46 results on '"ERBA N"'
Search Results
2. Comparison between different D-Dimer cutoff values to assess the individual risk of recurrent venous thromboembolism: analysis of results obtained in the DULCIS study
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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
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- 2016
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3. Prevalence and significance of anti-prothrombin (aPT) antibodies in patients with Lupus Anticoagulant (LA)
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Pengo, V., Denas, G., Bison, E., Banzato, A., Padayattil Jose, S., Gresele, P., Marongiu, F., Erba, N., Veschi, F., Ghirarduzzi, A., De Candia, E., Montaruli, B., Marietta, M., Testa, S., Barcellona, D., and Tripodi, A.
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- 2010
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4. Clinical course of high‐risk patients diagnosed with antiphospholipid syndrome
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PENGO, V., RUFFATTI, A., LEGNANI, C., GRESELE, P., BARCELLONA, D., ERBA, N., TESTA, S., MARONGIU, F., BISON, E., DENAS, G., BANZATO, A., PADAYATTIL JOSE, S., and ILICETO, S.
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- 2010
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5. Major bleeding in patients undergoing PCI and triple or dual antithrombotic therapy: a parallel-cohort study
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Denas, G., Padayattil Jose, S., Gresele, P., Erba, N., Testa, S., De Micheli, V., Quintavalla, R., Poli, D., Bracco, A., Fierro, T., Iliceto, S., and Pengo, V.
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- 2013
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6. Vitamin K antagonist therapy: changes in the treated populations and in management results in Italian anticoagulation clinics compared with those recorded 20 years ago
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Palareti G, Antonucci E, Migliaccio L, Erba N, Marongiu F, Pengo V, Poli D, Testa S, Tosetto A, Tripodi A, Moia M, Paoletti O, Guazzaloca G, Marcucci R, Falanga A, Lerede T, Piana A, Cibecchini F, Martini G, Ruocco L, Pedrini S, Masciocco L, Saracino P, Benvenuto A, Vasselli C, Bucherini E, Toma A, Barbera P, Insana A, Paparo C, Rupoli S, Malcangi G, Sangiorgio R, Zighetti ML, Mangione C, Agostinelli E, Ageno W, Oriana V, Liberato NL, Casasco P, Palareti, G, Antonucci, E, Migliaccio, L, Erba, N, Marongiu, F, Pengo, V, Poli, D, Testa, S, Tosetto, A, Tripodi, A, Moia, M, Paoletti, O, Guazzaloca, G, Marcucci, R, Falanga, A, Lerede, T, Piana, A, Cibecchini, F, Martini, G, Ruocco, L, Pedrini, S, Masciocco, L, Saracino, P, Benvenuto, A, Vasselli, C, Bucherini, E, Toma, A, Barbera, P, Insana, A, Paparo, C, Rupoli, S, Malcangi, G, Sangiorgio, R, Zighetti, M, Mangione, C, Agostinelli, E, Ageno, W, Oriana, V, Liberato, N, and Casasco, P
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Male ,Vitamin K ,Atrial fibrillation ,Bleeding ,Thrombotic ,Venous thromboembolism ,Warfarin ,Administration, Oral ,030204 cardiovascular system & hematology ,Ambulatory Care Facilities ,0302 clinical medicine ,Risk Factors ,Registries ,030212 general & internal medicine ,Aged, 80 and over ,education.field_of_study ,Incidence ,Incidence (epidemiology) ,Middle Aged ,Vitamin K antagonist ,Italy ,Heart Valve Prosthesis ,Emergency Medicine ,Female ,Major bleeding ,medicine.drug ,medicine.medical_specialty ,medicine.drug_class ,Population ,Hemorrhage ,History, 21st Century ,03 medical and health sciences ,Population Groups ,Fibrinolytic Agents ,Thromboembolism ,Internal medicine ,Internal Medicine ,medicine ,Humans ,education ,Aged ,Chi-Square Distribution ,business.industry ,Acenocoumarol ,Anticoagulants ,History, 20th Century ,medicine.disease ,Im - Original ,Surgery ,Observational study ,business - Abstract
Vitamin K antagonists (VKA) are the most widely used anticoagulants in the world. An appropriate management of treated patients is crucial for their efficacy and safety. The prospective, observational, multicenter, inception-cohort FCSA-START Register, a branch of START Register (NCT02219984) included VKA-treated patients managed by centers of Italian Federation of anticoagulation clinics (AC). Baseline patient characteristics and data during treatment were analyzed and compared with those of ISCOAT study, performed by the Federation and published in 1996/7. 5707 naïve patients [53% males, mean age 73.0 years (28.1% >80 years)], 61.6% treated for atrial fibrillation (AF), and 28.0% for venous thromboembolism were included. During the 8906 patient-years (pt-yrs) of observation, 123 patients had major bleeding (MB) (1.38% pt-yrs; fatal: 0.11% pt-yrs), while non-major clinically relevant bleeds were 144 (1.62% pt-yrs). Bleeding was more frequent in elderly (≥70 years; p = 0.04), and during initial 3-month therapy (p = 0.02). Bleeding rate was 2.5% pt-yrs for temporally related INR results
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- 2017
7. 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
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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
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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 (
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- 2019
8. Survey of lupus anticoagulant diagnosis by central evaluation of positive plasma samples
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PENGO, V., BIASIOLO, A., GRESELE, P., MARONGIU, F., ERBA, N., VESCHI, F., GHIRARDUZZI, A., DE CANDIA, E., MONTARULI, B., TESTA, S., BARCELLONA, D., and TRIPODI, A.
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- 2007
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9. Recurrence of intracranial hemorrhage after resumption of anticoagulation in patients who had a first episode occurred during Vitamin K Antagonists anticoagulation. Results of a collaborative study: OC 42.2
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Daniela, P, Antonucci, E, Testa, S, Erba, N, Guazzaloca, G, Tiraferri, E, Ciardiello, A, Lerede, T, Nante, G, and Palareti, G
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- 2013
10. D-dimer and ultrasound in combination italian study (DULCIS) to establish the optimal duration of anticoagulation for venous thromboembolism on behalf of the DULCIS investigators: OC 12.4
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Cosmi, B, Legnani, C, Erba, N, Ghirarduzzi, A, Poli, D, Testa, S, Prandoni, P, Pengo, V, Falanga, A, and Palareti, G
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- 2013
11. Standardized low molecular weight heparin bridging regimen in outpatients on oral anticoagulants undergoing invasive procedure or surgery: an inception cohort management study: OC-TH-075
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Pengo, V, Cucchini, U, Denas, G, Erba, N, Guazzaloca, G, La Rosa, L, De Micheli, V, Testa, S, Frontoni, R, Prisco, D, and Iliceto, S
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- 2009
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12. Coagulation abnormalities in migraine and ischaemic cerebrovascular disease: a link between migraine and ischaemic stroke?
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Moschiano, F., D’Amico, D., Ciusani, E., Erba, N., Rigamonti, A., Schieroni, F., and Bussone, G.
