263 results on '"M. Di Nisio"'
Search Results
2. Baseline characteristics of patients with atrial fibrillation and cancer enrolled in the BLITZ-AF Cancer registry
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P Ameri, M Alings, F Colivicchi, R Collins, L De Luca, M Di Nisio, G Fabbri, D Gabrielli, S Janssens, A P Maggioni, I Parrini, F J Pinto, F M Turazza, J L Zamorano, and M M Gulizia
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Cardiology and Cardiovascular Medicine - Abstract
Background Evidences on atrial fibrillation (AF) in patients with cancer are limited, specifically with respect to antithrombotic therapy. Methods BLITZ-AF Cancer is a prospective, non-interventional study of the epidemiology and management of AF in patients with cancer. Patients were included from 112 cardiology units in Italy, Belgium, Netherlands, Spain, Portugal, and Ireland, based on the following criteria: age ≥18 years; documented cancer other than basal-cell or squamous-cell carcinoma of the skin diagnosed within 3 years; electrocardiographically confirmed AF within 1 year; no concomitant interventional study. Follow-up is ongoing. Results From June 26th, 2019 to Sep. 30th, 2021, 1,514 subjects were enrolled. The most frequent cancer locations were lung (14.9%), colorectal (14.1%), breast (13.9%), prostate (8.8%), and non-Hodgkin lymphoma (8.1%); 463 (30.6%) of participants had metastases. AF was first-detected in 323 (21.3%), paroxysmal in 460 (30.4%), persistent in 192 (12.7%), long-standing persistent in 33 (2.2%), and permanent in 506 (33.4%); 590 (39.0%) patients had symptoms attributable to AF. Baseline characteristics are presented in Table 1. Males were more than women and almost half of the subjects was >75 years-old. Cardiovascular risk factors were common and approximately 31% had heart failure or coronary artery disease. Previous thromboembolic and haemorrhagic events had occurred in 14% and 10% of subjects, respectively. The median CHA2DS2VASc score was 3. As shown in Figure 1, the prescription of oral anticoagulants, especially direct-acting ones (DOACs), rose after the cardiology assessment, while the percentage of participants without any antithrombotic therapy declined. Among 1,427 patients with non-valvular AF (i.e., no mitral stenosis or prosthetic mechanical valve), 997 (69.9%) were prescribed on DOACs at discharge/after consultation. At multivariable logistic regression analysis, variables associated with DOAC use were female sex (OR 1.58, 95% CI 1.22–2.05), age (OR 2.00, 95% CI 1.39–2.88 and OR 2.63, 95% CI 1.84–3.76, respectively, for 65–74 years and ≥75 years vs Conclusions BLITZ-AF Cancer provides extensive information on a large, contemporary cohort of individuals with AF and cancer. This baseline snapshot indicates that cardiologists pursue the implementation of DOACs in these patients, although residual use of other antithrombotic therapies or lack of any thrombo-prophylaxis remains substantial. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): This study was supported by an unrestricted grant from Daiichi Sankyo. more...
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- 2022
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Catalog
3. Effects of body composition on the procoagulant imbalance in obese patients
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Matteo Candeloro, D Caniglia, Cosima Schiavone, Maria Teresa Guagnano, Emanuele Valeriani, Maria Domenica Guglielmi, S La Barba, Ettore Porreca, M. Di Nisio, and R Auciello
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medicine.medical_specialty ,education.field_of_study ,Hematology ,business.industry ,Population ,Odds ratio ,030204 cardiovascular system & hematology ,Anthropometry ,medicine.disease ,Obesity ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Coagulation ,Internal medicine ,medicine ,Composition (visual arts) ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,education ,business ,Protein C ,medicine.drug - Abstract
Obesity is associated with increased thrombotic risk and hypercoagulability whose main driver is an excess of coagulation factor VIII relative to protein C. The aims of this study were to evaluate the association between factor VIII, protein C, factor VIII-to-protein C ratio and bioimpedance parameters of body composition in obese patients. We analysed blood from 69 obese patients and 23 non-obese healthy controls. Plasma levels of factor VIII, protein C, and factor VIII-to-protein C ratio were correlated with total fat, visceral fat, and muscle mass. Compared to controls, obese patients had significantly higher factor VIII (110.5% vs 78.05%, p 1 was significantly associated with body-mass index (odds ratio 1.08, 95% CI 1.02 to 1.14) and fat-to-muscle ratio (odds ratio 2.47, 95% CI 1.10 to 5.55). Factor VIII-to-protein C ratio strongly correlated with D-dimer levels in the overall population (rho 0.44, p more...
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- 2020
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4. Edoxaban for treatment of venous thromboembolism in patient groups with different types of cancer: Results from the Hokusai VTE Cancer study
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H. R. Büller, Annelise Segers, Michele Mercuri, Peter Verhamme, Anil Duggal, Noémie Kraaijpoel, J. I. Weitz, Manila Gaddh, Sudeep Shivakumar, N. van Es, Michael A. Grosso, Marc Carrier, Tzu-Fei Wang, Gordon Royle, M. Di Nisio, Ajay K. Kakkar, George Zhang, Frits I. Mulder, David A. Garcia, Saskia Middeldorp, Gary E. Raskob, Vascular Medicine, Graduate School, ACS - Pulmonary hypertension & thrombosis, and ARD - Amsterdam Reproduction and Development more...
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Dalteparin ,medicine.medical_specialty ,Pyridines ,medicine.drug_class ,030204 cardiovascular system & hematology ,Lower risk ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Breast cancer ,Edoxaban ,Internal medicine ,Neoplasms ,medicine ,Humans ,Cancer-associated venous thromboembolism ,Gastrointestinal cancer ,Lung cancer ,business.industry ,Anticoagulant ,Pulmonary embolism ,Absolute risk reduction ,Anticoagulants ,Cancer ,Thrombosis ,Hematology ,medicine.disease ,Thiazoles ,chemistry ,030220 oncology & carcinogenesis ,Neoplasm Recurrence, Local ,business ,Direct oral anticoagulant ,Venous thromboembolism - Abstract
Background The safety and efficacy of edoxaban and dalteparin is unclear for several cancer groups. Methods We evaluated the occurrence of the primary outcome in large cancer groups. The primary outcome was the composite of recurrent VTE or major bleeding over 12 months. Results In patients with gastrointestinal cancer, the primary outcome occurred in 19.4% patients given edoxaban and in 15.0% given dalteparin (risk difference [RD], 4.4%; 95%-CI, −4.1% to 12.8%). The corresponding rates for edoxaban and dalteparin were 10.4% and 10.7% for lung cancer (RD, −0.3%; 95%-CI, −10.0% to 9.5%), 13.6% and 12.5% for urogenital cancer (RD, 1.1; 95%-CI, −10.1–12.4), 3.1% and 11.7% for breast cancer (RD, −8.6; 95%-CI, −19.3–2.2), 8.9% and 10.9% for hematological malignancies (RD, −2.0; 95%-CI, −13.1–9.1), and 10.4% and 17.4% for gynecological cancer (RD, −7.0; 95%-CI, −19.8–5.7). In the subgroup of gastrointestinal cancer, edoxaban was associated with a 3.5% lower absolute risk of recurrent VTE and a 7.9% higher risk of major bleeding. Conclusion Edoxaban has a similar risk-benefit ratio to dalteparin in most cancer groups. In those with gastrointestinal cancer, the lower risk of recurrent VTE and the advantages of oral therapy need to be balanced against the increased risk of major bleeding. more...
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- 2020
5. TAPSE or right-to-lleft ventricle diameter ratio at echocardiography to predict death in patients with acute pulmonary embolism: a meta-analysis
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L A Cimini, G Maraziti, M Candeloro, M Plywaczewska, P Pruszczyk, M Di Nisio, G Agnelli, and C Becattini
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Cardiology and Cardiovascular Medicine - Abstract
Background Right ventricle (RV) dysfunction at echocardiography is a recognized predictor of death or clinical deterioration in patients with acute pulmonary embolism (PE). However, the best predictor of death among echo parameters of RV dysfunction is unknown. Purpose This meta-analysis is aimed at assessing the role of individual parameter of RV dysfunction at echocardiography to predict all-cause short-term death in patients with acute PE. Methods OVID was searched between 1993 and January 2020 for studies i) including patients with confirmed acute PE; ii) reporting on RV assessment at echocardiography at admission; iii) reporting on short-term all-cause or PE-related death. The primary study outcome is short-term (30 days or in-hospital) all-cause mortality. Results We report here on the role of tricuspid annular plane excursion (TAPSE) and right-to-left ventricle diameter ratio (RV/LV) at echocardiography as predictors of short-term death in patients with acute PE. TAPSE. Abnormal TAPSE at echocardiography was associated with increased risk for short-term death in all-comers with acute PE (eight studies; 3298 patients; RR 2.78 CI 95% 0.53–14.63; Figure 1) and in hemodynamically stable patients (six studies; 3013 patients; RR 2.76 CI 95% 1.44–5.30 I2 58%). The association is confirmed for different cut-off values of TAPSE (≥15mm or any cut-off value >15mm). RV/LV. In eight studies reporting on continuous measures, the difference between mean right and left ventricle diameter at echocardiography in patients who died vs those who survived ranged from 0.02 to 0.3 mm. Abnormal RV/LV ratio at echocardiography was not associated with increased risk for short-term death in all-comers with acute PE (six studies; 2292 patients; RR 1.48 CI 95% 0.43–5.08), nor in hemodynamically stable patients (four studies; 1014 patients; RR 1.20 CI 95% 0.72–1.99, I2=0%). Conclusion Abnormal TAPSE is associated with short-term death in patients with acute PE. In these patients, the prognostic role of RV/LV diameter ratio as stand-alone parameter of RV dysfunction at echocardiography remains unclear. Funding Acknowledgement Type of funding sources: None. Figure 1. Association between TAPSE and all-cause more...
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- 2021
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6. Effects of body composition on the procoagulant imbalance in obese patients
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M, Candeloro, M, Di Nisio, E, Valeriani, R, Auciello, S, La Barba, M T, Guagnano, D, Caniglia, C, Schiavone, M D, Guglielmi, and E, Porreca
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Factor VIII ,Body Composition ,Humans ,Obesity ,Body Mass Index ,Protein C - Abstract
Obesity is associated with increased thrombotic risk and hypercoagulability whose main driver is an excess of coagulation factor VIII relative to protein C. The aims of this study were to evaluate the association between factor VIII, protein C, factor VIII-to-protein C ratio and bioimpedance parameters of body composition in obese patients. We analysed blood from 69 obese patients and 23 non-obese healthy controls. Plasma levels of factor VIII, protein C, and factor VIII-to-protein C ratio were correlated with total fat, visceral fat, and muscle mass. Compared to controls, obese patients had significantly higher factor VIII (110.5% vs 78.05%, p 0.001), protein C (120.99% versus 110.51%, p = 0.014), and factor VIII-to-protein C ratio (0.93 versus 0.73, p = 0.002). In obese patients, factor VIII correlated with body-mass index, body fat percentage, muscle mass percentage, and fat-to-muscle ratio, whereas protein C had significant relationships with body fat percentage, muscle mass percentage and fat-to-muscle ratio, but not with body-mass index. Factor VIII-to-protein C ratio 1 was significantly associated with body-mass index (odds ratio 1.08, 95% CI 1.02 to 1.14) and fat-to-muscle ratio (odds ratio 2.47, 95% CI 1.10 to 5.55). Factor VIII-to-protein C ratio strongly correlated with D-dimer levels in the overall population (rho 0.44, p 0.001) and obese patients (rho 0.41, p 0.001). In obese patients, bioimpedance measures of body fat and muscle mass percentage were associated with factor VIII and protein C. Factor VIII-to-protein C ratio was strongly associated with fat-to-muscle ratio and only modestly related to BMI. more...
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- 2020
7. Corrigendum to 'Edoxaban for treatment of venous thromboembolism in patient groups with different types of cancer: Results from the Hokusai VTE Cancer study' [Thromb. Res. vol. 185, January 2020, pages 13-19]
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George Zhang, Frits I. Mulder, Annelise Segers, Peter Verhamme, M. Di Nisio, Manila Gaddh, Noémie Kraaijpoel, Marc Carrier, Ajay K. Kakkar, David A. Garcia, N. van Es, Michael A. Grosso, Gordon Royle, Saskia Middeldorp, Michele Mercuri, H. R. Büller, J. I. Weitz, Tzu-Fei Wang, Gary E. Raskob, Sudeep Shivakumar, and Anil Duggal more...
