Descriptor: "MESH: Pulmonary Embolism" - Searchworks@Jio Institute Digital Library Search Results

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129 results on '"MESH: Pulmonary Embolism"'

1. D-Dimer Level and Neutrophils Count as Predictive and Prognostic Factors of Pulmonary Embolism in Severe Non-ICU COVID-19 Patients

Author: Benjamin Thoreau, Joris Galland, Maxime Delrue, Marie Neuwirth, Alain Stepanian, Anthony Chauvin, Azeddine Dellal, Olivier Nallet, Melanie Roriz, Mathilde Devaux, Jonathan London, Gonzague Martin-Lecamp, Antoine Froissart, Nouara Arab, Bertrand Ferron, Marie-Helene Groff, Viviane Queyrel, Christine Lorut, Lucile Regard, Emilie Berthoux, Guillaume Bayer, Chloe Comarmond, Bertrand Lioger, Arsène Mekinian, Tali-Anne Szwebel, Thomas Sené, Blanca Amador-Borrero, Olivier Mangin, Pierre O. Sellier, Virginie Siguret, Stéphane Mouly, Jean-Philippe Kevorkian, Lariboisière COVID Group, Dominique Vodovar, Damien Sene, Gestionnaire, Hal Sorbonne Université, Service de médecine interne et centre de référence des maladies rares [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Cochin (IC UM3 (UMR 8104 / U1016)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Hôpital Lariboisière-Fernand-Widal [APHP], Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], Groupe Hospitalier Diaconesses Croix Saint-Simon, Centre hospitalier de Pau, Centre Hospitalier Intercommunal de Créteil (CHIC), Centre hospitalier de Sens, Centre Hospitalier du Nord Mayenne (CHNM), Centre Hospitalier Universitaire de Nice (CHU Nice), Service de pneumologie [CHU Cochin], Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre hospitalier Saint Joseph - Saint Luc [Lyon], Centre Hospitalier Privé Claude Galien - Ramsay Santé, Service de médecine interne [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU), Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Service de médecine interne [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP], Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Centre Hospitalier Agen-Nérac, CHI Créteil, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Simone Veil (CH Simone Veil), Fondation Ophtalmologique Adolphe de Rothschild [Paris], VODOVAR, Dominique, Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP), centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)
Subjects: Male, MESH: Pulmonary Embolism, pulmonary embolism, Computed Tomography Angiography, Neutrophils, [SDV]Life Sciences [q-bio], MESH: Logistic Models, 030204 cardiovascular system & hematology, MESH: Neutrophils, Gastroenterology, MESH: Venous Thromboembolism, predictive factor, 0302 clinical medicine, Risk Factors, MESH: Risk Factors, MESH: COVID-19, 030212 general & internal medicine, anticoagulation, Computed tomography angiography, MESH: Aged, MESH: Middle Aged, medicine.diagnostic_test, Incidence (epidemiology), neutrophil, Venous Thromboembolism, Middle Aged, Prognosis, QR1-502, 3. Good health, Pulmonary embolism, [SDV] Life Sciences [q-bio], Infectious Diseases, Cohort, Female, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Microbiology, Article, MESH: Prognosis, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, Virology, Internal medicine, D-dimer, medicine, MESH: Fibrin Fibrinogen Degradation Products, Humans, MESH: SARS-CoV-2, Aged, Retrospective Studies, MESH: Humans, SARS-CoV-2, business.industry, Proportional hazards model, ICU transfer, COVID-19, Retrospective cohort study, MESH: Retrospective Studies, medicine.disease, mortality, MESH: Computed Tomography Angiography, MESH: Male, Logistic Models, business, prognostic, MESH: Female
Abstract: The incidence of pulmonary embolism (PE) is high during severe Coronavirus Disease 2019 (COVID-19). We aimed to identify predictive and prognostic factors of PE in non-ICU hospitalized COVID-19 patients. In the retrospective multicenter observational CLOTVID cohort, we enrolled patients with confirmed RT-PCR COVID-19 who were hospitalized in a medicine ward and also underwent a CT pulmonary angiography for a PE suspicion. Baseline data, laboratory biomarkers, treatments, and outcomes were collected. Predictive and prognostics factors of PE were identified by using logistic multivariate and by Cox regression models, respectively. A total of 174 patients were enrolled, among whom 86 (median [IQR] age of 66 years [55–77]) had post-admission PE suspicion, with 30/86 (34.9%) PE being confirmed. PE occurrence was independently associated with the lack of long-term anticoagulation or thromboprophylaxis (OR [95%CI], 72.3 [3.6–4384.8]) D-dimers ≥ 2000 ng/mL (26.3 [4.1–537.8]) and neutrophils ≥ 7.0 G/L (5.8 [1.4–29.5]). The presence of these two biomarkers was associated with a higher risk of PE (p = 0.0002) and death or ICU transfer (HR [95%CI], 12.9 [2.5–67.8], p &lt, 0.01). In hospitalized non-ICU severe COVID-19 patients with clinical PE suspicion, the lack of anticoagulation, D-dimers ≥ 2000 ng/mL, neutrophils ≥ 7.0 G/L, and these two biomarkers combined might be useful predictive markers of PE and prognosis, respectively.
Published: 2021
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2. Distal medullary canal decompression in long stem hip replacement in long bone metastasis: Does it reduce cardiopulmonary complications?

Author: Siamak Sarrafan, Vivek Ajit Singh, and Ramesh Singh Veriah
Subjects: musculoskeletal diseases, medicine.medical_specialty, pulmonary embolism, Bone disease, Medullary cavity, Decompression, Long bone, long stem hip replacement, Symposium - Musculoskeletal Oncology, 03 medical and health sciences, long stem hip replacement MeSH terms: Metastasis, hip prosthesis, 0302 clinical medicine, lcsh:Orthopedic surgery, Hip replacement, Medicine, Orthopedics and Sports Medicine, Femur, mesh: hip joint arthroplasty, mesh: hip prosthesis, 030222 orthopedics, business.industry, Femoral canal, mesh: Metastasis, Bone metastasis, medicine.disease, Pulmonary embolism, Surgery, lcsh:RD701-811, medicine.anatomical_structure, 030220 oncology & carcinogenesis, hip joint arthroplasty, business, distal canal decompression, mesh: pulmonary embolism
Abstract: Background: The femur is the most common long bone affected by metastatic bone disease, with 25% involving the proximal third of the femur. Long stem cemented hip replacement (LHR) is an important option for cases of impending fracture. Pulmonary embolism is a critical complication that can occur. This study evaluates the effectiveness of distal femoral canal decompression in reducing the risk of cardiopulmonary events. Materials and Methods: Thirty two patients with metastatic bone disease of the proximal femur undergoing LHR were recruited and randomized. Conventional technique was used in 16 cases and distal decompression of the medullary canal was carried out for the other 16 patients. The decompression was carried out through a trocar inserted into the distal medullary canal, connected to a vacuum suction. Quantity of emboli was detected through A4 chambers transesophageal echocardiography; the blood pressure and oxygen saturation readings were also recorded. Results: The decompression group experienced significantly lower Grade 2 and Grade 3 embolic events compared to the conventional group (11 vs. 26), and the duration of the embolic phenomena was shorter. Insertion of the stem and relocating the hip gave the highest amount embolic events. There was a significant drop in systolic blood pressure (SBP) in 12 out of 16 patients (75.0%) in the conventional group and 5 out of 16 patients in the decompression group (31.3%). This is statically significant (P = 0.0124). The average drop in SBP for the conventional group is 45.8 mmHg and the decompression group was 32.9 mmHg. Oxygen saturation remained at above 96% in the decompression group. However, in the conventional group, 25% of the patients had their oxygen saturation drop to below 96% during the insertion of stem and relocation of hip joint. Conclusion: Distal femoral canal decompression is an effective method in reducing the risk of cardiopulmonary embolic events associated with LHR.
Published: 2018

3. Prescription du bilan étiologique dans la maladie thromboembolique veineuse : évaluation de la pratique des médecins généralistes d’Île-de-France

Author: Neyraud, Vincent, Université Paris Descartes - Faculté de Médecine (UPD5 Médecine), Université Paris Descartes - Paris 5 (UPD5), and Alexandra Yannoutsos
Subjects: Bilan étiologique, MESH: Pulmonary Embolism, SAPL, MESH: Thrombophilia, Hereditary, MESH: Envenous Thrombosis, MESH: Primary Health Care, Cancer occulte, MESH: Venous Thromboembolism, Soins primaires, Médecine générale, MESH: General Practice, Maladie thromboembolique veineuse, MESH: Antiphospholipid Syndrome, Thrombose veineuse profonde, MESH: Neoplasms, Thrombophilie héréditaire, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Embolie pulmonaire
Abstract: La maladie thromboembolique veineuse (MTEV) est une maladie grave et fréquente. L’enquête étiologique est primordiale en cas de MTEV idiopathique, particulièrement chez un patient âgé où la MTEV peut être la première manifestation d’un cancer occulte. Le médecin généraliste est l’acteur principal du suivi et participe à la réalisation du bilan étiologique dans le cadre d’une prise en charge globale. Les dernières recommandations françaises ont été actualisées en 2019. La recherche d’un cancer occulte est maintenant encadrée par des recommandations. Nous avons réalisé une étude descriptive auprès de médecins généralistes d’Ile-de-France tirés au sort en les interrogeant sur leurs habitudes de prescriptions du bilan étiologique de MTEV à l’aide de cas cliniques fictifs et d’un questionnaire Google Forms. La grande majorité des médecins interrogés estime que la MTEV est fréquente en médecine générale mais certains facteurs de risque sont mal connus. Il existe une large prescription du bilan de thrombophilie héréditaire, souvent non indiquée, et le bilan de thrombophilie réalisé est souvent incomplet. La recherche d’un cancer occulte reste largement effectuée lors d’une situation de MTEV idiopathique, mais le bilan est également souvent incomplet. L’utilisation systématique du scanner TAP est fréquente alors que les examens du dépistage national de cancer ne sont pas toujours actualisés. Les réponses des médecins sont hétérogènes de par la complexité des situations et leur volonté de sécuriser le patient. Il serait intéressant d’intensifier la diffusion des nouvelles recommandations à l’ensemble des médecins spécialistes en médecine générale.
Published: 2019

4. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study

Author: Morgan Jaffrelot, Marije Ten Wolde, Renée A. Douma, Menno V. Huisman, Paul L. den Exter, Olivier Thierry Rutschmann, Farès Moustafa, Pierre-Marie Roy, Josien van Es, Alessandra Principe, Pieter Willem Kamphuisen, A Trinh-Duc, Marc Philip Righini, Olivier Sanchez, Marco J. J. H. Grootenboers, Marc Durian, Y. Whitney Cheung, Guy Meyer, Catherine Le Gall, Franck Verschuren, Grégoire Le Gal, Klaas W Van Kralingen, Petra M. G. Erkens, Henri Bounameaux, Anja A. van Houten, Alexandre Ghuysen, Germa Hazelaar, Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, Department of Vascular Medicine (AMSTERDAM - DVM), Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), University of Amsterdam [Amsterdam] (UvA)-University of Amsterdam [Amsterdam] (UvA), Department of Thrombosis and Hemostasis (LEIDEN - DTH), Leiden University Medical Center (LUMC), Service des Urgences (PMR), CHRU - ANGERS, Emergency Department (FV - ED), Saint Luc University Hospital, Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service des Urgences (MG), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service d'Accueil des Urgences (AGEN - SAU), Centre Hospitalier d'Agen, Service d'Accueil des Urgences (ARGENTEUIL - SAU), CH Argenteuil, Département des Urgences, CHU Clermont-Ferrand, Service des Urgences (CHPM - SU), CH Morlaix, Department of Internal Medicine (ROTTERDAM - Med Int), Maasstad Hospital, Department of Vascular Medicine (DVM - AMC), Department of General Practice (CAPHRI), Maastricht University [Maastricht], Department of Vascular Medicine (DVM - Groningen), University Medical Center Groningen [Groningen] (UMCG), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO)-Université de Brest (UBO), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Cardiovascular Centre (CVC), Vascular Ageing Programme (VAP), Vascular Medicine, Other departments, 01 Internal and external specialisms, Family Medicine, RS: CAPHRI School for Public Health and Primary Care, Biochemie, RS: CAPHRI - Clinical epidemiology, and Hematology
Subjects: Male, MESH: Pulmonary Embolism, REVISED GENEVA SCORE, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, Gastroenterology, MESH: Venous Thromboembolism, 0302 clinical medicine, Reference Values, Outpatients, EXCLUSION, Prevalence, Cutoff, Prospective Studies, 030212 general & internal medicine, Geneva score, Prospective cohort study, ELDERLY-PATIENTS, ddc:616, MESH: Aged, MESH: Angiography, MESH: Risk, Respiratory disease, Age Factors, Angiography, MESH: Reference Values, General Medicine, EMERGENCY, Thrombosis, 3. Good health, Pulmonary embolism, Europe, MESH: Emergency Service, Hospital, Acute Disease, MESH: Diagnostic Errors, MESH: Acute Disease, Female, Emergency Service, Hospital, Risk, medicine.medical_specialty, MESH: Probability, Age adjustment, Sensitivity and Specificity, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, Internal medicine, D-dimer, medicine, MANAGEMENT, MESH: Fibrin Fibrinogen Degradation Products, Humans, COMPUTED-TOMOGRAPHY, Diagnostic Errors, MESH: Prevalence, Aged, Probability, MESH: Age Factors, VENOUS THROMBOEMBOLISM, MESH: Humans, business.industry, DIAGNOSTIC STRATEGIES, medicine.disease, MESH: Male, MESH: Prospective Studies, MESH: Sensitivity and Specificity, Surgery, CLINICAL PROBABILITY, MESH: Outpatients, THROMBOSIS, MESH: Europe, Pulmonary Embolism, business, MESH: Female
Abstract: International audience; IMPORTANCE: D-dimer measurement is an important step in the diagnostic strategy of clinically suspected acute pulmonary embolism (PE), but its clinical usefulness is limited in elderly patients. OBJECTIVE: To prospectively validate whether an age-adjusted D-dimer cutoff, defined as age × 10 in patients 50 years or older, is associated with an increased diagnostic yield of D-dimer in elderly patients with suspected PE. DESIGN, SETTINGS, AND PATIENTS: A multicenter, multinational, prospective management outcome study in 19 centers in Belgium, France, the Netherlands, and Switzerland between January 1, 2010, and February 28, 2013. INTERVENTIONS: All consecutive outpatients who presented to the emergency department with clinically suspected PE were assessed by a sequential diagnostic strategy based on the clinical probability assessed using either the simplified, revised Geneva score or the 2-level Wells score for PE; highly sensitive D-dimer measurement; and computed tomography pulmonary angiography (CTPA). Patients with a D-dimer value between the conventional cutoff of 500 µg/L and their age-adjusted cutoff did not undergo CTPA and were left untreated and formally followed-up for a 3-month period. MAIN OUTCOMES AND MEASURES: The primary outcome was the failure rate of the diagnostic strategy, defined as adjudicated thromboembolic events during the 3-month follow-up period among patients not treated with anticoagulants on the basis of a negative age-adjusted D-dimer cutoff result. RESULTS: Of the 3346 patients with suspected PE included, the prevalence of PE was 19%. Among the 2898 patients with a nonhigh or an unlikely clinical probability, 817 patients (28.2%) had a D-dimer level lower than 500 µg/L (95% CI, 26.6%-29.9%) and 337 patients (11.6%) had a D-dimer between 500 µg/L and their age-adjusted cutoff (95% CI, 10.5%-12.9%). The 3-month failure rate in patients with a D-dimer level higher than 500 µg/L but below the age-adjusted cutoff was 1 of 331 patients (0.3% [95% CI, 0.1%-1.7%]). Among the 766 patients 75 years or older, of whom 673 had a nonhigh clinical probability, using the age-adjusted cutoff instead of the 500 µg/L cutoff increased the proportion of patients in whom PE could be excluded on the basis of D-dimer from 43 of 673 patients (6.4% [95% CI, 4.8%-8.5%) to 200 of 673 patients (29.7% [95% CI, 26.4%-33.3%), without any additional false-negative findings. CONCLUSIONS AND RELEVANCE: Compared with a fixed D-dimer cutoff of 500 µg/L, the combination of pretest clinical probability assessment with age-adjusted D-dimer cutoff was associated with a larger number of patients in whom PE could be considered ruled out with a low likelihood of subsequent clinical venous thromboembolism. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01134068.
Published: 2014
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5. Usefulness of Preemptive Anticoagulation in Patients With Suspected Pulmonary Embolism

Author: Grégoire Le Gal, Arnaud Perrier, Marc Blondon, Marc Philip Righini, Drahomir Aujesky, Calvez, Ghislaine, Service de médecine interne générale (SMIG), Hôpital Universitaire de Genève, 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), Division of General Internal Medicine (DGIM), Bern University Hospital, and Service d'angiologie et d'hémostase (MR)
Subjects: MESH: Pulmonary Embolism, Pulmonary and Respiratory Medicine, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Suspected pulmonary embolism, MESH: Anticoagulants, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, In patient, 030212 general & internal medicine, Risks and benefits, Intensive care medicine, MESH: Humans, business.industry, Anticoagulants, Diagnostic test, Heparin, medicine.disease, 3. Good health, Pulmonary embolism, [SDV] Life Sciences [q-bio], Anticoagulant therapy, Pulmonary Embolism, Cardiology and Cardiovascular Medicine, business, medicine.drug, Decision analysis
Abstract: International audience; The usefulness of anticoagulation in patients with suspected non-massive pulmonary embolism (PE) is uncertain. We recently published a decision analysis model suggesting a benefit for preemptive anticoagulation in patients with an intermediate or high probability of PE, even with short diagnostic delays (0-3 h). In case of a low probability of PE, the decision to treat or not could partly rely on the expected diagnostic delay. Once the diagnosis is confirmed, achieving rapidly therapeutic anticoagulation levels decreases future thrombotic complications.
Published: 2012
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6. Elevated Admission Glucose and Mortality in Patients With Acute Pulmonary Embolism

Author: José Labarère, Marie Méan, Nathalie Scherz, Drahomir Aujesky, Department of Internal Medicine (DIM -CHUV), Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), BCM, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, and Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-CHU Grenoble
Subjects: Blood Glucose, Male, MESH: Pulmonary Embolism, Research design, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Kaplan-Meier Estimate, MESH: Hospitalization, 030204 cardiovascular system & hematology, Logistic regression, 0302 clinical medicine, Acute care, 030212 general & internal medicine, Original Research, MESH: Aged, MESH: Middle Aged, Clinical Care/Education/Nutrition/Psychosocial Research, Thrombolysis, Middle Aged, 3. Good health, Pulmonary embolism, Hospitalization, Female, medicine.medical_specialty, MESH: Diabetes Mellitus, Patient Readmission, MESH: Pennsylvania, 03 medical and health sciences, Diabetes mellitus, Internal medicine, Severity of illness, Diabetes Mellitus, MESH: Patient Readmission, Internal Medicine, medicine, Humans, MESH: Kaplan-Meier Estimate, Aged, Advanced and Specialized Nursing, MESH: Humans, business.industry, Odds ratio, Pennsylvania, medicine.disease, MESH: Male, Surgery, Hyperglycemia, MESH: Blood Glucose, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Pulmonary Embolism, MESH: Hyperglycemia, business, MESH: Female
Abstract: OBJECTIVE Although associated with adverse outcomes in other cardiopulmonary conditions, the prognostic value of elevated glucose in patients with acute pulmonary embolism (PE) is unknown. We sought to examine the association between glucose levels and mortality and hospital readmission rates for patients with PE. RESEARCH DESIGN AND METHODS We evaluated 13,621 patient discharges with a primary diagnosis of PE from 185 acute care hospitals in Pennsylvania (from January 2000 to November 2002). Admission glucose levels were analyzed as a categorical variable (≤110, >110–140, >140–170, >170–240, and >240 mg/dL). The outcomes were 30-day all-cause mortality and hospital readmission. We used random-intercept logistic regression to assess the independent association between admission glucose levels and mortality and hospital readmission, adjusting for patient (age, sex, race, insurance, comorbid conditions, severity of illness, laboratory parameters, and thrombolysis) and hospital (region, size, and teaching status) factors. RESULTS Elevated glucose (>110 mg/dL) was present in 8,666 (63.6%) patients. Patients with a glucose level ≤110, >110–140, >140–170, >170–240, and >240 mg/dL had a 30-day mortality of 5.6, 8.4, 12.0, 15.6, and 18.3%, respectively (P < 0.001). Compared with patients with a glucose level ≤110 mg/dL, the adjusted odds of dying were greater for patients with a glucose level >110–140 (odds ratio 1.19 [95% CI 1.00–1.42]), >140–170 (1.44 [1.17–1.77]), >170–240 (1.54 [1.26–1.90]), and >240 mg/dL (1.60 [1.26–2.03]), with no difference in the odds of hospital readmission. CONCLUSIONS In patients with acute PE, elevated admission glucose is common and independently associated with short-term mortality.
Published: 2011
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7. Prognostic importance of anaemia in patients with acute pulmonary embolism

Author: David Jiménez, Drahomir Aujesky, Jacques Donzé, Marie Méan, José Labarère, Department of Internal Medicine (DIM -CHUV), Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), BCM, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, and Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-CHU Grenoble
Subjects: MESH: Pulmonary Embolism, Male, 0301 basic medicine, MESH: Anemia, MESH: Logistic Models, 030204 cardiovascular system & hematology, Logistic regression, MESH: Length of Stay, Hemoglobins, 0302 clinical medicine, Odds Ratio, Cardiopulmonary disease, MESH: Aged, MESH: Middle Aged, Anemia, Hematology, Middle Aged, Prognosis, Thrombosis, 3. Good health, Pulmonary embolism, MESH: Hemoglobins, medicine.anatomical_structure, Acute Disease, MESH: Acute Disease, Female, medicine.medical_specialty, MESH: Pennsylvania, MESH: Prognosis, Odds, 03 medical and health sciences, Internal medicine, medicine, Hospital discharge, Humans, In patient, Aged, MESH: Humans, Lung, business.industry, Length of Stay, Pennsylvania, medicine.disease, MESH: Odds Ratio, MESH: Male, Surgery, Logistic Models, 030104 developmental biology, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Pulmonary Embolism, business, MESH: Female
Abstract: SummaryAlthough associated with adverse outcomes in other cardiopulmonary diseases, limited evidence exists on the prognostic value of anaemia in patients with acute pulmonary embolism (PE). We sought to examine the associations between anaemia and mortality and length of hospital stay in patients with PE. We evaluated 14,276 patients with a primary diagnosis of PE from 186 hospitals in Pennsylvania, USA. We used random-intercept logistic regression to assess the association between anaemia at the time of presentation and 30-day mortality and discretetime logistic hazard models to assess the association between anaemia and time to hospital discharge, adjusting for patient (age, gender, race, insurance type, clinical and laboratory variables) and hospital (region, size, teaching status) factors. Anaemia was present in 38.7% of patients at admission. Patients with anaemia had a higher 30-day mortality (13.7% vs. 6.3%; p
Published: 2011
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8. Volumetric or time‐based capnography for excluding pulmonary embolism in outpatients?

