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Background: Risk of VTE recurrence (VTEr) in patients with cancer-associated thrombosis (CAT) is high. Cancer-related risk factors for VTEr have been studied, but information about the importance of location of metastasis is scarce., Objectives: 1) Evaluate rate of VTEr in CAT patients according to location of metastasis, and 2) Identify variables associated to VTEr during long-term follow-up., Methods: A retrospective, single-center, non-interventional study of consecutives patients with CAT conducted between 2007 and 2022. Haematological neoplasms were excluded., Results: Among 1248 patients with CAT (age 64.1 ± 12.8 years; 48.2 % female) followed-up for 13.19 months (p25-75, 5.6-26.9) there were 141 VTEr. The rate of VTE recurrence in patients without and with metastasis were 4.72 per 100 patient-years (95%CI: 3.66-6) and 10.05 per 100 patient-years (95 % CI: 7.89-12.61), respectively. The metastases locations associated with VTEr, compared to those without metastasis, were lung (rate ratio [RR]: 2.21; 95 % CI: 1.42-3.43), liver (RR: 2.02; 95%CI: 1.26-3.24), pancreas (RR: 6.21; 95 % CI: 1.52-25.35), pleura (RR: 2.93; 95%CI: 1.58-5.41), bone (RR: 2.16; 95 % CI: 1.29-3.64) and adrenal (RR: 6.18; 95%CI: 2.97-12.86). Multivariate analysis of variables associated with VTEr beyond 12 months were male sex (hazard ratio [HR] 1.54, 95%CI: 1.08-2.19), ECOG performance status >1 (HR 1.74, 95%CI: 1.03-2.94), metastasis in 1-2 locations (HR 2.38, 95%CI: 1.68-3.37) and metastasis in >2 locations (HR 3.88, 95%CI: 1.68-8.98)., Conclusions: The rate of VTEr differs according to the location of metastasis. We identified variables related to VTEr during long-term follow-up which may help clinicians decide whether to continue anticoagulation., Competing Interests: Declaration of competing interest Dr. Jara-Palomares received grants from Leo Pharma and MSD, and personal fees from Daichii, Rovi, GlaxoSmithKline, and Actellion outside the submitted work. Dr. Carrier has received research funding from BMS, Pfizer, and Leo Pharma, and honoraria from Bayer, Pfizer, BMS, Servier, and Leo Pharma. No other conflicts of interest are declared., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Randomized controlled trials (RCTs) that conduct subgroup analyses have the potential to provide information on treatment decisions in specific groups of patients from heterogeneous populations. Although we understand several factors can modify the incidence of venous thromboembolism (VTE) and the benefit/risk ratio of anticoagulation treatments, further evidence is warranted to show the heterogeneity of treatment effects in different subgroups of patients., Aims: The primary purpose was to evaluate the appropriateness and interpretation of subgroup analysis performed on VTE RCTs reporting pharmacological interventions., Materials and Methods: A systematic review of RCTs published between January 2017 and January 2022 was conducted. Claims of subgroup effects were evaluated with predefined criteria. High-quality claims of subgroup effect were further analyzed and discussed., Results: Overall, 28 RCTs with a generally low bias risk were included. The purposes of the treatments included pharmacologic thromboprophylaxis (17), therapeutic dose anticoagulation (9), and catheter-directed pharmacologic thrombolysis (2). The evaluated subgroup analyses generally presented: a high number of subgroup analyses reported, a lack of prespecification, and a lack of usage of statistical tests for interaction. The authors reported 13 claims of subgroup effect; only two were considered potentially reliable to represent heterogeneity in the direction or magnitude of treatment effect., Conclusions: Subgroup analyses of VTE RCTs reporting pharmacologic interventions are generally methodologically poor. Most claims of subgroup effect did not meet critical criteria and lacked credibility. Clinicians in this field may proceed with scepticism when assessing claims of subgroup effects due to methodological concerns and misleading interpretations., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: The aim was to analyze the temporal relationship between short-term air pollution exposure and acute symptomatic unprovoked pulmonary embolism (PE)., Patients/methods: We performed a prospective, multicenter study in consecutive patients diagnosed with acute symptomatic unprovoked PE from February 2012 to January 2013. We analyzed demographic and clinical data, patients' addresses, meteorological and air pollutants data (PM 10 , SO 2 , CO, NO 2 , ozone emission data). We considered the