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1. A prognostic score to identify women at increased risk for abnormal uterine bleeding during anticoagulation for venous thromboembolism

Author: Gabrielle Sarlon-Bartoli, Juan Criado, Saskia Middeldorp, José Antonio Nieto, María del Carmen Díaz-Pedroche, Farès Moustafa, Nuria Ruiz-Giménez, Benjamin Brenner, Manuel Monreal, Pierpaolo DI Micco, Paolo Prandoni, Dominique Farge-Bancel, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Sebastian Schellong, Inna Tzoran, Abilio Reis, Marijan Bosevski, Henri Bounameaux, Radovan Malý, Peter Verhamme, Joseph A. Caprini, Hanh My Bui, M.D. Adarraga, P. Agudo, C. Amado, J.I. Arcelus, A. Ballaz, J. Bascuñana, R. Barba, C. Barbagelata, M. Barrón, B. Barrón-Andrés, A. Blanco-Molina, F. Beddar Chaib, E. Botella, I. Cañas, R. Carrero-Arribas, I. Casado, P. Cerdá, L. Chasco, J. Criado, C. de Ancos, J. de Miguel, J. del Toro, P. Demelo-Rodríguez, A.M. Díaz-Brasero, M.C. Díaz-Pedroche, J.A. Díaz-Peromingo, I.M. Domínguez, A. Dubois-Silva, J.C. Escribano, F. Espósito, A.I. Farfán-Sedano, C. Falgá, C. Fernández-Capitán, B. Fernández-Jiménez, J. Fernández-Muixi, J.L. Fernández-Reyes, C. Font, I. Francisco, F. Galeano-Valle, M.A. García, F. García-Bragado, M. García de Herreros, O. Gavín-Blanco, A. Gil-Díaz, C. Gómez-Cuervo, A.M. Gómez-Mosquera, M. Gonzalez-Moreno, E. Grau, L. Guirado, J. Gutiérrez, L. Hernández-Blasco, L. Jara-Palomares, M.J. Jaras, D. Jiménez, I. Jou, M.D. Joya, B. Lacruz, S. Lainez-Justo, Latorre A, Lima J, Lobo Jl, M. López-De la Fuente, L. López-Jiménez, M. López-Meseguer, P. López-Miguel, J.J. López-Núñez, R. López-Reyes, J.B. López-Sáez, M.A. Lorente, A. Lorenzo, O. Madridano, A. Maestre, P.J. Marchena, J.M. Martín-Guerra, F. Martín-Martos, M. Mellado, E. Mena, J. Moisés, M.I. Mercado, M. Monreal, A. Muñoz-Blanco, G. Muñoz-Gamito, M.V. Morales, J.A. Nieto, E. Noguera-Gras, M.J. Núñez-Fernández, M. Olid-Velilla, J. Osorio, S. Otalora, R. Otero, D. Paredes-Ruiz, P. Parra, V. Parra, J.M. Pedrajas, M. Pérez-López, M.L. Peris, M.L. Pesce, J.A. Porras, J. Poyo-Molina, R. Puchades, A. Riera-Mestre, F. Rivera-Civico, A. Rivera-Gallego, M. Roca, V. Rosa, A. Rodríguez-Cobo, C. Rodríguez-Matute, P. Ruiz-Artacho, N. Ruiz-Giménez, J. Ruiz-Ruiz, G. Salgueiro, T. Sancho, V. Sendín, P. Sigüenza, S. Soler, B. Suárez-Rodríguez, J.M. Suriñach, G. Tiberio, M.I. Torres, A. Torres-Sánchez, J. Trujillo-Santos, F. Uresandi, E. Usandizaga, R. Valle, J.F. Varona, L. Vela, J.R. Vela, A. Villalobos, P. Villares, C. Ay, S. Nopp, I. Pabinger, M.M. Engelen, C. Martens, P. Verhamme, H.H.B. Yoo, J.D. Arguello, A.C. Montenegro, J. Roa, J. Hirmerova, R. Malý, S. Accassat, L. Bertoletti, A. Bura-Riviere, J. Catella, R. Chopard, F. Couturaud, O. Espitia, S. El Harake, R. Le Mao, I. Mahé, F. Moustafa, L. Plaisance, G. Sarlon-Bartoli, P. Suchon, E. Versini, S. Schellong, A. Braester, B. Brenner, G. Kenet, I. Tzoran, P. Sadeghipour, M. Basaglia, F. Bilora, C. Bortoluzzi, B. Brandolin, M. Ciammaichella, A. De Angelis, F. Dentali, P. Di Micco, E. Imbalzano, S. Merla, R. Pesavento, P. Prandoni, C. Siniscalchi, A. Tufano, A. Visonà, N. Vo Hong, B. Zalunardo, D. Kigitovica, E. Rusa, A. Skride, S. Fonseca, M. Manuel, J. Meireles, M. Bosevski, A. Eftimova, M. Zdraveska, H. Bounameaux, L. Mazzolai, A. Aujayeb, J.A. Caprini, I. Weinberg, and H.M. Bui
Subjects: Anticoagulants, Venous thromboembolism, Uterine bleeding, Prognostic score, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Introduction: Little is known about the clinical characteristics of women at increased risk for abnormal uterine bleeding (UB) during anticoagulation for venous thromboembolism (VTE). Methods: We used the RIETE registry to identify the baseline characteristics of women developing abnormal UB during anticoagulation. We used logistic regression analysis to identify independent predictors for abnormal UB. Then, we built a prognostic score to identify at-risk women. Results: From March 2001 through October 2022, there were 54,372 women with VTE. During anticoagulation (median, 181 days), 318 (0.6%) developed abnormal UB (major bleeding = 88, clinically relevant non-major (CRNM) = 230). On multivariable analysis, women aged 70 kg, with uterine cancer, recent UB, anemia, estrogen-related VTE, or receiving rivaroxaban or apixaban were at increased risk for abnormal UB. Using the prognostic score, 42,273 women (78%) were at low-risk, 8,828 (16%) intermediate-, and 3,271 (6.1%) at high-risk for abnormal UB. Their rates of abnormal UB were: 0.28 (95%CI: 0.23–0.35), 1.32 (95%CI: 1.07–1.61) and 7.12 (95%CI: 5.98–8.41) bleeds per 100 patient-years, respectively. The c-statistic was 0.80 (95%CI: 0.77–0.83). The rates of major UB were: 0.06 (95%CI: 0.04–0.09), 0.43 (95%CI: 0.30–0.60) and 1.85 (95%CI: 1.31–2.53) per 100 patient-years, respectively (c-statistic: 0.84; 95%CI: 0.80–0.89). The rates of CRNM uterine bleeding were: 0.21 (95%CI: 0.17–0.26), 0.85 (95%CI: 0.65–1.08), and 5.02 (95%CI: 4.09–6.10) bleeds per 100 patient-years, respectively (c-statistic: 0.78; 95%CI: 0.75–0.82). Conclusions: Using 7 variables easily available at admission, we built a prognostic score that reliably identified women with VTE at increased risk for abnormal UB during anticoagulation.
Published: 2023
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2. First three months of anticoagulation for venous thromboembolism in non-cancer patients: LMWH VS. VKAs. Findings from the RIETE registry

Author: Manuel J. Núñez Fernández, Cristina Martínez Reglero, José Antonio Nieto Rodríguez, Ana Chouza Piñeiro, Laura Barcia Sixto, Ana Maestre Peiró, Javier Trujillo Santos, Adriana Visonà, José Luis Fernández-Reyes, Manuel Monreal Bosch, M.D. Adarraga, M. Agud, J. Aibar, M.A. Aibar, C. Amado, J.I. Arcelus, C. Baeza, A. Ballaz, R. Barba, C. Barbagelata, M. Barrón, B. Barrón-Andrés, M. Bernal, A. Blanco-Molina, E. Botella, A.M. Camon, I. Cañas, I. Casado, J. Castro, L. Chasco, J. Criado, C. de Ancos, J. de Miguel, J. del Toro, P. Demelo-Rodríguez, J.A. Díaz-Peromingo, M.V. Di Campli, J. Díez-Sierra, I.M. Domínguez, M. Encabo, J.C. Escribano, C. Falgá, A.I. Farfán-Sedano, K. Fernández de Roitegui, C. Fernández-Capitán, J.L. Fernández-Reyes, M.A. Fidalgo, K. Flores, C. Font, L. Font, I. Francisco, I. Furest, C. Gabara, F. Galeano-Valle, M.A. García, F. García-Bragado, M. García de Herreros, R. García-Hernáez, M.M. García-Mullor, A. García-Raso, O. Gavín-Sebastián, A. Gil-Díaz, C. Gómez-Cuervo, J. González-Martínez, E. Grau, M. Giménez-Suau, L. Guirado, J. Gutiérrez, L. Hernández-Blasco, E. Hernando, L. Jara-Palomares, M.J. Jaras, D. Jiménez, M.D. Joya, I. Jou, J. Lima, P. Llamas, J.L. Lobo, L. López-Jiménez, P. López-Miguel, J.J. López-Núñez, R. López-Reyes, J.B. López-Sáez, A. Lorenzo, M. Loring, O. Madridano, A. Maestre, P.J. Marchena, M. Martín del Pozo, F. Martín-Martos, C. Mella, M. Mellado, M.I. Mercado, J. Moisés, M. Monreal, M.V. Morales, A. Muñoz-Blanco, D. Muñoz-Guglielmetti, N. Muñoz-Rivas, M.S. Navas, J.A. Nieto, A. Núñez-Ares, M.J. Núñez-Fernández, B. Obispo, M. Olid, M.C. Olivares, J.L. Orcastegui, M.D. Ortega-Recio, J. Osorio, S. Otalora, R. Otero, P. Parra, V. Parra, J.M. Pedrajas, A. Peinado, G. Pellejero, A. Pérez-Jacoiste, J.A. Porras, J. Portillo, A. Riera-Mestre, A. Rivas, F. Rivera, D.A. Rodríguez-Chiaradía, A. Rodríguez-Cobo, C. Rodríguez-Matute, J. Rogado, R. Rojo, V. Rosa, P. Ruiz-Artacho, N. Ruiz-Giménez, J. Ruiz-Ruiz, P. Ruiz-Sada, J.C. Sahuquillo, G. Salgueiro, A. Sampériz, R. Sánchez-Martínez, J.F. Sánchez-Muñoz-Torrero, T. Sancho, S. Soler, J.M. Suriñach, R. Tirado, M.I. Torres, C. Tolosa, J. Trujillo-Santos, F. Uresandi, B. Valero, R. Valle, J.R. Vela, G. Vidal, P. Villares, C. Zamora, P. Gutiérrez, F.J. Vázquez, M. Engelen, T. Vanassche, P. Vehamme, J. Hirmerova, R. Malý, N. Ait Abdallah, L. Bertoletti, A. Bura-Riviere, B. Crichi, P. Debourdeau, O. Espitia, D. Farge-Bancel, H. Helfer, I. Mahé, F. Moustafa, G. Poenou, S. Schellong, A. Braester, B. Brenner, I. Tzoran, F. Bilora, B. Brandolin, E. Bucherini, M. Ciammaichella, D. Colaizzo, P. Di Micco, E. Grandone, E. Imbalzano, R. Maida, D. Mastroiacovo, F. Pace, R. Pesavento, P. Prandoni, R. Quintavalla, A. Rocci, C. Siniscalchi, A. Tufano, A. Visonà, B. Zalunardo, A. Skride, S. Strautmane, A. Zaicenko, M. Ferreira, S. Fonseca, F. Martins, J. Meireles, M. Bosevski, H. Bounameaux, L. Mazzolai, J.A. Caprini, A.J. Tafur, I. Weinberg, H. Wilkins, and H.M. Bui
Subjects: Long-term treatment. low molecular weight heparin. vitamin k-antagonist. venous thrombosis. pulmonary embolism. deep vein thrombosis, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background: The use of low-molecular-weight heparin (LMWH) for long-term therapy of venous thromboembolism (VTE) in patients without cancer has not been consistently evaluated. Methods: We used the data in the RIETE registry to compare the 3-month outcomes (VTE recurrences, major bleeding or death) in non-cancer patients with VTE, according to long-term therapy with LMWH or vitamin K antagonists (VKAs). Results: As of March 2018, 14,582 non-cancer patients with VTE had received initial therapy with LMWH and then switched to VKAs, while 9151 were prescribed LMWH for initial and long-term therapy. Overall, 11,494 had initially presented with pulmonary embolism (PE) and 12,239 with isolated deep vein thrombosis (DVT). Among 11,494 patients initially presenting with PE, 84 had VTE recurrences, 204 major bleeding and 406 died. Among 12,239 patients with isolated DVT, 133 developed VTE recurrences, 137 bled and 289 died. On propensity score analysis, PE patients on long-term LMWH therapy were at increased risk for PE recurrences (OR: 3.30; 95%CI: 1.67–6.48), major bleeding (OR: 1.68; 95%CI: 1.21–2.32) or death (OR: 3.16; 95%CI: 2.43–4.09) compared with those receiving VKAs. In patients with DVT, those on long-term LMWH also were at increased risk for PE recurrences (OR: 2.31; 95%CI: 1.13–4.73), major bleeding (OR 2.28; 95%CI: 1.51–3.44) or death (OR: 2.32; 95%CI: 1.54–3.51). Conclusions: In the RIETE non-cancer patients with VTE, long-term therapy with VKAs was associated with a lower risk for recurrences, major bleeding or death.
Published: 2020
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3. Heart Rate and Mortality in Patients With Acute Symptomatic Pulmonary Embolism

Author: G. Pellejero, Jose Gutierrez, R. Malý, M. Basaglia, L. Chasco, P. Suchon, R. Le Mao, Laurent Bertoletti, F. Martins, J. Caprini, A. Braester, F. Galeano-Valle, Hanh My Bui, J. Alonso, Y. Sato, G. Vidal, Y. Nishimoto, C. Tolosa, E. Nofuentes-Pérez, A.M. Díaz-Brasero, N. Ait Abdallah, M.D. Adarraga, R. Sánchez-Martínez, L. Font, Raquel López-Reyes, Inna Tzoran, Karine Lacut, J. del Toro, Andris Skride, Ana Jaureguizar, Joseph A. Caprini, C. Amado, R. García de la Garza, A.M. Camon, S. Merla, Luciano López-Jiménez, G. Salgueiro, Sebastian Schellong, Alfonso Muriel, F. Bilora, S. Lainez-Justo, B. Suárez-Rodríguez, Carme Font, F. Beddar Chaib, I. Francisco, C. Jiménez-Alfaro, P. Azcarate-Agüero, Maurizio Ciammaichella, J.A. Porras, N. Vo Hong, F. Martín-Martos, Dominique Farge-Bancel, D. Farge-Bancel, José Luis Lobo, M. Giménez-Suau, E. Grau, F. García-Bragado, Ángeles Blanco-Molina, Carmen Fernández-Capitán, María del Carmen Díaz-Pedroche, C. Grange, Adriana Visonà, L. Guirado, P. Villares, P. López-Miguel, José María Pedrajas, S. Accassat, Beatriz Valero, B. Crichi, Juan J. López-Núñez, Luis Jara-Palomares, G. Sarlon-Bartoli, J. Lima, C. Bortoluzzi, Alicia Lorenzo, C. de Ancos, M.A. Fidalgo, Philippe Debourdeau, Pablo Javier Marchena, C. Rodríguez-Matute, A.I. Farfán-Sedano, José Luis Fernández-Reyes, J.C. Escribano, Juan I. Arcelus, M. Barrón, I. Quere, Remedios Otero, A. De Angelis, P. Morange, Peter Verhamme, G. Kenet, P. Prandoni, Pedro Ruiz-Artacho, C. Siniscalchi, A. Zaicenko, M. Olid-Velilla, C. García-Díaz, B. Barrón-Andrés, T. Sancho, Fernando Uresandi, Javier Trujillo-Santos, A. Muñoz-Blanco, A. Villalobos, A. Dubois-Silva, J. Moisés, J. Osorio, M.I. Mercado, J.M. Suriñach, M.A. Aibar, M.D. Joya, Cihan Ay, J.A. Díaz-Peromingo, H. Bounameaux, Diego Martínez-Urbistondo, Thomas Vanassche, L. Bertoletti, Marijan Bosevski, Farès Moustafa, M. Martín del Pozo, J.F. Sánchez-Muñoz-Torrero, H.M. Bui, Ingrid Pabinger, M.C. Olivares, M. García de Herreros, M.J. Núñez-Fernández, B. Zalunardo, J.F. Varona, Stephan Nopp, Behnood Bikdeli, B. Brandolin, B. Bikdeli, Olga Madridano, Manuel Monreal, M.J. Jaras, Alessandra Bura-Rivière, Abílio Reis, J. Portillo, O. Espitia, J. Catella, Aitor Ballaz, F. Esposito, R. Barba, R. Valle, H. Helfer, I. Tzoran, J.B. López-Sáez, P. Ruiz-Artacho, M.A. García, J. Aibar, C. Gómez-Cuervo, C. Gabara, A. Latorre, J. Ruiz-Ruiz, Benjamin Brenner, S. Fonseca, S. Schellong, Raffaele Pesavento, Barry M. Brenner, Silvia Soler, Paolo Prandoni, Victor F. Tapson, Ana Maestre, Pierpaolo Di Micco, M. Muñoz, J. Criado, D. Jiménez, Antonella Tufano, G. Krstevski, B. Valero, Henri Bounameaux, M.I. Torres, G. Poenou, Isabelle Mahé, Aída Gil-Díaz, A. Asuero, S. Otalora, V. Rosa, L. Vela, E. Imbalzano, C. Vandenbriele, C. Barbagelata, Jana Hirmerova, J. Meireles, David Jiménez, Lucia Mazzolai, L. Hernández-Blasco, M. Bosevski, Gili Kenet, C. Mella, M. Monreal, J.R. Vela, P. Di Micco, Carlos Zamora, K. Flores, P. Demelo-Rodríguez, Radovan Malý, J. Birzulis, J.A. Nieto, J. Castro, M.V. Di Campli, Francis Couturaud, Raquel Barba, Jaureguizar, A., Jimenez, D., Bikdeli, B., Ruiz-Artacho, P., Muriel, A., Tapson, V., Lopez-Reyes, R., Valero, B., Kenet, G., Monreal, M., Prandoni, P., Brenner, B., Farge-Bancel, D., Barba, R., Di Micco, P., Bertoletti, L., Schellong, S., Tzoran, I., Reis, A., Bosevski, M., Bounameaux, H., Maly, R., Verhamme, P., Caprini, J. A., Bui, H. M., Adarraga, M. D., Aibar, J., Aibar, M. A., Alonso, J., Amado, C., Arcelus, J. I., Asuero, A., Azcarate-Aguero, P., Ballaz, A., Barbagelata, C., Barron, M., Barron-Andres, B., Blanco-Molina, A., Beddar Chaib, F., Camon, A. M., Castro, J., Chasco, L., Criado, J., de Ancos, C., del Toro, J., Demelo-Rodriguez, P., Diaz-Brasero, A. M., Diaz-Pedroche, M. C., Diaz-Peromingo, J. A., Di Campli, M. V., Dubois-Silva, A., Escribano, J. C., Esposito, F., Farfan-Sedano, A. I., Fernandez-Capitan, C., Fernandez-Reyes, J. L., Fidalgo, M. A., Flores, K., Font, C., Font, L., Francisco, I., Gabara, C., Galeano-Valle, F., Garcia, M. A., Garcia-Bragado, F., Garcia de Herreros, M., Garcia de la Garza, R., Garcia-Diaz, C., Gil-Diaz, A., Gomez-Cuervo, C., Gimenez-Suau, M., Grau, E., Guirado, L., Gutierrez, J., Hernandez-Blasco, L., Jara-Palomares, L., Jaras, M. J., Jimenez-Alfaro, C., Joya, M. D., Lainez-Justo, S., Latorre, A., Lima, J., Lobo, J. L., Lopez-Jimenez, L., Lopez-Miguel, P., Lopez-Nunez, J. J., Lopez-Saez, J. B., Lorenzo, A., Madridano, O., Maestre, A., Marchena, P. J., Martin del Pozo, M., Martin-Martos, F., Martinez-Urbistondo, D., Mella, C., Mercado, M. I., Moises, J., Munoz, M., Munoz-Blanco, A., Nieto, J. A., Nofuentes-Perez, E., Nunez-Fernandez, M. J., Olid-Velilla, M., Olivares, M. C., Osorio, J., Otalora, S., Otero, R., Pedrajas, J. M., Pellejero, G., Porras, J. A., Portillo, J., Rodriguez-Matute, C., Rosa, V., Ruiz-Ruiz, J., Salgueiro, G., Sanchez-Martinez, R., Sanchez-Munoz-Torrero, J. F., Sancho, T., Soler, S., Suarez-Rodriguez, B., Surinach, J. M., Torres, M. I., Tolosa, C., Trujillo-Santos, J., Uresandi, F., Valle, R., Varona, J. F., Vela, L., Vela, J. R., Vidal, G., Villalobos, A., Villares, P., Zamora, C., Ay, C., Nopp, S., Pabinger, I., Vanassche, T., Vandenbriele, C., Hirmerova, J., Accassat, S., Ait Abdallah, N., Bura-Riviere, A., Catella, J., Couturaud, F., Crichi, B., Debourdeau, P., Espitia, O., Grange, C., Helfer, H., Lacut, K., Le Mao, R., Mahe, I., Morange, P., Moustafa, F., Poenou, G., Sarlon-Bartoli, G., Suchon, P., Quere, I., Braester, A., Basaglia, M., Bilora, F., Bortoluzzi, C., Brandolin, B., Ciammaichella, M., De Angelis, A., Imbalzano, E., Merla, S., Pesavento, R., Siniscalchi, C., Tufano, A., Visona, A., Vo Hong, N., Zalunardo, B., Nishimoto, Y., Sato, Y., Birzulis, J., Skride, A., Zaicenko, A., Fonseca, S., Martins, F., Meireles, J., Krstevski, G., and Mazzolai, L.
Subjects: Male, Registrie, Pulmonary and Respiratory Medicine, medicine.medical_specialty, pulmonary embolism, Critical Care and Intensive Care Medicine, Logistic regression, Heart Rate, Internal medicine, Heart rate, medicine, In patient, Aged, Aged, 80 and over, business.industry, medicine.disease, mortality, Pulmonary embolism, Prospective Studie, Increased risk, Spain, Cardiology, Positive relationship, Female, Cardiology and Cardiovascular Medicine, business, Human
Abstract: Background: The association between heart rate (HR) and pulmonary embolism (PE) outcomes has not been well studied. Furthermore, optimal cutoffs to identify low-risk and intermediate- to high-risk patients are not well known. Research Question: Does an association exist between baseline HR and PE outcome across the continuum of HR values? Study Design and Methods: The current study included 44,331 consecutive nonhypotensive patients with symptomatic PE from the Registro Informatizado de la Enfermedad TromboEmbólica registry between 2001 and 2021. Outcomes included 30-day all-cause and PE-specific mortality. We used hierarchical logistic regression to assess the association between admission HR and outcomes. Results: A positive relationship was found between admission HR and 30-day all-cause and PE-related mortality. Considering an HR of 80 to 99 beats/min as a reference, patients in the higher HR strata showed higher rates of all-cause death (adjusted OR, 1.5 for HR of 100-109 beats/min; adjusted OR, 1.7 for HR of 110-119 beats/min; adjusted OR, 1.9 for HR of 120-139 beats/min; and adjusted OR, 2.4 for HR of ≥ 140 beats/min). Patients in the lower strata of HR showed significantly lower rates of 30-day all-cause mortality compared with the same reference group (adjusted OR, 0.6 for HR of 60-79 beats/min; and adjusted OR, 0.5 for HR of < 60 beats/min). The findings for 30-day PE-related mortality were similar. For identification of low-risk patients, a cutoff value of 80 beats/min (vs 110 beats/min) increased the sensitivity of the simplified Pulmonary Embolism Severity Index (sPESI) from 93.4% to 98.8%. For identification of intermediate- to high-risk patients, a cutoff value of 140 beats/min (vs 110 beats/min) increased the specificity of the Bova score from 93.2% to 98.0%. Interpretation: In nonhypotensive patients with acute symptomatic PE, a high HR portends an increased risk of all-cause and PE-related mortality. Modifying the HR cutoff in the sPESI and the Bova score improves prognostication of patients with PE.
Published: 2022

