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1. E-book: Ritmestoornissen - Uitgave 2023

Author

A. Capiau, M. Grymonprez, T. De Backer, S. Gevaert, K. Boussery, L. Lahousse, M. Finoulst, P. Vankrunkelsven, G. Claessen, T. Germeys, J. Demeestere, R. Lemmens, T. Vanassche, R. Willems, M.A.J. De Smet, and L. Leybaert

Subjects
General Medicine
Published
2023
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2. E-book: Hematologie en hemostase – Uitgave 2023

Author

S. Van Dessel, W. Laleman, E. Gielen, T. Germeys, R. Lemmens, T. Vanassche, R. Willems, M. Finoulst, P. Vankrunkelsven, A. Capiau, M. Grymonprez, T. De Backer, S. Gevaert, K. Boussery, L. Lahousse, V. Wouters, A. Gadisseur, C. Kenyon, J. Wytsman, K. Traen, W. Froyman, E. Despierre, M. Stockman, A. Hendrickx, and V. Peeters

Subjects
General Medicine
Published
2023
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3. Association of fatal and non-fatal adverse health outcomes with urinary peptides reflecting collagen I turnover

Author

J Melgarejo, D Wei, A Latosinska, T Vanassche, S Janssens, H Mischak, J A Staessen, P Verhamme, and Z Y Zhang

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background Imbalance of collagen I (COL1) turnover, featured by increased synthesis and decreased degradation of collagen fibers, is a hallmark of fibrosis in the heart and blood vessels that associates with poor cardiovascular outcomes. Such as imbalance of COL1 turnover could be reflected in urine and serve as fingerprint for future adverse outcomes in general population, and high risk subjects. Purpose We hypothesize that imbalance of proteomic signatures of urinary peptides (UPs) reflecting COL1 turnover relate to adverse health outcomes in participants from a general population Methods We randomly recruited 776 participants (51.2% women; 50.5 years) from the Flemish Study on Environment, Genes and Health Outcomes cohort and measured UPs proteome by capillary electrophoresis coupled with mass spectrometry. Our analyses focused on 148 peptides of COL1 alpha-1 (COL1A1) chain that retained ≥70% signal in the whole sample. The primary endpoint included fatal and nonfatal cardiovascular endpoints. Secondary endpoints consisted of total mortality, fatal and nonfatal cardiac, coronary, and heart failure endpoints. Multivariate Cox proportional models, partial least squares analysis (PLS), log-likelihood test, and receiver operating characteristics (ROC) curve were applied. Results Over a median follow up of 12.4 years, 110 primary endpoints occurred, 61 participants died, 81, 41 and 24 experienced cardiac, coronary, and heart failure endpoints; respectively. In PLS analyses, upregulation of UPs signatures closer to C- and N-terminal locations of the COL1A1 chain whereas downregulation of mid-region UPs were associated with lower risk of adverse health outcomes. This pattern was inverted in subjects with cardiovascular disease, as upregulation of terminal and downregulation of mid region UPs increased risk. Adding UPs to a basic model including sex, age and usual cardiovascular risk factors significantly improved model performance between 2.54% to 4.93% (P≤0.001) for prediction of adverse health outcomes. In ROC plots, adding UPs to the basic model increased the area under the curve up to 4.00% (P Conclusions UPs reflecting COL1 turnover predicted adverse health outcomes. The inverted up- and down regulations of UPs in between participants with and without previous cardiovascular diseases might be explained by a shift in the UPs signatures of COL1 fragments linked to distinct fibrotic processes. Urinary proteomic might have clinical importance in documenting the extent of collagen accumulation that relates to adverse health outcomes. In patients at high cardiovascular risk, modification of collagen I fibers turnover might be a potential treatment target Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The European Union the European Research Council and the European Research Area Net for Cardiovascular Diseases.

Published
2022
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4. Atherogenic lipoprotein profile associated with anthropometric indices of obesity and their association with cardiometabolic risk markers: a cross-sectional study in community

Author

D Wei, J Melgarejo, T Vanassche, L Van Aelst, S Janssens, P Verhamme, J Redon, and Z Y Zhang

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background Obesity, especially abdominal fat accumulation, is strongly associated with various metabolic comorbidities. Whether simple anthropometric measures are independently associated with atherogenic lipoproteins is not completely clear. Methods We randomly recruited 505 participants (51.5% women; mean age: 48.8 years) from the Flemish community, who had undergone lipoprotein particle measurements by nuclear magnetic resonance spectroscopy and conventional lipid measurements. Each lipoprotein fraction was subgrouped into large, medium, and small subclass. Anthropometric measures included body mass index (BMI) and waist-to-hip ratio (WHR), and defined BMI obesity as BMI ≥30 kg/m2, and WHR obesity as WHR ≥0.85 (women) or 0.9 (men). Results In the multivariable logistic regression analysis, total very-low-density lipoprotein (VLDL) particle and its subclasses were positively associated with BMI obesity (adjusted odds ratio [OR] for total VLDL: 2.37; 95% confidence interval [CI]: 1.70–3.31) and WHR obesity (OR for total VLDL: 2.06 [95% CI: 1.55–2.73]). The level of total high-density lipoprotein (HDL) particle and its subclass was negatively associated with BMI (OR for total HDL: 0.63 [95% CI: 0.45–0.90), but not with WHR (P≥0.11). None of the low-density lipoprotein (LDL) particles was associated with the two types of obesity (P≥0.092). BMI was inversely associated with the size of LDL and HDL particles, whereas high WHR was significantly associated with smaller VLDL and HDL sizes. For conventional lipid measures, both BMI and WHR were independently associated with high triglyceride and remnant cholesterol, both mainly driven from VLDL particles, and low HDL cholesterol (P≤0.008). These associations were confirmed in multivariable linear regression analysis, except the association of BMI with HDL number and the association of WHR with HDL size. With partial least squares analysis, the lipoprotein profiles of BMI and WHR were significantly associated with a high 10-year cardiovascular disease risk score, the homeostasis model assessment-estimated insulin resistance (HOMA-IR), and C-reactive protein. Conclusion BMI and WHR were independently associated with high triglyceride-rich lipoproteins, decreased HDL cholesterol. The size of LDL and HDL was more consistently associated with BMI than WHR. The lipoprotein alterations may link obesity with high cardiometabolic risk. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The European Research Council; the European Research Area Net for Cardiovascular Diseases

