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1. Bleeding and venous thromboembolism arising in acutely ill hospitalized medical patients. Findings from the Spanish national discharge database.

Author

Guijarro R, San Roman C, Arcelus JI, Montes-Santiago J, Gómez-Huelgas R, Gallardo P, and Monreal M

Subjects
Acute Disease, Aged, Aged, 80 and over, Anticoagulants therapeutic use, Chemoprevention, Comorbidity, Databases, Factual, Female, Fondaparinux, Heparin therapeutic use, Heparin, Low-Molecular-Weight therapeutic use, Humans, Male, Middle Aged, Polysaccharides therapeutic use, Pulmonary Embolism prevention & control, Risk Assessment, Risk Factors, Spain epidemiology, Venous Thromboembolism prevention & control, Venous Thrombosis prevention & control, Heart Failure epidemiology, Hemorrhage epidemiology, Hospitalization statistics & numerical data, Pulmonary Embolism epidemiology, Respiratory Insufficiency epidemiology, Venous Thromboembolism epidemiology, Venous Thrombosis epidemiology
Abstract

Background: There is scarce evidence to identify which acutely ill medical patients might benefit from prophylaxis against venous thromboembolism (VTE)., Methods: The Spanish National Discharge Database was used to identify predictors of bleeding and VTE during hospitalization for an acute medical illness., Results: Of 1,148,301 patients, 3.10% bled, 1.21% were diagnosed with VTE, and 8.64% died. The case-fatality rate was: 20.8% for bleeding and 19.7% for VTE. Eight clinical variables were independently associated with an increased risk for VTE and bleeding, one with a decreased risk for both events, 4 with an increased risk for VTE and a decreased risk for bleeding, 2 with an increased risk for bleeding but a decreased risk for VTE, and 1 with a decreased risk for bleeding. When all these variables were considered, we composed a risk scoring system, in which we assigned points to each variable according to the ratio between the odds ratio for bleeding and for VTE. Overall, 21% of patients scored less than 0 points and had a bleeding vs. VTE ratio of 1.19; 55% scored 0 to 1.0 points and had a ratio of 2.13; and 24% scored over 1.0 points and had a ratio of 6.10., Conclusions: A risk score based on variables documented at admission can identify patients with different ratios (near 1.0; about 2.0; and >6.0) between the rate of bleeding and of VTE., (© 2013. Published by Elsevier B.V. on behalf of European Federation of Internal Medicine. All rights reserved.)

Published
2014
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2. [News on venous thromboembolic disease].

Author

Arcelus JI, García-Bragado F, Jiménez D, Lozano Sánchez FS, Lecumberri R, and Román Sánchez P

Subjects
Antithrombins therapeutic use, Factor Xa Inhibitors, Humans, Practice Guidelines as Topic, Venous Thromboembolism etiology, Venous Thrombosis diagnosis, Anticoagulants therapeutic use, Orthopedic Procedures, Postoperative Complications prevention & control, Pulmonary Embolism drug therapy, Venous Thromboembolism prevention & control, Venous Thrombosis drug therapy
Abstract

This paper brings together the latest developments that have occurred in different aspects of venous thromboembolism (VTE): VTE prophylaxis in high-risk orthopedic surgery and acutely ill hospitalized medical patients; therapeutic advances in pulmonary embolism and superficial vein thrombosis and VTE future prospects. It summarizes the reviews that five speakers made in-depth for the Second Day in New Anticoagulant Treatment, held in Madrid on November 18, 2011, organized by the Foundation for the Study of Thromboembolic Disease in Spain and endorsed by the Spanish Society of Internal Medicine, Spanish Society of Pneumology and Thoracic Surgery, Spanish Society of Cardiology, Spanish Society of Thrombosis and Haemostasis and the Spanish Society of Angiology and Vascular Surgery., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Published
2012
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3. Clinical presentation and time-course of postoperative venous thromboembolism: Results from the RIETE Registry.

Author

Arcelus JI, Monreal M, Caprini JA, Guisado JG, Soto MJ, Núñez MJ, and Alvárez JC

Subjects
Aged, Argentina, Europe, Female, Fibrinolytic Agents adverse effects, Hemorrhage chemically induced, Humans, Incidence, Israel, Male, Middle Aged, Neoplasms surgery, Orthopedic Procedures adverse effects, Prospective Studies, Pulmonary Embolism mortality, Pulmonary Embolism prevention & control, Recurrence, Registries, Time Factors, Venous Thromboembolism complications, Venous Thromboembolism drug therapy, Venous Thromboembolism mortality, Fibrinolytic Agents therapeutic use, Pulmonary Embolism etiology, Surgical Procedures, Operative adverse effects, Venous Thromboembolism etiology
Abstract

There is little literature about the clinical presentation and time-course of postoperative venous thromboembolism (VTE) in different surgical procedures. RIETE is an ongoing, prospective registry of consecutive patients with objectively confirmed, symptomatic acute VTE. In this analysis, we analysed the baseline characteristics, thromboprophylaxis and therapeutic patterns, time-course, and three-month outcome of all patients with postoperative VTE. As of January 2006, there were 1,602 patients with postoperative VTE in RIETE: 393 (25%) after major orthopaedic surgery (145 elective hip arthroplasty, 126 knee arthroplasty, 122 hip fracture); 207 (13%) after cancer surgery; 1,002 (63%) after other procedures. The percentage of patients presenting with clinically overt pulmonary embolism (PE) (48%, 48%, and 50% respectively), the average time elapsed from surgery to VTE (22 +/- 16, 24 +/- 16, and 21 +/- 15 days, respectively), and the three-month incidence of fatal PE (1.3%, 1.4%, and 0.8%, respectively), fatal bleeding (0.8%, 1.0%, and 0.2%, respectively), or major bleeding (2.3%, 2.9%, and 2.8%, respectively) were similar in the three groups. However, the percentage of patients who had received thromboprophylaxis (96%, 76% and 52%, respectively), the duration of prophylaxis (17 +/- 9.6, 13 +/- 8.9, and 12 +/- 11 days, respectively) and the mean daily doses of low-molecular-weight heparin (4,252 +/- 1,016, 3,260 +/- 1,141, and 3,769 +/- 1,650 IU, respectively), were significantly lower in those undergoing cancer surgery or other procedures. In conclusion, the clinical presentation, time-course, and three-month outcome of VTE was similar among the different subgroups of patients, but the use of prophylaxis in patients undergoing cancer surgery or other procedures was suboptimal.

Published
2008
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4. The management and outcome of acute venous thromboembolism: a prospective registry including 4011 patients.

Author

Arcelus JI, Caprini JA, Monreal M, Suárez C, and González-Fajardo J

Subjects
Acute Disease, Aged, Aged, 80 and over, Female, Fibrinolytic Agents therapeutic use, Heparin therapeutic use, Humans, Male, Middle Aged, Prospective Studies, Pulmonary Embolism diagnosis, Spain epidemiology, Thrombolytic Therapy methods, Treatment Outcome, Vena Cava Filters, Venous Thrombosis diagnosis, Professional Practice statistics & numerical data, Pulmonary Embolism therapy, Registries, Venous Thrombosis therapy
Abstract

Objective: To obtain a realistic overview of management and clinical outcomes of patients with venous thromboembolism (VTE) in Spain on the basis of data from a national multicenter registry., Methods: A prospective registry was initiated in Spain in March 2001. Data were collected from patients with objectively confirmed deep vein thrombosis (DVT) and/or pulmonary embolism (PE) and entered into the online registry by physicians who were responsible for the management of these patients., Results: As of August 2002, 4011 patients with confirmed VTE were included in the registry: 60% with DVT, 23% with PE, and 17% with both DVT and PE. Diagnostic methods for VTE included compression ultrasonography (86%), venography (10%), V/Q lung scans (42%), computed tomography scan (28%), and pulmonary angiography (0.9%). D-dimer testing was performed in 61% of cases and was positive in 92% of patients with confirmed VTE. The majority of DVT (95%) were located in the lower extremities (82% proximal and 4% bilateral), while 4.8% were located in the upper extremities or neck veins. Most patients (90.5%) were admitted to hospital. In the acute phase, treatment consisted of low molecular weight heparin (LMWH) in 88%, unfractionated heparin (UFH) in 11%, and fibrinolysis in 0.8%. Cava filters were inserted in 2% of patients, mainly because of active bleeding (13%), increased hemorrhagic risk (38%), or recurrent VTE (29%). Absolute bed rest was recommended to 63% of patients. Secondary prevention of VTE included oral anticoagulants (75%) and LMWH (24.5%). Therapeutic compression stockings were prescribed to 53% of patients at the time of hospital discharge. Regarding the main clinical outcomes during an average (+/-SD) follow-up period of 156 +/- 95 days, 19% had adverse events: 12.5% of patients died, 5.5% had clinically confirmed VTE recurrence, and 9.8% suffered bleeding complications (44% with major bleeding)., Conclusions: This prospective observational multicenter registry provides a large database reflecting the actual day-to-day clinical practice regarding VTE management in a European country. The most important findings were the increasing use of spiral computed tomography for PE diagnosis, the unexpectedly high proportion of patients admitted to hospital despite the use of LMWH in almost 90% of cases in the acute phase, and the utilization of LMWH for secondary prevention in almost 25% of cases. On the other hand, this large-scale prospective registry permits on-line consultation of high-risk situations to assess how difficult cases were treated and what their outcomes were. This will provide a most useful tool for the practicing physician responsible for the management of VTE patients.

Published
2003
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5. Safety of the pulmonary embolism rule‐out criteria rule: Findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) registry.

Author

Truong, Perrine, Mazzolai, Lucia, Font, Carme, Ciammaichella, Maurizio, González‐Martínez, José, Tufano, Antonella, Gavín‐Sebastián, Olga, Le Mao, Raphael, Monreal, Manuel, Hugli, Olivier, Adarraga, MD, Alberich‐Conesa, A, Alonso‐Carrillo, J, Amado, C, Amorós, S, Arcelus, JI, Ballaz, A, Barba, R, Barbagelata, C, and Barrón, M

Subjects
PULMONARY embolism, VEINS, CONFIDENCE intervals, MEDICAL screening, RETROSPECTIVE studies, COMPARATIVE studies, DECISION making, THROMBOEMBOLISM, DESCRIPTIVE statistics, SYMPTOMS, RESEARCH funding, PATIENT safety, LONGITUDINAL method, ALGORITHMS
Abstract

Background: The diagnostic strategy for pulmonary embolism (PE) includes a D‐dimer test when PE probability is low or intermediate, but false‐positive D‐dimer results are frequent and can result in an unnecessary computed tomography pulmonary angiogram. The PE rule‐out criteria (PERC) rule excludes PE without D‐dimer testing when pretest probability is <15%. The aim of this study was to assess the safety of the PERC rule strategy in patients included in the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) registry. Methods: This retrospective cohort study used data from the RIETE registry, an ongoing, international prospective registry of patients with objectively confirmed venous thromboembolism. The primary outcome was the failure rate of the PERC strategy, represented by the proportion of PERC‐negative (PERC‐N) patients with a PE included in the registry. Secondary outcomes were a comparison of the clinical characteristics, treatment strategy, and outcome of PERC‐N versus PERC‐positive (PERC‐P) patients at 3 months. Results: From 2001 to 2021, a total of 49,793 patients with acute PE were enrolled in the RIETE registry. We included 48,903 in the final analysis after exclusion of 890 patients with an undetermined PERC status. Only 346 patients were PERC‐N with a failure rate of 0.7% (95% confidence interval 0.6%–0.8%). PERC‐N patients presented more frequently with chest pain but less often with dyspnea, syncope, or hypotension. They also had subsegmental or segmental PE more frequently, were more often treated with direct oral anticoagulants, and received mechanical or pharmacological thrombolysis less often. In addition, PERC‐N patients had a lower incidence of recurrent deep vein thrombosis, major bleeding, and death attributed to PE during the 3‐month follow‐up. Conclusions: A low failure rate of the PERC rule was observed in the RIETE registry, thus supporting its use to safely identify patients with an unlikely probability of PE. [ABSTRACT FROM AUTHOR]

Published
2023
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6. Machine learning to predict major bleeding during anticoagulation for venous thromboembolism: possibilities and limitations.

Author

Mora, Damián, Mateo, Jorge, Nieto, José A., Bikdeli, Behnood, Yamashita, Yugo, Barco, Stefano, Jimenez, David, Demelo‐Rodriguez, Pablo, Rosa, Vladimir, Yoo, Hugo Hyung Bok, Sadeghipour, Parham, Monreal, Manuel, Adarraga, MD, Alberich‐Conesa, A, Alonso‐Carrillo, J, Agudo, P, Amado, C, Amorós, S, Arcelus, JI, and Ballaz, A

Subjects
THROMBOEMBOLISM, MACHINE learning, ANTICOAGULANTS, HEMORRHAGE, DATABASES
Abstract

Summary: Predictive tools for major bleeding (MB) using machine learning (ML) might be advantageous over traditional methods. We used data from the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) to develop ML algorithms to identify patients with venous thromboembolism (VTE) at increased risk of MB during the first 3 months of anticoagulation. A total of 55 baseline variables were used as predictors. New data prospectively collected from the RIETE were used for further validation. The RIETE and VTE‐BLEED scores were used for comparisons. External validation was performed with the COMMAND‐VTE database. Learning was carried out with data from 49 587 patients, of whom 873 (1.8%) had MB. The best performing ML method was XGBoost. In the prospective validation cohort the sensitivity, specificity, positive predictive value and F1 score were: 33.2%, 93%, 10%, and 15.4% respectively. F1 value for the RIETE and VTE‐BLEED scores were 8.6% and 6.4% respectively. In the external validation cohort the metrics were 10.3%, 87.6%, 3.5% and 5.2% respectively. In that cohort, the F1 value for the RIETE score was 17.3% and for the VTE‐BLEED score 9.75%. The performance of the XGBoost algorithm was better than that from the RIETE and VTE‐BLEED scores only in the prospective validation cohort, but not in the external validation cohort. [ABSTRACT FROM AUTHOR]

Published
2023
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7. Timing and characteristics of venous thromboembolism after noncancer surgery

Author

Exposito-Ruiz, M, Arcelus, JI, Caprini, JA, Lopez-Espada, C, Bura-Riviere, A, Amado, C, Loring, M, Mastroiacovo, D, and Monreal, M

Subjects
Duration of risk, Deep vein thrombosis, Pulmonary embolism, Surgery, Thromboprophylaxis
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

