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2. Gynecological Cancer and Venous Thromboembolism: A Narrative Review to Increase Awareness and Improve Risk Assessment and Prevention

Author

Falanga, A, Lorusso, D, Colombo, N, Cormio, G, Cosmi, B, Scandurra, G, Zanagnolo, V, Marietta, M, Falanga A., Lorusso D., Colombo N., Cormio G., Cosmi B., Scandurra G., Zanagnolo V., Marietta M., Falanga, A, Lorusso, D, Colombo, N, Cormio, G, Cosmi, B, Scandurra, G, Zanagnolo, V, Marietta, M, Falanga A., Lorusso D., Colombo N., Cormio G., Cosmi B., Scandurra G., Zanagnolo V., and Marietta M.

Abstract

The prevention and appropriate management of venous thromboembolism in cancer patients is of paramount importance. However, the literature data report an underestimation of this major problem in patients with gynecological cancers, with an inconsistent venous thromboembolism risk assessment and prophylaxis in this patient setting. This narrative review provides a comprehensive overview of the available evidence regarding the management of venous thromboembolism in cancer patients, focusing on the specific context of gynecological tumors, exploring the literature discussing risk factors, risk assessment, and pharmacological prophylaxis. We found that the current understanding and management of venous thromboembolism in gynecological malignancy is largely based on studies on solid cancers in general. Hence, further, larger, and well-designed research in this area is needed.

Published
2024

3. OC 46.1 Absolute Quantitative Proteomics for Occult Cancer Screening in Patient with Unprovoked Venous Thromboembolism: Results from the Prospective PLATO-VTE Study

Author

Guman, N., primary, Kraaijpoel, N., additional, Mulder, F., additional, Carrier, M., additional, Jara-Palomares, L., additional, Di Nisio, M., additional, Ageno, W., additional, Beyer-Westendorf, J., additional, Klok, E., additional, Vanassche, T., additional, Otten, H., additional, Cosmi, B., additional, Kamphuisen, P., additional, Sánchez-López, V., additional, Best, M., additional, Bossuyt, P., additional, Versteeg, H., additional, van Vlijmen, B., additional, van Es, N., additional, and Mohammed, Y., additional

Published
2023
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4. PB0479 The ABC-Bleeding Score for Prediction of On-Treatment Clinically Relevant Bleeding in Patients with Unprovoked Venous Thromboembolism: Results from the Prospective PLATO-VTE Study

Author

Guman, N., primary, Becking, A., additional, Kraaijpoel, N., additional, Mulder, F., additional, Carrier, M., additional, Jara-Palomares, L., additional, Di Nisio, M., additional, Ageno, W., additional, Beyer-Westendorf, J., additional, Klok, E., additional, Vanassche, T., additional, Otten, H., additional, Cosmi, B., additional, Peters, M., additional, Ten Wolde, M., additional, Bossuyt, P., additional, Gerdes, V., additional, Büller, H., additional, Kamphuisen, P., additional, and van Es, N., additional

Published
2023
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10. D-dimer and reduced dose apixaban for extended treatment after unprovoked venous thromboembolism: the Apidulcis study

Author

Palareti, G., Poli, D., Pesavento, R., Legnani, C., Antonucci, E., Bucherini, E., Testa, S., Paoletti, O., Chistolini, A., Ceccato, D., Martinelli, I., Bucciarelli, P., Falanga, A., Tosetto, A., Sarti, L., Mastroiacovo, D., Cosmi, B., Visona, A., Santoro, R. C., Zanatta, N., Grandone, E., Bertu, L., Pengo, V., Caiano, L., Prandoni, P., Lotti, E., Crudele, F., Ageno, W., Abenante, A., Colombo, G., Guarascio, M., Cancellieri, E., Morandini, R., Zambelli, S., Martini, S., Vastola, M., Serrao, A., Abbattista, M., Artoni, A., Capecchi, M., Gianniello, F., Scimeca, B., Barcella, L., Gamba, S., Lerede, T., Maggioni, A., Schieppati, F., Russo, L., Zunino, F., Artuso, A., Bellesso, S., Cadau, J., Carli, G., Nichele, I., Perbellini, O., Caronna, A., Gabrielli, F., Lami, F., Nicolini, A., Scaglioni, F., Pinelli, M., Desideri, G., Borgese, L., Favaretto, E., Libra, A., Migliaccio, L., Sartori, M., Panzavolta, C., Scandiuzzi, T., Zalunardo, B. -M., Ierardi, A., Leotta, M., Strangio, A., Guzzon, S., Colaizzo, D., Favuzzi, G., Lombardi, M. R., Ferrini, P. M., Tassoni, M. I., Corradini, S., Iotti, M., Lambertini, I., Veropalumbo, M. R., Lessiani, G., Parisi, R., Bortoluzzi, C., H. N., Vo, Chiarugi, P., Casini, M., Violo, C., Nuti, M., Angeloni, L., Carrozzi, L., Pancani, R., Chimera, D., Conti, V., Meschi, C., Cattaneo, M., Podda, G., Birocchi, S., Cuppini, S., Marzolo, M., Milan, M., Martini, G., Merelli, S., Pontoglio, S., Portesi, N., Villalta, S., De Lucchi, L., Sponghiado, A., Becattini, C., Giustozzi, M., Vinci, A., Pignatelli, P., Bucci, T., Menichelli, D., Pastori, D., Pomero, F., Casalis, S., Galli, E., Ciammaichella, M., Maida, R., De Cristofaro, R., Alberelli, M. A., Basso, M. R., De Candia, E., Di Gennaro, L., Mumoli, N., Capra, R., Orlando, M., Porta, C., Rotiroti, G., Demarco, M., Petrillo, P., Rossi, E., Bartolomei, F., Soldati, D., Russo, U., Burgo, I., Ziliotti, M., Pataccini, C., Terroni, L., Ugolotti, M. C., Di Giorgio, A., Cavagna, L., Mete, F., Gino, M., Santoro, A., De Carlo, A., Cappelli, R., Bicchi, M., Dyrmo, L., Grifoni, E., Masotti, L., Ria, L., Spagnolo, M., Rupoli, S., Federici, I., Morsia, E., Scortechini, A. R., Torre, E., Franchini, M., Montorsi, P., Galgano, G., De Luca, A., Muiesan, M. L., Paini, A., Stassaldi, D., Denas, G., and Palareti G, Poli D, Ageno W, Legnani C, Antonucci E, Bucherini E, Testa S, Paoletti O, Chistolini A, Serrao A, Martinelli I, Bucciarelli P, Falanga A, Tosetto A, Sarti L, Mastroiacovo D, Cosmi B, Visonà A, Santoro RC, Zanatta N, Grandone E, Bertù L, Pengo V, Caiano LM, Prandoni P

Subjects
venous thromboembolism, d-dimer, anticoagulation therapy, apixaban, anticoagulation therapy, Recurrence, Settore MED/09 - MEDICINA INTERNA, D-dimer, venous thromboembolism, oral anticoagulants, apixaban, Humans, Anticoagulants, Hematology, Prospective Studies, Venous Thromboembolism, d-dimer
Abstract

