanassche, T. Tomko, J. Hirmerova, A. Bura‐Riviere, D. Farge‐Bancel, A. Hij, I. Mahe, A. Merah, F. Moustafa, I. Quere, D. Babalis, I. Tzinieris, A. Braester, G. Barillari, E. Bucherini, J. Campodomico, M. Ciammaichella, P. Ferrazzi, R. Maida, F. Pace, S. Pasca, R. Pesavento, C. Piovella, L. Rota, E. Tiraferri, A. Tufano, A. Visonà, A. Skride, A. Belovs, M. Moreira, J.L. Ribeiro, M.S. Sousa, A. Alatri, L. Calanca, L. Mazzolai, Rosa-Salazar, V., Trujillo-Santos, J., Diaz Peromingo, J. A., Apollonio, A., Sanz, O., Maly, R., Munoz-Rodriguez, F. J., Serrano, J. C., Soler, S., Monreal, M., Decousus, H., Prandoni, P., Brenner, B., Barba, R., Di Micco, P., Bertoletti, L., Schellong, S., Tzoran, I., Reis, A., Bosevski, M., Bounameaux, H., Wells, P., Papadakis, M., Adarraga, M. D., Alibalic, A., Alvarado-Faria, A., Arcelus, J. I., Auguet, T., Ballaz, A., Barron, M., Barron-Andres, B., Bascunana, J., Benitez, J. F., Blanco-Molina, A., Bueso, T., Canas, A., Casado, A., Castejon-Pina, N., Chaves, E. L., del Molino, F., del Toro, J., Diaz, J. A., Falga, C., Fernandez-Capitan, C., Font, L., Gallego, P., Garcia-Bragado, F., Garcia-Ortega, A., Gomez, V., Gonzalez, J., Gonzalez-Marcano, D., Grau, E., Guijarro, R., Guil, M., Guirado, L., Gutierrez-Guisado, J., Hernandez-Blasco, L., Jara-Palomares, L., Jaras, M. J., Jimenez, D., Jimenez, R., Lacruz, B., Lecumberri, R., Lobo, J. L., Lopez-Jimenez, L., Lopez-Montes, L., Lopez-Reyes, R., Lopez-Saez, J. B., Lorente, M. A., Lorenzo, A., Madridano, O., Maestre, A., Marchena, P. J., Martin-Antoran, J. M., Martin-Martos, F., Montreal, M., Morales, M. V., Nauffal, D., Nieto, J. A., Nunez, M. J., Otalora, S., Otero, R., Pagan, B., Pedrajas, J. M., Peris, M. L., Pons, I., Porras, J. A., Riera-Mestre, A., Rivas, A., Rodriguez-Davila, M. A., Ruiz-Gimenez, N., Sabio, P., Samperiz, A., Sanchez, R., Soto, M. J., Surinach, J. M., Tiberio, G., Tirado, R., Tolosa, C., Uresandi, F., Valero, B., Valle, R., Vela, J., Villalobos, A., Verhamme, P., Tomko, T., Villalta, J., Malfante, P., Mahe, I., Vanassche, T., Moustafa, F., Babalis, D., Hirmerova, J., Barillari, G., Bucherini, E., Farge-Bance, D., Ciammaichella, M., Ferrazzi, P., Maida, R., Pace, F., Quere, I., Pesavento, R., Piovella, C., Rota, L., Tzinieris, I., Tufano, A., Skride, A., Moreira, M., Ribeiro, J. L., Alatri, A., Calanca, L., Visona, A., Belovs, A., Sousa, M. S., Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), and Université Montpellier 1 (UM1)-Université de Montpellier (UM)

Subjects
Adult, Male, Canada, medicine.medical_specialty, Time Factors, Upper extremity, Deep vein, Renal function, Hemorrhage, Risk Assessment, deep vein thrombosis, Decision Support Techniques, Hospital, Predictive Value of Tests, Risk Factors, Deep vein thrombosi, Upper Extremity Deep Vein Thrombosis, Humans, Medicine, Registries, Israel, Adverse effect, Anticoagulant therapy, Aged, Outcome, Deep vein thrombosis, Outpatients, Anticoagulants, Europe, Female, Middle Aged, Pulmonary Embolism, South America, Treatment Outcome, business.industry, Cancer, Outpatient, [SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology, Hematology, medicine.disease, Thrombosis, Confidence interval, 3. Good health, Pulmonary embolism, Surgery, outpatients, medicine.anatomical_structure, Heart failure, business
Abstract

