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1. D-dimer levels and 90-day outcome in patients with acute pulmonary embolism with or without cancer

Author

Ana, Maestre, Javier Trujillo Santos, Adriana, Visoná, José Luís Lobo, Enric, Grau, Radovan, Malý, Rita, Duce, Manuel, Monreal, Alcalde, M, Arcelus, Ji, Ballaz, A, Barba, R, Barrón, M, Barrón Andrés, B, Bascuñana, J, Bedate, P, Blanco Molina, A, Bueso, T, Casado, I, Conget, F, del Molino, F, del Toro, J, Falgá, C, Fernández Capitán, C, Fuentes, Mi, Gallego, P, García, J, García Bragado, F, Gavín, O, Gómez, V, González, J, González Bachs, E, Grau, E, Guil, M, Guijarro, R, Gutiérrez, J, Hernández, L, Jara Palomares, L, Jaras, Mj, Jiménez, D, Jiménez, S, Lobo, Jl, López Jiménez, L, López Sáez JB, Lorente, Ma, Lorenzo, A, Luque, Jm, Madridano, O, Macià, M, Maestre, A, Marchena, Pj, Martín, M, Monreal, M, Mora, Jm, Muñoz, Fj, Nauffal, Md, Nieto, Ja, Núñez, Mj, Ogea, Jl, Otero, R, Pedrajas, Jm, Peris, Ml, Riera Mestre, A, Rivas, A, Rodríguez Dávila MA, Román, P, Rosa, V, Ruiz, J, Ruiz Ribó MD, Ruiz Gamietea, A, Ruiz Giménez, N, Sahuquillo, Jc, Samperiz, A, Sánchez Muñoz Torrero JF, Soler, S, Tiberio, G, Tilvan, Rm, Tolosa, C, Trujillo, J, Uresandi, F, Valdés, M, Valero, B, Valle, R, Vela, J, Vidal, G, Villalobos, A, Villalta, J, Malý, R, Hirmerova, J, Tomko, T, Bertoletti, L, Bura Riviere, A, Farge Bancel, D, Grange, C, Hij, A, Mahe, I, Merah, A, Quere, I, Schellong, S, Babalis, D, Papadakis, M, Tzinieris, I, Braester, A, Brenner, B, Tzoran, I, Zeltser, D, Barillari, G, Ciammaichella, M, Dalla Valle, F, Di Micco, P, Duce, R, Maida, R, Pasca, S, Piovella, C, Poggio, R, Prandoni, Paolo, Quintavalla, R, Rocci, A, Rota, L, Schenone, A, Tiraferri, E, Tonello, D, Tufano, A, Visonà, A, Zalunardo, B, Brinquinho, M, Gomes, D, Gonçalves, F, Santos, M, Saraiva, M, Bosevski, M, Kovacevic, D, Alatri, A, Aujeski, D, Bounameaux, H, Calanca, L, Mazzolai, L., 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
Male, medicine.medical_specialty, 030204 cardiovascular system & hematology, Gastroenterology, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Neoplasms, Internal medicine, D-dimer, medicine, Humans, In patient, 030212 general & internal medicine, Aged, business.industry, Anticoagulants, Cancer, [SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology, Hematology, Prognosis, medicine.disease, 3. Good health, Pulmonary embolism, Quartile, Cardiology, Female, Registry data, Pulmonary Embolism, business
Abstract

International audience; BACKGROUND:The prognostic value of D-dimer testing in patients with acute pulmonary embolism (PE) has not been thoroughly studied.METHODS:We used the RIETE Registry data to assess the 90-day prognostic value of increased IL Test D-dimer levels at baseline in patients with PE, according to the presence or absence of cancer.RESULTS:As of May 2013, 3,283 patients with acute PE underwent D-dimer testing using IL Test D-dimer. Among 2,588 patients without cancer, those with D-dimer levels in the highest quartile had a higher rate of fatal PE (2.6% vs. 0.9%; p=0.002), fatal bleeding (1.1% vs. 0.3%; p=0.017) and all-cause death (9.1% vs. 4.4%; p