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- 2004
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13. Prevalence of HFE mutations in upper Northern Italy: study of 1132 unrelated blood donors
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Mariani, R, Salvioni, A, Corengia, C, Erba, N, Lanzafame, C, De Micheli, V, Baldini, V, Arosio, C, Fossati, L, Trombini, P, Oberkanins, C, and Piperno, A
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- 2003
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14. Comparison between different D-Dimer cutoff values to assess the individual risk of recurrent venous thromboembolism: Analysis of results obtained in the DULCIS study
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Palareti, G, Legnani, C, Cosmi, B, Antonucci, E, Erba, N, Poli, D, Testa, S, Tosetto, A, De Micheli, V, Ghirarduzzi, A, Veropalumbo, MR, Chiara, UM, Prisco, D, Aterotrombotiche, M, Paoletti O, Falanga, A, Luigi, S, Donadini, M, Rancan, E, Quintavalla, R, Ferrini, PM, Santoro, RC, Orlandini, F, Benedetti, R, Cattaneo, M, Lussana, F, Bertinato, E, Cappelli, R, Pizzini, AM, Angeloni, L, D'angelo, A, Crippa, L, Bortolotti, R, Vandelli, MR, Palareti, G, Legnani, C, Cosmi, B, Antonucci, E, Erba, N, Poli, D, Testa, S, Tosetto, A, De Micheli, V, Ghirarduzzi, A, Veropalumbo, M, Chiara, U, Prisco, D, Aterotrombotiche, M, Paoletti, O, Falanga, A, Luigi, S, Donadini, M, Rancan, E, Quintavalla, R, Ferrini, P, Santoro, R, Orlandini, F, Benedetti, R, Cattaneo, M, Lussana, F, Bertinato, E, Cappelli, R, Pizzini, A, Angeloni, L, D'Angelo, A, Crippa, L, Bortolotti, R, Vandelli, M, G. PALARETI, C. LEGNANI, B. COSMI, E. ANTONUCCI, N. ERBA, D. POLI, S. TESTA, A. TOSETTO, and ON BEHALF OF THE DULCIS (D-DIMER-ULTRASONOGRAPHY IN COMBINATION ITALIAN STUDY) INVESTIGATORS
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0301 basic medicine ,Male ,Cutoff criteria ,medicine.medical_specialty ,recurrence ,Clinical Biochemistry ,venous thromboembolism ,Individual risk ,Clinical biochemistry ,Fibrin Fibrinogen Degradation Products ,03 medical and health sciences ,Reference Values ,Risk Factors ,Internal medicine ,D-dimer ,medicine ,Cutoff ,Humans ,Aged ,Aged, 80 and over ,business.industry ,Biochemistry (medical) ,Anticoagulants ,Hematology ,General Medicine ,Middle Aged ,Surgery ,Recurrent event ,030104 developmental biology ,Reference values ,Female ,business ,Venous thromboembolism - Abstract
SummaryIntroduction D-dimer assay, generally evaluated according to cutoff points calibrated for VTE exclusion, is used to estimate the individual risk of recurrence after a first idiopathic event of venous thromboembolism (VTE). Methods Commercial D-dimer assays, evaluated according to predetermined cutoff levels for each assay, specific for age (lower in subjects
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- 2016
15. The prothrombin time/international normalized ratio (PT/INR) Line: derivation of local INR with commercial thromboplastins and coagulometers – two independent studies
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POLLER L, IBRAHIM S, KEOWN M, PATTISON A, JESPERSEN J, EUROPEAN ACTION ON A.N.T.I.C.O.A.G.U.L.A.T.I.O.N. COLLABORATORS: MARUN S, MUNTEAN W, ASPÖCK G, BAILLEUL E, WIJNS W, MICHEL T, JOCHMANS K, CHATELAIN B, MARCELIS L, NIJS AN, JOHNSTON M, KYNDE K, SYRÄJLÄ M, SAVOLAINEN ER, IVASKA K, RAJAMÄKI A, VANHARANTA R, JUHAN I, AILLAUD MF, GUILLIN MC, HUISSE MG, SIE P, LECOMPTE T, SCHMITT Y, HARENBERG J, PLESCH W, ARONIS S, THEODOSSIADES G, TSOUKANAS B, MARKALA D, DITSA M, CAHILL M, MADDEN M, FITZGERALD H, MCCARTHY D, COLLINS B, ROONEY S, NAPARSTEK E, MARONGIU F, ERBA N, TESTA S, MARIANI G, POTÌ R, MANNUCCI PM, TRIPODI A, BADER R, PENGO V, GRESELE P, D'INCÀ M, AGENO W, TOSETTO A, HENSGENS HE, IDEMA RN, OOSTERHOUT DH, MULDER AB, HAMULYAK K, VD DUSSEN H, MUSIAL J, GAGO T, PALMEIRO A, CAMPOS M, MARQUES DIAS DA, CUNHA MONTEIRO Á, ANGELA CUNHA M, DE GAIA WN, PETERNEL P, STEGNAR M, FONTCUBERTA J, BORRELL M, REVERTER JC, SANTASUSANA PD, LOPEZ FERNANDEZ MF, MONTERO J, RIBERA CASADO C, VICENTE V, EDLUND B, EGBERG N, LÄMMLE B, ALBERIO L, DE MOERLOOSE P, REBER G, MACHIN SJ, MACKIE I, LAWRIE A, LUCKIT J, SHANKS D, DOLAN G, FLAHERTY T, LUDLAM CA, WALKER ID, LAWSON DE, TRISCOTT M, MARLAR RA, HEIT JA, WATZKE H, WEISSER B, GALLUS AS, OSMOND J, CORNET I, MUNSTER AM, LEED B, CHILLOU C, DEFARD M, HORELLOU MH, HALKIN H, LOEBSTEIN R, KIRGNER I, DENTALI F, TRAPANI LOMBARDO V, SOTTILOTTA G, CONSIGLIO P, DE MICHELE S, MOIA M, CARPENEDO M, OLIVIERO B, MANOTTI C, TASSONI MI, PALARETI G, BRUSI C, LEGNANI C, PEGORARO C, ANDRIANI C, GRAZIA CIRIGLIANO M, RIBALDI E, ABBATE R, POLI D, PERRICONE C, SCHIAVULI M, CASIERA C, LUPONE MR, ROSSI E, CRIVELLI S, BIROLINI A, PARENTE F, MIGLIETTA AM, CAMPOBASSO M, SYDOR W, KREVEL B, FERNANDEZ MA, LOZANO M, SHIACH C, BOWYER C, CHARLES F., PALARETI, GUALTIERO, COSMI, BENILDE, POLLER L, IBRAHIM S, KEOWN M, PATTISON A, JESPERSEN J, EUROPEAN ACTION ON ANTICOAGULATION. COLLABORATORS: MARUN S, MUNTEAN W, ASPÖCK G, BAILLEUL E, WIJNS W, MICHEL T, JOCHMANS K, CHATELAIN B, MARCELIS L, NIJS AN, JOHNSTON M, KYNDE K, SYRÄJLÄ M, SAVOLAINEN ER, IVASKA K, RAJAMÄKI A, VANHARANTA R, JUHAN I, AILLAUD MF, GUILLIN MC, HUISSE MG, SIE P, LECOMPTE T, SCHMITT Y, HARENBERG J, PLESCH W, ARONIS S, THEODOSSIADES G, TSOUKANAS B, MARKALA D, DITSA M, CAHILL M, MADDEN M, FITZGERALD H, MCCARTHY D, COLLINS B, ROONEY S, NAPARSTEK E, PALARETI G, MARONGIU F, ERBA N, TESTA S, MARIANI G, POTÌ R, MANNUCCI PM, TRIPODI A, BADER R, PENGO V, GRESELE P, D'INCÀ M, AGENO W, TOSETTO A, HENSGENS HE, IDEMA RN, OOSTERHOUT DH, MULDER AB, HAMULYAK K, VD DUSSEN H, MUSIAL J, GAGO T, PALMEIRO A, CAMPOS M, MARQUES-DIAS DA, CUNHA MONTEIRO Á, ANGELA CUNHA M, DE GAIA WN, PETERNEL P, STEGNAR M, FONTCUBERTA J, BORRELL M, REVERTER JC, SANTASUSANA PD, LOPEZ-FERNANDEZ MF, MONTERO J, RIBERA CASADO C, VICENTE V, EDLUND B, EGBERG N, LÄMMLE B, ALBERIO L, DE MOERLOOSE P, REBER G, MACHIN SJ, MACKIE I, LAWRIE A, LUCKIT J, SHANKS D, DOLAN G, FLAHERTY T, LUDLAM CA, WALKER ID, LAWSON DE, TRISCOTT M, MARLAR RA, HEIT JA, WATZKE H, WEISSER B, GALLUS AS, OSMOND J, CORNET I, MUNSTER AM, LEED B, CHILLOU C, DEFARD M, HORELLOU MH, HALKIN H, LOEBSTEIN R, KIRGNER I, DENTALI F, TRAPANI LOMBARDO V, SOTTILOTTA G, CONSIGLIO P, DE MICHELE S, MOIA M, CARPENEDO M, OLIVIERO B, MANOTTI C, TASSONI MI, COSMI B, BRUSI C, LEGNANI C, PEGORARO C, ANDRIANI C, GRAZIA CIRIGLIANO M, RIBALDI E, ABBATE R, POLI D, PERRICONE C, SCHIAVULI M, CASIERA C, LUPONE MR, ROSSI E, CRIVELLI S, BIROLINI A, PARENTE F, MIGLIETTA AM, CAMPOBASSO M, SYDOR W, KREVEL B, FERNANDEZ MA, LOZANO M, SHIACH C, BOWYER C, CHARLES F., Interne Geneeskunde, Biochemie, and RS: CARIM School for Cardiovascular Diseases
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INR correction ,endocrine system ,medicine.medical_specialty ,coagulometers ,Prothrombin Time/*standard ,Reproducibility of Result ,PT ,World Health Organization ,International Normalized Ratio/*standard ,Thromboplastin ,Automation ,Laboratory/standard ,ECAA plasmas ,Predictive Value of Tests ,health services administration ,medicine ,Animals ,Humans ,heterocyclic compounds ,International Normalized Ratio ,cardiovascular diseases ,thromboplastins ,Blood Coagulation ,Reference standards ,Mathematics ,Automation, Laboratory ,Observer Variation ,Prothrombin time ,Analysis of Variance ,medicine.diagnostic_test ,business.industry ,fungi ,Reproducibility of Results ,Hematology ,Reference Standards ,Surgery ,INR Line ,Multicenter study ,Calibration ,Linear Models ,Prothrombin Time ,Cattle ,Rabbits ,Observer variation ,Nuclear medicine ,business - Abstract
The WHO scheme for prothrombin time (PT) standardization has been limited in application, because of its difficulties in implementation, particularly the need for mandatory manual PT testing and for local provision of thromboplastin international reference preparations (IRP).The value of a new simpler procedure to derive international normalized ratio (INR), the PT/INR Line, based on only five European Concerted Action on Anticoagulation (ECAA) calibrant plasmas certified by experienced centres has been assessed in two independent exercises using a range of commercial thromboplastins and coagulometers. INRs were compared with manual certified values with thromboplastin IRP from expert centres and in the second study also with INRs from local ISI calibrations.In the first study with the PT/INR Line, 8.7% deviation from certified INRs was reduced to 1.1% with human reagents, and from 7.0% to 2.6% with rabbit reagents. In the second study, deviation was reduced from 11.2% to 0.4% with human reagents by both local ISI calibration and the PT/INR Line. With rabbit reagents, 10.4% deviation was reduced to 1.1% with both procedures; 4.9% deviation was reduced to 0.5% with bovine/combined reagents with local ISI calibrations and to 2.9% with the PT/INR Line. Mean INR dispersion was reduced with all thromboplastins and automated systems using the PT/INR Line.The procedure using the PT/INR Line provides reliable INR derivation without the need for WHO ISI calibration across the range of locally used commercial thromboplastins and automated PT systems included in two independent international studies.? 2010 International Society on Thrombosis and Haemostasis.