Published
2022
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5. 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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6. Het nut van implanteerbare looprecorders na een embolische beroerte van ongekende oorsprong

Author

T. Germeys, J. Demeestere, R. Lemmens, T. Vanassche, and R. Willems

Subjects
General Medicine
Abstract

The use of implantable loop recorders after embolic stroke of undetermined source Unknown intermittent atrial fibrillation (AF) is a potential source of embolism in patients with embolic stroke of undetermined source (ESUS). Prolonged heart rhythm monitoring with implantable loop recorders (ILR) could increase the detection of AF. Patients with detected (subclinical) AF may benefit from a therapy with anticoagulants after ESUS. The authors of this article performed a retrospective analysis of patients who received an ILR after suspected ESUS at the University Hospitals of Leuven (Belgium) between April 2008 and March 2019. They describe the proportion of patients in whom AF was detected and studied the predictors of AF detection. With prolonged monitoring, the AF detection rate increased, mainly in the first 2 years after implantation. AF was detected in 28 out of 84 patients (33.3%) after a median follow-up of 8 months. Patients with AF were significantly older and tended to have more arterial hypertension. All patients with detected AF received oral anticoagulation. Although a 24-hour Holter monitoring and a week recorder were negative for AF detection, an ILR established (subclinical) AF in 1 out of 3 patients after ESUS.

Published
2022
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7. Management of edoxaban in patients undergoing multiple procedures: a subanalysis of the EMIT-AF/VTE program

Author

M Saxena, C Von Heymann, A Santamaria, J Jin, C Chen, A Borrow, T Vanassche, M Unverdorben, and P Colonna

Subjects
Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract

Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Background Patients with atrial fibrillation (AF) or venous thromboembolism (VTE) receiving long-term direct oral anticoagulant (DOAC) therapy undergo diagnostic or therapeutic procedures at a rate of approximately 10% annually. The prospective Global EMIT-AF/VTE program (Edoxaban Management in Diagnostic and Therapeutic Procedures; NCT02950168, NCT02951039) demonstrated that physician-guided periprocedural management of the DOAC edoxaban in these patients was associated with low bleeding and thromboembolic event rates. It is unclear whether the experience of a previous (index) procedure influences the periprocedural management of subsequent procedures. Purpose To analyze differences in periprocedural edoxaban management in patients on chronic anticoagulation therapy undergoing multiple diagnostic or therapeutic procedures. Methods Baseline characteristics were recorded in patients enrolled in the EMIT-AF/VTE program who underwent multiple procedures. Details of periprocedural edoxaban interruption were collected from patients who underwent two procedures of the same European Heart Rhythm Association (EHRA) bleeding risk level or procedural type. Only data from the index and second procedure of the same category were included in this analysis; procedures conducted less than 7 days apart were excluded. All analyses are exploratory and descriptive in nature. Results Among 227 patients who underwent multiple procedures, the most common types were vascular and gastrointestinal (GI) procedures. Patients had a mean ± standard deviation age of 72.1 ± 9.8 years, a CHA2DS2-VASc score of 3.2 ± 1.6, a HAS-BLED score of 1.9 ± 1.0, and were mostly male (67.0%). Patients who underwent low/minor risk procedures were less likely to undergo edoxaban interruption with their second procedure compared with their index procedure (Figure 1A), and the median interruption duration was shorter for the second procedure (Table 1). A second high risk procedure was associated with a higher rate of both pre- and postprocedural edoxaban interruption compared with a patient’s index procedure, but treatment resumed earlier (Figure 1B). Patients who underwent vascular procedures had a lower rate of pre- and postprocedural interruption and a shorter interruption time with their second procedure (Table 1). Conversely, patients who underwent GI procedures experienced pre- and postprocedural interruption more often for their second procedure. The median interruption duration was longer for GI procedures than for vascular procedures (Table 1). Conclusion Overall, periprocedural edoxaban interruption varied by procedural bleeding risk and type. Edoxaban interruption patterns differed between index and second procedures, indicating that periprocedural edoxaban management may be influenced by the experience of previous procedures.

Published
2022
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8. E-book: Uit de pers gelicht 2021

Author

M. Finoulst, B. Aertgeerts, J. De Lepeleire, P. Vankrunkelsven, P.H. Meersseman, T. Vanassche, E. Van Leeuwen, T. Christiaens, M. Petrovic, G. Claessen, and I. Dehaene

Subjects
General Medicine
Published
2022
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9. Immuungemedieerde antistofgebaseerde trombocytopenie met trombose

Author

Patrik Vankrunkelsven, Marleen Finoulst, and T. Vanassche

Subjects
business.industry, Medicine, General Medicine, business
Abstract

De Morgen, 6 april 2021: “EMA ziet dan toch verband tussen AstraZeneca-vaccin en trombose” “Er is een verband tussen het vaccin van AstraZeneca en de zeldzame combinatie van bloedstolsel en een verlaagd aantal bloedplaatjes.” Dat zegt Marco Cavaleri, hoofd vaccinatiestrategie van het Europees Geneesmiddelenbureau (EMA), in de Italiaanse media.