4. Enoxaparin versus dalteparin or tinzaparin in patients with cancer and venous thromboembolism: The RIETECAT study

Author: Trujillo-Santos J, Farge-Bancel D, Pedrajas JM, Gómez-Cuervo C, Ballaz A, Braester A, Mahé I, Villalobos A, Porras JA, Monreal M, RIETE Investigators, M D Adarraga, J Aibar, M A Aibar, C Amado, J I Arcelus, A Asuero, R Barba, C Barbagelata, M Barrón, B Barrón-Andrés, A Blanco-Molina, E Botella, A M Camon, I Casado, J Castro, M Castro, L Chasco, J Criado, C de Ancos, J Del Toro, P Demelo-Rodríguez, A M Díaz-Brasero, J A Díaz-Peromingo, M V Di Campli, A Dubois-Silva, J C Escribano, F Espósito, C Falgá, A I Farfán-Sedano, C Fernández-Capitán, J L Fernández-Reyes, M A Fidalgo, K Flores, C Font, L Font, I Francisco, C Gabara, F Galeano-Valle, M A García, F García-Bragado, M García de Herreros, R García de la Garza, C García-Díaz, R García-Hernáez, A García-Raso, A Gil-Díaz, M Giménez-Suau, E Grau, L Guirado, J Gutiérrez, L Hernández-Blasco, E Hernando, L Jara-Palomares, M J Jaras, D Jiménez, R Jiménez, C Jiménez-Alfaro, M D Joya, S Lainez-Justo, A Latorre, J Lima, P Llamas, J L Lobo, L López-Jiménez, P López-Miguel, J J López-Núñez, R López-Reyes, J B López-Sáez, A Lorenzo, O Madridano, A Maestre, P J Marchena, F Martín-Martos, D Martínez-Urbistondo, C Mella, M I Mercado, J Moisés, M V Morales, A Muñoz-Blanco, N Muñoz-Rivas, M S Navas, J A Nieto, E Nofuentes-Pérez, M J Núñez-Fernández, B Obispo, M Olid, M C Olivares, J L Orcastegui, J Osorio, S Otalora, R Otero, D Paredes, P Parra, G Pellejero, J Portillo, F Rivera-Civico, D A Rodríguez-Chiaradía, C Rodríguez-Matute, J Rogado, V Rosa, P Ruiz-Artacho, N Ruiz-Giménez, J Ruiz-Ruiz, P Ruiz-Sada, G Salgueiro, R Sánchez-Martínez, J F Sánchez-Muñoz-Torrero, T Sancho, S Soler, B Suárez-Rodríguez, J M Suriñach, R Tirado, M I Torres, C Tolosa, F Uresandi, B Valero, R Valle, J F Varona, G Vidal, P Villares, C Zamora, M Engelen, T Vanassche, P Verhamme, J Hirmerova, R Malý, N Ait Abdallah, L Bertoletti, A Bura-Riviere, J Catella, F Couturaud, B Crichi, P Debourdeau, O Espitia, N Falvo, H Helfer, K Lacut, R Le Mao, F Moustafa, G Poenou, I Quere, S Schellong, B Brenner, I Tzoran, R Nikandish, F Bilora, B Brandolin, M Ciammaichella, P Di Micco, E Imbalzano, R Maida, F Pace, R Pesavento, P Prandoni, R Quintavalla, A Rocci, C Siniscalchi, A Tufano, A Visonà, B Zalunardo, J Birzulis, A Skride, A Zaicenko, S Fonseca, F Martins, J Meireles, M Bosevski, H Bounameaux, L Mazzolai, C I Ochoa-Chaar, I Weinberg, H M Bui, J, Trujillo-Santo, D, Farge-Bancel, Jm, Pedraja, C, Gómez-Cuervo, A, Ballaz, A, Braester, I, Mahé, A, Villalobo, Ja, Porra, M, Monreal, Investigators, Riete, D Adarraga, M, Aibar, J, A Aibar, M, Amado, C, I Arcelus, J, Asuero, A, Barba, R, Barbagelata, C, Barrón, M, Barrón-Andrés, B, Blanco-Molina, A, Botella, E, M Camon, A, Casado, I, Castro, J, Castro, M, Chasco, L, Criado, J, de Ancos, C, Del Toro, J, Demelo-Rodríguez, P, M Díaz-Brasero, A, A Díaz-Peromingo, J, V Di Campli, M, Dubois-Silva, A, C Escribano, J, Espósito, F, Falgá, C, I Farfán-Sedano, A, Fernández-Capitán, C, L Fernández-Reyes, J, A Fidalgo, M, Flores, K, Font, C, Font, L, Francisco, I, Gabara, C, Galeano-Valle, F, A García, M, García-Bragado, F, García de Herreros, M, García de la Garza, R, García-Díaz, C, García-Hernáez, R, García-Raso, A, Gil-Díaz, A, Giménez-Suau, M, Grau, E, Guirado, L, Gutiérrez, J, Hernández-Blasco, L, Hernando, E, Jara-Palomares, L, J Jaras, M, Jiménez, D, Jiménez, R, Jiménez-Alfaro, C, D Joya, M, Lainez-Justo, S, Latorre, A, Lima, J, Llamas, P, L Lobo, J, López-Jiménez, L, López-Miguel, P, J López-Núñez, J, López-Reyes, R, B López-Sáez, J, Lorenzo, A, Madridano, O, Maestre, A, J Marchena, P, Martín-Martos, F, Martínez-Urbistondo, D, Mella, C, I Mercado, M, Moisés, J, V Morales, M, Muñoz-Blanco, A, Muñoz-Rivas, N, S Navas, M, A Nieto, J, Nofuentes-Pérez, E, J Núñez-Fernández, M, Obispo, B, Olid, M, C Olivares, M, L Orcastegui, J, Osorio, J, Otalora, S, Otero, R, Paredes, D, Parra, P, Pellejero, G, Portillo, J, Rivera-Civico, F, A Rodríguez-Chiaradía, D, Rodríguez-Matute, C, Rogado, J, Rosa, V, Ruiz-Artacho, P, Ruiz-Giménez, N, Ruiz-Ruiz, J, Ruiz-Sada, P, Salgueiro, G, Sánchez-Martínez, R, F Sánchez-Muñoz-Torrero, J, Sancho, T, Soler, S, Suárez-Rodríguez, B, M Suriñach, J, Tirado, R, I Torres, M, Tolosa, C, Uresandi, F, Valero, B, Valle, R, F Varona, J, Vidal, G, Villares, P, Zamora, C, Engelen, M, Vanassche, T, Verhamme, P, Hirmerova, J, Malý, R, Ait Abdallah, N, Bertoletti, L, Bura-Riviere, A, Catella, J, Couturaud, F, Crichi, B, Debourdeau, P, Espitia, O, Falvo, N, Helfer, H, Lacut, K, Le Mao, R, Moustafa, F, Poenou, G, Quere, I, Schellong, S, Brenner, B, Tzoran, I, Nikandish, R, Bilora, F, Brandolin, B, Ciammaichella, M, Di Micco, P, Imbalzano, E, Maida, R, Pace, F, Pesavento, R, Prandoni, P, Quintavalla, R, Rocci, A, Siniscalchi, C, Tufano, A, Visonà, A, Zalunardo, B, Birzulis, J, Skride, A, Zaicenko, A, Fonseca, S, Martins, F, Meireles, J, Bosevski, M, Bounameaux, H, Mazzolai, L, I Ochoa-Chaar, C, Weinberg, I, and M Bui, H
Subjects: dalteparin, recurrences, tinzaparin, venous thromboembolism, cancer, enoxaparin, Hematology, cohort, LMWH
Abstract: Venous thromboembolism (VTE) is a frequent complication in patients with cancer and a leading cause of morbidity and death. The objective of the RIETECAT study was to compare the long-term effectiveness and safety of enoxaparin versus dalteparin or tinzaparin for the secondary prevention of VTE in adults with active cancer. We used the data from the multicenter, multinational RIETE registry to compare the rates of VTE recurrences, major bleeding, or death over 6 months in patients with active cancer and acute VTE using full doses of enoxaparin versus dalteparin or tinzaparin, and a multivariable Cox proportional hazard model was used to analyze the primary end point. From January 2009 to June 2018, 4451 patients with active cancer received full doses of the study drugs: enoxaparin, 3526 patients; and dalteparin or tinzaparin, 925 (754 + 171) patients. There was limited difference in VTE recurrences (2.0% vs 2.5%) and mortality rate (19% vs 17%) between the enoxaparin and dalteparin or tinzaparin subgroups. However, there was a slight numerical increase in major bleeding (3.1% vs 1.9%). Propensity score matching confirmed that there were no differences in the risk for VTE recurrences (adjusted hazard ratio [aHR], 0.81; 95% confidence interval [CI], 0.48-1.38), major bleeding (aHR, 1.40; 95% CI, 0.80-2.46), or death (aHR, 1.07; 95% CI, 0.88-1.30) between subgroups. In RIETECAT, in patients with cancer and VTE receiving full-dose enoxaparin or dalteparin or tinzaparin, no statistically significant differences were observed regarding effectiveness and safety outcomes over a 6-month period.
Published: 2022

5. Symptomatic subsegmental versus more central pulmonary embolism: Clinical outcomes during anticoagulation

Author: Carmen Fernández‐Capitán, Ana Rodriguez Cobo, David Jiménez, Olga Madridano, Maurizio Ciammaichella, Esther Usandizaga, Remedios Otero, Pierpaolo Di Micco, Farès Moustafa, Manuel Monreal, M.D. Adarraga, M.A. Aibar, M. Alfonsa, J.I. Arcelus, P. Azcarate‐Agüero, A. Ballaz, P. Baños, R. Barba, M. Barrón, B. Barrón‐Andrés, J. Bascuñana, A. Blanco‐Molina, A.M. Camón, L. Chasco, A.J. Cruz, R. del Pozo, J. de Miguel, J. del Toro, M.C. Díaz‐Pedroche, J.A. Díaz‐Peromingo, J.C. Escribano, C. Falgá, C. Fernández‐Aracil, M.A. Fidalgo, C. Font, L. Font, M.A. García, F. García‐Bragado, M. García‐Morillo, A. García‐Raso, A.I. García‐Sánchez, O. Gavín, I. Gaya, C. Gómez, V. Gómez, J. González, E. Grau, R. Guijarro, J. Gutiérrez, G. Hernández‐Comes, L. Hernández‐Blasco, E. Hernando, L. Jara‐Palomares, M.J. Jaras, D. Jiménez, M.D. Joya, J. Lima, P. Llamas, J.L. Lobo, R. López‐Reyes, J.B. López‐Sáez, M.A. Lorente, A. Lorenzo, M. Lumbierres, A. Maestre, P.J. Marchena, F. Martín‐Martos, M. Martín‐Romero, M.V. Morales, J.A. Nieto, S. Nieto, A. Núñez, M.J. Núñez, M. Odriozola, M.C. Olivares, S. Otalora, J.M. Pedrajas, G. Pellejero, C. Pérez‐Ductor, M.L. Peris, I. Pons, J.A. Porras, L. Ramírez, O. Reig, A. Riera‐Mestre, D. Riesco, A. Rivas, M.A. Rodríguez‐Dávila, V. Rosa, P. Ruiz‐Artacho, J.C. Sahuquillo, M.C. Sala‐Sainz, A. Sampériz, R. Sánchez‐Martínez, S. Soler, B. Sopeña, J.M. Suriñach, C. Tolosa, M.I. Torres, J. Troya, J. Trujillo‐Santos, F. Uresandi, B. Valero, R. Valle, J. Vela, L. Vela, G. Vidal, A. Villalobos, T. Vanassche, C. Vandenbriele, P. Verhamme, H.H.B. Yoo, P. Wells, J. Hirmerova, R. Malý, E. Salgado, L. Bertoletti, A. Bura‐Riviere, N. Falvo, D. Farge‐Bancel, A. Hij, I. Mahé, I. Quere, A. Braester, B. Brenner, M. Ellis, I. Tzoran, G. Antonucci, G. Barillari, F. Bilora, C. Bortoluzzi, E. Bucherini, A. Camerota, C. Cattabiani, F. Dentali, R. Duce, M. Giorgi‐Pierfranceschi, E. Grandone, E. Imbalzano, G. Lessiani, R. Maida, D. Mastroiacovo, F. Pace, R. Pesavento, M. Pesavento, R. Poggio, P. Prandoni, R. Quintavalla, A. Rocci, C. Siniscalchi, E. Tiraferri, D. Tonello, A. Visonà, B. Zalunardo, V. Gibietis, A. Skride, B. Vitola, A. Alatri, H. Bounameaux, L. Calanca, and L. Mazzolai
Subjects: Subsegmental, medicine.medical_specialty, anticoagulant, deep vein thrombosis, outcomes, pulmonary embolism, subsegmental, medicine.drug_class, Deep vein, Outcomes, Deep vein thrombosis, Internal medicine, medicine, First episode, lcsh:RC633-647.5, business.industry, Pulmonary embolism, Hazard ratio, Anticoagulant, Anticoagulants, lcsh:Diseases of the blood and blood-forming organs, Hematology, Heparin, Original Articles ‐ Thrombosis, medicine.disease, Thrombosis, Confidence interval, medicine.anatomical_structure, Cardiology, Original Article, business, medicine.drug
Abstract: The RIETE Investigators., [Background] The optimal therapy of patients with acute subsegmental pulmonary embolism (PE) is controversial., [Methods] We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to compare the rate of symptomatic PE recurrences during anticoagulation in patients with subsegmental, segmental, or more central PEs. [Results] Among 15 963 patients with a first episode of symptomatic PE, 834 (5.2%) had subsegmental PE, 3797 (24%) segmental, and 11 332 (71%) more central PE. Most patients in all subgroups received initial therapy with low‐molecular‐weight heparin, and then most switched to vitamin K antagonists. Median duration of therapy was 179, 185, and 204 days, respectively. During anticoagulation, 183 patients developed PE recurrences, 131 developed deep vein thrombosis (DVT), 543 bled, and 1718 died (fatal PE, 135). The rate of PE recurrences was twofold higher in patients with subsegmental PE than in those with segmental (hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.16‐3.85) or more central PE (HR, 1.89; 95% CI, 1.12‐3.13). On multivariable analysis, patients with subsegmental PE had a higher risk for PE recurrences than those with central PE (adjusted HR, 1.75; 95% CI, 1.02‐3.03). After stratifying patients with subsegmental PE according to ultrasound imaging in the lower limbs, the rate of PE recurrences was similar in patients with DVT, in patients without DVT, and in those with no ultrasound imaging. [Conclusions] Our study reveals that the risk for PE recurrences in patients with segmental PE is not lower than in those with more central PE, thus suggesting that the risk of PE recurrences is not influenced by the anatomic location of PE.
Published: 2021

6. Incidence of major adverse cardiovascular events among patients with provoked and unprovoked venous thromboembolism: Findings from the Registro Informatizado de Enfermedad Tromboembólica Registry