8. Systolic blood pressure and mortality in acute symptomatic pulmonary embolism

Author

Quezada, A, Jimenez, D, Bikdeli, B, Moores, L, Porres-Aguilar, M, Aramberri, M, Lima, J, Ballaz, A, Yusen, RD, 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, Caprini, JA, Bui, HM, Adarraga, MD, Agud, M, Aibar, MA, Alfonso, J, Amado, C, Arcelus, JI, Azcarate-Aguero, P, Barbagelata, C, Barron, M, Barron-Andres, B, Blanco-Molina, A, Camon, AM, Canas, I, Carrasco, C, Castro, J, Cerda, P, Chasco, L, de Ancos, C, del Toro, J, Demelo, P, Diaz-Peromingo, JA, Diaz-Simon, R, Elias-Hernandez, T, Escribano, JC, Falga, C, Farfan, AI, Fernandez-Capitan, C, Fernandez-Criado, MC, de Roitegui, F, Fidalgo, MA, Font, C, Font, L, Furest, I, Garcia, MA, Garcia-Bragado, F, Garcia-Morillo, M, Garcia-Raso, A, Gavin-Blanco, O, Gavin-Sebastian, O, Gayol, MC, Gil-Diaz, A, Gomez, V, Gomez-Cuervo, C, Gonzalez-Martinez, J, Grau, E, Gutierrez, J, Hernandez-Blasco, LM, Iglesias, M, Jara-Palomares, L, Jaras, MJ, Joya, MD, Jou, I, Lacruz, B, Lecumberri, R, Llamas, P, Lobo, JL, Lopez-Jimenez, L, Lopez-Miguel, P, Lopez-Nunez, JJ, Lopez-Reyes, R, Lopez-Saez, JB, Lorente, MA, Lorenzo, A, Loring, M, Lumbierres, M, Madridano, O, Maestre, A, Marchena, PJ, del Pozo, M, Martin-Fortea, P, Martin-Martos, F, Martinez-Garcia, MA, Martinez-Gonzalez, L, Mellado, M, Moises, J, Montesa, C, Morales, MV, Nieto, JA, Nunez, MJ, Olivares, MC, Olivera, PE, Otalora, S, Otero, R, Panadero-Macia, M, Pedrajas, JM, Pellejero, G, Perez-Ductor, C, Perez-Jacoiste, A, Perez-Rus, G, Peris, ML, Porras, JA, Riera-Mestre, A, Rivas, A, Rodriguez-Cobo, A, Rodriguez-Hernandez, A, Rosa, V, Rubio, CM, Ruiz-Artacho, P, Ruiz-Ruiz, J, Ruiz-Sada, P, Sahuquillo, JC, Sala-Sainz, MC, Salgueiro, G, Samperiz, A, Sanchez-Camara, S, Sanchez-Martinez, R, Sanchez-Munoz-Torrero, JF, Sancho, T, Soler, S, Suarez, S, Surinach, JM, Tiberio, G, Tolosa, C, Torres, MI, Trujillo-Santos, J, Uresandi, F, Valero, B, Valle, R, Vela, JR, Vidal, G, Villares, P, Gutierrez, P, Vazquez, FJ, Vilaseca, A, Vanassche, T, Vandenbriele, C, Hirmerova, J, Salgado, E, Benzidia, I, Bura-Riviere, A, Debourdeau, P, Helfer, H, Hij, A, Mahe, I, Moustafa, F, Braester, A, Sharif-Kashani, B, Barillari, G, Bilora, F, Bortoluzzi, C, Brandolin, B, Ciammaichella, M, Dentali, F, Imbalzano, E, Landolfi, R, Maida, R, Mastroiacovo, D, Mumoli, N, Pace, F, Pesavento, R, Pomero, F, Quintavalla, R, Rocci, A, Siniscalchi, C, Tufano, A, Visona, A, Hong, NV, Zalunardo, B, Kalejs, RV, Skride, A, Strautmane, S, Zdraveska, M, Mazzolai, L, Caprini, J, Tafur, AJ, and RIETE Investigators

Subjects
Male, Cardiac & Cardiovascular Systems, Blood Pressure, 030204 cardiovascular system & hematology, GUIDELINES, THERAPY, 0302 clinical medicine, Cause of Death, EPIDEMIOLOGY, 030212 general & internal medicine, Prospective Studies, Registries, RISK, Aged, 80 and over, OUTCOMES, Pulmonary embolism, Survival Rate, Systolic blood pressure, Acute Disease, Cardiology, Female, Cardiology and Cardiovascular Medicine, Life Sciences & Biomedicine, Major bleeding, circulatory and respiratory physiology, medicine.medical_specialty, Canada, Systole, DIAGNOSIS, 03 medical and health sciences, Internal medicine, MANAGEMENT, medicine, Humans, In patient, cardiovascular diseases, Mortality, Aged, VENOUS THROMBOEMBOLISM, Science & Technology, business.industry, Odds ratio, medicine.disease, Confidence interval, United States, THROMBOSIS, Increased risk, Blood pressure, Spain, Cardiovascular System & Cardiology, PROGNOSTICATION, Pulmonary Embolism, business, Venous thromboembolism
Abstract

BACKGROUND: The optimal cutoff for systolic blood pressure (SBP) level to define high-risk pulmonary embolism (PE) remains to be defined. METHODS: To evaluate the relationship between SBP levels on admission and mortality in patients with acute symptomatic PE, the current study included 39,257 consecutive patients with acute symptomatic PE from the RIETE registry between 2001 and 2018. Primary outcomes included all-cause and PE-specific 30-day mortality. Secondary outcomes included major bleeding and recurrent venous thromboembolism (VTE). RESULTS: There was a linear inverse relationship between admission SBP and 30-day all-cause and PE-related mortality that persisted after multivariable adjustment. Patients in the lower SBP strata had higher rates of all-cause death (reference: SBP 110-129 mmHg) (adjusted odds ratio [OR] 2.9; 95% confidence interval [CI], 2.0-4.2 for SBP 190 mmHg). Consistent findings were also observed for 30-day PE-related death. CONCLUSIONS: In patients with acute symptomatic PE, a low SBP portends an increased risk of all-cause and PE-related mortality. The highest mortality was observed in patients with SBP

Published
2019

9. Natural history of patients with venous thromboembolism and hereditary hemorrhagic telangiectasia. Findings from the RIETE registry

Author

Riera-Mestre, A, Mora-Lujan, JM, Trujillo-Santos, J, Del Toro, J, Nieto, JA, Pedrajas, JM, Lopez-Reyes, R, Soler, S, Ballaz, A, Cerda, P, 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, Caprini, JA, Bui, HM, Adarraga, MD, Agud, M, Aibar, MA, Alcalde-Manero, M, Alfonso, J, Amado, C, Arcelus, JI, Barbagelata, C, Barron, M, Barron-Andres, B, Blanco-Molina, A, Camon, AM, Canas, I, Castro, J, de Miguel, J, del Toro, J, Demelo, P, Diaz-Pedroche, C, Diaz-Peromingo, JA, Dominguez, I, Escribano, JC, Falga, C, Fernandez-Capitan, C, Fernandez-Criado, MC, Fidalgo, MA, Flores, K, Font, C, Font, L, Furest, I, Garcia, MA, Garcia-Bragado, F, Garcia-Raso, A, Gavin-Bianco, O, Gavin-Sebastian, O, Gil-Diaz, A, Godoy-Diaz, D, Gomez, V, Gomez-Cuelvo, C, Gonzalez-Martinez, J, Grau, E, Guirado, L, Gutierrez, J, Hernandez-Blasco, LM, Jara-Palomares, L, Jaras, MJ, Jimenez, D, Joya, MD, Jou, I, Lalueza, A, Lecumberri, R, Lima, J, Llamas, P, Lobo, JL, Lopez-Jimenez, L, Lopez-Meseguer, M, Lopez-Miguel, P, Lopez-Nunez, JJ, Lopez-Saez, JB, Lorente, MA, Loring, M, Lumbierres, M, Madridano, O, Maestre, A, Marchena, PJ, Martin-Martos, F, Martinez-Baquerizo, C, Martinez-Garcia, MA, Mellado, M, Moises, J, Morales, MV, Munoz-Bianco, A, Nunez, MJ, Olivares, MC, Olivera, PE, Ortega, C, Osorio, J, Otalora, S, Otero, R, Panadero-Macia, M, Parra, V, Pellejero, G, Perez-Ductor, C, Perez-Rus, G, Penis, ML, Pesantez, D, Porras, JA, Rivas, A, Rodriguez-Cobo, A, Rodriguez-Matute, C, Rosa, V, Rubio, CM, Ruiz-Artacho, P, Ruiz-Sada, P, Sahuquillo, JC, Sala-Sainz, MC, Salgueiro, G, Samperiz, A, Sanchez-Martinez, R, Sanchez-Munoz-Torrero, JF, Segui, E, Suarez, S, Surinach, JM, Tolosa, C, Torres, MI, Uresandi, F, Valero, B, Valle, R, Vidal, G, Aar, C, Villares, P, Gutierrez, P, Vazquez, FJ, Vilaseca, A, Vanassche, T, Vandenbriele, C, Hirmerova, J, Salgado, E, Benzidia, I, Bura-Riviere, A, Debourdeau, P, Courtois, MC, Helfer, H, Hij, A, Mahe, I, Moustafa, F, Braester, A, Bilora, F, Bortoluzzi, C, Ciammaichella, M, Dentali, F, Fermi, P, Imbaizano, E, Lodigiani, C, Maida, R, Mastroiacovo, D, Mumoli, N, Pace, F, Pesavento, R, Pomero, F, Quintavalla, R, Rocci, A, Rota, L, Siniscalchi, C, Tiraferri, E, Tufano, A, Visona, A, Hong, NV, Zalunardo, B, Kalejs, RV, Kigitovica, D, Skride, A, Zdraveska, M, Mazzola, L, Capnini, JA, Tafur, AJ, Vanassche, T, Verhamme, P, Riera-Mestre, A., Mora-Lujan, J. M., Trujillo-Santos, J., Del Toro, J., Nieto, J. A., Pedrajas, J. M., Lopez-Reyes, R., Soler, S., Ballaz, A., Cerda, P., 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., Caprini, J. A., Bui, H. M., Adarraga, M. D., Agud, M., Aibar, M. A., Alcalde-Manero, M., Alfonso, J., Amado, C., Arcelus, J. I., Barbagelata, C., Barron, M., Barron-Andres, B., Blanco-Molina, A., Camon, A. M., Canas, I., Castro, J., De Miguel, J., Demelo, P., Diaz-Pedroche, C., Diaz-Peromingo, J. A., Dominguez, I. M., Escribano, J. C., Falga, C., Fernandez-Capitan, C., Fernandez-Criado, M. C., Fidalgo, M. A., Flores, K., Font, C., Font, L., Furest, I., Garcia, M. A., Garcia-Bragado, F., Garcia-Raso, A., Gavin-Blanco, O., Gavin-Sebastian, O., Gil-Diaz, A., Godoy-Diaz, D., Gomez, V., Gomez-Cuervo, C., Gonzalez-Martinez, J., Grau, E., Guirado, L., Gutierrez, J., Hernandez-Blasco, L. M., Jara-Palomares, L., Jaras, M. J., Jimenez, D., Joya, M. D., Jou, I., Lalueza, A., Lecumberri, R., Lima, J., Llamas, P., Lobo, J. L., Lopez-Jimenez, L., Lopez-Meseguer, M., Lopez-Miguel, P., Lopez-Nunez, J. J., Lopez-Saez, J. B., Lorente, M. A., Loring, M., Lumbierres, M., Madridano, O., Maestre, A., Marchena, P. J., Martin-Martos, F., Martinez-Baquerizo, C., Martinez-Garcia, M. A., Mellado, M., Moises, J., Morales, M. V., Munoz-Blanco, A., Nunez, M. J., Olivares, M. C., Olivera, P. E., Ortega, C., Osorio, J., Otalora, S., Otero, R., Panadero-Macia, M., Parra, V., Pellejero, G., Perez-Ductor, C., Perez-Rus, G., Peris, M. L., Pesantez, D., Porras, J. A., Rivas, A., Rodriguez-Cobo, A., Rodriguez-Matute, C., Rosa, V., Rubio, C. M., Ruiz-Artacho, P., Ruiz-Sada, P., Sahuquillo, J. C., Sala-Sainz, M. C., Salgueiro, G., Samperiz, A., Sanchez-Martinez, R., Sanchez-Munoz-Torrero, J. F., Segui, E., Suarez, S., Surinach, J. M., Tolosa, C., Torres, M. I., Uresandi, F., Valero, B., Valle, R., Vidal, G., Vilar, C., Villares, P., Gutierrez, P., Vazquez, F. J., Vilaseca, A., Vanassche, T., Vandenbriele, C., Hirmerova, J., Salgado, E., Benzidia, I., Bura-Riviere, A., Debourdeau, P., Courtois, M. C., Helfer, H., Hij, A., Mahe, I., Moustafa, F., Braester, A., Bilora, F., Bortoluzzi, C., Ciammaichella, M., Dentali, F., Ferrazzi, P., Imbalzano, E., Lodigiani, C., Maida, R., Mastroiacovo, D., Mumoli, N., Pace, F., Pesavento, R., Pomero, F., Quintavalla, R., Rocci, A., Rota, L., Siniscalchi, C., Tiraferri, E., Tufano, A., Visona, A., Vo Hong, N., Zalunardo, B., Kalejs, R. V., Kigitovica, D., Skride, A., Zdraveska, M., Mazzolai, L., and Tafur, A. J.