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- 2011
16. D-dimer to guide the duration of anticoagulation in patients with venous thromboembolism: a management study
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Palareti G, Cosmi B, Legnani C, Antonucci E, De Micheli V, Ghirarduzzi A, Poli D, Testa S, Tosetto A, Pengo V, Prandoni P, Erba N, Veropalumbo MR, Chiara UM, Prisco D, Paoletti O, Falanga A, Luigi S, Donadini M, Rancan E, Quintavalla R, Ferrini PM, Santoro RC, Orlandini F, Benedetti R, Cattaneo M, Lussana F, Bertinato E, Cappelli R, Pizzini AM, Angeloni L, D'Angelo A, Crippa L, Bortolotti R, Vandelli MR, Ageno W, Tripodi A, Imberti D, Moia M, Pesavento R, Magrini N, Marongiu F, Zonzin P, Piaggesi N, Silingardi M, Palareti, G, Cosmi, B, Legnani, C, Antonucci, E, De Micheli, V, Ghirarduzzi, A, Poli, D, Testa, S, Tosetto, A, Pengo, V, Prandoni, P, Erba, N, Veropalumbo, M, Chiara, U, Prisco, D, Paoletti, O, Falanga, A, Luigi, S, Donadini, M, Rancan, E, Quintavalla, R, Ferrini, P, Santoro, R, Orlandini, F, Benedetti, R, Cattaneo, M, Lussana, F, Bertinato, E, Cappelli, R, Pizzini, A, Angeloni, L, D'Angelo, A, Crippa, L, Bortolotti, R, Vandelli, M, Ageno, W, Tripodi, A, Imberti, D, Moia, M, Pesavento, R, Magrini, N, Marongiu, F, Zonzin, P, Piaggesi, N, Silingardi, M, Gualtiero Palareti, Benilde Cosmi, Cristina Legnani, Emilia Antonucci, Valeria De Micheli, Angelo Ghirarduzzi, Daniela Poli, Sophie Testa, Alberto Tosetto, Vittorio Pengo, and and Paolo Prandoni, on behalf of the DULCIS (D-dimer and ULtrasonography in Combination Italian Study) Investigators
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Male ,medicine.medical_specialty ,Time Factors ,Immunology ,Biochemistry ,Drug Administration Schedule ,Fibrin Fibrinogen Degradation Products ,Pregnancy ,Recurrence ,Internal medicine ,D-dimer ,medicine ,Humans ,D-dimer, venous thromboembolism, vitamin K antagonists ,Vein ,Aged ,Hematology ,business.industry ,Hazard ratio ,Anticoagulants ,Cell Biology ,Venous Thromboembolism ,Middle Aged ,medicine.disease ,Thrombosis ,Confidence interval ,Surgery ,Clinical trial ,medicine.anatomical_structure ,Treatment Outcome ,Withholding Treatment ,Female ,business ,anticoagulation, fibrin fragment d substance, venous thromboembolism, recurrence risk ,Follow-Up Studies - Abstract
The optimal duration of anticoagulation in patients with venous thromboembolism (VTE) is uncertain. We investigated whether persistently negative D-dimers in patients with vein recanalization or stable thrombotic burden can identify subjects at low recurrence risk. Outpatients with a first VTE (unprovoked or associated with weak risk factors) were eligible after at least 3 months (12 in those with residual thrombosis) of anticoagulation. They received serial D-dimer measurements using commercial assays with predefined age/sex-specific cutoffs and were followed for up to 2 years. Of 1010 patients, anticoagulation was stopped in 528 (52.3%) with persistently negative D-dimer who subsequently experienced 25 recurrences (3.0% pt-y; 95% confidence interval [CI], 2.0-4.4%). Of the remaining 482 patients, 373 resumed anticoagulation and 109 refused it. Recurrent VTE developed in 15 patients (8.8% pt-y; 95% CI, 5.0-14.1) of the latter group and in 4 of the former (0.7% pt-y; 95% CI, 0.2-1.7; hazard ratio = 2.92; 95% CI, 1.87-9.72; P = .0006). Major bleeding occurred in 14 patients (2.3% pt-y; 95% CI, 1.3-3.9) who resumed anticoagulation. Serial D-dimer measurement is suitable in clinical practice for the identification of VTE patients in whom anticoagulation can be safely discontinued. This study was registered at clinicaltrials.gov as #NCT00954395.
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- 2014
17. Standardized low-molecular-weight heparin bridging regimen in outpatients on oral anticoagulants undergoing invasive procedure or surgery: an inception cohort management study
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Pengo, V, Cucchini, U, Denas, G, Erba, N, Guazzaloca, G, La Rosa, L, De Micheli, V, Testa, S, Frontoni, R, Prisco, D, Nante, G, Iliceto, S, Moia, M, Oliviero, B, Molinatti, M, Cappelli, R, Zasso, A, Carrer, A, Borella, C, Ciabatta, C, Poli, D, Pollio, G, Iannone, AM, Coffetti, N, Pagliaro, P, Pedico, P, Porcu, A, Lorenz, C., SIRAGUSA, Sergio, Pengo, V, Cucchini, U, Denas, G, Erba, N, Guazzaloca, G, La Rosa, L, De Micheli, V, Testa, S, Frontoni, R, Prisco, D, Nante, G, Iliceto, S, Moia, M, Oliviero, B, Molinatti, M, Cappelli, R, Zasso, A, Carrer, A, Borella, C, Siragusa, S, Ciabatta, C, Poli, D, Pollio, G, Iannone, AM, Coffetti, N, Pagliaro, P, Pedico, P, Porcu, A, and Lorenz, C
- Subjects
Bridging, low molecular wight heparins ,Settore MED/15 - Malattie Del Sangue - Abstract
BACKGROUND: Bridging therapy with low-molecular-weight heparin is usually recommended in patients who must stop oral anticoagulants before surgical or invasive procedures. To date, there is no universally accepted bridging regimen tailored to the patient's thromboembolic risk. This prospective inception cohort management study was designed to assess the efficacy and safety of an individualized bridging protocol applied to outpatients. METHODS AND RESULTS: Oral anticoagulants were stopped 5 days before the procedure. Low-molecular-weight heparin was started 3 to 4 days before surgery and continued for 6 days after surgery at 70 anti-factor Xa U/kg twice daily in high-thromboembolic-risk patients and prophylactic once-daily doses in moderate- to low-risk patients. Oral anticoagulation was resumed the day after the procedure with a boost dose of 50% for 2 days and maintenance doses afterward. The patients were followed up for 30 days. Of the 1262 patients included in the study (only 15% had mechanical valves), 295 (23.4%) were high-thromboembolic-risk patients and 967 (76.6%) were moderate- to low-risk patients. In the intention-to-treat analysis, there were 5 thromboembolic events (0.4%; 95% confidence interval, 0.1 to 0.9), all in high-thromboembolic-risk patients. There were 15 major (1.2%; 95% confidence interval, 0.7 to 2.0) and 53 minor (4.2%; 95% confidence interval, 3.2 to 5.5) bleeding episodes. Major bleeding was associated with twice-daily low-molecular-weight heparin administration (high-risk patients) but not with the bleeding risk of the procedure. CONCLUSIONS: This management bridging protocol, tailored to patients' thromboembolic risk, appears to be feasible, effective, and safe for many patients, but safety in patients with mechanical prosthetic valves has not been conclusively established.
- Published
- 2009
18. Clinical course of high risk patients diagnosed with Antiphospholipid Syndrome (APS)
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Pengo, V, Ruffatti, A, Legnani, C, Gresele, Paolo, Barcellona, D, Erba, N, Testa, S, Marongiu, F, Bison, E, Denas, G, Banzato, A, PADAYATTIL JOSE, S, and Iliceto, S.