Author: Erkki Heinonen, Frédéric Thys, Oliver Lope Sanchez, G. Le Gal, Guy Meyer, Arnaud Perrier, F. Verschuren, Marc Philip Righini, Acute Medicine Department, Accidents and Emergency Unit (FV - AMD), Université Catholique de Louvain = Catholic University of Louvain (UCL), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, Service de médecine interne générale (SMIG), GE Healthcare Helsinki (EH), GE Healthcare Helsinki, 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), Centre d'Investigation Clinique (CIC - Brest), and Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: MESH: Pulmonary Embolism, Time Factors, Pulmonary Embolism/blood/*diagnosis/metabolism, 030204 cardiovascular system & hematology, MESH: Carbon Dioxide, MESH: Respiratory Dead Space, MESH: Aged, 80 and over, 0302 clinical medicine, Respiratory Dead Space, Outpatients, Prospective Studies, Prospective cohort study, Capnography, ddc:616, Aged, 80 and over, MESH: Aged, Carbon Dioxide/*metabolism, Likelihood Functions, ddc:618, MESH: Middle Aged, medicine.diagnostic_test, Incidence (epidemiology), MESH: Enzyme-Linked Immunosorbent Assay, Hematology, Middle Aged, Point-of-Care Systems, MESH: Predictive Value of Tests, MESH: Point-of-Care Systems, 3. Good health, Pulmonary embolism, Europe, Predictive value of tests, Fibrin Fibrinogen Degradation Products/metabolism, medicine.medical_specialty, Enzyme-Linked Immunosorbent Assay, Sensitivity and Specificity, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, Predictive Value of Tests, Multicenter trial, MESH: Fibrin Fibrinogen Degradation Products, medicine, Humans, Aged, MESH: Humans, Receiver operating characteristic, business.industry, MESH: Time Factors, MESH: Capnography, Carbon Dioxide, MESH: ROC Curve, medicine.disease, MESH: Prospective Studies, MESH: Sensitivity and Specificity, Confidence interval, MESH: Outpatients, Surgery, ROC Curve, 030228 respiratory system, MESH: Likelihood Functions, MESH: Europe, Pulmonary Embolism, Nuclear medicine, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; BACKGROUND: Volumetric capnography is technically more demanding but theoretically better than the time-based alveolar deadspace fraction (P(a)CO(2) - EtCO(2))/P(a)CO(2) as a bedside diagnostic tool for excluding pulmonary embolism (PE) in outpatients. OBJECTIVE: We compared both diagnostic accuracy in patients with a suspected PE and positive D-dimer enzyme-linked immunosorbent assay results. PATIENTS AND METHODS: In this clinical multicenter trial with prospective inclusion and 3-month follow-up, alveolar deadspace fraction was compared by receiver operating characteristic (ROC) analysis with other parameters derived from volumetric capnography. RESULTS: Capnography was performed in 239 patients, and 205 tests (86%) were conclusive. The incidence of PE was 33%. The alveolar deadspace fraction accuracy expressed with ROC curve analysis was 0.73 +/- 0.04. The diagnostic performances of parameters from volumetric capnography were not significantly better. Sixteen per cent [95% confidence interval (CI) 12-21%] of patients presented a (P(a)CO(2) - EtCO(2))/P(a)CO(2) ratio under the cut-off value of 0.15, with a low clinical probability. This combination excluded PE, with a sensitivity of 96% (95% CI 89-99%) and a negative likelihood ratio of 0.17 (95% CI 0.09-0.33%). CONCLUSION: Volumetric capnography failed to show superiority to alveolar deadspace fraction measurements [(P(a)CO(2) - EtCO(2))/P(a)CO(2)] for exclusion of PE in outpatients with positive D-dimer test results. Future studies should clarify the safety of excluding PE in patients combining low clinical probability with positive D-dimer results and (P(a)CO(2) - EtCO(2))/P(a)CO(2) ratios below the cut-off value of 0.15.
Published: 2010
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9. Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial

Author: Dominique Mottier, Guy Meyer, Jacques Cornuz, Michel Nonent, Pierre-Alexandre Alois Poletti, Henri Bounameaux, Olivier Sanchez, Grégoire Le Gal, Marc Philip Righini, Arnaud Perrier, Cédric Petit Le Manach, Frédéric Thys, Thomas V. Perneger, Drahomir Aujesky, Olivier Thierry Rutschmann, Franck Verschuren, Pierre-Marie Roy, Marie-Pierre Revel, Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, 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), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Internal Medicine (DIM -CHUV), Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Centre de Recherche Clinique (CRC Angers), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Service des Urgences (PMR), CHRU - ANGERS, Emergency Department (FV - ED), Saint Luc University Hospital, Division of General Internal Medicine, Université de Lausanne (UNIL), Département de radiologie [Brest] (DR - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille, Emergency Radiology Service, HUG (HUG), Université de Genève (UNIGE), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Division of Clinical Epidemiology (DCE), Geneva University Hospital (HUG), Service de médecine interne générale (SMIG), Hôpital Universitaire de Genève = University Hospitals of Geneva (HUG), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Lausanne = University of Lausanne (UNIL), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), and Université de Genève = University of Geneva (UNIGE)
Subjects: Male, MESH: Pulmonary Embolism, Pulmonary Embolism/diagnosis/etiology/ultrasonography, 030204 cardiovascular system & hematology, law.invention, 0302 clinical medicine, Randomized controlled trial, Risk Factors, MESH: Risk Factors, law, 030212 general & internal medicine, Geneva score, Ultrasonography, Venous Thrombosis, MESH: Middle Aged, Respiratory disease, MESH: Enzyme-Linked Immunosorbent Assay, General Medicine, Middle Aged, Thrombosis, 3. Good health, Pulmonary embolism, medicine.anatomical_structure, Female, Venous Thrombosis/complications, Radiology, MESH: Tomography, X-Ray Computed, Fibrin Fibrinogen Degradation Products/metabolism, medicine.medical_specialty, MESH: Probability, Enzyme-Linked Immunosorbent Assay, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, MESH: Fibrin Fibrinogen Degradation Products, medicine, Humans, ddc:610, Vein, Contraindication, Probability, MESH: Humans, business.industry, medicine.disease, MESH: Male, Surgery, Clinical trial, MESH: Venous Thrombosis, Pulmonary Embolism, Tomography, X-Ray Computed, business, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; BACKGROUND: Multislice CT (MSCT) combined with D-dimer measurement can safely exclude pulmonary embolism in patients with a low or intermediate clinical probability of this disease. We compared this combination with a strategy in which both a negative venous ultrasonography of the leg and MSCT were needed to exclude pulmonary embolism. METHODS: We included 1819 consecutive outpatients with clinically suspected pulmonary embolism in a multicentre non-inferiority randomised controlled trial comparing two strategies: clinical probability assessment and either D-dimer measurement and MSCT (DD-CT strategy [n=903]) or D-dimer measurement, venous compression ultrasonography of the leg, and MSCT (DD-US-CT strategy [n=916]). Randomisation was by computer-generated blocks with stratification according to centre. Patients with a high clinical probability according to the revised Geneva score and a negative work-up for pulmonary embolism were further investigated in both groups. The primary outcome was the 3-month thromboembolic risk in patients who were left untreated on the basis of the exclusion of pulmonary embolism by diagnostic strategy. Clinicians assessing outcome were blinded to group assignment. Analysis was per protocol. This study is registered with ClinicalTrials.gov, number NCT00117169. FINDINGS: The prevalence of pulmonary embolism was 20.6% in both groups (189 cases in DD-US-CT group and 186 in DD-CT group). We analysed 855 patients in the DD-US-CT group and 838 in the DD-CT group per protocol. The 3-month thromboembolic risk was 0.3% (95% CI 0.1-1.1) in the DD-US-CT group and 0.3% (0.1-1.2) in the DD-CT group (difference 0.0% [-0.9 to 0.8]). In the DD-US-CT group, ultrasonography showed a deep-venous thrombosis in 53 (9% [7-12]) of 574 patients, and thus MSCT was not undertaken. INTERPRETATION: The strategy combining D-dimer and MSCT is as safe as the strategy using D-dimer followed by venous compression ultrasonography of the leg and MSCT for exclusion of pulmonary embolism. An ultrasound could be of use in patients with a contraindication to CT.
Published: 2008
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10. Comparison of the revised Geneva score with the Wells rule for assessing clinical probability of pulmonary embolism

Author: M.V. Huisman, Drahomir Aujesky, E. Kruisman, Marc Philip Righini, J. Spaan, Frederikus A. Klok, M. Nijkeuter, Arnaud Perrier, G. Le Gal, P.-M. Roy, Section of Vascular Disease (LUMC - Vasc Dis), Leiden University Medical Center (LUMC), Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, Division of Internal Medicine (DA), Université de Lausanne (UNIL), Service des Urgences (PMR), CHRU - ANGERS, General Internal Medicine (AP), Geneva University Hospital (HUG), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), 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), ACS - Amsterdam Cardiovascular Sciences, Other Research, and Biomedical Engineering and Physics
Subjects: Adult, Male, MESH: Pulmonary Embolism, Pediatrics, medicine.medical_specialty, MESH: Probability, 030204 cardiovascular system & hematology, Single Center, Decision Support Techniques, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, D-dimer, Prevalence, Humans, Medicine, Pulmonary Embolism/diagnosis, 030212 general & internal medicine, Geneva score, MESH: Prevalence, health care economics and organizations, Probability, ddc:616, MESH: Humans, MESH: Middle Aged, Receiver operating characteristic, business.industry, Area under the curve, MESH: Decision Support Techniques, MESH: Adult, Hematology, Middle Aged, MESH: ROC Curve, medicine.disease, MESH: Male, MESH: Predictive Value of Tests, Pulmonary embolism, ROC Curve, Area Under Curve, Predictive value of tests, MESH: Area Under Curve, Female, Pulmonary Embolism, business, MESH: Female, Venous thromboembolism, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; BACKGROUND: The revised Geneva score, a standardized clinical decision rule in the diagnosis of pulmonary embolism (PE), was recently developed. The Wells clinical decision is widely used but lacks full standardization, as it includes subjective clinician's judgement. We have compared the performance of the revised Geneva score with the Wells rule, and their usefulness for ruling out PE in combination with D-dimer measurement. METHODS: In 300 consecutive patients, the clinical probability of PE was assessed prospectively by the Wells rule and retrospectively using the revised Geneva score. Patients comprised a random sample from a single center, participating in a large prospective multicenter diagnostic study. The predictive accuracy of both scores was compared by area under the curve (AUC) of receiver operating characteristic (ROC) curves. RESULTS: The overall prevalence of PE was 16%. The prevalence of PE in the low-probability, intermediate-probability and high-probability categories as classified by the revised Geneva score was similar to that of the original derivation set. The performance of the revised Geneva score as measured by the AUC in a ROC analysis did not differ statistically from the Wells rule. After 3 months of follow-up, no patient classified into the low or intermediate clinical probability category by the revised Geneva score and a normal D-dimer result was subsequently diagnosed with acute venous thromboembolism. CONCLUSIONS: This study suggests that the performance of the revised Geneva score is equivalent to that of the Wells rule. In addition, it seems safe to exclude PE in patients by the combination of a low or intermediate clinical probability by the revised Geneva score and a normal D-dimer level. Prospective clinical outcome studies are needed to confirm this latter finding.
Published: 2008
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11. High frequency of factor V Leiden in surgical patients with symptomatic venous thromboembolism despite prophylaxis

Author: Francis Couturaud, Emmanuel Oger, Karine Lacut, Christophe Leroyer, Mohamed Baba-Ahmed, Grégoire Le Gal, Calvez, Ghislaine, Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO)-Université de Brest (UBO), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Pharmacologie [Rennes], and CHU Pontchaillou [Rennes]
Subjects: Male, MESH: Pulmonary Embolism, MESH: Treatment Failure, MESH: Factor V, 030204 cardiovascular system & hematology, MESH: Aged, 80 and over, 0302 clinical medicine, Gene Frequency, Risk Factors, MESH: Risk Factors, Epidemiology, Odds Ratio, Orthopedic Procedures, Prospective Studies, Treatment Failure, Aged, 80 and over, Venous Thrombosis, MESH: Aged, 0303 health sciences, MESH: Middle Aged, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, MESH: Genetic Predisposition to Disease, Hematology, Middle Aged, MESH: Case-Control Studies, 3. Good health, Pulmonary embolism, Venous thrombosis, MESH: Thromboembolism, Female, France, Adult, medicine.medical_specialty, MESH: Anticoagulants, Thrombophilia, MESH: Orthopedic Procedures, 03 medical and health sciences, Thromboembolism, Internal medicine, MESH: Gene Frequency, medicine, Factor V Leiden, Humans, Point Mutation, Genetic Predisposition to Disease, cardiovascular diseases, Risk factor, Aged, Retrospective Studies, MESH: Point Mutation, 030304 developmental biology, MESH: Humans, business.industry, Vascular disease, Anticoagulants, Factor V, MESH: Adult, MESH: Retrospective Studies, medicine.disease, MESH: Male, MESH: Odds Ratio, MESH: Prospective Studies, Surgery, MESH: France, Case-Control Studies, MESH: Venous Thrombosis, Orthopedic surgery, Pulmonary Embolism, business, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: SummaryAmong candidate risk factors associated with postoperative venous thromboembolism (VTE), the role of factorV Leiden (FVL) mutation remains unclear. We performed a case-control study to assess the potential significance of FVL mutation in postoperative VTE cases despite prophylaxis. We used data from the ongoing case-control “EDITH” study. We extracted 133VTE cases and 144 controls who had undergone either surgery or had plaster cast in the previous three months. Prophylaxis adequacy with regard to the recommendations published by theAmerican College of Chest Physicians was retrospectively assessed. FVL mutation was present in 20VTE cases and four controls (OR 5.9, 95% CI 2–18). Prophylaxis was judged as adequate in 116 cases (88.5 %) and in 129 controls (87.2 %) (p = 0.66). The frequency of FVL mutation was not different in VTE cases occurring while on adequate prophylaxis and in VTE cases occurring after the end of adequate prophylaxis (p = 0.27). FVL mutation was closely associated with postoperative VTE in patients classified as having received an adequate prophylaxis (8.4; 95% CI, 2.4 to 29). This study shows a close association between the presence of factorV Leiden mutation in symptomaticVTE occurring after surgery despite prophylaxis.
Published: 2007
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12. Idraparinux versus standard therapy for venous thromboembolic disease

Author: Renseigné, Non, Buller, Harry R, Cohen, Ander T, Davidson, Bruce, Decousus, Hervé, Gallus, Alex S, Gent, Michael, Pillion, Gerard, Piovella, Franco, Prins, Martin H, Raskob, Gary E, Architectures, Languages and Compilers to Harness the End of Moore Years (ALCHEMY), Laboratoire de Recherche en Informatique (LRI), Université Paris-Sud - Paris 11 (UP11)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-Université Paris-Sud - Paris 11 (UP11)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-Inria Saclay - Ile de France, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria), Groupe de recherche sur la thrombose (GRT (EA 3065)), Université Jean Monnet [Saint-Étienne] (UJM), Cluster Infectious Diseases, Amsterdam BioMed Cluster, ACS - Amsterdam Cardiovascular Sciences, Vascular Medicine, Groupe de recherche sur la thrombose, pharmacologie des antithrombotiques et situations à risque (GRT), and Université Jean Monnet - Saint-Étienne (UJM)
Subjects: Male, MESH: Pulmonary Embolism, Vitamin K, MESH: Heparin, Idraparinux, Oligosaccharides, 030204 cardiovascular system & hematology, 0302 clinical medicine, Recurrence, MESH: Incidence, 030212 general & internal medicine, MESH: Treatment Outcome, Venous Thrombosis, MESH: Middle Aged, Incidence, Hazard ratio, MESH: Follow-Up Studies, General Medicine, Heparin, Middle Aged, Vitamin K antagonist, Thrombosis, 3. Good health, Pulmonary embolism, Venous thrombosis, Treatment Outcome, Anesthesia, Female, MESH: Hemorrhage, medicine.drug, medicine.drug_class, Hemorrhage, MESH: Anticoagulants, 03 medical and health sciences, medicine, Humans, MESH: Humans, business.industry, Anticoagulants, MESH: Vitamin K, Odds ratio, medicine.disease, MESH: Male, MESH: Recurrence, MESH: Venous Thrombosis, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Pulmonary Embolism, business, MESH: Female, MESH: Oligosaccharides, Follow-Up Studies
Abstract: International audience; BACKGROUND: Venous thromboembolism is treated with unfractionated heparin or low-molecular-weight heparin, followed by a vitamin K antagonist. We investigated the potential use of idraparinux, a long-acting inhibitor of activated factor X, as a substitute for standard therapy. METHODS: We conducted two randomized, open-label noninferiority trials involving 2904 patients with deep-vein thrombosis and 2215 patients with pulmonary embolism to compare the efficacy and safety of idraparinux versus standard therapy. Patients received either subcutaneous idraparinux (2.5 mg once weekly) or a heparin followed by an adjusted-dose vitamin K antagonist for either 3 or 6 months. The primary efficacy outcome was the 3-month incidence of symptomatic recurrent venous thromboembolism (nonfatal or fatal). RESULTS: In the study of patients with deep venous thrombosis, the incidence of recurrence at day 92 was 2.9% in the idraparinux group as compared with 3.0% in the standard-therapy group (odds ratio, 0.98; 95% confidence interval [CI], 0.63 to 1.50), a result that satisfied the prespecified noninferiority requirement. At 6 months, the hazard ratio for idraparinux was 1.01. The rates of clinically relevant bleeding at day 92 were 4.5% in the idraparinux group and 7.0% in the standard-therapy group (P=0.004). At 6 months, bleeding rates were similar. In the study of patients with pulmonary embolism, the incidence of recurrence at day 92 was 3.4% in the idraparinux group and 1.6% in the standard-therapy group (odds ratio, 2.14; 95% CI, 1.21 to 3.78), a finding that did not meet the noninferiority requirement. CONCLUSIONS: In patients with deep venous thrombosis, once-weekly subcutaneous idraparinux for 3 or 6 months had an efficacy similar to that of heparin plus a vitamin K antagonist. However, in patients with pulmonary embolism, idraparinux was less efficacious than standard therapy. (ClinicalTrials.gov numbers, NCT00067093 [ClinicalTrials.gov] and NCT00062803 [ClinicalTrials.gov].).
Published: 2007
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13. Catastrophic antiphospholipid syndrome and pulmonary embolism in a 3-year-old child

Author: Jean-Nicolas Dacher, Thierry Blanc, Eléonore Blondiaux, Carine Olivier, Jeanne-Yvonne Borg, Service d'imagerie médicale [CHU Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Service de pédiatrie néonatale et réanimation - neuropédiatrie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Hôpital Charles Nicolle [Rouen]-Université de Rouen Normandie (UNIROUEN), Laboratoire d'hématologie [Rouen], Breton, Céline, Hôpital Charles Nicolle [Rouen], and Normandie Université (NU)-Normandie Université (NU)-CHU Rouen
Subjects: MESH: Pulmonary Embolism, MESH: Fatal Outcome, medicine.medical_specialty, Pediatrics, Catastrophic illness, media_common.quotation_subject, 030204 cardiovascular system & hematology, Catastrophic antiphospholipid syndrome, 03 medical and health sciences, Fatal Outcome, 0302 clinical medicine, Antiphospholipid syndrome, Thromboembolism, MESH: Catastrophic Illness, MESH: Antiphospholipid Syndrome, medicine, Humans, Radiology, Nuclear Medicine and imaging, Medical history, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Girl, Catastrophic Illness, Neuroradiology, media_common, 030203 arthritis & rheumatology, MESH: Humans, business.industry, MESH: Child, Preschool, Antiphospholipid Syndrome, medicine.disease, 3. Good health, Pulmonary embolism, Surgery, Embolism, MESH: Thromboembolism, Child, Preschool, Pediatrics, Perinatology and Child Health, Female, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Pulmonary Embolism, business, MESH: Female
Abstract: International audience; We report a rare example of catastrophic antiphospholipid syndrome (CAPS) in a young child. A 3-year-old girl with no previous medical history presented with extensive and recurrent thromboses. The diagnosis of CAPS was based on the occurrence of cardiopulmonary embolism in the child with a high titre of autoantibodies directed against phospholipids and beta-2-glycoprotein 1. In spite of a relatively rapid diagnosis and multiple treatments, the outcome was unfavourable. Multimodality imaging, including both ultrasonography and spiral CT, allowed close follow-up of the thromboses.
Published: 2006
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14. Hyperhomocysteinemia and low B vitamin levels are independently associated with venous thromboembolism: results from the EDITH study: a hospital‐based case–control study

Author: Oger, Emmanuel, Lacut, Karine, Le Gal, Grégoire, Couturaud, Francis, Guénet, D., Abalain, Jean-Hervé, Roguedas, Anne-Marie, Mottier, Dominique, Renseigné, Non, 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), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Pneumologie, Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Laboratoire de Médecine Nucléaire (BREST - Med Nuc), and Laboratoire de Biochimie (BREST - Biochimie)
Subjects: MESH: Pulmonary Embolism, Male, 030204 cardiovascular system & hematology, Gastroenterology, MESH: Genotype, chemistry.chemical_compound, MESH: Aged, 80 and over, 0302 clinical medicine, MESH: Risk Factors, Risk Factors, Medicine, Prospective Studies, 030212 general & internal medicine, MESH: Aged, Aged, 80 and over, Venous Thrombosis, MESH: Middle Aged, biology, MESH: Methylenetetrahydrofolate Reductase (NADPH2), Hematology, Middle Aged, MESH: Case-Control Studies, 3. Good health, Vitamin B 12, MESH: Hyperhomocysteinemia, Female, Adult, Vitamin, Hyperhomocysteinemia, medicine.medical_specialty, Adolescent, Genotype, 03 medical and health sciences, Internal medicine, Humans, Vitamin B12, Risk factor, Methylenetetrahydrofolate Reductase (NADPH2), Aged, MESH: Adolescent, MESH: Humans, business.industry, Case-control study, MESH: Adult, Odds ratio, medicine.disease, MESH: Prospective Studies, MESH: Male, Surgery, B vitamins, MESH: Vitamin B 12, chemistry, Case-Control Studies, Methylenetetrahydrofolate reductase, MESH: Venous Thrombosis, biology.protein, Pulmonary Embolism, business, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; BACKGROUND: Moderate hyperhomocysteinemia and B vitamins deficiency are thought to be risk factors for venous thromboembolism (VTE). The causality and independence of those associations are still questioned. METHODS: We measured fasting serum total homocysteine, folates, and vitamin B12 levels as well as 5,10-methylenetetrahydrofolate reductase (MTHFR) C677T genotypes in 467 patients hospitalized with a first well-documented deep vein thrombosis and/or pulmonary embolism not related to a major acquired risk factor and 467 controls matched for gender and age. RESULTS: Mild hyperhomocysteinemia, low serum folates, and vitamin B12 were associated with VTE independently of each other. In multivariate analysis, odds ratios (OR) (95% CI) for VTE associated with mild hyperhomocysteinemia (>15 micromol L(-1)), low serum folates (< or = 4.9 nmol L(-1)), and vitamin B12 (< or = 253 pmol L(-1)) were 1.48 (1.05-2.08), 3.14 (1.35-7.32) and 1.42 (1.03-1.98), respectively. An MTHFRC677T genotype was not significantly associated with VTE; OR (95% CI): 1.13 (0.70-1.81) CONCLUSIONS: The current data provides further knowledge in the complex relationship between hyperhomocysteinemia, low vitamin levels, and VTE.
Published: 2006
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15. Venous thromboembolism prevention in surgery and obstetrics