Published
2014

2. Validation of a score for predicting fatal bleeding in patients receiving anticoagulation for venous thromboembolism

Author

José Antonio Nieto, Rosario, Solano, Natacha Trapero Iglesias, Nuria Ruiz Giménez, Carmen Fernández Capitán, Beatriz, Valero, Gregorio, Tiberio, Alessandra Bura Riviere, Manuel, Monreal, Monreal, M, Decousus, H, Prandoni, Paolo, Brenner, B, Barba, R, Di Micco, P, Bertoletti, L, Schellong, S, Papadakis, M, Tzoran, I, Reis, A, Bosevski, M, Bounameaux, H, Malý, R, Arcelus, Ji, Arroyo, M, Ballaz, A, Barrón, M, Barrón Andrés, B, Bascuñana, J, Bedate, P, Blanco Molina, A, Bueso, T, Casado, I, del Molino, F, del Toro, J, Falgá, C, Fernández Capitán, C, Fole, D, Gallego, P, García Bragado, F, Gavín, O, Gómez, V, González, J, González Bachs, E, Grau, E, Guil, M, Guijarro, R, Gutiérrez, J, Hernández, L, Hernández Huerta, S, Jara Palomares, L, Jaras, Mj, Jiménez, D, Lecumberri, R, Lobo, Jl, López Jiménez, L, López Sáez JB, Lorente, Ma, Lorenzo, A, Luque, Jm, Madridano, O, Maestre, A, Marchena, Pj, Martín Villasclaras JJ, Muñoz, Fj, Nauffal, Md, Nieto, Ja, Núñez, Mj, Ogea, Jl, Otero, R, Paul, He, Pedrajas, Jm, Peris, Ml, Quezada, Ca, Riera Mestre, A, Rivas, A, Rodríguez Dávila MA, Román, P, Rosa, V, Ruiz, J, Ruiz Gamietea, A, Ruiz Giménez, N, Sahuquillo, Jc, Samperiz, A, Sánchez Muñoz Torrero JF, Soler, S, Tiberio, G, Tolosa, C, Trujillo, J, Uresandi, F, Valdés, M, Valero, B, Valle, R, Vela, J, Vidal, G, Villalobos, A, Villalta, J, Hirmerova, J, Salgado, E, Sánchez, Gt, Bura Riviere, A, Farge Bancel, D, Mahe, I, Merah, A, Quere, I, Babalis, D, Tzinieris, I, Braester, A, Barillari, G, Ciammaichella, M, Duce, R, Maida, R, Pasca, S, Pesavento, R, Piovaccari, G, Piovella, C, Poggio, R, Prandoni, P, Quintavalla, R, Rota, L, Schenone, A, Tiraferri, E, Tonello, D, Tufano, A, Visonà, A, Zalunardo, B, Barbosa, Al, Gomes, D, Gonçalves, F, Santos, M, Saraiva, M, Alatri, A, Aujeski, D, Calanca, L, and Mazzolai, L.

Subjects
Male, medicine.medical_specialty, Databases, Factual, medicine.drug_class, Low molecular weight heparin, Hemorrhage, Fatal outcome, Cohort Studies, Predictive Value of Tests, Risk Factors, Thromboembolism, medicine, Humans, Survival rate, Aged, Aged, 80 and over, Framingham Risk Score, business.industry, Reproducibility of Results, Anticoagulants, Venous Thromboembolism, Odds ratio, Hematology, medicine.disease, Prognosis, Surgery, Pulmonary embolism, Survival Rate, Predictive value of tests, Cohort, Female, business, Cohort study
Abstract