Published
2021
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10. A randomized, open-label, adaptive, proof-of-concept clinical trial of modulation of host thromboinflammatory response in patients with COVID-19: the DAWn-Antico study

Author

T, Vanassche, M M, Engelen, Q, Van Thillo, J, Wauters, J, Gunst, C, Wouters, C, Vandenbriele, S, Rex, L, Liesenborghs, A, Wilmer, P, Meersseman, G, Van den Berghe, D, Dauwe, G, Verbeke, M, Thomeer, T, Fivez, D, Mesotten, D, Ruttens, L, Heytens, I, Dapper, S, Tuyls, B, De Tavernier, P, Verhamme, Ann, Belmans, Vanassche, T., Engelen, M. M., Van Thillo, Q., Wauters, J., Gunst, J., Wouters, C., Vandenbriele, C., Rex, S., LIESENBORGHS, L., Wilmer, A., Meersseman, P., Van den Berghe, G., Dauwe, D., VERBEKE, Geert, Thomeer, M., Fivez, T., MESOTTEN, Dieter, RUTTENS, David, Heytens, L., Dapper, I., Tuyls, S., De Tavernier, B., and Verhamme, P.

Subjects
Male, Oncology, medicine.medical_treatment, Medicine (miscellaneous), Disease, 030204 cardiovascular system & hematology, Severity of Illness Index, law.invention, Study Protocol, 0302 clinical medicine, Belgium, Randomized controlled trial, Low molecular weight heparins, law, Outcome Assessment, Health Care, Pharmacology (medical), Aprotinin, lcsh:R5-920, 0303 health sciences, Incidence, Venous Thromboembolism, Anakinra, Antirheumatic Agents, Drug Therapy, Combination, Female, Kallikreins, lcsh:Medicine (General), medicine.drug, medicine.medical_specialty, Critical Care, Bradykinin, 03 medical and health sciences, Intensive care, Internal medicine, Fibrinolysis, medicine, Humans, Thromboinflammatory response, 030304 developmental biology, Inflammation, SARS-CoV-2, business.industry, COVID-19, Thrombosis, Heparin, Low-Molecular-Weight, Clinical trial, Interleukin 1 Receptor Antagonist Protein, Regimen, business
Abstract

Background The peak of the global COVID-19 pandemic has not yet been reached, and many countries face the prospect of a second wave of infections before effective vaccinations will be available. After an initial phase of viral replication, some patients develop a second illness phase in which the host thrombotic and inflammatory responses seem to drive complications. Severe COVID-19 disease is linked to high mortality, hyperinflammation, and a remarkably high incidence of thrombotic events. We hypothesize a crucial pathophysiological role for the contact pathway of coagulation and the kallikrein-bradykinin pathway. Therefore, drugs that modulate this excessive thromboinflammatory response should be investigated in severe COVID-19. Methods In this adaptive, open-label multicenter randomized clinical trial, we compare low molecular weight heparins at 50 IU anti-Xa/kg twice daily—or 75 IU anti-Xa twice daily for intensive care (ICU) patients—in combination with aprotinin to standard thromboprophylaxis in hospitalized COVID-19 patients. In the case of hyperinflammation, the interleukin-1 receptor antagonist anakinra will be added on top of the drugs in the interventional arm. In a pilot phase, the effect of the intervention on thrombotic markers (D-dimer) will be assessed. In the full trial, the primary outcome is defined as the effect of the interventional drugs on clinical status as defined by the WHO ordinal scale for clinical improvement. Discussion In this trial, we target the thromboinflammatory response at multiple levels. We intensify the dose of low molecular weight heparins to reduce thrombotic complications. Aprotinin is a potent kallikrein pathway inhibitor that reduces fibrinolysis, activation of the contact pathway of coagulation, and local inflammatory response. Additionally, aprotinin has shown in vitro inhibitory effects on SARS-CoV-2 cellular entry. Because the excessive thromboinflammatory response is one of the most adverse prognostic factors in COVID-19, we will add anakinra, a recombinant interleukin-1 receptor antagonist, to the regimen in case of severely increased inflammatory parameters. This way, we hope to modulate the systemic response to SARS-CoV-2 and avoid disease progressions with a potentially fatal outcome. Trial registration The EU Clinical Trials Register 2020-001739-28. Registered on April 10, 2020.

Published
2020
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11. Correction to: A randomized, open-label, adaptive, proof-of-concept clinical trial of modulation of host thromboinflammatory response in patients with COVID-19: the DAWn-Antico study

Author

T. Vanassche, M. M. Engelen, Q. Van Thillo, J. Wauters, J. Gunst, C. Wouters, C. Vandenbriele, S. Rex, L. Liesenborghs, A. Wilmer, P. Meersseman, G. Van den Berghe, D. Dauwe, G. Verbeke, M. Thomeer, T. Fivez, D. Mesotten, D. Ruttens, L. Heytens, I. Dapper, S. Tuyls, B. De Tavernier, P. Verhamme, DAWn consortium members, Dauwe, Dieter/0000-0002-9771-2543, and Wouters, Carine/0000-0002-6426-8845

Subjects
lcsh:R5-920, Correction, Medicine (miscellaneous), Pharmacology (medical), lcsh:Medicine (General)
Abstract

Vanassche, T (corresponding author), Katholieke Univ Leuven, Dept Cardiovasc Sci, Ctr Mol & Vasc Biol, Leuven, Belgium. Univ Hosp Leuven, Dept Cardiovasc Sci, Leuven, Belgium. thomas.vanassche@uzleuven.be

Published
2020
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12. 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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13. 023 Risk Stratification Using CHA2DS2-VASc and CHADS2 Scores in Patients With Chronic Atherosclerotic Cardiovascular Disease Receiving Aspirin With or Without Rivaroxaban: An Analysis of the COMPASS Trial