Subjects
0301 basic medicine, Registrie, lcsh:Medicine, 030105 genetics & heredity, Research & Experimental Medicine, THERAPY, 0302 clinical medicine, Pharmacology (medical), Registries, Telangiectasia, EPISTAXIS, Genetics (clinical), Venous Thrombosis, Embòlia pulmonar, Genetics & Heredity, OUTCOMES, FACTOR-VIII, General Medicine, Heparin, Hemorrhagic hereditary telangiectasia, Middle Aged, Pulmonary embolism, Rare diseases, Natural history, Venous thrombosis, Medicine, Research & Experimental, Deep venous thrombosis, Telangiectasia, Hereditary Hemorrhagic, medicine.symptom, Malalties rares, Life Sciences & Biomedicine, medicine.drug, Human, Venous thromboembolism, Adult, medicine.medical_specialty, Hemorrhage, Therapeutics, HHT, 03 medical and health sciences, Internal medicine, medicine, Humans, cardiovascular diseases, Risk factor, Deep venous thrombosi, Aged, Tromboflebitis, Bleeding episodes, Science & Technology, business.industry, Research, lcsh:R, Thrombophlebitis, medicine.disease, Terapèutica, equipment and supplies, business, Rare disease, 030217 neurology & neurosurgery, RENDU-OSLER-WEBER
Abstract

BACKGROUND: Limited data exist about the clinical presentation, ideal therapy and outcomes of patients with hereditary hemorrhagic telangiectasia (HHT) who develop venous thromboembolism (VTE). METHODS: We used the data in the RIETE Registry to assess the clinical characteristics, therapeutic approaches and clinical outcomes during the course of anticoagulant therapy in patients with HHT according to initial presentation as pulmonary embolism (PE) or deep venous thrombosis (DVT). RESULTS: Of 51,375 patients with acute VTE enrolled in RIETE from February 2009 to January 2019, 23 (0.04%) had HHT: 14 (61%) initially presented with PE and 9 (39%) with DVT alone. Almost half (47.8%) of the patients with VTE had a risk factor for VTE. Most PE and DVT patients received low-molecular-weight heparin for initial (71 and 100%, respectively) and long-term therapy (54 and 67%, respectively). During anticoagulation for VTE, the rate of bleeding events (major 2, non-major 6) far outweighed the rate of VTE recurrences (recurrent DVT 1): 50.1 bleeds per 100 patient-years (95%CI: 21.6-98.7) vs. 6.26 recurrences (95%CI: 0.31-30.9; p = 0.020). One major and three non-major bleeding were epistaxis. No patient died of bleeding. One patient died shortly after being diagnosed with acute PE. CONCLUSIONS: During anticoagulation for VTE in HHT patients, there were more bleeding events than VTE recurrences. Most bleeding episodes were non-major epistaxis. ispartof: ORPHANET JOURNAL OF RARE DISEASES vol:14 issue:1 ispartof: location:England status: published

Published
2019

10. Frequency and prognostic impact of acute kidney injury in patients with acute pulmonary embolism. Data from the RIETE registry

Author

Murgier, M, Darmon, M, Zeni, F, Valle, R, Del Toro, J, Llamas, P, Mazzolai, L, Villalobos, A, Monreal, M, Brenner, B, Farge-Bancel, D, Barba, R, Di Micco, P, Bertoletti, L, Tzoran, I, Reis, A, Bounameaux, H, Maly, R, Verhamme, P, Bosevski, M, Caprini, JA, Adarraga, MD, Aibar, MA, Aibar, J, Alfonso, M, Amado, C, Aranda, C, Arcelus, JI, Ballaz, A, Barron, M, Barron-Andres, B, Bascunana, J, Blanco-Molina, A, Camon, AM, Carrasco, C, Cruz, AJ, del Pozo, R, del Toro, J, Diaz-Pedroche, MC, Diaz-Peromingo, JA, Encabo, M, Falga, C, Fernandez-Capitan, C, Fidalgo, MA, Font, C, Font, L, Furest, I, Garcia, MA, Garcia-Bragado, F, Garcia-Morillo, M, Garcia-Raso, A, Gavin, O, Gomez, V, Gonzalez-Martinez, J, Grau, E, Guijarro, R, Gutierrez, J, Isern, V, Jara-Palomares, L, Jaras, MJ, Jimenez, D, Jimenez, J, Jou, I, Joya, MD, Lalueza, A, Lima, J, Lobo, JL, Lopez-Jimenez, L, Lopez-Miguel, P, Lopez-Reyes, R, Lopez-Saez, JB, Lorente, MA, Lorenzo, A, Loring, M, Lumbierres, M, Madridano, O, Marchena, PJ, Martin-Martos, F, Martin-Romero, M, Morales, MV, Nieto, JA, Nunez, A, Nunez, MJ, Olivares, MC, Otalora, S, Otero, R, Pedrajas, JM, Pellejero, G, Perez-Ductor, C, Peris, ML, Pesce, ML, Porras, JA, Riesco, D, Rivas, A, Rodriguez-Davila, MA, Rosa, V, Rubio, CM, Ruiz-Artacho, P, Sahuquillo, JC, Sala-Sainz, MC, Samperiz, A, Sanchez-Munoz-Torrero, JF, Sancho, T, Soler, S, Soto, MJ, Surinach, JM, Tolosa, C, Torres, MI, Trujillo-Santos, J, Uresandi, F, Usandizaga, E, Vela, J, Vidal, G, Gutierrez, P, Vazquez, FJ, Vilaseca, A, Vanassche, T, Vandenbriele, C, Hirmerova, J, Salgado, E, Benzidia, I, Bura-Riviere, A, Hij, A, Merah, A, Mahe, I, Moustafa, F, Braester, A, EllisM, Bilora, F, Bortoluzzi, C, Brandolin, B, Bucherini, E, Cattabiani, C, Ciammaichella, M, Dentali, F, DiMicco, P, Giorgi-Pierfranceschi, M, Grandone, E, Imbalzano, E, Maida, R, Mastroiacovo, D, Ngoc, V, Pace, F, Pallotti, G, Parisi, R, Pesavento, R, Prandoni, P, Quintavalla, R, Rocci, A, Romualdi, R, Siniscalchi, C, Sotgiu, P, Tiraferri, E, Tonello, D, Tufano, A, Visona, A, Skride, A, Krstevski, G, Zdraveska, M, and Caprini, J

Subjects
Risk, Pulmonary embolism, Bleeding, Mortality, Biomarkers, Acute kidney injury
Abstract

Rationale: Acute kidney injury (AKI) is associated with a poor outcome. Although pulmonary embolism(PE) may promote AKI through renal congestion and/or hemodynamic instability, its frequency and influence on outcome in patients with acute PE have been poorly studied. Methods: The frequency of AKI (defined according to the "Kidney Disease: Improving Global Outcomes" definition) at baseline and its influence on the 30-day mortality was evaluated in patients with acute PE from the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry. We used multivariate analysis to assess whether the presence of AKI influenced the risk for 30-day death. Results: The study included 21,131 patients, of whom 6222 (29.5%) had AKI at baseline: 4385 patients (21%) in stage 1, 1385 (6.5%) in stage 2 and 452 (2%) in stage 3. The proportion of patients with high-risk PE in those with no AKI, AKI stage 1, AKI stage 2 or AKI stage 3 was: 2.8%, 5.3%, 8.8% and 12%, respectively (p < 0.001). After 30 days, 1236 patients (5.9%) died. Overall mortality was 4% in patients with no AKI, 8.4% in AKI stage 1, 14% in AKI stage 2 and 17% in AKI stage 3 (all p < 0.001). AKI was independently associated with an increased risk of all-cause death at 30 days (odds ratio = 1.25; 95% CI: 1.02-1.54). Conclusions: One in every 3-4 patients with acute PE had AKI at baseline. The presence of AKI independently predicted 30-day mortality. This study suggests that AKI may deserve to be evaluated as a prognostic factor in patients with acute PE. (C) 2019 Elsevier B.V. All rights reserved.

Published
2019

11. Mortality after pulmonary embolism in patients with diabetes. Findings from the RIETE registry

Author

de Miguel-Diez, J, Lopez-de-Andres, A, Jimenez-Trujillo, I, Hernandez-Barrera, V, Jimenez-Garcia, R, Lorenzo, A, Pedrajas, JM, Visona, A, Lopez-Miguel, P, Monreal, M, Adarraga, MD, Aibar, MA, Aibar, J, Alfonso, M, Amado, C, Aranda, C, Arcelus, JI, Ballaz, A, Barba, R, Barron, M, Barron-Andres, B, Bascunana, J, Blanco-Molina, A, Camon, AM, Carrasco, C, Cruz, AJ, del Toro, J, Diaz-Pedroche, MC, Diaz-Peromingo, JA, Falga, C, Fernandez-Capitan, C, Fidalgo, MA, Font, C, Font, L, Furest, I, Garcia, MA, Garcia-Bragado, F, Garcia-Morillo, M, Garcia-Ortega, A, Gavin, O, Gomez, V, Gonzalez-Martinez, J, Grau, E, Guijarro, R, Guirado, L, Gutierrez, J, Hernandez-Blasco, L, Isern, V, Jara-Palomares, L, Jaras, MJ, Jimenez, D, Jimenez, J, Jou, I, Joya, MD, Lalueza, A, Lima, J, Lobo, JL, Lopez-Jimenez, L, Lopez-Reyes, R, Lopez-Saez, JB, Lorente, MA, Loring, M, Lumbierres, M, Madridano, O, Marchena, PJ, Martin-Martos, Morales, MV, Nieto, JA, Nunez, A, Nunez, MJ, Olivares, MC, Otalora, S, Otero, R, Pellejero, G, Perez-Ductor, C, Perez-Jacoiste, A, Penis, ML, Pesce, ML, Porras, JA, Riesco, D, Rivas, A, Rodriguez-Davila, MA, Rosa, V, Rubio, CM, Ruiz-Artacho, P, Sahuquillo, JC, Sala-Sainz, MC, Samperiz, A, Sanchez-Munoz-Torrero, JF, Sancho, T, Soler, S, Soto, MJ, Surinach, JM, Tolosa, C, Torrents, A, Torres, MI, Trujillo-Santos, J, Uresandi, F, Usandizaga, E, Valle, R, Vela, J, Vidal, G, Villalobos, A, Gutierrez, P, Vazquez, FJ, Vilaseca, A, Vanasschc, T, Vandenbriele, C, Verhamme, P, Hirmerova, J, Maly, R, Salgado, E, Benzidia, I, Bertoletti, L, Bura-Riviere, A, Farge-Bancel, D, Hij, A, Merah, A, Mahe, I, Moustafa, F, Braester, A, Brenner, B, Ellis, M, Tzoran, I, Bilora, F, Bortoluzzi, C, Brandolin, B, Bucherini, E, Cattabiani, C, Ciammaichella, M, Dentali, F, Di Micco, P, Giorgi-Pierfranceschi, M, Grandone, E, Imbalzano, E, Maida, R, Mastroiacovo, D, Ngoc, V, Pace, F, Parisi, R, Pesavento, R, Prandoni, P, Quintavalla, R, Rocci, A, Siniscalchi, C, Sotgiu, P, Tiraferri, E, Tufano, A, Zalunardo, B, Kalejs, R, Skride, A, Vitola, B, Bosevski, M, Zdraveska, M, Ii, B, Fresa, M, Mazzolai, L, Caprini, J, and Bui, HM

Subjects
Cardiovascular events, Type 2 diabetes mellitus, Pulmonary embolism, Comorbidity, Mortality
Abstract

Background: Among patients presenting with pulmonary embolism (PE), those with diabetes are at increased risk to die than those without diabetes. The reasons have not been identified. We used the RIETE (Registro Informatizado Enfermedad Trombo Embolica) database to compare the mortality rate and the causes of death during anticoagulation in patients with PE according to the presence or absence of diabetes. Methods: A matched retrospective cohort study from consecutively enrolled patients in RIETE, from 179 hospitals in 24 countries. For each patient with diabetes we selected two patients with no diabetes matched by age, sex and year of diagnosis of the PE. Results: As of September 2017, there were 2010 PE patients with diabetes and two age-and-gender matched controls. Mean age was 74 +/- 11 years, 46% were men. Patients with diabetes were more likely to have comorbidities, to be using antiplatelets and to have more severe PE. During anticoagulation (median, 219 days), patients with diabetes had a higher mortality (hazard ratio [HR]: 1.45; 95% confidence intervals [CI]: 1.25-1.67) and a higher rate of arterial ischemic events (HR: 2.89; 95%CI: 1.71-4.94) than those without diabetes. On multivariable analysis, diabetes was not associated with an increased risk for death (HR: 1.26; 95%CI: 0.97-1.63). We also failed to find differences according to the use of antiplatelet drugs concomitantly. Conclusions: In our cohort of patients with PE, diabetes was not an independent predictor for death. The influence of arterial events or antiplatelet drugs (if any) was low.

Published
2019

12. Outcomes in Neurosurgical Patients Who Develop Venous Thromboembolism

Author

Cote, L. P., Greenberg, S., Caprini, J. A., Stone, J., Arcelus, J. I., Lopez Jimenez, L., Rosa, V., Schellong, S., Monreal, 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, Font, C, Fuentes, Mi, 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, 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, Mosquera, D, Muñoz, Fj, Nauffal, Md, Nieto, Ja, Núñez, Mj, Ogea, Jl, Otero, R, Pedrajas, Jm, Peris, Ml, Raissouni, N, 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, Villalobos, A, Villalta, J, Malý, R, Hirmerova, J, 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, Di Micco, P, Duce, R, Pasca, S, Pesavento, R, Piovella, C, Poggio, R, Prandoni, Paolo, Quintavalla, R, Rocci, A, Rota, L, Schenone, A, Tiraferri, E, Tonello, D, Tufano, A, Visonà, A, Zalunardo, B, Barbosa, Al, Gonçalves, F, Rodrigues, Am, Santos, M, Saraiva, M, Bosevski, M, Kovacevic, D, Alatri, A, Aujeski, D, Bounameaux, H, Calanca, L, Mazzolai, L, and Caprini, J.

Subjects
Adult, Male, medicine.medical_specialty, business.industry, Anticoagulants, Venous Thromboembolism, Hematology, General Medicine, Middle Aged, medicine.disease, Neurosurgical Procedures, 3. Good health, Pulmonary embolism, Postoperative Complications, Humans, Medicine, Female, Registries, Pulmonary Embolism, business, Intensive care medicine, Venous thromboembolism, Aged
Abstract

Objectives: Registro Informatizado de Enfermedad TromboEmbólica (RIETE) database was used to investigate whether neurosurgical patients with venous thromboembolism (VTE) were more likely to die of bleeding or VTE and the influence of anticoagulation on these outcomes. Methods: Clinical characteristics, treatment details, and 3-month outcomes were assessed in those who developed VTE after neurosurgery. Results: Of 40 663 patients enrolled, 392 (0.96%) had VTE in less than 60 days after neurosurgery. Most patients in the cohort (89%) received initial therapy with low-molecular-weight heparin, (33% received subtherapeutic doses). In the first week, 10 (2.6%) patients died (8 with pulmonary embolism [PE], no bleeding deaths; P = .005). After the first week, 20 (5.1%) patients died (2 with fatal bleeding, none from PE). Overall, this cohort was more likely to develop a fatal PE than a fatal bleed (8 vs 2 deaths, P = .058). Conclusions: Neurosurgical patients developing VTE were more likely to die from PE than from bleeding in the first week, despite anticoagulation.