International audience; BACKGROUND:No studies have identified which patients with upper-extremity deep vein thrombosis (DVT) are at low risk for adverse events within the first week of therapy.METHODS:We used data from Registro Informatizado de la Enfermedad TromboEmbólica to explore in patients with upper-extremity DVT a prognostic score that correctly identified patients with lower limb DVT at low risk for pulmonary embolism, major bleeding, or death within the first week.RESULTS:As of December 2014, 1135 outpatients with upper-extremity DVT were recruited. Of these, 515 (45%) were treated at home. During the first week, three patients (0.26%) experienced pulmonary embolism, two (0.18%) had major bleeding, and four (0.35%) died. We assigned 1 point to patients with chronic heart failure, creatinine clearance levels 30-60 mL min(-1) , recent bleeding, abnormal platelet count, recent immobility, or cancer without metastases; 2 points to those with metastatic cancer; and 3 points to those with creatinine clearance levels < 30 mL min(-1) . Overall, 759 (67%) patients scored ≤ 1 point and were considered to be at low risk. The rate of the composite outcome within the first week was 0.26% (95% confidence interval [CI] 0.004-0.87) in patients at low risk and 1.86% (95% CI 0.81-3.68) in the remaining patients. C-statistics was 0.73 (95% CI 0.57-0.88). Net reclassification improvement was 22%, and integrated discrimination improvement was 0.0055.CONCLUSIONS:Using six easily available variables, we identified outpatients with upper-extremity DVT at low risk for adverse events within the first week. These data may help to safely treat more patients at home.

Published
2015
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9. Long-term mortality and its predictors in patients with critical leg ischaemia

Author

G Marino, H Correra, A Notarbartolo, A Costantini, J Pangrazzi, Ar Todini, G Regina, G Fellin, E Ferrari, M Bellone, L Irace, M Fontanili, W Visconti, D Vanni, G Tognoni, F Colombo, G Lombardi, T Bruni, Bertele, L Mozzon, R De Angelis, A Traversaro, P Pola, E Fedeli, E Pavarini, S Garattini, D Calzoni, A Podestà, R Marrocu, R Rossi, Dorucci, P Fiorani, Piglionica, E Vedovato, Di Giovanani, G Del Carratore, G Tonietto, I Dell'Olivo, Piergiorgio Cao, M Salvini, Gb Ponti, M Sforza, L Miglierina, C Santirocco, S Mazzucchetti, E Ponzio, Gl Petrilli, I Cassina, F Vatteroni, M Belvedere, Gc Botta, D Guidetti, P Tenchini, C Setacci, E Mosca, A Marcialis, M Filippini, M Altieri, C Corsi, C Pratesi, D Bertini, F Avanzini, C Costanzo, G Ioannidis, Elmo Mannarino, E Lavorato, G Petralia, L Maffei, P Bedoni, E Alò, Gm Andreozzi, G Emanuelli, Gm Losapio, Ea Belgrano, S Romeo, S Signorelli, G Vigliotti, G Pamich, G De Gaetano, Aa Dal Lago, M Medori, A Puzzo, Gb Agus, M Fullone, G Bittolo Bon, M Pascali, A Guala, M Grilli, A Moratti, E Bucherini, Mc Bordoni, Roberto Lonardi, M Cecchi, A Guastini, L Nardella, Gm Biasi, E Benedetti Valentini, M. C. Roncaglioni, A Visona, C Giansante, M Taurino, R Ambrosi, M Florena, L Ralli, P Valitutti, E Delmonte, A Pagnan, C Spartera, D Palombo, Della Vedova, N Zocca, L Lucentini, M Bartolo, G Agrifoglio, E Borgatti, N Zinicola, I Urban, G Baldino, N Fiotti, L Graziano, E Nessi, D Frigerio, E Agresta, L Gracco, G. Tuscano, R Russo, G Samori, E Banchini, S Berra, A Odero, M Ieran, Inzoli, F Baglietto, G Marcon, R Martini, G Maniscalco, C Flandoli, P Brustia, S Rizzo, R Colli, A Grasso, A Bigalli, L Di Pino, A Grossi, E. Rolli, C Cordiano, E Marrapodi, E Burigo, P Tarantola, N Gonano, Fabio Verzini, M Pollastri, and G Pedeferri