Author

Scott D. Berkowitz, P. Verhamme, J. Sen, S. Yusuf, John Varigos, K.A.A Fox, S. Fonguh, Sonia S. Anand, John W. Eikelboom, John Amerena, T. Vanassche, and Andrew Tonkin

Subjects
Pulmonary and Respiratory Medicine, Rivaroxaban, Aspirin, medicine.medical_specialty, business.industry, Atherosclerotic cardiovascular disease, Internal medicine, Risk stratification, Cardiology, Medicine, In patient, Cardiology and Cardiovascular Medicine, business, medicine.drug
Published
2020
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14. Clinical outcomes during anticoagulant therapy in fragile patients with venous thromboembolism

Author

Farès Moustafa, Matteo Giorgi Pierfranceschi, Pierpaolo Di Micco, Eugenio Bucherini, Alicia Lorenzo, Aurora Villalobos, José A. Nieto, Beatriz Valero, Ángel L. Sampériz, Manuel Monreal, Hervé Decousus, Paolo Prandoni, Benjamin Brenner, Raquel Barba, Laurent Bertoletti, Inna Tzoran, Abilio Reis, Marijan Bosevski, Henri Bounameaux, Radovan Malý, Philip Wells, Manolis Papadakis, MD Adarraga, P Agudo, MA Aibar, M Alfonso, JI Arcelus, A Ballaz, R Barba, M Barrón, B Barrón‐Andrés, J Bascuñana, A Blanco‐Molina, I Cañas, I Casado, N Chic, R del Pozo, J del Toro, MC Díaz‐Pedroche, JA Díaz‐Peromingo, C Falgá, C Fernández‐Aracil, C Fernández‐Capitán, MA Fidalgo, C Font, L Font, P Gallego, MA García, F García‐Bragado, O Gavín, C Gómez, V Gómez, J González, E Grau, A Grimón, R Guijarro, L Guirado, J Gutiérrez, G Hernández‐Comes, L Hernández‐Blasco, L Jara‐Palomares, MJ Jaras, D Jiménez, J Jiménez, MD Joya, P Llamas, JL Lobo, P López, L López‐Jiménez, R López‐Reyes, JB López‐Sáez, MA Lorente, M Lumbierres, JM Luque, PJ Marchena, F Martín‐Martos, M Mellado, S Nieto, A Núñez, MJ Núñez, S Otalora, R Otero, JM Pedrajas, G Pérez, C Pérez‐Ductor, ML Peris, I Pons, JA Porras, O Reig, A Riera‐Mestre, D Riesco, A Rivas, M Rodríguez, MA Rodríguez‐Dávila, V Rosa, E Rosillo‐Hernández, P Ruiz‐Artacho, N Ruiz‐Giménez, JC Sahuquillo, MC Sala‐Sainz, R Sánchez‐Martínez, O Sanz, S Soler, B Sopeña, JM Suriñach, C Tolosa, MI Torres, J Troya, J Trujillo‐Santos, F Uresandi, E Usandizaga, R Valle, J Vela, L Vela, MP Vicente, B Xifre, T Vanassche, P Verhamme, HHB Yoo, P Wells, J Hirmerova, R Malý, P Dulíček, E Salgado, L Bertoletti, A Bura‐Riviere, D Farge‐Bancel, A Hij, I Mahé, A Merah, A Braester, B Brenner, I Tzoran, G Antonucci, G Barillari, F Bilora, C Bortoluzzi, B Brandolin, C Cattabiani, M Ciammaichella, N Dell'Elce, F Dentali, R Duce, E Grandone, E Imbalzano, G Lessiani, R Maida, D Mastroiacovo, F Pace, R Parisi, M Pellegrinet, R Pesavento, M Pinelli, R Poggio, P Prandoni, R Quintavalla, A Rocci, E Tiraferri, D Tonello, A Tufano, A Visonà, V Gibietis, A Skride, B Vitola, M Bosevski, M Zdraveska, H Bounameaux, L Mazzolai, RIETE Investigators, Decousus, H., Prandoni, P., Brenner, B., Barba, R., Bertoletti, L., Tzoran, I., Reis, A., Bosevski, M., Bounameaux, H., Malý, R., Wells, P., Papadakis, M., Adarraga, M.D., Agudo, P., Aibar, M.A., Alfonso, M., Arcelus, J.I., Ballaz, A., Barrón, M., Barrón-Andrés, B., Bascuñana, J., Blanco-Molina, A., Cañas, I., Casado, I., Chic, N., Del Pozo, R., Del Toro, J., Díaz-Pedroche, M.C., Díaz-Peromingo, J.A., Falgá, C., Fernández-Aracil, C., Fernández-Capitán, C., Fidalgo, M.A., Font, C., Font, L., Gallego, P., García, M.A., García-Bragado, F., Gavín, O., Gómez, C., Gómez, V., González, J., Grau, E., Grimón, A., Guijarro, R., Guirado, L., Gutiérrez, J., Hernández-Comes, G., Hernández-Blasco, L., Jara-Palomares, L., Jaras, M.J., Jiménez, D., Jiménez, J., Joya, M.D., Llamas, P., Lobo, J.L., López, P., López-Jiménez, L., López-Reyes, R., López-Sáez, J.B., Lorente, M.A., Lumbierres, M., Luque, J.M., Marchena, P.J., Martín-Martos, F., Mellado, M., Nieto, S., Núñez, A., Núñez, M.J., Otalora, S., Otero, R., Pedrajas, J.M., Pérez, G., Pérez-Ductor, C., Peris, M.L., Pons, I., Porras, J.A., Reig, O., Riera-Mestre, A., Riesco, D., Rivas, A., Rodríguez, M., Rodríguez-Dávila, M.A., Rosa, V., Rosillo-Hernández, E., Ruiz-Artacho, P., Ruiz-Giménez, N., Sahuquillo, J.C., Sala-Sainz, M.C., Sánchez-Martínez, R., Sanz, O., Soler, S., Sopeña, B., Suriñach, J.M., Tolosa, C., Torres, M.I., Troya, J., Trujillo-Santos, J., Uresandi, F., Usandizaga, E., Valle, R., Vela, J., Vela, L., Vicente, M.P., Xifre, B., Vanassche, T., Verhamme, P., Yoo, H., Hirmerova, J., Dulíček, P., Salgado, E., Bura-Riviere, A., Farge-Bancel, D., Hij, A., Mahé, I., Merah, A., Braester, A., Antonucci, G., Barillari, G., Bilora, F., Bortoluzzi, C., Brandolin, B., Cattabiani, C., Ciammaichella, M., Dell'Elce, N., Dentali, F., Duce, R., Grandone, E., Imbalzano, E., Lessiani, G., Maida, R., Mastroiacovo, D., Pace, F., Parisi, R., Pellegrinet, M., Pesavento, R., Pinelli, M., Poggio, R., Quintavalla, R., Rocci, A., Tiraferri, E., Tonello, D., Tufano, A., Visonà, A., Gibietis, V., Skride, A., Vitola, B., Zdraveska, M., Mazzolai, L., Moustafa, F., Giorgi Pierfranceschi, M., Di Micco, P., Bucherini, E., Lorenzo, A., Villalobos, A., Nieto, J. A., Valero, B., Samperiz, A. L., Monreal, M., Maly, R., Adarraga, M. D., Aibar, M. A., Arcelus, J. I., Barron, M., Barron-Andres, B., Bascunana, J., Canas, I., del Pozo, R., del Toro, J., Diaz-Pedroche, M. C., Diaz-Peromingo, J. A., Falga, C., Fernandez-Aracil, C., Fernandez-Capitan, C., Fidalgo, M. A., Garcia, M. A., Garcia-Bragado, F., Gavin, O., Gomez, C., Gomez, V., Gonzalez, J., Grimon, A., Gutierrez, J., Hernandez-Comes, G., Hernandez-Blasco, L., Jaras, M. J., Jimenez, D., Jimenez, J., Joya, M. D., Lobo, J. L., Lopez, P., Lopez-Jimenez, L., Lopez-Reyes, R., Lopez-Saez, J. B., Lorente, M. A., Luque, J. M., Marchena, P. J., Martin-Martos, F., Nunez, A., Nunez, M. J., Pedrajas, J. M., Perez, G., Perez-Ductor, C., Peris, M. L., Porras, J. A., Rodriguez, M., Rodriguez-Davila, M. A., Rosillo-Hernandez, E., Ruiz-Gimenez, N., Sahuquillo, J. C., Sala-Sainz, M. C., Sanchez-Martinez, R., Sopena, B., Surinach, J. M., Torres, M. I., Vicente, M. P., Yoo, H. H. B., Dulicek, P., Mahe, I., and Visona, A.