Author: Fernando J. Vazquez, Hanh My Bui, R. Maida, Alicia Lorenzo, Iva Golemi, Remedios Otero, R. Otero, G. Pellejero, Pilar Llamas, M.J. Soto, J. del Toro, Inna Tzoran, K. Sablinskis, Carmine Siniscalchi, E. Bucherini, G. Vidal, Juan J. López-Núñez, N. Mumoli, J.M. Suriñach, S. Ruiz-Alcaraz, H. Bounameaux, Jose Gutierrez, E. Salgado, C. Carrasco, I. Gaya, R. Parisi, M.D. Adarraga, Peter Verhamme, Meritxell Mellado, N. Vo Hong, I. Jou, M.C. Gayol, M. García-Morillo, Marco Fresa, Luis Jara-Palomares, Daniela Mastroiacovo, M. Sablinskis, A. Rodríguez-Hernández, R. Díaz-Simón, Miguel Ángel Aibar, David Jiménez, Ángel Sampériz, Raquel López-Reyes, Isabelle Mahé, P. Ruiz-Sada, Martin Ellis, J.A. Porras, Omer Iftikhar, Ángeles Blanco-Molina, J. Aibar, R. Malý, M. Pérez-Pinar, Adriana Visonà, L. Guirado, Carme Font, M. Encabo, M.A. Lorente, María del Carmen Díaz-Pedroche, F. García-Bragado, Gianfranco Lessiani, P. Prandoni, T. Sancho, I. Sanoja, A. Tafur, Manuel Monreal, M.J. Jaras, Alessandra Bura-Rivière, Javier Trujillo-Santos, E. Grau, J. Castro, E. Imbalzano, P. Demelo, A.M. Camon, P. López-Miguel, R. Quintavalla, Alfonso Tafur, Laurent Bertoletti, N. Falvo, J. Ruiz-Ruiz, M. Pinelli, M.A. Fidalgo, Pablo Javier Marchena, Anna Rocci, Aitor Ballaz, José González-Martínez, Andrei Braester, J.F. Sánchez-Muñoz-Torrero, J. Bascuñana, Philippe Debourdeau, J.M. Pedrajas, Giovanni Barillari, C. Vandenbriele, H.M. Bui, M. Iglesias, M. Bosevski, Raffaele Pesavento, Barry M. Brenner, Antonella Tufano, Silvia Soler, F. Pace, Paolo Prandoni, L. Font, L. Bertoletti, A. García-Raso, G. Pérez-Rus, V. Salazar, Juan I. Arcelus, Barbara Ney, Lauren Cote, Raquel Barba, B. Brandolin, Luciano López-Jiménez, Pierpaolo Di Micco, C. Fernández-Capitán, M. Martín Fernández, M.A. García, R. Barba, R. Valle, Carmen Fernández-Capitán, M.L. Pesce, J.M. Martín-Guerra, D. Farge-Bancel, Conxita Falga, M. Lumbierres, Fernando Uresandi, Benjamin Brenner, Elvira Grandone, Mónica Loring, Dominique Farge-Bancel, A. Lalueza, Cristiano Bortoluzzi, M.J. Núñez, M.C. Olivares, Maurizio Ciammaichella, M.D. Joya, Agustina Rivas, Joan Carles Sahuquillo, C.M. Rubio, Abílio Reis, A. Vilaseca, P. Di Micco, Jana Hirmerova, M. Monreal, José María Pedrajas, M.L. Peris, M.A. Rodríguez-Dávila, S. Otalora, F. Bilora, E. Usandizaga, C. Amado, Pedro Ruiz-Artacho, Roberto Quintavalla, B. Barrón-Andrés, P.M. Azcarate, I. Benzidia, Lucia Mazzolai, P. Gutiérrez, Jorge Lima, O. Gavín, Thomas Vanassche, Farès Moustafa, V. Gómez, Andris Skride, Joseph A. Caprini, A. Gil-Díaz, Behnood Bikdeli, A. Hij, L. Rodríguez-Fernández, Olga Madridano, C. Rodríguez-Martín, C. de Ancos, Ana Maestre, M.C. Fernández-Criado, Henri Bounameaux, M.I. Torres, Radovan Malý, A.I. Farfán, I. Tzoran, J.A. Díaz-Peromingo, J.B. López-Sáez, M. Barrón, C. Tolosa, José Luis Lobo, Francesco Dentali, M. Zdraveska, Marijan Bosevski, L.M. Hernández Blasco, J.A. Nieto, Ma Morales, J. Caprini, Golemi, I., Cote, L., Iftikhar, O., Brenner, B., Tafur, A., Bikdeli, B., Fernandez-Capitan, C., Pedrajas, J. M., Otero, R., Quintavalla, R., Monreal, M., Prandoni, P., Farge-Bancel, D., Barba, R., Di Micco, P., Bertoletti, L., Tzoran, I., Reis, A., Bounameaux, H., Maly, R., Verhamme, P., Bosevski, M., Caprini, J. A., Bui, H. M., Adarraga, M. D., Aibar, M. A., Aibar, J., Amado, C., Arcelus, J. I., Azcarate, P. M., Ballaz, A., Barron, M., Barron-Andres, B., Bascunana, J., Blanco-Molina, A., Camon, A. M., Carrasco, C., Castro, J., de Ancos, C., del Toro, J., Demelo, P., Diaz-Pedroche, M. C., Diaz-Peromingo, J. A., Diaz-Simon, R., Encabo, M., Falga, C., Farfan, A. I., Fernandez-Criado, M. C., Fidalgo, M. A., Font, C., Font, L., Garcia, M. A., Garcia-Bragado, F., Garcia-Morillo, M., Garcia-Raso, A., Gavin, O., Gaya, I., Gayol, M. C., Gil-Diaz, A., Guirado, L., Gomez, V., Gonzalez-Martinez, J., Grau, E., Gutierrez, J., Hernandez Blasco, L. M., Iglesias, M., Jara-Palomares, L., Jaras, M. J., Jimenez, D., Jou, I., Joya, M. D., Lalueza, A., Lima, J., Llamas, P., Lobo, J. L., Lopez-Jimenez, L., Lopez-Miguel, P., Lopez-Nunez, J. J., Lopez-Reyes, R., Lopez-Saez, J. B., Lorente, M. A., Lorenzo, A., Loring, M., Lumbierres, M., Madridano, O., Maestre, A., Marchena, P. J., Martin-Guerra, J. M., Martin Fernandez, M., Mellado, M., Morales, M. V., Nieto, J. A., Nunez, M. J., Olivares, M. C., Otalora, S., Pellejero, G., Perez-Pinar, M., Perez-Rus, G., Peris, M. L., Pesce, M. L., Porras, J. A., Rivas, A., Rodriguez-Davila, M. A., Rodriguez-Fernandez, L., Rodriguez-Hernandez, A., Rodriguez-Martin, C., Rubio, C. M., Ruiz-Alcaraz, S., Ruiz-Artacho, P., Ruiz-Ruiz, J., Ruiz-Sada, P., Sahuquillo, J. C., Salazar, V., Samperiz, A., Sanchez-Munoz-Torrero, J. F., Sancho, T., Sanoja, I., Soler, S., Soto, M. J., Surinach, J. M., Tolosa, C., Torres, M. I., Trujillo-Santos, J., Uresandi, F., Usandizaga, E., Valle, R., Vidal, G., Gutierrez, P., Vazquez, F. J., Vilaseca, A., Vanassche, T., Vandenbriele, C., Hirmerova, J., Salgado, E., Benzidia, I., Bura-Riviere, A., Debourdeau, P., Falvo, N., Hij, A., Mahe, I., Moustafa, F., Braester, A., Ellis, M., Barillari, G., Bilora, F., Bortoluzzi, C., Brandolin, B., Bucherini, E., Ciammaichella, M., Dentali, F., Grandone, E., Imbalzano, E., Lessiani, G., Maida, R., Mastroiacovo, D., Mumoli, N., Vo Hong, N., Pace, F., Parisi, R., Pesavento, R., Pinelli, M., Rocci, A., Siniscalchi, C., Tufano, A., Visona, A., Skride, A., Sablinskis, K., Sablinskis, M., Zdraveska, M., Fresa, M., Ney, B., Mazzolai, L., and Caprini, J.
Subjects: Registrie, Male, Time Factors, Databases, Factual, Major adverse cardiovascular event, 030204 cardiovascular system & hematology, Coronary artery disease, 0302 clinical medicine, Retrospective Studie, Cardiovascular Disease, Major adverse limb events, Medicine, Registries, 030212 general & internal medicine, Myocardial infarction, Stroke, Incidence, Incidence (epidemiology), Hazard ratio, Major adverse limb event, Heart Disease Risk Factor, Middle Aged, Prognosis, Cardiovascular Diseases, Major adverse cardiovascular events, Female, VTE, Cardiology and Cardiovascular Medicine, Human, Provoked, Venous thromboembolism, medicine.medical_specialty, Time Factor, Prognosi, Risk Assessment, 03 medical and health sciences, Internal medicine, Humans, cardiovascular diseases, Aged, Retrospective Studies, business.industry, Unstable angina, medicine.disease, equipment and supplies, Confidence interval, Heart Disease Risk Factors, Surgery, business, Mace
Abstract: Registro Informatizado de Enfermedad Tromboembólica Investigators., [Objective] Overlap exists between the risk factors for coronary artery disease and venous thromboembolism (VTE). However, a paucity of data is available on the incidence of major acute cardiovascular events (MACE) and major adverse limb events (MALE) among patients presenting with VTE. Moreover, it is unknown whether the rate of cardiovascular outcomes differs among patients with unprovoked vs provoked VTE., [Methods] We analyzed the data from 2009 to 2017 in the Registro Informatizado de Enfermedad Tromboembólica registry, an ongoing, multicenter, international registry of consecutive patients with a diagnosis of objectively confirmed VTE. The query was restricted it to patients with data entry for the arterial outcomes. The baseline prevalence of coronary artery disease risk factors was compared between patients with provoked (ie, immobility, cancer, surgery, travel >6 hours, hormonal causes) and unprovoked VTE. After the initial VTE event, we followed up patients for the composite primary outcome of incident MACE (ie, stroke, myocardial infarction, unstable angina) and/or MALE (ie, major limb events). We used the χ2 test for baseline associations and a Cox proportional hazard for multivariate analysis. We used IBM SPSS, version 24 (IBM Corp, Armonk, NY) for statistical analysis. A P value of, [Results] We analyzed the data from 41,259 patients with VTE, of whom 22,633 (55.6%) had experienced a provoked VTE. During follow-up, the patients with provoked VTE were more likely to develop MACE or MALE than were patients with unprovoked VTE (hazard ratio [HR], 1.3; 95% confidence interval [CI], 1.1-1.5). The association of arterial events with recent immobility (HR, 1.4; 95% CI, 1.5-12.1) and cancer (HR, 1.7; 95% CI, 1.4-1.9) was strong. After adjusting for multiple conventional cardiovascular risk factors, provoked VTE, compared with unprovoked VTE, was significantly associated with an increased hazard for MACE (HR, 1.4; 95% CI, 1.1-1.7). Cancer remained a significant adjusted predictor for both MACE (HR, 1.7; 95% CI, 1.4-2.1) and MALE (HR, 2.1; 95% CI 1.01-4.6) in those with provoked VTE., [Conclusions] Among patients with VTE, provoked cases, specifically those with cancer-associated VTE, have an increased risk of major arterial events.
Published: 2020

7. Timing and characteristics of venous thromboembolism after noncancer surgery

Author: Manuela Expósito-Ruiz, Juan Ignacio Arcelus, Joseph A. Caprini, Cristina López-Espada, Alessandra Bura-Riviere, Cristina Amado, Mónica Loring, Daniela Mastroiacovo, Manuel Monreal, Paolo Prandoni, Benjamin Brenner, Dominique Farge-Bancel, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Sebastian Schellong, Inna Tzoran, Abilio Reis, Marijan Bosevski, Henri Bounameaux, Radovan Malý, Peter Verhamme, Hanh My Bui, M.D. Adarraga, M. Agud, J. Aibar, M.A. Aibar, C. Amado, J.I. Arcelus, C. Baeza, A. Ballaz, R. Barba, C. Barbagelata, M. Barrón, B. Barrón-Andrés, A. Blanco-Molina, E. Botella, A.M. Camon, S. Campos, I. Cañas, I. Casado, J. Castro, J. Criado, C. de Ancos, J. de Miguel, J. del Toro, P. Demelo-Rodríguez, C. Díaz-Pedroche, J.A. Díaz-Peromingo, J. Díez-Sierra, I.M. Domínguez, J.C. Escribano, C. Falgá, A.I. Farfán, K. Fernández de Roitegui, C. Fernández-Aracil, C. Fernández-Capitán, J.L. Fernández-Reyes, M.A. Fidalgo, K. Flores, C. Font, L. Font, I. Francisco, I. Furest, C. Gabara, F. Galeano-Valle, M.A. García, F. García-Bragado, R. García-Hernáez, A. García-Raso, O. Gavín-Sebastián, A. Gil-Díaz, C. Gómez-Cuervo, J. González-Martínez, E. Grau, M. Giménez-Suau, L. Guirado, J. Gutiérrez, L. Hernández-Blasco, E. Hernando, M. Herreros, L. Jara-Palomares, M.J. Jaras, D. Jiménez, R. Jiménez, M.D. Joya, I. Jou, A. Lalueza, R. Lecumberri, J. Lima, P. Llamas, J.L. Lobo, L. López-Jiménez, P. López-Miguel, J.J. López-Núñez, R. López-Reyes, J.B. López-Sáez, A. Lorenzo, M. Loring, O. Madridano, A. Maestre, P.J. Marchena, M. Martín del Pozo, F. Martín-Martos, C. Mella, M. Mellado, M.I. Mercado, J. Moisés, M. Monreal, M.V. Morales, A. Muñoz-Blanco, D. Muñoz-Guglielmetti, N. Muñoz-Rivas, J.A. Nieto, A. Núñez-Ares, M.J. Núñez-Fernández, B. Obispo, M.C. Olivares, J.L. Orcastegui, M.D. Ortega-Recio, J. Osorio, S. Otalora, R. Otero, D. Paredes, P. Parra, V. Parra, J.M. Pedrajas, G. Pellejero, D. Pesántez, J.A. Porras, J. Portillo, A. Riera-Mestre, A. Rivas, F. Rivera, A. Rodríguez-Cobo, C. Rodríguez-Matute, J. Rogado, V. Rosa, C.M. Rubio, P. Ruiz-Artacho, N. Ruiz-Giménez, J. Ruiz-Ruiz, P. Ruiz-Sada, J.C. Sahuquillo, G. Salgueiro, A. Sampériz, J.F. Sánchez-Muñoz-Torrero, T. Sancho, P. Sigüenza, S. Soler, J.M. Suriñach, M.I. Torres, C. Tolosa, J. Trujillo-Santos, F. Uresandi, R. Valle, J.R. Vela, G. Vidal, P. Villares, C. Zamora, P. Gutiérrez, F.J. Vázquez, T. Vanassche, C. Vandenbriele, P. Verhamme, J. Hirmerova, R. Malý, I. Benzidia, L. Bertoletti, A. Bura-Riviere, B. Crichi, P. Debourdeau, O. Espitia, D. Farge-Bancel, H. Helfer, I. Mahé, F. Moustafa, G. Poenou, S. Schellong, A. Braester, B. Brenner, I. Tzoran, F. Bilora, B. Brandolin, E. Bucherini, M. Ciammaichella, D. Colaizzo, P. Di Micco, E. Grandone, D. Marchi, D. Mastroiacovo, R. Maida, F. Pace, R. Pesavento, P. Prandoni, R. Quintavalla, N. Rinzivillo, A. Rocci, C. Siniscalchi, A. Tufano, A. Visonà, B. Zalunardo, V. Gibietis, D. Kigitovica, A. Skride, M. Ferreira, S. Fonseca, F. Martins, J. Meireles, M. Bosevski, G. Krstevski, H. Bounameaux, L. Mazzolai, J.A. Caprini, A.J. Tafur, I. Weinberg, H. Wilkins, H.M. Bui, Exposito-Ruiz, M., Arcelus, J. I., Caprini, J. A., Lopez-Espada, C., Bura-Riviere, A., Amado, C., Loring, M., Mastroiacovo, D., Monreal, M., Prandoni, P., Brenner, B., Farge-Bancel, D., Barba, R., Di Micco, P., Bertoletti, L., Schellong, S., Tzoran, I., Reis, A., Bosevski, M., Bounameaux, H., Maly, R., Verhamme, P., Bui, H. M., Adarraga, M. D., Agud, M., Aibar, J., Aibar, M. A., Baeza, C., Ballaz, A., Barbagelata, C., Barron, M., Barron-Andres, B., Blanco-Molina, A., Botella, E., Camon, A. M., Campos, S., Canas, I., Casado, I., Castro, J., Criado, J., de Ancos, C., de Miguel, J., Toro, J. D., Demelo-Rodriguez, P., Diaz-Pedroche, C., Diaz-Peromingo, J. A., Diez-Sierra, J., Dominguez, I. M., Escribano, J. C., Falga, C., Farfan, A. I., Fernandez de Roitegui, K., Fernandez-Aracil, C., Fernandez-Capitan, C., Fernandez-Reyes, J. L., Fidalgo, M. A., Flores, K., Font, C., Font, L., Francisco, I., Furest, I., Gabara, C., Galeano-Valle, F., Garcia, M. A., Garcia-Bragado, F., Garcia-Hernaez, R., Garcia-Raso, A., Gavin-Sebastian, O., Gil-Diaz, A., Gomez-Cuervo, C., Gonzalez-Martinez, J., Grau, E., Gimenez-Suau, M., Guirado, L., Gutierrez, J., Hernandez-Blasco, L., Hernando, E., Herreros, M., Jara-Palomares, L., Jaras, M. J., Jimenez, D., Jimenez, R., Joya, M. D., Jou, I., Lalueza, A., Lecumberri, R., Lima, J., Llamas, P., Lobo, J. L., Lopez-Jimenez, L., Lopez-Miguel, P., Lopez-Nunez, J. J., Lopez-Reyes, R., Lopez-Saez, J. B., Lorenzo, A., Madridano, O., Maestre, A., Marchena, P. J., Martin del Pozo, M., Martin-Martos, F., Mella, C., Mellado, M., Mercado, M. I., Moises, J., Morales, M. V., Munoz-Blanco, A., Munoz-Guglielmetti, D., Munoz-Rivas, N., Nieto, J. A., Nunez-Ares, A., Nunez-Fernandez, M. J., Obispo, B., Olivares, M. C., Orcastegui, J. L., Ortega-Recio, M. D., Osorio, J., Otalora, S., Otero, R., Paredes, D., Parra, P., Parra, V., Pedrajas, J. M., Pellejero, G., Pesantez, D., Porras, J. A., Portillo, J., Riera-Mestre, A., Rivas, A., Rivera, F., Rodriguez-Cobo, A., Rodriguez-Matute, C., Rogado, J., Rosa, V., Rubio, C. M., Ruiz-Artacho, P., Ruiz-Gimenez, N., Ruiz-Ruiz, J., Ruiz-Sada, P., Sahuquillo, J. C., Salgueiro, G., Samperiz, A., Sanchez-Munoz-Torrero, J. F., Sancho, T., Siguenza, P., Soler, S., Surinach, J. M., Torres, M. I., Tolosa, C., Trujillo-Santos, J., Uresandi, F., Valle, R., Vela, J. R., Vidal, G., Villares, P., Zamora, C., Gutierrez, P., Vazquez, F. J., Vanassche, T., Vandenbriele, C., Hirmerova, J., Benzidia, I., Crichi, B., Debourdeau, P., Espitia, O., Helfer, H., Mahe, I., Moustafa, F., Poenou, G., Braester, A., Bilora, F., Brandolin, B., Bucherini, E., Ciammaichella, M., Colaizzo, D., Grandone, E., Marchi, D., Maida, R., Pace, F., Pesavento, R., Quintavalla, R., Rinzivillo, N., Rocci, A., Siniscalchi, C., Tufano, A., Visona, A., Zalunardo, B., Gibietis, V., Kigitovica, D., Skride, A., Ferreira, M., Fonseca, S., Martins, F., Meireles, J., Krstevski, G., Mazzolai, L., Tafur, A. J., Weinberg, I., and Wilkins, H.
Subjects: Adult, Male, Registrie, medicine.medical_specialty, Time Factors, Time Factor, Duration of risk, 030204 cardiovascular system & hematology, Drug Administration Schedule, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, Deep vein thrombosi, Interquartile range, medicine, Humans, Registries, cardiovascular diseases, 030212 general & internal medicine, Aged, Venous Thrombosis, Benign disease, business.industry, Risk Factor, Incidence (epidemiology), Pulmonary embolism, Anticoagulant, Anticoagulants, Venous Thromboembolism, Heparin, Low-Molecular-Weight, Middle Aged, equipment and supplies, medicine.disease, Thrombosis, Surgery, Time course, Thromboprophylaxi, Female, Postoperative Complication, Cardiology and Cardiovascular Medicine, business, Venous thromboembolism, Human, Surgical patients
Abstract: Background Venous thromboembolism (VTE) is a major cause of morbidity and mortality postoperatively. The use of pharmacologic prophylaxis is effective in reducing the incidence of VTE. However, the prophylaxis is often discontinued at hospital discharge, especially for those with benign disease. The implications of this practice are not known. We assessed the data from a large, ongoing registry regarding the time course of VTE and outcomes after noncancer surgery. Methods We analyzed the RIETE (Computerized Registry on Venous Thromboembolism) registry, which includes data from consecutive patients with symptomatic confirmed VTE. In the present study, we focused on general surgical patients who had developed symptomatic postoperative VTE in the first 8 weeks after noncancer surgery. The main objective was to assess the interval between surgery and the occurrence of VTE. Additional variables included the clinical presentation associated with the event, the use of thrombosis prophylaxis, and unfavorable outcomes. Results The data from 3296 patients were analyzed. The median time from surgery to the detection of VTE was 16 days (interquartile range, 8-30 days). Of the VTE events, 77% were detected after the first postoperative week and 27% after 4 weeks. Overall, 43.9% of the patients with VTE had received pharmacologic prophylaxis after surgery for a median of 8 days (interquartile range, 5-14 days), and three quarters of the VTE events were detected after pharmacologic prophylaxis had been discontinued. Overall, 54% of the patients with VTE had presented with pulmonary embolism. For 15% of the patients, the clinical outcome was unfavorable, including 4% who had died within 90 days. Conclusions The risk of VTE after noncancer general surgery remains high for ≤2 months. More than one half of the patients had presented with symptomatic PE as the VTE event, and 15% had had unfavorable outcomes. Only 44% of these patients had received pharmacologic prophylaxis for around 1 week.
Published: 2021