- Published
- 2009
19. Survey on lupus anticoagulant (LA) diagnosis in italy
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Pengo, Vittorio, Biasiolo, A, Ruffatti, Amelia, Gresele, P, Marongiu, F, Erba, N, Veschi, F, Ghirarduzzi, A, DE CANDIA, E, Montaruli, B, Testa, S, Barcellona, D, and Tripodi, A.
- Published
- 2007
20. Thrombotic events during oral anticoagulant treatment: results of the inception cohort prospective collaborative ISCOAT study
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Palareti, G, Manotti, C, D'Angelo, A, Pengo, Vittorio, Erba, N, Moia, M, Ciavarella, N, Devoto, G, Berrettini, M, Leali, N, Poggi, M, and Legnani, C.
- Published
- 1997
21. Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaborative study (ISCOAT). Italian Study on Complications of Oral Anticoagulant Therapy
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Palareti, G, Leali, N, Coccheri, S, Poggi, M, Manotti, C, D'Angelo, A, Pengo, Vittorio, Erba, N, Moia, M, Ciavarella, N, Devoto, G, Berrettini, M, and Musolesi, S.
- Published
- 1996
22. Major bleeding in patients undergoing PCI and triple or dual antithrombotic therapy: a parallel-cohort study
- Author
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Denas, G., primary, Padayattil Jose, S., additional, Gresele, P., additional, Erba, N., additional, Testa, S., additional, De Micheli, V., additional, Quintavalla, R., additional, Poli, D., additional, Bracco, A., additional, Fierro, T., additional, Iliceto, S., additional, and Pengo, V., additional
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- 2012
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23. Standardized Low–Molecular-Weight Heparin Bridging Regimen in Outpatients on Oral Anticoagulants Undergoing Invasive Procedure or Surgery
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Pengo, V., primary, Cucchini, U., additional, Denas, G., additional, Erba, N., additional, Guazzaloca, G., additional, La Rosa, L., additional, De Micheli, V., additional, Testa, S., additional, Frontoni, R., additional, Prisco, D., additional, Nante, G., additional, and Iliceto, S., additional
- Published
- 2009
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24. Genetic abnormalities of the protein C system: shared risk factors in young adults with migraine with aura and with ischemic stroke?
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D' Amico, D, primary, Moschiano, F, additional, Leone, M, additional, Ariano, C, additional, Ciusani, E, additional, Erba, N, additional, Grazzi, L, additional, Ferraris, A, additional, Schieroni, F, additional, and Bussone, G, additional
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- 1998
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25. AN IMPROVED TEST TO IDENTIFY aPC-RESISTANT FACTOR V-LEIDEN
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Preda, L., primary, Erba, N., additional, Figini, S., additional, Carniti, G.C., additional, and Rossi, E., additional
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- 1997
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26. Guida alla terapia antitrombotica curata dalla Federazione Nazionale Centri per la Diagnosi della Trombosi e la Sorveglianza delle Terapie Antitrombotiche (FCSA)
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Barcellona, D, Contino, L, Erba, N, Falanga, A, Finazzi, G, Gresele, P, Manotti, C, Marongiu, F, Moia, M, Pengo, V, Poli, D, Testa, S, Tiraferri, E, Tosetto, A, and Tripodi, A
27. Prevalence and significance of anti-prothrombin (aPT) antibodies in patients with Lupus Anticoagulant (LA)
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Pengo V, Denas G, Bison E, Banzato A, Sp, Jose, Gresele P, Marongiu F, Erba N, Veschi F, Ghirarduzzi A, Erica De Candia, Montaruli B, Marietta M, Testa S, Barcellona D, Tripodi A, and Italian Federation of Thrombosis Centers (FCSA)
- Subjects
Adult ,Male ,medicine.medical_specialty ,Gastroenterology ,Antibodies ,antiprothrombin antibodies ,Antiphospholipid syndrome ,Internal medicine ,medicine ,Humans ,In patient ,Lupus anticoagulant ,biology ,Vascular disease ,business.industry ,Clinical events ,Settore MED/09 - MEDICINA INTERNA ,Hematology ,Middle Aged ,Antiphospholipid Syndrome ,medicine.disease ,Thrombosis ,Thromboembolic risk ,beta 2-Glycoprotein I ,Lupus Coagulation Inhibitor ,Immunology ,biology.protein ,Female ,Prothrombin ,Antibody ,business - Abstract
Objective Anti-prothrombin (aPT) antibodies have been found in Lupus Anticoagulant (LA) positive patients. Their prevalence and relative contribution to thromboembolic risk in LA-positive patients is not well defined. The aim of this study was to determine their presence and association with thromboembolic events in a large series of patients with confirmed LA. Methods Plasma from LA-positive patients was collected at Thrombosis Centers and sent to a reference central laboratory for confirmation. Positive plasma was tested using home-made ELISA for the presence of aPT and anti-β2GPI antibodies. Results LA was confirmed in 231 patients. Sixty-one of 231 (26%, 95%CI 22-33) LA positive subjects were positive for IgG aPT and 62 (27%, 95% CI 21-33) were positive for IgM aPT antibodies. Clinical features of Antiphospholipid Syndrome (APS) were not associated with the presence of IgG aPT [43 APS in 61 (70%) positive and 109 APS in 170 (64%) negative IgG aPT subjects, p = ns] or IgM aPT. Rate of positivity of IgG and IgM aβ2GPI was significantly higher than that of IgG and IgM aPT. Clinical events accounting for APS occurred in 97 of 130 (75%) IgG aβ2GPI positive and in 55 of 101 (54%) IgG aβ2GPI negative patients (OR 2.4, 95% CI 1.4 to 4.3, p = 0.002). No significant association with clinical events in patients positive for both IgG aPT and IgG aβ2GPI as compared to those positive for one or another test was found. When patients negative for both IgG aPT and IgG aβ2GPI (LA positive only) were compared with remaining patients, a significantly lower association with clinical events was found (OR = 0.4, 95% CI: 0.2 to 0.7, p = 0.004). Conclusions As compared to IgG aβ2GPI, the prevalence of IgG aPT in patients with LA is significantly lower and not associated with the clinical features of APS.
28. Homocysteine plasma levels in patients with migraine with aura.
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Moschiano F, D'Amico D, Usai S, Grazzi L, Di Stefano M, Ciusani E, Erba N, and Bussone G
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- 2008
29. Duration of anticoagulation after isolated pulmonary embolism
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Cristina Legnani, Angelo Ghirarduzzi, Benilde Cosmi, Alberto Tosetto, Emilia Antonucci, Nicoletta Erba, Gualtiero Palareti, Sophie Testa, Vittorio Pengo, Daniela Poli, Paolo Prandoni, Palareti G, Cosmi B, Antonucci E, Legnani C, Erba N, Ghirarduzzi A, Poli D, Testa S, Tosetto A, Pengo V, and Prandoni P
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Deep vein ,Subgroup analysis ,030204 cardiovascular system & hematology ,RECURRENT VENOUS THROMBOEMBOLISM ,Body Mass Index ,Fibrin Fibrinogen Degradation Products ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,RISK-FACTOR ,Risk Factors ,Internal medicine ,Prevalence ,EPIDEMIOLOGY ,Humans ,Medicine ,Thrombolytic Therapy ,In patient ,DEEP-VEIN THROMBOSIS ,Prospective Studies ,cardiovascular diseases ,030212 general & internal medicine ,Blood Coagulation ,Aged ,Venous Thrombosis ,business.industry ,Anticoagulants ,Venous Thromboembolism ,Middle Aged ,medicine.disease ,Thrombosis ,Pulmonary embolism ,Surgery ,COMMUNITY ,medicine.anatomical_structure ,Multivariate Analysis ,Female ,Ultrasonography ,Pulmonary Embolism ,business ,Venous thromboembolism - Abstract
In the D-dimer and ULtrasonography in Combination Italian Study (DULCIS), serial D-dimer measurement in combination with assessment of residual thrombosis (in patients with deep vein thrombosis (DVT)) identified patients who safely discontinued anticoagulation after an unprovoked venous thromboembolism (VTE).In this subgroup analysis, the value of D-dimer tests was assessed in patients with isolated pulmonary embolism (PE) compared with those with DVT, with or without PE (DVT/PE). The DULCIS database was reanalysed in relation to this target.26.8% of the DULCIS patients had isolated PE as the index event; this was more prevalent in females (34.1%) than in males (21.1%; pversus 3.8% ppy; nonsignificant) who stopped anticoagulation for negative D-dimer, but it was markedly high (11.2% ppy; pversus two (7.4%) out of 27; p=0.0085).Serial D-dimer assessment can inform on the risk of recurrent VTE and help determine the duration of anticoagulation in patients with isolated PE.
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- 2016
30. Age and gender specific cut-off values to improve the performance of D-dimer assays to predict the risk of venous thromboembolism recurrence
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Armando Tripodi, Paolo Carraro, Nicoletta Erba, Cristina Legnani, Gualtiero Palareti, Michela Cini, Benilde Cosmi, Legnani C, Cini M, Cosmi B, Carraro P, Tripodi A, Erba N, and Palareti G.