Subjects
medicine.medical_specialty, Gastrointestinal bleeding, anticoagulants, recurrence, venous thromboembolism, hemorrhage, mortality, recurrences, Renal function, 030204 cardiovascular system & hematology, Lower risk, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, medicine, 030212 general & internal medicine, business.industry, anticoagulant, Retrospective cohort study, Hematology, Odds ratio, medicine.disease, Confidence interval, Surgery, Natural history, Original Article, business, Original Articles: Thrombosis
Abstract

Essentials Recent randomized trials suggested fewer bleeding events in fragile patients with VTE receiving DOACs.The frequency, clinical characteristics and outcome of these patients have not been reported in real life.Fragile patients with VTE had a higher risk for major bleeding or death and a lower risk for recurrences than non‐fragile. Background Subgroup analyses from randomized trials suggested favorable results for the direct oral anticoagulants in fragile patients with venous thromboembolism (VTE). The frequency and natural history of fragile patients with VTE have not been studied yet. Objectives To compare the clinical characteristics, treatment and outcomes during the first 3 months of anticoagulation in fragile vs non‐fragile patients with VTE. Methods Retrospective study using consecutive patients enrolled in the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry. Fragile patients were defined as those having age ≥75 years, creatinine clearance (CrCl) levels ≤50 mL/min, and/or body weight ≤50 kg. Results From January 2013 to October 2016, 15 079 patients were recruited. Of these, 6260 (42%) were fragile: 37% were aged ≥75 years, 20% had CrCl levels ≤50 mL/min, and 3.6% weighed ≤50 kg. During the first 3 months of anticoagulant therapy, fragile patients had a lower risk of VTE recurrences (0.78% vs 1.4%; adjusted odds ratio [OR]: 0.52; 95% confidence intervals [CI]: 0.37‐0.74) and a higher risk of major bleeding (2.6% vs 1.4%; adjusted OR: 1.41; 95% CI: 1.10‐1.80), gastrointestinal bleeding (0.86% vs 0.35%; adjusted OR: 1.84; 95% CI: 1.16‐2.92), haematoma (0.51% vs 0.07%; adjusted OR: 5.05; 95% CI: 2.05‐12.4), all‐cause death (9.2% vs 3.5%; adjusted OR: 2.02; 95% CI: 1.75‐2.33), or fatal PE (0.85% vs 0.35%; adjusted OR: 1.77; 95% CI: 1.10‐2.85) than the non‐fragile. Conclusions In real life, 42% of VTE patients were fragile. During anticoagulation, they had fewer VTE recurrences and more major bleeding events than the non‐fragile.