8. Clinical outcomes during anticoagulant therapy in fragile patients with venous thromboembolism

Author: Farès Moustafa, Matteo Giorgi Pierfranceschi, Pierpaolo Di Micco, Eugenio Bucherini, Alicia Lorenzo, Aurora Villalobos, José A. Nieto, Beatriz Valero, Ángel L. Sampériz, Manuel Monreal, Hervé Decousus, Paolo Prandoni, Benjamin Brenner, Raquel Barba, Laurent Bertoletti, Inna Tzoran, Abilio Reis, Marijan Bosevski, Henri Bounameaux, Radovan Malý, Philip Wells, Manolis Papadakis, MD Adarraga, P Agudo, MA Aibar, M Alfonso, JI Arcelus, A Ballaz, R Barba, M Barrón, B Barrón‐Andrés, J Bascuñana, A Blanco‐Molina, I Cañas, I Casado, N Chic, R del Pozo, J del Toro, MC Díaz‐Pedroche, JA Díaz‐Peromingo, C Falgá, C Fernández‐Aracil, C Fernández‐Capitán, MA Fidalgo, C Font, L Font, P Gallego, MA García, F García‐Bragado, O Gavín, C Gómez, V Gómez, J González, E Grau, A Grimón, R Guijarro, L Guirado, J Gutiérrez, G Hernández‐Comes, L Hernández‐Blasco, L Jara‐Palomares, MJ Jaras, D Jiménez, J Jiménez, MD Joya, P Llamas, JL Lobo, P López, L López‐Jiménez, R López‐Reyes, JB López‐Sáez, MA Lorente, M Lumbierres, JM Luque, PJ Marchena, F Martín‐Martos, M Mellado, S Nieto, A Núñez, MJ Núñez, S Otalora, R Otero, JM Pedrajas, G Pérez, C Pérez‐Ductor, ML Peris, I Pons, JA Porras, O Reig, A Riera‐Mestre, D Riesco, A Rivas, M Rodríguez, MA Rodríguez‐Dávila, V Rosa, E Rosillo‐Hernández, P Ruiz‐Artacho, N Ruiz‐Giménez, JC Sahuquillo, MC Sala‐Sainz, R Sánchez‐Martínez, O Sanz, S Soler, B Sopeña, JM Suriñach, C Tolosa, MI Torres, J Troya, J Trujillo‐Santos, F Uresandi, E Usandizaga, R Valle, J Vela, L Vela, MP Vicente, B Xifre, T Vanassche, P Verhamme, HHB Yoo, P Wells, J Hirmerova, R Malý, P Dulíček, E Salgado, L Bertoletti, A Bura‐Riviere, D Farge‐Bancel, A Hij, I Mahé, A Merah, A Braester, B Brenner, I Tzoran, G Antonucci, G Barillari, F Bilora, C Bortoluzzi, B Brandolin, C Cattabiani, M Ciammaichella, N Dell'Elce, F Dentali, R Duce, E Grandone, E Imbalzano, G Lessiani, R Maida, D Mastroiacovo, F Pace, R Parisi, M Pellegrinet, R Pesavento, M Pinelli, R Poggio, P Prandoni, R Quintavalla, A Rocci, E Tiraferri, D Tonello, A Tufano, A Visonà, V Gibietis, A Skride, B Vitola, M Bosevski, M Zdraveska, H Bounameaux, L Mazzolai, RIETE Investigators, Decousus, H., Prandoni, P., Brenner, B., Barba, R., Bertoletti, L., Tzoran, I., Reis, A., Bosevski, M., Bounameaux, H., Malý, R., Wells, P., Papadakis, M., Adarraga, M.D., Agudo, P., Aibar, M.A., Alfonso, M., Arcelus, J.I., Ballaz, A., Barrón, M., Barrón-Andrés, B., Bascuñana, J., Blanco-Molina, A., Cañas, I., Casado, I., Chic, N., Del Pozo, R., Del Toro, J., Díaz-Pedroche, M.C., Díaz-Peromingo, J.A., Falgá, C., Fernández-Aracil, C., Fernández-Capitán, C., Fidalgo, M.A., Font, C., Font, L., Gallego, P., García, M.A., García-Bragado, F., Gavín, O., Gómez, C., Gómez, V., González, J., Grau, E., Grimón, A., Guijarro, R., Guirado, L., Gutiérrez, J., Hernández-Comes, G., Hernández-Blasco, L., Jara-Palomares, L., Jaras, M.J., Jiménez, D., Jiménez, J., Joya, M.D., Llamas, P., Lobo, J.L., López, P., López-Jiménez, L., López-Reyes, R., López-Sáez, J.B., Lorente, M.A., Lumbierres, M., Luque, J.M., Marchena, P.J., Martín-Martos, F., Mellado, M., Nieto, S., Núñez, A., Núñez, M.J., Otalora, S., Otero, R., Pedrajas, J.M., Pérez, G., Pérez-Ductor, C., Peris, M.L., Pons, I., Porras, J.A., Reig, O., Riera-Mestre, A., Riesco, D., Rivas, A., Rodríguez, M., Rodríguez-Dávila, M.A., Rosa, V., Rosillo-Hernández, E., Ruiz-Artacho, P., Ruiz-Giménez, N., Sahuquillo, J.C., Sala-Sainz, M.C., Sánchez-Martínez, R., Sanz, O., Soler, S., Sopeña, B., Suriñach, J.M., Tolosa, C., Torres, M.I., Troya, J., Trujillo-Santos, J., Uresandi, F., Usandizaga, E., Valle, R., Vela, J., Vela, L., Vicente, M.P., Xifre, B., Vanassche, T., Verhamme, P., Yoo, H., Hirmerova, J., Dulíček, P., Salgado, E., Bura-Riviere, A., Farge-Bancel, D., Hij, A., Mahé, I., Merah, A., Braester, A., Antonucci, G., Barillari, G., Bilora, F., Bortoluzzi, C., Brandolin, B., Cattabiani, C., Ciammaichella, M., Dell'Elce, N., Dentali, F., Duce, R., Grandone, E., Imbalzano, E., Lessiani, G., Maida, R., Mastroiacovo, D., Pace, F., Parisi, R., Pellegrinet, M., Pesavento, R., Pinelli, M., Poggio, R., Quintavalla, R., Rocci, A., Tiraferri, E., Tonello, D., Tufano, A., Visonà, A., Gibietis, V., Skride, A., Vitola, B., Zdraveska, M., Mazzolai, L., Moustafa, F., Giorgi Pierfranceschi, M., Di Micco, P., Bucherini, E., Lorenzo, A., Villalobos, A., Nieto, J. A., Valero, B., Samperiz, A. L., Monreal, M., Maly, R., Adarraga, M. D., Aibar, M. A., Arcelus, J. I., Barron, M., Barron-Andres, B., Bascunana, J., Canas, I., del Pozo, R., del Toro, J., Diaz-Pedroche, M. C., Diaz-Peromingo, J. A., Falga, C., Fernandez-Aracil, C., Fernandez-Capitan, C., Fidalgo, M. A., Garcia, M. A., Garcia-Bragado, F., Gavin, O., Gomez, C., Gomez, V., Gonzalez, J., Grimon, A., Gutierrez, J., Hernandez-Comes, G., Hernandez-Blasco, L., Jaras, M. J., Jimenez, D., Jimenez, J., Joya, M. D., Lobo, J. L., Lopez, P., Lopez-Jimenez, L., Lopez-Reyes, R., Lopez-Saez, J. B., Lorente, M. A., Luque, J. M., Marchena, P. J., Martin-Martos, F., Nunez, A., Nunez, M. J., Pedrajas, J. M., Perez, G., Perez-Ductor, C., Peris, M. L., Porras, J. A., Rodriguez, M., Rodriguez-Davila, M. A., Rosillo-Hernandez, E., Ruiz-Gimenez, N., Sahuquillo, J. C., Sala-Sainz, M. C., Sanchez-Martinez, R., Sopena, B., Surinach, J. M., Torres, M. I., Vicente, M. P., Yoo, H. H. B., Dulicek, P., Mahe, I., and Visona, A.
Subjects: medicine.medical_specialty, Gastrointestinal bleeding, anticoagulants, recurrence, venous thromboembolism, hemorrhage, mortality, recurrences, Renal function, 030204 cardiovascular system & hematology, Lower risk, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, medicine, 030212 general & internal medicine, business.industry, anticoagulant, Retrospective cohort study, Hematology, Odds ratio, medicine.disease, Confidence interval, Surgery, Natural history, Original Article, business, Original Articles: Thrombosis
Abstract: Essentials Recent randomized trials suggested fewer bleeding events in fragile patients with VTE receiving DOACs.The frequency, clinical characteristics and outcome of these patients have not been reported in real life.Fragile patients with VTE had a higher risk for major bleeding or death and a lower risk for recurrences than non‐fragile. Background Subgroup analyses from randomized trials suggested favorable results for the direct oral anticoagulants in fragile patients with venous thromboembolism (VTE). The frequency and natural history of fragile patients with VTE have not been studied yet. Objectives To compare the clinical characteristics, treatment and outcomes during the first 3 months of anticoagulation in fragile vs non‐fragile patients with VTE. Methods Retrospective study using consecutive patients enrolled in the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry. Fragile patients were defined as those having age ≥75 years, creatinine clearance (CrCl) levels ≤50 mL/min, and/or body weight ≤50 kg. Results From January 2013 to October 2016, 15 079 patients were recruited. Of these, 6260 (42%) were fragile: 37% were aged ≥75 years, 20% had CrCl levels ≤50 mL/min, and 3.6% weighed ≤50 kg. During the first 3 months of anticoagulant therapy, fragile patients had a lower risk of VTE recurrences (0.78% vs 1.4%; adjusted odds ratio [OR]: 0.52; 95% confidence intervals [CI]: 0.37‐0.74) and a higher risk of major bleeding (2.6% vs 1.4%; adjusted OR: 1.41; 95% CI: 1.10‐1.80), gastrointestinal bleeding (0.86% vs 0.35%; adjusted OR: 1.84; 95% CI: 1.16‐2.92), haematoma (0.51% vs 0.07%; adjusted OR: 5.05; 95% CI: 2.05‐12.4), all‐cause death (9.2% vs 3.5%; adjusted OR: 2.02; 95% CI: 1.75‐2.33), or fatal PE (0.85% vs 0.35%; adjusted OR: 1.77; 95% CI: 1.10‐2.85) than the non‐fragile. Conclusions In real life, 42% of VTE patients were fragile. During anticoagulation, they had fewer VTE recurrences and more major bleeding events than the non‐fragile.
Published: 2017

9. Vitamin K Antagonists After 6 Months of Low-Molecular-Weight Heparin in Cancer Patients with Venous Thromboembolism

Author: Chatree Chai-Adisaksopha, Alfonso Iorio, Mark A. Crowther, Javier de Miguel, Estuardo Salgado, Marija Zdraveska, Carmen Fernández-Capitán, José Antonio Nieto, Giovanni Barillari, Laurent Bertoletti, Manuel Monreal, M.A. Aibar, J.I. Arcelus, A. Ballaz, R. Barba, M. Barrón, B. Barrón-Andrés, J. Bascuñana, A. Blanco-Molina, T. Bueso, B. Calvo, G. Cañada, I. Cañas, I. Casado, A. Culla, J. de Miguel, J. del Toro, J.A. Díaz-Peromingo, C. Falgá, C. Fernández-Capitán, C. Font, L. Font, P. Gallego, F. García-Bragado, V. Gómez, J. González, E. Grau, M. Guil, L. Guirado, J. Gutiérrez, G. Hernández, L. Hernández-Blasco, V. Isern, L. Jara-Palomares, M.J. Jaras, D. Jiménez, B. Lacruz, R. Lecumberri, J.L. Lobo, L. López-Jiménez, R. López-Reyes, J.B. López-Sáez, M.A. Lorente, A. Lorenzo, O. Madridano, A. Maestre, I. Manrique-Abos, P.J. Marchena, J.M. Martín-Antorán, F. Martín-Martos, M. Monreal, M.V. Morales, R. Morillo, D. Nauffal, J.A. Nieto, S. Nieto, M.J. Núñez, M. Odriozola, S. Otalora, R. Otero, B. Pagán, J.M. Pedrajas, C. Pérez, M.L. Peris, I. Pons, J.A. Porras, L. Ramirez, A. Riera, A. Rivas, C. Rodríguez, M.A. Rodríguez-Dávila, V. Rosa, N. Ruiz-Giménez, A. Sampériz, R. Sánchez, M.C. Sala, J.C. Sahuquillo, O. Sanz, S. Soler, I. Suárez-González, J.M. Suriñach, G. Tiberio, C. Tolosa, J. Trujillo-Santos, F. Uresandi, B. Valero, R. Valle, J. Vela, M.P. Vicente, G. Vidal, V. Vilella-Tomás, J. Villalta, P.C. Malfante, T. Vanassche, P. Verhamme, P. Wells, J. Hirmerova, R. Malý, T. Tomko, G. Celis, E. Salgado, G.T. Sánchez, L. Bertoletti, A. Bura-Riviere, D. Farge-Bancel, A. Hij, I. Mahé, A. Merah, I. Quere, M. Papadakis, A. Braester, B. Brenner, I. Tzoran, A. Apollonio, G. Barillari, A. Bertone, F. Bilora, E. Bucherini, G. Candelero, M. Ciammaichella, P. Di Micco, P. Ferrazzi, E. Grandone, G. Lessiani, C. Lodigiani, D. Mastroiacovo, F. Pace, R. Pesavento, M. Pinelli, P. Prandoni, M. Rosa, L. Rota, E. Tiraferri, D. Tonello, A. Tufano, U. Venturelli, A. Visonà, B. Zalunardo, E. Drucka, D. Kigitovica, A. Skride, M.S. Sousa, M. Bosevski, M. Zdraveska, H. Bounameaux, L. Mazzolai, and J.C. Serrano
Subjects: Male, medicine.medical_specialty, Vitamin K, medicine.drug_class, Deep vein, Low molecular weight heparin, Anticoagulants, Cancer, Low-molecular-weight heparin, Thromboembolism, Warfarin, 030204 cardiovascular system & hematology, Recurrent deep vein thrombosis, 03 medical and health sciences, 0302 clinical medicine, Recurrence, Neoplasms, medicine, Humans, Registries, Propensity Score, Aged, Retrospective Studies, business.industry, Retrospective cohort study, General Medicine, Venous Thromboembolism, Heparin, Low-Molecular-Weight, medicine.disease, Thrombosis, Pulmonary embolism, Surgery, Venous thrombosis, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Female, business, medicine.drug
Abstract: BACKGROUND: Low-molecular-weight heparin (LMWH) is the treatment of choice in cancer patients with venous thromboembolism. However, data on continuing LMWH treatment beyond 6 months remain scanty. METHODS: We used the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry to compare the rate of venous thromboembolism recurrences and major bleeding appearing beyond the first 6 months of anticoagulant therapy in cancer patients with venous thromboembolism, according to therapy with LMWH or vitamin K antagonists (VKA). We performed a propensity score-matched cohort study. RESULTS: After propensity matching, 482 cancer patients continued to receive LMWH and 482 switched to VKA. During the course of anticoagulant therapy (mean 275.5 days), 57 patients developed venous thrombosis recurrences (recurrent pulmonary embolism 26, recurrent deep vein thrombosis 29, both 2), 28 had major bleeding, 38 had nonmajor bleeding, and 129 died. No patient died of recurrent venous thrombosis, and 5 patients died of bleeding (2 were on LMWH, 3 on VKA). Patients who continued with LMWH had a similar rate of deep vein thrombosis recurrences (relative risk [RR] 1.41; 95% confidence interval [CI], 0.68-2.93), pulmonary embolism recurrences (RR 0.73; 95% CI, 0.34-1.58), major bleeding (RR 0.96; 95% CI, 0.51-1.79), or nonmajor bleeding (RR 1.15; 95% CI, 0.55-2.40), compared with those who switched to VKA, but a higher mortality rate (RR 1.58; 95% CI, 1.13-2.20). CONCLUSIONS: In cancer patients with venous thromboembolism who completed 6 months of LMWH therapy, switching to VKA was associated with a similar risk of venous thrombosis recurrences or bleeding when compared with patients who continued LMWH. (C) 2018 Elsevier Inc. All rights reserved.
Published: 2017

10. Analysis of noncatheter-associated upper extremity deep venous thrombosis from the RIETE registry

Author: C. Pérez-Ductor, Raffaele Pesavento, Barry M. Brenner, Silvia Soler, Paolo Prandoni, Luciano López-Jiménez, Pierpaolo Di Micco, S. Nieto, Renzo Poggio, Inna Tzoran, T. Bueso, Alicia Lorenzo, Carmen Fernández-Capitán, F. García-Bragado, D. Riesco, Thomas Vanassche, M. Papadakis, J. del Toro, N. Ruiz-Giménez, M.J. Núñez, F. Martín-Martos, Mark M. Levy, Benjamin Brenner, J.A. Porras, G. Vidal, V. Gómez, A. Braester, Cristina Perez Ductor, R. Barba, R. Valle, Bernardo Sopeña, Lidia Luciana Rota, J.C. Sahuquillo, E. Tiraferri, J.M. Martín-Antorán, M.S. Sousa, Conxita Falga, Jose Gutierrez, Ángeles Blanco-Molina, J.M. Suriñach, H. Bounameaux, Isabelle Mahé, María del Carmen Díaz-Pedroche, Philip S. Wells, B. Pagán, Agustina Rivas, J. Bascuñana, G. Antonucci, Carme Font, Antonella Tufano, Maurizio Ciammaichella, S. Otalora, Ángel Sampériz, J. González, R. Maida, Giovanni Barillari, Andris Skride, P. Di Micco, Manuel Monreal, M.J. Jaras, Alessandra Bura-Rivière, F. Pace, Diego Tonello, Remedios Otero, R. Malý, L. Bertoletti, R. Lecumberri, M.A. Aibar, K. Champion, D. Kigitovica, J. Binetti, M.L. Peris, M.A. Rodríguez-Dávila, Adriana Visonà, L. Guirado, Miguel Martín, Abílio Reis, P. Gallego, O. Reig, G. Pérez, Hervé Decousus, Daniel H. Newton, E. Salgado, P. Prandoni, Laurent Bertoletti, Peter Verhamme, Luke G. Wolfe, Javier Trujillo-Santos, M.A. García, M.A. Fidalgo, Paola Ferrazzi, Pablo Javier Marchena, J. Villalta, M.A. Lorente, Elvira Grandone, O. Sanz, M.C. Sala-Sainz, F. Bilora, M. Bosevski, I. Cañas, Vladimir Rosa, David Jiménez, Juan I. Arcelus, E. Grau, B. Zalunardo, Beatriz Valero, Luis Jara-Palomares, Manuel Monreal Bosch, José María Pedrajas, Pedro Ruiz-Artacho, B. Barrón-Andrés, Fernando Uresandi, E. Rosillo-Hernández, M.D. Joya, Rita Duce, L. Font, C. Tolosa, Francesco Dentali, I. Manrique-Abos, F. Carmona, Andreas Erdmann, Antoni Riera-Mestre, L. Hernández-Blasco, Nuria Chic, J.B. López-Sáez, J. Vela, J. Hirmerova, A. Grimón, G. Hernández-Comes, D. Farge-Bancel, C. Fernández-Aracil, Raquel López-Reyes, Raúl Sánchez, Michael F. Amendola, J.A. Nieto, A. Merah, I. Tzoran, J.L. Ribeiro, E. Drucka, Lucia Mazzolai, Radovan Malý, María Belén Alfonso, José Luis Lobo, M. Zdraveska, I. Pérez, Marijan Bosevski, Manolis Papadakis, Raquel Barba, R. Aranda, A.R. Ramos, R. del Pozo, M. Barrón, A. Hij, R. Agüero, Ramón Lecumberri, Corrado Lodigiani, Henri Bounameaux, A. Culla, A. Núñez, J.A. Díaz-Peromingo, and Barbara Ney
Subjects: Adult, Male, medicine.medical_specialty, Multivariate analysis, Adolescent, Hemorrhage, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Catheterization, Peripheral, 03 medical and health sciences, Immobilization, Young Adult, 0302 clinical medicine, Recurrence, Aged, Aged, 80 and over, Catheterization, Peripheral, Female, Humans, Middle Aged, Neoplasms, Pulmonary Embolism, Registries, Upper Extremity Deep Vein Thrombosis, Venous Thromboembolism, 80 and over, Medicine, cardiovascular diseases, Young adult, Prospective cohort study, business.industry, Odds ratio, medicine.disease, Thrombosis, Confidence interval, Surgery, Pulmonary embolism, Venous thrombosis, 030228 respiratory system, Cardiology and Cardiovascular Medicine, business
Abstract: We sought to determine the risk factors for subsequent bleeding and recurrent venous thromboembolism (VTE) events following isolated noncatheter-associated upper extremity deep venous thrombosis (non-CA-UEDVT) to better inform future treatment decisions for this group of patients.The RIETE registry (Registro Informatizado de Enfermedad TromboEmbólica [Computerized Registry of Patients with Venous Thromboembolism]) is a prospective international registry of patients with objectively confirmed symptomatic VTE. Patients with a symptomatic, isolated, proximal UEDVT from March 2001 through March 2015 were analyzed. Any patient with an indwelling catheter or pacemaker lead at the DVT site and at the time of thrombosis was considered to have a CA-UEDVT and was excluded. Patient and treatment characteristics such as age, gender, comorbidities, VTE risk factors, treatment drug, and duration were collected. Outcomes examined included recurrent DVT, subsequent pulmonary embolism (PE), and hemorrhage. Multivariate analysis was performed using stepwise logistic regression.Of the 1100 patients who met the study criteria, 580 (53%) were male. The mean age of the patients was 50 ± 20 years, and overall patient survival at 1 year was 85%. Recurrent VTE occurred in 59 patients (5.4%). Of these, 46 patients (4%) had recurrent DVT, 10 (0.9%) had a PE following UEDVT diagnosis, and 3 (0.3%) had both. PE was fatal in three patients (0.3%). Bleeding occurred in 50 patients (4.5%), major bleeding in 19 patients (1.7%), and fatal bleeding in 6 patients (0.5%). On multivariate analysis, malignant disease was associated with VTE recurrence (odds ratio [OR], 2.00; 95% confidence interval [CI], 1.04-3.45; P .04), whereas hemorrhage was associated with age (OR, 1.03; 95% CI, 1.01-1.05; P = .002) and malignant disease (OR, 2.53; 95% CI, 1.34-4.76; P .005). Hemorrhage and recurrent VTE were also significantly associated (OR, 2.79; 95% CI, 1.16-6.76; P .03).PE following non-CA-UEDVT is rare. Malignant disease was associated with VTE recurrence. Age and malignant disease were associated with hemorrhage, and VTE recurrence was associated with hemorrhage. Further prospective studies should be undertaken to best determine length of anticoagulation treatment for the varied populations of patients with UEDVT.
Published: 2017