Author: Samama, C. M., Albaladejo, P., Benhamou, D., Bertin-Maghit, M., Bruder, N., Doublet, J. D., Laversin, S., Leclerc, S., Marret, E., Mismetti, P., Samain, E., Steib, A., Renseigné, Non, Service d'anesthésie-réanimation [Hôtel-Dieu], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Hôtel-Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut de biologie et chimie des protéines [Lyon] (IBCP), Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Département d'anesthésie-réanimation, Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), France Télécom Recherche & Développement (FT R&D), France Télécom, Institut Mondor de recherche biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Groupe de recherche sur la thrombose (GRT (EA 3065)), Université Jean Monnet [Saint-Étienne] (UJM), Hôpital Hôtel-Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Hôtel-Dieu [Paris], Institut de biologie et chimie des protéines [Lyon] ( IBCP ), Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique ( CNRS ), Assistance Publique - Hôpitaux de Marseille ( APHM ) - Hôpital de la Timone [CHU - APHM] ( TIMONE ), France Télécom Recherche & Développement ( FT R&D ), Institut Mondor de recherche biomédicale ( IMRB ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Groupe de recherche sur la thrombose ( GRT (EA 3065) ), and Université Jean Monnet [Saint-Étienne] ( UJM )
Subjects: MESH: Pulmonary Embolism, medicine.medical_treatment, MESH: Pregnancy Complications, Hematologic, 030204 cardiovascular system & hematology, MESH : Anticoagulants, Postoperative Complications, MESH: Pregnancy, 0302 clinical medicine, Pregnancy, Risk Factors, MESH: Risk Factors, MESH: Postoperative Complications, MESH: Fibrinolytic Agents, MESH : Female, MESH: Heparin, Low-Molecular-Weight, MESH: Puerperal Disorders, Venous Thrombosis, Obstetrics, MESH : Venous Thrombosis, MESH : Risk Factors, 3. Good health, Pulmonary embolism, Venous thrombosis, 030220 oncology & carcinogenesis, MESH : Pulmonary Embolism, Ambulatory, Female, Neurosurgery, medicine.medical_specialty, MESH : Heparin, Low-Molecular-Weight, Compression stockings, MESH: Anticoagulants, 03 medical and health sciences, MESH : Pregnancy Complications, Hematologic, Fibrinolytic Agents, medicine, Humans, Intensive care medicine, MESH: Humans, business.industry, MESH : Humans, Pregnancy Complications, Hematologic, MESH : Puerperal Disorders, MESH : Fibrinolytic Agents, [ SDV.SP.PHARMA ] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Anticoagulants, Puerperal Disorders, Heparin, Low-Molecular-Weight, Vascular surgery, medicine.disease, Surgery, MESH : Pregnancy, Critical appraisal, Anesthesiology and Pain Medicine, MESH: Venous Thrombosis, Orthopedic surgery, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, MESH : Postoperative Complications, Pulmonary Embolism, business, MESH: Female
Abstract: International audience; BACKGROUND AND OBJECTIVE: To produce up-to-date clinical practice guidelines on the prevention of venous thromboembolism in surgery and obstetrics. METHODS: A Steering Committee defined the scope of the topic, the questions to be answered, and the assessment criteria. Eight multidisciplinary working groups (total of 70 experts) performed a critical appraisal of the literature in the following disciplines: pharmacology of antithrombotic agents, orthopaedics; general surgery (gastrointestinal (GI) and varicose vein surgery); urology; gynaecology and obstetrics; thoracic, cardiac and vascular surgery; surgery of the head, neck and spine; and surgery of burns patients. The resultant reports and guidelines were submitted for comment and completion of the Appraisal of Guidelines Research & Evaluation questionnaire to a total of 150 peer reviewers, before producing definite guidelines. RESULTS: The report answers the following questions for each type of surgery: (i) What is the venous thromboembolism incidence according to clinical and/or paraclinical criteria in the absence of prophylaxis? (with stratification of venous thromboembolism risk into low, moderate and high categories); (ii) What is the efficacy and safety of the prophylactic measures used? (iii) When should prophylaxis be introduced and how long should it last? (iv) Does ambulatory surgery affect efficacy and safety of prophylaxis? CONCLUSIONS: Apart from answering the above questions, the guidelines provide a summary table for each discipline. This table stratifies types of surgery into the three risk categories, specifies the recommended prophylaxis for venous thromboembolism (pharmacological and/or mechanical) and grades each recommendation. In addition, whenever appropriate, the recommended prophylaxis is adjusted to low- and high-risk patients.
Published: 2006
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16. Differential value of risk factors and clinical signs for diagnosing pulmonary embolism according to age

Author: Arnaud Perrier, Drahomir Aujesky, Guy Meyer, Marc Philip Righini, P.-M. Roy, Henri Bounameaux, G. Le Gal, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, Service des Urgences (PMR), CHRU - ANGERS, Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Division of General Medicine (DGM), Lausanne university hospital, Department of Internal Medicine (AP), and Geneva University Hospital (HUG)
Subjects: Male, MESH: Pulmonary Embolism, Pleural effusion, 030204 cardiovascular system & hematology, Chest pain, Cohort Studies, Electrocardiography, 0302 clinical medicine, Risk Factors, MESH: Risk Factors, Prospective Studies, 030212 general & internal medicine, MESH: Cohort Studies, Cardiopulmonary disease, Venous Thrombosis, MESH: Aged, MESH: Middle Aged, Age Factors, MESH: Follow-Up Studies, Hematology, Middle Aged, MESH: Predictive Value of Tests, 3. Good health, Pulmonary embolism, Venous thrombosis, MESH: Thromboembolism, Female, Radiography, Thoracic, medicine.symptom, medicine.medical_specialty, Tachypnea, Diagnosis, Differential, 03 medical and health sciences, Predictive Value of Tests, MESH: Diagnosis, Differential, Thromboembolism, Internal medicine, medicine, Humans, Intensive care medicine, Aged, MESH: Age Factors, MESH: Humans, business.industry, Emergency department, MESH: Radiography, Thoracic, medicine.disease, MESH: Prospective Studies, MESH: Male, MESH: Electrocardiography, MESH: Venous Thrombosis, Etiology, Pulmonary Embolism, business, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Follow-Up Studies
Abstract: International audience; INTRODUCTION: The diagnostic value of clinical presentation of pulmonary embolism (PE) is uncertain in the elderly, who often have concomitant cardiopulmonary diseases that may mimic PE. The aim of our study was to assess the differential value of risk factors, symptoms and clinical signs of venous thromboembolism, results of electrocardiogram and chest X-ray for the diagnosis of PE in suspected patients according to age. METHODS: We analyzed data from two outcome studies which enrolled 1721 consecutive patients presenting in the emergency department with clinically suspected PE defined as acute onset of new or worsening shortness of breath or chest pain without any other obvious etiology. All patients underwent a sequential diagnostic work-up and a 3-month follow-up. RESULTS: The proportion of confirmed PE was 24.2% (416 of 1721). Strength of the association with PE did not differ according to age group for history of venous thromboembolism (VTE), recent surgery, tachypnea at admission or right ventricular strain on electrocardiogram. Active malignancy, hemoptysis, tachycardia, hemidiaphragmatic elevation and pleural effusion at chest X-ray were no more associated with PE in the patients aged of 75 years or more. Finally, symptoms and signs of deep venous thrombosis, and an alternative diagnosis less probable than PE were associated with PE in all age groups, but the strength of this association decreased significantly with advancing age. CONCLUSION: Some risk factors, symptoms and signs of VTE are less strongly or even not at all associated with PE in the elderly. Physicians should take this into account when attending elderly patients suspected of PE and when assessing their clinical probability of PE.
Published: 2005
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17. The Simplified Pulmonary Embolism Severity Index (PESI): validation of a clinical prognostic model for pulmonary embolism

Author: Marc Philip Righini, G. Le Gal, Drahomir Aujesky, Guy Meyer, P.-M. Roy, F. Verschuren, Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, Centre de Recherche Clinique (CRC Angers), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Department of Emergency Medicine, Saint Luc University Hospital, Division of General Internal Medicine, Université de Lausanne (UNIL), 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), Centre d'Investigation Clinique (CIC - Brest), and Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: MESH: Pulmonary Embolism, medicine.medical_specialty, Validation study, Index (economics), MEDLINE, 030204 cardiovascular system & hematology, Severity of Illness Index, MESH: Prognosis, 03 medical and health sciences, 0302 clinical medicine, Pulmonary Embolism/pathology, MESH: Severity of Illness Index, Severity of illness, medicine, Humans, 030212 general & internal medicine, MESH: Models, Theoretical, ComputingMilieux_MISCELLANEOUS, ddc:616, MESH: Humans, business.industry, Hematology, Models, Theoretical, Prognosis, medicine.disease, Pulmonary embolism, Surgery, Emergency medicine, Prognostic model, Pulmonary Embolism, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience
Published: 2011
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18. Fibrinolysis for patients with intermediate-risk pulmonary embolism

Author: Sebastian Schellong, Mustapha Sebbane, Thierry Danays, Samuel Z. Goldhaber, Guy Meyer, Irene M. Lang, Cecilia Becattini, Eric Vicaut, Francis Couturaud, Christian Kupatt, Bożena Sobkowicz, Adam Torbicki, Claudia Dellas, Franck Verschuren, Erich Bluhmki, Hélène Bouvaist, Abstr Act, Nicolas Meneveau, Branislav Stefanovic, Benjamin Brenner, Annette Geibel, Piotr Pruszczyk, Mareike Lankeit, Jan Beyer-Westendorf, Ana Franca, Nils Kucher, Klaus Empen, David Jiménez, Matija Kozak, Nazzareno Galiè, Holger Thiele, Antoniu Petris, Giancarlo Agnelli, Gerard Pacouret, Aldo Salvi, Stavros Konstantinides, Matteo Rugolotto, Massimiliano Palazzini, Hôpital Européen Georges Pompidou [APHP] ( HEGP ), GIRC Thrombose, Service de Statistiques, Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Diderot - Paris 7 ( UPD7 ) -Hôpitaux Universitaires Saint-Louis, Lariboisière, Fernand-Widal, BOEHRINGER INGELHEIM, Boehringer Ingelheim, Internal and Cardiovascular Medicine - Stroke Unit ( PERUGIA - ICM-SU ), Università degli Studi di Perugia ( UNIPG ), Carl Gustav Carus University ( DRESDEN - CGCU ), Technische Universität Dresden ( TUD ), Service de Cardiologie, CHU Grenoble, Groupe d'Etude de la Thrombose de Bretagne Occidentale ( GETBO ), Université de Brest ( UBO ), Centre d'Investigation Clinique ( CIC - Brest ), Université de Brest ( UBO ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Département de Médecine Interne et Pneumologie [Brest] ( DMIP - Brest ), Centre Hospitalier Régional Universitaire de Brest ( CHRU Brest ), Department of Cardiology, University of Freiburg [Freiburg], Cardiovascular Division ( SZG ), Brigham and Women's Hospital [Boston], Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) ( PCVP / CARDIO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université de Franche-Comté ( UFC ) -Université Bourgogne Franche-Comté [COMUE] ( UBFC ), Service de Cardiologie A ( TOURS - Cardiologie A ), CHRU Tours, Dresden-Friedrichstadt Hospital ( DRESDEN-FRIEDRICHSTADT HOSPITAL ), Dresden-Friedrichstadt Hospital, Département de Médecine d'Urgence, Hôpital Lapeyronie, Cologne Center for Genomics (CCG), University of Cologne, Emergency Department ( FV - ED ), Saint Luc University Hospital, Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpitaux Universitaires Saint-Louis, Lariboisière, Fernand-Widal, Internal and Cardiovascular Medicine - Stroke Unit (PERUGIA - ICM-SU), Università degli Studi di Perugia (UNIPG), Carl Gustav Carus University (DRESDEN - CGCU), Technische Universität Dresden = Dresden University of Technology (TU Dresden), 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), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Cardiovascular Division (SZG), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service de Cardiologie A (TOURS - Cardiologie A), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Dresden-Friedrichstadt Hospital (DRESDEN-FRIEDRICHSTADT HOSPITAL), Emergency Department (FV - ED), HEGP ( SPRM ), Hôpital Européen Georges Pompidou [APHP] ( HEGP ) -Université Paris Descartes - Paris 5 ( UPD5 ), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( PCVP / CARDIO ), Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ) -Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Guy Meyer, Eric Vicaut, Thierry Danay, Giancarlo Agnelli, Cecilia Becattini, Jan Beyer-Westendorf, Erich Bluhmki, Helene Bouvaist, Benjamin Brenner, Francis Couturaud, Claudia Della, Klaus Empen, Ana Franca, Nazzareno Galiè, Annette Geibel, Samuel Z. Goldhaber, David Jimenez, Matija Kozak, Christian Kupatt, Nils Kucher, Irene M. Lang, Mareike Lankeit, Nicolas Meneveau, Gerard Pacouret, Massimiliano Palazzini, Antoniu Petri, Piotr Pruszczyk, Matteo Rugolotto, Aldo Salvi, Sebastian Schellong, Mustapha Sebbane, Bozena Sobkowicz, Branislav S. Stefanovic, Holger Thiele, Adam Torbicki, Franck Verschuren, and Stavros V. Konstantinides
Subjects: MESH: Pulmonary Embolism, Male, MESH: Heparin, MESH : Stroke, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Ventricular Dysfunction, Right, MESH : Aged, MESH : Ventricular Dysfunction, Right, law.invention, MESH : Tissue Plasminogen Activator, MESH: Aged, 80 and over, Randomized controlled trial, MESH: Risk Factors, law, Risk Factors, MESH: Tissue Plasminogen Activator, MESH: Fibrinolytic Agents, MESH: Double-Blind Method, MESH : Female, Stroke, MESH: Ventricular Dysfunction, Right, MESH: Treatment Outcome, MESH: Aged, Aged, 80 and over, MESH: Middle Aged, Age Factors, General Medicine, Middle Aged, MESH : Risk Factors, Troponin, 3. Good health, Pulmonary embolism, Treatment Outcome, Anesthesia, Tissue Plasminogen Activator, MESH : Pulmonary Embolism, Drug Therapy, Combination, Female, MESH: Hemorrhage, medicine.drug, medicine.medical_specialty, Randomization, MESH : Male, Tenecteplase, 610 Medicine & health, Hemorrhage, MESH : Treatment Outcome, MESH : Hemorrhage, Placebo, MESH: Stroke, Double-Blind Method, Fibrinolytic Agents, Fibrinolysis, medicine, Fibrinolysi, MESH : Double-Blind Method, Humans, Decompensation, MESH : Middle Aged, MESH : Aged, 80 and over, Aged, MESH: Age Factors, MESH: Humans, [ SDV ] Life Sciences [q-bio], business.industry, Heparin, MESH : Drug Therapy, Combination, MESH : Humans, MESH : Fibrinolytic Agents, medicine.disease, MESH: Male, Surgery, MESH: Drug Therapy, Combination, MESH : Troponin, MESH : Heparin, MESH: Troponin, MESH : Age Factors, business, Pulmonary Embolism, MESH: Female
Abstract: International audience; BACKGROUND: The role of fibrinolytic therapy in patients with intermediate-risk pulmonary embolism is controversial. METHODS: In a randomized, double-blind trial, we compared tenecteplase plus heparin with placebo plus heparin in normotensive patients with intermediate-risk pulmonary embolism. Eligible patients had right ventricular dysfunction on echocardiography or computed tomography, as well as myocardial injury as indicated by a positive test for cardiac troponin I or troponin T. The primary outcome was death or hemodynamic decompensation (or collapse) within 7 days after randomization. The main safety outcomes were major extracranial bleeding and ischemic or hemorrhagic stroke within 7 days after randomization. RESULTS: Of 1006 patients who underwent randomization, 1005 were included in the intention-to-treat analysis. Death or hemodynamic decompensation occurred in 13 of 506 patients (2.6%) in the tenecteplase group as compared with 28 of 499 (5.6%) in the placebo group (odds ratio, 0.44; 95% confidence interval, 0.23 to 0.87; P=0.02). Between randomization and day 7, a total of 6 patients (1.2%) in the tenecteplase group and 9 (1.8%) in the placebo group died (P=0.42). Extracranial bleeding occurred in 32 patients (6.3%) in the tenecteplase group and 6 patients (1.2%) in the placebo group (P
Published: 2014
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19. <scp>d</scp>-Dimer and Duration of Anticoagulation

Author: Marie-Antoinette Sevestre, Gilles Pernod, José Labarère, Techniques pour l'Evaluation et la Modélisation des Actions de la Santé (TIMC-IMAG-ThEMAS), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), ThEMAS, VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, and Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-CHU Grenoble
Subjects: MESH: Age Factors, MESH: Aged, MESH: Pulmonary Embolism, MESH: Humans, business.industry, MEDLINE, General Medicine, MESH: Anticoagulants, 030204 cardiovascular system & hematology, MESH: Recurrence, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, MESH: Risk Factors, Duration (music), Anesthesia, MESH: Venous Thrombosis, D-dimer, MESH: Fibrin Fibrinogen Degradation Products, Medicine, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, 030212 general & internal medicine, business, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2007
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20. The prognostic value of pro-B-Type natriuretic peptide in acute pulmonary embolism

Author: Mathieu Bonnet, Marie-Odile Benoit, Franck Verschuren, Nicolas Meneveau, Guy Meyer, Damien Gruson, Marc Philip Righini, Olivier Sanchez, Francis Couturaud, Francis Zech, Pierre-Marie Roy, Emergency Department (FV - ED), Saint Luc University Hospital, Service de Biochimie (HEGP - Biochimie), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Département d'Endocrinologie et Nutrition (LOUVAIN - Endocrino), Université Catholique de Louvain = Catholic University of Louvain (UCL), Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), 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), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service des Urgences (PMR), CHRU - ANGERS, Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Emergency Department ( FV - ED ), Service de Biochimie ( HEGP - Biochimie ), Assistance publique - Hôpitaux de Paris (AP-HP), Département d'Endocrinologie et Nutrition ( LOUVAIN - Endocrino ), Université Catholique de Louvain ( UCL ), Département de Médecine Interne et Pneumologie [Brest] ( DMIP - Brest ), Centre Hospitalier Régional Universitaire de Brest ( CHRU Brest ), Groupe d'Etude de la Thrombose de Bretagne Occidentale ( GETBO ), Université de Brest ( UBO ), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( PCVP / CARDIO ), Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ) -Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Service des Urgences ( PMR ), Service d'angiologie et d'hémostase ( MR ), HEGP ( SPRM ), and Hôpital Européen Georges Pompidou [APHP] ( HEGP )
Subjects: Male, MESH: Pulmonary Embolism, [SDV]Life Sciences [q-bio], MESH : Aged, 030204 cardiovascular system & hematology, Cohort Studies, 0302 clinical medicine, Natriuretic Peptide, Brain, Natriuretic peptide, Medicine, MESH : Female, 030212 general & internal medicine, MESH: Natriuretic Peptide, Brain, MESH: Cohort Studies, ddc:616, MESH: Aged, MESH : Prognosis, MESH: Middle Aged, Cardiogenic shock, MESH : Acute Disease, Hematology, Middle Aged, Prognosis, 3. Good health, Pulmonary embolism, Acute Disease, MESH : Pulmonary Embolism, Cardiology, MESH: Acute Disease, Female, hormones, hormone substitutes, and hormone antagonists, Cohort study, MESH : Natriuretic Peptide, Brain, medicine.medical_specialty, medicine.drug_class, MESH : Male, MESH : Cohort Studies, MESH: Prognosis, 03 medical and health sciences, Internal medicine, Humans, In patient, Clinical significance, MESH : Middle Aged, cardiovascular diseases, Aged, MESH: Humans, Receiver operating characteristic, [ SDV ] Life Sciences [q-bio], business.industry, MESH : Humans, MESH: ROC Curve, medicine.disease, MESH: Male, Surgery, ROC Curve, Pulmonary Embolism, business, Venous thromboembolism, MESH: Female, MESH : ROC Curve
Abstract: International audience; AIMS: To assess the clinical performance of pro-B-type natriuretic peptide 1-108 (proBNP) for the prognosis of acute pulmonary embolism. METHODS: This study was ancillary to a recently published multicentre study including 570 patients with acute pulmonary embolism. ProBNP values were analysed using a new sandwich immunoassay proBNP1-108, Bioplex2200 (Bio-Rade Laboratories). Data was compared with BNP and N-terminal (NT) proBNP values. Adverse outcomes at 30 days were defined as death, secondary cardiogenic shock, or recurrent venous thromboembolism. RESULTS: ProBNP values were analysed in 549 patients, with 39 (7.1%) presenting adverse outcomes. All three natriuretic peptides were significantly elevated in these 39 patients compared with the group without adverse outcomes (BNP: p < 0.001; NT-proBNP: p < 0.001; proBNP: 0.044), with median proBNP values being 605 pg/ml (113-1437) and 109 pg/ml (30-444), respectively. Multivariate analyses revealed that proBNP significantly depended on patient age (p < 0.001) and renal failure (p=0.001), with proBNP values increasing with both factors. The areas under the receiver operating curve were 0.74 (95% CI 0.69-0.79) for BNP, 0.76 (95% CI 0.72-0.80) for NT-proBNP, and 0.70 (95% CI 0.65-0.75) for proBNP, meaning that the performance of proBNP was significantly lower than that of the two other peptides (p = 0.017). CONCLUSION: ProBNP, BNP, and NT-proBNP values were significantly increased in patients with adverse outcomes after acute pulmonary embolism. However, the prognostic performance of proBNP for predicting adverse versus favourable outcomes was lower than that of the other natriuretic peptides, thus limiting the clinical relevance of proBNP as a prognostic marker in pulmonary embolism.
Published: 2013
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21. V/Q SPECT interpretation for pulmonary embolism diagnosis: which criteria to use?