Published
2014

13. 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

14. 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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15. Platelet count and outcome in patients with acute venous thromboembolism

Author

Di Micco, P., Ruiz Giménez, N., Nieto, J. A., Aujesky, D., del Molino, F., Valle, R., Barrón, M., Maestre, A., Monreal, M., Monreal, M, Decousus, H, Prandoni, Paolo, Brenner, B, Barba, R, Di Micco, P, Bertoletti, L, Schellong, S, Tzoran, I, Dr Abilio, R, Bosevski, M, Bounameaux, H, Malý, R, Andújar, V, Arcelus, Ji, Arroyo, M, Ballaz, A, Barrón, M, Barrón Andrés, B, Bascuñana, J, Bedate, P, Benítez, Jf, Blanco Molina, A, Boix, L, Bosco, J, Bueso, T, Casado, I, Chaves, E, Contra, A, de Ancos CL, de Miguel, J, del Molino, F, del Toro, J, Elías Hernández, T, Falgá, C, Farfán, A, Fernández Capitán, C, Fole, D, Font, C, Fuentes, Mi, Gallego, P, García Bragado, F, Gavín, O, Gómez, V, González, J, González Basch, E, González Nieto JA, Grau, E, Guil, M, Guijarro, R, Gutiérrez, J, Hernández, L, Hernández Huerta, S, Jara, L, Jaras, Mj, Jiménez, D, Lecumberri, R, Lobo, Jl, López Jiménez, L, López, L, Lorenzo, A, Luque, Jm, Macià, M, Madridano, O, Maestre, A, Marchena, Pj, Martín, M, 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, Ruíz, J, Ruiz Gamietea, A, Ruiz Giménez, N, Sahuquillo, Jc, Sánchez, R, Sánchez Muñoz Torrero JF, Soler, S, Soto, Mj, Toda, M, Todolí, Ja, Tolosa, C, Trujillo, J, Valdés, M, Valero, B, Valle, R, Vela, J, Vidal, G, Vilar, C, Villalobos, A, Villalta, J, Zorrilla, V, Gadelha, T, Hirmerova, J, Miklosovà, M, Salgado, E, Bura Riviere, A, Farge Bancel, D, Mahe, I, Merah, A, Quere, I, Faul, J, Braester, A, Zeltser, D, Barillari, G, Ciammaichella, M, Dalla Valle, F, Duce, R, Maida, R, Pasca, S, Piovella, C, Poggio, R, Prandoni, P, Quintavalla, R, Rocci, A, Rota, L, Schenone, A, Tiraferri, E, Tonello, D, Tufano, A, Visonà, A, Zalunardo, B, Cardoso, C, Santos, M, Saraiva, M, Aujeski, D, Mazzolai, L, and Caprini, J.

Subjects
Blood Platelets, Male, Risk, medicine.medical_specialty, Cell Count, Hemorrhage, 030204 cardiovascular system & hematology, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Platelet, In patient, Registries, 030212 general & internal medicine, Mortality, Aged, Aged, 80 and over, Thrombocytosis, business.industry, Incidence, Mortality rate, Venous Thromboembolism, Hematology, Odds ratio, Middle Aged, medicine.disease, Thrombocytopenia, Thrombosis, Confidence interval, Surgery, Pulmonary embolism, Treatment Outcome, Acute Disease, Female, business, Venous thromboembolism
Abstract

SummaryThe relationship between platelet count and outcome in patients with acute venous thromboembolism (VTE) has not been consistently explored. RIETE is an ongoing registry of consecutive patients with acute VTE. We categorised patients as having very low- (450,000/μl) platelet count at baseline, and compared their three-month outcome. As of October 2012, 43,078 patients had been enrolled in RIETE: 21,319 presenting with pulmonary embolism and 21,759 with deep-vein thrombosis. In all, 502 patients (1.2%) had very low-; 5,472 (13%) low-; 28,386 (66%) normal-; 7,157 (17%) high-; and 1,561 (3.6%) very high platelet count. During the three-month study period, the recurrence rate was: 2.8%, 2.2%, 1.8%, 2.1% and 2.2%, respectively; the rate of major bleeding: 5.8%, 2.6%, 1.7%, 2.3% and 4.6%, respectively; the rate of fatal bleeding: 2.0%, 0.9%, 0.3%, 0.5% and 1.2%, respectively; and the mortality rate: 29%, 11%, 6.5%, 8.8% and 14%, respectively. On multivariate analysis, patients with very low-, low-, high- or very high platelet count had an increased risk for major bleeding (odds ratio [OR]: 2.70, 95% confidence interval [CI]: 1.85–3.95; 1.43 [1.18–1.72]; 1.23 [1.03–1.47]; and 2.13 [1.65–2.75]) and fatal bleeding (OR: 3.70 [1.92–7.16], 2.10 [1.48–2.97], 1.29 [0.88–1.90] and 2.49 [1.49–4.15]) compared with those with normal count. In conclusion, we found a U-shaped relationship between platelet count and the three-month rate of major bleeding and fatal bleeding in patients with VTE.

Published
2013

16. Thrombolytic therapy and outcome of patients with an acute symptomatic pulmonary embolism

Author

RIERA MESTRE, A., Jiménez, D., Muriel, A., Lobo, J. L., Moores, L., Yusen, R. D., Casado, I., Nauffal, D., Oribe, M., Monreal, M., Monreal, M, Decousus, H, Prandoni, Paolo, Brenner, B, Barba, R, Di Micco, P, Bertoletti, L, Papadakis, M, Bounameaux, H, Bosevski, M, Arcelus, Ji, Arcos, P, Barrón, M, Blanco, A, Bosco, J, Campano, F, Casado, I, Casas, Jm, Cisneros, E, Chaves, E, Conget, F, del Campo, R, del Toro, J, Falgá, C, Fernández Capitán, C, Ferreiro, M, Font, C, Gabriel, F, Gallego, P, García Bragado, F, Guil, M, Gutiérrez, J, Hernández, L, Hernández Huerta, D, Jaras, M, Jiménez Castro, D, Jiménez, S, Jiménez Gil, M, Lecumberri, R, Lobo, Jl, López Jiménez, L, Lorenzo, A, Luque, Jm, Madridano, O, Maestre, A, Marchena, Pj, Martín Villasclaras JJ, Mascareño, Mc, Morales, M, Nauffal, Md, Nieto, Ja, Núñez, Mj, Ogea, Jl, Ogea, M, Otero, R, Pedrajas, Jm, Rabuñal, R, Riera Mestre, A, Rodríguez Dávila MA, Roldán, V, Román, M, Román, P, Rosa, V, Rubio, S, Ruiz, Md, Ruíz, J, Ruiz Gamietea, A, Sahuquillo, Jc, Samperiz, A, Sánchez, R, Sánchez Muñoz Torrero JF, Soler, S, Soto, M, Tiberio, G, Tolodí, Ja, Tolosa, C, Torres, Mi, Trujillo, J, Uresandi, F, Valdés, M, Valdés, V, Valdés, R, Vidal, G, Villalta, J, Zorrilla, V, Bura Riviere, A, Debourdeau, P, Durant, C, Farge Bancel, D, Mahe, I, Rivron Guillot, K, Zeltser, D, Barillari, A, Barillari, G, Ciammaichella, M, Dalla Valle, F, Duce, R, Farneti, L, Maida, R, Pasca, S, Piovella, C, Poggio, R, Prandoni, P, Quintavalla, R, Schenone, A, Tiraferri, E, Tonello, D, Visonà, A, and Bounameaux, H.

Subjects
Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Blood Pressure, Lower risk, Risk Assessment, Fibrinolytic Agents, Predictive Value of Tests, Risk Factors, Internal medicine, Odds Ratio, medicine, Humans, Thrombolytic Therapy, Registries, Israel, Propensity Score, Intensive care medicine, Aged, Retrospective Studies, Aged, 80 and over, Chi-Square Distribution, business.industry, Retrospective cohort study, Hematology, Thrombolysis, Odds ratio, Middle Aged, medicine.disease, Pulmonary embolism, Europe, Logistic Models, Treatment Outcome, Predictive value of tests, Acute Disease, Propensity score matching, Cardiology, Female, Pulmonary Embolism, business, Chi-squared distribution
Abstract

To cite this article: Riera-Mestre A, Jimenez D, Muriel A, Lobo JL, Moores L, Yusen RD, Casado I, Nauffal D, Oribe M, Monreal M, for the RIETE investigators. Thrombolytic therapy and outcome of patients with an acute symptomatic pulmonary embolism. J Thromb Haemost 2012; 10: 751-9. Summary. Background: While the primary therapy for most patients with a pulmonary embolism (PE) consists of antico- agulation, the efficacy of thrombolysis relative to standard therapy remains unclear. Methods: In this retrospective cohort study of 15 944 patients with an objectively confirmed symp- tomatic acute PE, identified from the multicenter, international, prospective, Registro Informatizado de la Enfermedad TromboEmbolica (RIETE registry), we aimed to assess the association between thrombolytic therapy and all-cause mor- tality during the first 3 months after the diagnosis of a PE. After creating two subgroups, stratified by systolic blood pressure (SBP) (< 100 mm Hg vs. other), we used propensity score- matching for a comparison of patients who received thrombol- ysis to those who did not in each subgroup. Results: Patients who received thrombolysis were younger, had fewer comorbid diseases and more signs of clinical severity compared with those who did not receive it. In the subgroup with systolic hypoten- sion, analysis of propensity score-matched pairs (n = 94 pairs) showed a non-statistically significant but clinically relevant lower risk of death for thrombolysis compared with no thrombolysis (odds ratio (OR) 0.72; 95% confidence interval (CI), 0.36-1.46; P = 0.37). In the normotensive subgroup, analysis of propensity score-matched pairs (n = 217 pairs) showed a statistically significant and clinically meaningful increased risk of death for thrombolysis compared with no thrombolysis (OR 2.32; 95% CI, 1.15-4.68; P = 0.018). When we imputed data for missing values for echocardiography and troponin tests in the group of normotensive patients, we no longer detected the increased risk of death associated with thrombolytic therapy. Conclusions: In normotensive patients with acute symptomatic PE, thrombolytic therapy is associated with a higher risk of death than no thrombolytic therapy. In hemodynamically unstable patients, thrombolytic therapy is possibly associated with a lower risk of death than no thrombolytic therapy. However, study design limitations do not imply a causal relationship between thrombolytics and outcome.

Published
2012

17. 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

18. Usefulness of Thrombophilia Testing in Venous Thromboembolic Disease

Author

Gabriel, F., Portoles, O., Labios, M., Rodriguez, C., Cisneros, E., Vela, J., Nunez, M., Ansotegui, E, Alcalde, M, Arcelus, Ji, Barba, R, Blanco, A, Barrón, M, Bueso, T, Casado, I, Cisneros, E, del Toro, J, Delgado, C, Durán, M, Falgá, C, Fernández Capitán, C, Gabriel, F, Gallego, P, García Bragado, F, Guijarro, R, Guil, M, Gutiérrez, J, Gutiérrez Tous MR, Hermosa, Mj, Hernández, L, Hernández Huerta, D, Jiménez, Gil, Jordán, Sm, Lecumberri, R, Lobo, Jl, López, L, Lorenzo, A, Madridano, O, Maestre, A, Marchena, Pj, Martín Villasclaras JJ, Monreal, M, Nauffal, M, Nieto, Ja, Núñez, Mj, Ogea, Jl, Oribe, M, Pedrajas, Jm, Rabuñal, R, Riera Mestre, A, Rodríguez, C, Román, P, Rosa, V, Rubio, S, Ruiz Gamietea, A, Ruiz Giménez, N, Sahuquillo, Jc, Samperiz, Al, Sánchez Muñoz Torrero JF, Sánchez, R, Solanich, X, Soler, S, Soler, C, Tiberio, G, Tirado, R, Toda, M, Todolí, Ja, Tolosa, C, Trujillo, J, Uresandi, F, Valdés, M, Valdés, V, Valle, R, Vahi, M, Vela, J, Villalta, J, Boccalon, H, Farge Bancel, D, Le Corvoisier, P, Rivron Guillot, K, Brenner, B, Zeltser, D, Barillari, G, Barillari, A, Ciammaichella, M, Dalla Valle, F, Di Micco, P, Duce, R, Ferrari, A, Pasca, S, Poggio, R, Prandoni, Paolo, Quintavalla, R, Rota, L, Schenone, A, and Visonà, A.

Subjects
Adult, Male, medicine.medical_specialty, Thrombophilia, Risk Factors, Internal medicine, medicine, Factor V Leiden, Humans, Upper Extremity Deep Vein Thrombosis, Registries, Activated Protein C Resistance, Aged, Venous Thrombosis, business.industry, Age Factors, Factor V, Venous Thromboembolism, Hematology, General Medicine, Odds ratio, Middle Aged, medicine.disease, Confidence interval, Surgery, Pulmonary embolism, Prothrombin G20210A, Female, Prothrombin, business, Protein C, Follow-Up Studies, medicine.drug
Abstract

Information on thrombophilia risk factors for patients with upper extremity deep vein thrombosis (UEDVT) is limited. The genetic, acquired, and coagulation risk factors of an acute episode of lower EDVT (LEDVT) or UEDVT, either isolated or associated with pulmonary embolism (PE), were studied.A total of 4503 patients participated in a thrombophilia study. Odds ratio (OR) and 95% confidence intervals (CIs) were calculated.Mean age of the participants was 55 ± 19 years. The risk of LEDVT or UEDVT, isolated or associated with PE, was calculated according to thrombophilia factors. We found association between LEDVT and factor V Leiden ([FVL]; OR: 1.8; 95% CI 1.4-2.4) and resistance to activated protein C ([APC-R]; OR: 1.6; 95% CI 1.1-2.4). The LEDVT + PE presented an association with PTG20210A (OR: 1.5; 95% CI 1.1-2.1). No association was found between the thrombophilic defects studied and UEDVT or UEDVT + PE.Both FVL and APC-R carriers had the risk of developing LEDVT. The PTG20210A carriers had the risk of developing LEDVT + PE. No thrombophilic defects studied presented risk factors for UEDVT or UEDVT + PE.

Published
2012

19. Long-term therapy with low-molecular-weight heparin in cancer patients with venous thromboembolism

Author

Marchena, P. J., Nieto, J. A., Guil, M., García Bragado, F., Rabuñal, R., Boccalon, H., Trujillo Santos, J., Monreal, M., Akcalde, M, Arcelus, Ji, Barba, R, Blanco, A, Barrón, M, Casado, I, Casas, Jm, Cisneros, E, del Campo R., Ce, del Toro, J, Durán, M, Falgá, C, Fernández Capitán, C, Font, C, Gabriel, F, Gallego, P, García Bragado, F, Guijarro, R, Guil, M, Gutiérrez, J, Gutiérrez, Mr, Hermosa, Mj, Hernández, L, Hernández Huerta, D, Jiménez, M, Lobo, Jl, López, L, Lorenzo, A, Luque, Jm, Madridano, O, Marchena, Pj, Martín Villasclaras JJ, Montes, J, Monreal, M, Morales, M, Nauffal, Md, Nieto, Ja, Núñez, Mj, Oribe, M, Pedrajas, Jm, 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 Muñoz Torrero JF, Soler, S, Soto, Mj, Tiberio, G, Todolí, Ja, Tolosa, C, Trujillo, J, Uresandi, F, Valdés, V, Valle, R, Vidal, G, Villalta, J, Boccalon, H, Durant, C, Farge Bancel, D, Mahe, I, Rivron Guillot, K, Brenner, B, Barillari, A, Barillari, G, Ciammaichella, M, Di Micco, P, Dalla Valle, F, Duce, R, Maida, R, Pasca, S, Piovella, C, Poggio, R, Prandoni, Paolo, Quintavalla, R, Schenone, A, Tiraferri, E, Visonà, A, and Bosevski, M.