Subjects
medicine.medical_specialty, business.industry, Critical leg ischaemia, Ischemia, medicine.disease, Internal medicine, Peripheral vascular disease, medicine, Cardiology, Surgery, Long term mortality, In patient, Predictive variables, Mortality, Cardiology and Cardiovascular Medicine, business
Abstract

Objective:To assess the predictivity of predefined variables with respect to long-term mortality in a cohort of patients with chronic critical leg ischaemia (CLI).Design:Prospective observational study.Methods:Census offices were asked to release information on survival or death status of 574 patients with CLI 2 years after their recruitment in the study.Results:Of 522 patients with available information, 165 (31.6%) died within 2 years of hospital admission, mostly from vascular causes as expected. Among the variables considered, male sex, current smoking, arterial hypertension, diabetes mellitus, hypercholesterolaemia, obesity, history of myocardial infarction and low ankle systolic pressure showed no univariate association with mortality. The multivariate analysis also excluded revascularisation procedures and the Fontaine stage as prognostic factors in terms of mortality. Besides age ≥ 70 years (relative risk, RR 1.94; 95% confidence interval (CI) 1.37–2.70), only a history of stroke (RR 1.82; 95% CI 1.19–2.79) and major amputation (RR 1.90; 95% CI 1.30–2.80) were significantly associated with mortality.Conclusions:CLI is a clinical condition of such severity that most of the recognised cardiovascular risk factors cannot further influence the fate of the patients, one-third of whom die within 2 years.

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10. A prospective epidemiological survey of the natural history of chronic critical leg ischaemia

Author

M Belvedere, G Fellin, E Ponzio, P Tenchini, M Bellone, L Di Pino, E. Rolli, W Visconti, S Romeo, C Setacci, Elmo Mannarino, F Colombo, Aa Dal Lago, S Berra, M Ieran, G Petralia, Ea Belgrano, L Mozzon, L Lucentini, M Bartolo, R De Angelis, M Medori, G Lombardi, D Frigerio, A Traversaro, F Vatteroni, E Marrapodi, G Ioannidis, M Salvini, G Baldino, A Guastini, E Agresta, H Correra, G De Gaetano, G Vigliotti, P Pola, R Russo, D Calzoni, A Visona, F Avanzini, S Garattini, C Flandoli, E Fedeli, D Palombo, A Odero, E Ferrari, C Spartera, E Favretti, R Rossi, Gl Petrilli, R Ambrosi, I Cassina, G Bittolo Bon, M Pascali, R Colli, C Costanzo, L Maffei, M Cecchi, N Gonano, E Nessi, E Benedetti Valentini, F Baglietto, G Maniscalco, S Rizzo, M Sforza, E Burigo, E Banchini, R Marrocu, S Signorelli, Mc Bordoni, G Samori, Gb Agus, A Guala, P Brustia, Ar Todini, Piglionica, G Regina, M Fullone, A Notarbartolo, D Bertini, Fabio Verzini, A Costantini, Dorucci, Della Vedova, G Tognoni, M Pollastri, P Bedoni, J Pangrazzi, E Vedovato, A Bigalli, M Taurino, A Puzzo, L Nardella, Gm Biasi, M Florena, P Valitutti, C Corsi, G Tonietto, Piergiorgio Cao, E Pavarini, L Ralli, G Marino, L Miglierina, A Pagnan, E Delmonte, E Mosca, A Marcialis, R Martini, C Giansante, G Agrifoglio, G Pedeferri, G Emanuelli, Coppi Ridolfi, N Fiotti, L Graziano, N Zocca, D Guidetti, I Urban, Inzoli, Gm Andreozzi, C Pratesi, E Bucherini, M Filippini, Roberto Lonardi, A Grasso, G. Tuscano, A Grossi, C Cordiano, M Fontanili, E Alò, Gm Losapio, T Bruni, Bertele, G Marcon, P Fiorani, A Podestà, Di Giovanani, G Del Carratore, I Dell'Olivo, Gb Ponti, P Tarantola, C Santirocco, S Mazzucchetti, Gc Botta, L Gracco, E Lavorato, L Irace, E Borgatti, N Zinicola, M Altieri, G Pamich, M Grilli, A Moratti, M. C. Roncaglioni, D Vanni, and L Pasqualini