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Oncology ,medicine.medical_specialty ,business.industry ,MEDLINE ,Cancer ,Regret ,Hematology ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Primary outcome ,chemistry ,Edoxaban ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,Cumulative incidence ,In patient ,business ,Venous thromboembolism - Abstract
The authors regret that panel E of Fig. 1 was missing, showing the cumulative incidence of the primary outcome in hematologic cancer. The authors would like to apologise for any inconvenience caused. more...
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- 2020
8. OC-14 Risk factors for recurrence in patients with cancer-associated venous thromboembolism: results from the Hokusai-VTE cancer study
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Marc Carrier, H. R. Büller, Floris T. M. Bosch, Frits I. Mulder, Michael A. Grosso, M. Di Nisio, David A. Garcia, Peter Verhamme, Jeffrey I. Weitz, Tzu-Fei Wang, Jean M. Connors, Annelise Segers, N. van Es, and Gary E. Raskob more...
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Oncology ,medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Cancer ,In patient ,Hematology ,business ,medicine.disease ,Venous thromboembolism - Published
- 2021
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9. PO-92 Evaluation of gemcitabine and platinum agents for the prediction of venous thromboembolism in patients with cancer: results from the Vienna Cancer and thrombosis Study
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Cihan Ay, Matthias Preusser, A. Moik, Ingrid Pabinger, N. van Es, M. Di Nisio, Florian Posch, and T. Füreder
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Oncology ,medicine.medical_specialty ,Platinum Agents ,business.industry ,Cancer ,Hematology ,medicine.disease ,Thrombosis ,Gemcitabine ,Internal medicine ,Medicine ,In patient ,business ,Venous thromboembolism ,medicine.drug - Published
- 2021
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10. Clinical course of isolated distal deep vein thrombosis in patients with active cancer: a multicenter cohort study
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Serena M. Passamonti, Stefano Barco, Giovanni Barillari, Michelangelo Sartori, Federica Bagna, Daniela Mastroiacovo, S. Pegoraro, Walter Ageno, Raffaella Benedetti, Francesco Dentali, Corrado Lodigiani, Nicola Mumoli, Mariasanta Napolitano, M. Di Nisio, M. N. D. Di Minno, Fulvio Pomero, Dentali, F, Pegoraro, S, Barco, S, DI MINNO, Matteo, Mastroiacovo, D, Pomero, F, Lodigiani, C, Bagna, F, Sartori, M, Barillari, G, Mumoli, N, Napolitano, M, Passamonti, S. M, Benedetti, R, Ageno, W, Di Nisio, M., Dentali, F., Pegoraro, S., Barco, S., di Minno, M., Mastroiacovo, D., Pomero, F., Lodigiani, C., Bagna, F., Sartori, M., Barillari, G., Mumoli, N., Napolitano, M., Passamonti, S., Benedetti, R., and Ageno, W. more...
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Male ,medicine.medical_specialty ,distal deep vein thrombosis ,mortality ,neoplasm ,observational study ,venous thromboembolism ,Hematology ,Time Factors ,Deep vein ,Hemorrhage ,030204 cardiovascular system & hematology ,Disease-Free Survival ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Risk Factors ,Neoplasms ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Venous Thrombosis ,business.industry ,Incidence ,Clinical course ,Anticoagulants ,Cancer ,distal deep vein thrombosi ,Venous Thromboembolism ,Heparin ,Middle Aged ,medicine.disease ,Thrombosis ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Italy ,Female ,Pulmonary Embolism ,business ,Venous thromboembolism ,Distal deep vein thrombosis ,Mortality ,Neoplasm ,Observational study ,medicine.drug ,Cohort study - Abstract
Essentials Isolated distal deep vein thrombosis (IDDVT) is frequently associated with cancer. No study has specifically evaluated the long-term clinical course of cancer-associated IDDVT. Patients with cancer-associated IDDVT are at very high risk of symptomatic recurrence and death. We observed low rates of major bleeding during anticoagulation. SummaryBackground Although isolated distal deep vein thrombosis (IDDVT) is frequently associated with cancer, no study has specifically evaluated the long-term clinical course of IDDVT in this setting. Aim To provide data on the rate of recurrent venous thromboembolism (VTE), major bleeding events and death in IDDVT patients with active cancer. Patients and Methods Consecutive patients with active cancer and an objective IDDVT diagnosis (January 2011 to September 2014) were included from our files. We collected information on baseline characteristics, IDDVT location and extension, VTE risk factors, and type and duration of anticoagulant treatment. Results A total of 308 patients (mean age 66.2 [standard deviation (SD), 13.2 years]; 57.1% female) with symptomatic IDDVT and a solid (n = 261) or hematologic (n = 47) cancer were included at 13 centers. Cancer was metastatic in 148 (48.1%) patients. All but three (99.0%) patients received anticoagulant therapy, which consisted of low-molecular-weight heparin in 288 (93.5%) patients. Vitamin K antagonists were used for the long-term treatment in 46 (14.9%) patients, whereas all others continued the initial parenteral agent for a mean treatment duration of 4.2 months (SD, 4.6 months). During a total follow-up of 355.8 patient-years (mean, 13.9 months), there were 47 recurrent objectively diagnosed VTEs for an incidence rate of 13.2 events per 100 patient-years. During anticoagulant treatment, the annual incidence of major bleeding was 2.0 per 100 patient-years. Conclusions Cancer patients with IDDVT have a high risk of VTE recurrence. Additional studies are warranted to investigate the optimal intensity and duration of anticoagulant treatment for these patients. more...
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- 2017
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11. Is stand‐alone D‐dimer testing safe to rule out acute pulmonary embolism?
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T. van der Hulle, M. Di Nisio, Frederikus A. Klok, H.R. Büller, Menno V. Huisman, N. van Es, Javier Galipienzo, Amsterdam Cardiovascular Sciences, Vascular Medicine, and ACS - Pulmonary hypertension & thrombosis more...
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Adult ,Male ,Risk ,medicine.medical_specialty ,pulmonary embolism ,diagnosis ,venous thromboembolism ,030204 cardiovascular system & hematology ,Gastroenterology ,Fibrin Fibrinogen Degradation Products ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,parasitic diseases ,D-dimer ,Individual data ,medicine ,Humans ,In patient ,Prospective Studies ,030212 general & internal medicine ,Aged ,Probability ,business.industry ,Incidence ,Hemodynamics ,Hematology ,Middle Aged ,medicine.disease ,Predictive value ,Pulmonary embolism ,Surgery ,sensitivity and specificity ,Female ,business ,Venous thromboembolism - Abstract
Essentials A stand-alone D-dimer below 750 μg/L has been proposed to rule out acute pulmonary embolism (PE). This was a post-hoc analysis on data from 6 studies comprising 7268 patients with suspected PE. The negative predictive value of a D-dimer more...
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- 2017
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12. Improving the diagnostic management of upper extremity deep vein thrombosis
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Giuseppe Camporese, Jan Beyer-Westendorf, N. van Es, Marc Philip Righini, Anita Aggarwal, A. Kleinjan, M. Di Nisio, Suzanne M. Bleker, H.R. Büller, Peter Verhamme, Patrick M.M. Bossuyt, Vascular Medicine, Other departments, Amsterdam Cardiovascular Sciences, APH - Personalized Medicine, APH - Methodology, Epidemiology and Data Science, and ACS - Pulmonary hypertension & thrombosis more...
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Adult ,Male ,medicine.medical_specialty ,Clinical variables ,Cardiology ,Diagnostic accuracy ,030204 cardiovascular system & hematology ,Sensitivity and Specificity ,Severity of Illness Index ,Fibrin Fibrinogen Degradation Products ,03 medical and health sciences ,0302 clinical medicine ,Upper Extremity Deep Vein Thrombosis ,D-dimer ,Severity of illness ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Clinical decision ,Aged ,ddc:616 ,business.industry ,Anticoagulants ,Hematology ,Middle Aged ,Confidence interval ,Surgery ,ROC Curve ,Calibration ,Female ,Radiology ,business ,Algorithms - Abstract
Essentials The Constans score and D-dimer can rule out upper extremity deep vein thrombosis without imaging. We evaluated the performance of an extended Constans score and an age-adjusted D-dimer threshold. The extended Constans score did not increase the efficiency compared to the original score. Age-adjusted D-dimer testing safely increased the efficiency by 4%, but this needs validation. SummaryBackground Among patients with clinically suspected upper extremity deep vein thrombosis (UEDVT), a clinical decision rule based on the Constans score combined with D-dimer testing can safely rule out the diagnosis without imaging in approximately one-fifth of patients. Objectives To evaluate the performance of the original Constans score, an extended Constans score and an age-adjusted D-dimer positivity threshold. Methods Data of 406 patients with suspected UEDVT previously enrolled in a multinational diagnostic management study were used. The discriminatory performance, calibration and diagnostic accuracy of the Constans score were evaluated. The Constans score was extended by selecting clinical variables that may have incremental value in detecting UEDVT, conditional on the original Constans score items. The performance of the Constans rule was evaluated in combination with fixed and age-adjusted D-dimer thresholds. Results The original Constans score showed good discriminatory performance (c-statistic, 0.81; 95% confidence interval [CI], 0.76–0.85). An extended Constans score with five additional clinical items improved discriminatory performance and calibration, but this did not translate into a higher efficiency in avoiding imaging tests. Compared with a fixed threshold, age-adjusted D-dimer testing increased the proportion of patients for whom imaging and anticoagulation could be withheld from 21% to 25% (gain, 3.7%; 95% CI, 2.3–6.0%). Conclusions The Constans score has good discriminatory performance in the diagnosis of UEDVT. Age-adjusted D-dimer testing is likely to safely increase the efficiency of the diagnostic algorithm, but this approach needs prospective validation. more...
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- 2017
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13. Relationship between type of unprovoked venous thromboembolism and cancer location: An individual patient data meta-analysis
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Matthew T. Rondina, Luis Jara-Palomares, Mariëlle Beckers, Juan Manuel Praena-Fernández, Noémie Kraaijpoel, V. Rieu, H. R. Büller, Paolo Prandoni, Philippe Robin, Andrea Piccioli, Piotr Religa, Hans-Martin Otten, M. Di Nisio, Patrick M.M. Bossuyt, Pierre-Yves Salaun, Ramón Lecumberri, G. Le Gal, N. van Es, Marc Carrier, 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), Thrombosis Program, University of Ottawa [Ottawa], Vascular Medicine, Epidemiology and Data Science, APH - Methodology, APH - Personalized Medicine, ACS - Pulmonary hypertension & thrombosis, Graduate School, and Amsterdam Reproduction & Development (AR&D) more...
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medicine.medical_specialty ,Deep vein ,[SDV]Life Sciences [q-bio] ,Prevalence ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Risk Factors ,Internal medicine ,Neoplasms ,Venous thrombosis ,medicine ,Humans ,OCCULT CANCER ,cardiovascular diseases ,ComputingMilieux_MISCELLANEOUS ,RISK ,Science & Technology ,Meta-analysis [publication type] [(MeSH terms)] ,business.industry ,Pulmonary embolism ,Cancer ,Hematology ,medicine.disease ,equipment and supplies ,Occult ,Thrombosis ,3. Good health ,Meta-analysis ,THROMBOSIS ,medicine.anatomical_structure ,Peripheral Vascular Disease ,030220 oncology & carcinogenesis ,Cardiovascular System & Cardiology ,business ,Life Sciences & Biomedicine ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,Venous thromboembolism - Abstract
[Background] Unprovoked venous thromboembolism (VTE) may be the first manifestation of an underlying cancer. We aimed to assess the period prevalence of occult cancer detection stratified by VTE location (deep vein thrombosis [DVT], pulmonary embolism [PE] or both) and the anatomical relationship between occult cancer and VTE., [Methods] Post-hoc analysis of a systematic review and individual patient data meta-analysis of adults with unprovoked VTE with at least 12 months of follow-up. Cancer types were grouped according to thoracic, abdomino-pelvic, or other locations., [Results] A total of 2300 patients were eligible including 1218 with DVT only (53%), 719 with PE only (31%), and 363 with both PE and DVT (16%). The pooled 12-month period prevalence of cancer in DVT only, PE only, and DVT + PE was 5.6% (95% CI, 4.4 to 7.2), 4.3% (95% CI, 2.7 to 6.9), and 5.6% (95% CI, 1.7 to 15.5), respectively. Most occult cancers were located in the abdomen (68.4%). The proportion of patients with an abdomino-pelvic cancer was not different in patients with DVT + PE (81%; 95% CI, 54 to 96) than in those with DVT (68%; 95% CI, 57 to 78) or PE alone (65%; 95% CI, 48 to 79)., [Conclusion] The 12-month prevalence of occult cancer was similar in patients with DVT only, PE only, or both. Most cancers were located in the abdomen, and there was no relationship between VTE type and cancer location. more...