SummaryBackgroundThe only available score to assess the risk for fatal bleeding in patients with venous thromboembolism (VTE) has not been validated yet.MethodsWe used the RIETE database to validate the risk-score for fatal bleeding within the first 3months of anticoagulation in a new cohort of patients recruited after the end of the former study. Accuracy was measured using the ROC curve analysis.ResultsAs of December 2011, 39,284 patients were recruited in RIETE. Of these, 15,206 had not been included in the former study, and were considered to validate the score. Within the first 3months of anticoagulation, 52 patients (0.34%; 95% CI: 0.27-0.45) died of bleeding. Patients with a risk score of 4 points had a rate of 1.44%. The c-statistic for fatal bleeding was 0.775 (95% CI 0.720-0.830). The score performed better for predicting gastrointestinal (c-statistic, 0.869; 95% CI: 0.810-0.928) than intracranial (c-statistic, 0.687; 95% CI: 0.568-0.806) fatal bleeding. The score value with highest combined sensitivity and specificity was 1.75. The risk for fatal bleeding was significantly increased (odds ratio: 7.6; 95% CI 3.7-16.2) above this cut-off value.ConclusionsThe accuracy of the score in this validation cohort was similar to the accuracy found in the index study. Interestingly, it performed better for predicting gastrointestinal than intracranial fatal bleeding.

Published
2013
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3. Unsuspected pulmonary embolism in patients with cancer

Author

Silvia, Soler, Cristina, Delgado, Aitor, Ballaz, Elena, Cisneros, Radován, Malý, Dimitrios, Babalis, Manuel, Monréal, Decousus, H, Prandoni, Paolo, Brenner, B, Barba, R, Di Micco, P, Bertoletti, L, Papadakis, M, Bosevski, M, Bounameaux, H, Malý, R, Arcelus, Ji, Arcos, Mp, Ballaz, A, Barrón, M, Blanco Molina, A, Bosco, J, Chaves, E, Conget, F, Delgado, C, De Ancos, C, del Toro, J, Falgá, C, Farfán, A, Fernández Capitán, C, Gallego, P, García Bragado, F, Gómez del Olmo, V, Guijarro, J, Guillém, N, Gutiérrez, J, Hernández, L, Hernández Huerta, D, Jaras, Mj, Jiménez, D, Jiménez, S, Jiménez Gil, M, Lobo, Jl, López Jiménez, L, Lorenzo, A, Luque, Jm, Macia, M, Madridano, O, Maestre, A, Marchena, Pj, Martín Villasclaras JJ, Monreal, M, Morales, M, Nauffal, Md, Nieto, Ja, Ogea, Jl, Pedrajas, Jm, Riera Mestre, A, Rodríguez Dávila MA, Román, P, Román Bernal, B, Rosa, V, Ruíz, J, Ruiz Gamietea, A, Ruiz Giménez, N, Ruiz Ribó MD, Sahuquillo, Jc, Samperiz, A, Sánchez, R, Sánchez Muñoz Torrero JF, Soler, S, Soto, Mj, Tiberio, G, Todolí, Ja, Tolosa, C, Trujillo, J, Uresandi, F, Valdés, M, Valdés, V, Valle, R, Vidal, G, Villalta, J, Zorrilla, V, Bura Riviere, A, Debourdeau, P, Mahe, I, Babalis, D, Tzinieris, I, Barillari, A, Barillari, G, Ciammaichella, C, Dalla Valle, F, Maida, R, Pasca, S, Piovella, C, Poggio, R, Prandoni, P, Quintavalla, R, Schenone, A, Tonello, D, Visonà, A, and Tomko, T.