Author: Francis Couturaud, Ronan Abgral, Grégoire Le Gal, Philippe Robin, Pierre-Yves Le Roux, Pierre-Yves Salaun, Emmanuel Nowak, Alexandra Le Duc-Pennec, Aurélien Delluc, Department of Nuclear Medicine, Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Laboratoire Epigenetique et Cancer, Centre National de la Recherche Scientifique (CNRS), Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), 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), Centre d'Investigation Clinique (CIC - Brest), and Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: MESH: Pulmonary Embolism, Male, [SDV]Life Sciences [q-bio], MESH: Observer Variation, 030218 nuclear medicine & medical imaging, MESH: Aged, 80 and over, 0302 clinical medicine, Clinical history, Cutoff, MESH: Ventilation-Perfusion Ratio, MESH: Aged, High probability, Aged, 80 and over, Observer Variation, MESH: Middle Aged, Middle Aged, Diagnostic strategy, 3. Good health, Pulmonary embolism, MESH: Reproducibility of Results, MESH: Young Adult, 030220 oncology & carcinogenesis, Female, MESH: Image Enhancement, Algorithms, Adult, Adolescent, MESH: Algorithms, Sensitivity and Specificity, MESH: Tomography, Emission-Computed, Single-Photon, 03 medical and health sciences, Reference test, Young Adult, Image Interpretation, Computer-Assisted, medicine, Ventilation-Perfusion Ratio, Humans, Radiology, Nuclear Medicine and imaging, Aged, MESH: Adolescent, Tomography, Emission-Computed, Single-Photon, MESH: Humans, business.industry, Reproducibility of Results, MESH: Adult, medicine.disease, Image Enhancement, MESH: Sensitivity and Specificity, MESH: Male, Confidence interval, Nuclear medicine, business, Pulmonary Embolism, MESH: Female, MESH: Image Interpretation, Computer-Assisted
Abstract: International audience; UNLABELLED: Ventilation-perfusion (V/Q) SPECT has been reported to improve the diagnostic performance of V/Q imaging for the diagnosis of pulmonary embolism (PE). However, only sparse data based on an objective reference test are available, and the criteria used for interpretation have varied widely. Therefore, the aim of our study was to assess the performance of V/Q SPECT using various criteria for interpretation, in comparison with a validated independent diagnostic strategy. METHODS: The SPECT study included patients for whom V/Q SPECT data were compared with the results of an independent and validated diagnostic algorithm for PE. V/Q SPECT scans were performed after intravenous injection of (99m)Tc-macroaggregated albumin and simultaneous ventilation with (81m)Kr gas. Interpretation was performed independently by 2 nuclear medicine physicians who were not aware of the clinical history, diagnostic strategy conclusion, or patient's outcome. Sensitivity, specificity, and likelihood ratios were evaluated for various combinations of mismatched defect numbers and sizes (segmental or subsegmental). Generation of receiver-operating-characteristic curves was based on the number of mismatch defects and the number of subsegmental mismatch defects or equivalent. RESULTS: Of the 249 patients who were analyzed, the diagnosis of PE was confirmed in 49 and ruled out in 200 according to the previously validated independent strategy. Of all the tested criteria, the best performance was achieved using a diagnostic cutoff of at least 1 segmental or 2 subsegmental mismatches, with sensitivity and specificity of 0.92 (95% confidence interval, 0.84-1) and 0.91 (95% confidence interval, 0.87-0.95), respectively. With a negative V/Q SPECT result, the posttest probability of PE was 0.010, 0.037, and 0.119 for a low, intermediate, and high clinical probability. With a positive V/Q SPECT result, the posttest probability of PE was 0.531, 0.814, and 0.939 for a low, intermediate, and high probability. CONCLUSION: For V/Q SPECT interpretation, a diagnostic cutoff of 1 segmental or 2 subsegmental mismatches seems best for confirming or excluding acute PE.
Published: 2013
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22. Diuretics in normotensive patients with acute pulmonary embolism and right ventricular dilatation

Author: Pascal Lim, Pascal Gueret, Jean-Luc Dubois Randé, Armand Mekontso-Dessap, Romain Gallet, Guy Meyer, Bernard Maitre, Julien Ternacle, Priscille Jurzak, Alexandre Bensaid, INSERM U955, équipe 3, Service de cardiologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut Mondor de Recherche Biomédicale (IMRB), and Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)
Subjects: Male, MESH: Pulmonary Embolism, MESH: Dilatation, Pathologic, Ventricular Dysfunction, Right, medicine.medical_treatment, Fluid Expansion, Hemodynamics, Blood Pressure, 030204 cardiovascular system & hematology, chemistry.chemical_compound, MESH: Furosemide, 0302 clinical medicine, Bolus (medicine), MESH: Aged, 80 and over, Furosemide, 030212 general & internal medicine, Diuretics, MESH: Ventricular Dysfunction, Right, Aged, 80 and over, Right ventricular, MESH: Aged, MESH: Middle Aged, General Medicine, MESH: Blood Pressure, Middle Aged, 3. Good health, Pulmonary embolism, Acute Disease, Cardiology, MESH: Acute Disease, Female, Cardiology and Cardiovascular Medicine, Dilatation, Pathologic, medicine.drug, Adult, medicine.medical_specialty, 03 medical and health sciences, Internal medicine, medicine, Humans, Diuretic, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, MESH: Diuretics, Aged, Creatinine, MESH: Humans, business.industry, MESH: Adult, Oxygenation, medicine.disease, MESH: Male, Blood pressure, chemistry, business, MESH: Female
Abstract: International audience; BACKGROUND: The benefit of load expansion is controversial in acute pulmonary embolism (PE). The aim of this study was to evaluate the benefit of furosemide in cases of normotensive acute PE. METHODS AND RESULTS: We retrospectively included 70 consecutive normotensive patients (systolic blood pressure ≥ 90 mmHg) admitted for acute PE with right ventricular dilation. Overall, 40 patients were treated during the first 24h by repeated bolus of furosemide (78 ± 42 mg, range 40-160 mg) and 30 patients received isotonic saline solution (1.6 ± 0.9L). Severity of hemodynamic status was similar in both groups, but patients in the furosemide group were older and had a greater creatinine level. At 24h, only the furosemide group had a decreased shock index (0.82 ± 0.22 vs. 0.63 ± 0.16, P
Published: 2013

23. Diuretics in normotensive patients with acute pulmonary embolism and right ventricular dilatation

Author: Ternacle, Julien, Gallet, Romain, Mekontso-Dessap, Armand, Meyer, Guy, Maitre, Bernard, Bensaid, Alexandre, Jurzak, Priscille, Gueret, Pascal, Dubois Randé, Jean-Luc, Lim, Pascal, Guellaen, Georges, INSERM U955, équipe 3, Service de cardiologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut Mondor de Recherche Biomédicale (IMRB), and Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)
Subjects: Right ventricular, MESH: Pulmonary Embolism, MESH: Aged, MESH: Dilatation, Pathologic, MESH: Middle Aged, MESH: Humans, Pulmonary embolism, Fluid Expansion, MESH: Adult, MESH: Blood Pressure, MESH: Male, MESH: Furosemide, MESH: Aged, 80 and over, [SDV.BBM] Life Sciences [q-bio]/Biochemistry, Molecular Biology, Diuretic, MESH: Acute Disease, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, MESH: Diuretics, MESH: Female, MESH: Ventricular Dysfunction, Right
Abstract: International audience; BACKGROUND: The benefit of load expansion is controversial in acute pulmonary embolism (PE). The aim of this study was to evaluate the benefit of furosemide in cases of normotensive acute PE. METHODS AND RESULTS: We retrospectively included 70 consecutive normotensive patients (systolic blood pressure ≥ 90 mmHg) admitted for acute PE with right ventricular dilation. Overall, 40 patients were treated during the first 24h by repeated bolus of furosemide (78 ± 42 mg, range 40-160 mg) and 30 patients received isotonic saline solution (1.6 ± 0.9L). Severity of hemodynamic status was similar in both groups, but patients in the furosemide group were older and had a greater creatinine level. At 24h, only the furosemide group had a decreased shock index (0.82 ± 0.22 vs. 0.63 ± 0.16, P
Published: 2013

24. Effect of age on the assessment of clinical probability of pulmonary embolism by prediction rules

Author: G. Le Gal, Marc Philip Righini, Arnaud Perrier, Henri Bounameaux, Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, 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), Department of Internal Medicine (AP), and Geneva University Hospital (HUG)
Subjects: MESH: Pulmonary Embolism, medicine.medical_specialty, MESH: Probability, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Text mining, Predictive Value of Tests, Risk Factors, MESH: Risk Factors, Prevalence, medicine, Humans, 030212 general & internal medicine, Intensive care medicine, ComputingMilieux_MISCELLANEOUS, MESH: Prevalence, Aged, Probability, MESH: Age Factors, MESH: Aged, MESH: Humans, MESH: Middle Aged, business.industry, Age Factors, Hematology, Middle Aged, medicine.disease, MESH: Predictive Value of Tests, Pulmonary embolism, Databases as Topic, Radiology, Pulmonary Embolism, business, MESH: Databases as Topic, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience
Published: 2004
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25. [EGFR activating mutation in lung adenocarcinoma: risk factor of thromboembolic event?]

Author: Noël-Savina, Elise, Paleiron, Nicolas, Le Gal, Grégoire, Descourt, Renaud, Service d'Oncologie Thoracique (BREST - ICH), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Hôpital d'Instruction des Armées Clermont Tonnerre, Service de Santé des Armées, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), and Université de Brest (UBO)-Université de Brest (UBO)
Subjects: Male, MESH: Pulmonary Embolism, MESH: Enzyme Activation, MESH: Smoking, Lung Neoplasms, [SDV]Life Sciences [q-bio], Mutation, Missense, MESH: Receptor, Epidermal Growth Factor, Adenocarcinoma, MESH: Genes, erbB-1, MESH: Occupational Exposure, MESH: Venous Thromboembolism, MESH: Polycyclic Hydrocarbons, Aromatic, Risk Factors, MESH: Risk Factors, Occupational Exposure, Humans, Point Mutation, Thrombophilia, cardiovascular diseases, Polycyclic Aromatic Hydrocarbons, Sequence Deletion, Ultrasonography, MESH: Point Mutation, Venous Thrombosis, MESH: Mutation, Missense, MESH: Humans, MESH: Middle Aged, Smoking, MESH: Adenocarcinoma, MESH: Thrombophilia, Genes, erbB-1, Venous Thromboembolism, Middle Aged, MESH: Sequence Deletion, equipment and supplies, MESH: Male, MESH: Lung Neoplasms, Enzyme Activation, ErbB Receptors, Radiography, Mutagenesis, Insertional, von Willebrand Diseases, MESH: Mutagenesis, Insertional, MESH: Venous Thrombosis, Female, MESH: von Willebrand Diseases, Pulmonary Embolism, MESH: Female
Abstract: International audience; Cancer is a known risk factor for the development of venous thromboembolism (VTE) and in particular, adenocarcinoma of the lung is known to be associated with a higher risk of thromboembolic event. EGFR activating mutations are more frequently found in this histological subtype than in other lung cancers. We report three cases of VTE in patients with adenocarcinoma of the lung and EGFR activating mutation. Our reported case series is atypical because the VTE event occurred early in the adenocarcinoma history: either leading to the diagnosis of cancer, or appearing very early in the management of the neoplasm.
Published: 2012
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26. Diagnostic accuracy of single-photon emission tomography ventilation/perfusion lung scan in the diagnosis of pulmonary embolism

Author: Pierre-Yves Le Roux, J.-C. Cornily, Morgan Jaffrelot, Luc de Saint-Martin, Philippe Guillo, Christophe Leroyer, Pierre-Yves Salaun, Alexandra Le Duc-Pennec, Grégoire Le Gal, Aurélien Delluc, Department of Nuclear Medicine, Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), 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), Département de Cardiologie (CHRU - Cardio), Service des Urgences (MG), Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre d'Investigation Clinique (CIC - Brest), and Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Male, MESH: Pulmonary Embolism, 030204 cardiovascular system & hematology, Single-photon emission computed tomography, Critical Care and Intensive Care Medicine, Scintigraphy, 030218 nuclear medicine & medical imaging, 0302 clinical medicine, MESH: Aged, 80 and over, Prevalence, Prospective Studies, Prospective cohort study, Aged, 80 and over, MESH: Aged, MESH: Middle Aged, medicine.diagnostic_test, Respiratory disease, Middle Aged, 3. Good health, Pulmonary embolism, medicine.anatomical_structure, Female, Radiology, Cardiology and Cardiovascular Medicine, Perfusion, Pulmonary and Respiratory Medicine, Adult, medicine.medical_specialty, Adolescent, Ventilation/perfusion ratio, MESH: Tomography, Emission-Computed, Single-Photon, 03 medical and health sciences, medicine, Humans, MESH: Prevalence, Aged, Tomography, Emission-Computed, Single-Photon, MESH: Adolescent, Lung, MESH: Humans, business.industry, MESH: Adult, medicine.disease, MESH: Male, MESH: Prospective Studies, business, Nuclear medicine, Pulmonary Embolism, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; BACKGROUND: Planar ventilation/perfusion (V/Q) lung scintigraphy is a validated tool for the diagnosis of pulmonary embolism (PE). Nevertheless, given the high rate of nonconclusive V/Q, further investigation is often necessary. V/Q single-photon emission CT (SPECT) scan could improve V/Q performance, but sparse data are available on its accuracy. This study assessed the diagnostic performance of V/Q SPECT scan in a cohort of consecutive patients with suspected PE. METHODS: Three hundred twenty-one consecutive patients with a clinical suspicion of PE were prospectively included. Patients suspected of having PE were managed according to a reference diagnostic strategy validated by a 3-month follow-up. In addition to the reference strategy, patients had a V/Q SPECT scan, the results of which were compared with the initial work-up results. RESULTS: Prevalence of PE was 0 of 41 (0%; 95% CI, 0%-9%), six of 134 (4%; 95% CI, 2%-9%),15 of 36 (42%; 95% CI, 27%-58%), and 28 of 32 (88%; 95% CI, 72%-95%) in the normal, low,intermediate, and high V/Q SPECT scan probability groups, respectively. The combination of V/Q SPECT scan with clinical probability was diagnostic in 88% of patients. CONCLUSIONS: V/Q SPECT scan results show satisfactory accuracy for PE diagnosis. Validation of dedicated interpretation criteria is required, followed by outcome studies that use V/Q SPECT scan as part of a diagnostic strategy to rule out PE. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01183026; URL: www.clinicaltrials.gov
Published: 2012
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27. Enoxaparin followed by once-weekly idrabiotaparinux versus enoxaparin plus warfarin for patients with acute symptomatic pulmonary embolism: a randomised, double-blind, double-dummy, non-inferiority trial

Author: Büller, Hr, Gallus, As, Prins, Mh, Raskob, G, Decousus, H, Charbonnier, B, Leizorovicz, A, Laporte, S, Quenet, S, Brandjes, Dp, Middeldorp, S, Blüguermann, J, Amuchastegui, L, Ahuad Guerrero, R, Oberti, P, Alvarez, C, Cassettari, A, Santos, D, Macin, S, Santini, F, Ward, C, Coughlin, P, Salem, H, Gan, E, Leyden, M, Prosser, I, Crispin, P, Carroll, P, Gallus, A, Mcrae, S, Waites, J, Pilger, E, Koppensteiner, R, Kyrle, P, Schinko, H, Mrochek, A, Mitkovskaya, N, Prystrom, A, Motte, S, Ninane, V, Delcroix, M, Hainaut, P, Schneider, E, Saraiva, J, Maia, L, Barreto, S, Fernandes Manenti, E, Araujo, G, Dutra, O, Fiss, E, Moreira, R, Yankov, K, Nenkova, S, Ivanov, Y, Kostov, V, Bhargava, R, Chan, Y, Miron, Mj, Cusson, J, Ugarte, S, Morales, A, Andresen, M, Lanas, F, Arriagada, G, Mendoza, Jj, Zuñiga, C, Sepulveda, P, Wang, C, Liu, Z, Yuan, Y, Ma, Z, Fang, B, Liu, J, Bai, C, Wu, H, Yang, L, Ying, K, Kang, J, Li, Q, Cheng, Z, Zhang, J, Wang, H, Xie, C, Xia, G, Du, Y, Wu, Q, Zhou, X, Chen, L, Yi, Q, Wu, C, Hao, Q, Liu, S, Xiong, S, Jiang, S, Zhao, L, Xiao, Q, Qin, Z, Zhou, J, Dennis, R, Miserque, N, Igueredo, M, Londoño, D, Hildebrando, J, Granados, M, Buitrago, R, Solano, Mh, Pacheco Alvis PM, Botero, R, Saenz, O, Bergovec, M, Padovan, M, Vucic, N, Samarzija, M, Chlumsky, J, Spacek, R, Klimsa, Z, Gregor, P, Povolny, J, Podpera, I, Holm, F, Lang, P, Matoska, P, Sabl, P, Spinar, J, Spac, J, Husted, S, Avnstrom, S, Rasmussen, S, Christensen, A, Guindy, R, Hassanein, M, Paumets, M, Meriste, S, Ferrari, E, Achkar, A, Azarian, R, Meneveau, N, Lorut, C, Mouallem, J, Crestani, B, Proton, A, Salmeron, S, Lerousseau, L, Mottier, D, Wahl, D, Siafakas, N, Papadimitriou, D, Katis, K, Katsaris, G, Gaga, A, Damianos, A, Tipparaju, S, Kalkunte, S, Vidhut, J, Kalashetti, S, Mehta, P, Talwar, D, Ramanathan, R, Mishra, R, Zeltzer, D, Lahav, M, Brenner, B, Caraco, Y, Elias, M, Piovella, F, Barone, M, Poggio, R, Palla, A, Ghirarduzzi, A, Pini, M, Lodigiani, C, Prandoni, Paolo, Agnelli, G, Imberti, D, Scannapieco, G, Salvi, A, Bautista, E, Diaz, J, Mercado, R, Ranero, A, Rodriguez, D, Jerjes, C, Villeda Espinoza, E, Van Der Meer, J, Ijfering, W, Van Marwijk Kooy, M, Boersma, W, Van Leendert, R, Kroon, C, Dullemond Westland, A, Viergever, P, Kuipers, A, Grootenboers, M, Creemers, J, Pieters, W, De Munck, D, Timmer, H, Jackson, S, Sandset, P, Meyer, P, Kristiansen, T, Portugal, J, Paz, E, Salazar, D, Chavez, W, Castillo, L, De Guia, T, Lenora, F, Tomkowski, W, Kloczko, J, Rybak, Z, Gaciong, Z, Sobkowicz, B, Pruszczyk, P, Nizankowski, R, Mirek Bryniarska, E, Kukla, P, Reis, A, França, A, Cortez, M, Sa, J, Santos, F, Marques, Ma, Gordeev, I, Gendlin, G, Yablonsky, P, Sokurenko, G, Soroka, V, Lusov, V, Markov, V, Shvats, Y, Katerlnitskiy, I, Lapin, O, Lyamina, N, Subbotin, Y, Kim, I, Zilber, E, Kchaisheva, L, Poliacik, P, Macek, V, Pretorius, Jp, Abdullah, I, Basson, M, Bollinger, C, Breedt, J, Gani, M, Jansen, J, Le Roux, G, Nortje, H, Van Der Linder, M, Van Zyl, L, Viljoen, J, Bruning, A, Pujol Farriols, R, Raguer, E, Nuffal, D, Sanchez Rodriguez, A, Eriksson, H, Almgren, T, Carlsson, A, Elf, J, Olsson, Cg, Aagesen, J, Savas, I, Sahin, A, Erdogan, Y, Ozhan, M, Ongen, G, Celikel, T, Turker, H, Arseven, O, Tuncay, E, Ozacar, R, Gudz, I, Nykonenko, O, Skupyy, O, Kovalskyy, I, Prasol, V, Cohen, A, Rodriguez Cintron, W, Gurka, D, Bradley, J, Oliver, G, Spyropoulos, A, Lerner, R, Fulmer, J, Lu, Np, Wright, P, Han, D, Servi, R, Nadar, V, Quaranta, A, Gehring, J, Ginsberg, R, Jacobson, A, Colan, D, Vanway, C, Gurza, E, Braslow, B, Shorr, A, Rehm, J, Martin, J, Sellers, M, Concha, M, Gordon, I, Pullman, J, Moran, J, Welker, J, Panzarella, P, Mullins, M, Willms, D, Mcgrew, F, Turki, M, Menajovsky, L., Epidemiologie, MUMC+: KIO Kemta (9), RS: CAPHRI School for Public Health and Primary Care, Amsterdam Cardiovascular Sciences, Vascular Medicine, Department of Vascular Medicine (DVM - AMC), Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), University of Amsterdam [Amsterdam] (UvA)-University of Amsterdam [Amsterdam] (UvA), SA Pathology at Flinders Medical Center (ASG), Flinders University, Department of Epidemiology (MHP), Maastricht University [Maastricht], College of Public Health (CPH), University of Oklahoma (OU), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), and Université de Brest (UBO)-Université de Brest (UBO)
Subjects: Male, MESH: Pulmonary Embolism, Oligosaccharides, MESH: Factor X, 030204 cardiovascular system & hematology, MESH: Intention to Treat Analysis, MESH: Aged, 80 and over, 0302 clinical medicine, MESH: Double-Blind Method, 030212 general & internal medicine, MESH: Warfarin, Aged, 80 and over, MESH: Aged, education.field_of_study, Idrabiotaparinux, MESH: Middle Aged, General Medicine, Heparin, Middle Aged, Intention to Treat Analysis, 3. Good health, Pulmonary embolism, Acute Disease, MESH: Acute Disease, Drug Therapy, Combination, Female, medicine.drug, Adult, medicine.medical_specialty, MESH: Enoxaparin, Adolescent, Population, Biotin, MESH: Anticoagulants, Double blind, 03 medical and health sciences, Double-Blind Method, Internal medicine, MESH: Biotin, medicine, Humans, Enoxaparin, education, Aged, MESH: Adolescent, MESH: Humans, Intention-to-treat analysis, business.industry, Warfarin, Anticoagulants, MESH: Adult, Odds ratio, medicine.disease, MESH: Male, Surgery, MESH: Drug Therapy, Combination, Factor X, Pulmonary Embolism, business, MESH: Female, MESH: Oligosaccharides, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; BACKGROUND: Treatment of pulmonary embolism with low-molecular-weight heparin and vitamin K antagonists, such as warfarin, is not ideal. We aimed to assess non-inferiority of idrabiotaparinux, a reversible longlasting indirect inhibitor of activated factor X, to warfarin in patients with acute symptomatic pulmonary embolism. METHODS: In our randomised, double-blind, double-dummy, non-inferiority trial, we enrolled adults with objectively documented acute symptomatic pulmonary embolism attending 291 centres in 37 countries. We excluded patients who were pregnant, had active bleeding, kidney failure, or malignant hypertension, or were at high risk of death, bleeding, or adverse reactions to study drugs. We randomly allocated patients to receive 5-10 days' enoxaparin 1*0 mg/kg twice daily followed by subcutaneous idrabiotaparinux (starting dose 3*0 mg) or adjusted-dose warfarin (target international normalised ratio 2*0-3*0); regimens lasted 3 months or 6 months dependent on clinical presentation. Block randomisation was done with a central interactive computerised system, stratified by study centre and intended treatment duration. The primary efficacy outcome was recurrent venous thromboembolism at 99 days after randomisation. We estimated the odds ratio and 95% CI with a Mantel-Haenzsel χ(2) analysis (non-inferiority margin 2*0) in the intention-to-treat population. The main safety outcome was clinically relevant bleeding (major or non-major) in all patients at day 99. This study is registered with ClinicalTrials.gov, number NCT00345618. FINDINGS: Between Aug 1, 2006, and Jan 31, 2010, we enrolled 3202 patients aged 18-96 years. 34 (2%) of 1599 patients randomly allocated to receive enoxaparin-idrabiotaparinux and 43 (3%) of 1603 patients randomly allocated to receive enoxaparin-warfarin had recurrent venous thromboembolism (odds ratio 0*79, 95% CI 0*50-1*25; p(non-inferiority)=0*0001). 72 (5%) of 1599 patients in the enoxaparin-idrabiotaparinux group and 106 (7%) of 1603 patients in the enoxaparin-warfarin group had clinically relevant bleeding (0*67, 0*49-0*91; p(superiority)=0*0098). We noted similar differences in outcomes in those patients treated to 6 months. INTERPRETATION: Idrabiotaparinux could provide an attractive alternative to warfarin for the long-term treatment of pulmonary embolism, and seems to be associated with reduced bleeding. FUNDING: Sanofi-Aventis (Paris, France).
Published: 2012
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28. Dental Abnormalities in Schimke Immuno-osseous Dysplasia

