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1. Risk of recurrence after discontinuing anticoagulation in patients with COVID-19- associated venous thromboembolism: a prospective multicentre cohort studyResearch in context

Author

Luis Jara-Palomares, Behnood Bikdeli, David Jiménez, Alfonso Muriel, Pablo Demelo-Rodríguez, Farès Moustafa, Aurora Villalobos, Patricia López-Miguel, Luciano López-Jiménez, Sonia Otálora, María Luisa Peris, Cristina Amado, Romain Chopard, Francisco Rivera-Cívico, Manuel Monreal, María Dolores Adarraga, Ana Alberich Conesa, Jesús Aibar, Alicia Alda Lozano, Joaquín Alfonso, Jesús Alonso Carrillo, María Angelina García, Juan Ignacio Arcelus, Aitor Ballaz, Raquel Barba, María Barca Hernando, Cristina Barbagelata, Manuel Barrón, Belén Barrón Andrés, Fahd Beddar Chaib, María Ángeles Blanco Molina, Juan Carlos Caballero, Gonzalo Castellanos, Leyre Chasco, Juan Criado, Cristina de Ancos, Jorge del Toro, Pablo Demelo Rodríguez, Cristina de Juana Izquierdo, Ana María Díaz Brasero, José Antonio Díaz Peromingo, Álvaro Dubois Silva, Juan Carlos Escribano, Concepción Falgá, Ana Isabel Farfán Sedano, Cleofe Fernández Aracil, Carmen Fernández Capitán, Begoña Fernández Jiménez, José Luis Fernández Reyes, María Ángeles Fidalgo, Iria Francisco, Cristina Gabara, Francisco Galeano Valle, Francisco García Bragado, Alberto García Ortega, Olga Gavín Sebastián, María Allende Gil de Gómez, Aída Gil Díaz, Covadonga Gómez Cuervo, Adriana González Munera, Enric Grau, Leticia Guirado, Javier Gutiérrez, Luis Hernández Blasco, Luis Jara Palomares, María Jesús Jaras, Rafael Jiménez, Inés Jou, María Dolores Joya, Sara Lainez Justo, Antonio Lalueza, Ramón Lecumberri, José Manuel León Ramírez, Pilar Llamas, José Luis Lobo, Luciano López Jiménez, Patricia López Miguel, Juan José López Núñez, Antonio López Ruiz, Juan Bosco López Sáez, Alicia Lorenzo, Marina Lumbierres, Olga Madridano, Ana Maestre, Pablo Javier Marchena, María Marcos, Mar Martín del Pozo, Francisco Martín Martos, Jorge Manuel Maza, Elisabeth Mena, Maria Isabel Mercado, Jorge Moisés, María del Valle Morales, Maria Sierra Navas, José Antonio Nieto, Manuel Jesús Núñez Fernández, Mónica Olid, Lucía Ordieres Ortega, María Ortiz, Jeisson Osorio, Remedios Otero, Nazaret Pacheco Gómez, Javier Pagán, Andrea Catalina Palomeque, Ezequiel Paredes, Pedro Parra Caballero, José María Pedrajas, Cristina Pérez Ductor, Montserrat Pérez Pinar, María Lourdes Pesce, José Antonio Porras, Ramón Puchades, Francisco Rivera Cívico, Ana Rodríguez Cobo, Vladimir Rosa, Marta Romero Brugera, Pedro Ruiz Artacho, Nuria Ruiz Giménez, Justo Ruiz Ruiz, Georgina Salgueiro, Teresa Sancho, Vanesa Sendín, Patricia Sigüenza, Silvia Soler, Susana Suárez Fernández, Raimundo Tirado, Ana Torrents Vilar, María Isabel Torres, Javier Trujillo Santos, Fernando Uresandi, Reina Valle, José Felipe Varona, Paula Villares, Cihan Ay, Stephan Nopp, Ingrid Pabinger, Matthias Engelen, Thomas Vanassche, Peter Verhamme, Hugo Hyung Bok Yoo, Ana Cristina Montenegro, Silvia Natalia Morales, Jairo Roa, Jana Hirmerova, Radovan Malý, Laurent Bertoletti, Alessandra Bura-Riviere, Judith Catella, Francis Couturaud, Olivier Espitia, Claire Grange, Barbara Leclercq, Raphael Le Mao, Isabelle Mahé, Ludovic Plaisance, Gabrielle Sarlon Bartoli, Pierre Suchon, Edouard Versini, Sebastian Schellong, Benjamin Brenner, Najib Dally, Inna Tzoran, Parham Sadeghipour, Fahrid Rashidi, Alessia Abenante, Giovanni Barillari, Manuela Basaglia, Franca Bilora, Daniele Bissacco, Cristiano Bortoluzzi, Barbara Brandolin, Renato Casana, Maurizio Ciammaichella, Donatella Colaizzo, Francesco Dentali, Pierpaolo Di Micco, Elvira Grandone, Egidio Imbalzano, Daniela Lambertenghi Deliliers, Federica Negro, Raffaele Pesavento, Alessandra Poz, Paolo Prandoni, Paolo Scarinzi, Carmine Siniscalchi, Beldisa Taflaj, Antonella Tufano, Adriana Visonà, Ngoc Vo Hong, Beniamino Zalunardo, Andris Skride, Dana Kigitovica, Samuel Fonseca, Rafael Marques, José Meireles, Sara Barbosa Pinto, Marijan Bosevsky, Aleksandra Eftimova, Marijan Zdraveska, Henri Bounameaux, Lucia Mazzolai, Avinash Aujayeb, Joseph Caprini, Ido Weinberg, and Hanh My Bui

Subjects
Pulmonary embolism, Venous thromboembolism, Anticoagulation, COVID-19, SARS-CoV-2, Medicine (General), R5-920
Abstract

Summary: Background: The clinical relevance of recurrent venous thromboembolism (VTE) after discontinuing anticoagulation in patients with COVID-19-associated VTE remains uncertain. We estimated the incidence rates and mortality of VTE recurrences developing after discontinuing anticoagulation in patients with COVID-19-associated VTE. Methods: A prospective, multicenter, non-interventional study was conducted between March 25, 2020, and July 26, 2023, including patients who had discontinued anticoagulation after at least 3 months of therapy. All patients from the registry were analyzed during the study period to verify inclusion criteria. Patients with superficial vein thrombosis, those who did not receive at least 3 months of anticoagulant therapy, and those who were followed for less than 15 days after discontinuing anticoagulation were excluded. Outcomes were: 1) Incidence rates of symptomatic VTE recurrences, and 2) fatal PE. The rate of VTE recurrences was defined as the number of patients with recurrent VTE divided by the patient-years at risk of recurrent VTE during the period when anticoagulation was discontinued. Findings: Among 1106 patients with COVID-19-associated VTE (age 62.3 ± 14.4 years; 62.9% male) followed-up for 12.5 months (p25-75, 6.3–20.1) after discontinuing anticoagulation, there were 38 VTE recurrences (3.5%, 95% confidence interval [CI]: 2.5–4.7%), with a rate of 3.1 per 100 patient-years (95% CI: 2.2–4.2). No patient died of recurrent PE (0%, 95% CI: 0–7.6%). Subgroup analyses showed that patients with diagnosis in 2021–2022 (vs. 2020) (Hazard ratio [HR] 2.86; 95% CI 1.45–5.68) or those with isolated deep vein thrombosis (vs. pulmonary embolism) (HR 2.31; 95% CI 1.19–4.49) had significantly higher rates of VTE recurrences. Interpretation: In patients with COVID-19-associated VTE who discontinued anticoagulation after at least 3 months of treatment, the incidence rate of recurrent VTE and the case-fatality rate was low. Therefore, it conceivable that long-term anticoagulation may not be required for many patients with COVID-19-associated VTE, although further research is needed to confirm these findings. Funding: Sanofi and Rovi, Sanofi Spain.

Published
2024
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2. Thromboembolic Complications in COVID-19 Patients Hospitalized in Italian Ordinary Wards: Data from the Multicenter Observational START-COVID Register

Author

Daniela Poli, Emilia Antonucci, Walter Ageno, Paolo Prandoni, Giovanni Barillari, Giuseppina Bitti, Egidio Imbalzano, Eugenio Bucherini, Antonio Chistolini, Vittorio Fregoni, Silvia Galliazzo, Alberto Gandolfo, Elisa Grifoni, Franco Mastroianni, Serena Panarello, Raffaele Pesavento, Simona Pedrini, Girolamo Sala, Pasquale Pignatelli, Paola Preti, Federico Simonetti, Piera Sivera, Adriana Visonà, Sabina Villalta, Rossella Marcucci, and Gualtiero Palareti

Subjects
covid-19, venous thromboembolism, bleeding, thromboprophylaxis, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background Coronavirus disease 2019 (COVID-19) infection causes acute respiratory insufficiency with severe interstitial pneumonia and extrapulmonary complications; in particular, it may predispose to thromboembolic disease. The reported incidence of thromboembolic complications varies from 5 to 30% of cases. Aim We conducted a multicenter, Italian, retrospective, observational study on COVID-19 patients admitted to ordinary wards, to describe the clinical characteristics of patients at admission and bleeding and thrombotic events occurring during the hospital stay. Results The number of hospitalized patients included in the START-COVID-19 Register was 1,135, and the number of hospitalized patients in ordinary wards included in the study was 1,091, with 653 (59.9%) being males and 71 years (interquartile range 59–82 years) being the median age. During the observation, two (0.2%) patients had acute coronary syndrome episodes and one patient (0.1%) had an ischemic stroke; no other arterial thrombotic events were recorded. Fifty-nine patients had symptomatic venous thromboembolism (VTE) (5.4%) events, 18 (30.5%) deep vein thrombosis (DVT), 39 (66.1%) pulmonary embolism (PE), and 2 (3.4%) DVT+PE. Among patients with DVT, eight (44.4%) were isolated distal DVT and two cases were jugular thrombosis. Among patients with PE, seven (17.9%) events were limited to subsegmental arteries. No fatal PE was recorded. Major bleeding events occurred in nine (1.2%) patients and clinically relevant nonmajor bleeding events in nine (1.2%) patients. All bleeding events occurred among patients receiving thromboprophylaxis, more frequently when treated with subtherapeutic or therapeutic dosages. Conclusion Our findings confirm that patients admitted to ordinary wards for COVID-19 infection are at high risk for thromboembolic events. VTE recorded among these patients is mainly isolated PE, suggesting a peculiar characteristic of VTE in these patients.

Published
2022
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3. Treatment of venous thromboembolism in pregnancy: findings from the RIETE Registry

Author

Paolo Prandoni, Franca Bilora, Raffaele Pesavento, Giorgina Salgueiro, Angeles Blanco-Molina, Raquel Lòpez-Reyes, Manuel Monreal, and and the RIETE Investigators

Subjects
Venous thromboembolism, Pregnancy, Low-molecular- weight heparin, Anticoagulation, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Venous thromboembolism (VTE) is one of the leading cardiovascular etiologies of maternal morbidity and mortality. Indeed, pulmonary embolism (PE) accounts for approximately 9% of pregnancy-related deaths. In addition, pregnancy-related deep-vein thrombosis (DVT) can lead to (severe) post-thrombotic syndrome [...]

Published
2022
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6. Lipid Profile and Vascular Remodelling in Young Dyslipidemic Subjects Treated with Nutraceuticals Derived from Red Yeast Rice

Author

Massimo Puato, Alberto Zambon, Chiara Nardin, Elisabetta Faggin, Raffaele Pesavento, Alice Spinazzè, Paolo Pauletto, and Marcello Rattazzi

Subjects
Therapeutics. Pharmacology, RM1-950, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background and Aims. A relevant role is emerging for functional foods in cardiovascular prevention. The aim of this study was to assess the effect of a nutraceutical multitargeted approach on lipid profile and inflammatory markers along with vascular remodelling in a cohort of dyslipidemic subjects without history of cardiovascular (CV) disease. Methods and Results. We enrolled 25 subjects (mean age 48.2 years) with low to moderate CV risk profile and total cholesterol (TC) levels between 150 and 250 mg/dl. The patients were assigned to receive for one year a tablet/die of a nutraceutical combination containing red yeast rice (RYR) extract (Monacolin 3 mg/tablet) and coenzyme Q10 (30 mg/tablet). Treatment with the nutraceutical compounds led to a significant reduction of TC (from 227 to 201 mg/dl, p

Published
2021
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7. Intima-media thickness remodelling in hypertensive subjects with long-term well-controlled blood pressure levels

Author

Massimo Puato, Giovanni Boschetti, Marcello Rattazzi, Marta Zanon, Raffaele Pesavento, Elisabetta Faggin, Claudio Fania, Elisabetta Benetti, Paolo Palatini, and Paolo Pauletto

Subjects
carotid artery, hypertension, intima-media thickness, ultrasound, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Aim of this study was to evaluate in a long follow-up the carotid artery remodelling in a cohort of young hypertensive subjects having good blood pressure (BP) control. We studied 20 grade I hypertensives (HT) by assessing the B-mode ultrasound of mean carotid intima-media thickness (mean-IMT) and maximum IMT (M-MAX) in each carotid artery segment (common, bulb, internal), bilaterally. We compared their ultrasound measurements with those recorded 5 and 10 years earlier. While the first 5-year follow-up was observational, in the second 5-year follow-up, lifestyle modifications and/or pharmacological therapy were started to obtain well-controlled BP levels. Office BP was measured at the time of the ultrasound studies and every 6 months during the follow-up. BP levels were: 10 years 144/91 mmHg, 5 years 143/90 mmHg and 129 ± 79 mmHg at the time of the study. In the first 5-year observational follow-up, both mean-IMT and M-MAX increased (Δ 0.116 and Δ 0.165 mm, respectively, p