Subjects
Male, medicine.medical_specialty, Colorectal cancer, Comorbidity, Risk Assessment, Prostate, Neoplasms, Internal medicine, Prevalence, medicine, Humans, In patient, Registries, business.industry, Incidence (epidemiology), Anticoagulants, Cancer, Hematology, Prognosis, medicine.disease, Pulmonary embolism, Europe, Natural history, Treatment Outcome, medicine.anatomical_structure, Female, Radiology, Pulmonary Embolism, business
Abstract

Background The natural history of unsuspected pulmonary embolism (PE) in patients with cancer has not been thoroughly studied. Methods We used the RIETE Registry data to compare the clinical characteristics, treatment strategies and outcome in cancer patients with unsuspected PE and in those presenting with symptomatic, acute PE. Results Up to December 2011, 78 cancer patients with unsuspected PE and 1,994 with symptomatic PE had been enrolled. Patients with unsuspected PE more likely had colorectal cancer than those with symptomatic PE (28% vs. 13%), and less likely had prostate (3.8% vs. 10%) or hematologic (1.3% vs. 6.4%) cancer, or prior venous thromboembolism (3.8% vs. 12%). While the patients were receiving anticoagulant therapy, the incidence of PE recurrences (0% vs. 1.9%) or major bleeding (2.6% vs. 4.8%) were similar. After completion of anticoagulation, recurrent PE developed in 2.6% vs. 1.4% of patients, and major bleeding in 0% vs. 0.4%, respectively. Conclusions Our findings suggest that the clinical characteristics and outcome in cancer patients with unsuspected PE are quite similar to those in patients with symptomatic PE.

Published
2012

4. Thirty-day mortality rate in women with cancer and venous thromboembolism. Findings from the RIETE Registry

Author

Javier Trujillo Santos, José Manuel Casa, Ignacio, Casado, Ángel Luis Samperiz, Roberto, Quintavalla, Joan Carles Sahuquillo, Manuel, Monreal, Arcelus, Ji, Barba, R, Barrón, M, Blanco, A, Bosco, J, Casado, I, Casas, Jm, Cisneros, E, Chavez, E, del Campo, R, del Molino, F, del Toro, J, Durán, M, Falgá, C, Fernández Capitán, C, Gabriel, F, Gallego, P, García Bragado, F, Guijarro, R, Guil, M, Gutiérrez, J, Gutiérrez, Mr, Hernández, L, Hernández Toboso, S, Jiménez, D, Jiménez Gil, M, Jordán, S, Lecumberri, R, Lobo, Jl, López Jiménez, L, Lorenzo, A, Luque, Jm, Madridano, O, Maestre, A, Marchena, Pj, Martín Villasclaras JJ, Montes, J, Monreal, M, Morales, M, Nauffal, Md, Nieto, Ja, Núñez, Mj, Ochoa, F, Ogea, Jl, Oribe, M, Otero, R, Pedrajas, Jm, Ponce de León, L, Rabuñal, R, Riera Mestre, A, Rodríguez, Ma, Roldán, V, Román, P, Rosa, V, Rubio, S, Ruiz Gamietea, A, Ruíz Giménez, N, Sahuquillo, Jc, Samperiz, A, Sánchez, R, Muñoz Torrero SJ, Soler, S, Soto, Mj, Tiberio, G, Tolodí, Ja, Tolosa, C, Trujillo, J, Uresandi, F, Valdés, M, Valdés, V, Valdés, R, Vidal, G, Villalta, J, Boccalon, H, Debourdeau, P, Durant, C, Farge Bancel, D, Mahe, I, Rivron Guillot, K, Brenner, B, Barillari, A, Barillari, G, Ciammaichella, M, Di Micco, P, Dalla, Vf, Duce, R, Pasca, S, Piovella, C, Poggio, R, Prandoni, Paolo, Quintavalla, R, Schenone, A, Tiraferri, E, Visonà, A, Bosevski, M, and Bounameaux, H.