Author: Kristi Dehaai, Joel Charrow, Alireza Baradaran-Heravi, Dominique Bonneau, Helen Fryssira, Radovan Bogdanovic, C. N. Semerci, Thomas Lücke, M. S. Fenkçi, Kory Keller, Pierre Frange, D. R. Mcleod, M. Gendronneau, Salman Kirmani, David B. Lewis, Laura Massella, François Nobili, Olivia Kérourédan, Sophie Taque, Cornelius F. Boerkoel, K. Kohler, Stefan Fründ, Christine Kobelka, Martine Bonnaure-Mallet, Pierre Cochat, Jonathan Zonana, Ann Haskins Olney, Marie Morimoto, Anja Stein, Glenda Hendson, C. Shuen, David V. Milford, Natasa Stajic, Yumi Asakura, Mitra Basiratnia, Anna Buck, Laboratoire Hippolyte Fizeau (FIZEAU), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut national des sciences de l'Univers (INSU - CNRS)-Observatoire de la Côte d'Azur, COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA)-Université Côte d'Azur (UCA)-Centre National de la Recherche Scientifique (CNRS), Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL), College of Pharmacy, Microbiologie : Risques Infectieux, Université de Rennes (UR)-CHU Pontchaillou [Rennes]-Faculté de Chirurgie Dentaire de Rennes-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Brébion, Alice, Université Nice Sophia Antipolis (... - 2019) (UNS), Université Côte d'Azur (UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes]-Faculté de Chirurgie Dentaire de Rennes-Faculté d'Odontologie-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Rennes (UR)-CHU Pontchaillou [Rennes]-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Université de Rennes - UFR d'Odontologie (UR Odontologie), and Université de Rennes (UR)-Université de Rennes (UR)
Subjects: Pathology, Nephrotic Syndrome, Transcription, Genetic, tooth morphogenesis, SMARCAL1 protein, human, Arteriosclerosis, MESH: Bone Morphogenetic Protein 4, transforming growth factor beta1, Bone Morphogenetic Protein 4, fibroblast, Anodontia, 0302 clinical medicine, chondrodysplasia, tooth root, genetics, deciduous tooth, Cells, Cultured, 0303 health sciences, allele, 3. Good health, Clinical Trials and Human Investigations, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, MESH: Cell Survival, Immunohistochemistry, MESH: Molar, MESH: Cells, Cultured, medicine.medical_specialty, MESH: Immunologic Deficiency Syndromes, congenital malformation, Osteochondrodysplasias, 03 medical and health sciences, MESH: Skin, Wnt3A Protein, Microdontia, Humans, cell signaling, human, Tooth, Deciduous, General Dentistry, [SDV.MP] Life Sciences [q-bio]/Microbiology and Parasitology, Alleles, MESH: Cell Culture Techniques, MESH: Humans, Tooth Abnormalities, Schimke immuno-osseous dysplasia, genetic transcription, DNA Helicases, Immunologic Deficiency Syndromes, tooth development, Tooth Germ, 030206 dentistry, MESH: Bicuspid, Fibroblasts, medicine.disease, MESH: Tooth, Deciduous, molar tooth, Molar, culture technique, MESH: Arteriosclerosis, Mutation, BMP4 protein, human, Dental malformations, Pulmonary Embolism, Nephrotic syndrome, microdontia, tooth flora, MESH: Pulmonary Embolism, molar root hypoplasia, Cell Culture Techniques, Medizin, MESH: DNA Helicases, MESH: Transforming Growth Factor beta1, SMARCAL1, MESH: Tooth Root, Tooth Root, Skin, MESH: Tooth Abnormalities, hypoplasia, article, helicase, Odontogenesis, lung embolism, MESH: Odontogenesis, MESH: Mutation, premolar tooth, Cell Survival, Primary Immunodeficiency Diseases, MESH: Tooth Germ, Biology, Transforming Growth Factor beta1, stomatognathic system, MESH: Cell Proliferation, medicine, Bicuspid, MESH: Wnt3A Protein, tooth malformation, 030304 developmental biology, Cell Proliferation, MESH: Anodontia, cell culture, MESH: Alleles, MESH: Transcription, Genetic, immune deficiency, MESH: Osteochondrodysplasias, WNT3A protein, human, Hypodontia, stomatognathic diseases, Dysplasia, MESH: Fibroblasts, hypodontia, molar root, cytology, pathology, MESH: Nephrotic Syndrome
Abstract: Described for the first time in 1971, Schimke immuno-osseous dysplasia (SIOD) is an autosomal-recessive multisystem disorder that is caused by bi-allelic mutations of SMARCAL1, which encodes a DNA annealing helicase. To define better the dental anomalies of SIOD, we reviewed the records from SIOD patients with identified bi-allelic SMARCAL1 mutations, and we found that 66.0% had microdontia, hypodontia, or malformed deciduous and permanent molars. Immunohistochemical analyses showed expression of SMARCAL1 in all developing teeth, raising the possibility that the malformations are cell-autonomous consequences of SMARCAL1 deficiency. We also found that stimulation of cultured skin fibroblasts from SIOD patients with the tooth morphogens WNT3A, BMP4, and TGFÃŽÂ²1 identified altered transcriptional responses, raising the hypothesis that the dental malformations arise in part from altered responses to developmental morphogens. To the best of our knowledge, this is the first systematic study of the dental anomalies associated with SIOD. © 2012, International & American Associations for Dental Research. All rights reserved.
Published: 2012
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29. Oral Rivaroxaban for the Treatment of Symptomatic Pulmonary Embolism

Author: Agnelli, G, Berkowitz, S, Bounameaux, H, Büller, Hr, Cohen, A, Gallus, A, Lensing, Aw, Misselwitz, F, Haskell, L, Prins, Mh, Raskob, G, Schellong, S, Bauersachs, R, van Bellen, B, Boda, Z, Borris, L, Brenner, B, Brighton, T, Chlumsky, J, Davidson, B, Decousus, H, Eriksson, H, Jacobson, B, Kakkar, A, Kwong, Yl, Lee, Lh, Meijer, K, van der Meer, J, Minar, E, Monreal, M, Piovella, F, Sandset, Pm, Smith, M, Tomkowski, W, Verhamme, P, Wang, Y, Wells, P, Brandjes, D, Mac Gillavry, M, Otten, Hm, Carlsson, A, Laporte, S, Schulman, S, Gent, M, Turpie, A, Martinelli, I, Segers, A, Muhlhofer, E, Tewes, M, Trajanovic, M, Muller, K, Kim, C, Gebel, M, Benson, A, Pap, Af, Godrie, J, Horvat Broecker, A, Spadari, G, Peters Wulf, C, Roig, J, Baker, R, Bianchi, A, Blombery, P, Campbell, P, Carroll, P, Geraghty, R, Chong, B, Ramanathan, S, Archis, C, Coughlin, P, Salem, H, Crispin, P, Dean, M, Soni, R, Denaro, C, Kubler, P, Coghlan, D, Gan, Te, Tran, H, Coleman, C, Jackson, D, Khalafallah, A, Leahy, M, Leyden, M, Leyden, D, Sturtz, C, Mccann, A, Gibbs, H, Mcrae, S, Richards, B, Ward, C, Curnow, J, Baghestanian, M, Erdogmus, B, Samaha, E, Nikoupayan Mofrad, M, Hirschl, M, Sturm, W, Kirchmair, R, Marschang, P, Drexel, H, Mathies, R, Pilger, E, Brodmann, M, Weltermann, A, Buche, M, Demelenne, J, Gustin, M, Hainaut, P, Pothen, L, de Leersnyder, J, Motte, S, Schroë, H, Sprynger, M, Peerlinck, K, Delcroix, M, Vermassen, F, Verstraeten, P, Smet, V, Vossaert, R, Panico, M, Costa, C, Blondal, J, Kovacs, M, Rodger, M, Carrier, M, Wong, T, Bi, J, Chen, Z, Chen, R, Jing, Zc, He, J, Liu, C, Liu, S, Long, S, Ma, Y, Shao, Y, Wang, C, Yang, Yh, Xie, C, Xu, J, Ying, K, Zhihong, L, Hola, D, Jirat, S, Vitovec, M, Kovářová, K, Gilík, J, Dosál, J, Mandakova, E, Matoška, P, Podpera, I, Podperova, M, Spacek, R, Urbanova, R, Tuxen, C, Sukles, K, Pietila, K, Vesanen, M, Achkar, A, Agraou, B, Aquilanti, S, Rifaï, A, Berremili, T, Brisot, D, Brousse, C, Tarodo, P, Bura, A, Amid Lacombe, C, Malloizel, J, Boulon, C, Alavoine, L, Crestani, B, Mismetti, P, Buchmuller, A, Accassat, S, Elias, A, Elias, M, Emmerich, J, Ferrari, E, Guérin, T, Beaka, P, Lacroix, P, Szwebel, Ta, Benhamou, Y, de Maistre, E, Falvo, N, Mahe, I, Meneveau, N, Schiele, F, Meyer, G, Sanchez, O, Planquette, B, Mottier, D, Le Moigne, E, Couturaud, F, Parent, F, Pernod, G, Imbert, B, Elkouri, D, Dary, M, Queguiner, A, Quere, I, Galanaud, Jp, Roy, Pm, de Boisjolly Bonnefoi JM, Schmidt, J, Breuil, N, Heuser, S, Sevestre, Ma, Simoneau, G, Bergmann, Jf, Stephan, D, Trinh Duc, A, Gaillardou, A, Grange, C, Fassier, T, Wahl, D, Baron Von Bilderling, P, Kuhlencordt, P, Beyer Westendorf, J, Halbritter, K, Werth, S, Diehm, C, Lawall, H, Eifrig, B, Espinola Klein, C, Weisser, G, Giannitsis, E, Haering, Hu, Hasslacher, C, Herrmann, T, Hoffmann, U, Czihal, M, Horacek, T, Ibe, M, Bauer, A, Kieback, A, Landgraf, H, Lindhoff Last, E, Malyar, N, Petermann, W, Potratz, J, Ranft, J, Röcken, M, Pomper, L, Frommhold, R, Schwaiblmair, M, Berghaus, T, Taute, B, Lau, Yk, Tse, E, Olah, Z, Farkas, K, Kolossváry, E, Gurzó, M, Kis, E, Kovács, A, Landi, A, Lupkovics, G, Pecsvarady, Z, Riba, M, Sipos, G, Parakh, R, Sembiring, R, Barton, J, Goldstein, L, Gavish, D, Hoffman, R, Hussein, O, Inbal, A, Lishner, M, Elis, A, Lugassy, G, Varon, D, Zeltser, D, Rogowski, O, Steinvil, A, Zisman, D, Ageno, W, Ambrosio, G, Cattaneo, M, D'Angelo, A, Ghirarduzzi, A, Lotti, M, Pierfranceschi, Mg, Lodigiani, C, Palareti, G, Barone, M, Beltrametti, C, Porreca, E, Prandoni, Paolo, Spiezia, L, Quintavalla, R, Cho, Wh, Ha, Jw, Kim, Hs, Park, K, Sime, I, Miliauskas, S, Petrauskiene, R, Sathar, J, Beeker, A, Ten Cate, H, De Groot, M, Kamphuisen, P, Douma, R, Kooy, Mv, Coenen, J, Mäkelburg, A, Knol, M, Tichelaar, V, Harper, P, Knottenbelt, E, Ockelford, P, Young, L, Royle, G, Simpson, D, Chunilal, S, Ghanima, W, Foyn, S, Tveit, A, Abola, Mt, Adamiec, R, Gorski, P, Kloczko, J, Lewczuk, J, Nowak, M, Musial, J, Wronski, J, Ng, Hj, Adler, D, Becker, Jh, Ellis, G, Isaacs, R, Bloy, B, Allie, R, Eckstein, F, van Rensburg JH, Schmidt, S, Siebert, H, Zyl, L, Carrera, M, Del Campo, F, Diego, I, Garcia Bragado, F, Jiménez, D, Sánchez Álvarez, J, Redondo, M, Roman Sanchez, P, Villalta, J, Villegas Scivetti, M, Jonson, T, Tygesen, H, Lapidus, L, Ottosson, E, Själander, A, Asmis, L, Banyai, M, Heidemann, M, Baumgartner, I, Righini, M, Frank, U, Hayoz, D, Periard, D, Chang, Wt, Chiu, K, Wang, Ky, Weng, Zc, Angchaisuksiri, P, Pothirat, C, Rojnuckarin, P, Solis, J, Hunt, B, Luckit, J, Albrecht, C, Banish, D, Feinbloom, D, Botnick, W, Chen, D, Dexter, J, Ettinger, N, Gleeson, J, Jaffer, A, Joseph, S, Kennedy, M, Krell, K, Lavender, R, Lyons, R, Moll, S, Nadar, V, Darrow, K, Hardman, V, Rathbun, S, Rehm, J, Rodriguez Cintron, W, Stevens, K, Wright, P, Ramaswamy, M., ACS - Amsterdam Cardiovascular Sciences, Vascular Medicine, Other departments, Epidemiologie, MUMC+: KIO Kemta (9), RS: CAPHRI School for Public Health and Primary Care, Department of Vascular Medicine (DVM - AMC), Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), University of Amsterdam [Amsterdam] (UvA)-University of Amsterdam [Amsterdam] (UvA), Department of Epidemiology (MHP), Maastricht University [Maastricht], Groupe de recherche sur la thrombose (GRT (EA 3065)), Université Jean Monnet [Saint-Étienne] (UJM), Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, 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), Centre d'Investigation Clinique (CIC - Brest), and Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: MESH: Pulmonary Embolism, Male, Vitamin K, Administration, Oral, Pulmonary Embolism/drug therapy/mortality, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, chemistry.chemical_compound, 0302 clinical medicine, Rivaroxaban, Edoxaban, Recurrence, Hemorrhage/chemically induced, 030212 general & internal medicine, Vitamin K/antagonists & inhibitors, Enoxaparin/adverse effects/therapeutic use, MESH: Treatment Outcome, MESH: Aged, ddc:616, MESH: Middle Aged, Hazard ratio, General Medicine, MESH: Follow-Up Studies, Vitamin K antagonist, MESH: Thiophenes, Middle Aged, Thrombosis, Morpholines/adverse effects/therapeutic use, 3. Good health, Pulmonary embolism, MESH: International Normalized Ratio, Treatment Outcome, Anesthesia, MESH: Administration, Oral, Administration, Combination, Apixaban, Drug Therapy, Combination, Female, MESH: Hemorrhage, medicine.drug, Oral, MESH: Enoxaparin, medicine.drug_class, Morpholines, Anticoagulants/adverse effects/therapeutic use, MESH: Morpholines, Hemorrhage, Thiophenes, MESH: Anticoagulants, 03 medical and health sciences, Drug Therapy, medicine, Humans, International Normalized Ratio, Enoxaparin, MESH: Kaplan-Meier Estimate, Aged, MESH: Humans, business.industry, MESH: Vitamin K, Anticoagulants, medicine.disease, MESH: Male, MESH: Recurrence, Regimen, MESH: Drug Therapy, Combination, chemistry, Thiophenes/adverse effects/therapeutic use, business, Pulmonary Embolism, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Follow-Up Studies
Abstract: International audience; BACKGROUND: A fixed-dose regimen of rivaroxaban, an oral factor Xa inhibitor, has been shown to be as effective as standard anticoagulant therapy for the treatment of deep-vein thrombosis, without the need for laboratory monitoring. This approach may also simplify the treatment of pulmonary embolism. METHODS: In a randomized, open-label, event-driven, noninferiority trial involving 4832 patients who had acute symptomatic pulmonary embolism with or without deep-vein thrombosis, we compared rivaroxaban (15 mg twice daily for 3 weeks, followed by 20 mg once daily) with standard therapy with enoxaparin followed by an adjusted-dose vitamin K antagonist for 3, 6, or 12 months. The primary efficacy outcome was symptomatic recurrent venous thromboembolism. The principal safety outcome was major or clinically relevant nonmajor bleeding. RESULTS: Rivaroxaban was noninferior to standard therapy (noninferiority margin, 2.0; P=0.003) for the primary efficacy outcome, with 50 events in the rivaroxaban group (2.1%) versus 44 events in the standard-therapy group (1.8%) (hazard ratio, 1.12; 95% confidence interval [CI], 0.75 to 1.68). The principal safety outcome occurred in 10.3% of patients in the rivaroxaban group and 11.4% of those in the standard-therapy group (hazard ratio, 0.90; 95% CI, 0.76 to 1.07; P=0.23). Major bleeding was observed in 26 patients (1.1%) in the rivaroxaban group and 52 patients (2.2%) in the standard-therapy group (hazard ratio, 0.49; 95% CI, 0.31 to 0.79; P=0.003). Rates of other adverse events were similar in the two groups. CONCLUSIONS: A fixed-dose regimen of rivaroxaban alone was noninferior to standard therapy for the initial and long-term treatment of pulmonary embolism and had a potentially improved benefit-risk profile. (Funded by Bayer HealthCare and Janssen Pharmaceuticals; EINSTEIN-PE ClinicalTrials.gov number, NCT00439777.).
Published: 2012
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30. Effects of age on the risk of dying from pulmonary embolism or bleeding during treatment of deep vein thrombosis

Author: Juan Francisco Sanchez Muñoz Torrero, Henri, Bounameaux, José María Pedrajas, Alicia, Lorenzo, Silvino, Rubio, Clive, Kearon, Luís, Hernández, Manuel, Monreal, Monreal, M, Decousus, H, Prandoni, Paolo, Brenner, B, Barba, R, Di Micco, P, Rivron Guillot, K, Arcelus, Ji, Blanco, A, Barrón, M, Casado, I, Casas, Jm, Cisneros, E, del Campo, R, del Toro, J, Durán, M, Falgá, C, Fernández Capitán, C, Gabriel, F, Gallego, P, García Bragado, F, Gómez Zorilla, S, Guijarro, R, Guil, M, Gutiérrez, J, Hernández, L, Hernández Huerta, D, Jiménez, D, Jiménez, M, Jordán, S, Lecumberri, R, Lobo, Jl, López, L, Lorenzo, A, Luque, Jm, Madridano, O, Maestre, A, Marchena, Pj, Martín Villasclaras JJ, Nauffal, Md, Nieto, Ja, Núñez, Mj, Oribe, M, Otero, R, Pedrajas, Jm, Rabuñal, R, Riera Mestre, A, Román, P, Rosa, V, Rubio, S, Ruíz, Fj, Ruíz Giménez, N, Sahuquillo, Jc, Samperiz, A, Sánchez Muñoz Torrero JF, Sánchez, R, Soler, S, Soler, C, Tiberio, G, Todolí, Ja, Tolosa, C, Trujillo, J, Uresandi, F, Valdés, V, Valle, R, Vela, J, Vidal, G, Villalta, J, Boccalon, H, Delluc, A, Farge Bancel, D, Mahe, I, Barillari, A, Barillari, G, Ciammaichella, M, Dalla Valle, F, Duce, R, Piovella, C, Poggio, R, Prandoni, P, Pasca, S, Quintavalla, R, Schenone, A, Tiraferri, E, Visonà, A, Bosevski, M, Bounameaux, H., Servicio de Medicina Interna (SMI - Cacerès), Hospital San Pedro de Alcantara, Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, Servicio de Medicina Interna (SMI - Madrid), Hospital Clínico San Carlos, Servicio de Medicina Interna (SMI - La Paz - Madrid), Hospital Universitario La Paz, Servicio de Medicina Interna (SMI - Gijon), Hospital de Cabueñes, Department of Medicine (DM - McMaster), McMaster University [Hamilton, Ontario], Servicio de Medicina Interna (SMI), Hopital Universitario Germans Trias i Pujol, Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), and Université de Brest (UBO)-Université de Brest (UBO)
Subjects: Male, MESH: Pulmonary Embolism, Deep vein, 030204 cardiovascular system & hematology, MESH: Risk Assessment, 0302 clinical medicine, MESH: Aged, 80 and over, Risk Factors, MESH: Risk Factors, 030212 general & internal medicine, 10. No inequality, Venous Thrombosis, ddc:616, Aged, 80 and over, MESH: Aged, MESH: Middle Aged, Middle Aged, Thrombosis, Hemorrhage/chemically induced/mortality, 3. Good health, Pulmonary embolism, medicine.anatomical_structure, Female, Risk assessment, Cardiology and Cardiovascular Medicine, MESH: Hemorrhage, Adult, medicine.medical_specialty, Anticoagulants/adverse effects/therapeutic use, Hemorrhage, MESH: Anticoagulants, Risk Assessment, 03 medical and health sciences, Patient age, medicine, Humans, In patient, cardiovascular diseases, Pulmonary Embolism/mortality/prevention & control, Aged, MESH: Humans, business.industry, Anticoagulants, MESH: Adult, Odds ratio, medicine.disease, Confidence interval, MESH: Male, Surgery, MESH: Venous Thrombosis, Pulmonary Embolism, business, Venous Thrombosis/drug therapy, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; BACKGROUND: The risk of patients dying of pulmonary embolism (PE) or bleeding during the treatment of deep vein thrombosis (DVT), and whether these risks are influenced by patient age, has not been thoroughly studied. METHODS: We used data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) to assess the risk of fatal PE and fatal bleeding in 16,199 patients with lower limb DVT (without symptomatic PE at the time of inclusion) during the 3 months after diagnosis, with patients categorized according to age. RESULTS: During the 3 months of anticoagulant treatment, there were 31 fatal PEs (0.19%) and 83 fatal hemorrhages (0.51%). During the first 7 days of therapy, the frequency of fatal PEs was similar to that of fatal bleeding (12 vs 14 deaths, respectively; odds ratio [OR], 0.86; 95% confidence interval [CI], 0.39-1.87). However, from days 8 to 90, the frequency of fatal bleeding was greater than that of fatal PE (69 vs 19 deaths; OR, 3.64; 95% CI, 2.22-6.20). The higher frequency of fatal bleeding compared with fatal PE from days 8 to 90 appeared to be confined to patients who were aged ≥ 60 years. Multivariate analysis showed that patient age was independently associated with an increased risk of death from bleeding during the first 3 months: every 10 years the OR increased by 1.37 (95% CI, 1.12-1.67). CONCLUSIONS: During the first week of treatment, the risk of fatal bleeding and fatal PE were similar. Then, particularly in patients who were aged ≥ 60 years, the risk of dying from bleeding exceeded the risk of dying from PE.
Published: 2011
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31. Hospital discharge data can be used for monitoring procedures and intensive care related to severe maternal morbidity

