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3 results on '"Roberto Cappelli"'

1. Clinical applicability of D-dimer assay in the diagnosis of pulmonary embolism reduces with aging

Author

Luca Masotti, Giancarlo Landini, Fabio Antonelli, Elio Venturini, Roberto Cappelli, and Paola Rottoli

Subjects
D-dimer, Clinical probability, Pulmonary embolism, Diagnosis, Elderly, Medicine (General), R5-920
Abstract

Despite modern algorithms have been proposed for diagnosis of pulmonary embolism (PE), it remains understimed and often missed in clinical practice, especially in elderly patients, resulting in high morbidity and mortality when early and correctly untreated. One of the main controversial issue is represented by the role and applicability of D-dimer in the diagnostic work up of geriatric patients. Most recent guidelines in young-adult patients suggest to perform D-dimer assay by ELISA or immunoturbidimetric methods only in non high pre-test clinical probability (PTP) patients; in these patients negative D-dimer can safely rule out the diagnosis of PE. This strategy is safe also in elderly patients; however the percentage of patients with non high PTP and negative D-dimer reduces progressively with age, making difficult its clinical applicability. The Authors, starting from two case reports, up date the diagnostic management of PE underling the limitations of D-dimer assay in elderly patients.

Published
2007
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2. Mechanical prophylaxis of venous thromboembolism in ill hospitalized medical patients: evidence and guidelines

Author

Luca Masotti, Grazia Panigada, Mario Di Napoli, Giancarlo Landini, and Roberto Cappelli

Subjects
medicine.medical_specialty, Venous thromboembolism, Prophylaxis, Graduated compression stockings, Intermittent pneumatic compression, Comorbidity, Internal Medicine, business.industry, Cardiology, Context (language use), General Medicine, Fondaparinux, medicine.disease, equipment and supplies, law.invention, Randomized controlled trial, law, Medicine, cardiovascular diseases, business, Intensive care medicine, Stroke, medicine.drug
Abstract

Venous thromboembolism (VTE) represents one of the leading causes of mortality and morbidity in ill medical patients. Avoiding VTE is therefore of utmost importance in clinical practice. VTE prophylaxis can be assured by pharmacological strategies, such as heparinoids, unfractioned heparin, low molecular weight heparins, fondaparinux or oral anticoagulants and, when these are contraindicated, by mechanical measures, such as graduated compression stockings (GCS) and/ or intermittent pneumatic compression (ICP). However, due to the lack of solid literature evidence, VTE mechanical prophylaxis is not standardized in hospitalized ill medical patients. Much recently, findings from randomized clinical trials on VTE prophylaxis in ill medical patients, such as CLOTS I in patients with stroke and LIFENOX in patients with other kind of medical diseases, seem to increase doubts and reduce certainness in this context and recommendations from guidelines don’t help in reducing confusion. Therefore the aim of this review is to focus on mechanical prophylaxis of VTE in hospitalized ill medical patients.http://dx.doi.org/10.7175/rhc.v3i3.202

Published
2012

3. The intracerebral haemorrhage associated to oral anticoagulant therapy: the practical management of urgent reversal therapy

Author

Luca Masotti, Roberto Cappelli, Paolo Pennati, Daniela Rafanelli, Giancarlo Landini, Domenico Prisco, Giancarlo M. Liumbruno, Daniel Agustin Godoy, Alessandro Pampana, Daniela Poli, Mario Di Napoli, and Nicholas Koumpouros

Subjects
medicine.medical_specialty, business.industry, Warfarin, General Medicine, medicine.disease, Prothrombin complex concentrate, Hematoma, Neurology, Neurosurgery, Internal medicine, Geriatrics, Cardiology, medicine, Oral anticoagulant, In patient, Fresh frozen plasma, cardiovascular diseases, Risk factor, Complication, Intensive care medicine, business, Vitamin K antagonists, Intracerebral haemorrhage, Fresh frozen plasm, Recombinant actived Factor VII, OAT reversal, medicine.drug
Abstract

Intracerebral haemorrhage (ICH) represents the most feared complication of therapy with vitamin K antagonists (VKA), so-called oral anticoagulant therapy (OAT). This is a real emergency in clinical practice, being burdened by high mortality, morbidity and residual functional disability. In recent years, there have been widespread indications for the correct management of VKA associated ICH. The urgent OAT reversal represents the cornerstone of VKA associated ICH therapy. The knowledge of these guidelines is of fundamental importance in clinical practice. The urgent OAT reversal could stop the hematoma enlargement which is considered one of the main risk factor of poor outcome in this clinical setting. The aim of urgent OAT reversal is bringing the INR (International Normalized Ratio) to values ≤ 1.4. It is possible by using prothrombin complex concentrate (PCC), fresh frozen plasma (FFP), recombinant activated factor VII (raFVII) together with vitamin K1 intravenous infusion. In this article the Authors review the practical management of urgent OAT reversal in patients suffering for VKA related ICH.

Published
2011

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