Subjects
Male, medicine.medical_specialty, medicine.drug_class, Low molecular weight heparin, Hemorrhage, 030204 cardiovascular system & hematology, Lower risk, Gastroenterology, Drug Administration Schedule, 03 medical and health sciences, 0302 clinical medicine, Recurrence, Neoplasms, Internal medicine, medicine, Humans, Registries, Aged, business.industry, Incidence (epidemiology), Venous Thromboembolism, Hematology, Odds ratio, Heparin, Low-Molecular-Weight, Middle Aged, medicine.disease, Confidence interval, Pulmonary embolism, Surgery, Venous thrombosis, Treatment Outcome, 030220 oncology & carcinogenesis, Propensity score matching, Female, Pulmonary Embolism, business, Algorithms
Abstract

SummaryLong-term therapy with low-molecular-weight heparin (LMWH) is the treatment of choice for cancer patients with venous thromboembolism (VTE). However, the ideal doses of LMWH have not been thoroughly studied. We used the RIETE Registry data to assess the influence of the daily LMWH dosage on outcome during the first three months after VTE. We used propensity score-matching to compare patients who received

Published
2012

20. Clinical presentation and outcome of venous thromboembolism in COPD

Author

Bertoletti, L., Quenet, S., Mismetti, P., Hernandez, L., Martin Villasclaras, J. J., Tolosa, C., Valdes, M., Barron, M., Todoli, J. A., Monreal, M., Monreal, M, Pujol, I, Decousus, H, Prandoni, Paolo, Brenner, B, Barba, R, Di Micco, P, Bertoletti, L, Etienne, S, Papadakis, M, Bosevski, M, Bounameaux, H, Alcalde, M, Arcelus, Ji, Arcos, Mp, Barrón, M, Blanco Molina, A, Bosco, J, Cámara, T, Calvo, M, Casado, I, Casas, Jm, Cisneros, E, Chaves, E, Conget, F, Delgado, C, del Toro, J, Durán, M, Falgá, C, Fernández Capitán, C, Ferreiro, M, Font, C, Gabriel, F, Gallego, P, García Bragado, F, Guil, M, Guillém, N, Gutiérrez, J, Hermosa, Mj, Hernández, L, Hernández Huerta, D, Hernández Toboso, F, Jaras, Mj, Jiménez, D, Jiménez, S, Jiménez Gil, M, Lecumberri, R, Lobo, Jl, López Jiménez, L, Lorenzo, A, Luque, Jm, Madridano, O, Maestre, A, Manzano, V, Marchena, Pj, Martín Villasclaras JJ, Monte, R, Morales, M, Muñoz, S, Nauffal, Md, Nieto, Ja, Ogea, Jl, Oribe, M, Otero, R, Pedrajas, Jm, Rabuñal, R, Riera Mestre, A, Rodríguez Dávila MA, Román, M, Román, P, Román Bernal, B, Rosa, V, Rubio, S, Ruíz, J, Ruiz Gamietea, A, Ruiz Giménez, N, Sahuquillo, Jc, Samperiz, A, Sánchez, R, Muñoz Torrero JF, Soler, S, Soto, Mj, Tiberio, G, Tolodí, Ja, Tolosa, C, Torres, Mi, Trujillo, J, Uresandi, F, Valdés, M, Valdés, V, Valle, R, Vidal, G, Villalta, J, Zorrilla, V, Bura Riviere, A, Debourdeau, P, Mahe, I, Rivron Guillot, K, Zeltser, D, Barillari, A, Barillari, G, Ciammaichella, M, Valle, F, Duce, R, Maida, R, Pasca, S, Piovella, C, Poggio, R, Prandoni, P, Quintavalla, R, Rocci, A, Schenone, A, Tiraferri, E, Tonello, D, Visonà, A, Zalunardo, B, and Righini, M.

Subjects
Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Vena Cava Filters, Pulmonary disease, Kaplan-Meier Estimate, Pulmonary Disease, Chronic Obstructive, Fibrinolytic Agents, Risk Factors, Internal medicine, Humans, Medicine, Registries, cardiovascular diseases, Risk factor, Aged, Aged, 80 and over, Venous Thrombosis, COPD, business.industry, Venous Thromboembolism, Middle Aged, Prognosis, medicine.disease, respiratory tract diseases, Surgery, Pulmonary embolism, Venous thrombosis, Treatment Outcome, Female, Risk of death, Presentation (obstetrics), Pulmonary Embolism, business, Venous thromboembolism
Abstract

Chronic obstructive pulmonary disease (COPD) is a moderate risk factor for venous thromboembolism (VTE), but neither the clinical presentation nor the outcome of VTE in COPD patients is well known. The clinical presentation of VTE, namely pulmonary embolism (PE) or deep venous thrombosis (DVT), and the outcome at 3 months (death, recurrent VTE or bleeding) were compared between 2,984 COPD patients and 25,936 non-COPD patients included in the RIETE (Registro Informatizado de la Enfermedad TromboEmbólica) registry. This ongoing international, multi-centre registry includes patients with proven symptomatic PE or DVT. PE was the more frequent VTE presentation in COPD patients (n = 1,761, 59%). PE presentation was more significantly associated with COPD patients than non-COPD patients (OR 1.64, 95% CI 1.49-1.80). During the 3-month follow-up, mortality (10.8% versus 7.6%), minor bleeding (4.5% versus 2.3%) or first VTE recurrences as PE (1.5% versus 1.1%) were significantly higher in COPD patients than in non-COPD patients. PE was the most common cause of death. COPD patients presented more frequently with PE than DVT. It may explain the worse prognosis of COPD patients, with a higher risk of death, bleeding or VTE recurrences as PE compared with non-COPD patients. Further therapeutic options are needed.

Published
2011

21. 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

22. Influence of recent immobilization or surgery on mortality in cancer patients with venous thromboembolism

Author

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, Adarraga, Md, Arcelus, Ji, Ballaz, A, Barrón, M, Barrón Andrés, B, Bascuñana, J, Blanco Molina, A, Bueso, T, Casado, I, Castejón, N, Conget, F, del Molino, F, del Toro, J, Falgá, C, Fernández Capitán, C, Font, L, Fuentes, Mi, Gallego, P, García Bragado, F, García Lorenzo MD, Gómez, V, González, J, González Bachs, E, Grau, E, Guil, M, Gutiérrez, J, Hernández, L, Hernández Huerta, S, Jaras, Mj, Jiménez, D, Lecumberri, R, Lobo, Jl, López Jiménez, L, López Montes, L, López Reyes, R, López Sáez JB, Lorente, Ma, Lorenzo, A, Luque, Jm, Madridano, O, Marchena, Pj, Martín, M, Nauffal, D, Nieto, Ja, Núñez, Mj, Ogea, Jl, Pedrajas, Jm, Peris, Ml, Porras, Ja, Riera Mestre, A, Rivas, A, Rodríguez Dávila MA, Román, P, Roncero, A, Rosa, V, Ruiz Giménez, N, Ruiz, J, Sahuquillo, Jc, Samperiz, A, Sánchez Muñoz Torrero JF, Soler, S, Suriñach, Jm, Tiberio, G, Tolosa, C, Trujillo Santos, J, Uresandi, F, Valdés, M, Valero, B, Valle, R, Vela, J, Vidal, G, Villalta, J, Verhamme, P, Peerlinck, K, Gadelha, T, Ribeiro, R, Vassalo, J, Wells, P, Hirmerova, J, Kaletova, M, Tomko, T, Bura Riviere, A, Farge Bancel, D, Hij, A, Mahe, I, Merah, A, Babalis, D, Tzinieris, I, Braester, A, Zeltser, D, Amitrano, M, Barillari, G, Ciammaichella, M, Duce, R, Giorgi Pierfranceschi, M, Maida, R, Prandoni, P, Quintavalla, R, Rocci, A, Rota, L, Tiraferri, E, Tonello, D, Tufano, A, Visonà, A, Zalunardo, B, Sá Bastos, M, Sousa, Ms, Rei, R, Kovacevic, D, and Mazzolai, L.

Subjects
Male, medicine.medical_specialty, Multivariate analysis, Hemorrhage, Immobilization, Neoplasms, medicine, Humans, In patient, Registries, Aged, Aged, 80 and over, business.industry, Mortality rate, Anticoagulants, Cancer, Venous Thromboembolism, Hematology, Odds ratio, Middle Aged, medicine.disease, Pulmonary embolism, Surgery, Increased risk, Multivariate Analysis, Female, Pulmonary Embolism, business, Venous thromboembolism
Abstract

Background: The influence of recent immobilization or surgery on mortality in cancer patients with venous thromboembolism (VTE) has not been thoroughly studied. Methods: We used the RIETE Registry data to compare the 3-month mortality rate in cancer patients with VTE, with patients categorized according to the presence of recent immobilization, surgery or neither. The major outcomes were fatal pulmonary embolism (PE) and fatal bleeding within the first 3 months. Results: Of 6,746 patients with active cancer and acute VTE, 1,224 (18%) had recent immobilization, 1,055 (16%) recent surgery, and 4,467 (66%) had neither. The all-cause mortality was 23.4% (95% CI: 22.4-24.5), and the PE-related mortality: 2.5% (95% CI: 2.1-2.9). Four in every ten patients dying of PE had recent immobilization (37%) or surgery (5.4%). Only 28% of patients with immobilization had received prophylaxis, as compared with 67% of the surgical. Fatal PE was more common in patients with recent immobilization (5.0%; 95% CI: 3.9-6.3) than in those with surgery (0.8%; 95% CI: 0.4-1.6) or neither (2.2%; 95% CI: 1.8-2.6). On multivariate analysis, patients with immobilization were at an increased risk for fatal PE (odds ratio: 1.8; 95% CI: 1.2-2.5). Conclusions: One in every three cancer patients dying of PE had recent immobilization for ≥4 days. Many of these deaths could have been prevented with adequate thromboprophylaxis.

Published
2014

23. Pulmonary embolism and 3-month outcomes in 4036 patients with venous thromboembolism and chronic obstructive pulmonary disease: data from the RIETE registry

Author

Laurent, Bertoletti, Sara, Quenet, Silvy, Laporte, Joan, Sahuquillo, Francisco, Conget, José, Pedrajas, Mar, Martin, Ignacio, Casado, Antonio Riera Mestre, Manuel, Monreal, Arcelus, Ji, Arcos, Mp, Ballaz, A, Barba, R, Barrón, M, Barrón Andrés, B, Blanco Molina, A, Bosco, J, Chaves, E, Cañas, I, Casado, I, Contra, A, Conget, F, de Miguel, J, del Campo, R, del Toro, J, Falgá, C, Fernández Capitán, C, Gabriel, F, Gallego, P, García Bragado, F, Gavín, O, Gómez, V, González, J, Gracia, V, Guil, M, Guillem, N, Gutiérrez, J, Hernández, L, Hernández Huerta, D, Jaras, Mj, Jiménez, D, Jiménez, S, Jiménez Gil, M, Lobo, Jl, Lecumberri, R, López Jiménez, L, Lorenzo, A, Macià, M, Madridano, O, Marchena, Pj, Martín, M, Martín Villasclaras JJ, Monreal, M, Morales, M, Morán, Lp, Nauffal, Md, Nieto, Ja, Núñez, Mj, Mascareño, Mc, Ogea, Jl, Otero, R, Pedrajas, Jm, Riera Mestre, A, Rodríguez Dávila MA, Román, P, Román Bernal, B, Roldán, V, Rosa, V, Royo, C, Ruíz, J, Ruiz Gamietea, A, Ruiz Giménez, N, Sahuquillo, Jc, Sánchez, R, Sánchez Muñoz Torrero JF, Soler, S, Soto, Mj, Tiberio, G, Tolosa, C, Trujillo, J, Uresandi, F, Valdés, M, Valle, R, Vela, J, Vida, G, Villalta, J, Zorrilla, V, Bertoletti, L, Bura Riviere, A, Debourdeau, P, Farge Bancel, D, Lamuraglia, M, Mahe, I, Merah, A, Quere, I, Babalis, D, Papadakis, M, Brenner, B, Barillari, G, Ciammaichella, M, Di Micco, P, Dalla Valle, F, Duce, R, La Regina, M, Maida, R, Orlandini, F, Pasca, S, Piovella, C, Poggio, R, Prandoni, Paolo, Quintavalla, R, Rota, L, Schenone, A, Tonello, D, Visonà, A, Zalunardo, B, Bosevski, M, Bounameaux, H, Malý, R, Hirmerova, J, Salgado, E., BMC, Ed., Groupe de recherche sur la thrombose (GRT (EA 3065)), Université Jean Monnet [Saint-Étienne] (UJM), Service de Médecine Thérapeutique, CHU Saint-Etienne-Hôpital Nord - Saint Etienne, Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Saint Etienne, Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Internal Medicine, Hospital Municipal de Badalona, Department of Pneumonology, Hospital Clínico Universitario Lozano Blesa, Hospital Clínico San Carlos, Hospital Universitario Infanta Sofía, Hospital Universitario Virgen de las Nieves, Institut d'Investigació Biomèdica de Bellvitge [Barcelone] (IDIBELL)-Hospital Universitari de Bellvitge-Hospital Duran i Reynals, Hospital Universitari Germans Trias I Pujol, The RIETE Investigators, Universitat de Barcelona, [Bertoletti,L, Quenet,S, Laporte,S] Thrombosis Research Group, EA3065, University Saint-Etienne, Saint-Etienne, France. [Bertoletti,L, Laporte,S] CIE3, INSERM, Saint-Etienne, France. Department of Therapeutic Medicine, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France. [Sahuquillo,JC] Department of Internal Medicine, Hospital Municipal de Badalona, Barcelona, Spain. [Conget,F] Department of Pneumonology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain. [Pedrajas,JM] Department of Internal Medicine, Hospital Clínico San Carlos, Madrid, Spain. [Martin,M] Department of Internal Medicine, Hospital Infanta Sofía, Madrid, Spain. [Casado,I] Department of Pneumonology, Hospital Universitario Virgen de las Nieves, Granada, Spain. [Riera-Mestre,A] Department of Internal Medicine, Hospital Univesitari de Bellvitge - IDIBELL, Barcelona, Spain. [Monreal,M] Department of Internal Medicine, Hospital Universitari Germans Trias I Pujol, Badalona, Spain., and Bayer Pharma AG for supporting this Registry. Bayer Pharma AG’s support was limited to the part of RIETE outside Spain