D-dimer assay is used to stratify patients with unprovoked venous thromboembolism (VTE) for the risk of recurrence. However, this approach was never evaluated since direct oral anticoagulants are available. With this multicenter, prospective cohort study, we aimed to assess the value of an algorithm incorporating serial D-dimer testing and administration of reduced-dose apixaban (2.5 mg twice daily) only to patients with a positive test. A total of 732 outpatients aged 18 to 74 years, anticoagulated for ≥12 months after a first unprovoked VTE, were included. Patients underwent D-dimer testing with commercial assays and preestablished cutoffs. If the baseline D-dimer during anticoagulation was negative, anticoagulation was stopped and testing repeated after 15, 30, and 60 days. Patients with serially negative results (286 [39.1%]) were left without anticoagulation. At the first positive result, the remaining 446 patients (60.9%) were given apixaban for 18 months. All patients underwent follow-up planned for 18 months. The study was interrupted after a planned interim analysis for the high rate of primary outcomes (7.3%; 95% confidence interval [CI], 4.5-11.2), including symptomatic proximal deep vein thrombosis (DVT) or pulmonary embolism (PE) recurrence, death for VTE, and major bleeding occurring in patients off anticoagulation vs that in those receiving apixaban (1.1%; 95% CI, 0.4-2.6; adjusted hazard ratio [HR], 8.2; 95% CI, 3.2-25.3). In conclusion, in patients anticoagulated for ≥1 year after a first unprovoked VTE, the decision to further extend anticoagulation should not be based on D-dimer testing. The results confirmed the high efficacy and safety of reduced-dose apixaban against recurrences. This trial was registered at www.clinicaltrials.gov as #NCT03678506.

Published
2022

11. Anticoagulation in Italian patients with venous thromboembolism and thrombophilic alterations: findings from START2 register study

Author

Margaglione, M, Antonucci, E, D'Andrea, G, Migliaccio, L, Ageno, W, Bucherini, E, Cosmi, B, Falanga, A, Martini, G, Mastroiacovo, D, Paparo, C, Poli, D, Testa, S, Palareti, G, Margaglione M., Antonucci E., D'Andrea G., Migliaccio L., Ageno W., Bucherini E., Cosmi B., Falanga A., Martini G., Mastroiacovo D., Paparo C., Poli D., Testa S., Palareti G., Margaglione, M, Antonucci, E, D'Andrea, G, Migliaccio, L, Ageno, W, Bucherini, E, Cosmi, B, Falanga, A, Martini, G, Mastroiacovo, D, Paparo, C, Poli, D, Testa, S, Palareti, G, Margaglione M., Antonucci E., D'Andrea G., Migliaccio L., Ageno W., Bucherini E., Cosmi B., Falanga A., Martini G., Mastroiacovo D., Paparo C., Poli D., Testa S., and Palareti G.

Abstract

BACKGROUND: Randomised control trials have assessed the efficacy and safety of direct oral anticoagulants in the prophylaxis and treatment of venous thromboembolism (VTE). Positive but limited results have been reported in patients with inherited thrombophilia. Using an Italian, multicentre, prospective registry of consecutive patients presenting with symptomatic, acute VTE, we aimed to assess which factors are involved in making the choice of the drug that best fits the patient's risk profile in a large real-world setting of VTE patients. MATERIALS AND METHODS: We investigated 4,866 VTE patients who took oral anticoagulants in the period between 2012 and April 2018 to prevent a new thromboembolic episode. RESULTS: The large majority of patients who underwent thrombophilic screening, regardless of the results obtained, were prescribed direct oral anticoagulants rather than conventional anticoagulant therapy (p<0.001). During anticoagulation, bleeding events occurred more frequently in patients on conventional anticoagulant therapy (4.2%) than in those receiving direct oral anticoagulants (1.8%) and an increase in bleeding events was observed in patients who tested positive at the thrombophilic screening. Overall, a higher number of recurrent VTE was observed in patients not screened for thrombophilia (n=36; 1.7%) than in those screened (n=20; 0.7%; adjusted odds ratio: 2.2; 95% confidence interval: 1.2-4.1). DISCUSSION: The present data confirm previous findings from other post-marketing registries and suggest that the choice of oral anticoagulation is strongly driven by patients' characteristics and VTE manifestations. Factors leading to the prescription of thrombophilic screening may identify a patient with a lower risk of VTE recurrence during anticoagulation.

Published
2020

12. Guidance for the Management of Patients with Vascular Disease or Cardiovascular Risk Factors and COVID-19: Position Paper from VAS-European Independent Foundation in Angiology/Vascular Medicine

Author

Gerotziafas, G, Catalano, M, Colgan, M, Pecsvarady, Z, Wautrecht, J, Fazeli, B, Olinic, D, Farkas, K, Elalamy, I, Falanga, A, Fareed, J, Papageorgiou, C, Arellano, R, Agathagelou, P, Antic, D, Auad, L, Banfic, L, Bartolomew, J, Benczur, B, Bernardo, M, Boccardo, F, Cifkova, R, Cosmi, B, De Marchi, S, Dimakakos, E, Dimopoulos, M, Dimitrov, G, Durand-Zaleski, I, Edmonds, M, El Nazar, E, Erer, D, Esponda, O, Gresele, P, Gschwandtner, M, Gu, Y, Heinzmann, M, Hamburg, N, Hamade, A, Jatoi, N, Karahan, O, Karetova, D, Karplus, T, Klein-Weigel, P, Kolossvary, E, Kozak, M, Lefkou, E, Lessiani, G, Liew, A, Marcoccia, A, Marshang, P, Marakomichelakis, G, Matuska, J, Moraglia, L, Pillon, S, Poredos, P, Prior, M, Salvador, D, Schlager, O, Schernthaner, G, Sieron, A, Spaak, J, Spyropoulos, A, Sprynger, M, Suput, D, Stanek, A, Stvrtinova, V, Szuba, A, Tafur, A, Vandreden, P, Vardas, P, Vasic, D, Vikkula, M, Wennberg, P, Zhai, Z, Bikdeli, B, Guo, Y, Harenberg, J, Hu, Y, Lip, G, Roldan, V, Gerotziafas G. T., Catalano M., Colgan M. -P., Pecsvarady Z., Wautrecht J. C., Fazeli B., Olinic D. -M., Farkas K., Elalamy I., Falanga A., Fareed J., Papageorgiou C., Arellano R. S., Agathagelou P., Antic D., Auad L., Banfic L., Bartolomew J. R., Benczur B., Bernardo M. B., Boccardo F., Cifkova R., Cosmi B., De Marchi S., Dimakakos E., Dimopoulos M. A., Dimitrov G., Durand-Zaleski I., Edmonds M., El Nazar E. A., Erer D., Esponda O. L., Gresele P., Gschwandtner M., Gu Y., Heinzmann M., Hamburg N. M., Hamade A., Jatoi N. -A., Karahan O., Karetova D., Karplus T., Klein-Weigel P., Kolossvary E., Kozak M., Lefkou E., Lessiani G., Liew A., Marcoccia A., Marshang P., Marakomichelakis G., Matuska J., Moraglia L., Pillon S., Poredos P., Prior M., Salvador D. R. K., Schlager O., Schernthaner G., Sieron A., Spaak J., Spyropoulos A., Sprynger M., Suput D., Stanek A., Stvrtinova V., Szuba A., Tafur A., Vandreden P., Vardas P. E., Vasic D., Vikkula M., Wennberg P., Zhai Z., Bikdeli B., Guo Y., Harenberg J., Hu Y., Lip G. Y. H., Roldan V., Gerotziafas, G, Catalano, M, Colgan, M, Pecsvarady, Z, Wautrecht, J, Fazeli, B, Olinic, D, Farkas, K, Elalamy, I, Falanga, A, Fareed, J, Papageorgiou, C, Arellano, R, Agathagelou, P, Antic, D, Auad, L, Banfic, L, Bartolomew, J, Benczur, B, Bernardo, M, Boccardo, F, Cifkova, R, Cosmi, B, De Marchi, S, Dimakakos, E, Dimopoulos, M, Dimitrov, G, Durand-Zaleski, I, Edmonds, M, El Nazar, E, Erer, D, Esponda, O, Gresele, P, Gschwandtner, M, Gu, Y, Heinzmann, M, Hamburg, N, Hamade, A, Jatoi, N, Karahan, O, Karetova, D, Karplus, T, Klein-Weigel, P, Kolossvary, E, Kozak, M, Lefkou, E, Lessiani, G, Liew, A, Marcoccia, A, Marshang, P, Marakomichelakis, G, Matuska, J, Moraglia, L, Pillon, S, Poredos, P, Prior, M, Salvador, D, Schlager, O, Schernthaner, G, Sieron, A, Spaak, J, Spyropoulos, A, Sprynger, M, Suput, D, Stanek, A, Stvrtinova, V, Szuba, A, Tafur, A, Vandreden, P, Vardas, P, Vasic, D, Vikkula, M, Wennberg, P, Zhai, Z, Bikdeli, B, Guo, Y, Harenberg, J, Hu, Y, Lip, G, Roldan, V, Gerotziafas G. T., Catalano M., Colgan M. -P., Pecsvarady Z., Wautrecht J. C., Fazeli B., Olinic D. -M., Farkas K., Elalamy I., Falanga A., Fareed J., Papageorgiou C., Arellano R. S., Agathagelou P., Antic D., Auad L., Banfic L., Bartolomew J. R., Benczur B., Bernardo M. B., Boccardo F., Cifkova R., Cosmi B., De Marchi S., Dimakakos E., Dimopoulos M. A., Dimitrov G., Durand-Zaleski I., Edmonds M., El Nazar E. A., Erer D., Esponda O. L., Gresele P., Gschwandtner M., Gu Y., Heinzmann M., Hamburg N. M., Hamade A., Jatoi N. -A., Karahan O., Karetova D., Karplus T., Klein-Weigel P., Kolossvary E., Kozak M., Lefkou E., Lessiani G., Liew A., Marcoccia A., Marshang P., Marakomichelakis G., Matuska J., Moraglia L., Pillon S., Poredos P., Prior M., Salvador D. R. K., Schlager O., Schernthaner G., Sieron A., Spaak J., Spyropoulos A., Sprynger M., Suput D., Stanek A., Stvrtinova V., Szuba A., Tafur A., Vandreden P., Vardas P. E., Vasic D., Vikkula M., Wennberg P., Zhai Z., Bikdeli B., Guo Y., Harenberg J., Hu Y., Lip G. Y. H., and Roldan V.