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- 2019
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14. Current management strategies and long‐term clinical outcomes of upper extremity venous thrombosis
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K. Kaasjager, S van Wissen, Giuseppe Camporese, Peter Marschang, Marc Philip Righini, H. M. Otten, Anita Aggarwal, Benilde Cosmi, Suzanne M. Bleker, Jan Beyer-Westendorf, Ettore Porreca, Peter Verhamme, M. Di Nisio, Karina Meijer, A. Kleinjan, T Gary, Teresa Lerede, Angelo Ghirarduzzi, Harry R. Büller, N. van Es, Pieter W. Kamphuisen, Bleker, S.M, van Es, N., Kleinjan, A., Büller, H.R., Kamphuisen, P.W., Aggarwal, A., Beyer-Westendorf, J., Camporese, G., Cosmi, B., Gary, T., Ghirarduzzi, A., Kaasjager, K., Lerede, T., Marschang, P., Meijer, K., Otten, H.-M., Porreca, E., Righini, M., Verhamme, P., van Wissen, S., Di Nisio, M., Other departments, Amsterdam Cardiovascular Sciences, Vascular Medicine, Cardiovascular Centre (CVC), and Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET) more...
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Male ,Superficial vein thrombosis ,medicine.medical_treatment ,neoplasms ,030204 cardiovascular system & hematology ,0302 clinical medicine ,Risk Factors ,Prevalence ,DEEP-VEIN THROMBOSIS ,030212 general & internal medicine ,Prospective cohort study ,Upper extremity deep vein thrombosi ,ddc:616 ,Venous Thrombosis ,upper extremity deep vein thrombosis ,Incidence (epidemiology) ,RIETE REGISTRY ,Hazard ratio ,Venous Thromboembolism ,Hematology ,Middle Aged ,Pulmonary embolism ,Venous thrombosis ,Treatment Outcome ,WEIGHT HEPARIN DALTEPARIN ,Female ,hemorrhage ,Adult ,medicine.medical_specialty ,recurrence ,PULMONARY-EMBOLISM ,POSTTHROMBOTIC SYNDROME ,Compression stockings ,Fibrin Fibrinogen Degradation Products ,03 medical and health sciences ,Internal medicine ,medicine ,Humans ,Survival rate ,Aged ,therapy ,business.industry ,Anticoagulants ,Decision Support Systems, Clinical ,medicine.disease ,mortality ,BLEEDING COMPLICATIONS ,Surgery ,PROSPECTIVE COHORT ,CATHETER-RELATED THROMBOSIS ,RISK-FACTORS ,Neoplasm ,COMPRESSION STOCKINGS ,business ,Follow-Up Studies - Abstract
Essentials Few data exist on outcome of upper extremity deep and superficial vein thrombosis (UEDVT and UESVT). We followed 102 and 55 patients with UEDVT or UESVT, respectively, for a median of 3.5 years. Risk of recurrent venous thromboembolism was low in both diseases, and the mortality high. Postthrombotic symptoms were infrequent and cancer patients had a higher risk of recurrent VTE. Background There is scant information on the optimal management and clinical outcome of deep and superficial vein thrombosis of the upper extremity (UEDVT and UESVT). Objectives To explore treatment strategies and the incidence of recurrent venous thromboembolism (VTE), mortality, postthrombotic symptoms, and bleeding in patients with UEDVT and UESVT and to assess the prognosis of cancer patients with UEDVT. Patients/methods Follow-up of patients with UEDVT or UESVT, who were enrolled previously in a diagnostic management study. Results We followed 102 and 55 patients with UEDVT and UESVT, respectively, both for a median of 3.5 years. Anticoagulant treatment was started in 100 patients with UEDVT (98%) and in 40 (73%) with UESVT. Nine patients with UEDVT (9%) developed recurrent VTE, 26 (26%) died, 6 (8%) of 72 patients had moderate postthrombotic symptoms, and 5 (5%) experienced major bleeding. One patient with UESVT had a recurrent VTE, 18 (33%) died, none had moderate postthrombotic symptoms, and none had major bleeding. Of the cancer patients with UEDVT, 18% had recurrent VTE vs. 7.5% in non-cancer patients (adjusted hazard ratio 2.2, 95%CI 0.6-8.2). The survival rate was 50% in cancer patients with UEDVT vs. 60% in those without (adjusted HR 0.8, 95%CI 0.4-1.4). Conclusions The risk of recurrent VTE was low in patients with UEDVT, and negligible for UESVT. Mortality was high for both diseases. Postthrombotic symptoms were infrequent and mild. Anticoagulant therapy of UEDVT carried a substantial risk of major bleeding. Cancer patients had a significant risk of recurrent VTE more...
- Published
- 2016
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15. Residual vein obstruction in patients diagnosed with acute isolated distal deep vein thrombosis associated with active cancer
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M. N. D. Di Minno, S. Pegoraro, F. Bagna, Serena M. Passamonti, Nicola Mumoli, Stefano Barco, Giovanni Barillari, Walter Ageno, Corrado Lodigiani, Mariasanta Napolitano, Daniela Mastroiacovo, Francesco Dentali, M. Di Nisio, Raffaella Benedetti, Fulvio Pomero, Michelangelo Sartori, Dentali, F., Barco, S., Pegoraro, S., Di Minno, M. N. D., Mastroiacovo, D., Pomero, F., Lodigiani, C., Bagna, F., Sartori, M., Barillari, G., Mumoli, N., Napolitano, M., Passamonti, S. M., Benedetti, R., Ageno, W., Di Nisio, M., Dentali F., Barco S., Pegoraro S., Di Minno M.N.D., Mastroiacovo D., Pomero F., Lodigiani C., Bagna F., Sartori M., Barillari G., Mumoli N., Napolitano M., Passamonti S.M., Benedetti R., Ageno W., and Di Nisio M. more...
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Adult ,Male ,medicine.medical_specialty ,medicine.drug_class ,Deep vein ,030204 cardiovascular system & hematology ,Compression ultrasound ,Distal deep vein thrombosis ,Recurrence ,Residual vein obstruction ,Venous thromboembolism ,Hematology ,Cardiology and Cardiovascular Medicine ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Neoplasms ,medicine ,Humans ,In patient ,Distal deep vein thrombosi ,Aged ,Ultrasonography ,Venous Thrombosis ,business.industry ,Risk Factor ,Anticoagulant ,Cancer ,Anticoagulants ,Venous Thromboembolism ,Middle Aged ,medicine.disease ,Thrombosis ,Surgery ,Discontinuation ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Acute Disease ,Neoplasm ,Female ,business ,Human ,Cohort study - Abstract
After acute proximal deep vein thrombosis (DVT) the thrombotic mass decreases, especially during the first months of anticoagulation. The persistence of residual vein obstruction (RVO) may predict future recurrence in patients with cancer-associated DVT. We aimed to evaluate the proportion of patients with RVO after an episode of cancer associated isolated distal DVT (IDDVT), to identify variables associated with RVO, and to provide initial evidence of its association with recurrent VTE. We performed a post-hoc analysis of a multicenter cohort study of patients with isolated cancer-associated acute IDDVT. We included patients who underwent a control ultrasonography at the end of the anticoagulant treatment between day 30 and day 365 after index IDDVT, given that no recurrent VTE had already occurred on anticoagulant treatment. A total of 153 patients had ultrasonographic follow-up after a median of 92 days from index IDDVT: 45.8% had RVO and 54.2% exhibited complete recanalization. Female sex, Body Mass Index > 30Kg/m2 and involvement of axial calf veins showed the strongest association with RVO. The risk of recurrence was twofold higher in patients with (versus without) RVO. RVO persisted in approximately half of patients with an episode of cancer-associated IDDVT at anticoagulant discontinuation. Patients with RVO appeared to be at a higher risk for recurrent events. more...
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- 2018
16. Risk Scores for Occult Cancer in Patients with Venous Thromboembolism: A Post Hoc Analysis of the Hokusai-VTE Study
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George Zhang, Michael A. Grosso, Gary E. Raskob, M. Di Nisio, H. R. Büller, N. van Es, Min Lin, Noémie Kraaijpoel, Marc Carrier, ACS - Pulmonary hypertension & thrombosis, Graduate School, Vascular Medicine, and ARD - Amsterdam Reproduction and Development more...
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Clinical Decision-Making ,030204 cardiovascular system & hematology ,Risk Assessment ,Decision Support Techniques ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,Neoplasms ,Post-hoc analysis ,medicine ,Humans ,Multicenter Studies as Topic ,Cumulative incidence ,In patient ,030212 general & internal medicine ,Stroke ,Early Detection of Cancer ,Aged ,Randomized Controlled Trials as Topic ,Venous Thrombosis ,business.industry ,Incidence ,Hazard ratio ,Cancer ,Anticoagulants ,Hematology ,Venous Thromboembolism ,Middle Aged ,medicine.disease ,Confidence interval ,Female ,Occult cancer ,business ,Pulmonary Embolism ,Venous thromboembolism ,Factor Xa Inhibitors - Abstract
Venous thromboembolism (VTE) may be the first sign of an undiagnosed cancer. In patients with unprovoked VTE, the risk is approximately 5% in the year following VTE diagnosis. Cancer-specific screening is therefore often considered in these patients, but the optimal screening strategy remains controversial. Recently, two risk classification scores have been proposed that may help in identifying patients at high risk of occult cancer in whom extensive screening may be warranted. In the present post hoc analysis of the Hokusai-VTE study, we evaluated the performance of the Registro Informatizado de Pacientes con Enfermedad TromboEmbólica (RIETE) and Screening for Occult Malignancy in Patients with Idiopathic Venous Thromboembolism (SOME) scores for occult cancer in patients with acute VTE. A total of 8,032 patients were included in the analysis of whom 218 (2.7%; 95% confidence interval [CI], 2.4–3.1) developed cancer between 30-day and 12-month follow-up. The c-statistics of the RIETE and SOME scores were 0.62 (95% CI, 0.57–0.66) and 0.59 (95% CI, 0.55–0.62), respectively. In patients classified as ‘high risk’, the cumulative incidence of cancer diagnosis during follow-up was 2.9% (95% CI, 2.1–3.9) for the RIETE score and 2.7% (95% CI, 1.9–3.7) for the SOME score, corresponding to hazard ratios of 1.8 (95% CI, 1.3–2.5) and 1.5 (95% CI, 1.04–2.2), respectively. In conclusion, the performance of both scores was poor. When used dichotomously, the scores were able to identify a group of patients with a significantly higher risk of occult cancer, although it remains unknown whether this translates into improved clinical important outcomes. more...