Published
2017

15. 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

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

Author

Luis Jara-Palomares, Remedios Otero, David Jimenez, Marc Carrier, Inna Tzoran, Benjamin Brenner, Mireia Margeli, Juan Manuel Praena-Fernandez, Elvira Grandone, Manuel Monreal, Hervè Decousus, Paolo Prandoni, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Abilio Reis, Marijan Bosevski, Henri Bounameaux, Radovan Malý, Philip Wells, Manolis Papadakis, M.A. Aibar, M. Alfonso, M.I. Asensio-Cruz, T. Auguet, J.I. Arcelus, R. Barba, M. Barrón, B. Barrón-Andrés, J. Bascuñana, A. Blanco-Molina, T. Bueso, I. Cañas, A. Ceausu, N. Chic, A. Culla, R. del Pozo, J. del Toro, M.C. Díaz-Pedroche, J.A. Díaz-Peromingo, M. Duffort, T. Elias-Hernández, C. Falgá, C. Fernández-Aracil, C. Fernández-Capitán, M.A. Fidalgo, C. Font, L. Font, P. Gallego, M.A. García, F. García-Bragado, M. García-Rodenas, V. Gómez, J. González, E. Grau, A. Grimón, R. Guijarro, L. Guirado, J. Gutiérrez, G. Hernández-Comes, L. Hernández-Blasco, E. Hernando-López, L. Jara-Palomares, M.J. Jaras, D. Jiménez, M.D. Joya, P. Llamas, R. Lecumberri, J.L. Lobo, L. López-Jiménez, R. López-Reyes, J.B. López-Sáez, M.A. Lorente, A. Lorenzo, A. Maestre, P.J. Marchena, M. Martín, F. Martín-Martos, M. Monreal, J.A. Nieto, S. Nieto, A. Núñez, M.J. Núñez, M. Odriozola, S. Otalora, R. Otero, A. Ovejero, J.M. Pedrajas, G. Pérez, C. Pérez-Ductor, M.L. Peris, J.A. Porras, O. Reig, A. Riera-Mestre, D. Riesco, A. Rivas, M.A. Rodríguez-Dávila, V. Rosa, P. Ruiz-Artacho, N. Ruiz-Giménez, J.C. Sahuquillo, M.C. Sala-Sainz, A. Sampériz, R. Sánchez, O. Sanz, S. Soler, B. Sopeña, J.M. Suriñach, C. Tolosa, J. Trujillo-Santos, F. Uresandi, B. Valero, R. Valle, J. Vela, P. Vicente, G. Vidal, A. Villalobos, J. Villalta, T. Vanassche, P. Verhamme, P. Wells, J. Hirmerova, R. Malý, E. Salgado, L. Bertoletti, A. Bura-Riviere, D. Farge-Bancel, A. Hij, I. Mahé, A. Merah, F. Moustafa, M. Papadakis, A. Braester, B. Brenner, I. Tzoran, G. Antonucci, G. Barillari, A. Bertone, F. Bilora, C. Bortoluzzi, M. Ciammaichella, C. Di Girolamo, P. Di Micco, R. Duce, P. Ferrazzi, M. Giorgi-Pierfranceschi, E. Grandone, C. Lodigiani, R. Maida, D. Mastroiacovo, F. Pace, R. Pesavento, M. Pinelli, R. Poggio, P. Prandoni, L. Rota, E. Tiraferri, D. Tonello, A. Tufano, A. Visonà, B. Zalunardo, E. Drucka, D. Kigitovica, A. Skride, M.S. Sousa, M. Bosevski, M. Zdraveska, H. Bounameaux, L. Mazzolai, Jara-Palomares, L., Otero, R., Jimenez, D., Carrier, M., Tzoran, I., Brenner, B., Margeli, M., Praena-Fernandez, J. M., Grandone, E., Monreal, M., Decousus, H., Prandoni, P., Barba, R., Di Micco, P., Bertoletti, L., Reis, A., Bosevski, M., Bounameaux, H., Maly, R., Wells, P., Papadakis, M., Aibar, M. A., Alfonso, M., Asensio-Cruz, M. I., Auguet, T., Arcelus, J. I., Barron, M., Barron-Andres, B., Bascunana, J., Blanco-Molina, A., Bueso, T., Canas, I., Ceausu, A., Chic, N., Culla, A., del Pozo, R., del Toro, J., Diaz-Pedroche, M. C., Diaz-Peromingo, J. A., Duffort, M., Elias-Hernandez, T., Falga, C., Fernandez-Aracil, C., Fernandez-Capitan, C., Fidalgo, M. A., Font, C., Font, L., Gallego, P., Garcia, M. A., Garcia-Bragado, F., Garcia-Rodenas, M., Gomez, V., Gonzalez, J., Grau, E., Grimon, A., Guijarro, R., Guirado, L., Gutierrez, J., Hernandez-Comes, G., Hernandez-Blasco, L., Hernando-Lopez, E., Jaras, M. J., Joya, M. D., Llamas, P., Lecumberri, R., Lobo, J. L., Lopez-Jimenez, L., Lopez-Reyes, R., Lopez-Saez, J. B., Lorente, M. A., Lorenzo, A., Maestre, A., Marchena, P. J., Martin, M., Martin-Martos, F., Nieto, J. A., Nieto, S., Nunez, A., Nunez, M. J., Odriozola, M., Otalora, S., Ovejero, A., Pedrajas, J. M., Perez, G., Perez-Ductor, C., Peris, M. L., Porras, J. A., Reig, O., Riera-Mestre, A., Riesco, D., Rivas, A., Rodriguez-Davila, M. A., Rosa, V., Ruiz-Artacho, P., Ruiz-Gimenez, N., Sahuquillo, J. C., Sala-Sainz, M. C., Samperiz, A., Sanchez, R., Sanz, O., Soler, S., Sopena, B., Surinach, J. M., Tolosa, C., Trujillo-Santos, J., Uresandi, F., Valero, B., Valle, R., Vela, J., Vicente, P., Vidal, G., Villalobos, A., Villalta, J., Vanassche, T., Verhamme, P., Hirmerova, J., Salgado, E., Bura-Riviere, A., Farge-Bancel, D., Hij, A., Mahe, I., Merah, A., Moustafa, F., Braester, A., Antonucci, G., Barillari, G., Bertone, A., Bilora, F., Bortoluzzi, C., Ciammaichella, M., Di Girolamo, C., Duce, R., Ferrazzi, P., Giorgi-Pierfranceschi, M., Lodigiani, C., Maida, R., Mastroiacovo, D., Pace, F., Pesavento, R., Pinelli, M., Poggio, R., Rota, L., Tiraferri, E., Tonello, D., Tufano, A., Visona, A., Zalunardo, B., Drucka, E., Kigitovica, D., Skride, A., Sousa, M. S., Zdraveska, M., and Mazzolai, L.