Published
2017
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9. Heart Rate and Mortality in Patients With Acute Symptomatic Pulmonary Embolism

Author

G. Pellejero, Jose Gutierrez, R. Malý, M. Basaglia, L. Chasco, P. Suchon, R. Le Mao, Laurent Bertoletti, F. Martins, J. Caprini, A. Braester, F. Galeano-Valle, Hanh My Bui, J. Alonso, Y. Sato, G. Vidal, Y. Nishimoto, C. Tolosa, E. Nofuentes-Pérez, A.M. Díaz-Brasero, N. Ait Abdallah, M.D. Adarraga, R. Sánchez-Martínez, L. Font, Raquel López-Reyes, Inna Tzoran, Karine Lacut, J. del Toro, Andris Skride, Ana Jaureguizar, Joseph A. Caprini, C. Amado, R. García de la Garza, A.M. Camon, S. Merla, Luciano López-Jiménez, G. Salgueiro, Sebastian Schellong, Alfonso Muriel, F. Bilora, S. Lainez-Justo, B. Suárez-Rodríguez, Carme Font, F. Beddar Chaib, I. Francisco, C. Jiménez-Alfaro, P. Azcarate-Agüero, Maurizio Ciammaichella, J.A. Porras, N. Vo Hong, F. Martín-Martos, Dominique Farge-Bancel, D. Farge-Bancel, José Luis Lobo, M. Giménez-Suau, E. Grau, F. García-Bragado, Ángeles Blanco-Molina, Carmen Fernández-Capitán, María del Carmen Díaz-Pedroche, C. Grange, Adriana Visonà, L. Guirado, P. Villares, P. López-Miguel, José María Pedrajas, S. Accassat, Beatriz Valero, B. Crichi, Juan J. López-Núñez, Luis Jara-Palomares, G. Sarlon-Bartoli, J. Lima, C. Bortoluzzi, Alicia Lorenzo, C. de Ancos, M.A. Fidalgo, Philippe Debourdeau, Pablo Javier Marchena, C. Rodríguez-Matute, A.I. Farfán-Sedano, José Luis Fernández-Reyes, J.C. Escribano, Juan I. Arcelus, M. Barrón, I. Quere, Remedios Otero, A. De Angelis, P. Morange, Peter Verhamme, G. Kenet, P. Prandoni, Pedro Ruiz-Artacho, C. Siniscalchi, A. Zaicenko, M. Olid-Velilla, C. García-Díaz, B. Barrón-Andrés, T. Sancho, Fernando Uresandi, Javier Trujillo-Santos, A. Muñoz-Blanco, A. Villalobos, A. Dubois-Silva, J. Moisés, J. Osorio, M.I. Mercado, J.M. Suriñach, M.A. Aibar, M.D. Joya, Cihan Ay, J.A. Díaz-Peromingo, H. Bounameaux, Diego Martínez-Urbistondo, Thomas Vanassche, L. Bertoletti, Marijan Bosevski, Farès Moustafa, M. Martín del Pozo, J.F. Sánchez-Muñoz-Torrero, H.M. Bui, Ingrid Pabinger, M.C. Olivares, M. García de Herreros, M.J. Núñez-Fernández, B. Zalunardo, J.F. Varona, Stephan Nopp, Behnood Bikdeli, B. Brandolin, B. Bikdeli, Olga Madridano, Manuel Monreal, M.J. Jaras, Alessandra Bura-Rivière, Abílio Reis, J. Portillo, O. Espitia, J. Catella, Aitor Ballaz, F. Esposito, R. Barba, R. Valle, H. Helfer, I. Tzoran, J.B. López-Sáez, P. Ruiz-Artacho, M.A. García, J. Aibar, C. Gómez-Cuervo, C. Gabara, A. Latorre, J. Ruiz-Ruiz, Benjamin Brenner, S. Fonseca, S. Schellong, Raffaele Pesavento, Barry M. Brenner, Silvia Soler, Paolo Prandoni, Victor F. Tapson, Ana Maestre, Pierpaolo Di Micco, M. Muñoz, J. Criado, D. Jiménez, Antonella Tufano, G. Krstevski, B. Valero, Henri Bounameaux, M.I. Torres, G. Poenou, Isabelle Mahé, Aída Gil-Díaz, A. Asuero, S. Otalora, V. Rosa, L. Vela, E. Imbalzano, C. Vandenbriele, C. Barbagelata, Jana Hirmerova, J. Meireles, David Jiménez, Lucia Mazzolai, L. Hernández-Blasco, M. Bosevski, Gili Kenet, C. Mella, M. Monreal, J.R. Vela, P. Di Micco, Carlos Zamora, K. Flores, P. Demelo-Rodríguez, Radovan Malý, J. Birzulis, J.A. Nieto, J. Castro, M.V. Di Campli, Francis Couturaud, Raquel Barba, Jaureguizar, A., Jimenez, D., Bikdeli, B., Ruiz-Artacho, P., Muriel, A., Tapson, V., Lopez-Reyes, R., Valero, B., Kenet, G., Monreal, M., Prandoni, P., Brenner, B., Farge-Bancel, D., Barba, R., Di Micco, P., Bertoletti, L., Schellong, S., Tzoran, I., Reis, A., Bosevski, M., Bounameaux, H., Maly, R., Verhamme, P., Caprini, J. A., Bui, H. M., Adarraga, M. D., Aibar, J., Aibar, M. A., Alonso, J., Amado, C., Arcelus, J. I., Asuero, A., Azcarate-Aguero, P., Ballaz, A., Barbagelata, C., Barron, M., Barron-Andres, B., Blanco-Molina, A., Beddar Chaib, F., Camon, A. M., Castro, J., Chasco, L., Criado, J., de Ancos, C., del Toro, J., Demelo-Rodriguez, P., Diaz-Brasero, A. M., Diaz-Pedroche, M. C., Diaz-Peromingo, J. A., Di Campli, M. V., Dubois-Silva, A., Escribano, J. C., Esposito, F., Farfan-Sedano, A. I., Fernandez-Capitan, C., Fernandez-Reyes, J. L., Fidalgo, M. A., Flores, K., Font, C., Font, L., Francisco, I., Gabara, C., Galeano-Valle, F., Garcia, M. A., Garcia-Bragado, F., Garcia de Herreros, M., Garcia de la Garza, R., Garcia-Diaz, C., Gil-Diaz, A., Gomez-Cuervo, C., Gimenez-Suau, M., Grau, E., Guirado, L., Gutierrez, J., Hernandez-Blasco, L., Jara-Palomares, L., Jaras, M. J., Jimenez-Alfaro, C., Joya, M. D., Lainez-Justo, S., Latorre, A., Lima, J., Lobo, J. L., Lopez-Jimenez, L., Lopez-Miguel, P., Lopez-Nunez, J. J., Lopez-Saez, J. B., Lorenzo, A., Madridano, O., Maestre, A., Marchena, P. J., Martin del Pozo, M., Martin-Martos, F., Martinez-Urbistondo, D., Mella, C., Mercado, M. I., Moises, J., Munoz, M., Munoz-Blanco, A., Nieto, J. A., Nofuentes-Perez, E., Nunez-Fernandez, M. J., Olid-Velilla, M., Olivares, M. C., Osorio, J., Otalora, S., Otero, R., Pedrajas, J. M., Pellejero, G., Porras, J. A., Portillo, J., Rodriguez-Matute, C., Rosa, V., Ruiz-Ruiz, J., Salgueiro, G., Sanchez-Martinez, R., Sanchez-Munoz-Torrero, J. F., Sancho, T., Soler, S., Suarez-Rodriguez, B., Surinach, J. M., Torres, M. I., Tolosa, C., Trujillo-Santos, J., Uresandi, F., Valle, R., Varona, J. F., Vela, L., Vela, J. R., Vidal, G., Villalobos, A., Villares, P., Zamora, C., Ay, C., Nopp, S., Pabinger, I., Vanassche, T., Vandenbriele, C., Hirmerova, J., Accassat, S., Ait Abdallah, N., Bura-Riviere, A., Catella, J., Couturaud, F., Crichi, B., Debourdeau, P., Espitia, O., Grange, C., Helfer, H., Lacut, K., Le Mao, R., Mahe, I., Morange, P., Moustafa, F., Poenou, G., Sarlon-Bartoli, G., Suchon, P., Quere, I., Braester, A., Basaglia, M., Bilora, F., Bortoluzzi, C., Brandolin, B., Ciammaichella, M., De Angelis, A., Imbalzano, E., Merla, S., Pesavento, R., Siniscalchi, C., Tufano, A., Visona, A., Vo Hong, N., Zalunardo, B., Nishimoto, Y., Sato, Y., Birzulis, J., Skride, A., Zaicenko, A., Fonseca, S., Martins, F., Meireles, J., Krstevski, G., and Mazzolai, L.

Subjects
Male, Registrie, Pulmonary and Respiratory Medicine, medicine.medical_specialty, pulmonary embolism, Critical Care and Intensive Care Medicine, Logistic regression, Heart Rate, Internal medicine, Heart rate, medicine, In patient, Aged, Aged, 80 and over, business.industry, medicine.disease, mortality, Pulmonary embolism, Prospective Studie, Increased risk, Spain, Cardiology, Positive relationship, Female, Cardiology and Cardiovascular Medicine, business, Human
Abstract

Background: The association between heart rate (HR) and pulmonary embolism (PE) outcomes has not been well studied. Furthermore, optimal cutoffs to identify low-risk and intermediate- to high-risk patients are not well known. Research Question: Does an association exist between baseline HR and PE outcome across the continuum of HR values? Study Design and Methods: The current study included 44,331 consecutive nonhypotensive patients with symptomatic PE from the Registro Informatizado de la Enfermedad TromboEmbólica registry between 2001 and 2021. Outcomes included 30-day all-cause and PE-specific mortality. We used hierarchical logistic regression to assess the association between admission HR and outcomes. Results: A positive relationship was found between admission HR and 30-day all-cause and PE-related mortality. Considering an HR of 80 to 99 beats/min as a reference, patients in the higher HR strata showed higher rates of all-cause death (adjusted OR, 1.5 for HR of 100-109 beats/min; adjusted OR, 1.7 for HR of 110-119 beats/min; adjusted OR, 1.9 for HR of 120-139 beats/min; and adjusted OR, 2.4 for HR of ≥ 140 beats/min). Patients in the lower strata of HR showed significantly lower rates of 30-day all-cause mortality compared with the same reference group (adjusted OR, 0.6 for HR of 60-79 beats/min; and adjusted OR, 0.5 for HR of < 60 beats/min). The findings for 30-day PE-related mortality were similar. For identification of low-risk patients, a cutoff value of 80 beats/min (vs 110 beats/min) increased the sensitivity of the simplified Pulmonary Embolism Severity Index (sPESI) from 93.4% to 98.8%. For identification of intermediate- to high-risk patients, a cutoff value of 140 beats/min (vs 110 beats/min) increased the specificity of the Bova score from 93.2% to 98.0%. Interpretation: In nonhypotensive patients with acute symptomatic PE, a high HR portends an increased risk of all-cause and PE-related mortality. Modifying the HR cutoff in the sPESI and the Bova score improves prognostication of patients with PE.

Published
2022
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10. Low in-hospital mortality rate in patients with COVID-19 receiving thromboprophylaxis: data from the multicentre observational START-COVID Register