- Subjects
Adult ,Male ,medicine.medical_specialty ,Vitamin K ,VITAMIN K ANTAGONISTS ,law.invention ,Fibrin Fibrinogen Degradation Products ,Young Adult ,Sex Factors ,Randomized controlled trial ,Anticoagulation, d-dimer, Recurrence, Risk factors, Venous thromboembolism ,Fibrinolytic Agents ,law ,Predictive Value of Tests ,Recurrence ,Risk Factors ,Internal medicine ,D-dimer ,Internal Medicine ,Medicine ,Humans ,Young adult ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Age Factors ,Retrospective cohort study ,Venous Thromboembolism ,Middle Aged ,Surgery ,Predictive value of tests ,Emergency Medicine ,Female ,Fresh frozen plasma ,business ,Venous thromboembolism ,Fibrinolytic agent - Abstract
The Prolong study shows that continuing vitamin K antagonists (VKA) in patients with abnormal D: -dimer (evaluated by a qualitative assay, Clearview Simplify D: -dimer) results in a significant reduction of venous thromboembolism (VTE) recurrence. The present study retrospectively analyzes a subgroup of patients enrolled in the Prolong study with a view to calculate cut-off values for six quantitative D: -dimer methods to predict the risk of VTE recurrence. We measured D: -dimer levels by VIDAS D: -dimer Exclusion (bioMerieux), STA Liatest D: -dimer (DiagnosticaStago), HemosIL D: -dimer and HemosIL D: -dimer HS (Instrumentation Laboratory), Innovance D: -dimer (Siemens) and AutoDimer (Trinity Biotech) in frozen plasma aliquots sampled 30 ± 10 days after VKA cessation in 390 patients enrolled in the Prolong study. During follow-up (562.7 years), 28 patients had recurrent VTE (7.2%, 5.0% person-years). Since D: -dimer levels are positively correlated with age and significantly lower in men, we calculated method-specific cut-off values according to age and gender. The HRs for VTE recurrence calculated using method-specific cut-off values based on age and gender are higher than those using cut-off values indicated by the manufacturers for VTE exclusion in symptomatic outpatients. These data suggest that method-specific cut-off values calculated according to patient age and gender can be more accurate in identifying patients at a higher risk for VTE recurrence. These method-specific cut-off values are being evaluated in the ongoing prospective management multicenter DULCIS study.
- Published
- 2011
31. Prevalence of HFE mutations in upper northern Italy: study of 1132 unrelated blood donors
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Valentina Baldini, N. Erba, Alberto Piperno, C. Lanzafame, Cristina Arosio, Christian Oberkanins, Chiara Corengia, R. Mariani, P. Trombini, L. Fossati, A. Salvioni, V. De Micheli, Mariani, R, Salvioni, A, Corengia, C, Erba, N, Lanzafame, C, De Micheli, V, Baldini, V, Arosio, C, Fossati, L, Trombini, P, Oberkanins, C, and Piperno, A
- Subjects
Proband ,Adult ,congenital, hereditary, and neonatal diseases and abnormalities ,Genotype ,blood donors, C282Y, haemochromatosis, HFE, S65C, W169X ,Population ,Nonsense mutation ,Compound heterozygosity ,Gene Frequency ,Ethnicity ,Prevalence ,Medicine ,Humans ,Allele ,education ,Hemochromatosis Protein ,Allele frequency ,Aged ,Genetics ,education.field_of_study ,Hepatology ,business.industry ,Histocompatibility Antigens Class I ,Gastroenterology ,nutritional and metabolic diseases ,Membrane Proteins ,Heterozygote advantage ,Middle Aged ,Genetics, Population ,Italy ,Mutation ,business - Abstract
Background. In the Italian general population, prevalence of C282Y is lower than in Northern European countries. We hypothesised a higher prevalence of C282Y in Northern than in Central and Southern Italy. We previously identified a nonsense mutation (W169X) in haemochromatosis probands originating from a Northern Italian region (Brianza). Aim. To define the prevalence of HFE mutations in that region. Subjects and methods. A total of 1132 unrelated blood donors from the Blood Banks of Monza and Merate were investigated for C282Y, H63D, S65C and W169X mutations by PCR-restriction assays. A total of 300 were also tested for rare HFE and TFR2 mutations by reverse-hybridization test strips. Results. Two C282Y homozygotes, eight C282Y/H63D compound heterozygotes, 27 H63D homozygotes and one W169X heterozygote were found. The allele frequencies of C282Y, H63D, S65C, and W169X were 3.2, 13.4, 1.3, and 0.04%, respectively. Conclusions. Our results confirm the existence of a decreasing frequency of C282Y allele from upper to lower Northern Italy. This difference is probably related to the larger Celtic component of upper Northern Italian populations in which screening studies for haemochromatosis may even be cost effective. W169X, due to its severity, should be looked for in all haemochromatosis patients of Northern ancestry with an incomplete HFE genotype.
- Published
- 2003
32. Anticoagulant Therapy in Pregnant Women with Mechanical Heart Valves: Italian Federation of Centers for Diagnosis and Surveillance of the Antithrombotic Therapies (FCSA) Position Paper.
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Campello E, Bucciarelli P, Catalani F, Erba N, Squizzato A, and Poli D
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- Humans, Pregnancy, Female, Italy, Thrombosis prevention & control, Thrombosis diagnosis, Consensus, Heart Valve Prosthesis Implantation adverse effects, Risk Factors, Heparin adverse effects, Heparin therapeutic use, Anticoagulants therapeutic use, Anticoagulants adverse effects, Pregnancy Complications, Cardiovascular drug therapy, Pregnancy Complications, Cardiovascular diagnosis, Heart Valve Prosthesis
- Abstract
The management of anticoagulant therapy in pregnant women with mechanical heart valves (MHVs) is difficult and often challenging even for clinicians experienced in the field. These pregnancies, indeed, are burdened with higher rates of complications for both the mother and the fetus, compared to those in women without MHVs. The maternal need for an optimal anticoagulation as provided by vitamin K antagonists is counterbalanced by their teratogen effect on the embryo and fetus. On the other hand, several concerns have been raised about the efficacy of heparins in pregnant women with MHVs, considering the high risk of thrombotic complications in these patients. Therefore, numerous clinical issues about the management of pregnant women with MHVs remain unanswered, such as the selection of the best anticoagulant agent, the optimal anticoagulation levels to be achieved and maintained, and the evaluation of long-term effects for both the mother and the fetus. Based on a comprehensive review of the current literature, the Italian Federation of the Centers for the Diagnosis and the Surveillance of the Antithrombotic Therapies (FCSA) proposes experience-based suggestions and expert opinions. Particularly, this consensus document aims at providing practical guidance for clinicians dealing with pregnant women with MHVs, to optimize maternal and fetal outcomes while guaranteeing adequate anticoagulation. Finally, FCSA highlights the need for the creation of multidisciplinary teams experienced in the management of pregnant women with MHVs during pregnancy, delivery, and postpartum , in order to better deal with such complex clinical issues and provide a comprehensive counseling to these patients., Competing Interests: A.S. received honoraria for lectures, manuscript writing, and/or participation on advisory board from Daiichi Sankyo, Bayer, Pfizer, Bristol-Myers Squibb, Novartis, Viatris, Sanofi, Werfen, Boehringer-Ingelheim, Alexion, and Roche. All other authors have nothing to declare., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)
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- 2024
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33. Association of sex with major bleeding risks in sub-Saharian anticoagulated patients with mechanical heart valves: A cohort study from the Khartoum Emergency Salam Centre.
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Erba N, Tosetto A, Abdallah SA, Langer M, Giovanella E, Lentini S, Masini F, Mocini A, Portella G, Salvati AC, Squizzato A, Testa S, Lip GYH, and Poli D
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- Male, Humans, Female, Adult, Warfarin adverse effects, Cohort Studies, Prospective Studies, Anticoagulants adverse effects, Hemorrhage chemically induced, Hemorrhage diagnosis, Hemorrhage epidemiology, Risk Factors, Heart Valves, Thromboembolism epidemiology, Heart Valve Prosthesis adverse effects
- Abstract
Background: Rheumatic heart disease (RHD) with mechanical heart valve (MHV) replacement is common in Africa. However, MHV requires lifelong anticoagulation that could have a particular impact in women in reproductive age., Methods: We report data of a prospective observational cohort study conducted between August 2018 and September 2019 in MHV patients in the Salam Centre for Cardiac Surgery built in Khartoum by Emergency, an Italian Non-Governmental Organization, to evaluate bleeding risk, its associated determinants, and the impact of lifelong anticoagulation in fertile women., Results: We studied 3647 patients (median age 25.1 years; 53.9% female). During follow-up [median time 1.1 (0.1-1.2) years], we recorded 85 major bleedings (rate 2.16 × 100 pt-years), Major bleedings occurred more frequently among women (64/85 cases, 75.3%; rate 3.0 × 100 pt-years), compared to men (21/85 cases, 24.7%; rate 1.16 × 100 pt-years) (RR 2.6; 95% CI 1.6-4.5; p = 0.0001). Multivariate analysis was performed to identify variables associated with major bleeding, and female sex was the only risk factor significantly associated, whereas aspirin treatment and higher INR target showed a non-significant trend for higher bleeding risk. Thirty-two/85 (37.6%) of major bleedings were metrorrhagias. When we calculate the incidence of major bleedings after the exclusion of gynecological events, no sex differences in the bleeding risk were found (HR 1.3, 95% CI 0.8-2.3; p = 0.3)., Conclusions: Bleeding risk of young MHV patients on oral anticoagulant therapy is higher among women, mainly due to metrorrhagia. Women in the reproductive life are at high risk for gynecological bleeding when treated with anticoagulants., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)
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- 2024
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34. Gastrointestinal bleeding associated to aortic valve stenosis (Heyde's syndrome): a case series and literature review.