Author: Marie-Hélène Bouvier-Colle, Catherine Quantin, Catherine Deneux-Tharaux, Anne A. Chantry, Anne Ego, Christine Cans, Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants (UMR_S 953), Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Techniques pour l'Evaluation et la Modélisation des Actions de Santé (ThEMAS), CHU Grenoble, Unité de Recherche Clinique, Hôpital Jeanne de Flandre [Lille]-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Lipides - Nutrition - Cancer (U866) (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA), Chantry was supported by a doctoral grant from the French Ministry of Research, GRACE study group: G. Bal, G. Beucher, MJ. D'alche Gautier, AS. Ducloy-Bouthors, N. Lamendour, I. Le Fur, V. Tessier, J. Zeitlin, Université Pierre et Marie Curie - Paris 6 (UPMC), GENOME, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Hôpital Jeanne de Flandre [Lille], Université de Bourgogne (UB), Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants ( UMR_S 953 ), Université Paris-Sud - Paris 11 ( UP11 ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Techniques pour l'Evaluation et la Modélisation des Actions de Santé ( ThEMAS ), Hôpital Jeanne de Flandre [Lille]-Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Lipides - Nutrition - Cancer (U866) ( LNC ), Université de Bourgogne ( UB ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon ( ENSBANA ), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Laboratoire d'Analyse et de Techniques Economiques (LATEC), Université de Bourgogne (UB)-Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Descartes - Paris 5 (UPD5)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris-Sud - Paris 11 (UP11), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), and EGO, Anne
Subjects: MESH: Pulmonary Embolism, Epidemiology, Severe maternal morbidity, 030204 cardiovascular system & hematology, MESH : Intensive Care, MESH: Hospital Information Systems, 0302 clinical medicine, Sensitivity, MESH: Pregnancy, Pregnancy, Medicine, MESH : Female, 030212 general & internal medicine, Medical diagnosis, Hospital discharge data, ComputingMilieux_MISCELLANEOUS, Medical records, MESH: Middle Aged, Medical record, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH : Adult, Middle Aged, Patient Discharge, MESH: Postpartum Hemorrhage, 3. Good health, Pulmonary embolism, MESH: International Classification of Diseases, MESH: Pregnancy Complications, MESH: Young Adult, MESH : Pulmonary Embolism, MESH : Hypertension, Pregnancy-Induced, Hospital Information Systems, Female, France, MESH : Patient Discharge, MESH : Hospital Information Systems, Adult, MESH: Medical Records, medicine.medical_specialty, Adolescent, Critical Care, MEDLINE, MESH : Young Adult, MESH : Hospitals, Teaching, MESH : Postpartum Hemorrhage, MESH : Pregnancy Complications, MESH : Morbidity, Validity, 03 medical and health sciences, Young Adult, International Classification of Diseases, Intensive care, MESH : Adolescent, MESH : International Classification of Diseases, MESH : Medical Records, Humans, MESH : Middle Aged, MESH: Intensive Care, MESH: Hypertension, Pregnancy-Induced, Intensive care medicine, MESH : France, Hospitals, Teaching, MESH: Adolescent, Eclampsia, MESH: Humans, business.industry, MESH: Patient Discharge, Gold standard, MESH : Humans, Postpartum Hemorrhage, MESH: Adult, Hypertension, Pregnancy-Induced, MESH: Hospitals, Teaching, medicine.disease, Pregnancy Complications, MESH: France, MESH : Pregnancy, MESH: Morbidity, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Emergency medicine, 26 Positive predictive value, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Morbidity, business, Pulmonary Embolism, MESH: Female
Abstract: International audience; OBJECTIVE: To estimate the accuracy and reliability of the reporting of diagnoses and procedures related to severe acute maternal morbidity in French hospital discharge data. STUDY DESIGN AND SETTING: The study, conducted in four French tertiary teaching hospitals, covered the years 2006 and 2007 and 30,607 deliveries. We identified severe maternal morbid events-eclampsia, pulmonary embolism, procedures related to postpartum hemorrhages, and intensive care-in administrative hospital discharge data and medical records and compared their recording. Information from medical records was the gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value of the hospital discharge data for these events were calculated. False positives and false negatives were examined to identify the reasons for misrecorded information. RESULTS: The PPV of the hospital discharge data was 20% for eclampsia. For procedures related to postpartum hemorrhages, the PPVs were high, but sensitivities were lower; however, 95% of recording errors could be corrected. All indicators for intensive care exceeded 98%. CONCLUSION: Intensive care and procedures seem reliably reported in the hospital administrative database, which, therefore, can be used to monitor them. Using these data for monitoring diagnoses will require a greater investment by clinicians in the accuracy of their reporting.
Published: 2011
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32. The management of a sub-segmental pulmonary embolism: a cross-sectional survey of Canadian thrombosis physicians

Author: Miriam Kimpton, P. S. Wells, Susan R. Kahn, Michael J. Kovacs, G. Le Gal, Marc Carrier, Marc A. Rodger, David Anderson, Thrombosis Program, University of Ottawa [Ottawa], Clinical Epidemiology Unit, Ottawa-The Ottawa Hospital, 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), Centre for Clinical Epidemiology and Community Studies (CCECS), Jewish General Hospital, Department of Medecine [Montréal], McGill University = Université McGill [Montréal, Canada], Division of Hematology (MJK), University of Western Ontario (UWO), Department of Medicine - Halifax (DRA), and Dalhousie University [Halifax]
Subjects: MESH: Pulmonary Embolism, medicine.medical_specialty, Cross-sectional study, MEDLINE, 030204 cardiovascular system & hematology, MESH: Anticoagulants, MESH: Disease Management, 03 medical and health sciences, 0302 clinical medicine, MESH: Cross-Sectional Studies, MESH: Canada, MESH: Diagnosis, Differential, Medicine, MESH: Physicians, 030212 general & internal medicine, Disease management (health), ComputingMilieux_MISCELLANEOUS, MESH: Humans, business.industry, Hematology, medicine.disease, Thrombosis, Pulmonary embolism, Emergency medicine, Medical emergency, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience
Published: 2011
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33. Controversies in diagnosis of pulmonary embolism

Author: Stein, P. D., Sostman, H. D., Dalen, J. E., Bailey, D. L., Bajc, M., Goldhaber, S. Z., Goodman, L. R., Gottschalk, A., Hull, R. D., Matta, F., Pistolesi, M., Tapson, V. F., Weg, J. G., Wells, P. S., Woodard, P. K., Bailey, Dl, Bajc, M, Coleman, Re, Freeman, Lm, Frey, Ka, Gottschalk, A, Goodman, Lr, Naidich, Dp, Sostman, Hd, Woodard, Pk, Dalen, Je, Douketis, Jd, Elliott, Cg, Geibel, A, Goldhaber, Sz, Le Gal, G, Hales, Ca, Harris, B, Huisman, Mv, Hull, Rd, Kearon, C, Kucher, N, Leeper, Kv, Matta, F, Miniati, M, Pistolesi, M, Prandoni, Paolo, Sasahara, Aa, Stein, Pd, Tapson, Vf, Weg, Jg, Wells, Ps, Wakefield, T., Department of Internal Medicine and Research and Advanced Studies Program (DIMRASP), Michigan State University [East Lansing], Michigan State University System-Michigan State University System, Cardiovascular Division (SZG), Brigham and Women's Hospital [Boston], Thrombosis Research Unit, University of Calgary, Clinical Epidemiology Unit, Ottawa Hospital, Thrombosis Program, University of Ottawa [Ottawa], Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), and Université de Brest (UBO)-Université de Brest (UBO)
Subjects: Male, MESH: Pulmonary Embolism, medicine.medical_specialty, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, Single-photon emission computed tomography, Scintigraphy, MESH: Tomography, Emission-Computed, Single-Photon, 030218 nuclear medicine & medical imaging, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, MESH: Diagnosis, Differential, medicine, Humans, MESH: Data Collection, MESH: Lung, Lung, Tomography, Emission-Computed, Single-Photon, MESH: Angiography, Ct pulmonary angiography, MESH: Humans, medicine.diagnostic_test, business.industry, Data Collection, Angiography, Hematology, General Medicine, Lung scan, medicine.disease, MESH: Male, 3. Good health, Pulmonary embolism, Acute Disease, MESH: Acute Disease, Female, Radiology, Chest radiograph, business, Nuclear medicine, Pulmonary Embolism, Tomography, X-Ray Computed, MESH: Tomography, X-Ray Computed, Lower limbs venous ultrasonography, Perfusion, MESH: Female
Abstract: International audience; The approach to the diagnosis of acute pulmonary embolism (PE) is under constant revision with advances in technology, noninvasive approaches, and increasing awareness of the risks of ionizing radiation. Optimal approaches in some categories of patients are controversial. Data are insufficient for evidence-based recommendations. Therefore, this survey of investigators in the field was undertaken. Even among experts there were marked differences of opinion regarding the approach to the diagnosis of acute PE. Although CT pulmonary angiography was usually the imaging test of choice, the respondents were keenly aware of the dangers of ionizing radiation. In view of advances in scintigraphic diagnosis since the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) trial, ventilation/perfusion (V/Q) lung scans or perfusion scans alone and single photon emission computed tomography (SPECT) V/Q lung scans are often recommended. The choice depends on the patient's age, gender, and complexity of the findings on the plain chest radiograph.
Published: 2011
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34. The pulmonary embolism rule-out criteria (PERC) rule does not safely exclude pulmonary embolism

Author: Oliver Lope Sanchez, P.-M. Roy, Henri Bounameaux, F. Verschuren, Marc Philip Righini, Drahomir Aujesky, Olivier Hugli, Guy Meyer, G. Le Gal, Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, 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), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Division of General Internal Medicine (DGIM), and Bern University Hospital
Subjects: Male, MESH: Pulmonary Embolism, medicine.medical_specialty, Probability assessment, Enzyme-Linked Immunosorbent Assay, 030204 cardiovascular system & hematology, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, MESH: Diagnosis, Differential, D-dimer, Humans, Medicine, Pulmonary Embolism/diagnosis, Geneva score, Intensive care medicine, Aged, ddc:616, MESH: Aged, MESH: Humans, MESH: Middle Aged, business.industry, MESH: Enzyme-Linked Immunosorbent Assay, 030208 emergency & critical care medicine, Hematology, Decision rule, Middle Aged, medicine.disease, MESH: Male, 3. Good health, Pulmonary embolism, Female, Radiology, Pulmonary Embolism, business, Venous thromboembolism, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; BACKGROUND: The Pulmonary Embolism Rule-out Criteria (PERC) rule is a clinical diagnostic rule designed to exclude pulmonary embolism (PE) without further testing. We sought to externally validate the diagnostic performance of the PERC rule alone and combined with clinical probability assessment based on the revised Geneva score. METHODS: The PERC rule was applied retrospectively to consecutive patients who presented with a clinical suspicion of PE to six emergency departments, and who were enrolled in a randomized trial of PE diagnosis. Patients who met all eight PERC criteria [PERC((-))] were considered to be at a very low risk for PE. We calculated the prevalence of PE among PERC((-)) patients according to their clinical pretest probability of PE. We estimated the negative likelihood ratio of the PERC rule to predict PE. RESULTS: Among 1675 patients, the prevalence of PE was 21.3%. Overall, 13.2% of patients were PERC((-)). The prevalence of PE was 5.4% [95% confidence interval (CI): 3.1-9.3%] among PERC((-)) patients overall and 6.4% (95% CI: 3.7-10.8%) among those PERC((-)) patients with a low clinical pretest probability of PE. The PERC rule had a negative likelihood ratio of 0.70 (95% CI: 0.67-0.73) for predicting PE overall, and 0.63 (95% CI: 0.38-1.06) in low-risk patients. CONCLUSIONS: Our results suggest that the PERC rule alone or even when combined with the revised Geneva score cannot safely identify very low risk patients in whom PE can be ruled out without additional testing, at least in populations with a relatively high prevalence of PE.
Published: 2011
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35. Prognostic value of the Geneva prediction rule in patients in whom pulmonary embolism is ruled out

Author: Bertoletti, L, Le Gal, G, Aujesky, D, Roy, P-M, Sanchez, Oliver Lope, Verschuren, F, Bounameaux, Henri, Perrier, Arnaud, Righini, Marc Philip, Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, Groupe de recherche sur la thrombose (GRT (EA 3065)), Université Jean Monnet [Saint-Étienne] (UJM), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Division of General Internal Medicine (DGIM), Bern University Hospital, Service des Urgences (PMR), CHRU - ANGERS, Department of Pneumology and Intensive Care Unit (DPICU), Université Paris Descartes - Paris 5 (UPD5), Emergency Department (FV - ED), Saint Luc University Hospital, Department of Internal Medicine (AP), Geneva University Hospital (HUG), Université de Brest (UBO)-Université de Brest (UBO), Service d'angiologie et d'hémostase ( MR ), Groupe de recherche sur la thrombose ( GRT (EA 3065) ), Université Jean Monnet [Saint-Étienne] ( UJM ), Groupe d'Etude de la Thrombose de Bretagne Occidentale ( GETBO ), Université de Brest ( UBO ), Centre d'Investigation Clinique ( CIC - Brest ), Université de Brest ( UBO ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Division of General Internal Medicine ( DGIM ), Service des Urgences ( PMR ), Department of Pneumology and Intensive Care Unit ( DPICU ), Université Paris Descartes - Paris 5 ( UPD5 ), Emergency Department ( FV - ED ), Department of Internal Medicine ( AP ), and Geneva University Hospital ( HUG )
Subjects: MESH: Pulmonary Embolism, Male, MESH : Aged, MESH: Epidemiologic Methods, France/epidemiology, Switzerland/epidemiology, MESH: Belgium, Belgium, Neoplasms, MESH : Cardiovascular Diseases, MESH : Female, MESH: Neoplasms, Cardiovascular Diseases/mortality, ddc:616, MESH: Aged, MESH : Prognosis, MESH: Middle Aged, MESH : Adult, Middle Aged, Prognosis, Cardiovascular Diseases, MESH : Pulmonary Embolism, Female, Neoplasms/mortality, France, MESH : Belgium, Respiratory Insufficiency, MESH : Decision Support Techniques, Switzerland, Adult, MESH : Switzerland, Respiratory Insufficiency/mortality, MESH : Male, MESH: Switzerland, Patient Readmission, MESH : Epidemiologic Methods, MESH: Prognosis, Decision Support Techniques, [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, MESH: Patient Readmission, Humans, Pulmonary Embolism/diagnosis, MESH : Middle Aged, MESH : France, Belgium/epidemiology, MESH : Patient Readmission, Aged, MESH: Humans, MESH : Humans, MESH: Cardiovascular Diseases, MESH: Decision Support Techniques, MESH: Adult, MESH : Respiratory Insufficiency, MESH : Neoplasms, MESH: Male, MESH: France, Patient Readmission/statistics & numerical data, Epidemiologic Methods, Pulmonary Embolism, MESH: Female, MESH: Respiratory Insufficiency, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; OBJECTIVES: The prognosis of patients in whom pulmonary embolism (PE) is suspected but ruled out is poorly understood. We evaluated whether the initial assessment of clinical probability of PE could help to predict the prognosis for these patients. DESIGN: Retrospective analysis of data obtained during a prospective multicentre management study. SETTING: Six general and teaching hospitals in Belgium, France and Switzerland. SUBJECTS: In 1334 patients in whom PE was ruled out, 3-month mortality data were available (hospital readmission status was unknown for three patients) and clinical probability was evaluated with the revised Geneva score (RGS). MAIN OUTCOME MEASURES: Three-month mortality and readmission rates. RESULTS: Three-month mortality and readmissions rates were 3% and 19%, respectively and differed significantly depending on the RGS-determined PE probability group (P
Published: 2011
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36. Apixaban versus Enoxaparin for Thromboprophylaxis in Medically Ill Patients

Author: Goldhaber, Sz, Leizorovicz, A, Kakkar, A, Haas, Sk, Merli, G, Weitz, Ji, Ceresetto, Jm, Kyrle, P, Gallus, A, Cools, F, Saraiva, J, Faucher, Jp, Chlumsky, J, Husted, S, Emmerich, J, Bauersachs, R, Zeltser, D, Prandoni, Paolo, Ghiraduzzi, A, Leiva, J, Sparby, Ja, Torbiki, A, Kobalava, Z, Jacobson, B, Suarez, C, Fu, M, Savas, I, Parkhomenko, A, Ansell, J, Landis, Jr, Elliott, Cg, Borris, Lc, Samama, Mm, Pinede, L, Becker, F, Coppere, B, Nony, P, Merah, A, Alves, M, Boulet, H, Loppinet, A, Nicol, C, Ohanessian, L, Roncato, C, Knabb, Rm, Liaw, D, Smith, K, Hess, T, Rossi, L, Chen, D, Doan, C, Doran, J, Matheis, E, Ballard, M, Tsarova, O, Levenstein, S, Tvedegaard, M, Akkal, Z, Jure, H, Mercado, Da, Zangroniz, P, Constantino, M, Bello, F, Giumelli, C, de Sagastizabal, D, Risso Patron, F, Ceresetto, J, Dran, R, Vita, N, Baratta, S, Ahuad Guerrero, R, Penchasky, D, Rubinfeld, A, Layden, M, Karrasch, J, Coughlin, P, Peters, M, Gibbs, H, Ward, Ch, Hahn, U, Pilger, E, Minar, E, El Allaf, D, Marechal, P, Motte, S, Verhamme, P, Wollaert, B, Duck, L, Freire, A, Piegas, L, Jorge, Jm, Guimaraes, H, Oliveira, M, Blacher, C, Leães, P, Toniolo, J, Okoshi, M, Rosa, Dd, Cunha, C, Lobo, S, Leader, R, Dhar, A, Tarabain, O, Miron, M, Brossoit, R, Kahn, S, Kassis, J, Douketis, J, Spencer, F, Faucher, J, Alarcon, Ma, Gutierrez Valenzuela, F, Bisbal Malig, C, Vejar, M, Jaramillo, N, Saaibi, D, Londono, D, Kolman, P, Reiterer, P, Ballek, L, Spacek, R, Soucek, M, Patek, F, Vitovec, M, Kovarova, K, Ceska, R, Podpera, I, Faber, J, Oestergaard, L, Vejby Christensen, H, Frost, L, Rasmussen, Sl, Tuxen, C, Ingerslev, J, Knudsen, T, Torp Pedersen, C, Pedersen, C, Nielsen, H, Mottier, D, Simoneau, G, Leduc, J, Lorcerie, B, Paleiron, N, Proust, A, Conri, C, Pernod, G, Mismetti, P, Achkar, A, Maignan, M, Harenberg, J, Beyer, J, Horacek, T, Lawall, H, Hecker, U, Hammerstingl, C, Weil, J, Fischer, D, Brachmann, J, Klepzig, H, Cheng, G, Soltesz, P, Schnabel, R, Futo, L, Jobbagy, L, Singh, P, Talwar, D, Bhadade, R, Bharani, A, Krishnamurthy, S, Goyal, A, Mehta, P, Samiuddin, M, D'Souza, G, Sinha, S, Sathe, P, Sethuraman, S, Jaganmani, S, Sundaram, P, Saxena, A, Mehta, M, Omar, A, Rajkumar, J, Jog, S, Kumar, S, Hayek, T, Hussein, O, Lahav, M, Efrati, S, Elias, M, Grossman, E, Lugassy, G, Porath, A, Porreca, E, Prandoni, P, Tosetto, A, Imberti, D, Pierfranceschi, G, Ghirarduzzi, A, Scannapieco, G, Testa, S, Ling, P, Yusoff, K, Yusof, Z, Lopez Rosas, E, Hernandez, I, Nanez Terreros, H, Flota, L, Campos, E, Alcocer, M, Viergever, P, Sparby, J, Cotrina, R, Salas, M, Pamo, O, Fajardo, L, Horna, M, Ulloa, V, Toce, L, Moncada, Z, Salazar, O, Habaluyas, R, Collado, F, Edmilao, M, Abola, T, Sevilla, R, Torbicki, A, Tracz, W, Kasprzak, J, Jastrzebski, D, Psuja, P, Hiczkiewicz, J, Piepiorka, M, Pulkowski, G, Tyszkiewicz, I, Kuc, K, Gordeev, I, Boyarkin, M, Privalov, D, Abrosimov, V, Reshetko, O, Goloshchekin, B, Vishnevsky, A, Boldueva, S, Kostenko, V, Mkrtchian, V, Chernichka, I, Belenkov, Y, Rodoman, G, Andreev, D, Shvarts, Y, Aleksandrov, O, Zadionchenko, V, Klochkov, O, Tay, J, Jagadesan, R, Basson, M, Siebert, R, Viljoen, J, Gray, T, Abdool Gaffar, M, Suh, G, In, K, Choi, D, Kim, S, Baek, S, Chung, H, Shin, J, Alvarez Sala, L, Cepeda, J, Ferrer, M, Mallibovsky, L, Garcia Morillo, J, Villalta, J, Gomez Cerezo, J, Capitán, F, Gonzalez Garrido, F, Guijarro, C, Jimenez, D, Richart, C, Elf, J, Ueng, K, Huang, T, Karan, A, Erten, N, Abrahamovych, O, Chopey, I, Gavrysiuk, V, Kraiz, I, Karpenko, A, Volkov, V, Denesyuk, V, Kharchenko, N, Tseluyko, V, Batushkin, V, Sushko, V, Yagensky, A, Ignatenko, G, Dziublyk, O, Cohen, A, Bareford, D, Kesteven, P, Mccollum, P, Das, S, Conrad, S, Botnick, W, Nathanson, A, Hamad, A, Fraiz, J, Goytia Leos, D, Fulmer, J, Mclaren, G, Streiff, M, Hahn, B, Ardolic, B, Klausner, H, Welch, M, Pullman, J, Phillips, D, Felt, J, Mitchell, G, Margolis, B, Pendleton, R, Mahesh, A, Barney, J, Shadan, F, Schuller, D, Joslin, S, Feldman, J, Pearl, R, Welker, J, Hazelrigg, M, Stevens, S, Siegel, M, Meade, A, Bates, J, Tahirkheli, N, Rosenberg, D, Dishman, K, Ikerd, T, Feldman, G, O'Connell, C, Vaince, U, Dabbagh, O, Eyster, E, Weinstein, G, Ginsberg, R, Fine, J, Tillinghast, A, Alabi, F, Nathan, R, Haught, H, Oliver, M., Cardiovascular Division (SZG), Brigham and Women's Hospital [Boston], Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Thrombosis Research Institute (AKK), University College of London [London] (UCL), Institute for Experimental Oncology and Therapy Research (IEOTR), Technische Universität Munchen - Université Technique de Munich [Munich, Allemagne] (TUM), Jefferson Medical College (JMC), Thomas Jefferson University Hospitals, Thrombosis and Atherosclerosis Research Institute (TARI), McMaster University [Hamilton, Ontario], 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), Centre d'Investigation Clinique (CIC - Brest), and Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Male, MESH: Pulmonary Embolism, Placebo-controlled study, MESH: Hospitalization, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, law.invention, MESH: Venous Thromboembolism, chemistry.chemical_compound, 0302 clinical medicine, MESH: Aged, 80 and over, Randomized controlled trial, law, Risk Factors, MESH: Risk Factors, Medicine, MESH: Double-Blind Method, 030212 general & internal medicine, MESH: Treatment Outcome, Aged, 80 and over, MESH: Aged, MESH: Middle Aged, General Medicine, Orvostudományok, Venous Thromboembolism, Middle Aged, 3. Good health, Pulmonary embolism, Hospitalization, Treatment Outcome, Acute Disease, MESH: Acute Disease, Apixaban, Female, Respiratory Insufficiency, MESH: Hemorrhage, medicine.drug, Adult, medicine.medical_specialty, Randomization, MESH: Enoxaparin, Pyridones, Medicina, Hemorrhage, MESH: Anticoagulants, MESH: Drug Administration Schedule, Klinikai orvostudományok, Drug Administration Schedule, 03 medical and health sciences, Double-Blind Method, Internal medicine, MESH: Pyridones, Humans, Risk factor, Enoxaparin, MESH: Kaplan-Meier Estimate, Aged, Heart Failure, MESH: Humans, business.industry, Anticoagulants, MESH: Adult, medicine.disease, MESH: Male, Surgery, chemistry, Relative risk, Betrixaban, MESH: Heart Failure, Pyrazoles, business, Pulmonary Embolism, MESH: Female, MESH: Pyrazoles, MESH: Respiratory Insufficiency, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: The efficacy and safety of prolonging prophylaxis for venous thromboembolism in medically ill patients beyond hospital discharge remain uncertain. We hypothesized that extended prophylaxis with apixaban would be safe and more effective than short-term prophylaxis with enoxaparin. METHODS: In this double-blind, double-dummy, placebo-controlled trial, we randomly assigned acutely ill patients who had congestive heart failure or respiratory failure or other medical disorders and at least one additional risk factor for venous thromboembolism and who were hospitalized with an expected stay of at least 3 days to receive apixaban, administered orally at a dose of 2.5 mg twice daily for 30 days, or enoxaparin, administered subcutaneously at a dose of 40 mg once daily for 6 to 14 days. The primary efficacy outcome was the 30-day composite of death related to venous thromboembolism, pulmonary embolism, symptomatic deep-vein thrombosis, or asymptomatic proximal-leg deep-vein thrombosis, as detected with the use of systematic bilateral compression ultrasonography on day 30. The primary safety outcome was bleeding. All efficacy and safety outcomes were independently adjudicated. RESULTS: A total of 6528 subjects underwent randomization, 4495 of whom could be evaluated for the primary efficacy outcome - 2211 in the apixaban group and 2284 in the enoxaparin group. Among the patients who could be evaluated, 2.71% in the apixaban group (60 patients) and 3.06% in the enoxaparin group (70 patients) met the criteria for the primary efficacy outcome (relative risk with apixaban, 0.87; 95% confidence interval [CI], 0.62 to 1.23; P = 0.44). By day 30, major bleeding had occurred in 0.47% of the patients in the apixaban group (15 of 3184 patients) and in 0.19% of the patients in the enoxaparin group (6 of 3217 patients) (relative risk, 2.58; 95% CI, 1.02 to 7.24; P = 0.04). CONCLUSIONS: In medically ill patients, an extended course of thromboprophylaxis with apixaban was not superior to a shorter course with enoxaparin. Apixaban was associated with significantly more major bleeding events than was enoxaparin, Supported by Bristol-Myers Squibb and Pfizer
Published: 2011
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37. Hospital discharge data can be used for monitoring procedures and intensive care related to severe maternal morbidity