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- 2018
17. Venous thromboembolism in cancer patients receiving neoadjuvant chemotherapy: a systematic review and meta-analysis
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M. Di Nisio, Ettore Porreca, Anne W S Rutjes, and Matteo Candeloro
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Male ,Time Factors ,medicine.medical_treatment ,neoplasms ,030204 cardiovascular system & hematology ,0302 clinical medicine ,Risk Factors ,Neoplasms ,Prevalence ,Prospective cohort study ,610 Medicine & health ,Neoadjuvant therapy ,Aged, 80 and over ,Incidence ,Incidence (epidemiology) ,Venous Thromboembolism ,Hematology ,Middle Aged ,Esophageal cancer ,Neoadjuvant Therapy ,Treatment Outcome ,Italy ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Meta-analysis ,Female ,360 Social problems & social services ,Cohort study ,Adult ,medicine.medical_specialty ,venous thromboembolism ,review ,Risk Assessment ,Young Adult ,03 medical and health sciences ,Internal medicine ,medicine ,Humans ,Gastrointestinal cancer ,neoadjuvant therapy ,cardiovascular diseases ,Aged ,Neoplasm Staging ,business.industry ,Cancer ,meta-analysis ,equipment and supplies ,medicine.disease ,business - Abstract
Essentials Cancer patients are at risk for venous thromboembolism (VTE). The risk of VTE in less advanced stage cancer on neoadjuvant chemotherapy is unclear. In over 7800 patients, we found a 7% pooled incidence of VTE during neoadjuvant therapy. Highest VTE rates were observed in patients with bladder and esophageal cancer. Summary Background Venous thromboembolism (VTE) is a frequent complication in cancer patients receiving adjuvant treatment. The risk of VTE during neoadjuvant chemo-radiotherapy remains unclear. Objectives This systematic review evaluated the incidence of VTE in patients with cancer receiving neoadjuvant treatment. Methods MEDLINE and EMBASE databases were searched from inception to October 2017. Search results were supplemented with screening of conference proceedings of the American Society of Clinical Oncology (2009-2016) and the International Society of Thrombosis and Haemostasis (2003-2016). Two review authors independently screened titles and abstracts, and extracted data onto standardized forms. Results Twenty-eight cohort studies (7827 cancer patients, range 11 to 1398) were included. Twenty-five had a retrospective design. Eighteen cohorts included patients with gastrointestinal cancer, representing over two-thirds of the whole study population (n = 6002, 78%). In total, 508 of 7768 patients were diagnosed with at least one VTE during neoadjuvant treatment, for a pooled VTE incidence of 7% (95% CI, 5% to 10%) in the absence of substantial between-study heterogeneity. Heterogeneity was not explained by site of cancer or study design characteristics. VTE presented as pulmonary embolism in 22% to 96% of cases (16 cohorts), and it was symptomatic in 22% to 100% of patients (11 cohorts). The highest VTE rates were observed in patients with bladder (10.6%) or esophageal (8.4%) cancer. Conclusions This review found a relatively high incidence of VTE in cancer patients receiving neoadjuvant therapy in the presence of some between-study variation, which deserves further evaluation in prospective studies. more...
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- 2018
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18. Non-O blood group and outcomes of in vitro fertilization
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Adalisa Ponzano, Anne W S Rutjes, Maria Domenica Guglielmi, Gian Mario Tiboni, Ettore Porreca, and M. Di Nisio
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Adult ,medicine.medical_specialty ,Pregnancy Rate ,Assisted reproductive techniques ,610 Medicine & health ,Fertilization in Vitro ,030204 cardiovascular system & hematology ,Abortion ,03 medical and health sciences ,0302 clinical medicine ,360 Social problems & social services ,Pregnancy ,ABO blood group system ,Odds Ratio ,Genetics ,Humans ,Positive Pregnancy Test ,Medicine ,Thrombophilia ,ABO blood type ,Prospective Studies ,Treatment Failure ,Assisted Reproduction Technologies ,Prospective cohort study ,reproductive and urinary physiology ,Genetics (clinical) ,Blood type ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics ,Pregnancy Outcome ,Obstetrics and Gynecology ,General Medicine ,Odds ratio ,Reproductive Medicine ,Developmental Biology ,Blood Group Antigens ,Female ,business ,Live birth ,Live Birth ,Cohort study - Abstract
PURPOSE Retrospective and cross-sectional studies suggested that non-O blood group may be associated with failures of in vitro fertilization (IVF), but data remain controversial. The aim of this observational cohort study was to prospectively evaluate the effect of non-O blood type on clinical outcomes of IVF. METHODS Women more...
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- 2018
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19. Prevention of venous thromboembolism in hospitalized medical cancer patients: guidance from the SSC of the ISTH
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Marc Carrier, M. Di Nisio, Alok A. Khorana, Gary H. Lyman, and Vascular Medicine
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medicine.medical_specialty ,International Cooperation ,Population ,Cardiology ,Hemorrhage ,Fondaparinux ,law.invention ,Randomized controlled trial ,Medical illness ,law ,Polysaccharides ,Neoplasms ,Medicine ,Humans ,Renal Insufficiency ,Intensive care medicine ,education ,Societies, Medical ,education.field_of_study ,business.industry ,Heparin ,Cancer ,Anticoagulants ,Hematology ,Venous Thromboembolism ,Heparin, Low-Molecular-Weight ,medicine.disease ,Thrombocytopenia ,Hospitalization ,Increased risk ,business ,Venous thromboembolism ,medicine.drug - Abstract
Cancer patients hospitalized for an acute medical illness are at increased risk of venous thromboembolism (VTE). Pharmacological thromboprophylaxis is considered standard practice for these patients and current guidelines recommend prophylactic doses of low-molecular-weight heparins (LMWHs), unfractionated heparin (UFH), or fondaparinux in the absence of bleeding or other contraindications [1-4]. These recommendations are extrapolated from large placebo-controlled randomized clinical trials (RCTs) of VTE thromboprophylaxis in broad mixed populations of medical inpatients, none involving exclusively cancer patients or presenting efficacy and safety data for this subgroup [5-8]. Because cancer inpatients represent a unique population with increased risk of VTE and major hemorrhage, validation of the efficacy and safety of thromboprophylaxis in this group is critical. This article is protected by copyright. All rights reserved more...
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- 2014
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20. Treatment and long-term clinical outcomes of incidental pulmonary embolism in cancer patients: an international prospective cohort study
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N. Falvo, C. Tromeur, J. Schmidt, E. Confrere, N. Dublanchet, F. Piovella, M. Di Nisio, A.W. Rutjes, A. Muñoz, S. Accassat, Jan Beyer-Westendorf, M. Pinson, S.M. Bleker, R. Caliandro, F. Couturaud, I. Russi, J. Constans, M. Salgado Fernández, F. Lalezari, H.M. Otten, C. de Prado Maneiro, Marc Carrier, L. Bertoletti, J.D. Assaf, E. de Magalhaes, J.F. Bergmann, J. Baars, D. Iosub, Ettore Porreca, T. Lerede, S. Gonzàlez Santiago, P. Martinez Del Prado, G. Bozas, A. Kleinjan, N. Kraaijpoel, A.I. Ferrer Pérez, M.A. Sevestre, O. Sanchez, Anita Aggarwal, A. Rutten, C. Boulon, Anthony Maraveyas, B. Planquette, S. Aquilanti, A. Falanga, I. Désormais, M. Biosca, H.R. Büller, G. Meyer, S. Endig, C. Grange, P. Girard, J. Thaler, N. van Es, H. Helfer, Frederick R. Rickles, I. Mahé, P. Lacroix, I. García Escobar, N. Paleiron, L.F.M. Beenen, and Sandra Marten more...
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Pediatrics ,medicine.medical_specialty ,business.industry ,medicine ,Cancer ,Hematology ,medicine.disease ,Prospective cohort study ,business ,Pulmonary embolism ,Term (time) - Published
- 2018
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21. Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism
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M. Di Nisio, Hokusai Vte Cancer Investigators, Gary E. Raskob, Marc Carrier, Peter Verhamme, David A. Garcia, and N. van Es
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Oncology ,medicine.medical_specialty ,business.industry ,Cancer ,medicine.disease ,chemistry.chemical_compound ,chemistry ,Edoxaban ,Internal medicine ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Venous thromboembolism - Published
- 2019
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22. A worldwide survey to assess the current approach to the treatment of patients with cancer and venous thromboembolism
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M. Di Nisio, Pieter Willem Kamphuisen, A. Van de Geer, Harry R. Büller, Charles Faselis, Anita Aggarwal, F. R. Rickles, A. Kleinjan, Cardiovascular Centre (CVC), Vascular Ageing Programme (VAP), Other departments, Amsterdam Cardiovascular Sciences, and Vascular Medicine more...
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medicine.medical_specialty ,Time Factors ,medicine.drug_class ,PULMONARY-EMBOLISM ,Low molecular weight heparin ,030204 cardiovascular system & hematology ,SECONDARY PREVENTION ,Medical Oncology ,WARFARIN ,03 medical and health sciences ,0302 clinical medicine ,Neoplasms ,Internal medicine ,medicine ,Humans ,Drug Dosage Calculations ,DEEP-VEIN THROMBOSIS ,Intensive care medicine ,MALIGNANCY ,business.industry ,Data Collection ,Anticoagulant ,Warfarin ,Anticoagulants ,Cancer ,Venous Thromboembolism ,Hematology ,MOLECULAR-WEIGHT HEPARIN ,Heparin, Low-Molecular-Weight ,CHEMOTHERAPY ,medicine.disease ,Thrombosis ,United States ,BLEEDING COMPLICATIONS ,Pulmonary embolism ,Europe ,Venous thrombosis ,Pulmonology ,030220 oncology & carcinogenesis ,RISK-FACTORS ,UPPER-EXTREMITY ,Anticoagulant treatment ,venous thrombosis ,business ,medicine.drug - Abstract
SummaryLow-molecular-weight heparin (LWMH) is recommended as the preferred anticoagulant treatment over vitamin K antagonists (VKA) for venous thromboembolism (VTE) in patients with cancer. However, there is uncertainty about the duration and dose of LMWH treatment. Therefore, we designed this multinational survey to assess the current approach to the treatment of patients with cancer and VTE. An electronic survey tool was used to disseminate a survey containing 49 questions on different aspects of the treatment of patients with cancer and VTE, among both thrombosis and non-thrombosis specialists. A total of 229 invitations were sent, and 141 completed the survey (60% of the total). Fifty-eight percent of the respondents were from Europe, 35% from the US and the remaining 7% from other countries. Respondent’s specialties included haematology (23%), oncology (18%), pulmonology (15%) and general internal medicine (15%). LMWH was indicated as the first choice for the long-term treatment by 82% of the respondents, of whom 60% used full therapeutic doses and 40% chose a dose reduction. When continuing anticoagulants after the long-term treatment period, 44% of respondents preferred LMWH, 10% VKA, while the remaining 45% chose per individual patient for either LMWH or VKA. In conclusion, we observed a relatively high observance rate of the guidelines with respect to the use of LMWH for the long-term treatment of VTE in cancer. In contrast, the dose of LMWH and the type of anticoagulant chosen after the initial 3–12 months varied substantially, probably reflecting the limited available evidence. more...
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- 2013
23. Early pregnancy
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A. Zeadna, H. Holzer, W. Y. Son, E. Demirtas, S. Reinblatt, M. H. Dahan, V. Colleselli, E. D'Costa, L. Wildt, B. Seeber, A. A. Kashevarova, N. A. Skryabin, T. V. Nikitina, I. N. Lebedev, P. P. Bordignon, A. Mugione, V. S. Vanni, P. Vigano, E. Papaleo, M. Candiani, E. Somigliana, G. Amodio, S. Gregori, Y. H. Guo, R. Li, L. L. Wang, S. L. Chen, X. Chen, W. Guo, D. S. Ye, Y. D. Liu, M. M. Renzini, M. Dal Canto, G. Coticchio, R. Comi, C. Brigante, I. Caliari, F. Brambillasca, M. Merola, M. Lain, D. Turchi, G. Karagouga, M. Sottocornola, R. Fadini, M. Z. Wekker, F. Mol, M. van Wely, W. M. Ankum, B. W. Mol, F. van der Veen, P. J. Hajenius, N. M. van Mello, C. Verlengia, E. Alviggi, M. R. Rampini, P. Alfano, I. Pergolini, D. Marconi, N. Iacobelli, M. C. Muzi, G. Gelli, C. Alviggi, A. Colicchia, L. Herraiz-Nicuesa, M. Tejera-Alhambra, A. Garcia-Segovia, R. Ramos-Medina, B. Alonso, J. Gil-Pulido, L. Martin, M. Caballero, M. Rodriguez-Mahou, S. Sanchez-Ramon, P. G. de Jong, S. P. Kaandorp, M. Di Nisio, M. Goddijn, S. Middeldorp, B. Lledo, A. Turienzo, J. A. Ortiz, R. Morales, J. Ten, J. Llacer, R. Bernabeu, J. Gil, J. A. Leon, A. Seyfferth, A. Aguaron, J. Alonso, E. C. de Albornoz, J. Carbone, P. Caballero, E. Fernandez-Cruz, L. Ortiz-Quintana, Y. Y. Lou, F. Jin, Y. M. Zheng, L. J. Li, F. Le, L. Y. Wang, S. Y. Liu, P. P. Pan, C. X. Hu, A. Akoum, A. Bourdiec, R. Shao, C. V. Rao, F. Scarpellini, M. Sbracia, N. Jancar, E. V. Bokal, H. Ban-Frangez, S. Drobnic, S. Korosec, B. Pinter, V. Salamun, M. Yamaguchi, R. Honda, K. Uchino, T. Ohba, H. Katabuchi, O. Leylek, B. Tiras, A. Y. S. E. Saltik, C. Halicigil, N. Kavci, A. Wiser, A. Gilbert, R. Nahum, R. Orvieto, J. Hass, A. Hourvitz, A. Weissman, G. Younes, M. Dirnfeld, A. Hershko, A. Shulma, E. Shalom-Paz, T. Tulandi, S. M. O'Neill, E. Agerbo, L. C. Kenny, T. B. Henriksen, P. M. Kearney, R. A. Greene, P. B. Mortensen, A. S. Khashan, V. S. Talaulikar, B. E. Bax, I. Manyonda, and N. Van Mello more...