Abstract

COVID-19 is also manifested with hypercoagulability, pulmonary intravascular coagulation, microangiopathy, and venous thromboembolism (VTE) or arterial thrombosis. Predisposing risk factors to severe COVID-19 are male sex, underlying cardiovascular disease, or cardiovascular risk factors including noncontrolled diabetes mellitus or arterial hypertension, obesity, and advanced age. The VAS-European Independent Foundation in Angiology/Vascular Medicine draws attention to patients with vascular disease (VD) and presents an integral strategy for the management of patients with VD or cardiovascular risk factors (VD-CVR) and COVID-19. VAS recommends (1) a COVID-19-oriented primary health care network for patients with VD-CVR for identification of patients with VD-CVR in the community and patients' education for disease symptoms, use of eHealth technology, adherence to the antithrombotic and vascular regulating treatments, and (2) close medical follow-up for efficacious control of VD progression and prompt application of physical and social distancing measures in case of new epidemic waves. For patients with VD-CVR who receive home treatment for COVID-19, VAS recommends assessment for (1) disease worsening risk and prioritized hospitalization of those at high risk and (2) VTE risk assessment and thromboprophylaxis with rivaroxaban, betrixaban, or low-molecular-weight heparin (LMWH) for those at high risk. For hospitalized patients with VD-CVR and COVID-19, VAS recommends (1) routine thromboprophylaxis with weight-adjusted intermediate doses of LMWH (unless contraindication); (2) LMWH as the drug of choice over unfractionated heparin or direct oral anticoagulants for the treatment of VTE or hypercoagulability; (3) careful evaluation of the risk for disease worsening and prompt application of targeted antiviral or convalescence treatments; (4) monitoring of D-dimer for optimization of the antithrombotic treatment; and (5) evaluation of the risk of VTE before hospital dischar

Published
2020

14. Guidance for the Management of Patients with Vascular Disease or Cardiovascular Risk Factors and COVID-19: Position Paper from VAS-European Independent Foundation in Angiology/Vascular Medicine

Author

Gerotziafas G. T., Catalano M., Colgan M. -P., Pecsvarady Z., Wautrecht J. C., Fazeli B., Olinic D. -M., Farkas K., Elalamy I., Falanga A., Fareed J., Papageorgiou C., Arellano R. S., Agathagelou P., Antic D., Auad L., Banfic L., Bartolomew J. R., Benczur B., Bernardo M. B., Boccardo F., Cifkova R., Cosmi B., De Marchi S., Dimakakos E., Dimopoulos M. A., Dimitrov G., Durand-Zaleski I., Edmonds M., El Nazar E. A., Erer D., Esponda O. L., Gresele P., Gschwandtner M., Gu Y., Heinzmann M., Hamburg N. M., Hamade A., Jatoi N. -A., Karahan O., Karetova D., Karplus T., Klein-Weigel P., Kolossvary E., Kozak M., Lefkou E., Lessiani G., Liew A., Marcoccia A., Marshang P., Marakomichelakis G., Matuska J., Moraglia L., Pillon S., Poredos P., Prior M., Salvador D. R. K., Schlager O., Schernthaner G., Sieron A., Spaak J., Spyropoulos A., Sprynger M., Suput D., Stanek A., Stvrtinova V., Szuba A., Tafur A., Vandreden P., Vardas P. E., Vasic D., Vikkula M., Wennberg P., Zhai Z., Bikdeli B., Guo Y., Harenberg J., Hu Y., Lip G. Y. H., Roldan V., Gerotziafas, G, Catalano, M, Colgan, M, Pecsvarady, Z, Wautrecht, J, Fazeli, B, Olinic, D, Farkas, K, Elalamy, I, Falanga, A, Fareed, J, Papageorgiou, C, Arellano, R, Agathagelou, P, Antic, D, Auad, L, Banfic, L, Bartolomew, J, Benczur, B, Bernardo, M, Boccardo, F, Cifkova, R, Cosmi, B, De Marchi, S, Dimakakos, E, Dimopoulos, M, Dimitrov, G, Durand-Zaleski, I, Edmonds, M, El Nazar, E, Erer, D, Esponda, O, Gresele, P, Gschwandtner, M, Gu, Y, Heinzmann, M, Hamburg, N, Hamade, A, Jatoi, N, Karahan, O, Karetova, D, Karplus, T, Klein-Weigel, P, Kolossvary, E, Kozak, M, Lefkou, E, Lessiani, G, Liew, A, Marcoccia, A, Marshang, P, Marakomichelakis, G, Matuska, J, Moraglia, L, Pillon, S, Poredos, P, Prior, M, Salvador, D, Schlager, O, Schernthaner, G, Sieron, A, Spaak, J, Spyropoulos, A, Sprynger, M, Suput, D, Stanek, A, Stvrtinova, V, Szuba, A, Tafur, A, Vandreden, P, Vardas, P, Vasic, D, Vikkula, M, Wennberg, P, Zhai, Z, Bikdeli, B, Guo, Y, Harenberg, J, Hu, Y, Lip, G, Roldan, V, Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Trinity College Dublin, Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Mashhad University of Medical Sciences, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Gerotziafas G.T., Catalano M., Colgan M.-P., Pecsvarady Z., Wautrecht J.C., Fazeli B., Olinic D.-M., Farkas K., Elalamy I., Falanga A., Fareed J., Papageorgiou C., Arellano R.S., Agathagelou P., Antic D., Auad L., Banfic L., Bartolomew J.R., Benczur B., Bernardo M.B., Boccardo F., Cifkova R., Cosmi B., De Marchi S., Dimakakos E., Dimopoulos M.A., Dimitrov G., Durand-Zaleski I., Edmonds M., El Nazar E.A., Erer D., Esponda O.L., Gresele P., Gschwandtner M., Gu Y., Heinzmann M., Hamburg N.M., Hamade A., Jatoi N.-A., Karahan O., Karetova D., Karplus T., Klein-Weigel P., Kolossvary E., Kozak M., Lefkou E., Lessiani G., Liew A., Marcoccia A., Marshang P., Marakomichelakis G., Matuska J., Moraglia L., Pillon S., Poredos P., Prior M., Salvador D.R.K., Schlager O., Schernthaner G., Sieron A., Spaak J., Spyropoulos A., Sprynger M., Suput D., Stanek A., Stvrtinova V., Szuba A., Tafur A., Vandreden P., Vardas P.E., Vasic D., Vikkula M., Wennberg P., Zhai Z., Bikdeli B., Guo Y., Harenberg J., Hu Y., Lip G.Y.H., Roldan V., and UCL - SSS/DDUV/GEHU - Génétique