Author: Chantry, Anne, Deneux-Tharaux, Catherine, Cans, Christine, Ego, Anne, Quantin, Catherine, Bouvier-Colle, Marie-Hélène, Debs, Nayla, Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants (UMR_S 953), Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Techniques pour l'Evaluation et la Modélisation des Actions de Santé (ThEMAS), CHU Grenoble, Unité de Recherche Clinique, Hôpital Jeanne de Flandre [Lille]-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Lipides - Nutrition - Cancer (U866) (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA), Chantry was supported by a doctoral grant from the French Ministry of Research, GRACE study group: G. Bal, G. Beucher, MJ. D'alche Gautier, AS. Ducloy-Bouthors, N. Lamendour, I. Le Fur, V. Tessier, and J. Zeitlin
Subjects: MESH: Medical Records, MESH: Pulmonary Embolism, Severe maternal morbidity, Validity, MESH: Hospital Information Systems, Sensitivity, MESH: Pregnancy, MESH: Intensive Care, Hospital discharge data, MESH: Hypertension, Pregnancy-Induced, MESH: Adolescent, Medical records, MESH: Middle Aged, MESH: Humans, MESH: Patient Discharge, MESH: Adult, MESH: Hospitals, Teaching, MESH: Postpartum Hemorrhage, MESH: International Classification of Diseases, MESH: France, MESH: Morbidity, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Pregnancy Complications, MESH: Young Adult, 26 Positive predictive value, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Female
Abstract: International audience; OBJECTIVE: To estimate the accuracy and reliability of the reporting of diagnoses and procedures related to severe acute maternal morbidity in French hospital discharge data. STUDY DESIGN AND SETTING: The study, conducted in four French tertiary teaching hospitals, covered the years 2006 and 2007 and 30,607 deliveries. We identified severe maternal morbid events-eclampsia, pulmonary embolism, procedures related to postpartum hemorrhages, and intensive care-in administrative hospital discharge data and medical records and compared their recording. Information from medical records was the gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value of the hospital discharge data for these events were calculated. False positives and false negatives were examined to identify the reasons for misrecorded information. RESULTS: The PPV of the hospital discharge data was 20% for eclampsia. For procedures related to postpartum hemorrhages, the PPVs were high, but sensitivities were lower; however, 95% of recording errors could be corrected. All indicators for intensive care exceeded 98%. CONCLUSION: Intensive care and procedures seem reliably reported in the hospital administrative database, which, therefore, can be used to monitor them. Using these data for monitoring diagnoses will require a greater investment by clinicians in the accuracy of their reporting.
Published: 2011
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38. The prognostic value of markers of right ventricular dysfunction in pulmonary embolism: a meta-analysis

Author: Javed Ehtisham, Emmanuelle Cauderlier, Michèle Hamon, Guillaume Coutance, Martial Hamon, BMC, Ed., Service de cardiologie et de pathologie vasculaire [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Service de Radiologie [CHU Caen], Epidémiologie des maladies chroniques : impact des interactions gène environnement sur la santé des populations, Institut Pasteur de Lille, and Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé
Subjects: Male, MESH: Pulmonary Embolism, [SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Ventricular Dysfunction, Right, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, MESH: Risk Assessment, 0302 clinical medicine, MESH: Aged, 80 and over, Clinical endpoint, Natriuretic peptide, 030212 general & internal medicine, MESH: Ventricular Dysfunction, Right, Aged, 80 and over, MESH: Aged, education.field_of_study, MESH: Middle Aged, Mortality rate, Middle Aged, Prognosis, MESH: Predictive Value of Tests, 3. Good health, Pulmonary embolism, Echocardiography, Predictive value of tests, Cardiology, Female, MESH: Tomography, X-Ray Computed, medicine.medical_specialty, medicine.drug_class, Population, Risk Assessment, MESH: Prognosis, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Humans, MESH: Natriuretic Peptides, education, Natriuretic Peptides, Aged, MESH: Humans, business.industry, Research, MESH: Biological Markers, Odds ratio, medicine.disease, Confidence interval, MESH: Male, MESH: Echocardiography, business, Pulmonary Embolism, Tomography, X-Ray Computed, MESH: Female, Biomarkers
Abstract: International audience; INTRODUCTION: In pulmonary embolism (PE) without hemodynamic compromise, the prognostic value of right ventricular (RV) dysfunction as measured by echocardiography, computed tomography (CT) or biological (natriuretic peptides) markers has only been assessed in small studies. METHODS: Databases were searched using the combined medical subject headings for right ventricular dysfunction or right ventricular dilatation with the exploded term acute pulmonary embolism. This retrieved 8 echocardiographic marker based studies (n = 1249), three CT marker based studies (n = 503) and 7 natriuretic peptide based studies (n = 582). A meta-analysis of these data was performed with the primary endpoint of mortality within three months after pulmonary embolism, and a secondary endpoint of overall mortality and morbidity by pulmonary embolism. RESULTS: Patients with PE without hemodynamic compromise on admission and the presence of RV dysfunction determined by echocardiography and biological markers were associated with increased short-term mortality (odds ratio (OR) ECHO = 2.36; 95% confidence interval (CI): 1.3-43; OR BNP = 7.7; 95% CI: 2.9-20) while CT was not (ORCT = 1.54-95% CI: 0.7-3.4). However, corresponding pooled negative and positive likelihood ratios independent of death rates were unsatisfactory for clinical usefulness in risk stratification. CONCLUSIONS: The presence of echocardiographic RV dysfunction or elevated natriuretic peptides is associated with short-term mortality in patients with pulmonary embolism without hemodynamic compromise. In contrast, the prognostic value of RV dilation on CT has yet to be validated in this population. As indicated both by positive and negative likelihood ratios the current prognostic value in clinical practice remains very limited.
Published: 2011
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39. Safety of outpatient treatment in acute pulmonary embolism

Author: Petra M. G. Erkens, Marc Carrier, Marc A. Rodger, Gauruv Bose, Phil Wells, Esteban Gandara, Martin H. Prins, Alex Yi-Hao Shen, Grégoire Le Gal, Epidemiologie, MUMC+: KIO Kemta (9), Family Medicine, RS: CAPHRI School for Public Health and Primary Care, Department of General Practice (CAPHRI), Maastricht University [Maastricht], Thrombosis Program, University of Ottawa [Ottawa], Ottawa Hospital Research Institute [Ottawa] (OHRI), Department of Medicine, Ottawa Hospital, Clinical Epidemiology Unit, Ottawa-The Ottawa Hospital, 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), Cluster Infectious Diseases, and Amsterdam BioMed Cluster
Subjects: Male, MESH: Pulmonary Embolism, Palliative care, pulmonary embolism, Hemodynamics, MESH: Hospitalization, 030204 cardiovascular system & hematology, Biochemistry, Cohort Studies, 0302 clinical medicine, Outpatients, Risk of mortality, Ambulatory Care, 030212 general & internal medicine, MESH: Heparin, Low-Molecular-Weight, Stroke, MESH: Cohort Studies, 0303 health sciences, Hematology, Heparin, 3. Good health, Pulmonary embolism, Hospitalization, Cohort, Ambulatory, Acute Disease, MESH: Acute Disease, Female, Safety, MESH: Hemorrhage, Cohort study, medicine.drug, medicine.medical_specialty, MESH: Hemodynamics, medicine.drug_class, Immunology, MESH: Ambulatory Care, Low molecular weight heparin, Hemorrhage, MESH: Anticoagulants, 03 medical and health sciences, outpatient treatment, Heparin-induced thrombocytopenia, Internal medicine, medicine, Humans, Intensive care medicine, 030304 developmental biology, Retrospective Studies, MESH: Humans, business.industry, MESH: Safety, Anticoagulants, Retrospective cohort study, MESH: Retrospective Studies, Cell Biology, Heparin, Low-Molecular-Weight, medicine.disease, MESH: Male, MESH: Outpatients, business, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, 030215 immunology
Abstract: Abstract 3796 Introduction: Systematic reviews have shown that subcutaneous low molecular weight heparins (LMWH) are at least as safe and effective in the treatment of venous thromboembolism (VTE) as intravenous unfractionated heparin (UFH). LMWH allows patients with VTE to be treated as outpatients. However, patients with pulmonary embolism (PE) are still systematically admitted to the hospital for a few days to avoid potential complications. Physicians are reluctant to discharge patients due to insufficient data supporting the safety of outpatient management of PE. This study evaluates the safety of outpatient treatment of acute PE at the Ottawa Hospital. Methods: This is a retrospective cohort study of consecutive patients presenting at the Ottawa Hospital with acute PE diagnosed between January 1, 2007 and December 31, 2008. PE was defined as an arterial filling defect on CTPA or a high probability V/Q scan. Patients diagnosed with PE during hospitalization, patients with chronic PE and patients in whom anticoagulation treatment was not initiated (e.g. palliative care patients, small clinical non-significant PE) were excluded from the analyses. Patients were managed as outpatients if they were hemodynamically stable, did not require supplemental oxygenation and did not have contraindications to low molecular weight heparin therapy. Results: In this cohort of 473 patients with acute PE, 260 (55.0%) were treated as outpatients and 213 (45.0%) were admitted to the hospital. The majority of the patients were admitted because of severe comorbidities (45.5%) or hypoxia (22.1%).No outpatient died of fatal PE during the 3 month follow-up period. At the end of follow-up, the overall mortality was 5.0% (95% CI: 2.7 to 8.4%). The rates of recurrent venous thromboembolism (VTE) in the outpatient group were 0.4% (95% CI: 0.0 to 2.1%) and 3.8% (95% CI: 1.9 to 7.0%) within 14 days and 3 months, respectively. The rates of major bleeding episodes were 0% (95% CI: 0 to 1.4%) and 1.5% (95% CI: 0.4 to 3.9%) within 14 days and 3 months, respectively. Four (1.5%) outpatients were admitted to hospital within the first 14 days because of progressive shortness of breath and pain, a pre-syncopal episode or heparin induced thrombocytopenia. Conclusion: A majority of patients with acute PE can be managed as outpatients with a low risk of mortality, recurrent VTE and major bleeding episodes. Outpatient treatment in PE is feasible and safe in uncomplicated patients. Disclosures: Rodger: Pfizer: Research Funding; Leo Pharma: Research Funding; Sanofi Aventis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Canadian Institutes of Health Research: Research Funding; Heart and Stroke Foundation: Research Funding.
Published: 2010
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40. Prognostic importance of hyponatremia in patients with acute pulmonary embolism

Author: Marie Méan, Nathalie Scherz, José Labarère, Drahomir Aujesky, Michael J. Fine, Said A. Ibrahim, ThEMAS, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-CHU Grenoble, Department of Internal Medicine (DIM -CHUV), and Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV)
Subjects: Pulmonary and Respiratory Medicine, MESH: Pulmonary Embolism, medicine.medical_specialty, MESH: Comorbidity, MESH: Logistic Models, Comorbidity, Kaplan-Meier Estimate, E. Pulmonary Vascular Disease, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Patient Readmission, Severity of Illness Index, MESH: Prognosis, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Intensive care, MESH: Severity of Illness Index, Severity of illness, medicine, MESH: Patient Readmission, Humans, 030212 general & internal medicine, MESH: Kaplan-Meier Estimate, MESH: Age Factors, MESH: Humans, business.industry, Respiratory disease, Age Factors, nutritional and metabolic diseases, Odds ratio, medicine.disease, Prognosis, Confidence interval, 3. Good health, Pulmonary embolism, Surgery, Logistic Models, MESH: Hyponatremia, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Hyponatremia, Pulmonary Embolism
Abstract: International audience; RATIONALE: Although associated with adverse outcomes in other cardiopulmonary conditions, the prognostic value of hyponatremia, a marker of neurohormonal activation, in patients with acute pulmonary embolism (PE) is unknown. OBJECTIVES: To examine the associations between hyponatremia and mortality and hospital readmission rates for patients hospitalized with PE. METHODS: We evaluated 13,728 patient discharges with a primary diagnosis of PE from 185 hospitals in Pennsylvania (January 2000 to November 2002). We used random-intercept logistic regression to assess the independent association between serum sodium levels at the time of presentation and mortality and hospital readmission within 30 days, adjusting for patient (race, insurance, severity of illness, use of thrombolytic therapy) and hospital factors (region, size, teaching status). MEASUREMENTS AND MAIN RESULTS: Hyponatremia (sodium ≤135 mmol/L) was present in 2,907 patients (21.1%). Patients with a sodium level greater than 135, 130-135, and less than 130 mmol/L had a cumulative 30-day mortality of 8.0, 13.6, and 28.5% (P < 0.001), and a readmission rate of 11.8, 15.6, and 19.3% (P < 0.001), respectively. Compared with patients with a sodium greater than 135 mmol/L, the adjusted odds of dying were significantly greater for patients with a sodium 130-135 mmol/L (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.33-1.76) and a sodium less than 130 mmol/L (OR, 3.26; 95% CI, 2.48-4.29). The adjusted odds of readmission were also increased for patients with a sodium of 130-135 mmol/L (OR, 1.28; 95% CI, 1.12-1.46) and a sodium less than 130 mmol/L (OR, 1.44; 95% CI, 1.02-2.02). CONCLUSIONS: Hyponatremia is common in patients presenting with PE, and is an independent predictor of short-term mortality and hospital readmission.
Published: 2010
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41. Fondaparinux for the treatment of superficial-vein thrombosis in the legs

Author: Decousus, Hervé, Prandoni, Paolo, Mismetti, Patrick, Bauersachs, Rupert M, Boda, Zoltán, Brenner, Benjamin, Laporte, Silvy, Matyas, Lajos, Middeldorp, Saskia, Sokurenko, German, Leizorovicz, Alain, Bressollette, Luc, Groupe de recherche sur la thrombose (GRT (EA 3065)), Université Jean Monnet [Saint-Étienne] (UJM), Thromboembolism Unit (PP), Universita degli Studi di Padova, Klinikum Darmstadt (RMB), Klinikum Darmstadt, Department of Medicine (DEBRECEN - Dpt Medicine), University of Debrecen, Thrombosis and Haemostasis Unit, Technion - Israel Institute of Technology [Haifa], Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Saint Etienne, Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Vascular and Endovascular Surgery (DVES), University Teaching Hospital Miskolc, Departments of Clinical Epidemiology and General Internal Medicine (DCEGIM), Leiden University Medical Center (LUMC), City Hospital, City Hospital St Petersburg, Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), 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), Evaluation et modélisation des effets thérapeutiques, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Other departments, ACS - Amsterdam Cardiovascular Sciences, and Vascular Medicine
Subjects: Relative risk reduction, Male, MESH: Pulmonary Embolism, Superficial vein thrombosis, [SDV]Life Sciences [q-bio], Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Fondaparinux, 0302 clinical medicine, Recurrence, Medicine, MESH: Double-Blind Method, 030212 general & internal medicine, MESH: Treatment Outcome, Venous Thrombosis, MESH: Risk, MESH: Middle Aged, Anticoagulant, General Medicine, Orvostudományok, molecular-weight heparin randomized double-blind venous thromboembolism risk-factors medical patients thrombophlebitis metaanalysis prevention surgery prophylaxis, Middle Aged, Thrombosis, 3. Good health, Pulmonary embolism, Treatment Outcome, Anesthesia, Acute Disease, MESH: Acute Disease, Female, MESH: Hemorrhage, medicine.drug, Risk, [SDV.OT]Life Sciences [q-bio]/Other [q-bio.OT], medicine.drug_class, Hemorrhage, MESH: Anticoagulants, Placebo, Klinikai orvostudományok, 03 medical and health sciences, Double-Blind Method, Polysaccharides, Humans, MESH: Kaplan-Meier Estimate, MESH: Humans, business.industry, Anticoagulants, medicine.disease, Fondaparinux Sodium, MESH: Male, MESH: Recurrence, MESH: Polysaccharides, MESH: Venous Thrombosis, business, Pulmonary Embolism, MESH: Female
Abstract: International audience; BACKGROUND: The efficacy and safety of anticoagulant treatment for patients with acute, symptomatic superficial-vein thrombosis in the legs, but without concomitant deep-vein thrombosis or symptomatic pulmonary embolism at presentation, have not been established. METHODS: In a randomized, double-blind trial, we assigned 3002 patients to receive either fondaparinux, administered subcutaneously at a dose of 2.5 mg once daily, or placebo for 45 days. The primary efficacy outcome was a composite of death from any cause or symptomatic pulmonary embolism, symptomatic deep-vein thrombosis, or symptomatic extension to the saphenofemoral junction or symptomatic recurrence of superficial-vein thrombosis at day 47. The main safety outcome was major bleeding. The patients were followed until day 77. RESULTS: The primary efficacy outcome occurred in 13 of 1502 patients (0.9%) in the fondaparinux group and 88 of 1500 patients (5.9%) in the placebo group (relative risk reduction with fondaparinux, 85%; 95% confidence interval [CI], 74 to 92; P
Published: 2010
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42. Patients with a first symptomatic unprovoked deep vein thrombosis are at higher risk of recurrent venous thromboembolism than patients with a first unprovoked pulmonary embolism