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Reproductive Medicine ,Rehabilitation ,Obstetrics and Gynecology - Published
- 2013
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24. Treatment with tirofiban for acute coronary syndrome (ACS): a systematic review and network analysis
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Nigel Armstrong, M. di Nisio, Shona H. Lang, Nathan Manning, Jos Kleijnen, A Allen, Kate Misso, Family Medicine, and RS: CAPHRI School for Public Health and Primary Care
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medicine.medical_specialty ,Acute coronary syndrome ,Percutaneous ,Abciximab ,medicine.medical_treatment ,Myocardial Infarction ,Eptifibatide ,Platelet Glycoprotein GPIIb-IIIa Complex ,Immunoglobulin Fab Fragments ,Angioplasty ,Internal medicine ,medicine ,Humans ,Aggrastat ,Myocardial infarction ,Angioplasty, Balloon, Coronary ,Dose-Response Relationship, Drug ,business.industry ,Antibodies, Monoclonal ,General Medicine ,Tirofiban ,medicine.disease ,Surgery ,Treatment Outcome ,Systematic review ,Cardiology ,Tyrosine ,Platelet aggregation inhibitor ,Peptides ,business ,Platelet Aggregation Inhibitors ,circulatory and respiratory physiology ,medicine.drug - Abstract
Objective: To assess the efficacy of tirofiban in comparison to usual care or other GPIIb/IIIa antagonists (eptifibatide and abciximab). Results were analysed by drug administration with planned percutaneous coronary intervention (PCI) or as medical management without planned PCI, and separately for STEMI or NSTE ACS patients. Research design and methods: A systematic review was performed of randomized controlled trials of tirofiban, abciximab, eptifibatide or usual care given to patients with acute coronary syndrome. Nine databases were searched up to March 2010. Pair-wise meta-analysis was used to combine all available direct comparisons; indirect comparisons and network analysis were performed when this was not possible. The primary outcome was MACE (major adverse cardiac event). Results: The search yielded 8, 119 records and 50 trials were included (total number of patients 52,958). Compared to usual care, high and medium-dose tirofiban (25 and 10 mu g/kg/min) administered with planned PCI reduced MACE at 30 days for patients with STEMI (RR 0.67, 95% CI 0.45, 0.99; RR 0.28, 95% CI 0.10, 0.80), but was not effective as a medical management. Medium-dose tirofiban (10 mu g/kg/min) administered with planned PCI or low dose (0.4 mu g/kg/min) as medical management reduced the risk of MACE for patients with NSTE ACS (RR 0.39, 95% CI 0.21, 0.75; RR 0.58, 95% CI 0.41, 0.83) in comparison to usual care, but at the expense of increased thrombocytopenia (RR 3.26, 95% CI 1.31, 8.13). Evidence from RCTs and network analysis indicated tirofiban and abciximab were equally effective and safe. Comparing tirofiban and eptifibatide treatment by indirect and network analysis produced inconclusive results. Conclusions: Tirofiban was more effective than usual care for STEMI and NSTE ACS patients receiving planned PCI, and NSTE ACS patients receiving medical management. Tirofiban and abciximab were equally effective. Comparisons of tirofiban and eptifibatide were inconclusive. more...
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- 2012
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25. Can we use the Khorana risk score to predict venous thromboembolism in patients with cancer? A systematic review and meta-analysis
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Matteo Candeloro, M. Di Nisio, Frits I. Mulder, H. R. Büller, P.W. Kamphuisen, and N. van Es
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medicine.medical_specialty ,Framingham Risk Score ,business.industry ,Cancer ,Hematology ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Meta-analysis ,Internal medicine ,Medicine ,In patient ,030212 general & internal medicine ,business ,Venous thromboembolism - Published
- 2018
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26. Clinical impact of bleeding in cancer-associated venous thromboembolism: results from the Hokusai VTE Cancer randomized trial
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George Zhang, Annelise Segers, Frits I. Mulder, Noémie Kraaijpoel, H.R. Büller, M. Di Nisio, Peter Verhamme, A. K. Kakkar, N. van Es, Tzu-Fei Wang, Marc Carrier, J. I. Weitz, Saskia Middeldorp, Michael A. Grosso, Gary E. Raskob, Mathew Mercuri, and David A. Garcia more...
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medicine.medical_specialty ,Randomized controlled trial ,law ,business.industry ,Internal medicine ,medicine ,Cancer ,Hematology ,medicine.disease ,business ,Venous thromboembolism ,law.invention - Published
- 2018
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27. Read by Title
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P.W. Kamphuisen, A. Sturk, F.F. van Doormaal, Rienk Nieuwland, H. R. Büller, A. Kleinjan, R.J. Berckmans, and M. Di Nisio
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medicine.medical_specialty ,Factor VII ,biology ,business.industry ,Incidence (epidemiology) ,Cancer ,Hematology ,medicine.disease ,Thrombosis ,Gastroenterology ,Fibrin ,3. Good health ,Surgery ,Venous thrombosis ,chemistry.chemical_compound ,Clotting time ,chemistry ,Physiology (medical) ,Internal medicine ,medicine ,biology.protein ,Lung cancer ,business - Abstract
Background: Although in patients with cancer the risk of venous thromboembolism (VTE) is increased, the incidence is too low to routinely give prophylactic treatment. Procoagulant microparticles (MPs), especially tissue factor (TF)-bearing MPs, contribute to the risk of VTE in cancer patients. In the present study, we assessed the MP-associated procoagulant activity using a functional assay, the fibrin generation test (FGT), to identify cancer patients prone to develop VTE. Methods: As an ongoing study, plasma was collected from cancer patients, mainly with stage III or IV pancreatic, gastro-intestinal, breast or lung cancer. The MPassociated procoagulant activity was determined via the FGT with the addition of an inhibitory antibody to factor VII. The prolongation of the clotting time in the presence of anti-factor VII is a measure for the contribution of TF-bearing MPs to the clotting time. Patients were followed up for 6 months. Results: 100 patients were included, of which 77 have completed follow-up until now. The first 43 patients were used to establish a cut-off value of the FGT. Receiver operating characteristics showed that a prolongation of the clotting time of 13% after addition of anti-factor VII, was the optimal cut-off value. In the entire group, 8 of 77 patients (10%) developed VTE, of which 7 could have been predicted by the FGT. Using this cut-off value, 23 patients (30%) had a FGT-result above the cut-off (positive test) and 54 patients had a FGT-result below the cut-off (negative test). The prevalence of VTE was 30% in the FGT-positive patients and 2% in the FGTnegative patients (sensitivity 88%, specificity 77%). Conclusions: The FGT seems an excellent predictor for VTE in cancer patients. The next step will be to test the efficacy of prophylactic anticoagulants in patients with cancer and a high thrombosis risk based on the FGT. more...
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- 2009
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28. Prevention of catheter-related venous thrombosis with nadroparin in patients receiving chemotherapy for hematologic malignancies: a randomized, placebo-controlled study
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Clara P.W. Klerk, H. R. Büller, Bart J. Biemond, H. J. Baarslag, Tatjana M.H. Niers, M. Di Nisio, Oncology, Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam institute for Infection and Immunity, Cancer Center Amsterdam, and Clinical Haematology more...
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Venography ,Placebo-controlled study ,Antineoplastic Agents ,Placebo ,Placebos ,Catheters, Indwelling ,medicine ,Humans ,Prospective Studies ,Aged ,Venous Thrombosis ,medicine.diagnostic_test ,business.industry ,Anticoagulants ,Nadroparin ,Hematology ,Middle Aged ,medicine.disease ,Surgery ,Pulmonary embolism ,Venous thrombosis ,Catheter ,Hematologic Neoplasms ,Female ,business ,Central venous catheter - Abstract
Summary. Background: Hemato-oncology patients treated with intensive chemotherapy usually require the placement of a central venous catheter (CVC). CVCs are frequently complicated by catheter-related central venous thrombosis (CVT), which has been associated with an increased risk of pulmonary embolism and catheter-related infection. Objectives: To determine the efficacy and safety of thromboprophylaxis with s.c. low-molecular-weight heparin (nadroparin) administered once daily in a randomized placebo-controlled, double-blind trial in patients with hematologic malignancies. Patients and methods: Consecutive patients with hematologic malignancies requiring intensive chemotherapy including autologous stem cell transplantation were eligible. The patients were randomized to receive nadroparin 2850 antifactor Xa units once daily or placebo s.c. for 3 weeks. Venography was performed on day 21 after CVC insertion. Secondary outcomes were bleeding and catheter-related infection. Results: In total, 113 patients were randomized to nadroparin or placebo, and 87 patients (77%) underwent venography. In total, 11 venographically proven catheter-related CVTs were diagnosed. The frequency of catheter-related CVT was not significantly different between study groups, namely four catheter-related CVTs in the placebo group [9%; 95% CI: 0.002–0.16] vs. seven catheter-related CVTs in the nadroparin group (17%; 95% CI: 0.06–0.28). In addition, no difference in the incidence of catheter-related infection or bleeding was observed between the groups. Conclusion: This study showed that the actual risk for catheter-related CVT in patients with hematologic malignancies is lower than suggested in earlier studies in cancer patients. Although prophylactic administration of nadroparin appeared to be safe in this group of patients with a high risk of bleeding, it cannot be recommended for the prevention of catheter-related CVT or catheter-related infection in patients with hematologic malignancies. more...
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- 2007
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29. Management of cancer-associated disseminated intravascular coagulation: guidance from the SSC of the ISTH: reply
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Marcel Levi, Howard A. Liebman, Jecko Thachil, M. Di Nisio, Anna Falanga, Thachil, J, Falanga, A, Levi, M, Liebman, H, Di Nisio, M, and Vascular Medicine
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Disseminated intravascular coagulation ,medicine.medical_specialty ,business.industry ,thrombosis, hemostasis, coagulation ,Treatment outcome ,Cancer ,Hematology ,Disseminated Intravascular Coagulation ,medicine.disease ,Thrombosis ,Antifibrinolytic Agents ,Surgery ,Hemostasis ,Predictive value of tests ,Neoplasms ,medicine ,Coagulation (water treatment) ,Humans ,Blood Transfusion ,business ,Intensive care medicine ,Blood Coagulation ,Blood coagulation test - Published
- 2015
30. Decision analysis for cancer screening in idiopathic venous thromboembolism
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M. Di Nisio, H. R. Büller, H. M. Otten, A. W. A. Lensing, Andrea Piccioli, Paolo Prandoni, Martin H. Prins, Vascular Medicine, and Amsterdam Cardiovascular Sciences
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Radiography, Abdominal ,medicine.medical_specialty ,Sputum Cytology ,Cost-Benefit Analysis ,Colonoscopy ,Decision Support Techniques ,Life Expectancy ,Neoplasms ,Thromboembolism ,Cancer screening ,medicine ,Humans ,Mass Screening ,Mammography ,False Positive Reactions ,Stage (cooking) ,Randomized Controlled Trials as Topic ,Venous Thrombosis ,medicine.diagnostic_test ,business.industry ,Sputum ,Cancer ,Hematology ,medicine.disease ,Early Diagnosis ,medicine.anatomical_structure ,Costs and Cost Analysis ,Abdomen ,Radiology ,Tomography, X-Ray Computed ,business ,Follow-Up Studies ,Decision analysis - Abstract
Summary. Background: The SOMIT trial randomized patients with idiopathic venous thromboembolism (IVTE) and without signs of cancer at routine medical examination, to extensive screening for cancer plus 2 years of follow-up or to just 2-year follow-up. Methods: The data of the SOMIT-trial were used to perform a decision analysis. The screening tests were divided in several possible strategies. The number of detected cancer patients and the number of patients investigated further for an eventually benign condition were calculated for each strategy. The total costs for the screening strategy and for each detected cancer patient were determined. Based on the tumor type, stage, age and gender of the individual cancer patient, the difference in live years gained (LYG) was calculated between the two study groups. Results: Computed tomography (CT) of the abdomen combined with sputum cytology and mammography detected 12 of the 14 patients with cancer and had one false-positive result. In general, screening strategies including abdominal/pelvic ultrasonography (US) or tumor markers yielded a higher number of patients needed to screen in comparison with those using abdominal/pelvic CT. Furthermore, the strategies which included colonoscopy, tumor markers, and abdominal/pelvic US were significantly more costly, had inferior LYG and higher costs per LYG, when compared with strategies using abdominal/pelvic CT. Conclusions: Despite the limitations of this analysis, the screening for cancer with a strategy including abdominal/pelvic CT with or without mammography and/or sputum cytology appears potentially useful for cancer screening in patients with IVTE. The cost-effectiveness analysis of this strategy needs confirmation in a large trial. more...