11. Treatment of Right Heart Thrombi Associated with Acute Pulmonary Embolism

Author: Deisy Barrios, Jeremy Chavant, David Jiménez, Laurent Bertoletti, Vladimir Rosa-Salazar, Alfonso Muriel, Alain Viallon, Carmen Fernández-Capitán, Roger D. Yusen, Manuel Monreal, Hervè Decousus, Paolo Prandoni, Benjamin Brenner, Raquel Barba, Pierpaolo Di Micco, Inna Tzoran, Abilio Reis, Marijan Bosevski, Henri Bounameaux, Radovan Malý, Philip Wells, Peter Verhamme, M.D. Adarraga, M.A. Aibar, M. Alfonso, J.I. Arcelus, P.M. Azcarate-Agüero, A. Ballaz, R. Barba, M. Barrón, B. Barrón-Andrés, J. Bascuñana, A. Blanco-Molina, G. Cañada, I. Cañas, I. Casado, N. Chic, R. del Pozo, J. del Toro, M.C. Díaz-Pedroche, J.A. Díaz-Peromingo, C. Falgá, C. Fernández-Aracil, C. Fernández-Capitán, M.A. Fidalgo, C. Font, L. Font, P. Gallego, M.A. García, F. García-Bragado, P. García-Brotons, O. Gavín, C. Gómez, V. Gómez, J. González, E. Grau, A. Grimón, L. Guirado, J. Gutiérrez, G. Hernández-Comes, L. Hernández-Blasco, L. Jara-Palomares, M.J. Jaras, D. Jiménez, J. Jiménez, M.D. Joya, P. Llamas, J.L. Lobo, P. López, L. López-Jiménez, R. López-Reyes, J.B. López-Sáez, M.A. Lorente, A. Lorenzo, J.M. Luque, P.J. Marchena, C. Martínez, F. Martín-Martos, M. Monreal, J.A. Nieto, S. Nieto, A. Núñez, M.J. Núñez, S. Otalora, R. Otero, J.M. Pedrajas, G. Pérez, C. Pérez-Ductor, M.L. Peris, I. Pons, J.A. Porras, O. Reig, A. Riera-Mestre, D. Riesco, A. Rivas, M. Rodríguez, M.A. Rodríguez-Dávila, V. Rosa, J.C. Sahuquillo, M.C. Sala-Sainz, A. Sampériz, R. Sánchez-Martínez, O. Sanz, S. Soler, B. Sopeña, J.M. Suriñach, C. Tolosa, M.I. Torres, J. Trujillo-Santos, F. Uresandi, E. Usandizaga, B. Valero, R. Valle, J. Vela, G. Vidal, C. Vilar, B. Xifre, T. Vanassche, P. Verhamme, H.H.B. Yoo, P. Wells, J. Hirmerova, R. Malý, E. Salgado, L. Bertoletti, A. Bura-Riviere, D. Farge-Bancel, A. Hij, I. Mahé, A. Merah, F. Moustafa, A. Braester, B. Brenner, I. Tzoran, G. Antonucci, G. Barillari, F. Bilora, A. Bonanome, C. Bortoluzzi, B. Brandolin, M. Ciammaichella, P. De Ciantis, F. Dentali, P. Di Micco, R. Duce, M. Giorgi-Pierfranceschi, E. Grandone, E. Imbalzano, G. Lessiani, R. Maida, D. Mastroiacovo, F. Pace, R. Parisi, R. Pesavento, M. Pinelli, R. Poggio, P. Prandoni, R. Quintavalla, A. Rocci, E. Tiraferri, D. Tonello, A. Tufano, U. Venturelli, A. Visonà, V. Gibietis, A. Skride, B. Vitola, M. Bosevski, M. Zdraveska, H. Bounameaux, and L. Mazzolai
Subjects: Male, medicine.medical_specialty, Heart Diseases, medicine.medical_treatment, Hemorrhage, 030204 cardiovascular system & hematology, Lower risk, 03 medical and health sciences, Anticoagulation, 0302 clinical medicine, Reperfusion therapy, Recurrence, Internal medicine, Cause of Death, medicine, Humans, Thrombolytic Therapy, 030212 general & internal medicine, Propensity Score, Cause of death, Right heart thrombi, Aged, business.industry, Pulmonary embolism, Anticoagulants, Thrombosis, General Medicine, Thrombolysis, Middle Aged, medicine.disease, Confidence interval, Treatment, Treatment Outcome, Propensity score matching, Cardiology, Female, business, Pulmonary Embolism
Abstract: Background Evidence-based recommendations do not adequately address the treatment of right heart thrombi in patients who present with acute symptomatic pulmonary embolism. Methods This study included patients who had acute pulmonary embolism associated with right heart thrombi and participated in the Registro Informatizado de la Enfermedad TromboEmbolica registry. We assessed the effectiveness of anticoagulation versus reperfusion treatment for the outcomes of all-cause mortality, pulmonary embolism–related mortality, recurrent venous thromboembolism, and major bleeding rates through 30 days after initiation of pulmonary embolism treatment. We used propensity score matching to adjust for the likelihood of receiving reperfusion treatment. Results Of 325 patients with pulmonary embolism and right heart thrombi, 255 (78%; 95% confidence interval, 74-83) received anticoagulation and 70 (22%; 95% confidence interval, 17-26) also received reperfusion treatment. Propensity score–matched pairs analyses did not detect a statistically lower risk of all-cause death (6.2% vs 14%, P = .15) or pulmonary embolism–related mortality (4.7% vs 7.8%; P = .47) for reperfusion compared with anticoagulation. Of the patients who received reperfusion treatment, 6.2% had a recurrence during the study follow-up period, compared with 0% of those who received anticoagulation ( P = .049). The incidence of major bleeding events was not statistically different between the 2 treatment groups (3.1% vs 3.1%; P = 1.00). Conclusions In patients with pulmonary embolism and right heart thrombi, no significant difference was found between reperfusion therapy and anticoagulant therapy for mortality and bleeding. The risk of recurrences was significantly higher for reperfusion therapy compared with anticoagulation. Right heart thrombi may not warrant riskier interventions than standard anticoagulation.
Published: 2017

12. Development of a Risk Prediction Score for Occult Cancer in Patients With VTE

Author: Luis Jara-Palomares, Remedios Otero, David Jimenez, Marc Carrier, Inna Tzoran, Benjamin Brenner, Mireia Margeli, Juan Manuel Praena-Fernandez, Elvira Grandone, Manuel Monreal, Hervè Decousus, Paolo Prandoni, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Abilio Reis, Marijan Bosevski, Henri Bounameaux, Radovan Malý, Philip Wells, Manolis Papadakis, M.A. Aibar, M. Alfonso, M.I. Asensio-Cruz, T. Auguet, J.I. Arcelus, R. Barba, M. Barrón, B. Barrón-Andrés, J. Bascuñana, A. Blanco-Molina, T. Bueso, I. Cañas, A. Ceausu, N. Chic, A. Culla, R. del Pozo, J. del Toro, M.C. Díaz-Pedroche, J.A. Díaz-Peromingo, M. Duffort, T. Elias-Hernández, C. Falgá, C. Fernández-Aracil, C. Fernández-Capitán, M.A. Fidalgo, C. Font, L. Font, P. Gallego, M.A. García, F. García-Bragado, M. García-Rodenas, V. Gómez, J. González, E. Grau, A. Grimón, R. Guijarro, L. Guirado, J. Gutiérrez, G. Hernández-Comes, L. Hernández-Blasco, E. Hernando-López, L. Jara-Palomares, M.J. Jaras, D. Jiménez, M.D. Joya, P. Llamas, R. Lecumberri, J.L. Lobo, L. López-Jiménez, R. López-Reyes, J.B. López-Sáez, M.A. Lorente, A. Lorenzo, A. Maestre, P.J. Marchena, M. Martín, F. Martín-Martos, M. Monreal, J.A. Nieto, S. Nieto, A. Núñez, M.J. Núñez, M. Odriozola, S. Otalora, R. Otero, A. Ovejero, J.M. Pedrajas, G. Pérez, C. Pérez-Ductor, M.L. Peris, J.A. Porras, O. Reig, A. Riera-Mestre, D. Riesco, A. Rivas, M.A. Rodríguez-Dávila, V. Rosa, P. Ruiz-Artacho, N. Ruiz-Giménez, J.C. Sahuquillo, M.C. Sala-Sainz, A. Sampériz, R. Sánchez, O. Sanz, S. Soler, B. Sopeña, J.M. Suriñach, C. Tolosa, J. Trujillo-Santos, F. Uresandi, B. Valero, R. Valle, J. Vela, P. Vicente, G. Vidal, A. Villalobos, J. Villalta, T. Vanassche, P. Verhamme, P. Wells, J. Hirmerova, R. Malý, E. Salgado, L. Bertoletti, A. Bura-Riviere, D. Farge-Bancel, A. Hij, I. Mahé, A. Merah, F. Moustafa, M. Papadakis, A. Braester, B. Brenner, I. Tzoran, G. Antonucci, G. Barillari, A. Bertone, F. Bilora, C. Bortoluzzi, M. Ciammaichella, C. Di Girolamo, P. Di Micco, R. Duce, P. Ferrazzi, M. Giorgi-Pierfranceschi, E. Grandone, C. Lodigiani, R. Maida, D. Mastroiacovo, F. Pace, R. Pesavento, M. Pinelli, R. Poggio, P. Prandoni, L. Rota, E. Tiraferri, D. Tonello, A. Tufano, A. Visonà, B. Zalunardo, E. Drucka, D. Kigitovica, A. Skride, M.S. Sousa, M. Bosevski, M. Zdraveska, H. Bounameaux, L. Mazzolai, Jara-Palomares, L., Otero, R., Jimenez, D., Carrier, M., Tzoran, I., Brenner, B., Margeli, M., Praena-Fernandez, J. M., Grandone, E., Monreal, M., Decousus, H., Prandoni, P., Barba, R., Di Micco, P., Bertoletti, L., Reis, A., Bosevski, M., Bounameaux, H., Maly, R., Wells, P., Papadakis, M., Aibar, M. A., Alfonso, M., Asensio-Cruz, M. I., Auguet, T., Arcelus, J. I., Barron, M., Barron-Andres, B., Bascunana, J., Blanco-Molina, A., Bueso, T., Canas, I., Ceausu, A., Chic, N., Culla, A., del Pozo, R., del Toro, J., Diaz-Pedroche, M. C., Diaz-Peromingo, J. A., Duffort, M., Elias-Hernandez, T., Falga, C., Fernandez-Aracil, C., Fernandez-Capitan, C., Fidalgo, M. A., Font, C., Font, L., Gallego, P., Garcia, M. A., Garcia-Bragado, F., Garcia-Rodenas, M., Gomez, V., Gonzalez, J., Grau, E., Grimon, A., Guijarro, R., Guirado, L., Gutierrez, J., Hernandez-Comes, G., Hernandez-Blasco, L., Hernando-Lopez, E., Jaras, M. J., Joya, M. D., Llamas, P., Lecumberri, R., Lobo, J. L., Lopez-Jimenez, L., Lopez-Reyes, R., Lopez-Saez, J. B., Lorente, M. A., Lorenzo, A., Maestre, A., Marchena, P. J., Martin, M., Martin-Martos, F., Nieto, J. A., Nieto, S., Nunez, A., Nunez, M. J., Odriozola, M., Otalora, S., Ovejero, A., Pedrajas, J. M., Perez, G., Perez-Ductor, C., Peris, M. L., Porras, J. A., Reig, O., Riera-Mestre, A., Riesco, D., Rivas, A., Rodriguez-Davila, M. A., Rosa, V., Ruiz-Artacho, P., Ruiz-Gimenez, N., Sahuquillo, J. C., Sala-Sainz, M. C., Samperiz, A., Sanchez, R., Sanz, O., Soler, S., Sopena, B., Surinach, J. M., Tolosa, C., Trujillo-Santos, J., Uresandi, F., Valero, B., Valle, R., Vela, J., Vicente, P., Vidal, G., Villalobos, A., Villalta, J., Vanassche, T., Verhamme, P., Hirmerova, J., Salgado, E., Bura-Riviere, A., Farge-Bancel, D., Hij, A., Mahe, I., Merah, A., Moustafa, F., Braester, A., Antonucci, G., Barillari, G., Bertone, A., Bilora, F., Bortoluzzi, C., Ciammaichella, M., Di Girolamo, C., Duce, R., Ferrazzi, P., Giorgi-Pierfranceschi, M., Lodigiani, C., Maida, R., Mastroiacovo, D., Pace, F., Pesavento, R., Pinelli, M., Poggio, R., Rota, L., Tiraferri, E., Tonello, D., Tufano, A., Visona, A., Zalunardo, B., Drucka, E., Kigitovica, D., Skride, A., Sousa, M. S., Zdraveska, M., and Mazzolai, L.
Subjects: Pulmonary and Respiratory Medicine, Lung Diseases, Male, medicine.medical_specialty, Multivariate analysis, Anemia, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Sex Factors, Internal medicine, Neoplasms, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Registries, risk, Aged, Aged, 80 and over, Thrombocytosis, Venous Thrombosis, Framingham Risk Score, business.industry, screening, Case-control study, Age Factors, Cancer, Reproducibility of Results, Venous Thromboembolism, Middle Aged, medicine.disease, Pulmonary embolism, Surgery, Spain, Case-Control Studies, Surgical Procedures, Operative, Cohort, Multivariate Analysis, Female, Cardiology and Cardiovascular Medicine, Risk assessment, business, Pulmonary Embolism, neoplasm
Abstract: Background The benefits of a diagnostic workup for occult cancer in patients with VTE are controversial. Our aim was to provide and validate a risk score for occult cancer in patients with VTE. Methods We designed a nested case-control study in a cohort of patients with VTE included in the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry from 2001 to 2014. Cases included cancer detected beyond the first 30 days and up to 24 months after VTE. Control subjects were defined as patients with VTE with no cancer in the same period. Results Of 5,863 eligible patients, 444 (7.6%; 95% CI, 6.8%-8.2%) were diagnosed with occult cancer. On multivariable analysis, variables selected were male sex, age > 70 years, chronic lung disease, anemia, elevated platelet count, prior VTE, and recent surgery. We built a risk score assigning points to each variable. Internal validity was confirmed using bootstrap analysis. The proportion of patients with cancer who scored ≤ 2 points was 5.8% (241 of 4,150) and that proportion in those who scored ≥ 3 points was 12% (203 of 1,713). We also identified scores divided by sex and age subgroups. Conclusions This is the first risk score that has identified patients with VTE who are at increased risk for occult cancer. Our score needs to be externally validated.
Published: 2016

13. DVT Management and Outcome Trends, 2001 to 2014

Author: Raquel Morillo, David Jiménez, Miguel Ángel Aibar, Daniela Mastroiacovo, Philip S. Wells, Ángel Sampériz, Marta Saraiva de Sousa, Alfonso Muriel, Roger D. Yusen, Manuel Monreal, Hervè Decousus, Paolo Prandoni, Benjamin Brenner, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Sebastian Schellong, Inna Tzoran, Abilio Reis, Marijan Bosevski, Henri Bounameaux, Radovan Malý, Philip Wells, Manolis Papadakis, P. Agudo, M.A. Aibar, M. Akasbi, M. Alcalde-Manero, V. Andújar, J.I. Arcelus, A. Ballaz, R. Barba, M. Barrón, B. Barrón-Andrés, J. Bascuñana, A. Blanco-Molina, I. Cañas, I. Casado, J. de Miguel, J. del Toro, S. Díaz, J.A. Díaz-Peromingo, C. Falgá, C. Fernández-Capitán, C. Font, L. Font, P. Gallego, F. García-Bragado, M. García-Rodenas, V. Gómez, C.J. González, E. Grau, L. Guirado, J. Gutiérrez, G. Hernández, L. Hernández-Blasco, V. Isern, L. Jara-Palomares, M.J. Jaras, D. Jiménez, J.L. Lobo, L. López-Jiménez, R. López-Reyes, J.B. López-Sáez, M.A. Lorente, A. Lorenzo, O. Madridano, A. Maestre, P.J. Marchena, M. Martín, J.M. Martín-Antorán, F. Martín-Martos, M. Monreal, M.V. Morales, D. Nauffal, J.A. Nieto, S. Nieto, M.J. Núñez, C. Orbegoso, S. Otalora, R. Otero, B. Pagán, J.M. Pedrajas, C. Pérez, G. Pérez, M.L. Peris, I. Pons, J.A. Porras, O. Reig, A. Riera-Mestre, A. Rivas, C. Rodríguez, M.A. Rodríguez-Dávila, V. Rosa, A.S. Rosa-Murillo, N. Ruiz-Giménez, J.C. Sahuquillo, M.C. Sala, A. Sampériz, R. Sánchez, O. Sanz, S. Soler, J.M. Suriñach, C. Tolosa, J. Trujillo-Santos, F. Uresandi, B. Valero, R. Valle, J. Vela, G. Vidal, C. Vilar, J. Villalta, B. Xifre, T. Vanassche, P. Verhamme, P. Wells, J. Hirmerova, R. Malý, T. Tomko, G. Celis, E. Salgado, G.T. Sánchez, L. Bertoletti, A. Bura-Riviere, D. Farge-Bancel, A. Hij, I. Mahé, A. Merah, I. Quere, M. Papadakis, A. Braester, B. Brenner, I. Tzoran, A. Apollonio, G. Barillari, A. Bertone, F. Bilora, E. Bucherini, M. Ciammaichella, P. De Ciantis, F. Dentali, P. Di Micco, R. Duce, P. Ferrazzi, E. Grandone, G. Lessiani, C. Lodigiani, D. Mastroiacovo, F. Pace, R. Pesavento, M. Pinelli, R. Poggio, P. Prandoni, M. Rosa, L. Rota, E. Tiraferri, D. Tonello, A. Tufano, U. Venturelli, A. Visonà, B. Zalunardo, E. Drucka, D. Kigitovica, A. Skride, A. Mafalda, J.L. Ribeiro, M.S. Sousa, M. Bosevski, M. Zdraveska, H. Bounameaux, L. Mazzolai, Morillo, R., Jimenez, D., Aibar, M. A., Mastroiacovo, D., Wells, P. S., Samperiz, A., Saraiva de Sousa, M., Muriel, A., Yusen, R. D., Monreal, M., Decousus, H., Prandoni, P., Brenner, B., Barba, R., Di Micco, P., Bertoletti, L., Schellong, S., Tzoran, I., Reis, A., Bosevski, M., Bounameaux, H., Maly, R., Wells, P., Papadakis, M., Agudo, P., Akasbi, M., Alcalde-Manero, M., Andujar, V., Arcelus, J. I., Ballaz, A., Barron, M., Barron-Andres, B., Bascunana, J., Blanco-Molina, A., Canas, I., Casado, I., de Miguel, J., del Toro, J., Diaz, S., Diaz-Peromingo, J. A., Falga, C., Fernandez-Capitan, C., Font, C., Font, L., Gallego, P., Garcia-Bragado, F., Garcia-Rodenas, M., Gomez, V., Gonzalez, C. J., Grau, E., Guirado, L., Gutierrez, J., Hernandez, G., Hernandez-Blasco, L., Isern, V., Jara-Palomares, L., Jaras, M. J., Lobo, J. L., Lopez-Jimenez, L., Lopez-Reyes, R., Lopez-Saez, J. B., Lorente, M. A., Lorenzo, A., Madridano, O., Maestre, A., Marchena, P. J., Martin, M., Martin-Antoran, J. M., Martin-Martos, F., Morales, M. V., Nauffal, D., Nieto, J. A., Nieto, S., Nunez, M. J., Orbegoso, C., Otalora, S., Otero, R., Pagan, B., Pedrajas, J. M., Perez, C., Perez, G., Peris, M. L., Pons, I., Porras, J. A., Reig, O., Riera-Mestre, A., Rivas, A., Rodriguez, C., Rodriguez-Davila, M. A., Rosa, V., Rosa-Murillo, A. S., Ruiz-Gimenez, N., Sahuquillo, J. C., Sala, M. C., Sanchez, R., Sanz, O., Soler, S., Surinach, J. M., Tolosa, C., Trujillo-Santos, J., Uresandi, F., Valero, B., Valle, R., Vela, J., Vidal, G., Vilar, C., Villalta, J., Xifre, B., Vanassche, T., Verhamme, P., Hirmerova, J., Tomko, T., Celis, G., Salgado, E., Sanchez, G. T., Bura-Riviere, A., Farge-Bancel, D., Hij, A., Mahe, I., Merah, A., Quere, I., Braester, A., Apollonio, A., Barillari, G., Bertone, A., Bilora, F., Bucherini, E., Ciammaichella, M., De Ciantis, P., Dentali, F., Duce, R., Ferrazzi, P., Grandone, E., Lessiani, G., Lodigiani, C., Pace, F., Pesavento, R., Pinelli, M., Poggio, R., Rosa, M., Rota, L., Tiraferri, E., Tonello, D., Tufano, A., Venturelli, U., Visona, A., Zalunardo, B., Drucka, E., Kigitovica, D., Skride, A., Mafalda, A., Ribeiro, J. L., Sousa, M. S., Zdraveska, M., and Mazzolai, L.
Subjects: Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Vena Cava Filters, Hemorrhage, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Rate ratio, survival, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Cause of Death, medicine, Humans, Thrombolytic Therapy, Registries, 030212 general & internal medicine, Mortality, Population Growth, Intensive care medicine, Aged, Retrospective Studies, Aged, 80 and over, Venous Thrombosis, business.industry, Anticoagulants, Disease Management, Heparin, Low-Molecular-Weight, Length of Stay, Middle Aged, Prognosis, medicine.disease, Pulmonary embolism, Emergency medicine, Female, Cardiology and Cardiovascular Medicine, business, Venous thromboembolism, Hospital stay, DVT, prognosi
Abstract: Background A comprehensive evaluation of temporal trends in the treatment of patients who have DVT may assist with identification of modifiable factors that contribute to short-term outcomes. Methods We assessed temporal trends in length of hospital stay and use of pharmacological and interventional therapies among 26,695 adults with DVT enrolled in the Registro Informatizado de la Enfermedad TromboEmbólica registry between 2001 and 2014. We also examined temporal trends in risk-adjusted rates of all-cause, pulmonary embolism-related, and bleeding-related death to 30 days after diagnosis. Results The mean length of hospital stay decreased from 9.0 days in 2001 to 2005 to 7.6 days in 2010 to 2014 (P
Published: 2016

14. Comparaison du pronostic clinique des embolies pulmonaires non massives centrales et non centrales : une étude de cohorte basée sur un registre