Author

Rossella, Marcucci, Poli, Daniela, SOD Malattie Aterotrombotiche, Azienda Ospedaliero Universitaria-Careggi, Walter Ageno, Firenze., Giovanna, Colombo, UOSD Degenza Breve, e Internistica, Centro trombosi Ospedale di Circolo, Chiara Ambaglio, Varese., UOSD SIMT Servizio di Immunoematologia, e Medicina Trasfusionale, Ospedale di Treviglio, – Caravaggio, ASST Bergamo Ovest, Guido Arpaia, Bergamo., Giovanni Barillari, U. O. Medicina Interna Carate Brianza ASST-Vimercate., SOS di Dipartimento 'Malattie Emorragiche, e Trombotiche, Azienda Sanitaria Universitaria Friuli Centrale, Giuseppina Bitti, Presidio Ospedaliero Universitario 'Santa Maria della Misericordia'. Udine., Giuseppe Pio Martino Medicina Interna Ospedale Civile di Fermo, Eugenio Bucherini, Fermo (Ancona)., Antonio Chistolini, Monica Vastola— SS Az. le di Angiologia Faenza (RA) AUSL Romagna., Alessandra, Serrao, Dipartimento di Medicina Traslazionale, e di Precisione, Egidio De Gaudenzi, Sapienza Universita di Roma., Valeria De Micheli, SOC Medicina Interna Ospedale San Biagio – Domodossola., Anna Falanga, Ambulatorio Emostasi—Azienda Ospedaliera Di Lecco., Teresa, Lerede, Luca, Barcella, Laura, Russo, Usc, Simt, Centro Emostasi, e Trombosi, Ospedale Papa Giovanni XXIII, Vittorio Fregoni, Bergamo., Medicina Generale, U. O. C., Silvia Galliazzo, ASST Valtellina e Alto Lario Ospedale di Sondalo., UOC Medicina Generale, Ospedale San Valentino, Alberto Gandolfo, Montebelluna (TV)., Gianni, Biolo, Valentina, Trapletti, SC (UCO) Clinica Medica, Azienda sanitaria universitaria Giuliano Isontina (ASU GI)—Ospedale di Cattinara, Trieste, Ghigliotti, Giorgio, Elisa Grifoni, Clinica Delle Malattie Dell'apparato Cardiovascolare Policlinico San Martino Genova., Luca, Masotti, Medicina Interna, 2, Ospedale San Giuseppe, Egidio Imbalzano, Empoli (Fi)., UOC Medicina Interna, Gianfranco Lessiani, Policlinico di Messina., Unita, Angiologica, Dipartimento di Medicina, e Geriatria, Ospedale, Citta, Sant'Angelo, Niccolo Marchionni, Pescara., SOD Cardiologia Generale, Dipartimento, Cardiotoracovascolare, Aou, Careggi, Giuliana Martini, Firenze., Sara, Merelli, Nicola Portesi Centro Emostasi, Spedali Civili Di Brescia, Franco, Mastroianni, Giovanni, Larizza, Covid, Unit, Miulli, EE Ospedale Generale F., Carlo Nozzoli, Acquaviva delle Fonti (Ba)., SOD Medicina Interna, 1, Dipartimento di Emergenza AOU- Careggi, Serena Panarello, Firenze., Fioravanti, Chiara, SC Medicina Interna, Galliera, Eo, Simona Pedrini, Genova., Federica, Bertola, Servizio di Laboratorio, Istituto Ospedaliero Fondazione Poliambulanza, Raffaele Pesavento, Brescia., Filippo Pieralli, Davide Ceccato UO Clinica Medica 3 Azienda Ospedaliero Universitaria Padova., SOD Medicina Interna ad alta intensita, Dipartimento di Emergenza, AOU-, Careggi, Pasquale Pignatelli, Firenze., Daniele, Pastori, Centro, Trombosi, Clinica Medica, I, Paola Preti, Universita La Sapienza Roma., Centro Emostasi, e Trombosi Medicina Generale II, Matteo, IRCCS Fondazione Policlinico S., Elias Romano, Pavia., Alessandro, Morettini, Girolamo Sala, AOU-Careggi Firenze., Fabrizio, Foieni, Michela, Provisone, UOC Medicina II, Luca Sarti, Ospedale di Circolo Busto Arsizio (Va)., Antonella, Caronna, Struttura complessa di medicina interna ed area critica, Federico Simonetti, Ospedale di Baggiovara (Mo)., Ilaria, Bertaggia, Piera Sivera, UOC Ematologia Aziendale – Ospedale Versilia –Lido di Camaiore (Lucca)., Carmen, Fava, Ematologia e terapie cellulari, S. C. D. U., Viviana Scancassani, AO Ordine Mauriziano Umberto 1° Torino., Michele Spinicci, ASST Valtellina UOC di Medicina Sondrio., Alessio, Bartoloni, SOD Malattie Infettive, e Tropicali, Adriana Visona, Firenze., Beniamino, Zalunardo, Uoc, Angiologia, Ospedale San Giacomo Apostolo, Sabina Villalta, Castelfranco Veneto (Treviso)., and Castelfranco Veneto, (Treviso).

Subjects
Heparin, Anticoagulants, COVID-19, Antithrombotic, COVID-19 disease, Mortality, Hemorrhage, Venous Thromboembolism, Heparin, Low-Molecular-Weight, Im - Original, COVID-19 disease, Antithrombotic, Heparin, Mortality, Fibrinolytic Agents, Emergency Medicine, Internal Medicine, Humans, Hospital Mortality, Pulmonary Embolism, Retrospective Studies
Abstract

COVID-19 infection causes respiratory pathology with severe interstitial pneumonia and extra-pulmonary complications; in particular, it may predispose to thromboembolic disease. The current guidelines recommend the use of thromboprophylaxis in patients with COVID-19, however, the optimal heparin dosage treatment is not well-established. We conducted a multicentre, Italian, retrospective, observational study on COVID-19 patients admitted to ordinary wards, to describe clinical characteristic of patients at admission, bleeding and thrombotic events occurring during hospital stay. The strategies used for thromboprophylaxis and its role on patient outcome were, also, described. 1091 patients hospitalized were included in the START-COVID-19 Register. During hospital stay, 769 (70.7%) patients were treated with antithrombotic drugs: low molecular weight heparin (the great majority enoxaparin), fondaparinux, or unfractioned heparin. These patients were more frequently affected by comorbidities, such as hypertension, atrial fibrillation, previous thromboembolism, neurological disease, and cancer with respect to patients who did not receive thromboprophylaxis. During hospital stay, 1.2% patients had a major bleeding event. All patients were treated with antithrombotic drugs; 5.4%, had venous thromboembolism [30.5% deep vein thrombosis (DVT), 66.1% pulmonary embolism (PE), and 3.4% patients had DVT + PE]. In our cohort the mortality rate was 18.3%. Heparin use was independently associated with survival in patients aged ≥ 59 years at multivariable analysis. We confirmed the high mortality rate of COVID-19 in hospitalized patients in ordinary wards. Treatment with antithrombotic drugs is significantly associated with a reduction of mortality rates especially in patients older than 59 years.

Published
2022
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11. Elastic compression stockings for prevention of the post-thrombotic syndrome in patients with and without residual vein thrombosis and/or popliteal valve reflux

Author

Raffaele Pesavento, Paolo Prandoni, Martin H. Prins, Franco Noventa, Daniela Tormene, Anthonie W. A. Lensing, Gualtiero Palareti, Sabina Villalta, RS: CAPHRI - R5 - Optimising Patient Care, Epidemiologie, and MUMC+: KIO Kemta (9)

Subjects
Venous Thrombosis, medicine.medical_specialty, Elastic compression, business.industry, Hematology, medicine.disease, Postthrombotic Syndrome, Surgery, Vein thrombosis, Disease Progression, medicine, Humans, Valve reflux, In patient, Letters to the Editor, business, Stockings, Compression, Post-thrombotic syndrome
Published
2022
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13. Weight-adjusted versus fixed dose heparin thromboprophylaxis in hospitalized obese patients: A systematic review and meta-analysis

Author

Roberto Vettor, Claudio Pagano, Davide Ceccato, Raffaele Pesavento, Paolo Prandoni, and Angelo Di Vincenzo

Subjects
medicine.medical_specialty, medicine.drug_class, Population, Low molecular weight heparin, 030204 cardiovascular system & hematology, Lower risk, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Internal Medicine, medicine, Humans, Obesity, Prospective Studies, cardiovascular diseases, 030212 general & internal medicine, Anti-Xa levels, Heparin, Thromboprophylaxis, Venous thromboembolism, Anticoagulants, Heparin, Low-Molecular-Weight, Retrospective Studies, Venous Thromboembolism, education, education.field_of_study, business.industry, Anticoagulant, Low-Molecular-Weight, Odds ratio, medicine.disease, Meta-analysis, business, medicine.drug
Abstract

Fixed dose unfractionated or low molecular weight heparin is the recommended treatment for venous thromboembolism (VTE) prevention in hospitalized patients. However, its efficacy has been questioned in obese population. Results of previous studies on weight-adjusted doses of heparin for VTE prevention are contradictory. Different anticoagulant regimens are used in clinical practice, but their role remains to be elucidated.To clarify the efficacy and safety of weight-adjusted dose heparin for VTE prevention in obese subjects hospitalized for medical and surgical conditions.Twelve studies were identified as reporting VTE occurrence, major or minor bleeding and anti-Xa levels. A random-effect meta-analysis was conducted to derive odds ratios (OR) comparing fixed vs weight adjusted-doses heparins on VTE occurrence, bleeding, anti-Xa levels. Medical and surgical patients, prospective vs retrospective and quality of studies were extracted for moderators and meta-regression analysis.Weight-adjusted dose heparin administration was not associated with reduced VTE occurrence (6320/13317 patients, OR 1.03, 95% C.I. 0.79 to 1.35), nor increased bleeding (5840/10906 patients, OR 0.84, 95% C.I. 0.65 to 1.08), but it was associated with higher anti-Xa levels (284/294 patients, ES 2.04, 95% C.I. 1.16 to 2.92, p0.0001). A significant heterogeneity was present for comparison of anti-Xa levels (IWeight-adjusted dose as compared to fixed-dose of heparins in the prevention of VTE in obese patients was not associated with a lower risk of VTE nor a higher risk of bleeding.

Published
2021
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14. Residual pulmonary vascular obstruction and recurrence after acute pulmonary embolism: a systematic review and meta-analysis of individual participant data

Author

Philippe Robin, Romain Le Pennec, Maggie Eddy, Lindsey Sikora, Pierre-Yves Le Roux, Marc Carrier, Francis Couturaud, Cécile Tromeur, Benjamin Planquette, Olivier Sanchez, Raffaele Pesavento, Lucia Filippi, Marc A. Rodger, Michael J. Kovacs, Ranjeeta Mallick, Pierre-Yves Salaun, and Grégoire Le Gal

Subjects
Hematology
Published
2023
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16. The hazard of (sub)therapeutic doses of anticoagulants in non‐critically ill patients with Covid‐19: The Padua province experience

Author

Paolo Simioni, Giampaolo Pasquetto, Anna Postal, Davide Gorgi, Anna Chiara Frigo, Angelo Avogaro, Lucia Leone, Giuseppe Maria Marchese, Federico Capone, Alois Saller, Jacopo Monticelli, Pietro Criveller, Paola Fioretto, Marco Rossato, Cristiano Sarais, Raffaele Pesavento, Paolo Prandoni, Claudio Pagano, Roberto Vettor, Davide Ceccato, Alberto Cipriani, and Marco Gemelli

Subjects
Male, anticoagulants, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Clinical Decision-Making, Hemorrhage, 030204 cardiovascular system & hematology, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Antithrombotic, Coagulopathy, Humans, Medicine, Blood Coagulation, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Incidence, Incidence (epidemiology), Medical record, Hazard ratio, COVID-19, Thrombosis, Original Articles, Venous Thromboembolism, Hematology, Middle Aged, bleeding, COVID‐19, venous thromboembolism, medicine.disease, Confidence interval, coronavirus 2019, COVID-19 Drug Treatment, Treatment Outcome, Italy, Relative risk, Original Article, Female, Patient Safety, business
Abstract

Background Coronavirus Disease 2019 (COVID-19) is responsible for a worldwide pandemic, with a high rate of morbidity and mortality. The increasing evidence of an associated relevant prothrombotic coagulopathy has resulted in an increasing use of antithrombotic doses higher than usual in COVID-19 patients. Information on the benefit/risk ratio of this approach is still lacking. Objective To assess the incidence of relevant bleeding complications in association with the antithrombotic strategy and its relationship with the amount of drug. Methods Consecutive COVID-19 patients admitted between February and April 2020 were included in a retrospective analysis. Major bleedings (MB) and clinically relevant non-major bleeding (CRNMB) were obtained from patient medical records and were adjudicated by an independent committee. Results Of the 324 patients who were recruited, 240 had been treated with prophylactic doses and 84 with higher doses of anticoagulants. The rate of the composite endpoint of MB or CRNMB was 6.9 per 100-person/months in patients who had been given prophylactic doses, and 26.4 per 100-person/months in those who had been prescribed higher doses (hazard ratio, 3.89; 95% confidence interval, 1.90-7.97). The corresponding rates for overall mortality were 12.2 and 20.1 per 100-person/months, respectively. Conclusions The rate of relevant bleeding events was high in patients treated with (sub)therapeutic doses of anticoagulants. In the latter group, overall mortality did not differ from that of patients treated with standard prophylactic doses and was even higher. Our result does not support a strategy of giving (sub)therapeutic doses of anticoagulants in non-critically ill patients with COVID-19.

Published
2020
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17. Abnormal ankle-brachial index (ABI) predicts primary and secondary cardiovascular risk and cancer mortality

Author

Francesco Avossa, Manlio Prior, B. Zalunardo, R. Martini, A. De Paoli, Claudio Cimminiello, S. Cuppini, S. Benazzi, N. Zanatta, Adriana Visonà, Raffaele Pesavento, Ugo Fedeli, and Diego Tonello

Subjects
medicine.medical_specialty, Disease, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Risk Factors, Neoplasms, Internal medicine, Internal Medicine, medicine, Humans, Ankle Brachial Index, In patient, 030212 general & internal medicine, Myocardial infarction, Stroke, Cancer mortality, business.industry, Hazard ratio, Cancer, Prognosis, medicine.disease, medicine.anatomical_structure, Italy, Cardiovascular Diseases, Heart Disease Risk Factors, Ankle, business, human activities
Abstract

Background An abnormal ankle-brachial pressure index (ABI) is a marker of the risk for increased total and cardiovascular (CV) mortality. However, it is not clear whether it is associated with an even worse prognosis in patients with previous CV events or with cancer mortality. Materials and Methods Consecutive subjects undergoing ABI assessment for suspected peripheral artery disease or for stratification of CV risk in ten centers in the Veneto Region (northeast Italy), between 2011 and 2014 were enrolled. The ABI was expressed as normal ≥0.9 to ≤1.3, and abnormal 1.3. All-cause mortality and CV or cancer mortality and hospitalizations for CV disease were collected from administrative databases up to December 2018. Results The study enrolled 1,177 patients. ABI was abnormal in 57.2%. Median follow-up was 61.6 months (53.4–70.1). All-cause, CV and cancer mortality were higher in patients with abnormal than normal ABI, with hazard ratios (HR) respectively 2.0 (95% CI 1.48–2.69), 1.98 (95% CI 1.24–3.17) and 1.85 (95% CI 1.09–3.15). Among subjects with abnormal ABI, the risk of overall mortality, HR 1.57 (95% CI 1.17–2.12), and CV mortality, HR 2.39 (95% CI 1.43–3.99), was higher in those with previous CV events. These latter also had a higher risk of hospitalization for myocardial infarction and stroke: HR 1.85 (95% CI 1.023.37) and 2.17 (95% CI 1.10–4.28). Conclusions The co-existence of abnormal ABI and a history of CV events identifies subjects at higher risk, who call for a more aggressive approach. Abnormal ABI is also a predictor of cancer mortality.