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- 2005
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31. Diagnosis and treatment of incidental venous thromboembolism in cancer patients: guidance from the SSC of the ISTH
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Marc Carrier, Alok A. Khorana, M. Di Nisio, Agnes Y.Y. Lee, Howard A. Liebman, and Vascular Medicine
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medicine.medical_specialty ,Ct pulmonary angiography ,business.industry ,Deep vein ,Cancer ,Anticoagulants ,Guidelines as Topic ,Hematology ,Venous Thromboembolism ,medicine.disease ,Thrombosis ,Pulmonary embolism ,medicine.anatomical_structure ,Neoplasms ,medicine ,Humans ,cardiovascular diseases ,Radiology ,business ,Venous thromboembolism ,Perfusion ,Cancer staging - Abstract
Modern computer tomography (CT) with its higher sensitivity and resolution has increased the detection of incidental venous thromboembolism (VTE) in the venous and pulmonary vasculature during routine imaging for cancer staging and response assessment [1]. As a result, up to half of all VTEs diagnosed in oncology centers are incidental [1-5]. Although widely accepted, the diagnosis of incidental VTE is made without using the standard imaging studies required for confirming the presence of symptomatic VTE (i.e. compression ultrasonography for deep vein thrombosis [DVT] and CT pulmonary angiography [CTPA] or ventilation/perfusion lung scan for pulmonary embolism [PE]). The accuracy and reliability of staging imaging in making a diagnosis of DVT or PE have not been established. This article is protected by copyright. All rights reserved more...
- Published
- 2014
32. Anticoagulant treatment of cancer patients with pulmonary embolism in the real world. Actual use of low-molecular-weight heparin in cancer
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A, Kleinjan, B A, Hutten, M, Di Nisio, H R, Büller, and P W, Kamphuisen
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Male ,Time Factors ,Vitamin K ,Anticoagulants ,Heparin, Low-Molecular-Weight ,Middle Aged ,Neoplasms ,Practice Guidelines as Topic ,Humans ,Female ,Pulmonary Embolism ,Aged ,Netherlands ,Retrospective Studies - Abstract
Since 2004, guidelines recommend long-term treatment with low-molecular-weight heparin (LMWH) in patients with cancer and pulmonary embolism (PE). We assessed the proportion of cancer patients with PE actually treated with LMWH and the duration of anticoagulant treatment in the Netherlands.A retrospective cohort study in patients that were hospitalised for PE between 1998-2008. Patients with PE were selected from national hospital discharge records, after linkage to a national pharmacy database. Cancer patients with PE were matched for age, sex and year of diagnosis of PE to subjects with PE without cancer.600 cancer patients with PE were matched to 1200 patients with PE without cancer. Long-term LMWH was prescribed in 82 (13.7%) of the cancer patients and in eight (0.7%) of the cancer-free patients (p0.001); all the other patients received vitamin K antagonists (VKA). From 1998-2008, there was an increase in the use of LMWH in cancer patients: in 2007-2008, LMWH was prescribed in 42 (32%) cases, compared with one (1.7%) of the cancer patients with PE in 1998-1999. Median duration of treatment was 5.8 months (interquartile range 3.1-8.8) in cancer patients, compared with 7.0 months (4.9-11) in patients without cancer (p0.001), a difference that persisted after adjustment for mortality.Although the use of LMWH in patients with cancer and PE is increasing, in 2008, patients in the Netherlands are still mostly treated with VKA, and not with LMWH as recommended by guidelines. Cancer patients with PE on average receive shorter treatment than matched patients without cancer. more...
- Published
- 2014
33. Cannabinoide: weniger effektiv als erwartet
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M. di Nisio, Adrian V. Hernandez, Steve Ryder, S Schmidlkofer, Jos Kleijnen, Robert Wolff, Shona H. Lang, Sohan Deshpande, J C Keurentjes, Steven Duffy, Kate Misso, Marie Westwood, and Penny Whiting
- Abstract
Die Bundesregierung erlaubt ab 2016 die Verordnung von Cannabinoiden, bei Kostenubernahme durch die Krankenkassen. Diese umstrittene Entscheidung weckt Hoffnung bei Patienten mit chronischen Schmerzen, Spastik, AIDS und anderen Erkrankungen. Aber sind Cannabinoide herkommlichen Therapieansatzen tatsachlich uberlegen? Die Metaanalyse fasste Studien aus den Jahren 1975–2015 zusammen und wies nur fur wenige Symptome einen fraglichen Benefit nach. more...
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- 2015
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34. Harmonized guidance for disseminated intravascular coagulation from the International Society on Thrombosis and Haemostasis and the current status of anticoagulant therapy in Japan: a rebuttal
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Satoshi Gando, Shinichiro Kurosawa, Jecko Thachil, Hideo Wada, M. Di Nisio, Cheng Hock Toh, and Vascular Medicine
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Disseminated intravascular coagulation ,medicine.medical_specialty ,business.industry ,Rebuttal ,MEDLINE ,Anticoagulants ,Hematology ,Disseminated Intravascular Coagulation ,medicine.disease ,Thrombosis ,Anticoagulant therapy ,Practice Guidelines as Topic ,medicine ,Humans ,Intensive care medicine ,business - Published
- 2013
35. Guidance for diagnosis and treatment of DIC from harmonization of the recommendations from three guidelines
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H, Wada, J, Thachil, M, Di Nisio, P, Mathew, S, Kurosawa, S, Gando, H K, Kim, J D, Nielsen, C-E, Dempfle, M, Levi, and C-H, Toh
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Three guidelines have recently been published for the diagnosis and treatment of disseminated intravascular coagulation (DIC) in adults. This communication seeks to harmonize the recommendations in these guidelines using a modified GRADE system. The scoring system for diagnosis of DIC using global coagulation tests is known to correlate with key clinical observations and outcomes (Moderate quality). The cornerstone of DIC treatment is the treatment of the underlying condition (Moderate quality). In general, transfusion of platelets or plasma (components) in patients with DIC should be reserved for patients who are bleeding (Low quality). Therapeutic doses of heparin should be considered in cases of DIC where clinical features of thrombosis predominate. Heparin is not recommended in those patients with a high risk of bleeding, (Moderate quality). However, prophylactic doses of unfractionated heparin or low molecular we ight heparin is recommended in critically ill and non-bleeding patients with DIC for prevention of venous thromboembolism (Moderate to High quality). Although further prospective evidence from randomized controlled trials is required, administration of antithrombin or recombinant thrombomodulin may be considered in certain patients with DIC. In general, patients with DIC should not be treated with antifibrinolytic agents (Low quality). However those who present with severe bleeding, that is characterized by a markedly hyperfibrinolytic state such as leukemia (Low quality) and trauma (Moderate quality), may be treated with antifibrinolytic agents. © 2013 International Society on Thrombosis and Haemostasis. more...
- Published
- 2013
36. OC-01 - Clinical history of cancer patients with isolated distal deep vein thrombosis: a multicenter cohort study
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Corrado Lodigiani, M. N. D. Di Minno, Nicola Mumoli, Daniela Mastroiacovo, Mariasanta Napolitano, M. Di Nisio, S. Pegoraro, Serena M. Passamonti, Walter Ageno, Raffaella Benedetti, Fulvio Pomero, Stefano Barco, Giovanni Barillari, Michelangelo Sartori, Francesco Dentali, F. Bagna, Dentali, F., Pegoraro, S., Barco, S., di Minno, M., Mastroiacovo, D., Pomero, F., Lodigiani, C., Bagna, F., Sartori, M., Barillari, G., Mumoli, N., Napolitano, M., Passamonti, S., Benedetti, R., Ageno, W., and Nisio, M. more...
- Subjects
medicine.medical_specialty ,medicine.drug_class ,Deep vein ,Population ,Low molecular weight heparin ,030204 cardiovascular system & hematology ,Lower risk ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,cancer ,Vein ,education ,Thrombosis history ,distal deep vein thrombosis ,education.field_of_study ,business.industry ,distal deep vein thrombosi ,Hematology ,medicine.disease ,Thrombosis ,Pulmonary embolism ,Surgery ,Venous thrombosis ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,business - Abstract
Introduction Isolated distal deep vein thrombosis (IDDVT) accounts for one-fourth to one-half of all deep vein thrombosis (DVT) of the leg. Patients with IDDVT are frequently treated for a shorter period of time compared to patients with proximal DVT and/or pulmonary embolism (PE) due to a perceived lower risk of recurrence. About 10-20% of patients with venous thromboembolic events (VTEs) have concomitant cancer. Guidelines recommend long-term anticoagulant treatment in this group of patients due to their high risk of VTE recurrence. Unfortunately, information on the clinical history of IDDVT patients is limited and, to date, no study has evaluated the long-term risk of VTE recurrence in IDDVT patients with cancer. Aim To provide information on the clinical history of IDDVT patients with active cancer. Materials and Methods A multicenter, cohort study including active-cancer patients with an objective diagnosis of IDDVT (between January 2011 and September 2014) was conducted. Information on baseline characteristics, thrombosis location and extension, concomitant risk factors, type and duration of treatment was collected. All patients were followed for a minimum of 12 months and up to 24 months. During follow-up, VTE recurrence, major bleeding episodes and death were registered. Potential risk factors for VTE recurrence were evaluated. Results 308 patients (mean age 66.2 ± 13.2 years, female 57.1%) in 13 centers were included, Table 1; 261 patients had solid cancer and 47 patients hematologic cancer. At the time of IDDVT diagnosis, the disease was metastatic in 148 patients (48.1%); 99.0% of patients received anticoagulant treatment: 288 patients (93.5%) were initially treated with low molecular weight heparin, 15 with fondaparinux (5.2%) and 1 with unfractionated heparin; vitamin K antagonists were used in 46 patients (14.9%) only. Total follow-up was 389 patient-years, mean follow-up 15.2 months. Mean duration of treatment was 4.2 months. During the study period there were 47 episodes of VTE recurrence (36 proximal DVT or PE) for a incidence rate of 13.2 events per 100 patient-years; 7 patients had major bleeding (2.3%) and 137 died (44.5%). At multivariate analysis, previous VTE was associated with an increased risk of recurrence (OR 2.10; 95% 1.06, 4.14), whereas patients with gastrointestinal cancer had a lower risk of recurrence (OR 0.26; 95% CI 0.08, 0.86). Table 1 . Baseline characteristics of the population Number of patients 308 Age (years), mean ± SD 66.2 ± 13.2 Women 176 (57.1%) Men 132 (42.9%) Body-mass index > 30 Kg/m 2 25 (8.1%) Concomitant risk factors for VTE Recent surgery or trauma 79 (25.6%) In-patients/immobilization 45 (14.6%) Prolonged bed rest 47 (15.3%) Local or systemic infections 19 (6.2%) Qualifying distal venous thrombosis Axial calf veins 135 (43.8%) Muscolar calf veins 149 (48.4%) Medial gastrocnemius veins 113 (36.7%) Lateral gastrocnemius veins 45 (14.6%) Soleal veins 73 (23.7%) Bilateral venous thrombosis 22 (7.1%) More than one vein involved 127 (41.2%) Previous history of VTE 45 (14.6%) Family history of VTE 16 (5.2%) Primary cancer site Breast 54 (17.5%) Gastrointestinal 51 (16.6%) Pancreas 18 (5.8%) Hepatic 9 (2.9%) Lung 44 (14.3%) Hematologic 47 (15.3%) Prostate 17 (5.5%) Brain 15 (4.9%) Other 53 (17.2%) Metastases 148 (48.1%) Cancer therapy Systemic chemotherapy 174 (56.5%) Radiotherapy 20 (6.5%) Hormonal therapy 36 (11.7%) Anticoagulant therapy 305 (99%) Low-molecular-weight heparin 288 (93.5%) Fondaparinux 16 (5.2%) Unfractionated heparin 1 (0.3%) Heparin-Vitamin K antagonists 46 (14.9%) VTE = venous thromboembolism. Conclusions Cancer patients with IDDVT have a high risk of VTE recurrence. Other studies are warranted to address the adequate management of these patients. more...