Subjects
030204 cardiovascular system & hematology, antithrombotic, antiplatelet, chemistry.chemical_compound, 0302 clinical medicine, Rivaroxaban, Risk Factors, cardiovascular disease, Thrombophilia, 030212 general & internal medicine, antiplatelets, low-molecular-weight heparin, Societies, Medical, Low-Molecular-Weight, Hematology, 3. Good health, Europe, Cardiovascular Diseases, Thrombosi, Practice Guidelines as Topic, Position Paper, Risk assessment, medicine.drug, Human, medicine.medical_specialty, anticoagulants, medicine.drug_class, DOAC, Cardiology, Low molecular weight heparin, peripheral artery disease, deep vein thrombosis, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Medical, medicine, Humans, COVID-19 - cardiovascular disease - peripheral artery disease - deep vein thrombosis - antithrombotic - antiplatelets - anticoagulants - low-molecular-weight heparin - DOAC, Intensive care medicine, Contraindication, Angiology, Inflammation, Vascular disease, business.industry, Heparin, SARS-CoV-2, Risk Factor, anticoagulant, deep vein thrombosi, COVID-19, Thrombosis, Heparin, Low-Molecular-Weight, medicine.disease, COVID-19 Drug Treatment, chemistry, Betrixaban, business, Societies
Abstract

COVID-19 is also manifested with hypercoagulability, pulmonary intravascular coagulation, microangiopathy, and venous thromboembolism (VTE) or arterial thrombosis. Predisposing risk factors to severe COVID-19 are male sex, underlying cardiovascular disease, or cardiovascular risk factors including noncontrolled diabetes mellitus or arterial hypertension, obesity, and advanced age. The VAS-European Independent Foundation in Angiology/Vascular Medicine draws attention to patients with vascular disease (VD) and presents an integral strategy for the management of patients with VD or cardiovascular risk factors (VD-CVR) and COVID-19. VAS recommends (1) a COVID-19-oriented primary health care network for patients with VD-CVR for identification of patients with VD-CVR in the community and patients' education for disease symptoms, use of eHealth technology, adherence to the antithrombotic and vascular regulating treatments, and (2) close medical follow-up for efficacious control of VD progression and prompt application of physical and social distancing measures in case of new epidemic waves. For patients with VD-CVR who receive home treatment for COVID-19, VAS recommends assessment for (1) disease worsening risk and prioritized hospitalization of those at high risk and (2) VTE risk assessment and thromboprophylaxis with rivaroxaban, betrixaban, or low-molecular-weight heparin (LMWH) for those at high risk. For hospitalized patients with VD-CVR and COVID-19, VAS recommends (1) routine thromboprophylaxis with weight-adjusted intermediate doses of LMWH (unless contraindication); (2) LMWH as the drug of choice over unfractionated heparin or direct oral anticoagulants for the treatment of VTE or hypercoagulability; (3) careful evaluation of the risk for disease worsening and prompt application of targeted antiviral or convalescence treatments; (4) monitoring of D-dimer for optimization of the antithrombotic treatment; and (5) evaluation of the risk of VTE before hospital discharge using the IMPROVE-D-dimer score and prolonged post-discharge thromboprophylaxis with rivaroxaban, betrixaban, or LMWH.

Published
2020

17. The ISTH bleeding assessment tool as predictor of bleeding events in inherited platelet disorders: Communication from the ISTH SSC Subcommittee on Platelet Physiology

Author

Gresele, P., Falcinelli, E., Bury, L., Pecci, A., Alessi, M. -C., Borhany, M., Heller, P. G., Santoro, C., Cid, A. R., Orsini, S., Fontana, P., De Candia, E., Podda, G., Kannan, M., Jurk, K., Castaman, G., Falaise, C., Guglielmini, G., Noris, P., Zaninetti, C., Fiore, M., Tosetto, A., Zuniga, P., Miyazaki, K., Dupuis, A., Hayward, C., Casonato, A., Grandone, E., Mazzucconi, M. G., James, P., Fabris, F., Henskens, Y., Napolitano, M., Curnow, J., Gkalea, V., Fedor, M., Lambert, M. P., Zieger, B., Barcella, L., Cosmi, B., Giordano, P., Porri, C., Melazzini, F., Abid, M., Glembotsky, A. C., Ferrara, G., Russo, A., Deckmyn, H., Frelinger, A. L., Harrison, P., Mezzano, D., Mumford, A. D., Lordkipanidzé, M., BAT-VAL Study Investigators, Università degli Studi di Perugia = University of Perugia (UNIPG), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Unidad de Coagulopatías Congénitas. Hospital Universitario La Fe., Gresele, Paolo, Falcinelli, Emanuela, Bury, Loredana, Pecci, Alessandro, Alessi, Marie-Christine, Borhany, Munira, Heller, Paula G, Santoro, Cristina, Cid, Ana Rosa, Orsini, Sara, Fontana, Pierre, De Candia, Erica, Podda, Gianmarco, Kannan, Meganathan, Jurk, Kerstin, Castaman, Giancarlo, Falaise, Céline, Guglielmini, Giuseppe, Noris, Patrizia, Mariasanta Napolitano, Università degli Studi di Perugia (UNIPG), University of Perugia, Gresele, P., Falcinelli, E., Bury, L., Pecci, A., Alessi, M.-C., Borhany, M., Heller, P.G., Santoro, C., Cid, A.R., Orsini, S., Fontana, P., De Candia, E., Podda, G., Kannan, M., Jurk, K., Castaman, G., Falaise, C., Guglielmini, G., Noris, P., Zaninetti, C., Fiore, M., Tosetto, A., Zuniga, P., Miyazaki, K., Dupuis, A., Hayward, C., Casonato, A., Grandone, E., Mazzucconi, M.G., James, P., Fabris, F., Henskens, Y., Napolitano, M., Curnow, J., Gkalea, V., Fedor, M., Lambert, M.P., Zieger, B., Barcella, L., Cosmi, B., Giordano, P., Porri, C., Melazzini, F., Abid, M., Glembotsky, A.C., Ferrara, G., Russo, A., Deckmyn, H., Frelinger, A.L., Harrison, P., Mezzano, D., Mumford, A.D., Lordkipanidzé, M., and BAT-VAL Study Investigators