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De Carlini CC, Cantù E, Erba N, and Maggiolini S
- Abstract
Background: The association among aortic valve stenosis, gastrointestinal bleeding, and anaemia due to arteriovenous malformations, known as Heyde's syndrome (HS), is poorly understood and controversial. Recently, acquired Type 2A von Willebrand syndrome (vWS 2A) was shown to be the most likely aetiological mechanism of anaemia., Case Summary: We report two cases of HS in whom the percutaneous replacement of the aortic valve was resolutive for iron deficiency anaemia., Discussion: Iron deficiency anaemia and aortic stenosis are a common association in the elderly, so much that frequently; in such cases, the correction of the valvulopathy is often excluded as pre-operative anaemia is associated with higher morbidity and mortality. From this perspective, the correct diagnosis of HS is crucial to guide the decision to correct valvulopathy, as valvular substitution is resolutive for both anaemic disorders and aortic stenosis., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
- Published
- 2023
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35. Case Report: Right atrial organized thrombus three years after tricuspid annuloplasty.
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Abbass M, Mariani S, Musa S, Erba N, Masini F, and Lentini S
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- Female, Humans, Adolescent, Aortic Valve, Tricuspid Valve diagnostic imaging, Tricuspid Valve surgery, Anticoagulants, Tricuspid Valve Insufficiency diagnosis, Tricuspid Valve Insufficiency surgery, Atrial Fibrillation
- Abstract
Background: Occurrence of right atrial masses, especially in patients with history of cardiac surgery, is rare. Differential diagnosis between malignant and non-malignant aetiologies might be cumbersome, and surgery is often required to prevent complications or disease evolution. Case: We report the case of a 16-year-old girl from a rural area of Sudan, who underwent surgery for a modified De Vega's tricuspid annuloplasty, and mitral and aortic valve replacement with mechanical prostheses. The patient was on regular follow-up but demonstrated a poor compliance to anticoagulation therapy with a time in therapeutic range between 52% and 20%. She remained asymptomatic, but a right atrial mass was diagnosed by transthoracic echocardiography during a follow-up visit 41 months after the first operation. Surgical removal of the mass revealed an organized thrombus arising from the point where the Prolene stitches for the tricuspid annuloplasty were previously passed. The patient recovered from surgery, was discharged home on post-operative day 10 and the first follow-up visit at 30 days after discharge confirmed a good clinical status and a normal transthoracic echocardiography (TTE). Conclusions: This case report describes the diagnostic and therapeutic work-out of a thrombus formation on the suture lines of a tricuspid annuloplasty. Moreover, it highlights the importance of a strict and long follow-up after valvular surgery and of the adherence to anticoagulation therapy, especially for patients living in rural areas of developing countries., Competing Interests: No competing interests were disclosed., (Copyright: © 2023 Abbass M et al.)
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- 2023
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36. Oral anticoagulant management of patients with mechanical heart valves at the Salam Centre of Khartoum: Observations on quality of anticoagulation and thrombotic risk.
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Erba N, Tosetto A, Langer M, Abdallah SA, Giovanella E, Lentini S, Masini F, Mocini A, Portella G, Salvati AC, Squizzato A, Testa S, Lip GYH, and Poli D
- Subjects
- Adult, Aspirin pharmacology, Blood Coagulation, Female, Heart Valves, Hemorrhage chemically induced, Humans, Male, Anticoagulants adverse effects, Thrombosis chemically induced, Thrombosis etiology
- Abstract
Introduction: Rheumatic heart disease with mechanical heart valve (MHV) replacement is common in Africa. However, MHV requires long-life anticoagulation and managing this can be challenging., Methods and Results: We report data of a prospective observational study conducted between August 2018 and September 2019 in MHV patients in the Salam Centre for Cardiac Surgery built in Khartoum, by Emergency, an Italian Non-Governmental Organization, to evaluate the quality of anticoagulation control and the risk of thrombotic complications., Results: We studied 3647 patients (median age 25.1 years; 53.9 % female). Median Time in Therapeutic Range (TTR) was 53 % (interquartile range 37 % to 67 %) and 70 thrombotic events (rate 1.8 × 100 pt-years [95 % CI 1.38-2.23]) were recorded. Among patients in the first quartile of TTR (≤37 %), we recorded 34/70 (48.6 %) of all thrombotic events (rate 3.7 × 100 pt-years [95 % CI 2.5-5.1]), with a high mortality rate (2.2 × 100 pt-years [95 % CI 1.3-3.3]). In patients with guideline-recommended TTR (≥65 %) the event rate was 0.8 × 100 pt-years for thrombotic events [95 % CI 0.3-1.5] and 0.4 × 100 pt-years for mortality [95 % CI 0.1-0.9]. Multivariable analysis showed that having a TTR in the lowest quartile (≤37 %) and being noncompliant are significantly associated with increased thrombotic risk. Aspirin use or different valve type did not influence the thrombotic risk. Almost 40 % of all thromboembolic complications could have been potentially prevented by further improving VKA management to obtain a TTR > 37 %., Conclusion: The thrombotic risk of MHV patients on VKAs living in a low-income country like Sudan is associated with low quality of anticoagulation control. Efforts should be made to decrease the number of non-compliant patients and to reach a guideline-recommended TTR of ≥65 %., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2022
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37. Pregnancy Outcomes in Women With Mechanical Valve Prostheses Using Vitamin K Antagonist Therapy: The Experience of the Salam Centre for Cardiac Surgery in Sudan.
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Erba N, Gatti S, Hassan SAA, Langer M, Chatenoud L, Portella G, and Baiocchi R
- Abstract
Pregnancy and childbirth on anticoagulants after mechanical heart valve replacement present a high risk of complications for both mother and baby. On top of pregnancy worsening the mother's cardiac function, anticoagulant therapy itself is a crucial problem. A safe and effective anticoagulation regimen for both mother and fetus is not possible. The most effective drugs for preventing valve thrombosis are VKAs, whose dosage needs to be adjusted with frequent INR checks. Moreover, VKAs can have embryopathic and teratogenic action. Patients in follow-up and anticoagulant treatment at the Salam Centre for Cardiac Surgery in Sudan live spread out over a large area where transport to the Center is generally difficult; pregnancy treatment has, therefore, been adapted to the limitations of reality. Pregnancy is discouraged and contraception and therapeutic abortion are recommended, but this guidance frequently goes unheeded. Here we describe maternal and fetal outcomes in 307 consecutive pregnancies recorded by staff at the oral anticoagulant clinic (OAC) from April 2017 to November 2021. Out of 307 pregnancies, there were 15 maternal deaths (4.9%), 24 thrombotic events (7.8%) and 22 major bleedings (7.2%). Fifty pregnancies (16.3%) were terminated by therapeutic abortion. Only 47.6% of pregnancies had good maternal and neonatal outcomes. Data clearly show that, due to the complexity of pregnancy in women with mechanical heart valves and the scarcity of tertiary healthcare services in the area where patients live, maternal mortality is at an unacceptable level and requires a structured, multi-disciplinary intervention., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Erba, Gatti, Hassan, Langer, Chatenoud, Portella and Baiocchi.)
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- 2022
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38. Treating Children With Advanced Rheumatic Heart Disease in Sub-Saharan Africa: The NGO EMERGENCY's Project at the Salam Centre for Cardiac Surgery in Sudan.