Author: S. Soler, Carmen Fernández-Capitán, H. Bounameaux, David Jiménez, Manuel Monreal, N. Ruiz-Giménez, M. Blondon, J.C. Sahuquillo, R. Duce, and B. Gouin
Subjects: Cardiology and Cardiovascular Medicine
Abstract: Objectif Il est inconnu si la localisation d’une embolie pulmonaire (EP) non massive est associee au pronostic a court et a long terme des patients. Notre objectif est de caracteriser l’association entre la localisation des EP non massives et le risque de recidive de thromboembolie veineuse (TEV), de saignement majeur, et de mortalite, pendant et apres la periode d’anticoagulation. Methodes Parmi les participants du registre RIETE avec un premier episode de TEV survenant sous la forme d’une EP non massive symptomatique diagnostiquee par tomodensitometrie, nous avons compare le risque de recidive de TEV, de saignement majeur et de mortalite, pendant et apres la periode d’anticoagulation, entre les EP centrales (artere pulmonaire) et les EP non centrales (artere lobaire, segmentaire et sous-segmentaire), en utilisant un modele de Cox a risque proportionnel ajuste. Resultats Parmi les 6674 participants, les patients avec une EP centrale (40,5 %) sont comparables aux patients avec une EP non centrale, avec un âge moyen de 66 ans, une proportion comparable d’hommes (46,9 %), d’evenements thrombotiques idiopathiques (45,0 %) et associes a un cancer (22,3 %). Durant la periode d’anticoagulation [5256,1 patients-annee (p-a)], le risque de recidive de TEV est similaire entre les EP centrales et non centrales (2,5 vs 2,1 pour 100 p-a ; HR ajuste (HRa) 1,32, IC 95 % 0,91–1,90), tout comme le risque de saignement majeur et de mortalite. Apres l’arret de l’anticoagulation (2175,4 p-a), les participants ayant une EP centrale ont un risque legerement augmente de recidive de TEV comparativement aux participants avec une EP non centrale (11,0 vs 8,0 pour 100 p-a ; HRa 1,34, IC 95 % 1,01–1,78, p = 0,044). En restreignant l’analyse au sous-groupe des patients avec une EP idiopathique, le risque de recidive de TEV est similaire entre les EP centrales et non centrales (13,8 vs 11,9 pour 100 p-a, HRa 1,15, IC 95 % 0,79–1,68, p = 0,48). Les risques de saignement majeur et de mortalite sont similaires entre les deux groupes. Conclusion Parmi les EP non massives, la localisation centrale d’une EP est associee a un risque faiblement augmente de recidive de TEV apres l’arret de l’anticoagulation. Toutefois, une telle association n’existe pas dans le sous-groupe des EP idiopathiques. Ainsi, la pertinence clinique de cette premiere trouvaille est limitee et permet de conclure que la duree de l’anticoagulation d’une EP non massive idiopathique ne devrait pas etre influencee par sa localisation.
Published: 2017

15. INFLUENCE OF AGE ON THE COST EFFECTIVENESS OF DIAGNOSTIC STRATEGIES FOR SUSPECTED PULMONARY EMBOLISM

Author: M. Righini, M. Nendaz, G. Le Gal, H. Bounameaux, and A. Perrier
Subjects: Hematology
Published: 2007

16. A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the upper extremity

Author: V. Rosa‐Salazar, J. Trujillo‐Santos, J.A. Díaz Peromingo, A. Apollonio, O. Sanz, R. Malý, F.J. Muñoz‐Rodriguez, J.C. Serrano, S. Soler, M. Monreal, H. Decousus, P. Prandoni, B. Brenner, R. Barba, P. Di Micco, L. Bertoletti, S. Schellong, I. Tzoran, A. Reis, M. Bosevski, H. Bounameaux, P. Wells, M. Papadakis, M.D. Adarraga, A. Alibalic, A. Alvarado‐Faria, J.I. Arcelus, T. Auguet, A. Ballaz, M. Barrón, B. Barrón‐Andrés, J. Bascuñana, J.F. Benítez, A. Blanco‐Molina, T. Bueso, A. Cañas, A. Casado, N. Castejón‐Pina, E.L. Chaves, F del Molino, J del Toro, C. Falgá, C. Fernández‐Capitán, L. Font, P. Gallego, F. García‐Bragado, A. García‐Ortega, V. Gómez, J. González, D. González‐Marcano, E. Grau, R. Guijarro, M. Guil, L. Guirado, J. Gutiérrez‐Guisado, L. Hernández‐Blasco, L. Jara‐Palomares, M.J. Jaras, D. Jiménez, R. Jiménez, B. Lacruz, R. Lecumberri, J.L. Lobo, L. López‐Jiménez, L. López‐Montes, R. López‐Reyes, J.B. López‐Sáez, M.A. Lorente, A. Lorenzo, O. Madridano, A. Maestre, P.J. Marchena, J.M. Martín‐Antorán, F. Martín‐Martos, M.V. Morales, D. Nauffal, J.A. Nieto, M.J. Núñez, S. Otalora, R. Otero, B. Pagán, J.M. Pedrajas, M.L. Peris, I. Pons, J.A. Porras, A. Riera‐Mestre, A. Rivas, M.A. Rodríguez‐Dávila, N. Ruiz‐Giménez, P. Sabio, A. Sampériz, R. Sánchez, M.J. Soto, J.M. Suriñach, G. Tiberio, R. Tirado, C. Tolosa, F. Uresandi, B. Valero, R. Valle, J. Vela, A. Villalobos, J. Villalta, P. Malfante, P. Verhamme, T. Vanassche, T. Tomko, J. Hirmerova, A. Bura‐Riviere, D. Farge‐Bancel, A. Hij, I. Mahe, A. Merah, F. Moustafa, I. Quere, D. Babalis, I. Tzinieris, A. Braester, G. Barillari, E. Bucherini, J. Campodomico, M. Ciammaichella, P. Ferrazzi, R. Maida, F. Pace, S. Pasca, R. Pesavento, C. Piovella, L. Rota, E. Tiraferri, A. Tufano, A. Visonà, A. Skride, A. Belovs, M. Moreira, J.L. Ribeiro, M.S. Sousa, A. Alatri, L. Calanca, L. Mazzolai, Rosa-Salazar, V., Trujillo-Santos, J., Diaz Peromingo, J. A., Apollonio, A., Sanz, O., Maly, R., Munoz-Rodriguez, F. J., Serrano, J. C., Soler, S., Monreal, M., Decousus, H., Prandoni, P., Brenner, B., Barba, R., Di Micco, P., Bertoletti, L., Schellong, S., Tzoran, I., Reis, A., Bosevski, M., Bounameaux, H., Wells, P., Papadakis, M., Adarraga, M. D., Alibalic, A., Alvarado-Faria, A., Arcelus, J. I., Auguet, T., Ballaz, A., Barron, M., Barron-Andres, B., Bascunana, J., Benitez, J. F., Blanco-Molina, A., Bueso, T., Canas, A., Casado, A., Castejon-Pina, N., Chaves, E. L., del Molino, F., del Toro, J., Diaz, J. A., Falga, C., Fernandez-Capitan, C., Font, L., Gallego, P., Garcia-Bragado, F., Garcia-Ortega, A., Gomez, V., Gonzalez, J., Gonzalez-Marcano, D., Grau, E., Guijarro, R., Guil, M., Guirado, L., Gutierrez-Guisado, J., Hernandez-Blasco, L., Jara-Palomares, L., Jaras, M. J., Jimenez, D., Jimenez, R., Lacruz, B., Lecumberri, R., Lobo, J. L., Lopez-Jimenez, L., Lopez-Montes, L., Lopez-Reyes, R., Lopez-Saez, J. B., Lorente, M. A., Lorenzo, A., Madridano, O., Maestre, A., Marchena, P. J., Martin-Antoran, J. M., Martin-Martos, F., Montreal, M., Morales, M. V., Nauffal, D., Nieto, J. A., Nunez, M. J., Otalora, S., Otero, R., Pagan, B., Pedrajas, J. M., Peris, M. L., Pons, I., Porras, J. A., Riera-Mestre, A., Rivas, A., Rodriguez-Davila, M. A., Ruiz-Gimenez, N., Sabio, P., Samperiz, A., Sanchez, R., Soto, M. J., Surinach, J. M., Tiberio, G., Tirado, R., Tolosa, C., Uresandi, F., Valero, B., Valle, R., Vela, J., Villalobos, A., Verhamme, P., Tomko, T., Villalta, J., Malfante, P., Mahe, I., Vanassche, T., Moustafa, F., Babalis, D., Hirmerova, J., Barillari, G., Bucherini, E., Farge-Bance, D., Ciammaichella, M., Ferrazzi, P., Maida, R., Pace, F., Quere, I., Pesavento, R., Piovella, C., Rota, L., Tzinieris, I., Tufano, A., Skride, A., Moreira, M., Ribeiro, J. L., Alatri, A., Calanca, L., Visona, A., Belovs, A., Sousa, M. S., Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), and Université Montpellier 1 (UM1)-Université de Montpellier (UM)
Subjects: Adult, Male, Canada, medicine.medical_specialty, Time Factors, Upper extremity, Deep vein, Renal function, Hemorrhage, Risk Assessment, deep vein thrombosis, Decision Support Techniques, Hospital, Predictive Value of Tests, Risk Factors, Deep vein thrombosi, Upper Extremity Deep Vein Thrombosis, Humans, Medicine, Registries, Israel, Adverse effect, Anticoagulant therapy, Aged, Outcome, Deep vein thrombosis, Outpatients, Anticoagulants, Europe, Female, Middle Aged, Pulmonary Embolism, South America, Treatment Outcome, business.industry, Cancer, Outpatient, [SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology, Hematology, medicine.disease, Thrombosis, Confidence interval, 3. Good health, Pulmonary embolism, Surgery, outpatients, medicine.anatomical_structure, Heart failure, business
Abstract: International audience; BACKGROUND:No studies have identified which patients with upper-extremity deep vein thrombosis (DVT) are at low risk for adverse events within the first week of therapy.METHODS:We used data from Registro Informatizado de la Enfermedad TromboEmbólica to explore in patients with upper-extremity DVT a prognostic score that correctly identified patients with lower limb DVT at low risk for pulmonary embolism, major bleeding, or death within the first week.RESULTS:As of December 2014, 1135 outpatients with upper-extremity DVT were recruited. Of these, 515 (45%) were treated at home. During the first week, three patients (0.26%) experienced pulmonary embolism, two (0.18%) had major bleeding, and four (0.35%) died. We assigned 1 point to patients with chronic heart failure, creatinine clearance levels 30-60 mL min(-1) , recent bleeding, abnormal platelet count, recent immobility, or cancer without metastases; 2 points to those with metastatic cancer; and 3 points to those with creatinine clearance levels < 30 mL min(-1) . Overall, 759 (67%) patients scored ≤ 1 point and were considered to be at low risk. The rate of the composite outcome within the first week was 0.26% (95% confidence interval [CI] 0.004-0.87) in patients at low risk and 1.86% (95% CI 0.81-3.68) in the remaining patients. C-statistics was 0.73 (95% CI 0.57-0.88). Net reclassification improvement was 22%, and integrated discrimination improvement was 0.0055.CONCLUSIONS:Using six easily available variables, we identified outpatients with upper-extremity DVT at low risk for adverse events within the first week. These data may help to safely treat more patients at home.
Published: 2015

17. Les claudications intermittentes

Author: G. Camelot, D. Hayoz, J.P. Favre, F Becker, Joël Constans, Isabelle Quéré, H. Bounameaux, J.P. Boissel, P. Jego, J.L. Magne, Claire Mounier-Vehier, Denis Duboc, Dominique Stephan, Philippe Lacroix, and C. Boissier
Subjects: medicine.medical_specialty, business.industry, Arterial disease, Vascular disease, Internal medicine, Occlusive arterial disease, Cardiology, Medicine, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Claudication, medicine.disease
Published: 2005

18. Relationship between peripheral vascular disease and high plantar pressures in diabetic neuro-ischaemic patients

Author: Zoltan Pataky, Elisabetta Bobbioni-Harsch, J. P. Assal, Alain Golay, and H Bounameaux
Subjects: medicine.medical_specialty, Heel, Endocrinology, Diabetes and Metabolism, Ischemia, Blood Pressure, Endocrinology, Diabetic Neuropathies, medicine.artery, Internal medicine, Diabetes mellitus, Reflex, Pressure, Internal Medicine, medicine, Humans, Aged, Glycated Hemoglobin, Peripheral Vascular Diseases, Foot, business.industry, Vascular disease, Patella, General Medicine, Toes, medicine.disease, Diabetic foot, Metatarsus, Surgery, Peripheral, body regions, medicine.anatomical_structure, Peripheral neuropathy, Dorsalis pedis artery, Cardiology, Ankle, business, Diabetic Angiopathies
Abstract: It has been shown that high foot pressure in diabetic patients plays a crucial role in plantar ulcer development. The purpose of the study is to analyze the relationship between foot arterial pressures and plantar pressures in diabetic patients with both peripheral neuropathy vascular disease.We have evaluated the relationship between foot arterial pressures and plantar pressure parameters (Peak Plantar Pressure, Foot-Floor Contact and Plantar Pressure Integral) in eleven diabetic patients with both peripheral neuropathy and peripheral vascular disease. Peripheral neuropathy was defined as a tuning fork score4/8 measured at the great toe and internal malleolus with a Tuning fork (Rydel-Seiffer 128 Hz), the absence of both patellar and ankle reflexes and with a temperature discrimination more than +5 degrees C (Thermocross). The peripheral vascular disease (PVD) was evaluated by Doppler technique. Peak Plantar Pressure (PPP) and Foot-Floor Contact (FFC) were measured by Force-Sensing Resistive (FSR 174) sensors under the 1st, 3rd and 5th metatarsal heads as well as under the heel and big toe of both feet. The Plantar Pressure Integral (PPI) was defined by the integral of the pressure over the time.We have found significant relationship between plantar pressure parameters (PPP, FFC, and PPI) under the first metatarsal heads and Doppler arterial pressures of both tibial posterior and dorsalis pedis artery. However, there was no relationship between Doppler arterial pressures and plantar pressure parameters (PPP, FFC, PPI) under 3rd and 5th metatarsal heads or under both the heel and the big toe.According to our results, the peripheral vascular disease could contribute to the elevation of plantar pressures and to the prolonged duration of foot floor contact at each step in diabetic patients with both peripheral neuropathy and peripheral vascular disease. In such patients, severe ischaemia could lead to an increased risk of foot ulceration and consecutive lower extremity amputation.
Published: 2003

19. Outcome of Patients with Venous Thromboembolism and Factor V Leiden or Prothrombin 20210 Carrier Mutations During the Course of Anticoagulation

Author: Inna Tzoran, Manolis Papadakis, Benjamin Brenner, Ángeles Fidalgo, Agustina Rivas, Philip S. Wells, Olga Gavín, María Dolores Adarraga, Farès Moustafa, Manuel Monreal, Hervé Decousus, Paolo Prandoni, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Abilio Reis, Marijan Bosevski, Henri Bounameaux, Radovan Malý, Philip Wells, M.D. Adarraga, M.A. Aibar, M. Alfonso, J.I. Arcelus, R. Barba, M. Barrón, B. Barrón-Andrés, J. Bascuñana, A. Blanco-Molina, T. Bueso, G. Cañada, I. Cañas, N. Chic, R. del Pozo, J. del Toro, M.C. Díaz-Pedroche, J.A. Díaz-Peromingo, C. Falgá, C. Fernández-Capitán, M.A. Fidalgo, C. Font, L. Font, P. Gallego, A. García, M.A. García, F. García-Bragado, P. García-Brotons, O. Gavín, C. Gómez, V. Gómez, J. González, D. González-Marcano, E. Grau, A. Grimón, R. Guijarro, J. Gutiérrez, G. Hernández-Comes, L. Hernández-Blasco, M.J. Hermosa-Los Arcos, L. Jara-Palomares, M.J. Jaras, D. Jiménez, M.D. Joya, P. Llamas, R. Lecumberri, J.L. Lobo, P. López, L. López-Jiménez, R. López-Reyes, J.B. López-Sáez, M.A. Lorente, A. Lorenzo, A. Maestre, P.J. Marchena, F. Martín-Martos, M. Monreal, J.A. Nieto, S. Nieto, A. Núñez, M.J. Núñez, M. Odriozola, R. Otero, J.M. Pedrajas, G. Pérez, C. Pérez-Ductor, M.L. Peris, J.A. Porras, O. Reig, A. Riera-Mestre, D. Riesco, A. Rivas, C. Rodríguez, M.A. Rodríguez-Dávila, V. Rosa, N. Ruiz-Giménez, J.C. Sahuquillo, M.C. Sala-Sainz, A. Sampériz, R. Sánchez-Martínez, R. Sánchez Simón-Talero, O. Sanz, S. Soler, J.M. Suriñach, M.I. Torres, J. Trujillo-Santos, F. Uresandi, B. Valero, R. Valle, J. Vela, M.P. Vicente, A. Villalobos, T. Vanassche, P. Verhamme, P. Wells, J. Hirmerova, R. Malý, T. Tomko, G. del Pozo, E. Salgado, G.T. Sánchez, L. Bertoletti, A. Bura-Riviere, I. Mahé, A. Merah, F. Moustafa, M. Papadakis, A. Braester, B. Brenner, I. Tzoran, G. Antonucci, G. Barillari, F. Bilora, C. Bortoluzzi, C. Cattabiani, M. Ciammaichella, J. Di Biase, P. Di Micco, R. Duce, P. Ferrazzi, M. Giorgi-Pierfranceschi, E. Grandone, E. Imbalzano, C. Lodigiani, R. Maida, D. Mastroiacovo, F. Pace, R. Pesavento, M. Pinelli, R. Poggio, P. Prandoni, L. Rota, E. Tiraferri, D. Tonello, A. Tufano, A. Visonà, B. Zalunardo, V. Gibietis, A. Skride, B. Vitola, P. Monteiro, J.L. Ribeiro, M.S. Sousa, M. Bosevski, M. Zdraveska, H. Bounameaux, L. Calanca, A. Erdmann, L. Mazzolai, Tzoran, I., Papadakis, M., Brenner, B., Fidalgo, A., Rivas, A., Wells, P. S., Gavin, O., Adarraga, M. D., Moustafa, F., Monreal, M., Decousus, H., Prandoni, P., Barba, R., Di Micco, P., Bertoletti, L., Reis, A., Bosevski, M., Bounameaux, H., Maly, R., Wells, P., Aibar, M. A., Alfonso, M., Arcelus, J. I., Barron, M., Barron-Andres, B., Bascunana, J., Blanco-Molina, A., Bueso, T., Canada, G., Canas, I., Chic, N., del Pozo, R., del Toro, J., Diaz-Pedroche, M. C., Diaz-Peromingo, J. A., Falga, C., Fernandez-Capitan, C., Fidalgo, M. A., Font, C., Font, L., Gallego, P., Garcia, A., Garcia, M. A., Garcia-Bragado, F., Garcia-Brotons, P., Gomez, C., Gomez, V., Gonzalez, J., Gonzalez-Marcano, D., Grau, E., Grimon, A., Guijarro, R., Gutierrez, J., Hernandez-Comes, G., Hernandez-Blasco, L., Hermosa-Los Arcos, M. J., Jara-Palomares, L., Jaras, M. J., Jimenez, D., Joya, M. D., Llamas, P., Lecumberri, R., Lobo, J. L., Lopez, P., Lopez-Jimenez, L., Lopez-Reyes, R., Lopez-Saez, J. B., Lorente, M. A., Lorenzo, A., Maestre, A., Marchena, P. J., Martin-Martos, F., Nieto, J. A., Nieto, S., Nunez, A., Nunez, M. J., Odriozola, M., Otero, R., Pedrajas, J. M., Perez, G., Perez-Ductor, C., Peris, M. L., Porras, J. A., Reig, O., Riera-Mestre, A., Riesco, D., Rodriguez, C., Rodriguez-Davila, M. A., Rosa, V., Ruiz-Gimenez, N., Sahuquillo, J. C., Sala-Sainz, M. C., Samperiz, A., Sanchez-Martinez, R., Sanchez Simon-Talero, R., Sanz, O., Soler, S., Surinach, J. M., Torres, M. I., Trujillo-Santos, J., Uresandi, F., Valero, B., Valle, R., Vela, J., Vicente, M. P., Villalobos, A., Vanassche, T., Verhamme, P., Hirmerova, J., Tomko, T., del Pozo, G., Salgado, E., Sanchez, G. T., Bura-Riviere, A., Mahe, I., Merah, A., Braester, A., Antonucci, G., Barillari, G., Bilora, F., Bortoluzzi, C., Cattabiani, C., Ciammaichella, M., Di Biase, J., Duce, R., Ferrazzi, P., Giorgi-Pierfranceschi, M., Grandone, E., Imbalzano, E., Lodigiani, C., Maida, R., Mastroiacovo, D., Pace, F., Pesavento, R., Pinelli, M., Poggio, R., Rota, L., Tiraferri, E., Tonello, D., Tufano, A., Visona, A., Zalunardo, B., Gibietis, V., Skride, A., Vitola, B., Monteiro, P., Ribeiro, J. L., Sousa, M. S., Zdraveska, M., Calanca, L., Erdmann, A., and Mazzolai, L.
Subjects: Male, Heterozygote, medicine.medical_specialty, medicine.drug_class, Low molecular weight heparin, Hemorrhage, 030204 cardiovascular system & hematology, Gene mutation, Thrombophilia, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Factor V Leiden, Humans, Anticoagulant therapy, Activated Protein C Resistance, Rivaroxaban, biology, business.industry, Bleeding, Factor V, Anticoagulants, General Medicine, Middle Aged, medicine.disease, Surgery, Treatment Outcome, Mutation, biology.protein, Prothrombin G20210A, Female, Prothrombin, Activated protein C resistance, business, Venous thromboembolism, 030215 immunology, medicine.drug
Abstract: Background Individuals with factor V Leiden or prothrombin G20210A mutations are at a higher risk to develop venous thromboembolism. However, the influence of these polymorphisms on patient outcome during anticoagulant therapy has not been consistently explored. Methods We used the Registro Informatizado de Enfermedad TromboEmbolica database to compare rates of venous thromboembolism recurrence and bleeding events occurring during the anticoagulation course in factor V Leiden carriers, prothrombin mutation carriers, and noncarriers. Results Between March 2001 and December 2015, 10,139 patients underwent thrombophilia testing. Of these, 1384 were factor V Leiden carriers, 1115 were prothrombin mutation carriers, and 7640 were noncarriers. During the anticoagulation course, 160 patients developed recurrent deep vein thrombosis and 94 patients developed pulmonary embolism (16 died); 154 patients had major bleeding (10 died), and 291 patients had nonmajor bleeding. On multivariable analysis, factor V Leiden carriers had a similar rate of venous thromboembolism recurrence (adjusted hazard ratio [HR], 1.16; 95% confidence interval [CI], 0.82-1.64), half the rate of major bleeding (adjusted HR, 0.50; 95% CI, 0.25-0.99) and a nonsignificantly lower rate of nonmajor bleeding (adjusted HR, 0.66; 95% CI, 0.43-1.01) than noncarriers. Prothrombin mutation carriers and noncarriers had a comparable rate of venous thromboembolism recurrence (adjusted HR, 1.00; 95% CI, 0.68-1.48), major bleeding (adjusted HR, 0.75; 95% CI, 0.42-1.34), and nonmajor bleeding events (adjusted HR, 1.10; 95% CI, 0.77-1.57). Conclusions During the anticoagulation course, factor V Leiden carriers had a similar risk for venous thromboembolism recurrence and half the risk for major bleeding compared with noncarriers. This finding may contribute to decision-making regarding anticoagulation duration in selected factor V Leiden carriers with venous thromboembolism.
Published: 2017