Subjects
medicine.medical_specialty, animal structures, mild&#8208, Platelet Function Tests, Platelet disorder, inherited platelet disorder, Hemorrhage, 030204 cardiovascular system & hematology, Hemorrhage/diagnosis, 03 medical and health sciences, 0302 clinical medicine, Von Willebrand factor, hemic and lymphatic diseases, Internal medicine, von Willebrand Factor, Von Willebrand disease, Medicine, Humans, Platelet, Bleeding prediction, Bleeding score, Blood platelet disorders, Child, Communication, Hemorrhage, Humans, Inherited platelet disorders, Mild-moderate bleeding disorders, Platelet Function Tests, von Willebrand diseases, von Willebrand Factor, Child, Blood Platelet Disorders, ddc:616, mild-moderate bleeding disorders, biology, business.industry, mild-moderate bleeding disorder, Incidence (epidemiology), Communication, Settore MED/09 - MEDICINA INTERNA, bleeding prediction, von Willebrand Diseases/diagnosis/genetics, [SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology, Hematology, medicine.disease, Blood Platelet Disorders/diagnosis/genetics, 3. Good health, bleeding score, Institutional repository, von Willebrand Diseases, moderate bleeding disorders, inherited platelet disorders, Quartile, biology.protein, von Willebrand disease, business
Abstract

Background: The ISTH Bleeding Assessment Tool (ISTH-BAT) has been validated for clinical screening of suspected von Willebrand disease (VWD) and for bleeding prediction. Recently it has been validated for subjects with inherited platelet disorders (IPD) (BAT-VAL study). Objectives: To determine whether the ISTH-BAT bleeding score (BS) predicts subsequent bleeding events requiring treatment in IPD patients. Methods: Patients with IPD, type 1 VWD (VWD-1) and age- and sex-matched healthy controls enrolled in the BAT-VAL study were prospectively followed-up for 2years and bleeding episodes requiring treatment were recorded. Results: Of the 1098 subjects initially enrolled, 955 were followed-up and 124 suffered hemorrhages during follow-up, 60% of whom had inherited platelet function disorders (IPFD). Total number of events was significantly higher in IPFD (n=235) than VWD-1 (n=52) or inherited thrombocytopenia (IT; n=20). Events requiring transfusions were 66% in IPFD, 5.7% in VWD-1, and 3% in IT. Baseline BS was significantly higher in IPFD patients with a bleeding event at follow-up than in those without (p&nbsp

Published
2021

18. Comparison between different D-Dimer cutoff values to assess the individual risk of recurrent venous thromboembolism: analysis of results obtained in the DULCIS study

Author

Palareti, G., Legnani, C., Cosmi, B., Antonucci, E., Erba, N., Poli, D., Testa, S., Tosetto, A., De Micheli, Valeria, Ghirarduzzi, Angelo, Veropalumbo, Maria Rosaria, Chiara, Ugolotti Maria, Prisco, Domenico, Paoletti, Oriana, Falanga, Anna, Luigi, Steidl, Donadini, Marco, Rancan, Elena, Quintavalla, Roberto, Ferrini, Piera Maria, Santoro, Rita C, Orlandini, Francesco, Benedetti, Raffaella, Cattaneo, Marco, Lussana, Federico, Bertinato, Elena, Cappelli, Roberto, Pizzini, Attilia Maria, Angeloni, Lucia, Dʼangelo, Armando, Crippa, Luciano, Bortolotti, Roberta, and Vandelli, Maria Rita

Published
2016
Full Text
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21. D-dimer testing, with gender-specific cutoff levels, is of value to assess the individual risk of venous thromboembolic recurrence in non-elderly patients of both genders: a post hoc analysis of the DULCIS study

Author

Palareti G., Legnani C., Antonucci E., Cosmi B., Poli D., Testa S., Tosetto A., Ageno W., Falanga A., Ferrini P. M., Pengo V., Prandoni P., Prisco D., Ghirarduzzi A., Veropalumbo M. R., Ugolotti M. C., Erba N., De Micheli V., Paoletti O., Luigi S., Donadini M., Rancan E., Quintavalla R., Santoro R. C., Orlandini F., Benedetti R., Cattaneo M., Lussana F., Bertinato E., Cappelli R., Pizzini A. M., D'Angelo A., Crippa L., Angeloni L., Bortolotti R., Vandelli M. R., Tripodi A., Imberti D., Moia M., Pesavento R., Magrini N., Marongiu F., Zonzin P., Piaggesi N., Silingardi M., Palareti G., Legnani C., Antonucci E., Cosmi B., Poli D., Testa S., Tosetto A., Ageno W., Falanga A., Ferrini P.M., Pengo V., Prandoni P., Prisco D., Ghirarduzzi A., Veropalumbo M.R., Ugolotti M.C., Erba N., De Micheli V., Paoletti O., Luigi S., Donadini M., Rancan E., Quintavalla R., Santoro R.C., Orlandini F., Benedetti R., Cattaneo M., Lussana F., Bertinato E., Cappelli R., Pizzini A.M., D'Angelo A., Crippa L., Angeloni L., Bortolotti R., Vandelli M.R., Tripodi A., Imberti D., Moia M., Pesavento R., Magrini N., Marongiu F., Zonzin P., Piaggesi N., Silingardi M., Palareti, G, Legnani, C, Antonucci, E, Cosmi, B, Poli, D, Testa, S, Tosetto, A, Ageno, W, Falanga, A, Ferrini, P, Pengo, V, and Prandoni, P

Subjects
Male, medicine.medical_specialty, Patients, medicine.drug_class, Cardiology, 030204 cardiovascular system & hematology, Individual risk, Cohort Studies, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, 0302 clinical medicine, Sex Factors, Predictive Value of Tests, Recurrence, Risk Factors, Internal medicine, Post-hoc analysis, D-dimer, Internal Medicine, medicine, Cutoff, Humans, 030212 general & internal medicine, Prospective Studies, Aged, business.industry, Gender, Anticoagulants, Venous Thromboembolism, Vitamin K antagonist, Middle Aged, Confidence interval, Telemedicine, Venous thromboembolism, Discontinuation, Im - Original, Emergency Medicine, Female, business
Abstract

Male patients, especially the young, are at a higher risk of recurrent venous thromboembolism (RVTE) than females. Recent scientific reports show the use of D-dimer does not help predict RVTE risk in males. In the present report, we reviewed the data obtained in the DULCIS study (main report published in Blood 2014), focusing on D-dimer results recorded in non-elderly patients of both genders included in the study, and their relationship with RVTE events occurring during follow-up. Using specifically designed cutoff values for positive/negative interpretation, serial D-dimer measurements (performed during warfarin treatment and up to 3 months after discontinuation of anticoagulation) in 475 patients (males 57.3%) aged ≤ 65 years were obtained. D-dimer resulted positive in 46.3% and 30.5% of males and females, respectively (p = 0.001). Following management procedure, anticoagulation was stopped in 53.7% of males and 69.5% of females, who had persistently negative D-dimer results. The rate of subsequent recurrent events was 1.7% (95% CI 0.5–4.5%) and 0.4% (95% CI 0–2.5%) patient-years in males and females, respectively, with upper limits of confidence intervals always below the level of risk considered acceptable by international scientific societies for stopping anticoagulation (