Subjects
medicine.medical_specialty, business.industry, Epidemiology, Critical leg ischaemia, Ischemia, medicine.disease, Natural history, Peripheral vascular disease, medicine, Physical therapy, Surgery, Cardiology and Cardiovascular Medicine, Intensive care medicine, business
Abstract

Objective:To draw a picture of the different practices adopted for the diagnosis, specific treatment and general care of critical leg ischaemia (CLI) in the light of the recommendations of the recent Consensus Document.Design:Prospective observational study.Setting:A representative sample of vascular and general surgery, angiology, general medicine departments of the Italian National Health Service.Subjects:Patients with leg ischaemia considered as chronic and critical according to the definition and diagnostic criteria adopted in each centre.Chief outcome measures:Epidemiological profile of the standard population; prevalence of definition criteria and of diagnostic and therapeutic procedures; short and medium-term clinical outcome as well as of the general vascular morbidity and mortality.Main results:Over a 3 month period, 574 patients were recruited in 69 centres mainly on the basis of clinical findings of CLI (rest pain and/or trophic lesions). They had an adequate diagnostic assessment of their vascular lesions and a high cardiovascular risk in terms of prior morbidity and presence of risk factors. Over half of the patients underwent revascularisation and three quarters were given pharmacological treatments. At the end of the observation period, 50 patients had died (8.7%), three had had a myocardial infarction (0.5%), six a stroke (1.0%), 70 a major amputation (12.2%) and 103 had persistent CLI (17.9%).Conclusions:This survey confirms the dramatic prognosis of patients with CLI and provides an appropriate background and setting to conduct experimental clinical studies in this field.

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11. D-dimer and reduced dose apixaban for extended treatment after unprovoked venous thromboembolism: the Apidulcis study