Author: Mark Crowther, Susan R. Kahn, Linda M. Vickars, Isabelle Chagnon, David A. Anderson, M. T. Betancourt, Tim Ramsay, Richard H. White, G. Le Gal, Arnaud Perrier, Susan Solymoss, P. S. Wells, Michael J. Kovacs, Marc A. Rodger, Division of Hematology (MJK), University of Western Ontario (UWO), Centre for Clinical Epidemiology and Community Studies (CCECS), Jewish General Hospital, Department of Medecine [Montréal], McGill University = Université McGill [Montréal, Canada], Thrombosis Program, University of Ottawa [Ottawa], Clinical Epidemiology Unit, Ottawa-The Ottawa Hospital, Department of Medicine, Dalhousie University [Halifax], Department of Medicine (DM - HSC Montréal), University of Montreal, 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), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Medicine (DM - McMaster), McMaster University [Hamilton, Ontario], Department of Internal Medicine (AP), Geneva University Hospital (HUG), Department of Medicine (UDSM), UC Davis School of Medicine, Department of Medicine (UBC - St Paul Hospital), and University of British Colombia
Subjects: Male, MESH: Pulmonary Embolism, Deep vein, Administration, Oral, 030204 cardiovascular system & hematology, MESH: Venous Thromboembolism, Cohort Studies, 0302 clinical medicine, Recurrence, Medicine, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, MESH: Cohort Studies, MESH: Treatment Outcome, Venous Thrombosis, ddc:616, First episode, MESH: Aged, MESH: Risk, MESH: Middle Aged, Venous Thromboembolism, Hematology, Heparin, MESH: Follow-Up Studies, Middle Aged, Thrombosis, 3. Good health, Pulmonary embolism, Treatment Outcome, medicine.anatomical_structure, Anticoagulants/therapeutic use, MESH: Administration, Oral, Female, Cohort study, medicine.drug, Risk, medicine.medical_specialty, Venous Thrombosis/*complications/*therapy, MESH: Anticoagulants, Pulmonary Embolism/complications/*diagnosis, 03 medical and health sciences, Venous Thromboembolism/complications/*diagnosis, Internal medicine, Humans, cardiovascular diseases, Aged, MESH: Humans, business.industry, Anticoagulants, medicine.disease, equipment and supplies, MESH: Male, MESH: Prospective Studies, Surgery, MESH: Recurrence, Relative risk, MESH: Venous Thrombosis, Pulmonary Embolism, business, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Follow-Up Studies
Abstract: International audience; BACKGROUND: Previous studies are mixed as to whether patients with unprovoked pulmonary embolism (PE) have a higher rate of venous thromboembolism (VTE) recurrence after anticoagulation is discontinued than patients with unprovoked deep vein thrombosis (DVT). OBJECTIVES: To determine whether patients with unprovoked PE have a higher rate of VTE recurrence than patients with unprovoked DVT in a prospective multicenter cohort study. PATIENTS/METHODS: Six hundred and forty-six patients with a first episode of symptomatic unprovoked VTE were treated with heparin and subsequent oral anticoagulation for 5-7 months, and were followed every 6 months for recurrent VTE after their anticoagulant therapy was discontinued. RESULTS: Of 646 patients, 194 had isolated PE, 339 had isolated DVT, and 113 had both DVT and PE. After a mean of 18 months of follow-up, there were 91 recurrent VTE events (9.5% annualized risk of recurrent VTE in the total population). The crude recurrent VTE rate for the isolated PE, isolated DVT and DVT and PE groups were 7.7%, 16.5% and 17.7%, respectively. The relative risk of recurrent VTE for isolated DVT vs. isolated PE was 2.1 (95% confidence interval 1.2-3.7). CONCLUSIONS: This study has demonstrated that patients with a first episode of unprovoked isolated DVT are 2.1 times more likely to have a recurrent VTE episode than patients with a first episode of unprovoked isolated PE. These findings need to be considered when determining the optimal duration of anticoagulant therapy for patients with unprovoked VTE.
Published: 2010
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43. Incidence and clinical outcomes of occult cancers detected by computed tomographic pulmonary angiography in patients with acute pulmonary embolism

Author: Marc Carrier, P. S. Wells, Carole Dennie, G. Le Gal, A Y-H Shen, Thrombosis Program, University of Ottawa [Ottawa], Clinical Epidemiology Unit, Ottawa-The Ottawa Hospital, 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), and Department of Radiology (CD - OTTAWA)
Subjects: MESH: Pulmonary Embolism, medicine.medical_specialty, MEDLINE, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, medicine, Pulmonary angiography, Humans, In patient, MESH: Lung, 030212 general & internal medicine, MESH: Incidence, Lung, ComputingMilieux_MISCELLANEOUS, Retrospective Studies, MESH: Angiography, MESH: Humans, business.industry, Incidence, Incidence (epidemiology), Angiography, Retrospective cohort study, MESH: Retrospective Studies, Hematology, medicine.disease, Occult, 3. Good health, Pulmonary embolism, MESH: Neoplasms, Unknown Primary, Neoplasms, Unknown Primary, Radiology, Tomography, Pulmonary Embolism, Tomography, X-Ray Computed, business, MESH: Tomography, X-Ray Computed, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience
Published: 2010
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44. Clinical prediction rules for pulmonary embolism: a systematic review and meta-analysis

Author: Mathieu Nendaz, E. Ceriani, Marc Philip Righini, Christophe Combescure, Thomas V. Perneger, G. Le Gal, Henri Bounameaux, Arnaud Perrier, Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, Division of Clinical Epidemiology (DCE), Geneva University Hospital (HUG), 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), and Service de médecine interne générale (SMIG)
Subjects: MESH: Pulmonary Embolism, Pediatrics, medicine.medical_specialty, MEDLINE, 030204 cardiovascular system & hematology, Pulmonary Embolism/epidemiology/*pathology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, D-dimer, Prevalence, Humans, Medicine, ddc:610, 030212 general & internal medicine, Geneva score, MESH: Prevalence, ddc:613, ddc:616, MESH: Humans, business.industry, Hematology, medicine.disease, Confidence interval, 3. Good health, Pulmonary embolism, Pre- and post-test probability, Study heterogeneity, Meta-analysis, Pulmonary Embolism, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; SUMMARY BACKGROUND: Pretest probability assessment is necessary to identify patients in whom pulmonary embolism (PE) can be safely ruled out by a negative D-dimer without further investigations. OBJECTIVE: Review and compare the performance of available clinical prediction rules (CPRs) for PE probability assessment. PATIENTS/METHODS: We identified studies that evaluated a CPR in patients with suspected PE from Embase, Medline and the Cochrane database. We determined the 95% confidence intervals (CIs) of prevalence of PE in the various clinical probability categories of each CPR. Statistical heterogeneity was tested. RESULTS: We identified 9 CPR and included 29 studies representing 31215 patients. Pooled prevalence of PE for three-level scores (low, intermediate or high clinical probability) was: low, 6% (95% CI, 4-8), intermediate, 23% (95% CI, 18-28) and high, 49% (95% CI, 43-56) for the Wells score; low, 13% (95% CI, 8-19), intermediate, 35% (95% CI, 31-38) and high, 71% (95% CI, 50-89) for the Geneva score; low, 9% (95% CI, 8-11), intermediate, 26% (95% CI, 24-28) and high, 76% (95% CI, 69-82) for the revised Geneva score. Pooled prevalence for two-level scores (PE likely or PE unlikely) was 8% (95% CI,6-11) and 34% (95% CI,29-40) for the Wells score, and 6% (95% CI, 3-9) and 23% (95% CI, 11-36) for the Charlotte rule. CONCLUSION: Available CPR for assessing clinical probability of PE show similar accuracy. Existing scores are, however, not equivalent and the choice among various prediction rules and classification schemes (three- versus two-level) must be guided by local prevalence of PE, type of patients considered (outpatients or inpatients) and type of D-dimer assay applied.
Published: 2010
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45. Differences in clinical presentation of pulmonary embolism in women and men

Author: Arnaud Perrier, G. Le Gal, Marc Carrier, Helia Robert-Ebadi, Francis Couturaud, Marc Philip Righini, Henri Bounameaux, Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, 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), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Thrombosis Program, University of Ottawa [Ottawa], Clinical Epidemiology Unit, Ottawa-The Ottawa Hospital, Service de Pneumologie, Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Interfaces, Traitements, Organisation et Dynamique des Systèmes (ITODYS (UMR_7086)), Université Paris Diderot - Paris 7 (UPD7)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Université de Brest (UBO), University of Ottawa [Ottawa] (uOttawa), and Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7)
Subjects: Male, MESH: Pulmonary Embolism, MESH: Chi-Square Distribution, Deep vein, 030204 cardiovascular system & hematology, MESH: Risk Assessment, MESH: Venous Thromboembolism, 0302 clinical medicine, Recurrence, Risk Factors, MESH: Risk Factors, Prevalence, Multicenter Studies as Topic, 030212 general & internal medicine, Prospective cohort study, Geneva score, MESH: Aged, MESH: Middle Aged, Venous Thromboembolism, Hematology, Middle Aged, Thrombosis, MESH: Predictive Value of Tests, 3. Good health, Pulmonary embolism, Europe, Pre- and post-test probability, MESH: Health Status Disparities, medicine.anatomical_structure, Female, Presentation (obstetrics), MESH: Tomography, X-Ray Computed, medicine.medical_specialty, Risk Assessment, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, Sex Factors, MESH: Sex Factors, Predictive Value of Tests, Internal medicine, medicine, MESH: Fibrin Fibrinogen Degradation Products, Humans, MESH: Prevalence, Aged, Retrospective Studies, Chi-Square Distribution, MESH: Humans, business.industry, MESH: Biological Markers, MESH: Retrospective Studies, Health Status Disparities, medicine.disease, MESH: Male, MESH: Recurrence, Institutional repository, Physical therapy, MESH: Multicenter Studies as Topic, MESH: Europe, Pulmonary Embolism, Tomography, X-Ray Computed, business, MESH: Female, Biomarkers, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; BACKGROUND: The risk of recurrence of pulmonary embolism (PE) is higher in men than in women. Differences in clinical presentation of deep vein thrombosis (DVT) have been reported between the two genders but comparative data on PE are lacking. OBJECTIVES: To compare clinical characteristics between women and men with suspected and confirmed PE and their impact on clinical probability prediction scores and on diagnostic work-up of PE, and to assess whether differences at presentation could account for the increased recurrence rate in men. METHODS: Combined data from three prospective cohort studies including a total of 3414 outpatients with suspected PE were analyzed retrospectively. Clinical characteristics, pretest probability of PE, diagnostic yield of non-invasive tests and VTE recurrence rate were compared between genders. RESULTS: The overall prevalence of PE was similar among women and men (22.3% vs. 23.1%; P = 0.55). The clinical probability prediction scores (Geneva score and Wells score) performed equally well in both genders. A non-invasive diagnostic work-up was possible more often in men than in women. The proportion of PE-associated proximal DVT was higher in men than in women (43% vs. 33%; P = 0.009). VTE recurrence rate was also higher in men than women with PE (5.0% vs. 2.3%; P = 0.045). CONCLUSION: In spite of some differences in the clinical presentation of PE between women and men, clinical probability prediction scores perform equally in both genders. A higher prevalence of PE-associated proximal DVT in men could possibly indicate greater severity of PE episodes and partly account for the higher VTE recurrence rate in men.
Published: 2010
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46. Venous thromboembolism during pregnancy, postpartum or during contraceptive use

Author: A, Blanco-Molina, L L, Rota, P, Di Micco, B, Brenner, J, Trujillo-Santos, A, Ruiz-Gamietea, M, Monreal, A, Visona, Department of Internal Medicine (DIM - Rio de Janeiro), Federal University of Rio de Janeiro, Department of Internal Medicine (DIM - Cartagena), Hospital Universitario Santa Maria de Rosell, Servicio de Medicina Interna (SMI), Hopital Universitario Germans Trias i Pujol, Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), and Université de Brest (UBO)-Université de Brest (UBO)
Subjects: Adult, MESH: Pulmonary Embolism, MESH: Humans, MESH: Registries, Postpartum Period, Pregnancy Complications, Cardiovascular, MESH: Contraceptive Agents, MESH: Adult, MESH: Retrospective Studies, MESH: Pregnancy Complications, Cardiovascular, Venous Thromboembolism, MESH: Venous Thromboembolism, MESH: Cause of Death, MESH: Postpartum Period, MESH: Pregnancy, Contraceptive Agents, Pregnancy, Cause of Death, Humans, Female, Registries, Pulmonary Embolism, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Retrospective Studies
Abstract: International audience; Venous thromboembolism (VTE) is a leading cause of maternal death during pregnancy or postpartum, and in women using hormonal contraceptives. However, important issues concerning its natural history and therapy remain unsolved, and most of the protocols for treatment of VTE in this patient population are based on data extrapolated from other populations. RIETE is an ongoing registry of consecutive patients with objectively confirmed, symptomatic, acute VTE. We examined the clinical characteristics and three-month outcome of all enrolled women with pregnancy, postpartum or using hormonal contraceptives. As of December 2008, 173 pregnant women, 135 postpartum, and 798 contraceptive users were enrolled. Of these, 438 (40%) presented with pulmonary embolism (PE) and 668 with deep-vein thrombosis (DVT). Most women with acute PE had dyspnea (72%) or chest pain (75%), but only 2.0% had hypoxaemia. During the three-month study period, five women (0.45%; 95% CI: 0.17-1.00) died (3 had fatal PE), 13 (1.18%; 95% CI: 0.66-1.95) had VTE recurrences, and seven (0.63%; 95% CI: 0.28-1.25) major bleeding. Two of the three women with fatal PE died during the first few hours after arriving at the emergency ward, with no time to start any therapy. The outcome of pregnant or postpartum women with VTE is similar to that in contraceptive users, even though the treatment is different. The non-specific nature of PE signs may have caused some delay in PE diagnosis.
Published: 2010
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47. [Diagnostic strategy and comparison of clinical scores for pulmonary embolism]

Author: Blondon, Marc, Le Gal, Grégoire, Righini, Marc, Service de médecine interne générale (SMIG), Hôpital Universitaire de Genève, 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), and Service d'angiologie et d'hémostase (MR)
Subjects: MESH: Pulmonary Embolism, MESH: Humans, MESH: Enzyme-Linked Immunosorbent Assay, Factor V, Reproducibility of Results, Enzyme-Linked Immunosorbent Assay, MESH: Factor V, MESH: Radiography, Thoracic, MESH: Odds Ratio, MESH: Predictive Value of Tests, MESH: Reproducibility of Results, MESH: Risk Factors, Predictive Value of Tests, Risk Factors, Odds Ratio, Humans, Radiography, Thoracic, MESH: Tomography, X-Ray Computed, Pulmonary Embolism, Tomography, X-Ray Computed, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Ultrasonography
Abstract: International audience; The diagnostic approach to pulmonary embolism can be divided in several consecutive steps. First of all, the clinician must identify the patients with potential pulmonary embolism based on clinical presentation and the presence or absence of personal risk factors. Further investigations can then be guided by the use of a clinical probability score. The revised Geneva score and the Wells score are the most validated tools. They are reliable in stratifying patients into low, intermediate, and high-risk categories. When clinical probability is low or intermediate, the dosage of d-dimers is helpful. A negative result excludes pulmonary embolism with a very high negative predictive value, close to 100%. When positive, a multidetector thoracic CT will confirm or exclude the diagnosis. The utility of a lower-limb venous ultrasound is very low, and its use is therefore no longer recommended.
Published: 2010
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48. Oral rivaroxaban for symptomatic venous thromboembolism

Author: Bauersachs, R, Berkowitz, SD, Brenner, B, Buller, HR, Decousus, H, Gallus, AS, Lensing, AW, Misselwitz, F, Prins, MH, Raskob, GE, Segers, A, Verhamme, P, Wells, P, Agnelli, G, Bounameaux, H, Cohen, A, Davidson, BL, Piovella, F, Schellong, S, Berkowitz, S, Büller, H, Gallus, A, Lensing, A, Peters, G, Prins, M, Raskob, G, et, al, DI MINNO, GIOVANNI, Department of Vascular Medicine (DVM - AMC), Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), University of Amsterdam [Amsterdam] (UvA)-University of Amsterdam [Amsterdam] (UvA), Groupe de recherche sur la thrombose (GRT (EA 3065)), Université Jean Monnet [Saint-Étienne] (UJM), Department of Epidemiology (MHP), Maastricht University [Maastricht], Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, 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), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Tewes, Mitra (Beitragende*r), Bauersachs, R, Berkowitz, Sd, Brenner, B, Buller, Hr, Decousus, H, Gallus, A, Lensing, Aw, Misselwitz, F, Prins, Mh, Raskob, Ge, Segers, A, Verhamme, P, Wells, P, Agnelli, G, Bounameaux, H, Cohen, A, Davidson, Bl, Piovella, F, Schellong, S, Berkowitz, S, Büller, H, Lensing, A, Peters, G, Prins, M, Raskob, G, DI MINNO, Giovanni, Et, Al, ACS - Amsterdam Cardiovascular Sciences, Vascular Medicine, Epidemiologie, MUMC+: KIO Kemta (9), and RS: CAPHRI School for Public Health and Primary Care
Subjects: MESH: Pulmonary Embolism, MESH: Enoxaparin, medicine.drug_class, MESH: Factor Xa, Medizin, MESH: Morpholines, 030204 cardiovascular system & hematology, MESH: Anticoagulants, MESH: Intention to Treat Analysis, MESH: Venous Thromboembolism, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Edoxaban, medicine, MESH: Double-Blind Method, 030212 general & internal medicine, MESH: Warfarin, MESH: Kaplan-Meier Estimate, MESH: Aged, Rivaroxaban, Acenocoumarol, MESH: Humans, MESH: Middle Aged, business.industry, Warfarin, MESH: Injections, Subcutaneous, MESH: Vitamin K, General Medicine, Vitamin K antagonist, MESH: Thiophenes, medicine.disease, MESH: Male, 3. Good health, Venous thrombosis, chemistry, Anesthesia, MESH: Administration, Oral, MESH: Venous Thrombosis, MESH: Acute Disease, Apixaban, MESH: Acenocoumarol, business, MESH: Female, MESH: Hemorrhage, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug, Andexanet alfa
Abstract: Background: Rivaroxaban, an oral factor Xa inhibitor, may provide a simple, fixed-dose regimen for treating acute deep-vein thrombosis (DVT) and for continued treatment, without the need for laboratory monitoring. Methods: We conducted an open-label, randomized, event-driven, noninferiority study that compared oral rivaroxaban alone (15 mg twice daily for 3 weeks, followed by 20 mg once daily) with subcutaneous enoxaparin followed by a vitamin K antagonist (either warfarin or acenocoumarol) for 3, 6, or 12 months in patients with acute, symptomatic DVT. In parallel, we carried out a double-blind, randomized, event-driven superiority study that compared rivaroxaban alone (20 mg once daily) with placebo for an additional 6 or 12 months in patients who had completed 6 to 12 months of treatment for venous thromboembolism. The primary efficacy outcome for both studies was recurrent venous thromboembolism. The principal safety outcome was major bleeding or clinically relevant nonmajor bleeding in the initial-treatment study and major bleeding in the continued-treatment study. Results: The study of rivaroxaban for acute DVT included 3449 patients: 1731 given rivaroxaban and 1718 given enoxaparin plus a vitamin K antagonist. Rivaroxaban had noninferior efficacy with respect to the primary outcome (36 events [2.1%], vs. 51 events with enoxaparin-vitamin K antagonist [3.0%]; hazard ratio, 0.68; 95% confidence interval [CI], 0.44 to 1.04; P
Published: 2010
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49. Is N-terminal pro-brain natriuretic peptide superior to clinical scores for risk stratification in non-massive pulmonary embolism?

Author: Nicolas Vuilleumier, Denis F. Hochstrasser, Drahomir Aujesky, Henri Bounameaux, G. Le Gal, Marc Philip Righini, Jean-Christophe Cornily, Division of Laboratory Medicine (DLM), Geneva University Hospital (HUG), 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), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de Cardiologie (CHRU - Cardio), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, Division of General Internal Medicine, and Université de Lausanne (UNIL)
Subjects: MESH: Pulmonary Embolism, medicine.medical_specialty, medicine.drug_class, MEDLINE, 030204 cardiovascular system & hematology, MESH: Risk Assessment, Risk Assessment, Sensitivity and Specificity, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Pulmonary Embolism/*blood, Natriuretic Peptide, Brain, medicine, Natriuretic peptide, Natriuretic Peptide, Brain/*blood, Humans, 030212 general & internal medicine, MESH: Natriuretic Peptide, Brain, ddc:576, MESH: Peptide Fragments, ComputingMilieux_MISCELLANEOUS, ddc:616, MESH: Humans, business.industry, MESH: Biological Markers, Peptide Fragments/*blood, Hematology, medicine.disease, MESH: Sensitivity and Specificity, Peptide Fragments, Pulmonary embolism, Institutional repository, Risk stratification, Cardiology, Biological Markers/*blood, business, Risk assessment, Pulmonary Embolism, N-terminal pro-Brain Natriuretic Peptide, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Biomarkers
Abstract: International audience
Published: 2010
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50. Potential of an age adjusted D-dimer cut-off value to improve the exclusion of pulmonary embolism in older patients: a retrospective analysis of three large cohorts

Author: Pieter Willem Kamphuisen, Marieke J. H. A. Kruip, Marc Philip Righini, Pierre-Marie Roy, Grégoire Le Gal, Henri Bounameaux, Renée A. Douma, Maaike Sohne, Harry R. Büller, Arnaud Perrier, Department of Vascular Medicine (DVM - AMC), Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), University of Amsterdam [Amsterdam] (UvA)-University of Amsterdam [Amsterdam] (UvA), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, Division of Internal General Medicine (DIGM), University of Geneva [Switzerland], Department of Haematology (DH - Rotterdam), Erasmus Medical Centre, Centre de Recherche Clinique (CRC Angers), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Faculteit der Geneeskunde, Hematology, Cardiovascular Centre (CVC), Vascular Ageing Programme (VAP), Vascular Medicine, and ACS - Amsterdam Cardiovascular Sciences
Subjects: Male, MESH: Pulmonary Embolism, validity, Pediatrics, retrospective study, 030204 cardiovascular system & hematology, 0302 clinical medicine, MESH: Aged, 80 and over, Belgium, Older patients, Medicine, 030212 general & internal medicine, Biological Markers/blood, comparative study, Netherlands, General Environmental Science, ddc:616, Aged, 80 and over, MESH: Aged, receiver operating characteristic, MESH: Middle Aged, article, Age Factors, General Engineering, General Medicine, Middle Aged, Reference Standards, cohort analysis, 3. Good health, Pulmonary embolism, priority journal, D dimer, Female, MESH: Reference Standards, diagnostic value, France, lung embolism, Switzerland, Cohort study, Adult, medicine.medical_specialty, Age adjustment, Pulmonary Embolism/*diagnosis, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, D-dimer, MESH: Fibrin Fibrinogen Degradation Products, false negative result, Humans, controlled study, Fibrin Fibrinogen Degradation Products/*analysis, human, Derivation, Aged, Retrospective Studies, MESH: Age Factors, MESH: Humans, Receiver operating characteristic, business.industry, MESH: Biological Markers, Retrospective cohort study, MESH: Adult, MESH: Retrospective Studies, MESH: ROC Curve, medicine.disease, major clinical study, MESH: Male, ROC Curve, General Earth and Planetary Sciences, Pulmonary Embolism, business, MESH: Female, Biomarkers, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Objectives In older patients, the the D-dimer test for pulmonary embolism has reduced specificity and is therefore less useful. In this study a new, age dependent cut-off value for the test was devised and its usefulness with older patients assessed. Design Retrospective multicentre cohort study. Setting General and teaching hospitals in Belgium, France, the Netherlands, and Switzerland. Patients 5132 consecutive patients with clinically suspected pulmonary embolism. Intervention Development of a new D-dimer cut-off point in patients aged >50 years in a derivation set (data from two multicentre cohort studies), based on receiver operating characteristics (ROC) curves. This cut-off value was then validated with two independent validation datasets. Main outcome measures The proportion of patients in the validation cohorts with a negative D-dimer test, the proportion in whom pulmonary embolism could be excluded, and the false negative rates. Results The new D-dimer cut-off value was defined as (patient's age x 10) mu g/l in patients aged >50. In 1331 patients in the derivation set with an "unlikely" score from clinical probability assessment, pulmonary embolism could be excluded in 42% with the new cut-off value versus 36% with the old cut-off value (70 years, ranging from 13% to 16% in the three datasets. The failure rates (all ages) were 0.2% (95% CI 0% to 1.0%) in the derivation set and 0.6% (0.3% to 1.3%) and 0.3% (0.1% to 1.1%) in the two validation sets. Conclusions The age adjusted D-dimer cut-off point, combined with clinical probability, greatly increased the proportion of older patients in whom pulmonary embolism could be safely excluded.
Published: 2010
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