Published
2019

28. Cancer associated thrombosis in everyday practice: perspectives from GARFIELD-VTE

Author

Weitz, J.I., Haas, S., Ageno, W., Goldhaber, S.Z., Turpie, A.G.G., Goto, S., Angchaisuksiri, P., Nielsen, J.D., Kayani, G., Farjat, A.E., Schellong, S., Bounameaux, H., Mantovani, L.G., Prandoni, P., Kakkar, A.K., Loualidi, A., Colak, A., Bezuidenhout, A., Abdool-Carrim, A., Azeddine, A., Beyers, A., Dees, A., Mohamed, A., Aksoy, A., Abiko, A., Watanabe, A., Krichell, A., Fernandez, A.A., Tosetto, A., Khotuntsov, A., Oropallo, A., Slocombe, A., Kelly, A., Clark, A., Gad, A., Arouni, A., Schmidt, A., Berni, A., Kleiban, A.J., Machowski, A., Kazakov, A., Galvez, A., Lockman, A., Falanga, A., Chauhan, A., Riera-Mestre, A., Mazzone, A., D'Angelo, A., Herdy, A., Kato, A., Salem, A.A.E.E.M., Husin, A., Erdelyi, B., Jacobson, B., Amann-Vesti, B., Battaloglu, B., Wilson, B., Cosmi, B., Francois, B.J., Toufek, B., Hunt, B., Natha, B., Mustafa, B., Kho, B.C.S., Carine, B., Zidel, B., Dominique, B., Christophe, B., Trimarco, B., Luo, C., Cuneo, C.A., Diaz, C.J.S., Schwencke, C., Cader, C., Yavuz, C., Zaidman, C.J., Lunn, C., C. -C., W., Toh, C.H., Chiang, C.-., Elisa, C., Hsia, C.-., Huang, C.-., Kwok, C.-.K., Ward, C., Opitz, C., Jeanneret-Gris, C., C. Y., H., Bidi, C.L., Smith, C., Brauer, C., Lodigiani, C., Francis, C., Wu, C., Staub, D., Theodoro, D., Poli, D., Acevedo, D.-., Adler, D., Jimenez, D., Keeling, D., Scott, D., Imberti, D., Creagh, D., Helene, D.-., Hagemann, D., Le Roux, D., Skowasch, D., Belenky, D., Dorokhov, D., Petrov, D., Zateyshchikov, D., Prisco, D., Moller, D., Kucera, D., Esheiba, E.M., Panchenko, E., Dominique, E., Dogan, E., Kubat, E., Diaz, E.D., Tse, E.W.C., Yeo, E., Hashas, E., Grochenig, E., Tiraferri, E., Blessing, E., Michele, E.O., Usandizaga, E., Porreca, E., Ferroni, F., Nicolas, F., Ayala-Paredes, F., Koura, F., Henry, F., Cosmi, F., Erdkamp, F., Kamalov, G., Dalmau, G.-., Damien, G., Klein, G., Shah, G., Hollanders, G., Merli, G., Plassmann, G., Platt, G., Poirier, G., Sokurenko, G., Haddad, G., Ali, G., Agnelli, G., Gan, G.G., Kaye-Eddie, G., Le Gal, G., Allen, G., Esperon, G.A.L., Jean-Paul, G., Gerofke, H., Elali, H., Burianova, H., Ohler, H.-., Wang, H., Darius, H., Gogia, H.S., Striekwold, H., Gibbs, H., Hasanoglu, H., Turker, H., Franow, H., De Raedt, H., Schroe, H., Eldin, H.S., Zidan, H., Nakamura, H., Kim, H.Y., Lawall, H., Zhu, H., Tian, H., Yhim, H.-., Cate, H., Hwang, H.G., Shim, H., Kim, I., Libov, I., Sonkin, I., Suchkov, I., Song, I.-., Kiris, I., Staroverov, I., Looi, I., De La Azuela Tenorio, I.M., Savas, I., Gordeev, I., Podpera, I., Lee, J.H., Sathar, J., Welker, J., Beyer-Westendorf, J., Kvasnicka, J., Vanwelden, J., Kim, J.Y., Svobodova, J., Gujral, J., Marino, J., Galvar, J.T., Kassis, J., Kuo, J.-., Shih, J.-., Kwon, J.H., Joh, J.H., Park, J.H., Kim, J.S., Yang, J., Krupicka, J., Lastuvka, J., Pumprla, J., Vesely, J., Souto, J.C., Correa, J.A., Duchateau, J., Fletcher, J.P., del Toro, J., Paez, J.G.C., Nielsen, J., Filho, J.D.A., Saraiva, J., Peromingo, J.A.D., Lara, J.G., Fedele, J.L., Surinach, J.M., Chacko, J., Muntaner, J.A., Benitez, J.C.A., Abril, J.M.H., Humphrey, J., Bono, J., Kanda, J., Boondumrongsagoon, J., Yiu, K.H., Chansung, K., Boomars, K., Burbury, K., Kondo, K., Karaarslan, K., Takeuchi, K., Kroeger, K., Zrazhevskiy, K., Svatopluk, K., Shyu, K.-., Vandenbosch, K., Chang, K.-., Chiu, K.-., Jean-Manuel, K., Wern, K.J., Ueng, K.-., Norasetthada, L., Binet, L., Chew, L.P., Zhang, L., Cristina, L.M., Tick, L., Schiavi, L.B., Wong, L.L.L., Borges, L., Botha, L., Capiau, L., Timmermans, L., Lopez, L.E., Ria, L., Blasco, L.M., Guzman, L.A., Cervera, L.F., Isabelle, M., Bosch, M.M., de los Rios Ibarra, M., Fernandez, M.N., Carrier, M., Barrionuevo, M.R., Gamba, M.A.A., Cattaneo, M., Moia, M., Bowers, M., Chetanachan, M., Berli, M.A., Fixley, M., Faghih, M., Stuecker, M., Schul, M., Banyai, M., Koretzky, M., Myriam, M., Gaffney, M.E., Hirano, M., Kanemoto, M., Nakamura, M., Tahar, M., Emmanuel, M., Kovacs, M., Leahy, M., Levy, M., Munch, M., Olsen, M., De Pauw, M., Gustin, M., Van Betsbrugge, M., Boyarkin, M., Homza, M., Koto, M., Abdool-Gaffar, M., Nagib, M.A.F., Dessoki, M.E., Khan, M., Mohamed, M., Kim, M.H., Lee, M.-., Soliman, M., Ahmed, M.S., Bary, M.S.A., Moustafa, M.A., Hameed, M., Kanko, M., Majumder, M., Zubareva, N., Mumoli, N., Abdullah, N.A.N., Makruasi, N., Paruk, N., Kanitsap, N., Duda, N., Nordin, N., Nyvad, O., Barbarash, O., Gurbuz, O., Vilamajo, O.G., Flores, O.N., Gur, O., Oto, O., Marchena, P.J., Carroll, P., Lang, P., Maccallum, P., von Bilderling, P.B., Blombery, P., Verhamme, P., Jansky, P., Bernadette, P., De Vleeschauwer, P., Hainaut, P., Ferrini, P.M., Iamsai, P., Christian, P., Viboonjuntra, P., Rojnuckarin, P., Ho, P., Mutirangura, P., Wells, R., Martinez, R., Miranda, R.T., Kroening, R., Ratsela, R., Reyes, R.L., de Leon, R.F.D., Wong, R.S.M., Alikhan, R., Jerwan-Keim, R., Otero, R., Murena-Schmidt, R., Canevascini, R., Ferkl, R., White, R., Van Herreweghe, R., Santoro, R., Klamroth, R., Mendes, R., Prosecky, R., Cappelli, R., Spacek, R., Singh, R., Griffin, S., S. H., N., Chunilal, S., Middeldorp, S., Nakazawa, S., Toh, S.G., Christophe, S., Isbir, S., Raymundo, S., Ting, S.K., Motte, S., Aktogu, S.O., Donders, S., Cha, S.I., Nam, S.-., Marie-Antoinette, S.-., Maasdorp, S., Sun, S., Wang, S., Essameldin, S.M., Sholkamy, S.M., Kuki, S., Yoshida, S., Matsuoka, S., Mcrae, S., Watt, S., Patanasing, S., Jean-Leopold, S.-., Wongkhantee, S., Bang, S.-., Testa, S., Zemek, S., Behrens, S., Dominique, S., Mellor, S., Singh, S.S.G., Datta, S., Chayangsu, S., Solymoss, S., Everington, T., Abdel-Azim, T.A.A., Suwanban, T., Adademir, T., Hart, T., Beatrice, T., Luvhengo, T., Horacek, T., Zeller, T., Boussy, T., Reynolds, T., Biss, T., Chao, T.-., Casabella, T.S., Onodera, T., Numbenjapon, T., Gerdes, V., Cech, V., Krasavin, V., Tolstikhin, V., Bax, W.A., Malek, W.F.A., W. K., H., Pharr, W., Jiang, W., Lin, W.-., Zhang, W., Tseng, W.-., Lai, W.-., De Backer, W., Haverkamp, W., Yoshida, W., Korte, W., Choi, W., Kim, Y.-., Tanabe, Y., Ohnuma, Y., Mun, Y.-., Balthazar, Y., Park, Y., Shibata, Y., Burov, Y., Subbotin, Y., Coufal, Z., Yang, Z., Jing, Z., Pulmonary Medicine, Clinical Genetics, Internal Medicine, Vascular Medicine, ACS - Pulmonary hypertension & thrombosis, ARD - Amsterdam Reproduction and Development, ACS - Diabetes & metabolism, Weitz, J, Haas, S, Ageno, W, Goldhaber, S, Turpie, A, Goto, S, Angchaisuksiri, P, Nielsen, J, Kayani, G, Farjat, A, Schellong, S, Bounameaux, H, Mantovani, L, Prandoni, P, Kakkar, A, GARFIELD-VTE, I, Falanga, A, MUMC+: HVC Trombosezorg (8), RS: Carim - B04 Clinical thrombosis and Haemostasis, MUMC+: HVC Pieken Trombose (9), MUMC+: MA Alg Interne Geneeskunde (9), Interne Geneeskunde, and Biochemie