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Miccio R, Quattrociocchi M, Valgoi L, Chatenoud L, Lentini S, Giovanella E, Rolla L, Erba N, Gatti S, Rocchi D, Saad MB, Salvati A, Langer M, Portella G, and Strada G
- Abstract
Rheumatic heart disease is endemic in Sub-Saharan Africa and while efforts are under way to boost prophylaxis and early diagnosis, access to cardiac surgery is rarely affordable. In this article, we report on a humanitarian project by the NGO EMERGENCY, to build and run the Salam Centre for Cardiac Surgery in Sudan. This hospital is a center of excellence offering free-of-charge, high-quality treatment to patients needing open-heart surgery for advanced rheumatic and congenital heart disease. Since it opened in 2007, more than 8,000 patients have undergone surgery there; most of them Sudanese, but ~20% were admitted from other countries, an example of inter-African cooperation. The program is not limited to surgical procedures. It guarantees long-term follow-up and anticoagulant treatment, where necessary. By way of example, we report clinical features and outcome data for the pediatric cohort: 1,318 children under the age of 15, operated on for advanced rheumatic heart disease between 2007 and 2019. The overall 5-year survival rate was 85.0% (95% CI 82.7-87.3). The outcomes for patients with mitral valves repaired and with mitral valves replaced are not statistically different. Nevertheless, observing the trend of patients undergoing valve repair, a better outcome for this category might be assumed. RHD in children is an indicator of poor socio-economic conditions and an inadequate health system, which clearly will not be cured by cardiac surgery alone. Nevertheless, the results achieved by EMERGENCY, with the crucial involvement and participation of the Sudanese government over the years, show that building a hospital, introducing free cardiac surgery, and offering long-term post-operative care may help spread belief in positive change in the future., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Miccio, Quattrociocchi, Valgoi, Chatenoud, Lentini, Giovanella, Rolla, Erba, Gatti, Rocchi, Saad, Salvati, Langer, Portella and Strada.)
- Published
- 2021
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39. Duration of anticoagulation after isolated pulmonary embolism.
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Palareti G, Cosmi B, Antonucci E, Legnani C, Erba N, Ghirarduzzi A, Poli D, Testa S, Tosetto A, Pengo V, and Prandoni P
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- Adult, Aged, Blood Coagulation, Body Mass Index, Female, Fibrin Fibrinogen Degradation Products analysis, Humans, Male, Middle Aged, Multivariate Analysis, Prevalence, Prospective Studies, Risk Factors, Sex Factors, Thrombolytic Therapy, Venous Thrombosis drug therapy, Anticoagulants administration & dosage, Pulmonary Embolism drug therapy, Venous Thromboembolism drug therapy
- Abstract
In the D-dimer and ULtrasonography in Combination Italian Study (DULCIS), serial D-dimer measurement in combination with assessment of residual thrombosis (in patients with deep vein thrombosis (DVT)) identified patients who safely discontinued anticoagulation after an unprovoked venous thromboembolism (VTE).In this subgroup analysis, the value of D-dimer tests was assessed in patients with isolated pulmonary embolism (PE) compared with those with DVT, with or without PE (DVT/PE). The DULCIS database was reanalysed in relation to this target.26.8% of the DULCIS patients had isolated PE as the index event; this was more prevalent in females (34.1%) than in males (21.1%; p<0.0001). The rate of positive D-dimer was similar in isolated PE and DVT/PE. The rate of recurrences was not different in isolated PE or DVT/PE patients (4.8% ppy versus 3.8% ppy; nonsignificant) who stopped anticoagulation for negative D-dimer, but it was markedly high (11.2% ppy; p<0.0001) in those with isolated PE who remained without anticoagulation despite positive D-dimer. Recurrences were more frequently new isolated PE in patients with isolated PE than with DVT/PE (six (46.2%) out of 13 versus two (7.4%) out of 27; p=0.0085).Serial D-dimer assessment can inform on the risk of recurrent VTE and help determine the duration of anticoagulation in patients with isolated PE., (Copyright ©ERS 2016.)
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- 2016
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40. Recurrence of ICH after resumption of anticoagulation with VK antagonists: CHIRONE study.
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Poli D, Antonucci E, Dentali F, Erba N, Testa S, Tiraferri E, and Palareti G
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Anticoagulants adverse effects, Child, Female, Follow-Up Studies, Health Surveys, Humans, Intracranial Hemorrhages drug therapy, Male, Middle Aged, Recurrence, Risk Factors, Time Factors, Young Adult, Antifibrinolytic Agents adverse effects, Intracranial Hemorrhages chemically induced, Vitamin K antagonists & inhibitors
- Abstract
Objective: To evaluate the risk of recurrent intracranial hemorrhage (ICH) in patients on vitamin K antagonists (VKAs) after a first episode of ICH., Methods: The Cerebral Haemorrhage in patients Restarting Oral Anticoagulant Therapy (CHIRONE) Study collected data of patients eligible for the study from the database of 27 centers affiliated with the Italian Federation of Anticoagulation Clinics., Results: We enrolled 267 patients (163 male, median age 73.9 years) who had received VKA anticoagulation after an ICH event. During the total period of follow-up (778 patient-years), ICH recurred in 20 patients (7.5%; rate 2.56 × 100 patient-years) at a median time of 16.5 months, and was fatal in 5 patients (25%; rate 0.4 × 100 patient-years). Male sex, hypertension, prosthetic valves, previous ischemic stroke, renal failure, cancer, and spontaneous events were associated with the risk of recurrence, though none of them in isolation reached statistical significance. More than one-third of spontaneous recurrences occurred in patients with a posttraumatic index event., Conclusions: Our results show that patients with a history of ICH carry a significant risk of recurrent ICH when treated with VKA anticoagulation. The risk is also present, though to a lower degree, in patients with previous posttraumatic events. All patients with a history of ICH require a careful evaluation of their thromboembolic risk to estimate the net clinical benefit of (re)starting anticoagulation with VKAs.
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- 2014
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41. Age and gender specific cut-off values to improve the performance of D-dimer assays to predict the risk of venous thromboembolism recurrence.
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Legnani C, Cini M, Cosmi B, Carraro P, Tripodi A, Erba N, and Palareti G
- Subjects
- Adult, Age Factors, Aged, Aged, 80 and over, Female, Fibrinolytic Agents, Humans, Male, Middle Aged, Predictive Value of Tests, Recurrence, Retrospective Studies, Risk Factors, Sex Factors, Venous Thromboembolism drug therapy, Vitamin K antagonists & inhibitors, Young Adult, Fibrin Fibrinogen Degradation Products metabolism, Venous Thromboembolism blood, Venous Thromboembolism etiology
- Abstract
The Prolong study shows that continuing vitamin K antagonists (VKA) in patients with abnormal D-dimer (evaluated by a qualitative assay, Clearview Simplify D-dimer) results in a significant reduction of venous thromboembolism (VTE) recurrence. The present study retrospectively analyzes a subgroup of patients enrolled in the Prolong study with a view to calculate cut-off values for six quantitative D-dimer methods to predict the risk of VTE recurrence. We measured D-dimer levels by VIDAS D-dimer Exclusion (bioMerieux), STA Liatest D-dimer (DiagnosticaStago), HemosIL D-dimer and HemosIL D-dimer HS (Instrumentation Laboratory), Innovance D-dimer (Siemens) and AutoDimer (Trinity Biotech) in frozen plasma aliquots sampled 30 ± 10 days after VKA cessation in 390 patients enrolled in the Prolong study. During follow-up (562.7 years), 28 patients had recurrent VTE (7.2%, 5.0% person-years). Since D-dimer levels are positively correlated with age and significantly lower in men, we calculated method-specific cut-off values according to age and gender. The HRs for VTE recurrence calculated using method-specific cut-off values based on age and gender are higher than those using cut-off values indicated by the manufacturers for VTE exclusion in symptomatic outpatients. These data suggest that method-specific cut-off values calculated according to patient age and gender can be more accurate in identifying patients at a higher risk for VTE recurrence. These method-specific cut-off values are being evaluated in the ongoing prospective management multicenter DULCIS study.
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- 2013
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42. A comparison of lupus anticoagulant-positive patients with clinical picture of antiphospholipid syndrome and those without.
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Pengo V, Biasiolo A, Gresele P, Marongiu F, Erba N, Veschi F, Ghirarduzzi A, Barcellona D, and Tripodi A
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- Antibodies, Anticardiolipin blood, Antiphospholipid Syndrome complications, Antiphospholipid Syndrome epidemiology, Female, Humans, Italy epidemiology, Male, Odds Ratio, Pregnancy, Risk Assessment, beta 2-Glycoprotein I immunology, Antiphospholipid Syndrome immunology, Lupus Coagulation Inhibitor blood, Pregnancy Complications immunology, Thromboembolism immunology
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- 2007
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43. Genetic abnormalities of the protein C system: shared risk factors in young adults with migraine with aura and with ischemic stroke?
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D'Amico D, Moschiano F, Leone M, Ariano C, Ciusani E, Erba N, Grazzi L, Ferraris A, Schieroni F, and Bussone G
- Subjects
- Adult, Factor V, Female, Humans, Male, Point Mutation, Protein C genetics, Risk Factors, Activated Protein C Resistance complications, Brain Ischemia complications, Brain Ischemia genetics, Migraine Disorders complications, Migraine Disorders genetics, Protein S Deficiency complications
- Abstract
Migraine, particularly migraine with aura (MA), may be a risk factor for ischemic stroke (IS). The reasons for this association are unknown. We investigated the presence of genetic abnormalities of the protein C system in 83 MA patients, 31 IS patients, and 124 healthy controls, all aged under 45 years. We found an increased frequency of activated protein C resistance due to Arg506Gln factor V mutation, and of protein S deficiency in both disorders, with figures higher than those reported in the general population and significantly different from those found in controls. These prothrombotic genetic abnormalities may be shared risk factors in IS and MA, and may play a role in increasing the risk of cerebrovascular disease in migraineurs.