Subjects
Pulmonary and Respiratory Medicine, Lung Diseases, Male, medicine.medical_specialty, Multivariate analysis, Anemia, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Sex Factors, Internal medicine, Neoplasms, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Registries, risk, Aged, Aged, 80 and over, Thrombocytosis, Venous Thrombosis, Framingham Risk Score, business.industry, screening, Case-control study, Age Factors, Cancer, Reproducibility of Results, Venous Thromboembolism, Middle Aged, medicine.disease, Pulmonary embolism, Surgery, Spain, Case-Control Studies, Surgical Procedures, Operative, Cohort, Multivariate Analysis, Female, Cardiology and Cardiovascular Medicine, Risk assessment, business, Pulmonary Embolism, neoplasm
Abstract

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

Published
2016

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

Author

Inna Tzoran, Manolis Papadakis, Benjamin Brenner, Ángeles Fidalgo, Agustina Rivas, Philip S. Wells, Olga Gavín, María Dolores Adarraga, Farès Moustafa, Manuel Monreal, Hervé Decousus, Paolo Prandoni, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Abilio Reis, Marijan Bosevski, Henri Bounameaux, Radovan Malý, Philip Wells, M.D. Adarraga, M.A. Aibar, M. Alfonso, J.I. Arcelus, R. Barba, M. Barrón, B. Barrón-Andrés, J. Bascuñana, A. Blanco-Molina, T. Bueso, G. Cañada, I. Cañas, N. Chic, R. del Pozo, J. del Toro, M.C. Díaz-Pedroche, J.A. Díaz-Peromingo, C. Falgá, C. Fernández-Capitán, M.A. Fidalgo, C. Font, L. Font, P. Gallego, A. García, M.A. García, F. García-Bragado, P. García-Brotons, O. Gavín, C. Gómez, V. Gómez, J. González, D. González-Marcano, E. Grau, A. Grimón, R. Guijarro, J. Gutiérrez, G. Hernández-Comes, L. Hernández-Blasco, M.J. Hermosa-Los Arcos, L. Jara-Palomares, M.J. Jaras, D. Jiménez, M.D. Joya, P. Llamas, R. Lecumberri, J.L. Lobo, P. López, L. López-Jiménez, R. López-Reyes, J.B. López-Sáez, M.A. Lorente, A. Lorenzo, A. Maestre, P.J. Marchena, F. Martín-Martos, M. Monreal, J.A. Nieto, S. Nieto, A. Núñez, M.J. Núñez, M. Odriozola, R. Otero, J.M. Pedrajas, G. Pérez, C. Pérez-Ductor, M.L. Peris, J.A. Porras, O. Reig, A. Riera-Mestre, D. Riesco, A. Rivas, C. Rodríguez, M.A. Rodríguez-Dávila, V. Rosa, N. Ruiz-Giménez, J.C. Sahuquillo, M.C. Sala-Sainz, A. Sampériz, R. Sánchez-Martínez, R. Sánchez Simón-Talero, O. Sanz, S. Soler, J.M. Suriñach, M.I. Torres, J. Trujillo-Santos, F. Uresandi, B. Valero, R. Valle, J. Vela, M.P. Vicente, A. Villalobos, T. Vanassche, P. Verhamme, P. Wells, J. Hirmerova, R. Malý, T. Tomko, G. del Pozo, E. Salgado, G.T. Sánchez, L. Bertoletti, A. Bura-Riviere, I. Mahé, A. Merah, F. Moustafa, M. Papadakis, A. Braester, B. Brenner, I. Tzoran, G. Antonucci, G. Barillari, F. Bilora, C. Bortoluzzi, C. Cattabiani, M. Ciammaichella, J. Di Biase, P. Di Micco, R. Duce, P. Ferrazzi, M. Giorgi-Pierfranceschi, E. Grandone, E. Imbalzano, C. Lodigiani, R. Maida, D. Mastroiacovo, F. Pace, R. Pesavento, M. Pinelli, R. Poggio, P. Prandoni, L. Rota, E. Tiraferri, D. Tonello, A. Tufano, A. Visonà, B. Zalunardo, V. Gibietis, A. Skride, B. Vitola, P. Monteiro, J.L. Ribeiro, M.S. Sousa, M. Bosevski, M. Zdraveska, H. Bounameaux, L. Calanca, A. Erdmann, L. Mazzolai, Tzoran, I., Papadakis, M., Brenner, B., Fidalgo, A., Rivas, A., Wells, P. S., Gavin, O., Adarraga, M. D., Moustafa, F., Monreal, M., Decousus, H., Prandoni, P., Barba, R., Di Micco, P., Bertoletti, L., Reis, A., Bosevski, M., Bounameaux, H., Maly, R., Wells, P., Aibar, M. A., Alfonso, M., Arcelus, J. I., Barron, M., Barron-Andres, B., Bascunana, J., Blanco-Molina, A., Bueso, T., Canada, G., Canas, I., Chic, N., del Pozo, R., del Toro, J., Diaz-Pedroche, M. C., Diaz-Peromingo, J. A., Falga, C., Fernandez-Capitan, C., Fidalgo, M. A., Font, C., Font, L., Gallego, P., Garcia, A., Garcia, M. A., Garcia-Bragado, F., Garcia-Brotons, P., Gomez, C., Gomez, V., Gonzalez, J., Gonzalez-Marcano, D., Grau, E., Grimon, A., Guijarro, R., Gutierrez, J., Hernandez-Comes, G., Hernandez-Blasco, L., Hermosa-Los Arcos, M. J., Jara-Palomares, L., Jaras, M. J., Jimenez, D., Joya, M. D., Llamas, P., Lecumberri, R., Lobo, J. L., Lopez, P., Lopez-Jimenez, L., Lopez-Reyes, R., Lopez-Saez, J. B., Lorente, M. A., Lorenzo, A., Maestre, A., Marchena, P. J., Martin-Martos, F., Nieto, J. A., Nieto, S., Nunez, A., Nunez, M. J., Odriozola, M., Otero, R., Pedrajas, J. M., Perez, G., Perez-Ductor, C., Peris, M. L., Porras, J. A., Reig, O., Riera-Mestre, A., Riesco, D., Rodriguez, C., Rodriguez-Davila, M. A., Rosa, V., Ruiz-Gimenez, N., Sahuquillo, J. C., Sala-Sainz, M. C., Samperiz, A., Sanchez-Martinez, R., Sanchez Simon-Talero, R., Sanz, O., Soler, S., Surinach, J. M., Torres, M. I., Trujillo-Santos, J., Uresandi, F., Valero, B., Valle, R., Vela, J., Vicente, M. P., Villalobos, A., Vanassche, T., Verhamme, P., Hirmerova, J., Tomko, T., del Pozo, G., Salgado, E., Sanchez, G. T., Bura-Riviere, A., Mahe, I., Merah, A., Braester, A., Antonucci, G., Barillari, G., Bilora, F., Bortoluzzi, C., Cattabiani, C., Ciammaichella, M., Di Biase, J., Duce, R., Ferrazzi, P., Giorgi-Pierfranceschi, M., Grandone, E., Imbalzano, E., Lodigiani, C., Maida, R., Mastroiacovo, D., Pace, F., Pesavento, R., Pinelli, M., Poggio, R., Rota, L., Tiraferri, E., Tonello, D., Tufano, A., Visona, A., Zalunardo, B., Gibietis, V., Skride, A., Vitola, B., Monteiro, P., Ribeiro, J. L., Sousa, M. S., Zdraveska, M., Calanca, L., Erdmann, A., and Mazzolai, L.