Subjects
Male, Time Factors, Settore MED/09 - Medicina Interna, 030204 cardiovascular system & hematology, PROPHYLAXIS, 0302 clinical medicine, Recurrence, Risk Factors, Cause of Death, Neoplasms, Prospective Studies, Registries, 030212 general & internal medicine, DEEP-VEIN THROMBOSIS, Cancer, Aged, 80 and over, Venous Thrombosis, Hematology, Incidence (epidemiology), Anticoagulant, Hazard ratio, Middle Aged, Treatment Outcome, Female, CLINICAL-PRACTICE GUIDELINES, Cardiology and Cardiovascular Medicine, Venous thromboembolism, Adult, medicine.medical_specialty, Registry, medicine.drug_class, Hemorrhage, Malignancy, Anticoagulation, Risk Assessment, 03 medical and health sciences, Fibrinolytic Agents, SDG 3 - Good Health and Well-being, Internal medicine, medicine, MANAGEMENT, Humans, cardiovascular diseases, Aged, business.industry, Anticoagulants, medicine.disease, Confidence interval, RISK-FACTORS, Observational study, Pulmonary Embolism, business
Abstract

Venous thromboembolism (VTE) is common in cancer patients and is an important cause of morbidity and mortality. The Global Anticoagulant Registry in the FIELD (GARFIELD)-VTE (ClinicalTrials.gov: NCT02155491) is a prospective, observational study of 10,684 patients with objectively diagnosed VTE from 415 sites in 28 countries. We compared baseline characteristics, VTE treatment patterns, and 1-year outcomes (mortality, recurrent VTE and major bleeding) in 1075 patients with active cancer, 674 patients with a history of cancer, and 8935 patients without cancer. Patients with active cancer and history of cancer were older than cancer-free patients, with median ages of 64.8, 68.9, and 58.4 years, respectively. The most common sites of active cancer were lung (14.5%), colorectal (11.0%), breast (10.6%), and gynaecological (10.3%). Active cancer patients had a higher incidence of upper limb and vena cava thrombosis than cancer-free patients (9.0% vs 4.8% and 5.1% vs 1.4%, respectively), and were more likely to receive parenteral anticoagulation as monotherapy than cancer-free patients (57.8% vs 12.1%), and less likely to receive DOACs (14.2% vs 50.6%). Rates of death, recurrent VTE, and major bleeding were higher in active cancer patients than in cancer-free patients, with hazard ratios (95% confidence intervals) of 14.2 (12.1-16.6), 1.6 (1.2-2.0) and 3.8 (2.9-5.0), respectively. VTE was the second most common cause of death in patients with active cancer or history of cancer. In patients with VTE, those with active cancer are at higher risk of death, recurrence, and major bleeding than those without cancer.

Published
2020

29. Guidance for the Management of Patients with Vascular Disease or Cardiovascular Risk Factors and COVID-19: Position Paper from VAS-European Independent Foundation in Angiology/Vascular Medicine

Author

Gerotziafas, G.T. Catalano, M. Colgan, M.-P. Pecsvarady, Z. Wautrecht, J.C. Fazeli, B. Olinic, D.-M. Farkas, K. Elalamy, I. Falanga, A. Fareed, J. Papageorgiou, C. Arellano, R.S. Agathagelou, P. Antic, D. Auad, L. Banfic, L. Bartolomew, J.R. Benczur, B. Bernardo, M.B. Boccardo, F. Cifkova, R. Cosmi, B. De Marchi, S. Dimakakos, E. Dimopoulos, M.A. Dimitrov, G. Durand-Zaleski, I. Edmonds, M. El Nazar, E.A. Erer, D. Esponda, O.L. Gresele, P. Gschwandtner, M. Gu, Y. Heinzmann, M. Hamburg, N.M. Hamadé, A. Jatoi, N.-A. Karahan, O. Karetova, D. Karplus, T. Klein-Weigel, P. Kolossvary, E. Kozak, M. Lefkou, E. Lessiani, G. Liew, A. Marcoccia, A. Marshang, P. Marakomichelakis, G. Matuska, J. Moraglia, L. Pillon, S. Poredos, P. Prior, M. Salvador, D.R.K. Schlager, O. Schernthaner, G. Sieron, A. Spaak, J. Spyropoulos, A. Sprynger, M. Suput, D. Stanek, A. Stvrtinova, V. Szuba, A. Tafur, A. Vandreden, P. Vardas, P.E. Vasic, D. Vikkula, M. Wennberg, P. Zhai, Z. Bikdeli, B. Guo, Y. Harenberg, J. Hu, Y. Lip, G.Y.H. Roldan, V.