Published
2020
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19. Obstruction vasculaire pulmonaire résiduelle et récidive après embolie pulmonaire aiguë : revue systématique avec méta-analyse sur données individuelles des participants

Author

Philippe Robin, Romain Le Pennec, Maggie Eddy, Lindsey Sikora, Pierre-Yves Le Roux, Marc Carrier, Francis Couturaud, Cécile Tromeur, Benjamin Planquette, Olivier Sanchez, Raffaele Pesavento, Lucia Filippi, Marc A. Rodger, Mickael J. Kovacs, Ranjeeta Mallick, Pierre-Yves Salaun, and Grégoire Le Gal

Subjects
Cardiology and Cardiovascular Medicine
Published
2023
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20. Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Author

Behnood Bikdeli, David Jiménez, Jorge del Toro, Gregory Piazza, Agustina Rivas, José Luis Fernández‐Reyes, Ángel Sampériz, Remedios Otero, José María Suriñach, Carmine Siniscalchi, Javier Miguel Martín‐Guerra, Joaquín Castro, Alfonso Muriel, Gregory Y. H. Lip, Samuel Z. Goldhaber, Manuel Monreal, Paolo Prandoni, Benjamin Brenner, Dominique Farge‐Bancel, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Sebastian Schellong, Inna Tzoran, Abilio Reis, Marijan Bosevski, Henri Bounameaux, Radovan Malý, Peter Verhamme, Joseph A. Caprini, Hanh My Bui, María Dolores Adarraga, María Agud, Jesús Aibar, Miguel Ángel Aibar, Cristina Amado, Juan Ignacio Arcelus, Carlos Baeza, Aitor Ballaz, Cristina Barbagelata, Manuel Barrón, Belén Barrón‐Andrés, Ángeles Blanco‐Molina, Ernesto Botella, Ana María Camon, Inmaculada Cañas, Ignacio Casado, Leyre Chasco, Juan Criado, Cristina de Ancos, Javier de Miguel, Pablo Demelo‐Rodríguez, José Antonio Díaz‐Peromingo, Mario Virgilio Di Campli, Javier Díez‐Sierra, Irene Milagros Domínguez, José Carlos Escribano, Conxita Falgá, Ana Isabel Farfán‐Sedano, Carmen Fernández‐Capitán, Jose Luis Fernández‐Reyes, María Ángeles Fidalgo, Katia Flores, Carme Font, Llorenç Font, Iria Francisco, Cristina Gabara, Francisco Galeano‐Valle, David Galindo, María Angelina García, Ferrán García‐Bragado, Marta García de Herreros, Raquel García‐Hernáez, María Mar García‐Mullor, Arantxa García‐Raso, Olga Gavín‐Sebastián, Aida Gil‐Díaz, Covadonga Gómez‐Cuervo, Enric Grau, Leticia Guirado, Javier Gutiérrez, Luis Hernández‐Blasco, Elena Hernando, Miguel Herreros, Luis Jara‐Palomares, María Jesús Jaras, Rafael Jiménez, Maria Dolores Joya, José Manuel León, Jorge Lima, Pilar Llamas, José Luis Lobo, Luciano López‐Jiménez, Patricia López‐Miguel, Juan José López‐Núñez, Raquel López‐Reyes, Antonio López‐Ruiz, Juan Bosco López‐Sáez, Alicia Lorenzo, Olga Madridano, Ana Maestre, Pablo Javier Marchena, Mar Martín del Pozo, Francisco Martín‐Martos, Carmen Mella, Meritxell Mellado, Maria Isabel Mercado, Jorge Moisés, María del Valle Morales, Arturo Muñoz‐Blanco, Nuria Muñoz‐Rivas, María Sierra Navas, Jose Antonio Nieto, Manuel Jesús Núñez‐Fernández, Berta Obispo, Mónica Olid, María Carmen Olivares, José Luis Orcastegui, Clara Ortega‐Michel, Jeisson Osorio, Sonia Otalora, Pedro Parra, Virginia Parra, José María Pedrajas, Galadriel Pellejero, José Antonio Porras, José Portillo, Antoni Riera‐Mestre, Francisco Rivera‐Civico, Diego Agustín Rodríguez‐Chiaradía, Ana Rodríguez‐Cobo, Consolación Rodríguez‐Matute, Jacobo Rogado, Sonia Roig, Vladimir Rosa, Pedro Ruiz‐Artacho, Nuria Ruiz‐Giménez, Justo Ruiz‐Ruiz, Pablo Ruiz‐Sada, Giorgina Salgueiro, Rosario Sánchez‐Martínez, Juan Francisco Sánchez‐Muñoz‐Torrero, Teresa Sancho, Merçe Sirisi, Silvia Soler, Raimundo Tirado, María Isabel Torres, Carles Tolosa, Javier Trujillo‐Santos, Fernando Uresandi, Beatriz Valero, Reina Valle, Jerónimo Ramón Vela, Gemma Vidal, Paula Villares, Carles Zamora, Paula Gutiérrez, Fernando Javier Vázquez, Matthias Engelen, Thomas Vanassche, Jana Hirmerova, Estuardo Salgado, Nassim Ait Abdallah, Alessandra Bura‐Riviere, Benjamin Crichi, Philippe Debourdeau, Espitia Olivier, Nicolas Falvo, Silvia Galliazzo, Hélène Helfer, Isabelle Mahé, Farès Moustafa, Geraldine Poenou, Andrei Braester, Franca Bilora, Eugenio Bucherini, Maurizio Ciammaichella, Egidio Imbalzano, Rosa Maida, Daniela Mastroiacovo, Federica Pace, Raffaele Pesavento, Fulvio Pomero, Roberto Quintavalla, Anna Rocci, Roberta Romualdi, Antonella Tufano, Adriana Visonà, Beniamino Zalunardo, Valdis Gibietis, Dana Kigitovica, Andris Skride, Samuel Fonseca, Filipa Martins, Jose Meireles, Lucia Mazzolai, Alfonso J. Tafur, Cassius Iyad Ochoa‐Chaar, Ido Weinberg, Hannah Wilkins, Institut Català de la Salut, [Bikdeli B] Cardiovascular Medicine Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA. Yale/YNHH Center for Outcomes Research & Evaluation, New Haven, CT. Cardiovascular Research Foundation (CRF), New York, NY. [Jiménez D] Respiratory Department, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain. Medicine Department, Universidad de Alcalá (IRYCIS), Madrid, Spain. CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain. [Del Toro J] Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain. [Piazza G] Cardiovascular Medicine Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA. [Rivas A] Department of Pneumonology, Hospital Universitario Araba, Álava, Spain. [Fernández-Reyes JL] Department of Internal Medicine, Complejo Hospitalario de Jaén, Jaén, Spain. [Suriñach JM] Servei de Medicina Interna, Vall d’Hebron Hospital Universitari, Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus, Bikdeli, B., Jimenez, D., Toro, J. D., Piazza, G., Rivas, A., Fernandez-Reyes, J. L., Samperiz, A., Otero, R., Surinach, J. M., Siniscalchi, C., Martin-Guerra, J. M., Castro, J., Muriel, A., Lip, G. Y. H., Goldhaber, S. Z., Monreal, M., and Tufano, A

Subjects
Registrie, medicine.medical_specialty, Embolism, enfermedades cardiovasculares::enfermedades cardíacas::arritmias cardíacas::fibrilación atrial [ENFERMEDADES], Otros calificadores::/diagnóstico [Otros calificadores], Vascular Medicine, Risk Factors, Internal medicine, Other subheadings::Other subheadings::Other subheadings::/mortality [Other subheadings], Atrial Fibrillation, medicine, Other subheadings::/diagnosis [Other subheadings], Diseases of the circulatory (Cardiovascular) system, Humans, Registries, Cor - Malalties - Diagnòstic, Mortality, Original Research, Outcome, Otros calificadores::Otros calificadores::Otros calificadores::/mortalidad [Otros calificadores], business.industry, Risk Factor, Pulmonary embolism, Thrombosis, Atrial fibrillation, medicine.disease, Cardiovascular Diseases::Vascular Diseases::Embolism and Thrombosis::Embolism::Pulmonary Embolism [DISEASES], Stroke, Embòlia pulmonar - Mortalitat, RC666-701, Acute Disease, Cardiology, Avaluació de resultats (Assistència sanitària), Cardiology and Cardiovascular Medicine, business, enfermedades cardiovasculares::enfermedades vasculares::embolia y trombosis::embolia::embolia pulmonar [ENFERMEDADES], Cardiovascular Diseases::Heart Diseases::Arrhythmias, Cardiac::Atrial Fibrillation [DISEASES], Human
Abstract

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90‐day and 1‐year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90‐day all‐cause (odds ratio [OR], 2.81; 95% CI, 2.33–3.38) and PE‐related mortality (OR, 2.38; 95% CI, 1.37–4.14) and increased 1‐year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10–9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all‐cause mortality (OR, 1.91; 95% CI, 1.57–2.32) but not PE‐related mortality (OR, 1.50; 95% CI, 0.85–2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90‐day all‐cause (OR, 2.28; 95% CI, 1.75–2.97) and PE‐related (OR, 3.64; 95% CI, 2.01–6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.

Published
2021
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21. Mortality and Transfusion Requirements in COVID-19 Hospitalized Italian Patients According to Severity of the Disease

Author

Maria Teresa Sartori, Antonio De Laurenzo, Maurizio Margaglione, Lucia Mirabella, Gilda Cinnella, Lidia Dalfino, Davide Ceccato, Angelo Ostuni, Donatella Colaizzo, Roberto Vettor, Elvira Grandone, Mario Mastroianno, Giovanni Luca Tiscia, and Raffaele Pesavento

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), COVID-19, ICU, medical ward, mortality, transfusion, lcsh:Medicine, Disease, 030204 cardiovascular system & hematology, Article, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, medicine, Risk of mortality, In patient, 030212 general & internal medicine, business.industry, Medical record, lcsh:R, General Medicine, medicine.disease, Intensive care unit, Icu admission, Emergency medicine, business, Kidney disease
Abstract

There is paucity of data on the transfusion need and its impact on the overall mortality in patients with COVID-19. We explored mortality in hospitalized patients with COVID-19 who required transfusions. Information on clinical variables and in-hospital mortality were obtained from medical records of 422 patients admitted to medical wards or the Intensive Care Unit (ICU). In-hospital mortality occurred in 147 (34.8%) patients, 94 (63.9%) of whom were admitted to the ICU. The median fatalities age was 77 years (IQR 14). Overall, 100 patients (60 males) received transfusion during hospitalization. The overall mortality was significantly and independently associated with age, ICU admission, Chronic Kidney Disease (CKD), and the number of transfused Red Blood Cell (RBC) units. Specifically, CKD was associated with mortality in patients admitted to medical wards, whereas the number of transfused RBC units predicted mortality in those admitted to the ICU. Transfusion strongly interacted with the admission to ICU (OR: 9.9, 95% CI: 2.5&ndash, 40.0). In patients with COVID-19, age is one of the strongest risk factors in predicting mortality independently of the disease&rsquo, s severity. CKD confers a higher risk of mortality in patients admitted to medical wards. In those admitted to the ICU, the more RBC units are transfused, the more mortality increases.