20. Acute venous thromboembolism after non-major orthopaedic surgery or post-traumatic limb immobilisation

Author: Laurent, Bertoletti, Marc, Righini, Henri, Bounameaux, Luciano, López-Jiménez, Eros, Tiraferri, Adriana, Visonà, Manuel, Monreal, and H, Bounameaux
Subjects: medicine.medical_specialty, Chirurgie orthopedique, Wounds and Injuries/surgery, Immobilization/methods, Immobilization, Postoperative Complications, Recurrence, Surgical Procedures, Minimally Invasive, Venous Thromboembolism/etiology/physiopathology/prevention & control, medicine, Humans, Minimally Invasive Surgical Procedures, Registries, ddc:616, Clinical Trials as Topic, Vascular disease, business.industry, Heparin, Low-Molecular-Weight/administration & dosage, Vascular biology, Extremities, Venous Thromboembolism, Hematology, Heparin, Low-Molecular-Weight, Extremities/injuries/surgery, medicine.disease, Thrombosis, Surgery, Venous thrombosis, Acute Disease, Practice Guidelines as Topic, Orthopedic surgery, Wounds and Injuries, Venous disease, business, Venous thromboembolism, Follow-Up Studies
Abstract: Acute venous thromboembolism after non-major orthopaedic surgery or post-traumatic limb immobilisation - Findings from the RIETE registry
Published: 2011

21. Thrombolytic therapy: can it prevent the development of post-thrombotic syndrome?

Author: H. Bounameaux
Subjects: medicine.medical_specialty, business.industry, medicine, Intensive care medicine, business, medicine.disease, Post-thrombotic syndrome
Published: 1998

22. Prise en charge m??dicale de l??art??riopathie des membres inf??rieurs

Author: H Bounameaux and R Wütschert
Subjects: medicine.medical_specialty, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Ischemia, Interventional radiology, medicine.disease, Intermittent claudication, Blood pressure, Amputation, Diabetes mellitus, Internal medicine, medicine, Cardiology, Pharmacology (medical), Myocardial infarction, medicine.symptom, business, Angiology
Abstract: Peripheral arterial disease of the lower limbs is a manifestation of atherosclerosis, and may also affect other vascular territories such as the coronary and cerebral arteries. Progressive narrowing of the vessels up to total occlusion can present as intermittent claudication or pain at rest, with or without cutaneous lesions. Patients with intermittent claudication are at a low risk of amputation, and the symptom has to be regarded as a warning signal for myocardial infarction and stroke. Nevertheless, if the patient's walking distance is too limited to allow a near-normal life, symptomatic treatment to improve quality of life should be considered. Treatment may consist of walking exercise, surgical or interventional radiological revascularisation, or, in some cases, administration of vasoactive drugs. Antiplatelet agents should be administered in an attempt to limit disease progression and prevent cardiac and cerebrovascular complications, together with active measures to reduce established risk factors such as smoking, diabetes, hyperlipidaemia, and arterial hypertension. The presence of pain at rest indicates that a lower limb is jeopardised, especially when the criteria for critical ischaemia have also been met. These criteria include the presence of chronic (lasting for more than 2 weeks) symptoms of ischaemia at rest and a systolic blood pressure less than 50 mm Hg or 30 mm Hg at the ankle or big toe, respectively. In such a situation, revascularisation should be attempted whenever possible. If this is not possible or if the procedure has failed, prostacyclin administered intravenously for days or weeks is an alternative. After revascularisation, early reocclusion may be prevented by administering anticoagulants and late reocclusion by antiplatelet agents, in conjunction with eradication of risk factors. In all situations, therapeutic decision-making should be undertaken in a multidisciplinary setting and should include the following: specialists in angiology (an internist) and interventional radiology; a vascular surgeon; an orthopaedic surgeon, if necessary; and diabetes and infectious disease specialists.
Published: 1998

23. Altered Skin Microcirculation in Patients with Systemic Lupus Erythematosus

Author: H Bounameaux, P A Miescher, and Olivier Bongard
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, Physiology, Hemodynamics, Microcirculation, Blood cell, Internal medicine, Laser-Doppler Flowmetry, Humans, Lupus Erythematosus, Systemic, Medicine, skin and connective tissue diseases, Reactive hyperemia, Skin, Lupus erythematosus, integumentary system, business.industry, Raynaud Disease, Blood flow, Middle Aged, Laser Doppler velocimetry, medicine.disease, Pathophysiology, Capillaries, medicine.anatomical_structure, Case-Control Studies, Immunology, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Blood Flow Velocity
Abstract: Although microvasculitis is one of the more common manifestations of systemic lupus erythematosus, there is no data on the hemodynamics of the skin microcirculation in such patients. The combination of dynamic capillaroscopy measuring capillary blood cell velocity (CBV) and laser Doppler fluxmetry (LDF) was used to simultaneously evaluate the nutritional and the total skin microcirculation in the fingers of 24 consecutive patients with SLE, using normal matched subjects as controls. The nutritional skin flow, as assessed by the CBV, was significantly impaired in patients, as compared with controls, both at rest (p = 0.001) and during postocclusive reactive hyperemia (p = 0.006). By contrast, no differences were observed in total skin microcirculation, as assessed by LDF (n.s.). There was no significant correlation between hemodynamic parameters and the presence of Raynaud's phenomenon, morphological capillary changes or anticardiolipine antibodies. There was no correlation between the magnitude of the alteration of the capillary blood flow and capillary morphological abnormalities, suggesting that the microvascular damage might be caused by different pathophysiological mechanisms.
Published: 1997

24. Place des D-dimères dans la démarche diagnostique de la maladie thromboembolique

Author: H Bounameaux
Subjects: Gynecology, medicine.medical_specialty, business.industry, Deep vein, Medical screening, Respiratory disease, Gastroenterology, Elisa assay, medicine.disease, Pulmonary embolism, Latex fixation test, medicine.anatomical_structure, D-dimer, Internal Medicine, medicine, cardiovascular diseases, business, Venous disease
Abstract: Resume La presence de D-dimeres dans la circulation temoigne de la formation et de la lyse de fibrine, constituani principal du thrombus. En presence d'une quantite de D-dimeres inferieure a un seuil dependant de la technique de dosage utilisee, la presence d'une thrombose veineuse profonde ou d' une embolie pulmonaire peut titre exclue avec une valour predictive superieure a 95 %, ce qui fait de ce test une etape de depistage ideale dans une population de malades ambulatoires cliniquement suspects. Les souls tests valides en pratique clinique actuelle dans cette indication sont des tests Elisa, la sensibilite des tests au latex etant insuffisante.
Published: 1997

25. Antithrombotic strategy after total hip replacement. A cost-effectiveness analysis comparing prolonged oral anticoagulants with screening for deep vein thrombosis

Author: F P, Sarasin and H, Bounameaux
Subjects: Postoperative Complications, Time Factors, Cost-Benefit Analysis, Internal Medicine, Administration, Oral, Anticoagulants, Humans, Mass Screening, Thrombosis, Hip Prosthesis, Drug Administration Schedule, Decision Support Techniques
Abstract: Deep vein thrombosis (DVT) in the lower limbs is a major postoperative complication in patients undergoing total hip replacement. However, even with the most effective perioperative antithrombotic prophylactic methods, its incidence at the time of hospital discharge remains as high as 15 to 25.We used a decision analysis model to determine the clinical and economic effects of the following interventions: (1) stopping prophylactic antithrombotic therapy after the in-hospital perioperative period (7-14 days), (2) extending prophylactic antithrombotic therapy with oral anticoagulants up to 6 weeks or 3 months, and (3) screening for DVT at the time of hospital discharge by compression ultrasonography or venography. We measured for a hypothetical cohort of 10 000 patients the risk of developing recurrent DVT and symptomatic pulmonary embolism, the risk of major bleeding complications, and the costs associated with each strategy. Data were drawn from the published literature (MEDLINE search) and from our hospital cost manager.Compared with stopping prophylaxis at the time of hospital discharge, a 6-week course of prophylactic oral anticoagulant therapy would reduce the number of cases of recurrent DVT from 1172 to 493 and the number of symptomatic pulmonary embolisms from 234 to 99, and would be less costly. This gain would be achieved at the cost of 29 major bleeding complications if the bleeding risk is low (0.2 per month) and 71 if the bleeding risk is moderate (0.5 per month). Compared with stopping prophylaxis at discharge, ultrasound screening would reduce symptomatic pulmonary embolisms from 234 to 142, induce only 13 major bleeding episodes, and be cost-effective, with marginal costs per additional pulmonary embolism averted ranging from $3000 to $7000, depending on ultrasound sensitivity. Venography screening would be the most effective strategy; however, compared with ultrasound, its marginal costs per additional pulmonary embolism averted would exceed $80 000.After hip replacement with conventional perioperative antithrombotic prophylaxis, oral anticoagulation administered for 6 weeks is effective in preventing recurrent DVT and symptomatic pulmonary embolism, unless the bleeding risk is very high. Moreover, this strategy is less costly compared with stopping antithrombotic prophylaxis at the time of hospital discharge. Alternatively, ultrasound screening is also effective, minimizes the risks of bleeding, and has a low marginal cost-effectiveness ratio.
Published: 1996

26. d‐Dimer testing to predict recurrence risk in venous thromboembolism: looking for a useful threshold: a rebuttal

Author: H. Bounameaux, G. Le Gal, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Service d'angiologie et d'hémostase (MR), and Hôpital Universitaire de Genève
Subjects: medicine.medical_specialty, Time Factors, Rebuttal, Administration, Oral, MESH: Anticoagulants, 030204 cardiovascular system & hematology, Recurrence risk, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, 0302 clinical medicine, Text mining, Recurrence, Risk Factors, MESH: Risk Factors, Thromboembolism, Internal medicine, D-dimer, MESH: Fibrin Fibrinogen Degradation Products, medicine, Humans, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, Venous Thrombosis, MESH: Humans, business.industry, MESH: Time Factors, Anticoagulants, Hematology, MESH: ROC Curve, MESH: Recurrence, ROC Curve, MESH: Thromboembolism, MESH: Administration, Oral, MESH: Venous Thrombosis, Cardiology, business, Venous thromboembolism, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience
Published: 2004

27. Effects of Percutaneous Transiuminal Angioplasty on Skin Microcirculation in Patients with Disabling Peripheral Arterial Occlusive Disease

Author: H. Bounameaux, D. Didier, and O. Bongard
Subjects: Male, medicine.medical_specialty, Percutaneous, Physiology, medicine.medical_treatment, Embolism, Arterial Occlusive Diseases, Balloon, Microcirculation, Internal medicine, Angioplasty, Laser-Doppler Flowmetry, medicine, Humans, Clinical significance, Angioplasty, Balloon, Coronary, Aged, Skin, integumentary system, medicine.diagnostic_test, business.industry, Angiography, Blood flow, Middle Aged, Laser Doppler velocimetry, Surgery, Oxygen, Cardiology, Female, Cardiology and Cardiovascular Medicine, business
Abstract: Percutaneous transluminal angioplasty (PTA) provokes a huge trauma to the arterial wall and potentially liberates fragments of atherosclerotic material that may impair the microcirculation downstream. Incidence and clinical relevance of such embolisms are not known. This study was aimed at investigating the changes of the skin microcirculation in patients with peripheral arterial occlusive disease undergoing PTA of the lower limbs. Pedal transcutaneous oxygen tension (tcpO2) and nailfold skin microcirculation were measured in 21 patients with disabling peripheral arterial occlusive disease before and after PTA. Sixteen matched patients undergoing arteriography alone were used as controls. The skin microcirculation was investigated at the nailfold of the great toe by the combination of laser Doppler fluxmetry and dynamic capillaroscopy. PTA was successful in all patients. The tcpO2 decreased immediately after PTA (delta tcpO2 = -5 mm Hg; p < 0.004), whereas it tended to increase (delta tcpO2 = 1 mm Hg; NS) following arteriography as compared with baseline values. By contrast, blood flow increased in both groups, predominantly for the total circulation in the PTA group and for nutritional circulation (p < 0.0017) in the arteriography group, respectively. Consequently, the 'nutritional index', i.e., the index of nutritional versus total microcirculation, was decreased following PTA, particularly following mechanical recanalization (p < 0.02), but did not change in the controls. The changes of this 'nutritional index' and those of the tcpO2 were positively correlated (r = 0.4, p = 0.023).(ABSTRACT TRUNCATED AT 250 WORDS)
Published: 1994

28. Gesellschaft für Mikrozirkulation

Author: A.W.B. Stanton, A. Arvesen, O. Bongard, L. Rosén, R.H. Bull, L.P. Eltvik, J.R. Levick, A. Kroese, Alan C. Groom, Karel Tyml, Richard F. Potter, J. Pullen, B. Fagrell, D. Didier, P.S. Mortimer, E. Stranden, Catherine C. Roberts, E. Wahlberg, Christopher G. Ellis, and H. Bounameaux
Subjects: Physiology, Cardiology and Cardiovascular Medicine
Published: 1994

29. Contents, Vol. 14, 1994

Author: R.H. Bull, A. Kroese, L. Rosén, J.R. Levick, Alan C. Groom, Karel Tyml, E. Stranden, Richard F. Potter, J. Pullen, A. Arvesen, O. Bongard, D. Didier, H. Bounameaux, P.S. Mortimer, A.W.B. Stanton, Catherine C. Roberts, E. Wahlberg, B. Fagrell, Christopher G. Ellis, and L.P. Eltvik
Subjects: Physiology, Botany, Biology, Cardiology and Cardiovascular Medicine
Published: 1994

30. Récidive thromboembolique veineuse : y a-t-il une place pour les D-dimères ?

Author: H Bounameaux
Subjects: medicine.medical_specialty, business.industry, Gastroenterology, medicine.disease, Pulmonary embolism, Venous thrombosis, Text mining, Predictive value of tests, Internal medicine, D-dimer, Internal Medicine, medicine, Fibrin Fibrinogen Degradation Products, business
Published: 2002

31. [Pulmonary embolism and internal medicine]

Author: H, Bounameaux
Subjects: Physicians, Internal Medicine, Humans, Professional Practice, Pulmonary Embolism, Algorithms, Diagnostic Techniques and Procedures
Published: 2011

32. Severity Scoring of Atopic Dermatitis: The SCORAD Index

Author: S. Cambiaghi, T. Ruzicka, N.P. Burrows, R. Russell Jones, O. Correia, S.A. Wagner, J. Umbert, R.K. Winkelmann, J. Revuz, K.U. Schallreuter, R. Cardone, E. Ermacora, R.A.J. Eady, G. Tadini, G. Burg, T. Dobmeyer, R. Cavalli, G. Rizzitelli, G. Lunghi, F. Wantke, O. Adam, G. Fleischl, L. Wegener, J. McGrath, H. Bounameaux, G.E. Piérard, M. Götz, Jean-Claude Roujeau, E. Christophers, M. Sisto, P. Saiag, B. Morsches, J. Varani, Ch. Levenig, S.E.G. Fligiel, R.M. Trüeb, P. Corcuff, K. Holubar, O. Bongard, S. Veraldi, R. Jarisch, J. Berger, S. Bastuji-Garin, Olivier Chosidow, D.R. Inman, G.T. Nahass, J.-L. Lévêque, R.U. Peter, A. Brusasco, R. Situ, J. Dobmeyer, R.E. Schopf, and J. Brasch
Subjects: medicine.medical_specialty, medicine.diagnostic_test, Scorad index, business.industry, Dermatology, Atopic dermatitis, medicine.disease, Eczema Area and Severity Index, body regions, Assessment methods, medicine, SCORAD, Composite index, business, Childhood atopic dermatitis
Abstract: Background . Assessment methods for atopic dermatitis (AD) are not standardized, and therapeutic studies are difficult to interpret. Aims . To obtain a consensus on
Published: 1993

33. Clinical Investigation of Skin Microcirculation

Author: O Bongard and H Bounameaux
Subjects: medicine.medical_specialty, Coloring agents, Dermatology, Skin Diseases, Vascular, Microcirculation, Partial oxygen, Skin Physiological Phenomena, Clinical investigation, Vasoactive, Laser-Doppler Flowmetry, Pressure, medicine, Humans, Coloring Agents, Intensive care medicine, Skin, Total blood, integumentary system, business.industry, Capillaries, Surgery, Clinical Practice, Skin Temperature, business, Blood Gas Monitoring, Transcutaneous, Blood Flow Velocity, Xenon Radioisotopes
Abstract: Skin microcirculation is rather complex. The skin viability depends upon the nutritional circulation, which cannot be assessed by conventional macrocirculatory methods that evaluate total blood supply. The indisputable advantage of the microcirculatory methods is to provide information directly in diseased skin areas and assess the effectiveness of vasoactive drugs where they are supposed to act. Several techniques are available today to evaluate the skin microcirculation. Among them, capillaroscopy and transcutaneous measurement of the partial oxygen pressure are of special interest because they provide information which is directly useful in clinical practice. Other techniques remain experimental. In this paper, the main microcirculatory techniques are reviewed and their clinical implications discussed.
Published: 1993

34. Contemporary management of pulmonary embolism: the answers to ten questions

Author: H, Bounameaux
Subjects: Aged, 80 and over, Fibrin Fibrinogen Degradation Products, Age Factors, Anticoagulants, Humans, Middle Aged, Prognosis, Pulmonary Embolism, Tomography, X-Ray Computed, Algorithms, Biomarkers, Drug Administration Schedule, Aged
Abstract: Pulmonary embolism (PE) cannot be diagnosed solely on a clinical basis, because of the lack of sensitivity and specificity of clinical signs and symptoms. Pulmonary angiography is invasive and resource demanding. Because the prevalence of PE is relatively low (20% or less) amongst individuals who are clinically suspected of having the disease, submitting all of them to imaging (multi-detector CT angiography or ventilation/perfusion lung scintigraphy) would not be cost-effective. Therefore, diagnostic algorithms have been developed that include clinical probability assessment and D-dimer measurement to select the patients who require noninvasive imaging. Once the diagnosis is suspected or confirmed, therapy must be started to avoid potentially fatal recurrence. Treatment starts for an initial 3-month period with a 5-day course of parenteral unfractionated or low-molecular-weight heparin or fondaparinux overlapping with and followed by oral vitamin K antagonists monitored to maintain an international normalized ratio of 2-3. This initial period of 3 months may then be followed by a long-term secondary prevention period in patients who experience an idiopathic thromboembolic event and are at low risk of bleeding. New oral anticoagulants that do require patient monitoring and might exhibit a more favourable benefit-risk balance are currently under extensive clinical testing and might change the situation in the near future. A critical appraisal of the contemporary management of suspected PE is given in this overview with the discussion of 10 practical questions.
Published: 2010

35. Thromboxane Antagonism with terutroban in Peripheral Arterial Disease: the TAIPAD study

Author: J N, Fiessinger, H, Bounameaux, M A, Cairols, D L, Clement, S, Coccheri, J P, Fletcher, U, Hoffmann, A G G, Turpie, and R, Koppensteiner
Subjects: Adult, Male, Time Factors, Adenosine Diphosphate/chemistry, Platelet Aggregation, medicine.drug_class, Thromboxane, Naphthalenes/*therapeutic use, Blood Pressure, Naphthalenes, Pharmacology, Placebo, Placebos, Peripheral Arterial Disease, chemistry.chemical_compound, Double-Blind Method, Antithrombotic, medicine, Humans, Aged, ddc:616, Aspirin, business.industry, Thromboxanes, Hematology, Middle Aged, Propionic Acids/*therapeutic use, Receptor antagonist, Peripheral Arterial Disease/*drug therapy, Adenosine Diphosphate, chemistry, Terutroban, Anesthesia, Aspirin/therapeutic use, Arachidonic acid, Female, Propionates, business, Thromboxanes/*antagonists & inhibitors, Ex vivo, medicine.drug
Abstract: BACKGROUND: Terutroban is a selective prostaglandin endoperoxide (TP) receptor antagonist with antithrombotic, antivasoconstrictive and antiatherosclerotic properties and is currently in development for long-term cardiovascular secondary prevention. OBJECTIVES: TAIPAD is an international, double-blind, randomized controlled study comparing the effects of five dosages of oral terutroban vs. aspirin and placebo on platelet aggregation in peripheral arterial disease (PAD) patients. PATIENTS/METHODS: After 10 day's placebo run-in, included patients (n = 435; ankle-brachial pressure index, 0.7 ± 0.1) were randomly allocated to aspirin 75 mg day(-1), terutroban 1, 2.5, 5, 10 or 30 mg day(-1) or placebo. On day 5, the placebo group was reallocated to one of the terutroban groups for the rest of the study (day 83). Ex vivo platelet aggregation induced by the thromboxane analog U46619 (7 μm) was measured 24 h after dosing, as well as platelet aggregation induced by arachidonic acid (AA), collagen and ADP. RESULTS: Terutroban dose-dependently inhibited U46619-induced platelet aggregation at days 5 and 83. At day 5, the inhibition was significant vs. placebo for all terutroban dosages (P < 0.001). Terutroban (5, 10 and 30 mg day(-1)) was at least as effective as aspirin in inhibiting platelet aggregation induced by arachidonic acid (AA), collagen and adenosine diphosphate (ADP). Terutroban was well tolerated, with a safety profile similar to aspirin. CONCLUSIONS: In PAD patients, terutroban dose-dependently inhibited platelet aggregation 24 h after dosing, and was at least as effective as aspirin at 5, 10 and 30 mg day(-1). Terutroban was well tolerated.
Published: 2010