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- 2016
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37. Accuracy of diagnostic tests for clinically suspected upper extremity deep vein thrombosis: a systematic review
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Anne W S Rutjes, Ettore Porreca, M. Di Nisio, Patrick M.M. Bossuyt, Harry R. Büller, and G. L. Van Sluis
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Adult ,medicine.medical_specialty ,Upper extremity ,Adolescent ,Venography ,Contrast Media ,Deep vein thrombosis ,Sensitivity ,Specificity ,Sensitivity and Specificity ,Fibrin Fibrinogen Degradation Products ,Upper Extremity ,Young Adult ,Predictive Value of Tests ,medicine ,Plethysmograph ,Humans ,Child ,Aged ,Venous Thrombosis ,medicine.diagnostic_test ,business.industry ,Diagnostic Tests, Routine ,Reproducibility of Results ,Magnetic resonance imaging ,Ultrasonography, Doppler ,Hematology ,Phlebography ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Confidence interval ,Plethysmography ,Venous thrombosis ,Sample size determination ,Predictive value of tests ,Meta-analysis ,Hemorheology ,Radiology ,business ,Biomarkers - Abstract
Summary. Background: The best available test for the diagnosis of upper extremity deep venous thrombosis (UEDVT) is contrast venography. The aim of this systematic review was to assess whether the diagnostic accuracy of other tests for clinically suspected UEDVT is high enough to justify their use in clinical practise and to evaluate if any test can replace venography. Methods: MEDLINE and EMBASE databases were searched from inception to June 2009. Two reviewers independently evaluated study eligibility, extracted data, and assessed study quality. Results: We identified 17 papers, reporting on 793 patients. Overall, the methodological quality was poor, sample sizes were small, and large between-study differences were observed in spectrum and design. The summary estimates of sensitivity (95% confidence interval) were 97% (90–100%) for compression ultrasonography, 84% (72–97%) for Doppler ultrasonography, 91% (85–97%) for Doppler ultrasonography with compression, and 85% (72–99%) for phleboreography. The corresponding summary estimates of specificity were, respectively, 96% (87–100%), 94% (86–100%), 93% (80–100%), and 87% (71–100%). Clinical findings, a clinical score, D-dimer, magnetic resonance imaging, rheography and plethysmography were evaluated in one study each, involving a median number of 46 patients (range 21–214). Sensitivity and specificity ranged from 0% to 100% and from 14% to 100%. Conclusions: Methodological limitations, large between-study differences and small sample sizes limit the evidence of tests for clinically suspected UEDVT. Compression ultrasonography may be an acceptable alternative to venography. The addition of (color) Doppler does not seem to improve the accuracy. Adequately designed studies are warranted to confirm these findings. more...
- Published
- 2010
38. Cell-derived microvesicles and cancer
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F F, van Doormaal, A, Kleinjan, M, Di Nisio, H R, Büller, and R, Nieuwland
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Cell-Derived Microparticles ,Neoplasms ,Humans - Abstract
Blood and other body f luids contain cell-derived microvesicles. The presence of microvesicles in cancer patients was already noticed in the late 1970s. Since then, the prothrombotic state in cancer patients has invariably been associated with the presence of such microvesicles. More recently, a growing body of evidence supports an important contribution of microvesicles to cancer cell survival, invasiveness and metastases. Here, we will present an overview of the many contributions of microvesicles to cancer development and progression. In addition, their role in risk stratification and treatment of cancer patients is discussed. more...
- Published
- 2009
39. Treatment for superficial thrombophlebitis of the leg
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M Di Nisio, S Middeldorp, and IM Wichers
- Abstract
Background The optimal treatment of superficial thrombophlebitis (ST) of the legs remains poorly defined. While improving or relieving the local painful symptoms, treatment should aim at preventing venous thromboembolism (VTE), which might complicate the natural history of ST. This is an update of a review first published in 2007. Objectives To assess the efficacy and safety of topical, medical, and surgical treatments in patients presenting with ST of the legs. Search methods For this update the Cochrane Peripheral Vascular Diseases Group searched their Specialised Register (last searched 29 November 2011) and CENTRAL (2011, Issue 4). We handsearched reference lists of relevant papers and conference proceedings. Selection criteria Randomised controlled trials (RCTs) evaluating topical, medical, and surgical treatments for ST of the leg that included participants with a clinical diagnosis of ST of the legs or objective diagnosis of a thrombus in the superficial vein. Data collection and analysis Two authors assessed the trials for inclusion in the review, extracted the data, and assessed the quality of the studies. Data were independently extracted from the included studies and any disagreements resolved by consensus. Main results Twenty-six studies involving 5521 participants with ST of the legs were included in this review. The methodological quality of most of the trials was poor. Treatment ranged from fondaparinux, low molecular weight heparin (LMWH), unfractionated heparin (UFH), nonsteroidal anti-inflammatory agents (NSAIDs), topical treatment, oral treatment, intramuscular treatment, and intravenous treatment to surgery. In a placebo-controlled RCT of about 3000 patients, fondaparinux was associated with a significant reduction in symptomatic VTE (RR 0.15; 95% CI 0.04 to 0.50), extension (RR 0.08; 95% CI 0.03 to 0.22), and recurrence of ST (RR 0.21; 95% CI 0.08 to 0.54) with comparable rates of major bleeding (RR 0.99; 95% CI 0.06 to 15.86) relative to placebo. Both prophylactic and therapeutic doses of LMWH (RR 0.40; 95% CI 0.22 to 0.72 and RR 0.42; 95% CI 0.23 to 0.75, respectively) and NSAIDs ( RR 0.41; 95% CI 0.23 to 0.75) reduced the extension and recurrence of ST in comparison to placebo, with no significant effects on symptomatic VTE nor major bleeding. Overall, topical treatments improved local symptoms. However, no data were provided on the effects of these treatments on VTE and ST extension. Surgical treatment combined with elastic stockings in ST was associated with a lower VTE rate and ST progression compared with elastic stockings alone. Authors' conclusions Prophylactic dose fondaparinux given for six weeks appears to be a valid therapeutic option for ST of the legs. Further research is needed to assess the role of new oral direct thrombin and activated factor-X inhibitors, LMWH, NSAIDs; the optimal doses and duration of treatment; and whether a combination therapy may be more effective than single treatment. Adequately designed and conducted studies are required to clarify the role of topical and surgical treatments more...
- Published
- 2007
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40. Diagnostic accuracy of D-dimer test for exclusion of venous thromboembolism: a systematic review
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Anne W S Rutjes, H. R. Büller, Patrick M.M. Bossuyt, M. Di Nisio, Aeilko H. Zwinderman, and Alessandro Squizzato
- Subjects
medicine.medical_specialty ,Deep vein ,MEDLINE ,Sensitivity and Specificity ,Diagnosis, Differential ,Fibrin Fibrinogen Degradation Products ,Internal medicine ,Thromboembolism ,D-dimer ,medicine ,Humans ,cardiovascular diseases ,Immunoassay ,Venous Thrombosis ,medicine.diagnostic_test ,business.industry ,Data Collection ,Hematology ,medicine.disease ,Thrombosis ,Pulmonary embolism ,Venous thromboembolism ,Venous thrombosis ,medicine.anatomical_structure ,Meta-analysis ,Radiology ,Differential diagnosis ,business ,Pulmonary Embolism - Abstract
Summary. Background: The reported diagnostic accuracy of the D-dimer test for exclusion of deep vein thrombosis (DVT) and pulmonary embolism (PE) varies. It is unknown to what extent this is due to differences in study design or patient groups, or to genuine differences between D-dimer assays. Methods: Studies evaluating the diagnostic accuracy of the D-dimer test in the diagnosis of venous thromboembolism were systematically searched for in the MEDLINE and EMBASE databases up to March 2005. Reference lists of all included studies and of reviews related to the topic of the present meta-analysis were manually searched for other additional potentially eligible studies. Two reviewers independently extracted study characteristics using standardized forms. Results: In total, 217 D-dimer test evaluations for DVT and 111 for PE were analyzed. Several study design characteristics were associated with systematic differences in diagnostic accuracy. After adjustment for these features, the sensitivities of the D-dimer enzyme-linked immunofluorescence assay (ELFA) (DVT 96%; PE 97%), microplate enzyme-linked immunosorbent assay (ELISA) (DVT 94%; PE 95%), and latex quantitative assay (DVT 93%; PE 95%) were superior to those of the whole-blood D-dimer assay (DVT 83%; PE 87%), latex semiquantitative assay (DVT 85%; PE 88%) and latex qualitative assay (DVT 69%; PE 75%). The latex qualitative and whole-blood D-dimer assays had the highest specificities (DVT 99%, 71%; PE 99%, 69%). Conclusions: Compared to other D-dimer assays, the ELFA, microplate ELISA and latex quantitative assays have higher sensitivity but lower specificity, resulting in a more confident exclusion of the disease at the expense of more additional imaging testing. These conclusions are based on the most up-to-date and extensive systematic review of the topic area, including 184 articles, with 328 D-dimer test evaluations. more...
- Published
- 2007
41. Combined use of clinical pretest probability and D-dimer test in cancer patients with clinically suspected deep venous thrombosis
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M. Di Nisio, H. R. Büller, Anne W S Rutjes, Vascular Medicine, and ACS - Amsterdam Cardiovascular Sciences
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Diagnostic Imaging ,Male ,medicine.medical_specialty ,Malignancy ,Gastroenterology ,Sensitivity and Specificity ,Diagnosis, Differential ,Fibrin Fibrinogen Degradation Products ,Predictive Value of Tests ,Internal medicine ,Neoplasms ,D-dimer ,medicine ,Humans ,Cancer ,Aged ,Probability ,Venous Thrombosis ,D-dimer test ,Deep venous thrombosis ,Pretest clinical probability ,business.industry ,Hematology ,Middle Aged ,medicine.disease ,Pre- and post-test probability ,Venous thrombosis ,enzymes and coenzymes (carbohydrates) ,Predictive value of tests ,Cohort ,Female ,Radiology ,Differential diagnosis ,business ,Follow-Up Studies - Abstract
Summary. Background: The value of the D-dimer (DD) test in combination with the clinical pretest probability (PTP) has not been evaluated in cancer patients with suspected deep vein thrombosis (DVT), whereas this group of patients usually accounts for 10–25% of clinically suspected DVT. Methods: A cohort of 2066 consecutive patients with clinically suspected DVT was investigated. Patients were judged to be positive or negative for DVT according to the outcomes of serial compression ultrasound and a 3-month follow-up period with imaging test verification of the symptomatic cases. Diagnostic accuracy indices of the DD test according to the PTP score were assessed in patients with and without cancer. Results: Of the cohort, 244 (11%) were known to have cancer at presentation. A venous thromboembolic event was diagnosed in 41% of the patients with cancer and in 22% of the patients without malignancy. Among the cancer patients, 17% were considered to have a low PTP, 35% a moderate and 41% a high PTP. The negative predictive value (NPV) of the DD test was 100% (95%CI, 85–100) and 97% (95% CI, 88–99) among cancer patients with low PTP or low-moderate PTP. In the absence of malignancy, the corresponding NPV were 98% and 97%, respectively. The specificity of the DD test progressively decreased moving from the low to the higher PTP. Conclusions: In cancer patients with clinically suspected DVT, a negative DD might be useful in excluding the diagnosis within the low or low-moderate PTP groups. More studies are warranted to confirm these findings. more...