Published
2021

22. Heparin in COVID-19 patients is associated with reduced in-hospital mortality: the multicentre Italian CORIST Study

Author

Walter Ageno, Raffaele Pesavento, Marinella Astuto, Katleen de Gaetano Donati, Francesca Santilli, Filippo Aucella, Eleonora Taddei, Marianna Meschiari, Laura Scorzolini, Biagio Pinchera, Giustino Parruti, Licia Iacoviello, Andrea Vianello, Gabriella Guarnieri, Arturo Montineri, Crizia Colombo, Carlo Signorelli, Lorenzo Blandi, Raffaele De Caterina, Maria Musso, Francesco Petri, Stefano Maitan, Anna Odone, Lucia Caiano, Francesca Crosta, Lorenzo Marra, Giuseppe Patti, Emanuela Pasi, Jovana Milic, Marco Olivieri, Claudia Colomba, Francesco Maria Fusco, Claudia Ravaglia, Alexandra Virano, Carlo Torti, Samir Al Moghazi, Venerino Poletti, Riccardo Maragna, Carlo Sanrocco, Sandro Mancarella, Greta Barbieri, Arturo Ciccullo, Leonardo Grisafi, Paola Simeone, Lorenzo Menicanti, Antonella Palimodde, Gloria Maccagni, Alessandra Vergori, Daniela Niola, Marco G. Mennuni, Gianpiero D'Offizi, Claudia Marotta, Damiano D'Ardes, Vincenzo Sangiovanni, Paolo Bonfanti, Giovanni Larizza, Francesco Di Gennaro, Alessandro Mengozzi, Massimo Mapelli, Giuseppe Di Tano, Laura Carrozzi, Antonella Agodi, Francesco Menichetti, Marialaura Bonaccio, Andrea Antinori, Marco Vinceti, Armando Leone, Franco Mastroianni, Silvia Marongiu, Filippo Minutolo, Giulio Maresca, Beatrice Molena, Nausicaa Berselli, Francesco Cipollone, Massimo Fantoni, Antonella Cingolani, Giovanni Guaraldi, Raffaella Sgariglia, Piergiuseppe Agostoni, Antonio Cascio, Maria Mazzitelli, Roberta Parisi, Augusto Di Castelnuovo, Gian Battista Danzi, Luca Aiello, Roberto Vettor, Elvira Grandone, Laura Vocciante, Emauele Graziani, Cristina Mussini, Marianna Rossi, Marco Rossato, Roberto Cauda, Rosa Arboretti, Alessandro Bartoloni, Simona Costanzo, Francesco Gianfagna, Andrea Rognoni, Ferruccio Madaro, Rossella Marcucci, Pasquale Abete, Francesco Cacciatore, Ivan Gentile, Di Castelnuovo, A, Costanzo, S, Antinori, A, Berselli, N, Blandi, L, Bonaccio, M, Cauda, R, Guaraldi, G, Menicanti, L, Mennuni, M, Parruti, G, Patti, G, Santilli, F, Signorelli, C, Vergori, A, Abete, P, Ageno, W, Agodi, A, Agostoni, P, Aiello, L, Al Moghazi, S, Arboretti, R, Astuto, M, Aucella, F, Barbieri, G, Bartoloni, A, Bonfanti, P, Cacciatore, F, Caiano, L, Carrozzi, L, Cascio, A, Ciccullo, A, Cingolani, A, Cipollone, F, Colomba, C, Colombo, C, Crosta, F, Danzi, G, D'Ardes, D, de Gaetano Donati, K, Di Gennaro, F, Di Tano, G, D'Offizi, G, Fantoni, M, Fusco, F, Gentile, I, Gianfagna, F, Grandone, E, Graziani, E, Grisafi, L, Guarnieri, G, Larizza, G, Leone, A, Maccagni, G, Madaro, F, Maitan, S, Mancarella, S, Mapelli, M, Maragna, R, Marcucci, R, Maresca, G, Marongiu, S, Marotta, C, Marra, L, Mastroianni, F, Mazzitelli, M, Mengozzi, A, Menichetti, F, Meschiari, M, Milic, J, Minutolo, F, Molena, B, Montineri, A, Mussini, C, Musso, M, Niola, D, Odone, A, Olivieri, M, Palimodde, A, Parisi, R, Pasi, E, Pesavento, R, Petri, F, Pinchera, B, Poletti, V, Ravaglia, C, Rognoni, A, Rossato, M, Rossi, M, Sangiovanni, V, Sanrocco, C, Scorzolini, L, Sgariglia, R, Simeone, P, Taddei, E, Torti, C, Vettor, R, Vianello, A, Vinceti, M, Virano, A, Vocciante, L, De Caterina, R, Iacoviello, L, Danzi, G. B, De Gaetano Donati, K, Fusco, F. M, Simeone, P. G, Iacoviello, L., Di Castelnuovo, Augusto, Costanzo, Simona, Antinori, Andrea, Berselli, Nausicaa, Blandi, Lorenzo, Bonaccio, Marialaura, Cauda, Roberto, Guaraldi, Giovanni, Menicanti, Lorenzo, Mennuni, Marco, Parruti, Giustino, Patti, Giuseppe, Santilli, Francesca, Signorelli, Carlo, Vergori, Alessandra, Abete, Pasquale, Ageno, Walter, Agodi, Antonella, Agostoni, Piergiuseppe, Aiello, Luca, Al Moghazi, Samir, Arboretti, Rosa, Astuto, Marinella, Aucella, Filippo, Barbieri, Greta, Bartoloni, Alessandro, Bonfanti, Paolo, Cacciatore, Francesco, Caiano, Lucia, Carrozzi, Laura, Cascio, Antonio, Ciccullo, Arturo, Cingolani, Antonella, Cipollone, Francesco, Colomba, Claudia, Colombo, Crizia, Crosta, Francesca, Danzi, Gian Battista, D'Ardes, Damiano, de Gaetano Donati, Katleen, Di Gennaro, Francesco, Di Tano, Giuseppe, D'Offizi, Gianpiero, Fantoni, Massimo, Fusco, Francesco Maria, Gentile, Ivan, Gianfagna, Francesco, Grandone, Elvira, Graziani, Emauele, Grisafi, Leonardo, Guarnieri, Gabriella, Larizza, Giovanni, Leone, Armando, Maccagni, Gloria, Madaro, Ferruccio, Maitan, Stefano, Mancarella, Sandro, Mapelli, Massimo, Maragna, Riccardo, Marcucci, Rossella, Maresca, Giulio, Marongiu, Silvia, Marotta, Claudia, Marra, Lorenzo, Mastroianni, Franco, Mazzitelli, Maria, Mengozzi, Alessandro, Menichetti, Francesco, Meschiari, Marianna, Milic, Jovana, Minutolo, Filippo, Molena, Beatrice, Montineri, Arturo, Mussini, Cristina, Musso, Maria, Niola, Daniela, Odone, Anna, Olivieri, Marco, Palimodde, Antonella, Parisi, Roberta, Pasi, Emanuela, Pesavento, Raffaele, Petri, Francesco, Pinchera, Biagio, Poletti, Venerino, Ravaglia, Claudia, Rognoni, Andrea, Rossato, Marco, Rossi, Marianna, Sangiovanni, Vincenzo, Sanrocco, Carlo, Scorzolini, Laura, Sgariglia, Raffaella, Simeone, Paola Giustina, Taddei, Eleonora, Torti, Carlo, Vettor, Roberto, Vianello, Andrea, Vinceti, Marco, Virano, Alexandra, Vocciante, Laura, De Caterina, Raffaele, Iacoviello, Licia, Di Castelnuovo A., Costanzo S., Antinori A., Berselli N., Blandi L., Bonaccio M., Cauda R., Guaraldi G., Menicanti L., Mennuni M., Parruti G., Patti G., Santilli F., Signorelli C., Vergori A., Abete P., Ageno W., Agodi A., Agostoni P., Aiello L., Al Moghazi S., Arboretti R., Astuto M., Aucella F., Barbieri G., Bartoloni A., Bonfanti P., Cacciatore F., Caiano L., Carrozzi L., Cascio A., Ciccullo A., Cingolani A., Cipollone F., Colomba C., Colombo C., Crosta F., Danzi G.B., D'Ardes D., De Gaetano Donati K., Di Gennaro F., Di Tano G., D'Offizi G., Fantoni M., Fusco F.M., Gentile I., Gianfagna F., Grandone E., Graziani E., Grisafi L., Guarnieri G., Larizza G., Leone A., MacCagni G., Madaro F., Maitan S., Mancarella S., Mapelli M., Maragna R., Marcucci R., Maresca G., Marongiu S., Marotta C., Marra L., Mastroianni F., Mazzitelli M., Mengozzi A., Menichetti F., Meschiari M., Milic J., Minutolo F., Molena B., Montineri A., Mussini C., Musso M., Niola D., Odone A., Olivieri M., Palimodde A., Parisi R., Pasi E., Pesavento R., Petri F., Pinchera B., Poletti V., Ravaglia C., Rognoni A., Rossato M., Rossi M., Sangiovanni V., Sanrocco C., Scorzolini L., Sgariglia R., Simeone P.G., Taddei E., Torti C., Vettor R., Vianello A., Vinceti M., Virano A., Vocciante L., De Caterina R., and Iacoviello L.

Subjects
Male, medicine.medical_specialty, Settore MED/17 - Malattie Infettive, coronavirus, heparin, 030204 cardiovascular system & hematology, Lower risk, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, Clinical endpoint, medicine, Humans, Thrombophilia, 030212 general & internal medicine, Hospital Mortality, Blood Coagulation, Survival analysis, Aged, Retrospective Studies, treatment, business.industry, Heparin, Mortality rate, COVID-19,mortality, Low-Molecular-Weight, Anticoagulants, COVID-19, Retrospective cohort study, Hematology, Heparin, Low-Molecular-Weight, Middle Aged, mortality, Survival Analysis, COVID-19 Drug Treatment, coagulation activation, coronaviru, Italy, treatments, Propensity score matching, Female, business, medicine.drug
Abstract

Introduction A hypercoagulable condition was described in patients with coronavirus disease 2019 (COVID-19) and proposed as a possible pathogenic mechanism contributing to disease progression and lethality. Aim We evaluated if in-hospital administration of heparin improved survival in a large cohort of Italian COVID-19 patients. Methods In a retrospective observational study, 2,574 unselected patients hospitalized in 30 clinical centers in Italy from February 19, 2020 to June 5, 2020 with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 infection were analyzed. The primary endpoint in a time-to event analysis was in-hospital death, comparing patients who received heparin (low-molecular-weight heparin [LMWH] or unfractionated heparin [UFH]) with patients who did not. We used multivariable Cox proportional-hazards regression models with inverse probability for treatment weighting by propensity scores. Results Out of 2,574 COVID-19 patients, 70.1% received heparin. LMWH was largely the most used formulation (99.5%). Death rates for patients receiving heparin or not were 7.4 and 14.0 per 1,000 person-days, respectively. After adjustment for propensity scores, we found a 40% lower risk of death in patients receiving heparin (hazard ratio = 0.60; 95% confidence interval: 0.49–0.74; E-value = 2.04). This association was particularly evident in patients with a higher severity of disease or strong coagulation activation. Conclusion In-hospital heparin treatment was associated with a lower mortality, particularly in severely ill COVID-19 patients and in those with strong coagulation activation. The results from randomized clinical trials are eagerly awaited to provide clear-cut recommendations.

Published
2021
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23. Lung Ultrasound Patterns and Clinical-Laboratory Correlates during COVID-19 Pneumonia: A Retrospective Study from North East Italy

Author

Riccardo Senter, Anna Maria, Maria Teresa Giordani, Dora Luise, Angelo Avogaro, Samuele Gardin, Claudio Fossa, Enrico Nessi, Leonardo Molinari, Davide Gorgi, Vito Cianci, Eleonora Vania, Nicolò Zanforlin, Andi Sukthi, Elisa Fonte Basso, Caterina Sensi, Andrea Cellini, Andrea Sattin, Pietro Pettenella, Sandro Giannini, L. Previato, Andrea Vianello, Lorenzo Cerruti, Alessandro Toffolon, Sandro Savino, Gian Paolo Fadini, Roberto Vettor, Renato Ippolito, Stefano Pasqualin, Gaetano Arcidiacono, Federico Capone, Mirko Zanatta, Alois Saller, and Raffaele Pesavento

Subjects
medicine.medical_specialty, consolidations, lcsh:Medicine, Disease, 030204 cardiovascular system & hematology, Article, 03 medical and health sciences, B-lines, 0302 clinical medicine, Internal medicine, medicine, 030212 general & internal medicine, Stage (cooking), lung ultrasound, Lung, business.industry, lcsh:R, COVID-19, Retrospective cohort study, General Medicine, medicine.disease, Pathophysiology, Lung ultrasound, Pneumonia, medicine.anatomical_structure, Localized disease, business
Abstract

Background and Aim. Lung ultrasound (LUS) is a convenient imaging modality in the setting of coronavirus disease-19 (COVID-19) because it is easily available, can be performed bedside and repeated over time. We herein examined LUS patterns in relation to disease severity and disease stage among patients with COVID-19 pneumonia. Methods. We performed a retrospective case series analysis of patients with confirmed SARS-CoV-2 infection who were admitted to the hospital because of pneumonia. We recorded history, clinical parameters and medications. LUS was performed and scored in a standardized fashion by experienced operators, with evaluation of up to 12 lung fields, reporting especially on B-lines and consolidations. Results. We included 96 patients, 58.3% men, with a mean age of 65.9 years. Patients with a high-risk quick COVID-19 severity index (qCSI) were older and had worse outcomes, especially for the need for high-flow oxygen. B-lines and consolidations were located mainly in the lower posterior lung fields. LUS patterns for B-lines and consolidations were significantly worse in all lung fields among patients with high versus low qCSI. B-lines and consolidations were worse in the intermediate disease stage, from day 7 to 13 after onset of symptoms. While consolidations correlated more with inflammatory biomarkers, B-lines correlated more with end-organ damage, including extrapulmonary involvement. Conclusions. LUS patterns provide a comprehensive evaluation of patients with COVID-19 pneumonia that correlated with severity and dynamically reflect disease stage. LUS patterns may reflect different pathophysiological processes related to inflammation or tissue damage, consolidations may represent a more specific sign of localized disease, whereas B-lines seem to be also dependent upon generalized illness due to SARS-CoV-2 infection.

Published
2021

24. Disentangling the Association of Hydroxychloroquine Treatment with Mortality in Covid-19 Hospitalized Patients through Hierarchical Clustering