Subjects
Male, Heterozygote, medicine.medical_specialty, medicine.drug_class, Low molecular weight heparin, Hemorrhage, 030204 cardiovascular system & hematology, Gene mutation, Thrombophilia, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Factor V Leiden, Humans, Anticoagulant therapy, Activated Protein C Resistance, Rivaroxaban, biology, business.industry, Bleeding, Factor V, Anticoagulants, General Medicine, Middle Aged, medicine.disease, Surgery, Treatment Outcome, Mutation, biology.protein, Prothrombin G20210A, Female, Prothrombin, Activated protein C resistance, business, Venous thromboembolism, 030215 immunology, medicine.drug
Abstract

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

Published
2017
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18. Part 2: Answer: Haemorrhagic mesenteric cyst

Author

I Pilate, M Ruppert, T Vanassche, and F M Vanhoenacker

Subjects
Pathology, medicine.medical_specialty, business.industry, Mesenteric cyst, Physical Therapy, Sports Therapy and Rehabilitation, General Medicine, Anatomy, Fibrous tissue, medicine.disease, Cyst wall, Lesion, Cystic lesion, medicine.anatomical_structure, Retroperitoneal structures, Etiology, Medicine, Orthopedics and Sports Medicine, medicine.symptom, business, Mesentery
Abstract

The lesion was surgically removed. At microscopic analysis, the cyst wall contained fibrous tissue without an epithelial lining, consistent with a haemorrhagic mesenteric cyst of non-neoplastic origin (non-pancreatic pseudocyst). Mesenteric cysts form a heterogeneous group of rare intra-abdominal cystic lesions, situated in or near the mesentery and without connection to retroperitoneal structures. Incidence varies from 1/20 000 to 1/100 000 hospital admissions according to the age of the patient, with more frequent diagnosis in younger patients.1 Various classifications have been proposed based on the aetiology of the cystic structure, distinguishing embryonic and developmental cysts from lesions of traumatic, neoplastic and infectious origin. As most of these older classifications are confusing, the current classification of mesenteric cysts is essentially based on histopathological characteristics of the tissue or structure from which they derive.2 Cysts …

Published
2010
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19. A rare cause of acute abdominal pain in a young kickboxer

Author

I Pilate, M Ruppert, T Vanassche, and F M Vanhoenacker

Subjects
Male, medicine.medical_specialty, Mesenteric Cyst, Adolescent, business.industry, General surgery, Acute abdominal pain, Hemorrhage, Physical Therapy, Sports Therapy and Rehabilitation, General Medicine, Boxing, Abdominal Pain, Text mining, medicine, Humans, Orthopedics and Sports Medicine, Human medicine, Tomography, X-Ray Computed, business, Ultrasonography
Published
2010
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