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- 2006
42. Microsatellite polymorphism of the human leptin gene (LEP) and risk of cardiovascular disease
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M Di Nisio, Valentina Gatta, S Pintor, Franco Cuccurullo, C. Di Febbo, Valeria Moretta, Ettore Porreca, Giovanna Baccante, Chiara Palka, and Liborio Stuppia
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Leptin ,Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,education ,Medicine (miscellaneous) ,Disease ,Biology ,Sex Factors ,Gene Frequency ,Internal medicine ,Genotype ,medicine ,Diabetes Mellitus ,Humans ,Genetic Predisposition to Disease ,Genetic variability ,Allele frequency ,3' Untranslated Regions ,health care economics and organizations ,Aged ,Genetics ,Nutrition and Dietetics ,Polymorphism, Genetic ,Vascular disease ,digestive, oral, and skin physiology ,Smoking ,Case-control study ,Age Factors ,Middle Aged ,medicine.disease ,Endocrinology ,Logistic Models ,Cardiovascular Diseases ,Case-Control Studies ,Hypertension ,Microsatellite ,Female ,hormones, hormone substitutes, and hormone antagonists ,Microsatellite Repeats - Abstract
No data have been so far reported on the relationship between polymorphisms of LEP gene and cardiovascular disease.We genotyped a tetranucleotide repeat mapped in the 3'UTR of the LEP gene (LEP-tet) in 109 subjects with cardiovascular events and in 109 control subjects.Univariate analysis and multivariate logistic regression analysis adjusted for age, gender, smoking status, history of hyperlipidemia, hypertension or diabetes showed not significant association between the genotype of the LEP-tet and cardiovascular diseases. Moreover, no differences were observed in the plasma leptin concentrations between cases and control subjects (22 +/- 19 vs 22 +/- 14 ng/ml, P = 0.52) and in relation to the LEP-tet classes or carriage of specific alleles (P = 0.76 for the association between LEP-tet classes and leptin levels in overall analysis).In conclusion, our data do not support an association between the LEP-tet microsatellite polymorphism of the human LEP gene and cardiovascular diseases. more...
- Published
- 2005
43. Anticoagulants for the treatment of recurrent pregnancy loss in women without antiphospholipid syndrome
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M, Di Nisio, Lw, Peters, and S, Middeldorp
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Abortion, Habitual ,Pregnancy ,Pregnancy Complications, Hematologic ,Anticoagulants ,Humans ,Thrombophilia ,Female ,Antiphospholipid Syndrome ,Randomized Controlled Trials as Topic - Abstract
Since hypercoagulability might result in recurrent pregnancy loss, anticoagulant agents could potentially increase the live-birth rate in subsequent pregnancies in women with either inherited thrombophilia or unexplained pregnancy loss.To evaluate the efficacy and safety of anticoagulant agents, such as aspirin and heparin, in women with a history of at least two spontaneous miscarriages or one later intrauterine fetal death without apparent causes other than inherited thrombophilias.We searched the Cochrane Pregnancy and Childbirth Group trials register (March 2004), the Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2004), MEDLINE (January 1966 to March 2004), and EMBASE (1980 to March 2004). We scanned bibliographies of all located articles for any unidentified articles.Randomised and quasi-randomised controlled trials that assessed the effect of anticoagulant treatment on the live-birth rate in women with a history of at least two spontaneous miscarriages or one later intrauterine fetal death without apparent causes other than inherited thrombophilias were eligible. Interventions included aspirin, unfractionated heparin, and low molecular weight heparin for the prevention of birth loss. One treatment could be compared with another or with placebo.Two authors assessed the trials for inclusion in the review and extracted the data. Data were entered into the Review Manager software and double checked.Two studies (242 participants) were included in the review and for both of them data were extracted for the subgroups of women fulfilling the inclusion criteria of the review. In one study, 54 pregnant women with recurrent spontaneous abortion without detectable anticardiolipin antibodies were randomised to low-dose aspirin or placebo. Similar live-birth rates were observed with aspirin and placebo (relative risk (RR) 1.00, 95% confidence interval (CI) 0.78 to 1.29). In another study, a subgroup of 20 women who had had a previous fetal loss after the 20th week and had a thrombophilic defect were randomised to enoxaparin or aspirin. Enoxaparin treatment resulted in an increased live-birth rate, as compared to low-dose aspirin, RR 10.00, 95% CI 1.56 to 64.20).The evidence on the efficacy and safety of thromboprophylaxis with aspirin and heparin in women with a history of at least two spontaneous miscarriages or one later intrauterine fetal death without apparent causes other than inherited thrombophilias is too limited to recommend the use of anticoagulants in this setting. Large, randomised, placebo-controlled trials are urgently needed. more...
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- 2005
44. Aspirin or anticoagulants for the treatment of recurrent miscarriage in women without antiphospholipid syndrome
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Saskia Middeldorp, L. W. Peters, and M. Di Nisio
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medicine.medical_specialty ,Pregnancy ,Aspirin ,Obstetrics ,business.industry ,medicine.drug_class ,Low molecular weight heparin ,Abortion ,Cochrane Library ,medicine.disease ,Placebo ,Antiphospholipid syndrome ,Relative risk ,medicine ,business ,medicine.drug - Abstract
Background Since hypercoagulability might result in recurrent pregnancy loss, anticoagulant agents could potentially increase the live-birth rate in subsequent pregnancies in women with either inherited thrombophilia or unexplained pregnancy loss. Objectives To evaluate the efficacy and safety of anticoagulant agents, such as aspirin and heparin, in women with a history of at least two spontaneous miscarriages or one later intrauterine fetal death without apparent causes other than inherited thrombophilias. Search strategy We searched the Cochrane Pregnancy and Childbirth Group trials register (March 2004), the Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2004), MEDLINE (January 1966 to March 2004), and EMBASE (1980 to March 2004). We scanned bibliographies of all located articles for any unidentified articles. Selection criteria Randomised and quasi-randomised controlled trials that assessed the effect of anticoagulant treatment on the live-birth rate in women with a history of at least two spontaneous miscarriages or one later intrauterine fetal death without apparent causes other than inherited thrombophilias were eligible. Interventions included aspirin, unfractionated heparin, and low molecular weight heparin for the prevention of birth loss. One treatment could be compared with another or with placebo. Data collection and analysis Two authors assessed the trials for inclusion in the review and extracted the data. Data were entered into the Review Manager software and double checked. Main results Two studies (242 participants) were included in the review and for both of them data were extracted for the subgroups of women fulfilling the inclusion criteria of the review. In one study, 54 pregnant women with recurrent spontaneous abortion without detectable anticardiolipin antibodies were randomised to low-dose aspirin or placebo. Similar live-birth rates were observed with aspirin and placebo (relative risk (RR) 1.00, 95% confidence interval (CI) 0.78 to 1.29). In another study, a subgroup of 20 women who had had a previous fetal loss after the 20th week and had a thrombophilic defect were randomised to enoxaparin or aspirin. Enoxaparin treatment resulted in an increased live-birth rate, as compared to low-dose aspirin, RR 10.00, 95% CI 1.56 to 64.20). Authors' conclusions The evidence on the efficacy and safety of thromboprophylaxis with aspirin and heparin in women with a history of at least two spontaneous miscarriages or one later intrauterine fetal death without apparent causes other than inherited thrombophilias is too limited to recommend the use of anticoagulants in this setting. Large, randomised, placebo-controlled trials are urgently needed. more...
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- 2005
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45. The prognostic value of the D-dimer test in cancer patients treated with and without low-molecular-weight heparin
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Clara P.W. Klerk, Joost C. M. Meijers, H. R. Büller, M. Di Nisio, Vascular Medicine, and Amsterdam Cardiovascular Sciences
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medicine.medical_specialty ,business.industry ,medicine.drug_class ,Cancer ,Low molecular weight heparin ,Hematology ,medicine.disease ,Gastroenterology ,Text mining ,Internal medicine ,D-dimer ,medicine ,business ,Value (mathematics) - Published
- 2005
46. D-Dimer test in cancer patients with suspected acute pulmonary embolism
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Pieter Willem Kamphuisen, Maaike Sohne, H. R. Büller, M. Di Nisio, Vascular Medicine, and ACS - Amsterdam Cardiovascular Sciences
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Male ,medicine.medical_specialty ,Vascular medicine and diabetes [UMCN 2.2] ,Malignancy ,Sensitivity and Specificity ,Gastroenterology ,Fibrin Fibrinogen Degradation Products ,Predictive Value of Tests ,Neoplasms ,Internal medicine ,D-dimer ,medicine ,Humans ,In patient ,Prospective Studies ,Diagnostic Errors ,Prospective cohort study ,business.industry ,Case-control study ,Cancer ,Hematology ,Middle Aged ,medicine.disease ,Pulmonary embolism ,Case-Control Studies ,Predictive value of tests ,Acute Disease ,Female ,Radiology ,Pulmonary Embolism ,business - Abstract
Item does not contain fulltext BACKGROUND: The safety of a D-dimer (DD) measurement in cancer patients with clinically suspected pulmonary embolism (PE) is unclear. OBJECTIVES: The aim of this study was to assess the accuracy of the DD test in consecutive patients with clinically suspected PE with and without cancer. METHODS: The diagnostic accuracy of DD (Tinaquant D-dimer) was first retrospectively assessed in an unselected group of patients referred for suspected PE (n = 350). Subsequently, the predictive value of the DD was validated in a group of consecutive inpatients and outpatients with clinically suspected PE prospectively enrolled in a management study (n = 519). The results of the DD test in cancer patients were assessed according to the final diagnosis of PE and the 3-month clinical follow-up. RESULTS: In the first study group, DD showed a sensitivity and a negative predictive value (NPV) of 100% and 100% in patients with cancer and 97% and 98% in those without malignancy, respectively. In the validation cohort, the sensitivity and NPV of DD were both 100% (95% CI 82%-100% and 72%-100%, respectively), whereas in patients without malignancy, the corresponding estimates were 93% (95% CI 87%-98%) and 97% (95% CI, 95%-99%), respectively. The specificity of DD was low in patients with (21%) and without cancer (53%). CONCLUSIONS: A negative DD result safely excludes the diagnosis of PE in patients with cancer. Because of the low specificity, when testing 100 patients with suspected PE, a normal DD concentration safely excludes PE in 15 patients with cancer and in 43 patients without cancer. more...
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- 2005
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47. Anticoagulants for the treatment of recurrent pregnancy loss in women without antiphospholipid syndrome
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M Di Nisio, LW Peters, and S Middeldorp
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- 2004
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48. Safety and Feasibility of a Diagnostic Algorithm Combining Clinical Probability, D-Dimer Testing, and Ultrasonography for Suspected Upper Extremity Deep Venous Thrombosis: A Prospective Management Study
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M. Di Nisio, A. Kleinjan, and Jan Beyer-Westendorf
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medicine.medical_specialty ,Venous thrombosis ,business.industry ,D-dimer ,medicine ,Surgery ,Radiology ,Ultrasonography ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business - Published
- 2014
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49. Erratum
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M. Di Nisio, Patrick M.M. Bossuyt, Alessandro Squizzato, Anne Wilhelmina Saskia Rutjes, H. R. Büller, and Aeilko H. Zwinderman
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business.industry ,D-dimer ,Medicine ,Diagnostic accuracy ,Hematology ,business ,Nuclear medicine ,Venous thromboembolism - Published
- 2013
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50. International registry on the treatment of unsuspected pulmonary embolism in cancer patients
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Jan Beyer, M. Di Nisio, H. M. Otten, A. Kleinjan, Pieter Willem Kamphuisen, and H. R. Büller
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education.field_of_study ,medicine.medical_specialty ,Pediatrics ,business.industry ,Mortality rate ,Population ,Cancer ,Hematology ,medicine.disease ,Thrombosis ,Pulmonary embolism ,Ambulatory ,medicine ,Radiology ,Stage (cooking) ,Prospective cohort study ,education ,business - Abstract
Background: In cancer patients, clinically unsuspected pulmonary embolism (PE) represents a relatively common finding on computed tomography scans performed as part of the oncological follow-up. Patients with unsuspected PE may be at risk to develop symptomatic venous thromboembolism (VTE) and appear to have an increased mortality rate compared to patients without VTE. Current guidelines suggest the same initial and longterm anticoagulation for unsuspected VTE as for patients with symptomatic thrombosis. Based on these indications, cancer patients with unsuspected PE would be anticoagulated for at least 6 months or until the disease is active, which in most cases would mean indefinite treatment. In fact, dedicated studies on the treatment of unsuspected PE are missing, leaving doubts over the need for (indefinite) anticoagulation which exposes these patients to an increased risk of major bleeding events. Objectives: to evaluate the current treatment approaches for unsuspected PE and to assess their efficacy and safety in a large prospective cohort of cancer patients. Design and study population: Multicenter, international, prospective registry. All ambulatory or hospitalized cancer patients with a first diagnosis of unsuspected PE will be eligible for the study. Both solid and hematological cancers at any stage of disease will be considered for inclusion. Patients will be excluded in case of: 1) age more...
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- 2012
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