Author

Palareti, G., Poli, D., Pesavento, R., Legnani, C., Antonucci, E., Bucherini, E., Testa, S., Paoletti, O., Chistolini, A., Ceccato, D., Martinelli, I., Bucciarelli, P., Falanga, A., Tosetto, A., Sarti, L., Mastroiacovo, D., Cosmi, B., Visona, A., Santoro, R. C., Zanatta, N., Grandone, E., Bertu, L., Pengo, V., Caiano, L., Prandoni, P., Lotti, E., Crudele, F., Ageno, W., Abenante, A., Colombo, G., Guarascio, M., Cancellieri, E., Morandini, R., Zambelli, S., Martini, S., Vastola, M., Serrao, A., Abbattista, M., Artoni, A., Capecchi, M., Gianniello, F., Scimeca, B., Barcella, L., Gamba, S., Lerede, T., Maggioni, A., Schieppati, F., Russo, L., Zunino, F., Artuso, A., Bellesso, S., Cadau, J., Carli, G., Nichele, I., Perbellini, O., Caronna, A., Gabrielli, F., Lami, F., Nicolini, A., Scaglioni, F., Pinelli, M., Desideri, G., Borgese, L., Favaretto, E., Libra, A., Migliaccio, L., Sartori, M., Panzavolta, C., Scandiuzzi, T., Zalunardo, B. -M., Ierardi, A., Leotta, M., Strangio, A., Guzzon, S., Colaizzo, D., Favuzzi, G., Lombardi, M. R., Ferrini, P. M., Tassoni, M. I., Corradini, S., Iotti, M., Lambertini, I., Veropalumbo, M. R., Lessiani, G., Parisi, R., Bortoluzzi, C., H. N., Vo, Chiarugi, P., Casini, M., Violo, C., Nuti, M., Angeloni, L., Carrozzi, L., Pancani, R., Chimera, D., Conti, V., Meschi, C., Cattaneo, M., Podda, G., Birocchi, S., Cuppini, S., Marzolo, M., Milan, M., Martini, G., Merelli, S., Pontoglio, S., Portesi, N., Villalta, S., De Lucchi, L., Sponghiado, A., Becattini, C., Giustozzi, M., Vinci, A., Pignatelli, P., Bucci, T., Menichelli, D., Pastori, D., Pomero, F., Casalis, S., Galli, E., Ciammaichella, M., Maida, R., De Cristofaro, R., Alberelli, M. A., Basso, M. R., De Candia, E., Di Gennaro, L., Mumoli, N., Capra, R., Orlando, M., Porta, C., Rotiroti, G., Demarco, M., Petrillo, P., Rossi, E., Bartolomei, F., Soldati, D., Russo, U., Burgo, I., Ziliotti, M., Pataccini, C., Terroni, L., Ugolotti, M. C., Di Giorgio, A., Cavagna, L., Mete, F., Gino, M., Santoro, A., De Carlo, A., Cappelli, R., Bicchi, M., Dyrmo, L., Grifoni, E., Masotti, L., Ria, L., Spagnolo, M., Rupoli, S., Federici, I., Morsia, E., Scortechini, A. R., Torre, E., Franchini, M., Montorsi, P., Galgano, G., De Luca, A., Muiesan, M. L., Paini, A., Stassaldi, D., Denas, G., and Palareti G, Poli D, Ageno W, Legnani C, Antonucci E, Bucherini E, Testa S, Paoletti O, Chistolini A, Serrao A, Martinelli I, Bucciarelli P, Falanga A, Tosetto A, Sarti L, Mastroiacovo D, Cosmi B, Visonà A, Santoro RC, Zanatta N, Grandone E, Bertù L, Pengo V, Caiano LM, Prandoni P

Subjects
venous thromboembolism, d-dimer, anticoagulation therapy, apixaban, anticoagulation therapy, Recurrence, Settore MED/09 - MEDICINA INTERNA, D-dimer, venous thromboembolism, oral anticoagulants, apixaban, Humans, Anticoagulants, Hematology, Prospective Studies, Venous Thromboembolism, d-dimer
Abstract

D-dimer assay is used to stratify patients with unprovoked venous thromboembolism (VTE) for the risk of recurrence. However, this approach was never evaluated since direct oral anticoagulants are available. With this multicenter, prospective cohort study, we aimed to assess the value of an algorithm incorporating serial D-dimer testing and administration of reduced-dose apixaban (2.5 mg twice daily) only to patients with a positive test. A total of 732 outpatients aged 18 to 74 years, anticoagulated for ≥12 months after a first unprovoked VTE, were included. Patients underwent D-dimer testing with commercial assays and preestablished cutoffs. If the baseline D-dimer during anticoagulation was negative, anticoagulation was stopped and testing repeated after 15, 30, and 60 days. Patients with serially negative results (286 [39.1%]) were left without anticoagulation. At the first positive result, the remaining 446 patients (60.9%) were given apixaban for 18 months. All patients underwent follow-up planned for 18 months. The study was interrupted after a planned interim analysis for the high rate of primary outcomes (7.3%; 95% confidence interval [CI], 4.5-11.2), including symptomatic proximal deep vein thrombosis (DVT) or pulmonary embolism (PE) recurrence, death for VTE, and major bleeding occurring in patients off anticoagulation vs that in those receiving apixaban (1.1%; 95% CI, 0.4-2.6; adjusted hazard ratio [HR], 8.2; 95% CI, 3.2-25.3). In conclusion, in patients anticoagulated for ≥1 year after a first unprovoked VTE, the decision to further extend anticoagulation should not be based on D-dimer testing. The results confirmed the high efficacy and safety of reduced-dose apixaban against recurrences. This trial was registered at www.clinicaltrials.gov as #NCT03678506.

Published
2022

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