Subjects
Adult, medicine.medical_specialty, Hemorrhage, Neoplasms, Internal medicine, Pancreatic cancer, medicine, Carcinoma, Humans, Prospective Studies, Registries, Prospective cohort study, Aged, Aged, 80 and over, Gynecology, Lung, business.industry, Mortality rate, Anticoagulants, Cancer, Venous Thromboembolism, Hematology, Middle Aged, medicine.disease, Pulmonary embolism, Treatment Outcome, medicine.anatomical_structure, Female, Pulmonary Embolism, business, Ovarian cancer
Abstract

The influence of the site of cancer on outcome in cancer women with venous thromboembolism (VTE) is poorly understood. Reliable information on its influence might facilitate better use of prevention strategies. We assessed the 30-day outcome in all women with active cancer in the RIETE Registry, trying to identify if differences exist according to the tumor site. Up to May 2010, 2474 women with cancer and acute VTE had been enrolled. The most common sites were the breast (26%), colon (13%), uterus (9.3%), and haematologic (8.6%) cancers. During the 30-day study period, 329 (13%) patients died. Of them, 71 (2.9%) died of pulmonary embolism (PE), 22 (0.9%) died of bleeding. Fatal PE was more common in women with breast, colorectal, lung or pancreatic cancer (59% of the fatal PEs). Fatal bleeding was more frequent in women with colorectal, haematologic, ovarian cancer or carcinoma of unknown origin (55% of fatal bleedings).

Published
2011

5. Factors associated with elevated pulmonary arterial pressure levels on the echocardiographic assessment in patients with prior pulmonary embolism

Author

Remedios, Otero, Teresa, Elías, Luis, Jara, Javier Trujillo Santos, Laurent, Bertoletti, Dolores, Nauffal, Justo Ruiz Ruiz, Ángeles Blanco Molina, Manuel, Monreal, Arcelus, Ji, Arcos, Mp, Ballaz, A, Barba, R, Barragán, Jm, Barrón, M, Barrón Andrés, B, Bascuñana, J, Blanco Molina, A, Boix, L, Bosco, J, Bueso, T, Campano, Fj, Cañas, I, Casado, I, Conget, F, Contra, A, Chaves, E, de Miguel, J, del Campo, R, del Toro, J, Falgá, C, Fernández Capitán, C, Font, C, Gabriel, F, Gallego, P, García Bragado, F, Gómez, V, González, J, Gracia, V, Guil, M, Guijarro, R, Gutiérrez, J, Hernández, L, Hernández Huerta, D, Jara, L, Jaras, Mj, Jiménez, D, Jiménez Gil, M, Lecumberri, R, Lobo, Jl, López Jiménez, L, Lorenzo, A, Macià, M, Madridano, O, Marchena, Pj, Martín, M, Martín Villasclaras JJ, Monreal, M, Morales, M, Nauffal, Md, Nieto, Ja, Núñez, Mj, Ogea, Jl, Otero, R, Pedrajas, Jm, Riera Mestre, A, Rodríguez Dávila MA, Roldán, V, Román, P, Rodríguez, Em, Rosa, V, Ruíz, J, Ruiz Gamietea, A, Ruiz Giménez, N, Sahuquillo, Jc, Sánchez, R, Sánchez Muñoz Torrero JF, Soler, S, Soto, Mj, Tiberio, G, Todolí, Ja, Tolosa, C, Trujillo, J, Uresandi, F, Valdés, M, Valero, B, Valle, R, Vidal, G, Villalobos, A, Villalta, J, Zamora, L, Zorrilla, V, Bertoletti, L, Bura Riviere, A, Farge Bancel, D, Mahe, I, Quere, I, Papadakis, M, Braester, A, Brenner, B, Zeltser, D, Barillari, G, Ciammaichella, M, Di Micco, P, Dalla Valle, F, Duce, R, Maida, R, Pasca, S, Piovella, C, Poggio, R, Prandoni, Paolo, Quintavalla, R, Rota, L, Schenone, A, Tiraferri, E, Tonello, D, Venturelli, U, Visonà, A, Zalunardo, B, Bosevski, M, Alatri, A, Aujeski, D, Bounameaux, H, Mazzolai, L, Malý, R, Tomko, T, Salgado, E, Schellong, S, and Caprini, J.