number of days the patient had symptoms, and the study period constituted the previous 30 days. Likewise, the mean annual data of the reference season were calculated as well as the data of the 30-day study period corresponding to the same dates in the previous 3 years in order to obtain the monthly mean of the different pollutants for each period., Results: A total of 162 patients with acute symptomatic PE were recruited (43.2% unprovoked PE). The air pollutants could be determined in 50% of the patients with unprovoked PE, and a final analysis was performed in 35 patients. In the multiple comparison analysis to verify a possible correlation between the study period and the annual median, only NO 2 showed a statistically significant association (p = 0.009). When comparing the study period with the previous 3 years, only NO 2 maintained a statistically significant association for the 3 study periods., Conclusions: We found a relationship between short-term exposure to NO 2 and the presence of unprovoked PE., Competing Interests: Declaration of competing interest LJP reports personal fees from Bayer Hispania, Actelion, Rovi, PFIZER, Menarini, and Leo-Pharma, outside the submitted work. RO reports Grant support from Leo-Pharma and Bayer HealthCare-Fees for serving on advisory boards and giving lectures from Leo-Pharma, Rovi, Bayer HealthCare, MSD and Actelion. There is no other conflict of interest., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Introduction: Randomized clinical trials have demonstrated non-inferiority of rivaroxaban compared with vitamin K antagonists (VKAs) in the treatment of venous thromboembolism (VTE). Our objective was to analyze in real life, tolerance, recurrence, bleeding and adverse events of rivaroxaban in patients with acute symptomatic VTE., Material and Methods: Open follow-up study of a cohort of patients aged 18 and over diagnosed with deep vein thrombosis (DVT) and/or pulmonary embolism (PE) treated with rivaroxaban from December 2011 to January 2014., Results: The total number of patients treated with rivaroxaban was 103. The mean age was 58+/-17 years. The most frequent co-morbidities were: hypertension (30.0%), dyslipidemia (23.3%) and respiratory disease (25.2%). The type of thromboembolic event treated was: DVT (64.1%), PE (18.4%), DVT+PE (17.5%). Of the rivaroxaban-treated patients, 30% did so from the initial anticoagulant therapy and the other 70% in long-term or extended anticoagulant therapy. The median time of treatment with rivaroxaban was 6 months [corrected]. There was one recurrence and no deaths occurred. Six patients had bleeding, one of which was severe., Conclusions: Rivaroxaban provides a therapeutic alternative in a group of patients with VTE with advantages over VKAs, because of the convenience in dosing, lack of requirements for periodic monitoring and limited interaction with other drugs., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Introduction: An association between pulmonary embolism (PE) and a subsequent diagnosis of cancer has been repeatedly reported. Although screening and early detection might play a pivotal part in reducing mortality from cancer, there are currently no definite data to suggest that cancer screening may improve survival rates in patients with PE. We hereby present the results of a screening program and a two-year follow-up survey for detecting occult cancer in this patient population., Materials and Methods: A total of 107 patients with PE were consecutively enrolled. All subjects underwent an initial screening program followed by a two-year follow-up survey. We calculated the sensitivity of our screening program, and identified risk factors associated with occult cancer by means of logistic regression., Results: The initial screening program yielded positive results in five patients (4.7%), and four additional cases were identified during the 2-year follow-up. The overall sensitivity of our screening program in idiopathic PE was 55.5%. In the entire study cohort, the number necessary for screening was 12.1 (6.1 in idiopathic PE, and 58 in secondary PE). Logistic regression analysis revealed that a shock index >/=1 (odds ratio: 5.467; p=0.007) and idiopathic PE (odds ratio: 12.82; p=0.03) were independent risk factors for occult cancer in our PE patients., Conclusions: A simple and noninvasive screening program yields an acceptable sensitivity for detecting occult cancer in idiopathic PE patients. These results highlight the importance of screening for occult cancer in patients diagnosed with PE, especially in idiopathic forms., (Copyright 2009 Elsevier Ltd. All rights reserved.)