Subjects
Male, Internationality, Diseases::Respiratory Tract Diseases::Lung Diseases::Pulmonary Embolism [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Survival Analysis [Medical Subject Headings], Named Groups::Persons::Age Groups::Adult::Middle Aged [Medical Subject Headings], Comorbidity, 030204 cardiovascular system & hematology, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], Cohort Studies, Pulmonary Disease, Chronic Obstructive, 0302 clinical medicine, Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Epidemiologic Factors::Comorbidity [Medical Subject Headings], Prevalence, Tasa de Supervivencia, Registries, Young adult, Pneumology, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Morbidity::Prevalence [Medical Subject Headings], Embòlia pulmonar, Aged, 80 and over, COPD, Venous Thromboembolism, Middle Aged, Prognosis, 3. Good health, Pulmonary embolism, Survival Rate, Embolia Pulmonar, Deep venous thrombosis, Female, Pneumologia, Venous thromboembolism, Cohort study, Pulmonary and Respiratory Medicine, Adult, medicine.medical_specialty, Named Groups::Persons::Age Groups::Adult::Young Adult [Medical Subject Headings], Pronòstic mèdic, Análisis de Supervivencia, Check Tags::Male [Medical Subject Headings], Risk Assessment, 03 medical and health sciences, Young Adult, Internal medicine, Thromboembolism, medicine, Diseases::Respiratory Tract Diseases::Lung Diseases::Lung Diseases, Obstructive::Pulmonary Disease, Chronic Obstructive [Medical Subject Headings], Humans, cardiovascular diseases, Chronic obstructive pulmonary diseases, Intensive care medicine, Survival rate, Tromboembolisme, Survival analysis, Aged, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Mortality::Survival Rate [Medical Subject Headings], Disciplines and Occupations::Social Sciences::Internationality [Medical Subject Headings], business.industry, Enfermedad Pulmonar Obstructiva Crónica, Research, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk Assessment [Medical Subject Headings], equipment and supplies, medicine.disease, Survival Analysis, respiratory tract diseases, Check Tags::Female [Medical Subject Headings], 030228 respiratory system, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis [Medical Subject Headings], [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Registries [Medical Subject Headings], Estudios de Cohortes, Diseases::Cardiovascular Diseases::Vascular Diseases::Embolism and Thrombosis::Thromboembolism::Venous Thromboembolism [Medical Subject Headings], business, Medición de Riesgo
Abstract

Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't; BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) have a modified clinical presentation of venous thromboembolism (VTE) but also a worse prognosis than non-COPD patients with VTE. As it may induce therapeutic modifications, we evaluated the influence of the initial VTE presentation on the 3-month outcomes in COPD patients. METHODS COPD patients included in the on-going world-wide RIETE Registry were studied. The rate of pulmonary embolism (PE), major bleeding and death during the first 3 months in COPD patients were compared according to their initial clinical presentation (acute PE or deep vein thrombosis (DVT)). RESULTS Of the 4036 COPD patients included, 2452 (61%; 95% CI: 59.2-62.3) initially presented with PE. PE as the first VTE recurrence occurred in 116 patients, major bleeding in 101 patients and mortality in 443 patients (Fatal PE: first cause of death). Multivariate analysis confirmed that presenting with PE was associated with higher risk of VTE recurrence as PE (OR, 2.04; 95% CI: 1.11-3.72) and higher risk of fatal PE (OR, 7.77; 95% CI: 2.92-15.7). CONCLUSIONS COPD patients presenting with PE have an increased risk for PE recurrences and fatal PE compared with those presenting with DVT alone. More efficient therapy is needed in this subtype of patients. Yes

Published
2013

24. 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

25. A clinical prognostic model for the identification of low-risk patients with acute symptomatic pulmonary embolism and active cancer

Author

den Exter PL, Gómez, V, Jiménez, D, Trujillo Santos, J, Muriel, A, Huisman, Mv, Monreal, M, 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, Barrón Andrés, B, Blanco Molina, A, Boix, L, Bosco, J, Bueso, T, Campano, F, Cañas, I, Casado, I, Conget, F, de Miguel, J, del Campo, R, Chaves, E, del Toro, J, Falgá, C, Fernández Capitán, C, Gabriel, F, Gallego, P, García Bragado, F, Gavín, O, González, J, Gracia, V, Guil, M, Guillem, N, Gutiérrez, J, Hernández, L, Hernández Huerta, D, Jaras, Mj, Jiménez, S, Jiménez Gil, M, Lobo, Jl, Lecumberri, R, López Jiménez, L, Lorenzo, A, Macià, M, Madridano, O, Marchena, Pj, Martín, M, Martín Villasclaras JJ, Mejías, I, Montero, L, Morales, M, Nauffal, Md, Nieto, Ja, Núñez, Mj, Ogea, Jl, Otero, R, Pedrajas, Jm, Riera Mestre, A, Rodríguez Dávila MA, Román, P, Román Bernal, B, Roldán, V, Rosa, V, Royo, C, Ruíz, J, Ruiz Gamietea, A, Ruiz Giménez, N, Sahuquillo, Jc, Sánchez, R, Sánchez Muñoz Torrero JF, Soler, S, Soto, Mj, Tiberio, G, Tirado, R, Tolosa, C, Trujillo, J, Uresandi, F, Valdés, M, Valle, R, Vela, J, Vidal, G, Villalta, J, Zorrilla, V, Bura Riviere, A, Debourdeau, P, Farge Bancel, D, Lamuraglia, M, Mahe, I, Quere, I, Babalis, D, Barillari, G, Ciammaichella, M, Dalla Valle, F, Duce, R, La Regina, M, Maida, R, Orlandini, F, Pasca, S, Piovella, C, Poggio, R, Prandoni, P, Quintavalla, R, Rota, L, Schenone, A, Tonello, D, Visonà, A, Zalunardo, B, Alatri, A, Calanca, L, Mazzolai, L, Hirmerova, J, Tomko, T, Salgado, E., Bayer, and Sanofi España

Subjects
Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Clinical prediction rule, Critical Care and Intensive Care Medicine, Risk Assessment, Severity of Illness Index, Decision Support Techniques, Cohort Studies, Random Allocation, Risk Factors, Internal medicine, Neoplasms, medicine, Humans, Aged, Retrospective Studies, Aged, 80 and over, Framingham Risk Score, business.industry, Age Factors, Cancer, Reproducibility of Results, Retrospective cohort study, Middle Aged, medicine.disease, Prognosis, Surgery, Pulmonary embolism, Cohort, Multivariate Analysis, Female, Cardiology and Cardiovascular Medicine, Risk assessment, business, Pulmonary Embolism, Cohort study
Abstract

[Background] Physicians need a specific risk-stratification tool to facilitate safe and cost-effective approaches to the management of patients with cancer and acute pulmonary embolism (PE). The objective of this study was to develop a simple risk score for predicting 30-day mortality in patients with PE and cancer by using measures readily obtained at the time of PE diagnosis., [Methods] Investigators randomly allocated 1,556 consecutive patients with cancer and acute PE from the international multicenter Registro Informatizado de la Enfermedad TromboEmbólica to derivation (67%) and internal validation (33%) samples. The external validation cohort for this study consisted of 261 patients with cancer and acute PE. Investigators compared 30-day all-cause mortality and nonfatal adverse medical outcomes across the derivation and two validation samples., [Results] In the derivation sample, multivariable analyses produced the risk score, which contained six variables: age > 80 years, heart rate ≥ 110/min, systolic BP < 100 mm Hg, body weight < 60 kg, recent immobility, and presence of metastases. In the internal validation cohort (n = 508), the 22.2% of patients (113 of 508) classified as low risk by the prognostic model had a 30-day mortality of 4.4% (95% CI, 0.6%–8.2%) compared with 29.9% (95% CI, 25.4%–34.4%) in the high-risk group. In the external validation cohort, the 18% of patients (47 of 261) classified as low risk by the prognostic model had a 30-day mortality of 0%, compared with 19.6% (95% CI, 14.3%–25.0%) in the high-risk group., [Conclusions] The developed clinical prediction rule accurately identifies low-risk patients with cancer and acute PE., We are grateful to Sanofi Spain for supporting this registry with an unrestricted educational grant. We are also grateful to Bayer Pharma AG for supporting this registry. Bayer Pharma AG's support was limited to the part of RIETE outside Spain, which accounts for 15.53% of the total patients included in the RIETE Registry.

Published
2012

26. Low-molecular-weight or unfractionated heparin in venous thromboembolism: the influence of renal function

Author

Javier Trujillo Santos, Sebastian, Schellong, Conxita, Falga, Vanessa, Zorrilla, Pedro, Gallego, Manuel, Barrón, Manuel, Monreal, Arcelus, Ji, Ballaz, A, Barba, R, Barragán, Jm, Barrón, M, Barrón Andrés, B, Bascuñana, J, Blanco Molina, A, Bosco, J, Cañas, I, Casado, I, Conget, F, Chaves, E, de Miguel, J, del Campo, R, del Molino, F, del Toro, J, Falgá, C, Fernández, M, Fernández Capitán, C, Fuentes, L, Gabriel, F, Gallego, P, García Bragado, F, Gómez, V, González, J, Guil, M, Gutiérrez, J, Hernández, L, Hernández, Hd, Jaras, Mj, Jiménez, D, Jiménez, S, 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, Román, P, Rodríguez, Em, Román Bernal, B, Royo, C, Ruiz Martínez, C, Ruíz, J, Ruiz Gamietea, A, Ruiz Giménez, N, Sahuquillo, Jc, Sánchez, R, Sánchez Muñoz Torrero JF, Soler, S, Soto, Mj, Tiberio, G, Tolosa, C, Trujillo, J, Uresandi, F, Valdés, M, Valle, R, Vela, J, Vidal, G, Villalta, J, Zorrilla, V, Barillari, G, Ciammaichella, M, Di Micco, P, Dalla Valle, F, Duce, R, Maida, R, Orlandini, F, Pasca, S, Piovella, C, Poggio, R, Prandoni, Paolo, Quintavalla, R, Rota, L, Schenone, A, Tiraferri, E, Tonello, D, Visonà, A, Zalunardo, B, Bertoletti, L, Bura Riviere, A, Debourdeau, P, Farge Bancel, D, Lamuraglia, M, Mahe, I, Quere, I, Brenner, B, Alatri, A, Bounameaux, H, Calanca, L, Mazzolai, L, Malý, R, Hirmerova, J, Tomko, T, Schellong, S, Papadakis, M, Bosevski, M, Salgado, E, La Regina, M, and Rodríguez Dávila MA

Subjects
Adult, Male, medicine.medical_specialty, medicine.drug_class, Low molecular weight heparin, Renal function, Kidney, Kidney Function Tests, Gastroenterology, Internal medicine, medicine, Humans, Renal Insufficiency, Intensive care medicine, Aged, business.industry, Heparin, General Medicine, Odds ratio, Venous Thromboembolism, Heparin, Low-Molecular-Weight, Middle Aged, medicine.disease, Confidence interval, Pulmonary embolism, Treatment Outcome, Propensity score matching, Female, business, Venous thromboembolism, medicine.drug, Follow-Up Studies
Abstract

In patients with acute venous thromboembolism and renal insufficiency, initial therapy with unfractionated heparin may have some advantages over low-molecular-weight heparin.We used the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) Registry data to evaluate the 15-day outcome in 38,531 recruited patients. We used propensity score matching to compare patients treated with unfractionated heparin with those treated with low-molecular-weight heparin in 3 groups stratified by creatinine clearance levels at baseline:60 mL/min, 30 to 60 mL/min, or30 mL/min.Patients initially receiving unfractionated heparin therapy (n = 2167) more likely had underlying diseases than those receiving low-molecular-weight heparin (n = 34,665). Propensity score-matched groups of patients with creatinine clearance levels60 mL/min (n = 1598 matched pairs), 30 to 60 mL/min (n = 277 matched pairs), and30 mL/min (n = 210 matched pairs) showed an increased 15-day mortality for unfractionated heparin compared with low-molecular-weight heparin (4.5% vs 2.4% [P = .001], 5.4% vs 5.8% [P = not significant], and 15% vs 8.1% [P = .02], respectively), an increased rate of fatal pulmonary embolism (2.8% vs 1.2% [P = .001], 3.2% vs 2.5% [P = not significant], and 5.7% vs 2.4% [P = .02], respectively), and a similar rate of fatal bleeding (0.3% vs 0.3%, 0.7% vs 0.7%, and 0.5% vs 0.0%, respectively). Multivariate analysis confirmed that patients treated with unfractionated heparin were at increased risk for all-cause death (odds ratio, 1.8; 95% confidence interval, 1.3-2.4) and fatal pulmonary embolism (odds ratio, 2.3; 95% confidence interval, 1.5-3.6).In comparison with low-molecular-weight heparin, initial therapy with unfractionated heparin was associated with a higher mortality and higher rate of fatal pulmonary embolism in patients with creatinine clearance levels60 mL/min or30 mL/min, but not in those with levels between 30 and 60 mL/min.

Published
2012

27. Silent pulmonary embolism in patients with proximal deep vein thrombosis in the lower limbs

Author

Tzoran, I., Saharov, G., Brenner, B., Delsart, D., Román, P., Visoná, A., Jiménez, D., Monreal, M., Arcelus, Ji, Arcos, Mp, Ballaz, A, Barba, R, 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, Bertoletti, L, Bura Riviere, A, Debourdeau, P, Mahe, I, Papadakis, M, Babalis, D, Tzinieris, I, Brenner, B, Barillari, A, Barillari, G, Ciammaichella, M, Di Micco, P, Dalla Valle, F, Maida, R, Pasca, S, Piovella, C, Poggio, R, Prandoni, Paolo, Quintavalla, R, Schenone, A, Tonello, D, Visonà, A, Bosevski, M, Bounameaux, H, Malý, R, and Tomko, T.

Subjects
Male, medicine.medical_specialty, Time Factors, Deep vein, Hemorrhage, Risk Assessment, Risk Factors, medicine, Odds Ratio, Humans, Clinical significance, Prospective Studies, Registries, Israel, Prospective cohort study, Aged, Aged, 80 and over, Venous Thrombosis, Chi-Square Distribution, business.industry, Incidence (epidemiology), Incidence, Anticoagulants, Hematology, Odds ratio, Middle Aged, medicine.disease, Thrombosis, Survival Analysis, Surgery, Pulmonary embolism, Europe, medicine.anatomical_structure, Logistic Models, Treatment Outcome, Lower Extremity, Asymptomatic Diseases, Multivariate Analysis, Female, business, Pulmonary Embolism, Chi-squared distribution
Abstract

Summary. Background: One in every three patients with deep vein thrombosis (DVT) in the lower limbs may have silent pulmonary embolism (PE), but its clinical relevance has not been thoroughly studied. Methods: We used the RIETE Registry data to study patients with proximal DVT and no PE symptoms, but with a systematic search for PE. We compared the outcome of DVT patients with silent PE and those with no PE. Results: Of 2375 patients with DVT, 842 (35%) had silent PE and 1533 had no PE. During the first 15 days of anticoagulation, patients presenting with silent PE had a higher incidence of symptomatic PE events than those with no PE (0.95% vs. 0.13%; P = 0.015), with a similar incidence of major bleeding (0.95% vs. 1.63%; P = 0.09). In patients with silent PE, the incidence of PE events during the first 15 days was equal to the incidence of major bleeding (eight events each), but in those with no PE the incidence of PE events was eight times lower (3 vs. 25 bleeding events). Multivariate analysis confirmed that DVT patients with silent PE had a higher incidence of symptomatic PE events during the first 15 days than those with no PE (odds ratio, 4.80; 95% CI, 1.27–18.1), with no differences in bleeding. Conclusions: DVT patients with silent PE at baseline had an increased incidence of symptomatic PE events during the first 15 days of anticoagulant therapy. This effect disappeared after 3 months of anticoagulation.