Subjects
Male, medicine.medical_specialty, Hypertension, Pulmonary, Background factors, Pulmonary arterial pressure, Risk Factors, Internal medicine, medicine.artery, medicine, Humans, In patient, Arterial Pressure, Aged, business.industry, Hematology, medicine.disease, Prognosis, Pulmonary embolism, stomatognathic diseases, Lung disease, Echocardiography, Heart failure, Pulmonary artery, Cardiology, Chronic thromboembolic pulmonary hypertension, Female, business, Pulmonary Embolism
Abstract

Factors associated with the detection of raised systolic pulmonary artery pressure (sPAP) levels in patients with a prior episode of pulmonary embolism (PE) are not well known.We used the RIETE Registry database to identify factors associated with the finding of sPAP levels ≥50 mm Hg on trans-thoracic echocardiography, in 557 patients with a prior episode of acute, symptomatic PE.Sixty-two patients (11.1%; 95% CI: 8.72-14.1) had sPAP levels ≥50 mm Hg. These patients were more likely women, older, and more likely had chronic lung disease, heart failure, renal insufficiency or leg varicosities than those with PAP levels50mm Hg. During the index PE event, they more likely had recent immobility, and more likely presented with hypoxemia, increased sPAP levels, atrial fibrillation, or right bundle branch block. On multivariate analysis, women aged ≥70 years (hazard ratio [HR]: 2.0; 95% CI: 1.0-3.7), chronic heart or chronic lung disease (HR: 2.4; 95% CI: 1.3-4.4), atrial fibrillation at PE presentation (HR: 2.8; 95% CI: 1.3-6.1) or varicose veins (HR: 1.8; 95% CI: 1.0-3.3) were all associated with an increased risk to have raised sPAP levels. Chronic heart disease, varicose veins, and atrial fibrillation were independent predictors in women, while chronic heart disease, atrial fibrillation, a right bundle branch block or an S1Q3T3 pattern on the electrocardiogram were independent predictors in men.Women aged ≥70 years more likely had raised sPAP levels than men after a PE episode. Additional variables influencing this risk seem to differ according to gender.

Published
2012

6. Enoxaparin for symptomatic COVID-19 managed in the ambulatory setting: An individual patient level analysis of the OVID and ETHIC trials.

Author

Barco S, Virdone S, Götschi A, Ageno W, Arcelus JI, Bingisser R, Colucci G, Cools F, Duerschmied D, Gibbs H, Fumagalli RM, Gerber B, Haas S, Himmelreich JCL, Hobbs R, Hobohm L, Jacobson B, Kayani G, Lopes RD, MacCallum P, Micieli E, Righini M, Robert-Ebadi H, Rocha AT, Rosemann T, Sawhney J, Schellong S, Sebastian T, Spirk D, Stortecky S, Turpie AGG, Voci D, Kucher N, Pieper K, Held U, and Kakkar AK