36. Double-Blind, Randomized Comparison of Systemic Continuous Infusion of 0.25 Versus 0.50 mg/kg/24 h of Alteplase over 3 to 7 Days for Treatment of Deep Venous Thrombosis in Heparinized Patients: Results of the European Thrombolysis with rt-PA in Venous Thrombosis (ETTT) Trial

Author: H Bounameaux, J D Banga, E Bluhmki, S Coccheri, J N Fiessinger, W Haarmann, D Lockner, F Mahler, J Ninet, P A Schneider, A de Torrente, J van der Meer, and and R Verhaeghe
Subjects: Chemotherapy, medicine.medical_specialty, business.industry, medicine.medical_treatment, Hematology, Heparin, Thrombolysis, medicine.disease, Thrombosis, law.invention, Surgery, Venous thrombosis, Regimen, Randomized controlled trial, law, Anesthesia, medicine, Thrombus, business, medicine.drug
Abstract: Thirty-two patients with acute, proximal-vein thrombosis were treated with heparin and alteplase (0.25 versus 0.5 mg/kg/24 h during 3-7 days) in a randomized, double-blind, multicenter, European (ETTT) trial. The treatment resulted in a decrease of the venographic Marder's score from 18 (6-25) to 13 (2-24) units (median, range) in Group I (0.25 mg/kg/24 h, n = 15, median decrease 3.0, p = 0.32) and from 17.5 (3-33) to 15.5 (0-27) in Group II (0.5 mg/kg/24 h, n = 16, median decrease 4.0, p = 0.23). Comparison of the sequential venograms could be performed in 14 cases of Group I and in 15 cases in Group II. A minority of patients showed substantial partial recanalization of the initially obstructed veins on the control venogram (one in each treatment group) and most of the control venograms showed either thrombus size reductions (5 in Group I, 7 in Group II) or no change or even deterioration (8 in Group I, 7 in Group II). Major bleedings were observed in 7 patients (7/32, 22%), 5 of them occurring in Group II (5/17, 29%). Thus, the results of the ETTT trial show that the used low dosages of alteplase administered intravenously over 3-7 days in heparinized patients cannot be recommended as a treatment for patients with deep venous thrombosis of lower limbs and/or pelvis. Further studies are needed to define a more suitable dosage regimen of alteplase in this indication.
Published: 1992

37. Les nouvelles recommendations de lAmerican College of Chest Physicians (ACCP) sur les traitements antithrombotiques

Author: TF Lüscher, Walter A. Wuillemin, and H Bounameaux
Published: 2009

38. Die neuen Empfehlungen des American College of Chest Physicians (ACCP) über antithrombotische Behandlung

Author: H Bounameaux, WA Wuillemin, and TF Lüscher
Published: 2009

39. Diagnosing pulmonary embolism in elderly patients: a difficult challenge

Author: M. Righini and H. Bounameaux
Subjects: medicine.medical_specialty, business.industry, medicine, medicine.disease, Intensive care medicine, business, Pulmonary embolism
Published: 2009

40. A RIETE registry analysis of recurrent thromboembolism and hemorrhage in patients with catheter-related thrombosis

Author: A. Hij, C. Piovella, Ramón Lecumberri, José Luis Lobo, M. Zdraveska, F.J. Muñoz, F. Valle, Marijan Bosevski, P. Verhamme, N. Ruiz-Giménez, Olga Madridano, Steven Greenberg, A. Apollonio, J.F. Benítez, J.A. Porras, R. Maida, L. Bertoletti, G. Pérez-Rus, P. Román, R. Malý, M.J. Soto, J.M. Suriñach, H. Bounameaux, S. Pasca, J. González, B. Zalunardo, A. Merah, J. Caprini, J. Gutiérrez, I. Tzoran, M. Ciammaichella, A. García, Alicia Lorenzo, Manuel Monreal Bosch, R. Re, Abílio Reis, R. Valle, Lucia Mazzolai, M. Alcalde, Laurent Bertoletti, Peter Verhamme, Diego Tonello, J.B. López-Sáez, Juan I. Arcelus, Vladimir Rosa, D. Farge-Bancel, Isabelle Quéré, V. Vilella-Tomas, R. Jiménez, José María Pedrajas, J.M. Martín-Antorán, O. Sanz, P. Malfante, David Jiménez, L. López-Montes, B. Pagán, Inna Tzoran, J. Bascuñana, Beatriz Valero, E. Grau, Adriana Visonà, Francisco José Muñoz, M. Gómez-Durán, R. Guijarro, Antonella Tufano, A. Guida, J. Villalta, Luca Calanca, M.A. Lorente, M.J. Núñez, F. Conget, Lauren Cote, F. del Molino, M. Barrón, L. Rota, P. Prandoni, A. Braester, Raquel Barba, Radovan Malý, Ajla Alibalic, J. del Toro, I. Pons, Luis Jara-Palomares, B. Barrón-Andrés, Javier Trujillo-Santos, Fernando Uresandi, F. García-Bragado, P. Gallego, J. Malheiro, J. Vela, Henri Bounameaux, S. Hernández-Huerta, L. Hernández, P. Ferrazzi, Thomas Vanassche, Agustina Rivas, Giovanni Barillari, Farès Moustafa, J.A. Díaz, Ángeles Blanco-Molina, Pablo Javier Marchena, Benjamin Brenner, J. Hirmerova, M. Monreal, Raúl Sánchez, Aurora Villalobos, M.V. Morales, P. Di Micco, V. Gómez, Bernardo Sopeña, Ángel Sampériz, Antoni Riera-Mestre, Raquel López-Reyes, L. Font, M. Bosevski, Philip S. Wells, Joseph A. Caprini, I. Casado, R. Tirado, R. Barba, M.S. Sousa, Conxita Falga, J.A. Nieto, Remedios Otero, Lisa Baumann Kreuziger, Hervé Decousus, J.L. Ribeiro, G. Tiberio, M.L. Peris, M.A. Rodríguez-Dávila, A. Alatri, Isabelle Mahé, F. Pace, Luciano López-Jiménez, Sebastian Schellong, Carmen Fernández-Capitán, P. Sabio, Manuel Monreal, M.J. Jaras, Alessandra Bura-Rivière, F. Martín-Martos, S. Jiménez, Teresa Auguet, M. Macià, Dolores Nauffal, Barry M. Brenner, Silvia Soler, Paolo Prandoni, Pierpaolo Di Micco, J.C. Serrano, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), and Université Montpellier 1 (UM1)-Université de Montpellier (UM)
Subjects: medicine.medical_specialty, Catheters, Hemorrhage, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Recurrence, Recurrent thromboembolism, medicine, Humans, Registries, Risk factor, Venous Thrombosis, business.industry, Thrombosis, Odds ratio, medicine.disease, 3. Good health, Surgery, Pulmonary embolism, Catheter, Venous thrombosis, 030220 oncology & carcinogenesis, Concomitant, Pulmonary Embolism, Cardiology and Cardiovascular Medicine, business
Abstract: International audience; BACKGROUND:Few studies have investigated the treatment and the outcomes of patients with catheter-related thrombosis (CRT).METHODS:The RIETE registry (Registro Informatizado de Enfermedad TromboEmbólica [Computerized Registry of Patients with Venous Thromboembolism]) is a prospective international registry of consecutive patients with objectively confirmed venous thromboembolism (VTE). We analyzed the characteristics, treatment, and outcomes of patients with CRT.RESULTS:Of 558 patients with CRT, 45 (8%) presented with a pulmonary embolism (PE) concomitantly. More patients had central line-associated thrombosis compared with port systems, but catheter type did not influence the risk of presenting with a PE. Patients with only CRT were more often prescribed low-molecular-weight heparin for the duration of their anticoagulant treatment compared with patients presenting with concomitant PE. VTE recurrences and major bleeding events occurred frequently during treatment with anticoagulation (7 per 100 patient-years and 8.9 per 100 patient years, respectively). The rates of fatal PE recurrences (1.85 per 100 patient-years) and fatal bleeding (2.32 per 100 patient-years) were similar. Patients with an additional transient risk factor for VTE had the lowest risk for VTE recurrences (odds ratio [OR], 0.07; 90% confidence interval [CI], 0.01-0.45) compared with patients with CRT and no additional transient risk factors. PE at presentation increased the risk of recurrent thrombosis by 2.4 times. Renal insufficiency was also an independent predictor of recurrent thrombosis (OR, 3.93; 90% CI, 2.0-7.7). The odds of recurrent thrombosis was decreased by 77% in patients who received anticoagulation therapy for >90 days compared with patients with a shorter treatment (OR, 0.23; 90% CI, 0.1-0.56).CONCLUSIONS:Concomitant PE occurs less frequently in CRT than lower extremity deep venous thrombosis, but it is associated with a worse outcome. CRT occurs in high-risk patients, and duration of anticoagulation must be predicated on balancing these risks.
Published: 2015

41. Superficial thrombophlebitis and deep vein thrombosis. A controversial association

Author: H. Bounameaux
Subjects: Internal Medicine
Published: 1997

42. Les nouveaux anticoagulants

Author: H Bounameaux and J Vogel
Published: 2005

43. Venous thromboembolism prophylaxis in acutely ill medical patients: definite need for improvement

Author: P, Chopard, J, Dörffler-Melly, U, Hess, W A, Wuillemin, D, Hayoz, A, Gallino, E B, Bachli, C R, Canova, J, Isenegger, R, Rubino, and H, Bounameaux
Subjects: Adult, Male, Venous Thrombosis, Medical Audit, Professional Practice, Middle Aged, Hospitals, Cross-Sectional Studies, Acute Disease, Practice Guidelines as Topic, Humans, Female, Guideline Adherence, Hospitals, Teaching, Pulmonary Embolism, Switzerland, Aged, Quality of Health Care
Abstract: To examine the frequency and adequacy of thromboprophylaxis in acutely ill medical patients hospitalized in eight Swiss medical hospitals.A cross-sectional study of 1372 patients from eight Swiss hospitals was carried out. After exclusion of patients (275) given therapeutic anticoagulation, 1097 patients were audited. The adequacy of thromboprophylaxis was assessed by comparison with predefined explicit criteria.Of 1097 patients, 542 (49.4%) received thromboprophylaxis. According to the explicit criteria, 644 (58.7%) should have been on prophylaxis (P0.001, when compared with the rate observed). The rate of prevention differed widely between hospitals (from 29.4 to 88.6%) with no difference between teaching and nonteaching hospitals. According to the explicit criteria, a substantial proportion (44.9%) of the patients who should have been treated were not. Conversely, 41.3% of the patients were unnecessarily treated.Even though the appropriateness of the explicit criteria used could be challenged, our data suggest that the current practice is associated with important uncertainty leading to both overuse and underuse of thromboprophylaxis in patients hospitalized in medical wards. More efforts are urgently needed to develop new or endorse existing explicit, evidence-based criteria and guidelines for thromboprophylaxis in this population of patients.
Published: 2005

44. [Diagnosis of suspected deep venous thrombosis and pulmonary embolism during pregnancy]

Author: M, Righini and H, Bounameaux
Subjects: Adult, Plethysmography, Pregnancy Complications, Venous Thrombosis, Pregnancy, Postpartum Period, Humans, Female, Phlebography, Pulmonary Embolism, Tomography, Spiral Computed
Abstract: Venous thromboembolic disease (VTE) is a frequent clinical problem during pregnancy and post-partum. Pulmonary embolism (PE) remains the most common cause of mortality during pregnancy and post-partum in western countries. In the majority of cases, DVT may be diagnosed by non-invasive tests such as clinical probability, D-dimer measurement and venous compression ultrasonography. In contrast, at least one irradiating invasive exam is necessary in suspected PE. The lung scan, the most validated diagnostic test for PE during pregnancy and fetal irradiation is quite low, in particular if only perfusion lung scan is used. Helical computed tomography (hCT) has widely replaced lung scan in the diagnostic approach of suspected pulmonary embolism. However, it has never been validated in pregnant women.
Published: 2005

45. [The COPD-PE study: prevalence and prediction of pulmonary embolism in acute exacerbations of chronic obstructive pulmonary disease]

Author: A, Perrier, T, Perneger, J, Cornuz, V, Jounieaux, and H, Bounameaux
Subjects: Leg, Veins, Fibrin Fibrinogen Degradation Products, Pulmonary Disease, Chronic Obstructive, Cross-Sectional Studies, Predictive Value of Tests, Prevalence, Humans, France, Emergencies, Pulmonary Embolism, Tomography, Spiral Computed, Algorithms, Switzerland, Ultrasonography
Abstract: Patients suffering from chronic obstructive pulmonary disease (COPD) are often admitted to hospital with an exacerbation of their disease that manifests itself with an increase in cough and/or sputum, increased dyspnoea and sometimes chest pain. These episodes are most often attributed to an acute exacerbation of bronchial infection but the real cause is often unknown. COPD is considered a risk factor for pulmonary embolism (PE) and PE is part of the differential diagnosis of an acute exacerbation of COPD. However, the symptoms of these two conditions overlap to a considerable extent and the investigation of PE is often ignored in these patients. Therefore the true prevalence of PE in this situation is unknown. Nevertheless several small series suggest that up to 30% of patients seen as emergencies with exacerbations of COPD may have a deep vein thrombosis or PE. The aims of this study are therefore: 1. To evaluate the prevalence of PE in patients admitted as emergencies with exacerbations of COPD; and 2. To attempt to develop a prediction guide for PE in this population in order to identify the patients in whom PE should be investigated.600 consecutive patients admitted as emergencies with exacerbations of COPD will be included in a cross sectional study in three university hospitals (Geneva and Lausanne in Switzerland, and Amiens in France). Patients fulfilling the inclusion criteria will be investigated by a diagnostic algorithm appropriate for the study of PE, including D-dimer levels and, in those with abnormal results, ultrasonic scan of the deep veins of the legs and spiral CT scan. The patient characteristics on admission will be incorporated in a multivariate regression analysis in an attempt to identify the predictive factors for PE in these patients. The expected duration of the study is 24 months.This study should determine the prevalence of PE in patients admitted as emergencies with exacerbations of COPD and therefore help decide when, and in which patients, a systematic search for PE should be undertaken.
Published: 2004

46. Relationship between sympathetic reactivity and body weight loss in morbidly obese subjects

Author: Gilles Chassot, Alain Golay, O Bongard, H Bounameaux, Philippe Morel, Olivier Huber, Elisabetta Bobbioni-Harsch, F Habicht, Françoise Assimacopoulos-Jeannet, and D Weimer
Subjects: Adult, Male, medicine.medical_specialty, Sympathetic nervous system, Sympathetic Nervous System, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Gastric Bypass, Medicine (miscellaneous), Sympathetic Nervous System/physiopathology, Insulin resistance, Weight loss, Internal medicine, Weight Loss, medicine, Humans, Vasoconstriction/physiology, Postoperative Period, ddc:613, Skin, ddc:616, Nutrition and Dietetics, ddc:617, business.industry, Insulin, Stomach, medicine.disease, Obesity, Skin/blood supply, Obesity, Morbid, Endocrinology, medicine.anatomical_structure, Basal (medicine), Vasoconstriction, Regression Analysis, Female, medicine.symptom, Obesity, Morbid/physiopathology/surgery, Insulin Resistance, business, Energy Intake
Abstract: OBJECTIVE: To investigate the possible role of peripheral sympathetic activity in gastric bypass-induced body weight loss. SUBJECTS AND METHODS: In 42 morbidly obese patients (sex: 36 f/6 m; BMI: 46.0±0.7 kg/m2) undergoing a gastric bypass, the skin vasoconstrictor reflex in answer to a deep inspiration was measured by laser Doppler fluximetry. The extent of vasoconstriction, measured at the second finger of the left hand, was expressed as percent reduction of the basal blood flux (% vasoconstriction). Insulin sensitivity was assessed before surgery in a subset of patients (n=11), by the method of euglycemic, hyperinsulinemic clamp. Body weight and composition were evaluated before, and 3, 6 and 12 months after surgery. At the same time points, energy intake (kJ/day) was evaluated by means of both food record diary and alimentary anamnesis. RESULTS: The % vasoconstriction, which was significantly (P=0.01) greater in normoglycemic subjects than in diabetic ones, was also significantly (P=0.03) related to the extent of insulin sensitivity measured during the euglycemic clamp. The % vasoconstriction showed a significant (P>0.0001), positive correlation with weight reduction obtained between the 6th and 12th months following surgery; as a consequence, % vasoconstriction was significantly (P=0.0004) related to the overall body weight loss achieved during the year following the operation. These correlations remained significant in multiple regression analysis with adjustment for age, initial body weight, plasma glucose and insulin (P=0.0007 and 0.006, respectively). The % vasoconstriction was also significantly (P=0.0006), negatively related to energy intake measured 12 months after surgery. CONCLUSIONS: In conditions of stable body weight, the sympathetic nervous system (SNS) reactivity is influenced by the degree of insulin resistance. A high capacity to activate the SNS, measured before surgery, is associated with both a larger gastric bypass-induced weight loss and a lower energy intake, at the phase of weight stabilization.
Published: 2004

47. [Venous thromboembolism recurrence: is there a place for D-dimer?]

Author: H, Bounameaux
Subjects: Fibrin Fibrinogen Degradation Products, Venous Thrombosis, Predictive Value of Tests, Recurrence, Thromboembolism, Humans, Biomarkers
Published: 2002

48. Intermittent claudication: how should we react to this symptom?

Author: H Bounameaux
Subjects: medicine.medical_specialty, business.industry, Fibrinogen, Intermittent Claudication, Intermittent claudication, Treatment Outcome, Fibrinolytic Agents, Italy, Physical therapy, Medicine, Humans, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Glycosaminoglycans
Published: 2002

49. [Value of D-dimers in diagnosis of acute pulmonary embolism]

Author: M, Righini, H, Bounameaux, and A, Perrier
Subjects: Diagnosis, Differential, Fibrin Fibrinogen Degradation Products, Reference Values, Acute Disease, Humans, Pulmonary Embolism
Abstract: FIBRIN BREAKDOWN PRODUCTS: D-dimers are protein substances resulting from the action of 3 enzymes, thrombin, factor XIII and plasmin, on the fibrinogen molecules. In the case of thrombosis, all these enzymatic reactions are activated, explaining the increase in D-dimer levels induced. The notion of a threshold is only significant for a given test; the 500 micrograms/L threshold is widely used for tests relying on ELISA methods (enzyme-linked immunosorbent assay). FROM A TECHNICAL POINT OF VIEW: The use of D-dimer ELISA in excluding pulmonary embolism is now well established. New quantitative tests with latex, based on a turbidimetric method, also appear interesting in this context. The latter is reliable, rapid, inexpensive, remarkably sensitive (97 to 100%) and widely available.Performed in the initial stages of diagnosis in an out-patient population with a 20-25% prevalence of the disease, it excludes the diagnosis in around 30% of patients. Decisional analysis models have shown that this method is economically profitable. However, in elderly hospitalised patients, its clinical utility is lesser because of its low specificity in this population. The association of high clinical probability of pulmonary embolism and normal D-dimer leves is rare and has a weaker negative predictive value, even when the ELISA technique is used.
Published: 2002

50. Prediction of pulmonary embolism extent by clinical findings, D-dimer level and deep vein thrombosis shown by ultrasound

Author: C, Galle, J P, Papazyan, M J, Miron, D, Slosman, H, Bounameaux, and A, Perrier
Subjects: Adult, Aged, 80 and over, Male, Venous Thrombosis, Hemodynamics, Middle Aged, Prognosis, Respiratory Function Tests, Fibrin Fibrinogen Degradation Products, Risk Factors, Outpatients, Ventilation-Perfusion Ratio, Humans, Female, Prospective Studies, Pulmonary Embolism, Aged, Ultrasonography
Abstract: Pulmonary embolism (PE) may encompass a wide spectrum of severity. To determine whether clinical findings, D-dimer (DD) concentration, and deep vein thrombosis (DVT) shown by lower-limb venous compression ultrasonography (US) might predict the scintigraphic extent of PE, we studied 104 hemodynamically stable consecutive outpatients with acute PE diagnosed by a high-probability ventilation-perfusion lung scan. Scintigraphic extent of PE was classified into three categories: perfusion defects corresponding to30%, 30-50%, or50% of the total lung area. Median respiratory and heart rates were found to be significantly related to the extent of PE. Higher median alveolar-arterial oxygen difference values were observed as the proportion of lung perfusion defects increased (50% vs.30%, 6.3 vs. 3.6 kPa, P.0001). Median plasma DD concentration was 7950 microg/L in patients with50% perfusion defects compared to 2731 microg/L in those with30% defects (P = .0001). DD levels above 4000 microg/L were associated to more extensive perfusion defects (50% vs.30% defects, OR 30; 95% CI 5.8-155). Finally, a proximal DVT was more likely among patients with larger perfusion defects (50% vs.30% defects, OR 4.5; 95% CI 1.5-13.6). In conclusion, clinical signs such as tachypnea and tachycardia, alveolar-arterial oxygen difference, plasma DD concentration, and presence of DVT on US are predictors of a larger PE, as assessed by the extent of perfusion defects on high probability lung scans.
Published: 2002

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