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Background: The optimal duration of anticoagulation after a first unprovoked venous thromboembolism (VTE) is uncertain. Anticoagulant therapy is highly effective at reducing the risk of recurrent VTE, but this clinical benefit is not maintained once anticoagulation is stopped. Current guidelines suggest considering indefinite anticoagulation in all patients with unprovoked who have a non-high bleeding risk. However, this is a weak recommendation based on limited evidence. Deciding whether patients with a first unprovoked VTE should be considered for indefinite anticoagulant therapy requires estimation of the long-term risk of recurrent VTE after stopping anticoagulation. This risk however, is poorly established, hindering decision making. Methods: We performed a systematic review and meta-analysis of randomized clinical trials and prospective observational studies to determine the rate of recurrent VTE in the first year, in the second year, between years 2 and 5, and years 5 and 10; and the cumulative incidence for recurrent VTE at 2, 5 and 10 years after stopping anticoagulation in men and women with first unprovoked VTE, who had completed at least 3 months of initial treatment. Studies were identified through a comprehensive literature search using MEDLINE, EMBASE and the Cochrane CENTRAL databases. Data clarifications were requested from authors of eligible studies. Rates of recurrent VTE were calculated for each study from the total number of recurrent VTE events divided by the person-years of follow-up, and then pooled using random-effects meta-analysis. Results: Fourteen studies involving 6, 446 patients were included in the analysis. Among men with a first unprovoked VTE, the pooled rate of recurrent VTE per 100 person-years after stopping anticoagulation was 11.2 events (95% CI, 9.0-13.6) in the first year; 7.4 events (95% CI, 5.5-9.5) in the second year; 4.4 events/year (95% CI, 3.2-5.7) between years 2 and 5, and 3.8 events/year (95% CI, 1.6-6.9) between years 5 and 10 [Table 1]. Among women with a first unprovoked VTE, the pooled rate of recurrent VTE per 100 person-years after stopping anticoagulation was 8.6 events (95% CI, 6.5-11.0) within the first year; 5.2 events (95% CI, 3.5-7.2) in the second year; 3.0 events/year (95% CI, 1.6-4.7) between years 2 and 5, and 2.0 events/year (95% CI, 1.3-2.9) between years 5 and 10 [Table 1]. In men and women respectively, the cumulative incidence for recurrent VTE was 17.8% (95% CI, 14.0%-21.9%) and 13.4% (95% CI, 9.8%-17.4%) at 2 years, 28.2% (95% CI, 22.0%-34.4%) and 20.9% (95% CI, 14.0%-28.5%) at 5 years, and 40.8% (95% CI, 28.0%-53.9%) and 28.5% (95% CI, 19.5%-38.3%) at 10 years after stopping anticoagulant therapy [Table 2]. Conclusions: Among patients with a first unprovoked VTE who have completed at least 3 months of initial treatment, men have a higher long-term risk of recurrent VTE after stopping anticoagulation, and may be given greater consideration for indefinite anticoagulant therapy. Our findings affirm the importance of considering patient's sex in deciding the optimal duration of anticoagulation, and as such, emphasize the need for individualized, patient-centered approach for the long-term management of unprovoked VTE. Disclosures Carrier: BMS: Honoraria, Research Funding; Leo Pharma: Research Funding; Pfizer: Honoraria; Bayer: Honoraria. Weitz:Bristol-Myers Squibb: Honoraria; Daiichi-Sankyo: Honoraria; Ionis: Consultancy, Honoraria; Janssen: Honoraria; Servier: Honoraria; Novartis: Honoraria; Bayer: Honoraria; Boehringer Ingelheim: Honoraria, Research Funding. Schulman:Boehringer-Ingelheim: Honoraria, Research Funding; Daiichi-Sankyo: Honoraria; Sanofi: Honoraria; Bayer: Honoraria. Couturaud:Pfizer: Research Funding; Bayer: Honoraria, Other: Travel Support; AstraZeneca: Honoraria; Actelion: Other: Travel Support; Intermune: Other: Travel Support; Leo Pharma: Other: Travel Support; Daiichi Sankyo: Other: Travel Support. Becattini:Bayer HealthCare: Other: Lecture Fees; Boehringer Ingelheim: Other: Lecture Fees; Bristol Meyer Squibb: Other: Lecture Fees. Agnelli:Daiichi Sankyo: Other: Personal Fees; Boehringer Ingelheim: Other: Personal Fees; Bayer Healthcare: Other: Personal Fees; Pfizer: Other: Personal Fees; Bristol-Myers-Squibb: Other: Personal Fees. Brighton:Glaxo Smith Klein: Other: Personal Fees; Novo Nordisk: Other: Personal Fees; Bayer: Other: Personal Fees. Lensing:Bayer: Employment. Prins:Pfizer: Consultancy; Daiichi Sankyo: Consultancy. Hutton:Cornerstone Research Group: Honoraria. Palareti:Roche: Membership on an entity's Board of Directors or advisory committees; Werfen: Speakers Bureau; Alfa-Wassermann: Membership on an entity's Board of Directors or advisory committees; Daiichi-Sankyo: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees. Prandoni:Pfizer: Consultancy; Daiichi-Sankyo: Consultancy; Sanofi: Consultancy; Bayer: Consultancy. Büller:Pfizer: Consultancy, Research Funding; Daiichi-Sankyo: Consultancy, Research Funding; Roche: Consultancy, Research Funding; Sanofi-Aventis: Consultancy, Research Funding; BMS: Consultancy, Research Funding; Bayer: Consultancy, Research Funding; Boehringer Ingelheim: Consultancy, Research Funding; Thrombogenics: Consultancy, Research Funding; Isis: Consultancy, Research Funding; GlaxoSmithKline: Consultancy, Research Funding. Rodger:Biomerieux: Research Funding.