Abstract

Background: Antithrombotic treatment may improve the disease course in non-critically ill, symptomatic COVID-19 outpatients., Methods: We performed an individual patient-level analysis of the OVID and ETHIC randomized controlled trials, which compared enoxaparin thromboprophylaxis for either 14 (OVID) or 21 days (ETHIC) vs. no thromboprophylaxis for outpatients with symptomatic COVID-19 and at least one additional risk factor. The primary efficacy outcome included all-cause hospitalization and all-cause death within 30 days from randomization. Both studies were prematurely stopped for futility. Secondary efficacy outcomes were major symptomatic venous thromboembolic events, arterial cardiovascular events, or their composite occurring within 30 days from randomization. The same outcomes were assessed over a 90-day follow-up. The primary safety outcome was major bleeding (ISTH criteria)., Results: A total of 691 patients were randomized: 339 to receive enoxaparin and 352 to the control group. Over 30-day follow-up, the primary efficacy outcome occurred in 6.0 % of patients in the enoxaparin group vs. 5.8 % of controls for a risk ratio (RR) of 1.05 (95%CI 0.57-1.92). The incidence of major symptomatic venous thromboembolic events and arterial cardiovascular events was 0.9 % vs. 1.8 %, respectively (RR 0.52; 95%CI 0.13-2.06). Most cardiovascular thromboembolic events were represented by symptomatic venous thromboembolic events, occurring in 0.6 % vs. 1.5 % of patients, respectively. A similar distribution of outcomes between the treatment groups was observed over 90 days. No major bleeding occurred in the enoxaparin group vs. one (0.3 %) in the control group., Conclusions: We found no evidence for the clinical benefit of early administration of enoxaparin thromboprophylaxis in outpatients with symptomatic COVID-19. These results should be interpreted taking into consideration the relatively low occurrence of events., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Stefano Barco reports grants or contracts from Bayer, INARI, Boston Scientific, Medtronic, Bard, Sanofi, and Concept Medical; consulting fees from INARI; payment or honoraria from INARI, Boston Scientific, Penumbra and Concept Medical; and support for attending meetings and/or travel from Bayer and Sanofi. Roland Bingisser reports no conflicts of interest. Stefan Stortecky has received research grants to the institution from Edwards Lifesciences, Medtronic, Abbott Vascular, Boston Scientific and Guerbet AG and speaker fees from Boston Scientific. Giuseppe Colucci reports no conflicts of interest. Bernhard Gerber reports non-financial support and funding for an accredited continuing medical education programme from Axonlab, and Thermo Fisher Scientific; personal fees and funding for an accredited continuing medical education programme from Alnylam, Pfizer, and Sanofi; funding for an accredited continuing medical education programme from Bayer, Bristol Myers Squibb, Daiichi-Sankyo, Takeda, Octapharma, SOBI, Janssen, Novo Nordisk, Mitsubishi Pfizer, Tanabe Pharma, outside the submitted work. Jelle C L Himmelreich reports no conflicts of interest. DS reports employment by Sanofi-Aventis Switzerland. Thomas Rosemann reports no conflicts of interest. Walter Ageno reports research grants from Bayer; advisory boards for Bayer, Leo Pharma, Norgine, Sanofi, Techdow, Viatris. Juan Ignacio Arcelus declares speaker fees from Sanofi and Rovi. H.G reports personal fees from Pfizer, Bayer, Boehringer Ingelheim. Peter MacCallum reports no conflicts of interest. Daniel Duerschmied has received consulting fees from Boston Scientific and speakers' honoraria from Bayer, Daiichi Sankyo, Boston Scientific, Boehringer Ingelheim, and BMS/Pfizer. Tim Sebastian reports no conflicts of interest. Sylvia Haas reports honoraria from Bayer, BMS, Daiichi-Sankyo, Pfizer and Sanofi. Lukas Hobohm received lecture/consultant fees from Johnson&Johnson, INARI, MSD and Boston Scientific; outside the submitted work. The other authors report no conflicts of interest. Renato D Lopes reports research grants or contracts from Amgen, Bristol-Myers Squibb, GlaxoSmithKline, Medtronic, Pfizer, Sanofi-Aventis; funding for educational activities or lectures from Pfizer, Bristol-Myers Squibb, Novo Nordisk, AstraZeneca, and unding for consulting from Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Novo Nordisk, AstraZeneca., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Published
2023
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7. Venous thromboprophylaxis duration and adherence to international guidelines in patients undergoing major orthopaedic surgery: results of the international, longitudinal, observational DEIMOS registry.