Abstract

COVID-19 is also manifested with hypercoagulability, pulmonary intravascular coagulation, microangiopathy, and venous thromboembolism (VTE) or arterial thrombosis. Predisposing risk factors to severe COVID-19 are male sex, underlying cardiovascular disease, or cardiovascular risk factors including noncontrolled diabetes mellitus or arterial hypertension, obesity, and advanced age. The VAS-European Independent Foundation in Angiology/Vascular Medicine draws attention to patients with vascular disease (VD) and presents an integral strategy for the management of patients with VD or cardiovascular risk factors (VD-CVR) and COVID-19. VAS recommends (1) a COVID-19-oriented primary health care network for patients with VD-CVR for identification of patients with VD-CVR in the community and patients' education for disease symptoms, use of eHealth technology, adherence to the antithrombotic and vascular regulating treatments, and (2) close medical follow-up for efficacious control of VD progression and prompt application of physical and social distancing measures in case of new epidemic waves. For patients with VD-CVR who receive home treatment for COVID-19, VAS recommends assessment for (1) disease worsening risk and prioritized hospitalization of those at high risk and (2) VTE risk assessment and thromboprophylaxis with rivaroxaban, betrixaban, or low-molecular-weight heparin (LMWH) for those at high risk. For hospitalized patients with VD-CVR and COVID-19, VAS recommends (1) routine thromboprophylaxis with weight-adjusted intermediate doses of LMWH (unless contraindication); (2) LMWH as the drug of choice over unfractionated heparin or direct oral anticoagulants for the treatment of VTE or hypercoagulability; (3) careful evaluation of the risk for disease worsening and prompt application of targeted antiviral or convalescence treatments; (4) monitoring of D-dimer for optimization of the antithrombotic treatment; and (5) evaluation of the risk of VTE before hospital discharge using the IMPROVE-D-dimer score and prolonged post-discharge thromboprophylaxis with rivaroxaban, betrixaban, or LMWH. © 2020 Georg Thieme Verlag. All rights reserved.

Published
2020

30. D-dimer testing, with gender-specific cutoff levels, is of value to assess the individual risk of venous thromboembolic recurrence in non-elderly patients of both genders: a post hoc analysis of the DULCIS study

Author

Palareti, G, Legnani, C, Antonucci, E, Cosmi, B, Poli, D, Testa, S, Tosetto, A, Ageno, W, Falanga, A, Ferrini, P, Pengo, V, Prandoni, P, Ferrini, PM, Palareti, G, Legnani, C, Antonucci, E, Cosmi, B, Poli, D, Testa, S, Tosetto, A, Ageno, W, Falanga, A, Ferrini, P, Pengo, V, Prandoni, P, and Ferrini, PM

Abstract

Male patients, especially the young, are at a higher risk of recurrent venous thromboembolism (RVTE) than females. Recent scientific reports show the use of D-dimer does not help predict RVTE risk in males. In the present report, we reviewed the data obtained in the DULCIS study (main report published in Blood 2014), focusing on D-dimer results recorded in non-elderly patients of both genders included in the study, and their relationship with RVTE events occurring during follow-up. Using specifically designed cutoff values for positive/negative interpretation, serial D-dimer measurements (performed during warfarin treatment and up to 3 months after discontinuation of anticoagulation) in 475 patients (males 57.3%) aged ≤ 65 years were obtained. D-dimer resulted positive in 46.3% and 30.5% of males and females, respectively (p = 0.001). Following management procedure, anticoagulation was stopped in 53.7% of males and 69.5% of females, who had persistently negative D-dimer results. The rate of subsequent recurrent events was 1.7% (95% CI 0.5–4.5%) and 0.4% (95% CI 0–2.5%) patient-years in males and females, respectively, with upper limits of confidence intervals always below the level of risk considered acceptable by international scientific societies for stopping anticoagulation (< 5%). In conclusion, using sensitive quantitative assays with specifically designed cutoff values and serial measurements during and after discontinuation of anticoagulation, D-dimer testing is useful to predict the risk of RVTE and is of help in deciding the duration of anticoagulation in both male and female adult patients aged up to 65 years.

Published
2020

48. Thrombocytopenia and Mortality Risk in Patients With Atrial Fibrillation: An Analysis From the START Registry

Author

Pastori, D, Antonucci, E, Violi, F, Palareti, G, Pignatelli, P, Testa, S, Paoletti, O, Cosmi, B, Guazzaloca, G, Migliaccio, L, Poli, D, Marcucci, R, Maggini, N, Pengo, V, Falanga, A, Lerede, T, Ruocco, L, Martini, G, Pedrini, S, Bertola, F, Masciocco, L, Saracino, P, Benvenuto, A, Vasselli, C, Grandone, E, Colaizzo, D, Marzolo, M, Pinelli, M, Mastroiacovo, D, Ageno, W, Colombo, G, Bucherini, E, Serra, D, Toma, A, Barbera, P, Paparo, C, Insana, A, Rupoli, S, Malcangi, G, Zighetti, M, Mangione, C, Lione, D, Casasco, P, Nante, G, Tosetto, A, Oriana, V, Liberato, N, Zighetti, ML, Liberato, NL, Pastori, D, Antonucci, E, Violi, F, Palareti, G, Pignatelli, P, Testa, S, Paoletti, O, Cosmi, B, Guazzaloca, G, Migliaccio, L, Poli, D, Marcucci, R, Maggini, N, Pengo, V, Falanga, A, Lerede, T, Ruocco, L, Martini, G, Pedrini, S, Bertola, F, Masciocco, L, Saracino, P, Benvenuto, A, Vasselli, C, Grandone, E, Colaizzo, D, Marzolo, M, Pinelli, M, Mastroiacovo, D, Ageno, W, Colombo, G, Bucherini, E, Serra, D, Toma, A, Barbera, P, Paparo, C, Insana, A, Rupoli, S, Malcangi, G, Zighetti, M, Mangione, C, Lione, D, Casasco, P, Nante, G, Tosetto, A, Oriana, V, Liberato, N, Zighetti, ML, and Liberato, NL

Abstract

Background Thrombocytopenia is associated with increased mortality in the general population, but few data exist in patients with atrial fibrillation (AF) taking oral anticoagulants. We investigated factor determinants of thrombocytopenia in a large cohort of patients affected by AF and its association with total mortality. Methods and Results Multicenter prospective cohort study, including 5215 patients with AF from the START (Survey on Anticoagulated Patients Register) registry, 3877 (74.3%) and 1338 (25.7%) on vitamin K or non-vitamin K antagonist oral anticoagulants, respectively. Thrombocytopenia was defined by a platelet count <150×109/L. Determinants of thrombocytopenia were investigated, and all-cause mortality was the primary survival end point of the study. Thrombocytopenia was present in 592 patients (11.4%). At multivariable logistic regression analysis, chronic kidney disease (odds ratio [OR], 1.257; P=0.030), active cancer (OR, 2.065; P=0.001), liver cirrhosis (OR, 7.635; P<0.001), and the use of diuretics (OR, 1.234; P=0.046) were positively associated with thrombocytopenia, whereas female sex (OR, 0.387; P<0.001) and the use of calcium channel blockers (OR, 0.787; P=0.032) were negatively associated. During a median follow-up of 19.2 months (9942 patient-years), 391 deaths occurred (rate, 3.93%/year). Mortality rate increased from 3.8%/year to 9.9%/year in patients with normal platelet count and in those with moderate-severe thrombocytopenia, respectively (log-rank test, P=0.009). The association between moderate-severe thrombocytopenia and mortality persisted after adjustment for CHA2DS2 VASc score (hazard ratio, 2.431; 95% CI, 1.254-4.713; P=0.009), but not in the fully adjusted multivariable Cox regression analysis model. Conclusions Thrombocytopenia is common in patients with AF. Despite an increased incidence of mortality, thrombocytopenia was not associated with mortality at multivariable analysis. Thrombocytopenia may reflect the pres

Published
2019

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