We thank Dr. Rehman[1][1] for his interest in our article on deciding the optimal duration of anticoagulation in patients with acute unprovoked venous thromboembolism, [2][2] and his comments pertaining to the controversial topic of testing for thrombophilia in the management of venous

What you need to know Venous thromboembolism includes deep vein thrombosis (DVT) and pulmonary embolism. In DVT a blood clot forms in the lower extremities that may break off and travel to the lungs causing a pulmonary embolism. DVT is more common than pulmonary embolism during pregnancy1 and will constitute the focus of this clinical update. However, the prevalence, risk factors, and therapeutic options for DVT and venous thromboembolism in pregnancy are closely linked, and thus information regarding venous thromboembolism in pregnancy has also been covered where appropriate or when data regarding DVT are unavailable. Among pregnant women, pulmonary embolism is the most serious complication of DVT and remains one of the leading causes of maternal death in the developed world.2 Pregnancy related DVT is associated with a higher risk of embolic complications and of the post-thrombotic syndrome (chronic leg pain, intractable oedema, leg ulcers) than DVT in non-pregnant women.13 This article provides an update on the diagnosis and management of pregnant women with DVT. The risk of venous thromboembolism in pregnancy is about four times the risk among non-pregnant women of childbearing age4; it is highest in the third trimester …

This paper proposes a novel femtocell base stations placement scheme for effective indoor wireless coverage in commercial environments. The objectives are to place the minimum number of femtocell base stations while maximizing the covered area with the signal to interference plus noise ratio larger than the predefined threshold. This scheme consists of several algorithms that first partition the whole environment into subregions, place femtocell base stations into these subregions and adjust their positions one by one in a greedy way, until the coverage requirement can be satisfied. The subregion partition might be refined to create smaller subregions, if the coverage requirement cannot be met. Simulation results show that our proposed placement scheme is better than the existing ones because of taking interference mitigation into consideration.

We propose a simple yet effective and fair scheduler for dense Machine to Machine (M2M) implementations. The proposed scheduler aims to insure that all the devices that are randomly requesting for channel time are equally catered to. In other words the number of times each device is given access to the channel should approximately be equal to the number of times the rest of the devices are given access. The proposed scheduler known as the Improved Rejection Ratio (IRR) mainly takes decisions based on the previous history of successful attempts by a device to access the channel as well its unsuccessful attempts. Upon comparison with other relevant schedulers, the hardware based performance evaluation reveal the advantages of the proposed scheduler in terms of provision of fair and relatively uniform access to the devices requesting for channel time.

An 87-year-old woman presented to the emergency department three hours after acute onset of left hemiplegia, profound neglect and dysarthria (severe stroke; National Institutes of Health Stroke Scale [NIHSS] = 18). Noncontrast computed tomography (CT) of the head showed early ischemic changes in the

Accredited Social Health Activist (ASHA) has been chosen under the National Rural Health Mission (NRHM) in 2005 with the purpose of helping community members in availing health services at government hospitals with a special focus on the rural domain. This study aims to find out how ASHAs have been playing a significant role in Comprehensive Child Survival Programme (CCSP) works and activities, which reduces infant mortality in a village. She imparts knowledge and information about healthcare and services to the community members through oneto-one counselling, family counselling, group meetings with different actors like adolescents, pregnant women and lactating mothers. Because of dissemination of health information by ASHA through different mediums like group meetings, community members become aware of the government health facilities and they demand support of ASHA to receive different services under many health-related schemes. Hence, the effective work of ASHA has been shown through this study by applying various research methods.