Author

Arcelus JI and Felicissimo P

Subjects
Aged, Aged, 80 and over, Female, Guideline Adherence, Humans, Longitudinal Studies, Male, Middle Aged, Orthopedics, Venous Thromboembolism drug therapy, Venous Thromboembolism epidemiology, Enoxaparin therapeutic use, Fibrinolytic Agents therapeutic use, Mechanical Thrombolysis methods, Thrombolytic Therapy methods, Venous Thromboembolism therapy
Abstract

Background: Venous thromboembolism (VTE) is major health problem worldwide with substantial morbidity and mortality. This study aimed to assess post-operative VTE prophylaxis duration and adherence to the American College of Chest Physicians (ACCP) 2008 guidelines in patients having undergone major orthopaedic surgery (MOS)., Methods: This multinational, longitudinal, observational registry recruited consecutive patients (≥ 18 years of age) who underwent total hip replacement (THR), total knee replacement (TKR), and hip fracture surgery (HFS). There were 3 study visits: at admission to hospital, at discharge, and 4/6 weeks after surgery. Data on demographics, medical history, VTE risk factors, type and duration of mechanical and pharmacological prophylaxis, complications, and adherence to the ACCP 2008 guidelines were collected using case report forms., Results: Between October 2009 and July 2011, 2162 eligible patients were analyzed: THR: 646, TKR: 740, HFS: 776 (mean age [SD]: 64.5 [15.0] years; female: 61.3%; and mean hospitalization duration [SD]: 9.1 [8.2] days). VTE prophylaxis was prescribed to 96.2% of patients during hospitalization and 89.7% of patients after hospital discharge. Prophylaxis was prescribed according to the ACCP 2008 guidelines in 85.7% of patients during hospitalization and 63.4% of patients after hospital discharge. The main reasons for non-adherence to guidelines were no prescription and inadequate duration of prophylaxis. The low molecular weight heparin-enoxaparin-was the most commonly prescribed prophylaxis., Conclusion: We observed a gap between real life VTE prophylaxis and the ACCP 2008 recommendations. Improved prescription of extended thromboprophylaxis is warranted to ensure adherence to international guidelines., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Published
2013
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8. Should we follow the 9th ACCP guidelines for VTE prevention in surgical patients?

Author

Arcelus JI, Villar JM, and Muñoz N

Subjects
Anticoagulants adverse effects, Decision Support Techniques, Drug Administration Schedule, Evidence-Based Medicine, Fibrinolytic Agents adverse effects, Guideline Adherence, Hemorrhage chemically induced, Humans, Patient Selection, Practice Guidelines as Topic, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Venous Thromboembolism etiology, Anticoagulants administration & dosage, Fibrinolytic Agents administration & dosage, Practice Patterns, Physicians' standards, Surgical Procedures, Operative adverse effects, Venous Thromboembolism prevention & control
Abstract

The 9th edition of the American College of Chest Physicians (ACCP) guidelines on antithrombotic therapy and prevention, includes relevant changes compared to previous versions. In the 9th ACCP, leadership of most chapters was given to methodologists who were familiar with the GRADE methodology. All topic panelists underwent a selection process paying particular attention to their financial and intellectual conflicts of interests. In the 9th ACCP guidelines, evidence has been explicitly presented in many evidence profiles and summary of evidence tables. In order to get a more balanced trade-off between desirable and undesirable effects of the alternative prevention and therapeutic interventions, there has been an increased emphasis on clinically relevant events, as opposed to previous surrogate asymptomatic outcomes. In addition, there has been a systematic review and survey on patient values and preferences for thrombotic and bleeding outcomes. As a result of the above changes, the strength of most recommendations has been downgraded compared to previous editions. The main changes regarding prevention on nonorthopedic surgical patients include the adoption of two risk assessment models. The only recommendation that has been upgraded is to extend prophylaxis with low molecular weight heparins (LMWH) for four weeks after abdominal or pelvic cancer surgery. A controversial modification in orthopedic patients is recommendation in favor of the use of aspirin after hip or knee arthroplasty. New oral anticoagulants are recommended, but LMWH are suggested as the preferred option. Extending pharmacological prophylaxis for up to 35days rather than 10-14days is now suggested for patients undergoing major orthopedic surgery., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Published
2012
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