Author

Anna Sabena, Gabriele Giuliano, Raffaele Bruno, Francesco Cacciatore, Carlo Torti, Silvia Marongiu, Gloria Maccagni, Claudia Marotta, Giovanni Larizza, Francesco Petri, Massimo Mapelli, Giulio Maresca, Giulia Righetti, Alessandra Vergori, Ilaria Rossi, Damiano D'Ardes, Nicola Schiano Moriello, Ivan Gentile, Enrica Tamburrini, Luca Aiello, Piergiuseppe Agostoni, Antonio Cascio, Jovana Milic, Carlo Andrea Pivato, Agostino Virdis, Stefano Maitan, Francesco Cannata, Simona Costanzo, Carlo Signorelli, Franco Mastroianni, Federica Magni, Crizia Colombo, Giulio G. Stefanini, Lucia Caiano, Francesca Crosta, Lorenzo Marra, Giuseppe Patti, Katleen de Gaetano Donati, Valerio Langella, Annalisa Crisetti, Filippo Aucella, Antonella Cingolani, Francesco Salinaro, Augusto Di Castelnuovo, Giacomo Castiglione, Alessandro Gialluisi, Anna Odone, Cristina Mussini, Samir Al Moghazi, Lorenzo Blandi, Maria Musso, Marialaura Bonaccio, Raffaele De Caterina, Marco Olivieri, Roberto Cauda, Emanuela Pasi, Arturo Ciccullo, Stefano Perlini, Claudia Colomba, Antonella Palimodde, Gianpiero D'Offizi, Marco G. Mennuni, Walter Ageno, Raffaele Pesavento, Rosa Manuele, Roberta Mussinelli, Vincenzo Sangiovanni, Paolo Bonfanti, Andrea Antinori, Francesco Gianfagna, Andrea Rognoni, Laura Scorzolini, Riccardo Maragna, Rossella Marcucci, Filippo Minutolo, Armando Leone, Giustino Parruti, Licia Iacoviello, Lorenzo Menicanti, Sandro Mancarella, Rosa Arboretti, Greta Barbieri, Carlo Gaudiosi, Marco Rossato, Claudia Ravaglia, Andrea Vianello, Marianna Rossi, Emauele Graziani, Martina Barchitta, Giovanni Guaraldi, Enrico Maria Trecarichi, Gian Battista Danzi, Francesco Cipollone, Carlo Sanrocco, Marco Vinceti, Francesca Santilli, Marianna Meschiari, Gabriella Guarnieri, Antonella Agodi, Roberto Vettor, Raffaella Sgariglia, Ilaria My, Francesco Di Gennaro, Alessandro Mengozzi, Giuseppe Di Tano, Laura Carrozzi, Michele Spinicci, Venerino Poletti, Paola Simeone, Nausicaa Berselli, Francesco Maria Fusco, Di Castelnuovo A., Gialluisi A., Antinori A., Berselli N., Blandi L., Bonaccio M., Bruno R., Cauda R., Costanzo S., Guaraldi G., Menicanti L., Mennuni M., My I., Parruti G., Patti G., Perlini S., Santilli F., Signorelli C., Stefanini G., Vergori A., Ageno W., Agodi A., Agostoni P., Aiello L., Moghazi S.A., Arboretti R., Aucella F., Barbieri G., Barchitta M., Bonfanti P., Cacciatore F., Caiano L., Cannata F., Carrozzi L., Cascio A., Castiglione G., Cicullo A., Cingolani A., Cipollone F., Colomba C., Colombo C., Crisetti A., Crosta F., Danzi G.B., D'Ardes D., de Gaetano Donati K., Di Gennaro F., Di Tano G., D'Offizi G., Fusco F.M., Gaudiosi C., Gentile I., Gianfagna F., Giuliano G., Graziani E., Guarnieri G., Langella V., Larizza G., Leone A., Maccagni G., Magni F., Maitan S., Mancarella S., Manuele R., Mapelli M., Maragna R., Marcucci R., Maresca G., Marongiu S., Marotta C., Marra L., Mastroianni F., Mengozzi A., Meschiari M., Milic J., Minutolo F., Mussinelli R., Mussini C., Musso M., Odone A., Olivieri M., Palimodde A., Pasi E., Pesavento R., Petri F., Pivato C.A., Poletti V., Ravaglia C., Righetti G., Rognoni A., Rossato M., Rossi I., Rossi M., Sabena A., Salinaro F., Sangiovanni V., Sanrocco C., Moriello N.S., Scorzolini L., Sgariglia R., Simeone P.G., Spinicci M., Tamburrini E., Torti C., Trecarichi E.M., Vettor R., Vianello A., Vinceti M., Virdis A., de Caterina R., Iacoviello L., Di Castelnuovo, A, Gialluisi, A, Antinori, A, Berselli, N, Blandi, L, Bonaccio, M, Bruno, R, Cauda, R, Costanzo, S, Guaraldi, G, Menicanti, L, Mennuni, M, My, I, Parruti, G, Patti, G, Perlini, S, Santilli, F, Signorelli, C, Stefanini, G, Vergori, A, Ageno, W, Agodi, A, Agostoni, P, Aiello, L, Al Moghazi, S, Arboretti, R, Aucella, F, Barbieri, G, Barchitta, M, Bonfanti, P, Cacciatore, F, Caiano, L, Cannata, F, Carrozzi, L, Cascio, A, Castiglione, G, Cicullo, A, Cingolani, A, Cipollone, F, Colomba, C, Colombo, C, Crisetti, A, Crosta, F, Danzi, G, D'Ardes, D, de Gaetano Donati, K, Di Gennaro, F, Di Tano, G, D'Offizi, G, Fusco, F, Gaudiosi, C, Gentile, I, Gianfagna1, F, Giuliano, G, Graziani, E, Guarnieri, G, Langella, V, Larizza, G, Leone, A, Maccagni, G, Magni, F, Maitan, S, Mancarella, S, Manuele, R, Mapelli, M, Maragna, R, Marcucci, R, Maresca, G, Marongiu, S, Marotta, C, Marra, L, Mastroianni, F, Mengozzi, A, Meschiari, M, Milic, J, Minutolo, F, Mussinelli, R, Mussini, C, Musso, M, Odone, A, Olivieri, M, Palimodde, A, Pasi, E, Pesavento, R, Petri, F, Pivato, C, Poletti, V, Ravaglia, C, Righetti, G, Rognoni, A, Rossato, M, Rossi, I, Rossi, M, Sabena, A, Salinaro, F, Sangiovanni, V, Sanrocco, C, Schiano Moriello, N, Scorzolini, L, Sgariglia, R, Simeone, P, Spinicci, M, Tamburrini, E, Torti, C, Trecarichi, E, Vettor, R, Vianello, A, Vinceti, M, Virdis, A, De Caterina, R, Iacoviello, L, Di Castelnuovo, A., Gialluisi, A., Antinori, A., Berselli, N., Blandi, L., Bonaccio, M., Bruno, R., Cauda, R., Costanzo, S., Guaraldi, G., Menicanti, L., Mennuni, M., My, I., Parruti, G., Patti, G., Perlini, S., Santilli, F., Signorelli, C., Stefanini, G., Vergori, A., Ageno, W., Agodi, A., Agostoni, P., Aiello, L., Moghazi, S. A., Arboretti, R., Aucella, F., Barbieri, G., Barchitta, M., Bonfanti, P., Cacciatore, F., Caiano, L., Cannata, F., Carrozzi, L., Cascio, A., Castiglione, G., Cicullo, A., Cingolani, A., Cipollone, F., Colomba, C., Colombo, C., Crisetti, A., Crosta, F., Danzi, G. B., D’Ardes, D., de Gaetano Donati, K., Di Gennaro, F., Di Tano, G., D’Offizi, G., Fusco, F. M., Gaudiosi, C., Gentile, I., Gianfagna, F., Giuliano, G., Graziani, E., Guarnieri, G., Langella, V., Larizza, G., Leone, A., Maccagni, G., Magni, F., Maitan, S., Mancarella, S., Manuele, R., Mapelli, M., Maragna, R., Marcucci, R., Maresca, G., Marongiu, S., Marotta, C., Marra, L., Mastroianni, F., Mengozzi, A., Meschiari, M., Milic, J., Minutolo, F., Mussinelli, R., Mussini, C., Musso, M., Odone, A., Olivieri, M., Palimodde, A., Pasi, E., Pesavento, R., Petri, F., Pivato, C. A., Poletti, V., Ravaglia, C., Righetti, G., Rognoni, A., Rossato, M., Rossi, I., Rossi, M., Sabena, A., Salinaro, F., Sangiovanni, V., Sanrocco, C., Moriello, N. S., Scorzolini, L., Sgariglia, R., Simeone, P. G., Spinicci, M., Tamburrini, E., Torti, C., Trecarichi, E. M., Vettor, R., Vianello, A., Vinceti, M., Virdis, A., de Caterina, R., and Iacoviello, L.

Subjects
Male, Medicine (General), Antimalarial, 030204 cardiovascular system & hematology, Severity of Illness Index, Hospital Mortality, 0302 clinical medicine, Retrospective Studie, 80 and over, Cluster Analysis, 030212 general & internal medicine, Aged, Aged, 80 and over, Antimalarials, COVID-19, Female, Humans, Hydroxychloroquine, Italy, Middle Aged, Retrospective Studies, SARS-CoV-2, Treatment Outcome, Biotechnology, medicine.drug, Research Article, medicine.medical_specialty, Article Subject, Biomedical Engineering, Renal function, Health Informatics, 03 medical and health sciences, R5-920, Internal medicine, Diabetes mellitus, Severity of illness, medicine, Medical technology, R855-855.5, Cluster Analysi, business.industry, Cancer, Retrospective cohort study, medicine.disease, Obesity, COVID-19 Drug Treatment, Surgery, Observational study, business
Abstract

The efficacy of hydroxychloroquine (HCQ) in treating SARS-CoV-2 infection is harshly debated, with observational and experimental studies reporting contrasting results. To clarify the role of HCQ in Covid-19 patients, we carried out a retrospective observational study of 4,396 unselected patients hospitalized for Covid-19 in Italy (February–May 2020). Patients’ characteristics were collected at entry, including age, sex, obesity, smoking status, blood parameters, history of diabetes, cancer, cardiovascular and chronic pulmonary diseases, and medications in use. These were used to identify subtypes of patients with similar characteristics through hierarchical clustering based on Gower distance. Using multivariable Cox regressions, these clusters were then tested for association with mortality and modification of effect by treatment with HCQ. We identified two clusters, one of 3,913 younger patients with lower circulating inflammation levels and better renal function, and one of 483 generally older and more comorbid subjects, more prevalently men and smokers. The latter group was at increased death risk adjusted by HCQ (HR[CI95%] = 3.80[3.08-4.67]), while HCQ showed an independent inverse association (0.51[0.43-0.61]), as well as a significant influence of cluster∗HCQ interaction ( p < 0.001 ). This was driven by a differential association of HCQ with mortality between the high (0.89[0.65-1.22]) and the low risk cluster (0.46[0.39-0.54]). These effects survived adjustments for additional medications in use and were concordant with associations with disease severity and outcome. These findings suggest a particularly beneficial effect of HCQ within low risk Covid-19 patients and may contribute to clarifying the current controversy on HCQ efficacy in Covid-19 treatment.

Published
2021
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25. The hazard of fondaparinux in non-critically ill patients with COVID-19: Retrospective controlled study versus enoxaparin

Author

Lucia Filippi, Sabina Villalta, Lucia Leone, Fondacovit Investigators, Raffaele Pesavento, Paolo Prandoni, Anna Maria Cattelan, Egidio De Gaudenzi, and Laura Carrozzi

Subjects
Male, medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), medicine.drug_class, Low molecular weight heparin, Letter to the Editors-in-Chief, Hemorrhage, Fondaparinux, Risk Assessment, Coagulopathy, Risk Factors, medicine, 80 and over, Humans, Enoxaparin, Low-molecular-weight heparin, Intensive care medicine, Aged, Retrospective Studies, business.industry, Critically ill, COVID-19, Anticoagulants, Thrombosis, Venous Thromboembolism, Hematology, Middle Aged, medicine.disease, Hazard, Treatment Outcome, Italy, Anricoagulation, Venous thromboembolism, Aged, 80 and over, Factor Xa Inhibitors, Female, business, medicine.drug
Published
2020
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26. Baseline echocardiographic assessment of left ventricle kinetics alteration and mortality risk in a cohort of critically ill COVID-19 patients

Author

Cristiano Sarais, Roberto Vettor, Davide Ceccato, Federico Capone, Davide Gorgi, Alois Saller, Raffaele Pesavento, Mattia Grassi, Anna Postal, Beatrice Gusella, Alberto Cipriani, and Alessandro Toffolon

Subjects
medicine.medical_specialty, medicine.anatomical_structure, Coronavirus disease 2019 (COVID-19), Ventricle, business.industry, Critically ill, Internal medicine, Cohort, medicine, Cardiology, Baseline (configuration management), business
Abstract

Background SARS-CoV2 infection are frequently associated with cardiovascular manifestations, in particular with symptomatic acute coronary syndromes, cardiac arrhythmias and acute heart failure. However, the elevation of serum troponin seems to be non specific, and a cardiologic diagnostic workup should be performed. We aimed to assess the clinical characteristic and the prevalence of left ventricular (LV) dyssynergy patterns in a cohort of hospitalized non-critically ill COVID-19 patientsMethods Consecutive patients with an objective diagnosis of COVID-19, from February to April 2020. Baseline characteristics and comorbidities was collected. In case of increased troponin levels or symptoms suggestive for a concomitant cardiac syndrome, patients undergo to serial electrocardiograms, serial Troponin tests and bedside transthoracic echocardiogram.Results 402 consecutive patients were enrolled: 55 patients underwent an echocardiographic exam because of an increase in troponin levels or a suspected myocardial injury. Segmental left ventricular abnormalities were found in 10 (median WMSI 2.03 IQR 1.38-2.75) with a median LV ejection fraction was 30.1 % IQR, median troponin level was 3083 ng/L, median BNP was 761 ng/L. Death for any cause occurred in 4 patients among patients with regional LV abnormalities and in 3 with normal regional function (p= 0,02).Discussion A single bedside transthoracic echocardiogram performed in non critically ill COVID-19 patients with suspected cardiac injury has the potential to better assist clinicians in their challenging decision process. As an isolated increase of troponin levels is common in COVID patients, a bed-side echocardiographic evaluation of cardiac function should be routinely implemented during their early evaluation.