Published
2012

28. Venous thromboembolism in immobilized patients with dementia. Findings from the RIETE registry

Author

Nuñez, Mj, Villalba, Jc, Cebrián, E, Visoná, A, Lopez Jimenez, L, Núñez, M, Szwebel, Ta, Luque, Jm, Jaras, Mj, Monreal, M, Arcelus, Ji, Barba, R, Barrón, M, Blanco, A, Boix, L, Bosco, J, Calvo, M, Casado, I, Casas, Jm, Cisneros, E, Chavez, E, del Campo, R, del Toro, J, Durán, M, Falgá, C, Fernández Capitán, C, Gabriel, F, Gallego, P, García Bragado, F, Guil, M, Gutiérrez, J, Hernández, L, Hernández Huerta, D, Jiménez Gil, M, Lecumberri, R, Lobo, Jl, López Jiménez, L, Lorenzo, A, Madridano, O, Manzano, V, Maestre, A, Marchena, Pj, Martín Villasclaras JJ, Morales, M, Nauffal, Md, Nieto, Ja, Núñez, Mj, Ogea, Jl, Oribe, M, Otero, R, Pedrajas, Jm, Provenza, M, Rabuñal, R, Riera Mestre, A, Rodríguez, Ma, Roldán, V, Román, B, Román, P, Rosa, V, Royo, C, Rubio, S, Ruíz, C, Ruíz, J, Ruiz Gamietea, A, Ruíz Giménez, N, Sahuquillo, Jc, Samperiz, A, Sánchez, R, Sánchez Muñoz Torrero JF, Soler, S, Soto, Mj, Tiberio, G, Timiraos, J, Tolodí, Ja, Tolosa, C, Trujillo, J, Uresandi, F, Valdés, M, Valdés, V, Valle, R, Vidal, G, Villalta, J, Zorrilla, V, Bura Riviere, A, Debourdeau, P, Durant, C, Farge Bancel, D, Mahe, A, Mismetti, P, Rivron Guillot, K, Szwebel, T, Brenner, B, Barillari, A, Barillari, G, Ciammaichella, M, Di Micco, P, Dalla Valle, F, Duce, R, Pasca, S, Piovella, C, Poggio, R, Prandoni, Paolo, Quintavalla, R, Maida, R, Schenone, A, Tiraferri, E, Tonello, D, Visonà, A, Bosevski, M, and Papadakis, M.

Subjects
Male, medicine.medical_specialty, Deep vein, Hemorrhage, Internal medicine, medicine, Dementia, Humans, Registries, Aged, Aged, 80 and over, business.industry, Incidence (epidemiology), Incidence, Anticoagulants, Hematology, Odds ratio, Venous Thromboembolism, Heparin, Low-Molecular-Weight, Middle Aged, medicine.disease, Thrombosis, Surgery, Pulmonary embolism, Natural history, Clinical trial, medicine.anatomical_structure, Treatment Outcome, Female, business, Pulmonary Embolism
Abstract

Background The natural history of venous thromboembolism (VTE) in patients with dementia has not been thoroughly studied. Methods We used the RIETE Registry data to assess the clinical characteristics, treatment strategies and outcome during the first 3 months after acute VTE in all immobilized patients with dementia. Results As of August 2011, 37988 patients had been enrolled, of whom 1316 (3.5%) had dementia. Most patients in both subgroups were initially treated with low-molecular-weight heparin (LMWH). Then, 48% of patients with dementia and 25% of those without dementia received LMWH as long-term therapy. During the first 3 months of anticoagulant therapy, patients with dementia had a higher incidence of fatal pulmonary embolism (PE): 4.0% vs. 1.2% (odds ratio: 3.3; 95% CI: 2.5-4.4) and fatal bleeding: 1.4% vs. 0.5% (odds ratio: 2.9; 95% CI: 1.8-4.6) than those without dementia. In demented patients initially presenting with PE, the incidence of fatal PE during the first week outweighed that of fatal bleeding (42 vs. 4 deaths), but from Day 8, the incidence of fatal PE was similar to the incidence of fatal bleeding. In patients initially presenting with deep vein thrombosis (DVT), there were 4 fatal PE and 8 fatal bleeding events. Conclusions VTE patients with dementia had a high incidence of fatal PE and fatal bleeding. In those initially presenting with PE, the risk of dying of PE far outweighed that of fatal bleeding. In patients presenting with DVT alone, the risk of fatal PE was lower than that of fatal bleeding.

Published
2012

29. Effects of age on the risk of dying from pulmonary embolism or bleeding during treatment of deep vein thrombosis

Author

Juan Francisco Sanchez Muñoz Torrero, Henri, Bounameaux, José María Pedrajas, Alicia, Lorenzo, Silvino, Rubio, Clive, Kearon, Luís, Hernández, Manuel, Monreal, Monreal, M, Decousus, H, Prandoni, Paolo, Brenner, B, Barba, R, Di Micco, P, Rivron Guillot, K, Arcelus, Ji, Blanco, A, Barrón, M, Casado, I, Casas, Jm, Cisneros, E, del Campo, R, del Toro, J, Durán, M, Falgá, C, Fernández Capitán, C, Gabriel, F, Gallego, P, García Bragado, F, Gómez Zorilla, S, Guijarro, R, Guil, M, Gutiérrez, J, Hernández, L, Hernández Huerta, D, Jiménez, D, Jiménez, M, Jordán, S, Lecumberri, R, Lobo, Jl, López, L, Lorenzo, A, Luque, Jm, Madridano, O, Maestre, A, Marchena, Pj, Martín Villasclaras JJ, Nauffal, Md, Nieto, Ja, Núñez, Mj, Oribe, M, Otero, R, Pedrajas, Jm, Rabuñal, R, Riera Mestre, A, Román, P, Rosa, V, Rubio, S, Ruíz, Fj, Ruíz Giménez, N, Sahuquillo, Jc, Samperiz, A, Sánchez Muñoz Torrero JF, Sánchez, R, Soler, S, Soler, C, Tiberio, G, Todolí, Ja, Tolosa, C, Trujillo, J, Uresandi, F, Valdés, V, Valle, R, Vela, J, Vidal, G, Villalta, J, Boccalon, H, Delluc, A, Farge Bancel, D, Mahe, I, Barillari, A, Barillari, G, Ciammaichella, M, Dalla Valle, F, Duce, R, Piovella, C, Poggio, R, Prandoni, P, Pasca, S, Quintavalla, R, Schenone, A, Tiraferri, E, Visonà, A, Bosevski, M, Bounameaux, H., Servicio de Medicina Interna (SMI - Cacerès), Hospital San Pedro de Alcantara, Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, Servicio de Medicina Interna (SMI - Madrid), Hospital Clínico San Carlos, Servicio de Medicina Interna (SMI - La Paz - Madrid), Hospital Universitario La Paz, Servicio de Medicina Interna (SMI - Gijon), Hospital de Cabueñes, Department of Medicine (DM - McMaster), McMaster University [Hamilton, Ontario], Servicio de Medicina Interna (SMI), Hopital Universitario Germans Trias i Pujol, Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), and Université de Brest (UBO)-Université de Brest (UBO)

Subjects
Male, MESH: Pulmonary Embolism, Deep vein, 030204 cardiovascular system & hematology, MESH: Risk Assessment, 0302 clinical medicine, MESH: Aged, 80 and over, Risk Factors, MESH: Risk Factors, 030212 general & internal medicine, 10. No inequality, Venous Thrombosis, ddc:616, Aged, 80 and over, MESH: Aged, MESH: Middle Aged, Middle Aged, Thrombosis, Hemorrhage/chemically induced/mortality, 3. Good health, Pulmonary embolism, medicine.anatomical_structure, Female, Risk assessment, Cardiology and Cardiovascular Medicine, MESH: Hemorrhage, Adult, medicine.medical_specialty, Anticoagulants/adverse effects/therapeutic use, Hemorrhage, MESH: Anticoagulants, Risk Assessment, 03 medical and health sciences, Patient age, medicine, Humans, In patient, cardiovascular diseases, Pulmonary Embolism/mortality/prevention & control, Aged, MESH: Humans, business.industry, Anticoagulants, MESH: Adult, Odds ratio, medicine.disease, Confidence interval, MESH: Male, Surgery, MESH: Venous Thrombosis, Pulmonary Embolism, business, Venous Thrombosis/drug therapy, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; BACKGROUND: The risk of patients dying of pulmonary embolism (PE) or bleeding during the treatment of deep vein thrombosis (DVT), and whether these risks are influenced by patient age, has not been thoroughly studied. METHODS: We used data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) to assess the risk of fatal PE and fatal bleeding in 16,199 patients with lower limb DVT (without symptomatic PE at the time of inclusion) during the 3 months after diagnosis, with patients categorized according to age. RESULTS: During the 3 months of anticoagulant treatment, there were 31 fatal PEs (0.19%) and 83 fatal hemorrhages (0.51%). During the first 7 days of therapy, the frequency of fatal PEs was similar to that of fatal bleeding (12 vs 14 deaths, respectively; odds ratio [OR], 0.86; 95% confidence interval [CI], 0.39-1.87). However, from days 8 to 90, the frequency of fatal bleeding was greater than that of fatal PE (69 vs 19 deaths; OR, 3.64; 95% CI, 2.22-6.20). The higher frequency of fatal bleeding compared with fatal PE from days 8 to 90 appeared to be confined to patients who were aged ≥ 60 years. Multivariate analysis showed that patient age was independently associated with an increased risk of death from bleeding during the first 3 months: every 10 years the OR increased by 1.37 (95% CI, 1.12-1.67). CONCLUSIONS: During the first week of treatment, the risk of fatal bleeding and fatal PE were similar. Then, particularly in patients who were aged ≥ 60 years, the risk of dying from bleeding exceeded the risk of dying from PE.

Published
2011

30. Venous thromboembolism in patients with intracranial haemorrhage

Author

Lobo, J. L., Nieto, J. A., Zorrilla, V., Garrido, N., Madridano, O., Ruiz, J., Farge Bancel, D., Tiberio, G., Uresandi, F., Monreal, M., Monreal, M, Decousus, H, Prandoni, Paolo, Brenner, B, Barba, R, Di Micco, P, Rivron Guillot, K, Bosevski, M, Arcelus, Ji, 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, González, Jp, Guijarro, R, Guil, M, Gutiérrez, J, Gutiérrez, Mr, Hernández, L, Hernández Huerta, D, Hernández Toboso, S, Jiménez, D, Jiménez Gil, M, Lecumberri, R, Lobo, Jl, López Jiménez, L, Lorenzo, A, Luque, Jm, Madridano, O, Maestre, A, Marchena, Pj, Martín Villasclaras JJ, Montes, J, Montaña, M, Morales, M, Nauffal, Md, Nieto, Ja, Núñez, Mj, Ogea, Jl, Oribe, M, Otero, R, Pedrajas, Jm, Provenza, M, Rabuñal, R, Riera Mestre, A, Rodríguez, Ma, Roldán, V, Román, P, Rosa, V, Rubio, S, Ruíz, C, Ruíz, J, Ruiz Gamietea, A, Ruíz Giménez, N, Sahuquillo, Jc, Samperiz, A, Sánchez, R, Sánchez, Mt, Soler, S, Soto, Mj, Tiberio, G, Timiraos, J, Tolodí, Ja, Tolosa, C, Trujillo, J, Uresandi, F, Valdés, M, Valdés, V, Valle, R, Vidal, G, Villalta, J, Boccalon, H, Debourdeau, P, Durant, C, Farge Bancel, D, Mahe, I, Mismetti, P, Szwebel, T, Barillari, G, Ciammaichella, Bb, Ciammaichella, M, Dalla, Vf, Duce, R, Piovella, C, Poggio, R, Prandoni, P, Quintavalla, R, Schenone, A, Tiraferri, E, Tonello, D, Visonà, A, and Bosevski, M.

Subjects
Male, Risk, 0301 basic medicine, medicine.medical_specialty, Intracranial haemorrhage, Hemorrhage, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Humans, Medicine, Drug Dosage Calculations, In patient, Aged, business.industry, General surgery, Vascular biology, Anticoagulants, Hematology, Heparin, Low-Molecular-Weight, Middle Aged, Survival Analysis, Surgery, 030104 developmental biology, Spain, Female, Pulmonary Embolism, business, Intracranial Hemorrhages, Venous thromboembolism, Follow-Up Studies, Pneumonology
Abstract

Jose Luis Lobo1; Jose Antonio Nieto2; Vanesa Zorrilla1; Noelia Garrido2; Olga Madridano3; Justo Ruiz4; Dominique Farge-Bancel5; Gregorio Tiberio6; Fernando Uresandi7; Manuel Monreal8; the RIETE Investigators* 1Department of Pneumonology, Hospital de Txagorritxu, Vitoria, Spain; 2Department of Internal Medicine, Hospital Virgen de la Luz, Cuenca, Spain; 3Department of Internal Medicine, Hospital Infanta Sofia, Madrid, Spain; 4Department of Internal Medicine, Hospital de Fuenlabrada, Madrid, Spain; 5Department of Internal Medicine, Hopital SaintLouis, Paris, France; 6Department of Internal Medicine, Hospital Virgen del Camino, Pamplona, Navarra, Spain; 7Department of Pneumonology, Hospital de Cruces, Barakaldo, Vizcaya, Spain; 8Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain

Published
2011

31. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality

Author

Cohen, At, Agnelli, Giancarlo, Anderson, Fa, Arcelus, Ji, Bergqvist, D, Brecht, Jg, Greer, Ia, Heit, Ja, Hutchinson, Jl, Kakkar, Ak, Mottier, D, Oger, E, Samama, Mm, Spannagl, M, VTE Impact Assessment Group in Europe, Calvez, Ghislaine, Vascular Medicine - Department or Surgery (ATC), King's College Hospital (KCH), School of Chemistry, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Serv. Hématologie Biologie Hôtel Dieu, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Department of Internal Medicine, and University Hospital of Munich

Subjects
MESH: Pulmonary Embolism, Male, Risk, MESH: Registries, Hypertension, Pulmonary, MESH: Algorithms, MESH: Anticoagulants, MESH: Venous Thromboembolism, Postthrombotic Syndrome, Humans, cardiovascular diseases, Registries, Venous Thrombosis, MESH: Risk, MESH: Humans, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, MESH: Hypertension, Pulmonary, MESH: Postthrombotic Syndrome, Anticoagulants, Venous Thromboembolism, MESH: Hospitals, equipment and supplies, MESH: Male, Hospitals, Europe, MESH: Morbidity, MESH: Venous Thrombosis, Female, MESH: Europe, Morbidity, Pulmonary Embolism, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Algorithms
Abstract

International audience; Venous thromboembolism (VTE) is often asymptomatic, mis-diagnosed, and unrecognized at death, and there is a lack of routine postmortem examinations. These factors are thought to result in marked underestimates ofVTE incidence. The objective of our study was to estimate the total burden of VTE within the European Union (EU) per annum. An epidemiological model was constructed to estimate the number of community- and hospital-acquired incidents and recurrent cases (attack rate) of nonfatal VTE and VTE-related deaths, as well as incident and prevalent cases of post-thrombotic syndrome (PTS) and chronic thromboembolic pulmonary hypertension (PH) occurring in the EU per annum. Individual models were developed for six EU countries. The models were populated with data from published literature and, where necessary, expert opinions. The findings were tested using probabilistic sensitivity analyses. The estimated total number of symptomaticVTE events (range based on probabilistic sensitivity analysis) per annum within the six EU countries was 465,715 (404,664-538,189) cases of deep-vein thrombosis, 295,982 (242,450-360,363) cases of pulmonary embolism (PE), and 370,012 (300,193-483,108) VTE-related deaths. Of these deaths, an estimated 27,473 (7%) were diagnosed as being antemortem; 126,145 (34%) were sudden fatal PE, and 217,394 (59%) followed undiagnosed PE. Almost three-quarters of all VTE-related deaths were from hospital-acquired VTE. VTE is a major health problem in the EU, with over one million VTE events or deaths per annum in the six countries examined. Given the availability of effective VTE prophylaxis, many of these events and deaths could have been prevented. These results have important implications for the allocation of healthcare resources.