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- 1998
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44. Thrombotic events during oral anticoagulant treatment: results of the inception-cohort, prospective, collaborative ISCOAT study: ISCOAT study group (Italian Study on Complications of Oral Anticoagulant Therapy).
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Palareti G, Manotti C, DAngelo A, Pengo V, Erba N, Moia M, Ciavarella N, Devoto G, Berrettini M, Leali N, Poggi M, Legnani C, Musolesi S, and Coccheri S
- Subjects
- Administration, Oral, Age Factors, Aged, Anticoagulants administration & dosage, Cohort Studies, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Hemorrhage chemically induced, Humans, Italy epidemiology, Male, Middle Aged, Prospective Studies, Thromboembolism drug therapy, Thrombosis epidemiology, Anticoagulants adverse effects, Anticoagulants therapeutic use, Thrombosis etiology
- Abstract
The paper reports on rate and type of thrombotic events occurring during the observational, prospective, inception-cohort, multicenter ISCOAT study. 2,745 unselected, daily practice patients, consecutively referring to 34 Italian anticoagulation clinics to monitor the oral anticoagulant treatment, were included in the study from beginning of their first anticoagulant course. During a total follow-up of 2,011 patient-years of treatment 70 thrombotic events (3.5 per 100 patient years) were recorded in 67 patients: 20 fatal (1%), 39 major (1.9%) and 11 minor (0.6%). 34/70 events occurred within the first 90 days of treatment (relative risk - at multivariate analysis - of < or =90 days vs. >90 = 20.6, C.I. 12.7-33.5; p <0.0001). The risk was higher in patients aged > or =70 y (1.62, C.I. 1.0-2.61; p <0.05), and when indication for anticoagulant treatment was peripheral/cerebral arterial disease (1.84, C.I. 1.01-3.36; p <0.05). The frequency of thrombotic events was 17.5% when international normalised ratio (INR) levels were < 1.5, decreasing to 2.3% for INRs within the 2-2.99 category (relative risk of INRs <2.0 vs. > or =2 = 1.88, C.I. 1.16-3.07; p <0.05). The recorded rate of thrombotic events was lower than that reported in the few available studies. A greater risk should be expected during the first 90 days of treatment, when anticoagulation levels are <2.0 INR, in patients > 70 years and in those with cerebrovascular/peripheral arterial disease.
- Published
- 1997
45. [Hemorrhagic complications of oral anticoagulant therapy: results of a prospective multicenter study ISCOAT (Italian Study on Complications of Oral Anticoagulant Therapy)].
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Palareti G, Leali N, Coccheri S, Poggi M, Manotti C, D'Angelo A, Pengo V, Erba N, Moia M, Ciavarella N, Devoto G, Berretini M, and Musolesi S
- Subjects
- Aged, Female, Hemorrhage epidemiology, Humans, Italy epidemiology, Male, Middle Aged, Prospective Studies, Risk Factors, Warfarin adverse effects, Anticoagulants adverse effects, Hemorrhage chemically induced
- Abstract
Background: To assess the incidence of bleeding complications during oral anticoagulant therapy (OAT) in a population of patients representative of daily practice in Italian anticoagulation clinics., Design: prospective, inception-cohort, multicentre., Setting: Thirty-four anticoagulation clinics federated in the Italian Federation of Anticoagulation Clinics., Patients: 2745 consecutive patients, included from beginning of their first OAT course. Most patients were aged between 60 and 79 y (57.8%), with 8% being > or = 80 y. Venous thromboembolism was the most frequent indication for OAT (one third of all the patients), followed by non ischemic heart disease which mainly included atrial fibrillation (16.8% of patients). Warfarin (in 63.8% of patients) and acenocoumarol were the only anticoagulant drugs used. The targeted anticoagulation intensity was low (INR < or = 2.8) in 71% of patients and high (INR > 2.8) in the remainder., Outcomes: Fatal, major and minor bleeding events. Thrombotic events were also recorded, though not analyzed in the present report., Findings: During the 2011 patient-years (pt-y) of follow-up, 153 bleeding complications (7.6% pt-y) were recorded--5 fatal (all cerebral haemorrhages, 0.25% pt-y), 23 major (1.1% pt-y) and 125 minor (6.2% pt-y). The rate of events did not vary according to sex, coumarin type, size of enrolling centre or targeted therapeutic range; it was higher in older patients (10.5% pt-y in those aged > or = 70 y, relative risk--RR--1.75, p < 0.001), in cases where indication for anti-coagulant treatment was peripheral and/or cerebrovascular disease (12.5% pt-y; RR 1.80, p < 0.01) and during the first 90 days of treatment (11% pt-y, RR 1.75, p < 0.001). One fifth of bleeding events occurred at a very low anticoagulation intensity (INR < 2; the category rate being 7.7% pt-y); the rate was 4.8% pt-y in the 2.0-2.9 INR category, reaching 9.5% pt-y, 40.5% pt-y and 200% pt-y in the 3-4.4, 4.5-6.9 and > or = 7 INR categories respectively (RR for INR levels > 4.5 = 7.91, p < 0.0001)., Conclusions: The overall rate of bleeding events recorded in the present study was much lower than that recorded in other (including recent) observational and experimental studies. The risk of bleeding increased in the following cases: age > 70 y; arterial vascular disease as indication for OAT; first 3 months of treatment; INR values > or = 4.5. OAT has become safer in recent years, particularly if monitored in special anticoagulation clinics. Caution should be exercised when prescribing OAT in elderly patients and the intensity anticoagulation levels should be closely monitored to minimize incidental periods of overanticoagulation.
- Published
- 1997
46. Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaborative study (ISCOAT). Italian Study on Complications of Oral Anticoagulant Therapy.
- Author
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Palareti G, Leali N, Coccheri S, Poggi M, Manotti C, D'Angelo A, Pengo V, Erba N, Moia M, Ciavarella N, Devoto G, Berrettini M, and Musolesi S
- Subjects
- Acenocoumarol adverse effects, Administration, Oral, Adult, Aged, Aged, 80 and over, Anticoagulants administration & dosage, Cardiovascular Diseases drug therapy, Cohort Studies, Female, Hemorrhage mortality, Humans, Italy, Male, Middle Aged, Prospective Studies, Risk Factors, Warfarin adverse effects, Anticoagulants adverse effects, Hemorrhage chemically induced
- Abstract
Background: Bleeding is the most serious complication of the use of oral anticoagulation in the prevention and treatment of thromoboembolic complications. We studied the frequency of bleeding complications in outpatients treated routinely in anticoagulation clinics., Methods: In a prospective cohort from thirty-four Italian anticoagulation clinics, 2745 consecutive patients were studied from the start of their oral anticoagulation (warfarin in 64%, acenocourmarol in the rest). The target anticoagulation-intensity was low (international normalised ratio [INR] < or = 2.8) in 71% of the patients and high (> 2.8) in the remainder. We recorded demographic details and the main indication for treatment and, every 3-4 months, INR and outcome events. Such events included all complications (bleeding, thrombosis, other), although only bleeding events are reported here, and deaths. We divided bleeding into major and minor categories., Findings: 43% of the patients were women. Nearly three-fifths of the patients were aged 60-79; 8% were over 80. The main indication for treatment was venous thrombolism (33%), followed by non-ischaemic heart disease (17%). Mean follow-up was 267 days. Over 2011 patient-years of follow-up, 153 bleeding complications occurred (7.6 per 100 patient-years). 5 were fatal (all cerebral haemorrhages, 0.25 per 100 patient-years), 23 were major (1.1), and 125 were minor (6.2). The rate of events was similar between sexes, coumarin type, size of enrolling centre, and target INR. The rate was higher in older patients: 10.5 per 100 patient-years in those aged 70 or over, 6.0 in those aged under 70 (relative risk 1.75, 95% Cl 1.29-2.39, p < 0.001). The rate was also higher when the indication was peripheral and/or cerebrovascular disease than venous thromboembolism plus other indications (12.5 vs 6.0 per 100 patient-years) (1.80, 1.2-2.7, p < 0.01), and during the first 90 days of treatment compared with later (11.0 vs 6.3, 1.75, 1.27-2.44, p < 0.001). A fifth of the bleeding events occurred at low anticoagulation intensity (INR < 2, rate 7.7 per 100 patient-years of follow-up). The rates were 4.8, 9.5, 40.5, and 200 at INRs 2.0-2.9, 3-4.4, 4.5-6.9, and over 7, respectively (relative risks for INR > 4.5, 7.91, 5.44-11.5, p < 0.0001)., Interpretation: We saw fewer bleeding events than those recorded in other observational and experimental studies. Oral anticoagulation has become safer in recent years, especially if monitored in anticoagulation clinics. Caution is required in elderly patients and anticoagulation intensity should be closely monitored to reduce periods of overdosing.
- Published
- 1996
- Full Text
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