Published
2020
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27. Patient-Level, Institutional, and Temporal Variations in Use of Imaging Modalities to Confirm Pulmonary Embolism

Author

Ghazaleh Mehdipoor, David Jimenez, Laurent Bertoletti, Ángeles Fidalgo, Juan Francisco Sanchez Muñoz-Torrero, José Pedro Gonzalez-Martinez, Ángeles Blanco-Molina, Miguel Ángel Aibar, Pierre-Benoît Bonnefoy, Ramin Khorasani, Martin R. Prince, Behnood Bikdeli, Manuel Monreal, María Dolores Adarraga, María Agud, Pedro Azcarate-Agüero, Jesús Aibar, Joaquín Alfonso, Cristina Amado, Juan Ignacio Arcelus, Aitor Ballaz, Raquel Barba, Cristina Barbagelata, Manuel Barrón, Belén Barrón-Andrés, Ana María Camon, Inmaculada Cañas, Juan Criado, Cristina de Ancos, Javier de Miguel, Jorge del Toro, Pablo Demelo-Rodríguez, Carmen Díaz-Pedroche, José Antonio Díaz-Peromingo, Raquel Díaz-Simón, Javier Díez-Sierra, Irene Milagros Domínguez, José Carlos Escribano, Ana Isabel Farfán, Carmen Fernández-Capitán, José Luis Fernández-Reyes, Katia Flores, Carme Font, Llorenç Font, Iria Francisco, Cristina Gabara, Francisco Galeano-Valle, María Ángeles García, Ferran García-Bragado, María García-García, Aránzazu García-Raso, Olga Gavín-Blanco, Olga Gavín-Sebastián, María Carmen Gayol, Aída Gil-Díaz, Covadonga Gómez-Cuervo, Enric Grau, Javier Gutiérrez-Guisado, Luis Hernández-Blasco, Marina Iglesias, Luis Jara-Palomares, María Jesús Jaras, María Dolores Joya, Inés Jou, Beatriz Lacruz, Antonio Lalueza, Ramón Lecumberri, Jorge Lima, Pilar Llamas, José Luis Lobo, Luciano López-Jiménez, Patricia López-Miguel, Juan José López-Núñez, Raquel López-Reyes, Juan Bosco López-Sáez, Manuel Alejandro Lorente, Alicia Lorenzo, Mónica Loring, Marina Lumbierres, Olga Madridano, Ana Maestre, Pablo Javier Marchena, Miguel Martín-Fernández, Javier Miguel Martín-Guerra, Francisco Martín-Martos, Meritxel Mellado, María Isabel Mercado, Jorge Moisés, María del Valle Morales, Arturo Muñoz-Blanco, Diego Muñoz-Guglielmetti, José Antonio Nieto, Manuel Jesús Núñez, María Carmen Olivares, Clara Ortega-Michel, María Dolores Ortega-Recio, Jeisson Osorio, Remedios Otero, Diana Paredes, Pedro Parra, Virginia Parra, José María Pedrajas, Galadriel Pellejero, Cristina Pérez-Ductor, María Asunción Pérez-Jacoíste, David Pesántez, José Antonio Porras, José Portillo, Lluis Reig, Antoni Riera-Mestre, Agustina Rivas, Ana Rodríguez-Cobo, Irene Rodríguez-Galán, Consolación Rodríguez-Matute, Vladimir Rosa, Carmen María Rubio, Pedro Ruiz-Artacho, Nuria Ruiz-Giménez, Justo Ruiz-Ruiz, Pablo Ruiz-Sada, Paloma Ruiz-Torregrosa, Joan Carles Sahuquillo, Giorgina Salgueiro, Ángel Sampériz, Teresa Sancho, Silvia Soler, Susana Suárez, José María Suriñach, Gregorio Tiberio, María Isabel Torres, Carlos Tolosa, Javier Trujillo-Santos, Fernando Uresandi, Esther Usandizaga, Reina Valle, Jeronimo Ramón Vela, Gemma Vidal, Paula Villares, Carles Zamora, Paula Gutiérrez, Fernando Javier Vázquez, Thomas Vanassche, Christophe Vandenbriele, Peter Verhamme, Jana Hirmerova, Radovan Malý, Estuardo Salgado, Ilham Benzidia, Alessandra Bura-Riviere, Benjamin Crichi, Philippe Debourdeau, Dominique Farge-Bancel, Hélène Helfer, Isabelle Mahé, Farès Moustafa, Geraldine Poenou, Sebastian Schellong, Andrei Braester, Benjamin Brenner, Inna Tzoran, María Amitrano, Franca Bilora, Cristiano Bortoluzzi, Barbara Brandolin, Eugenio Bucherini, Maurizio Ciammaichella, Donatella Colaizzo, Francesco Dentali, Pierpaolo Di Micco, Eliana Giammarino, Elvira Grandone, Fabio Maggi, Sara Mangiacapra, Daniela Mastroiacovo, Rosa Maida, Federica Pace, Raffaele Pesavento, Fulvio Pomero, Paolo Prandoni, Roberto Quintavalla, Anna Rocci, Carmine Siniscalchi, Eros Tiraferri, Antonella Tufano, Adriana Visonà, Ngoc Vo Hong, Beniamino Zalunardo, Roberts V. Kalejs, Dana Kigitovica, Andris Skride, Melanie Ferreira, Jose Meireles, Abilio Reis, Marijan Bosevski, Gorjan Krstevski, Marija Zdraveska, Henri Bounameaux, Lucia Mazzolai, Joseph A. Caprini, Alfonso J. Tafur, Ido Weinberg, Hannah Wilkins, and Hanh My Bui

Subjects
Diagnostic Imaging, Male, medicine.medical_specialty, pulmonary embolism, Hospitals, Low-Volume, Time Factors, Computed Tomography Angiography, Health Status, Perfusion Imaging, Comorbidity, Imaging modalities, Predictive Value of Tests, Pregnancy, medicine, Humans, Radiology, Nuclear Medicine and imaging, angiography, Prospective Studies, Registries, Healthcare Disparities, Practice Patterns, Physicians', thrombosis, Computed tomography angiography, Aged, Ultrasonography, Aged, 80 and over, Venous Thrombosis, Modality (human–computer interaction), medicine.diagnostic_test, business.industry, Ventilation/perfusion scan, Phlebography, Venous Thromboembolism, Middle Aged, medicine.disease, Thrombosis, Pulmonary embolism, Hospitalization, ventilation-perfusion scan, Angiography, Female, Radiology, Cardiology and Cardiovascular Medicine, business, Pulmonary Embolism, Hospitals, High-Volume, Magnetic Resonance Angiography
Abstract

Background: The choice of the imaging modality for diagnosis of pulmonary embolism (PE) could be influenced by provider, patient or hospital characteristics, or over time. However, little is known about the choice of the diagnostic modalities in practice. The aim of this study was to evaluate the variations in the use of imaging modalities for patients with acute PE. Methods: Using the data from Registro Informatizado Enfermedad TromboEmbolica (RIETE), a prospective international registry of patients with venous thromboembolism (March 2001–January 2019), we explored the imaging modalities used in patients with acute PE. The imaging modalities included computed tomography pulmonary angiography, ventilation/perfusion scanning, pulmonary angiography, a combination of these tests, or PE signs and symptoms plus imaging-confirmed proximal deep vein thrombosis but no chest imaging. Results: Among 38 025 patients with confirmed PE (53.1% female, age: 67.3±17 years), computed tomography pulmonary angiography was the dominant modality of diagnosis in all RIETE enrollees (78.2% [99% CI, 77.6–78.7]); including pregnant patients (58.9% [99% CI, 47.7%–69.4%]) and patients with severe renal insufficiency (62.5% [99% CI, 59.9–65.0]). A greater proportion of patients underwent ventilation/perfusion scanning in larger hospitals compared with smaller hospitals (13.1% versus 7.3%, P P Conclusions: In a large multinational PE registry, variations were observed in the use of imaging modalities according to patient or institutional factors and over time. However, computed tomography pulmonary angiography was the dominant modality of diagnosis, even in pregnancy and severe renal insufficiency. The safety, costs, and downstream effects of these tests on PE-related and non-PE-related outcomes warrant further investigation.

Published
2020

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

Author

Fernando J. Vazquez, Hanh My Bui, R. Maida, Alicia Lorenzo, Iva Golemi, Remedios Otero, R. Otero, G. Pellejero, Pilar Llamas, M.J. Soto, J. del Toro, Inna Tzoran, K. Sablinskis, Carmine Siniscalchi, E. Bucherini, G. Vidal, Juan J. López-Núñez, N. Mumoli, J.M. Suriñach, S. Ruiz-Alcaraz, H. Bounameaux, Jose Gutierrez, E. Salgado, C. Carrasco, I. Gaya, R. Parisi, M.D. Adarraga, Peter Verhamme, Meritxell Mellado, N. Vo Hong, I. Jou, M.C. Gayol, M. García-Morillo, Marco Fresa, Luis Jara-Palomares, Daniela Mastroiacovo, M. Sablinskis, A. Rodríguez-Hernández, R. Díaz-Simón, Miguel Ángel Aibar, David Jiménez, Ángel Sampériz, Raquel López-Reyes, Isabelle Mahé, P. Ruiz-Sada, Martin Ellis, J.A. Porras, Omer Iftikhar, Ángeles Blanco-Molina, J. Aibar, R. Malý, M. Pérez-Pinar, Adriana Visonà, L. Guirado, Carme Font, M. Encabo, M.A. Lorente, María del Carmen Díaz-Pedroche, F. García-Bragado, Gianfranco Lessiani, P. Prandoni, T. Sancho, I. Sanoja, A. Tafur, Manuel Monreal, M.J. Jaras, Alessandra Bura-Rivière, Javier Trujillo-Santos, E. Grau, J. Castro, E. Imbalzano, P. Demelo, A.M. Camon, P. López-Miguel, R. Quintavalla, Alfonso Tafur, Laurent Bertoletti, N. Falvo, J. Ruiz-Ruiz, M. Pinelli, M.A. Fidalgo, Pablo Javier Marchena, Anna Rocci, Aitor Ballaz, José González-Martínez, Andrei Braester, J.F. Sánchez-Muñoz-Torrero, J. Bascuñana, Philippe Debourdeau, J.M. Pedrajas, Giovanni Barillari, C. Vandenbriele, H.M. Bui, M. Iglesias, M. Bosevski, Raffaele Pesavento, Barry M. Brenner, Antonella Tufano, Silvia Soler, F. Pace, Paolo Prandoni, L. Font, L. Bertoletti, A. García-Raso, G. Pérez-Rus, V. Salazar, Juan I. Arcelus, Barbara Ney, Lauren Cote, Raquel Barba, B. Brandolin, Luciano López-Jiménez, Pierpaolo Di Micco, C. Fernández-Capitán, M. Martín Fernández, M.A. García, R. Barba, R. Valle, Carmen Fernández-Capitán, M.L. Pesce, J.M. Martín-Guerra, D. Farge-Bancel, Conxita Falga, M. Lumbierres, Fernando Uresandi, Benjamin Brenner, Elvira Grandone, Mónica Loring, Dominique Farge-Bancel, A. Lalueza, Cristiano Bortoluzzi, M.J. Núñez, M.C. Olivares, Maurizio Ciammaichella, M.D. Joya, Agustina Rivas, Joan Carles Sahuquillo, C.M. Rubio, Abílio Reis, A. Vilaseca, P. Di Micco, Jana Hirmerova, M. Monreal, José María Pedrajas, M.L. Peris, M.A. Rodríguez-Dávila, S. Otalora, F. Bilora, E. Usandizaga, C. Amado, Pedro Ruiz-Artacho, Roberto Quintavalla, B. Barrón-Andrés, P.M. Azcarate, I. Benzidia, Lucia Mazzolai, P. Gutiérrez, Jorge Lima, O. Gavín, Thomas Vanassche, Farès Moustafa, V. Gómez, Andris Skride, Joseph A. Caprini, A. Gil-Díaz, Behnood Bikdeli, A. Hij, L. Rodríguez-Fernández, Olga Madridano, C. Rodríguez-Martín, C. de Ancos, Ana Maestre, M.C. Fernández-Criado, Henri Bounameaux, M.I. Torres, Radovan Malý, A.I. Farfán, I. Tzoran, J.A. Díaz-Peromingo, J.B. López-Sáez, M. Barrón, C. Tolosa, José Luis Lobo, Francesco Dentali, M. Zdraveska, Marijan Bosevski, L.M. Hernández Blasco, J.A. Nieto, Ma Morales, J. Caprini, Golemi, I., Cote, L., Iftikhar, O., Brenner, B., Tafur, A., Bikdeli, B., Fernandez-Capitan, C., Pedrajas, J. M., Otero, R., Quintavalla, R., Monreal, M., Prandoni, P., Farge-Bancel, D., Barba, R., Di Micco, P., Bertoletti, L., Tzoran, I., Reis, A., Bounameaux, H., Maly, R., Verhamme, P., Bosevski, M., Caprini, J. A., Bui, H. M., Adarraga, M. D., Aibar, M. A., Aibar, J., Amado, C., Arcelus, J. I., Azcarate, P. M., Ballaz, A., Barron, M., Barron-Andres, B., Bascunana, J., Blanco-Molina, A., Camon, A. M., Carrasco, C., Castro, J., de Ancos, C., del Toro, J., Demelo, P., Diaz-Pedroche, M. C., Diaz-Peromingo, J. A., Diaz-Simon, R., Encabo, M., Falga, C., Farfan, A. I., Fernandez-Criado, M. C., Fidalgo, M. A., Font, C., Font, L., Garcia, M. A., Garcia-Bragado, F., Garcia-Morillo, M., Garcia-Raso, A., Gavin, O., Gaya, I., Gayol, M. C., Gil-Diaz, A., Guirado, L., Gomez, V., Gonzalez-Martinez, J., Grau, E., Gutierrez, J., Hernandez Blasco, L. M., Iglesias, M., Jara-Palomares, L., Jaras, M. J., Jimenez, D., Jou, I., Joya, M. D., Lalueza, A., Lima, J., Llamas, P., Lobo, J. L., Lopez-Jimenez, L., Lopez-Miguel, P., Lopez-Nunez, J. J., Lopez-Reyes, R., Lopez-Saez, J. B., Lorente, M. A., Lorenzo, A., Loring, M., Lumbierres, M., Madridano, O., Maestre, A., Marchena, P. J., Martin-Guerra, J. M., Martin Fernandez, M., Mellado, M., Morales, M. V., Nieto, J. A., Nunez, M. J., Olivares, M. C., Otalora, S., Pellejero, G., Perez-Pinar, M., Perez-Rus, G., Peris, M. L., Pesce, M. L., Porras, J. A., Rivas, A., Rodriguez-Davila, M. A., Rodriguez-Fernandez, L., Rodriguez-Hernandez, A., Rodriguez-Martin, C., Rubio, C. M., Ruiz-Alcaraz, S., Ruiz-Artacho, P., Ruiz-Ruiz, J., Ruiz-Sada, P., Sahuquillo, J. C., Salazar, V., Samperiz, A., Sanchez-Munoz-Torrero, J. F., Sancho, T., Sanoja, I., Soler, S., Soto, M. J., Surinach, J. M., Tolosa, C., Torres, M. I., Trujillo-Santos, J., Uresandi, F., Usandizaga, E., Valle, R., Vidal, G., Gutierrez, P., Vazquez, F. J., Vilaseca, A., Vanassche, T., Vandenbriele, C., Hirmerova, J., Salgado, E., Benzidia, I., Bura-Riviere, A., Debourdeau, P., Falvo, N., Hij, A., Mahe, I., Moustafa, F., Braester, A., Ellis, M., Barillari, G., Bilora, F., Bortoluzzi, C., Brandolin, B., Bucherini, E., Ciammaichella, M., Dentali, F., Grandone, E., Imbalzano, E., Lessiani, G., Maida, R., Mastroiacovo, D., Mumoli, N., Vo Hong, N., Pace, F., Parisi, R., Pesavento, R., Pinelli, M., Rocci, A., Siniscalchi, C., Tufano, A., Visona, A., Skride, A., Sablinskis, K., Sablinskis, M., Zdraveska, M., Fresa, M., Ney, B., Mazzolai, L., and Caprini, J.