Published
2007

32. Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update 2014

Author

Leigh E. Gates, Margaret A. Tempero, Kari Bohlke, Nigel S. Key, Anna Falanga, Sandra L. Wong, Edward P. Balaban, Mark Levine, Jeffrey M. Clarke, Gary H. Lyman, Christopher R. Flowers, Nicole M. Kuderer, Agnes Y.Y. Lee, Alok A. Khorana, Ajay K. Kakkar, Mark R. Somerfield, Juan I. Arcelus, Charles W. Francis, Howard A. Liebman, Lyman, G, Bohlke, K, Khorana, A, Kuderer, N, Lee, A, Arcelus, J, Balaban, E, Clarke, J, Flowers, C, Francis, C, Gates, L, Kakkar, A, Key, N, Levine, M, Liebman, H, Tempero, M, Wong, S, Somerfield, M, Falanga, A, [Lyman,GH] Fred Hutchinson Cancer Research Center. University of Washington, Seattle, WA. [Kuderer,NM] University of Washington, Seattle, WA. [Bohlke,K, Somerfield,MR] American Society of Clinical Oncology, Alexandria, VA. [Khorana,AA] Cleveland Clinic, Cleveland, OH. [Lee,AY] University of British Columbia, Vancouver, British Columbia. [Levine,MN] McMaster University, Hamilton, Ontario, Canada. [Arcelus,JI] , Hospital Universitario Virgen de las Nieves. University of Granada, Granada, Spain. [Balaban,EP] Cancer Care Partnership, Mount Nittany Health and Penn State Hershey Cancer Institute, State College, PA. [Clarke,JM] Duke University Medical Center, Durham. [Key,NS] Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC. [Flowers,CR] Emory University School of Medicine, Atlanta, GA. [Francis,CW] James P. Wilmot Cancer Center and University of Rochester, Rochester, NY. [Gates,LE] Patient Representative, Denver, CO. [Kakkar,AK] Thrombosis Research Institute, London, United Kingdom. [Liebman,HA] University of Southern California Keck School of Medicine. Norris Comprehensive Cancer Center, Los Angeles. [Tempero,MA] , University of California San Francisco Pancreas Center, San Francisco, CA. [Wong,SL] University of Michigan, Ann Arbor, MI. [Falanga,A] Hospital Papa Giovanni XXIII, Bergamo, Italy., K12, NHLBI NIH HHS, United States, and Juan Ignacio Arcelus Honoraria: sanofi-aventis, AspenBio Pharma HL087165

Subjects
Cancer Research, medicine.medical_specialty, Venous Thromboembolism, Prophylaxis, and Treatment, Cancer, Chemicals and Drugs::Organic Chemicals::Carboxylic Acids::Acids, Carbocyclic::Benzoic Acids::Hydroxybenzoic Acids::Salicylic Acids::Aspirin [Medical Subject Headings], MEDLINE, Heparina de bajo-peso-molecular, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], Fibrinolytic Agents, Pancreatic cancer, Neoplasms, Medicine, Humans, Aspirina, Intensive care medicine, Aspirin, Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Hematologic Agents::Anticoagulants [Medical Subject Headings], business.industry, Cancer, Anticoagulants, Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Molecular Mechanisms of Pharmacological Action::Fibrin Modulating Agents::Fibrinolytic Agents [Medical Subject Headings], Guideline, Venous Thromboembolism, Heparin, Low-Molecular-Weight, Diseases::Neoplasms [Medical Subject Headings], medicine.disease, Neoplasias, Pulmonary embolism, Anticoagulantes, Oncology, ASCO Special Articles, Fibrinolíticos, business, Risk assessment, Diseases::Cardiovascular Diseases::Vascular Diseases::Embolism and Thrombosis::Thromboembolism::Venous Thromboembolism [Medical Subject Headings], Fibrinolytic agent, Tromboembolia venosa, medicine.drug
Abstract

More information, including Data and Methodology Supplements, slidesets, and clinicaltools and resources,is available atwww.asco.org/ guidelines/vte. Patient information is available at www.cancer.net. Visit www.asco.org/guidelineswiki to provide comments on the guideline or to submit new evidence, Purpose To provide current recommendations about the prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer. Methods PubMed and the Cochrane Library were searched for randomized controlled trials, systematic reviews, meta-analyses, and clinical practice guidelines from November 2012 through July 2014. An update committee reviewed the identified abstracts. Results Of the 53 publications identified and reviewed, none prompted a change in the 2013 recommendations. Recommendations Most hospitalized patients with active cancer require thromboprophylaxis throughout hospitalization. Routine thromboprophylaxis is not recommended for patients with cancer in the outpatient setting. It may be considered for selected high-risk patients. Patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy and/or dexamethasone should receive prophylaxis with either low–molecular weight heparin (LMWH) or low-dose aspirin. Patients undergoing major surgery should receive prophylaxis starting before surgery and continuing for at least 7 to 10 days. Extending prophylaxis up to 4 weeks should be considered in those undergoing major abdominal or pelvic surgery with high-risk features. LMWH is recommended for the initial 5 to 10 days of treatment for deep vein thrombosis and pulmonary embolism as well as for long-term secondary prophylaxis (at least 6 months). Use of novel oral anticoagulants is not currently recommended for patients with malignancy and VTE because of limited data in patients with cancer. Anticoagulation should not be used to extend survival of patients with cancer in the absence of other indications. Patients with cancer should be periodically assessed for VTE risk. Oncology professionals should educate patients about the signs and symptoms of VTE., Amgen (Inst), LEO Pharma, Bristol-Myers Squibb, Acerta (Inst), Infinity (Inst), Onyx Pharmaceuticals (Inst), Janssen Oncology (Inst), Gilead Sciences (Inst), Spectrum Pharmaceuticals (Inst), Celgene (Inst), TG Therapeutics (Inst), Genentech/Roche (Inst), Pharmacyclics (Inst), Eisai Inc, Bayer (Inst), Boehringer Ingelheim (Inst), Baxter Biosciences (Inst)

Published
2015
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33. Clinical presentation and time-course of postoperative venous thromboembolism: Results from the RIETE Registry

Author

Arcelus, Juan Ignacio, Monreal, Manuel, Caprini, Joseph A, Guisado, Javier Gutiérrez, Soto, Maria José, Núñez, Manuel Jesús, Alvárez, Juan Carlos, Renseigné, Non, Laboratoire des sciences et techniques de l'information, de la communication et de la connaissance (UMR 3192) (Lab-STICC), Université européenne de Bretagne - European University of Brittany (UEB)-Université de Bretagne Sud (UBS)-Université de Brest (UBO)-Institut Brestois du Numérique et des Mathématiques (IBNM), Université de Brest (UBO)-Télécom Bretagne-Institut Mines-Télécom [Paris] (IMT)-Centre National de la Recherche Scientifique (CNRS), Asociación de Investigación y Desarrollo en la Industria del Mueble y Afines (AIDIMA), AIDIMA, DEPARTAMENTO DE QUIMICA ORGANICA, Universidad de Concepción [Chile], RIETE investigators, [Arcelus,JI] Departamento de Cirugía de la Universidad de Granada y Hospital Virgen de las Nieves, Granada, Spain. [Monreal,M] Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. [Caprini,JA] Department of Surgery, Evanston Northwestern Healthcare, Evanston, Illinois,USA. [Gutiérrez Guisado,J] Servicio de Medicina Interna, Hospital Asepeyo Coslada, Madrid, Spain. [Soto,MJ] Servicio de Medicina Interna, Hospital Universitario Puerta del Mar, Cádiz, Spain. [Núñez,MJ] Servicio de Medicina Interna, Hospital Comarcal de Salnés, Pontevedra, Spain.[Alvárez,JC] Servicio de Medicina Interna, Hospital Virgen de Macarena, Sevilla, Spain., and The project has been partially supported by Red Respira from the Instituto Carlos III (RedRespira-ISCiii-RTIC-03/11). We express our gratitude to Sanofi-Aventis Spain for supporting this Registry with an unrestricted educational grant and the Registry Coordinating Center, S & H Medical Science Service, for their logistic and administrative support.

Subjects
Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Disease Attributes::Recurrence [Medical Subject Headings], Male, Diseases::Respiratory Tract Diseases::Lung Diseases::Pulmonary Embolism [Medical Subject Headings], Phenomena and Processes::Physical Phenomena::Time::Time Factors [Medical Subject Headings], medicine.medical_treatment, Named Groups::Persons::Age Groups::Adult::Middle Aged [Medical Subject Headings], Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], 0302 clinical medicine, Hemorragia, Estudios prospectivos, Procedimientos quirúrgicos, Prospective Studies, MESH: Incidence, Masculino, Hip fracture, MESH: Middle Aged, Incidence, Geographicals::Geographic Locations::Europe [Medical Subject Headings], Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Molecular Mechanisms of Pharmacological Action::Fibrin Modulating Agents::Fibrinolytic Agents [Medical Subject Headings], Humanos, 3. Good health, Embolia pulmonar, Sistema de registros, Geographicals::Geographic Locations::Asia::Asia, Western::Middle East::Israel [Medical Subject Headings], MESH: Hemorrhage, Venous thromboembolism, medicine.medical_specialty, Argentina, Check Tags::Male [Medical Subject Headings], Hemorrhage, Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Hemorrhage [Medical Subject Headings], MESH: Orthopedic Procedures, MESH: Surgical Procedures, Operative, 03 medical and health sciences, Fibrinolytic Agents, Humans, Aged, Mediana edad, MESH: Humans, medicine.disease, Check Tags::Female [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Orthopedic Procedures [Medical Subject Headings], Orthopedic surgery, Surgery, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Registries [Medical Subject Headings], Pulmonary Embolism, MESH: Female, MESH: Pulmonary Embolism, Time Factors, MESH: Registries, Geographicals::Geographic Locations::Americas::South America::Argentina [Medical Subject Headings], 030204 cardiovascular system & hematology, MESH: Venous Thromboembolism, Recurrence, Neoplasms, MESH: Fibrinolytic Agents, Orthopedic Procedures, MESH: Neoplasms, Registries, 030212 general & internal medicine, Israel, Prospective cohort study, Recurrencia local de neoplasia, MESH: Aged, Incidence (epidemiology), Femenino, MESH: Argentina, MESH: Israel, Venous Thromboembolism, Hematology, Diseases::Neoplasms [Medical Subject Headings], Middle Aged, Neoplasias, Pulmonary embolism, Europe, Venous thrombosis, Surgical Procedures, Operative, Female, Fibrinolíticos, Incidencia, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Prospective Studies [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Morbidity::Incidence [Medical Subject Headings], medicine, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative [Medical Subject Headings], Named Groups::Persons::Age Groups::Adult::Aged [Medical Subject Headings], Procedimientos ortopédicos, business.industry, Vascular disease, MESH: Time Factors, Arthroplasty, MESH: Prospective Studies, MESH: Male, MESH: Recurrence, Factores de tiempo, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, MESH: Europe, Europa ( Continente), Diseases::Cardiovascular Diseases::Vascular Diseases::Embolism and Thrombosis::Thromboembolism::Venous Thromboembolism [Medical Subject Headings], business, Ancianos, Tromboembolia venosa
Abstract

Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't; There is little literature about the clinical presentation and time-course of postoperative venous thromboembolism (VTE) in different surgical procedures. RIETE is an ongoing, prospective registry of consecutive patients with objectively confirmed, symptomatic acute VTE. In this analysis, we analysed the baseline characteristics, thromboprophylaxis and therapeutic patterns, time-course, and three-month outcome of all patients with postoperative VTE. As of January 2006, there were 1,602 patients with postoperative VTE in RIETE: 393 (25%) after major orthopaedic surgery (145 elective hip arthroplasty, 126 knee arthroplasty, 122 hip fracture); 207 (13%) after cancer surgery; 1,002 (63%) after other procedures. The percentage of patients presenting with clinically overt pulmonary embolism (PE) (48%, 48%, and 50% respectively), the average time elapsed from surgery to VTE (22 +/- 16, 24 +/- 16, and 21 +/- 15 days, respectively), and the three-month incidence of fatal PE (1.3%, 1.4%, and 0.8%, respectively), fatal bleeding (0.8%, 1.0%, and 0.2%, respectively), or major bleeding (2.3%, 2.9%, and 2.8%, respectively) were similar in the three groups. However, the percentage of patients who had received thromboprophylaxis (96%, 76% and 52%, respectively), the duration of prophylaxis (17 +/- 9.6, 13 +/- 8.9, and 12 +/- 11 days, respectively) and the mean daily doses of low-molecular-weight heparin (4,252 +/- 1,016, 3,260 +/- 1,141, and 3,769 +/- 1,650 IU, respectively), were significantly lower in those undergoing cancer surgery or other procedures. In conclusion, the clinical presentation, time-course, and three-month outcome of VTE was similar among the different subgroups of patients, but the use of prophylaxis in patients undergoing cancer surgery or other procedures was suboptimal. Yes

Published
2008

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