Subjects
Registrie, Male, Time Factors, Databases, Factual, Major adverse cardiovascular event, 030204 cardiovascular system & hematology, Coronary artery disease, 0302 clinical medicine, Retrospective Studie, Cardiovascular Disease, Major adverse limb events, Medicine, Registries, 030212 general & internal medicine, Myocardial infarction, Stroke, Incidence, Incidence (epidemiology), Hazard ratio, Major adverse limb event, Heart Disease Risk Factor, Middle Aged, Prognosis, Cardiovascular Diseases, Major adverse cardiovascular events, Female, VTE, Cardiology and Cardiovascular Medicine, Human, Provoked, Venous thromboembolism, medicine.medical_specialty, Time Factor, Prognosi, Risk Assessment, 03 medical and health sciences, Internal medicine, Humans, cardiovascular diseases, Aged, Retrospective Studies, business.industry, Unstable angina, medicine.disease, equipment and supplies, Confidence interval, Heart Disease Risk Factors, Surgery, business, Mace
Abstract

Registro Informatizado de Enfermedad Tromboembólica Investigators., [Objective] Overlap exists between the risk factors for coronary artery disease and venous thromboembolism (VTE). However, a paucity of data is available on the incidence of major acute cardiovascular events (MACE) and major adverse limb events (MALE) among patients presenting with VTE. Moreover, it is unknown whether the rate of cardiovascular outcomes differs among patients with unprovoked vs provoked VTE., [Methods] We analyzed the data from 2009 to 2017 in the Registro Informatizado de Enfermedad Tromboembólica registry, an ongoing, multicenter, international registry of consecutive patients with a diagnosis of objectively confirmed VTE. The query was restricted it to patients with data entry for the arterial outcomes. The baseline prevalence of coronary artery disease risk factors was compared between patients with provoked (ie, immobility, cancer, surgery, travel >6 hours, hormonal causes) and unprovoked VTE. After the initial VTE event, we followed up patients for the composite primary outcome of incident MACE (ie, stroke, myocardial infarction, unstable angina) and/or MALE (ie, major limb events). We used the χ2 test for baseline associations and a Cox proportional hazard for multivariate analysis. We used IBM SPSS, version 24 (IBM Corp, Armonk, NY) for statistical analysis. A P value of, [Results] We analyzed the data from 41,259 patients with VTE, of whom 22,633 (55.6%) had experienced a provoked VTE. During follow-up, the patients with provoked VTE were more likely to develop MACE or MALE than were patients with unprovoked VTE (hazard ratio [HR], 1.3; 95% confidence interval [CI], 1.1-1.5). The association of arterial events with recent immobility (HR, 1.4; 95% CI, 1.5-12.1) and cancer (HR, 1.7; 95% CI, 1.4-1.9) was strong. After adjusting for multiple conventional cardiovascular risk factors, provoked VTE, compared with unprovoked VTE, was significantly associated with an increased hazard for MACE (HR, 1.4; 95% CI, 1.1-1.7). Cancer remained a significant adjusted predictor for both MACE (HR, 1.7; 95% CI, 1.4-2.1) and MALE (HR, 2.1; 95% CI 1.01-4.6) in those with provoked VTE., [Conclusions] Among patients with VTE, provoked cases, specifically those with cancer-associated VTE, have an increased risk of major arterial events.

Published
2020

29. RAAS inhibitors are not associated with mortality in COVID-19 patients: Findings from an observational multicenter study in Italy and a meta-analysis of 19 studies

Author

Francesca Santilli, Marianna Meschiari, Gabriella Guarnieri, Francesco Petri, Anna Sabena, Gloria Maccagni, Giovanni Larizza, Massimo Mapelli, Maria Mazzitelli, Gian Battista Danzi, Katleen de Gaetano Donati, Annalisa Crisetti, Jovana Milic, Raffaele Pesavento, Biagio Pinchera, Riccardo Maragna, Carlo Andrea Pivato, Lorenzo Menicanti, Francesco Maria Fusco, Luca Aiello, Sandro Mancarella, Carlo Sanrocco, Alessandra Vergori, Greta Barbieri, Filippo Aucella, Silvia Marongiu, Giulio Maresca, Marianna Rossi, Andrea Antinori, Venerino Poletti, Francesco Cacciatore, Giacomo Castiglione, Enrico Maria Trecarichi, Lucia Caiano, Francesca Crosta, Roberto Vettor, Francesco Menichetti, Maria Musso, Francesco Salinaro, Marco Olivieri, Stefano Perlini, Claudia Colomba, Crizia Colombo, Ottavia Cozzi, Stefano Maitan, Marialaura Bonaccio, Ilaria My, Alexandra Virano, Paola Simeone, Marco Vinceti, Antonella Cingolani, Gianpiero D'Offizi, Damiano D'Ardes, Claudia Marotta, M. B. Lucia, Carlo Signorelli, Lorenzo Marra, Giuseppe Patti, Raffaele De Caterina, Armando Leone, Veronica Lio, Beatrice Molena, Giustino Parruti, Giulio G. Stefanini, Licia Iacoviello, Laura Vocciante, Franco Mastroianni, Raffaella Sgariglia, Cristina Mussini, Francesco Cipollone, Marco Rossato, Lorenzo Blandi, Emanuela Pasi, Samir Al Moghazi, Andrea Vianello, Filippo Minutolo, Ivan Gentile, Giovanni Guaraldi, Rosa Manuele, Pasquale Abete, Arturo Ciccullo, Antonella Palimodde, Giancarlo Scoppettuolo, Walter Ageno, Marco G. Mennuni, Roberta Mussinelli, Vincenzo Sangiovanni, Roberto Cauda, Laura Scorzolini, Paolo Bonfanti, Alessandro Gialluisi, Stefania Cianfrone, Piergiuseppe Agostoni, Antonio Cascio, Simona Costanzo, Augusto Di Castelnuovo, Nausicaa Berselli, Rosa Arboretti, Emauele Graziani, Martina Barchitta, Anna Odone, Francesco Di Gennaro, Alessandro Mengozzi, Alessandro Bartoloni, Giuseppe Di Tano, Laura Carrozzi, Ferruccio Madaro, Rossella Marcucci, Claudia Ravaglia, Di Castelnuovo, Augusto, Costanzo, Simona, Antinori, Andrea, Berselli, Nausicaa, Blandi, Lorenzo, Bonaccio, Marialaura, Cauda, Roberto, Gialluisi, Alessandro, Guaraldi, Giovanni, Menicanti, Lorenzo, Mennuni, Marco, Mussinelli, Roberta, My, Ilaria, Parruti, Giustino, Patti, Giuseppe, Perlini, Stefano, Santilli, Francesca, Signorelli, Carlo, Stefanini, Giulio G., Vergori, Alessandra, Abete, Pasquale, Ageno, Walter, Agostoni, Piergiuseppe, Aiello, Luca, Al Moghazi, Samir, Arboretti, Rosa, Aucella, Filippo, Barbieri, Greta, Barchitta, Martina, Bartoloni, Alessandro, Bonfanti, Paolo, Cacciatore, Francesco, Caiano, Lucia, Carrozzi, Laura, Cascio, Antonio, Castiglione, Giacomo, Cianfrone, Stefania, Ciccullo, Arturo, Cingolani, Antonella, Cipollone, Francesco, Colomba, Claudia, Colombo, Crizia, Cozzi, Ottavia, Crisetti, Annalisa, Crosta, Francesca, Danzi, Gian Battista, D'Ardes, Damiano, de Gaetano Donati, Katleen, Di Gennaro, Francesco, Di Tano, Giuseppe, D'Offizi, Gianpiero, Fusco, Francesco Maria, Gentile, Ivan, Graziani, Emauele, Guarnieri, Gabriella, Larizza, Giovanni, Leone, Armando, Lio, Veronica, Lucia, Mothanje Barbara, Maccagni, Gloria, Madaro, Ferruccio, Maitan, Stefano, Mancarella, Sandro, Manuele, Rosa, Mapelli, Massimo, Maragna, Riccardo, Marcucci, Rossella, Maresca, Giulio, Marongiu, Silvia, Marotta, Claudia, Marra, Lorenzo, Mastroianni, Franco, Mazzitelli, Maria, Mengozzi, Alessandro, Menichetti, Francesco, Meschiari, Marianna, Milic, Jovana, Minutolo, Filippo, Molena, Beatrice, Mussini, Cristina, Musso, Maria, Odone, Anna, Olivieri, Marco, Palimodde, Antonella, Pasi, Emanuela, Pesavento, Raffaele, Petri, Francesco, Pinchera, Biagio, Pivato, Carlo A., Poletti, Venerino, Ravaglia, Claudia, Rossato, Marco, Rossi, Marianna, Sabena, Anna, Salinaro, Francesco, Sangiovanni, Vincenzo, Sanrocco, Carlo, Scoppettuolo, Giancarlo, Scorzolini, Laura, Sgariglia, Raffaella, Simeone, Paola Giustina, Trecarichi, Enrico Maria, Vettor, Roberto, Vianello, Andrea, Vinceti, Marco, Virano, Alexandra, Vocciante, Laura, De Caterina, Raffaele, Iacoviello, Licia, Di Castelnuovo, A., Costanzo, S., Antinori, A., Berselli, N., Bl, I, L., Bonaccio, M., Cauda, R., Gialluisi, A., Guaraldi, G., Menicanti, L., Mennuni, M., Mussinelli, R., My, I., Parruti, G., Patti, G., Perlini, S., Santilli, F., Signorelli, C., Stefanini, G. G., Vergori, A., Abete, P., Ageno, W., Agostoni, P., Aiello, L., Al Moghazi, S., Arboretti, R., Aucella, F., Barbieri, G., Barchitta, M., Bartoloni, A., Bonfanti, P., Cacciatore, F., Caiano, L., Carrozzi, L., Cascio, A., Castiglione, G., Cianfrone, S., Ciccullo, A., Cingolani, A., Cipollone, F., Colomba, C., Colombo, C., Cozzi, O., Crisetti, A., Crosta, F., Danzi, G. B., D'Ardes, D., de Gaetano Donati, K., Di Gennaro, F., Di Tano, G., D'Offizi, G., Fusco, F. M., Gentile, I., Graziani, E., Guarnieri, G., Larizza, G., Leone, A., Lio, V., Lucia, M. B., Maccagni, G., Madaro, F., Maitan, S., Mancarella, S., Manuele, R., Mapelli, M., Maragna, R., Marcucci, R., Maresca, G., Marongiu, S., Marotta, C., Marra, L., Mastroianni, F., Mazzitelli, M., Mengozzi, A., Menichetti, F., Meschiari, M., Milic, J., Minutolo, F., Molena, B., Mussini, C., Musso, M., Odone, A., Olivieri, M., Palimodde, A., Pasi, E., Pesavento, R., Petri, F., Pinchera, B., Pivato, C. A., Poletti, V., Ravaglia, C., Rossato, M., Rossi, M., Sabena, A., Salinaro, F., Sangiovanni, V., Sanrocco, C., Scoppettuolo, G., Scorzolini, L., Sgariglia, R., Simeone, P. G., Trecarichi, E. M., Vettor, R., Vianello, A., Vinceti, M., Virano, A., Vocciante, L., De Caterina, R., Iacoviello, L., Blandi, L., Di Castelnuovo, A, Costanzo, S, Antinori, A, Berselli, N, Blandi, L, Bonaccio, M, Cauda, R, Gialluisi, A, Guaraldi, G, Menicanti, L, Mennuni, M, Mussinelli, R, My, I, Parruti, G, Patti, G, Perlini, S, Santilli, F, Signorelli, C, Stefanini, G, Vergori, A, Abete, P, Ageno, W, Agostoni, P, Aiello, L, Al Moghazi, S, Arboretti, R, Aucella, F, Barbieri, G, Barchitta, M, Bartoloni, A, Bonfanti, P, Cacciatore, F, Caiano, L, Carrozzi, L, Cascio, A, Castiglione, G, Cianfrone, S, Ciccullo, A, Cingolani, A, Cipollone, F, Colomba, C, Colombo, C, Cozzi, O, Crisetti, A, Crosta, F, Danzi, G, D'Ardes, D, de Gaetano Donati, K, Di Gennaro, F, Di Tano, G, D'Offizi, G, Fusco, F, Gentile, I, Graziani, E, Guarnieri, G, Larizza, G, Leone, A, Lio, V, Lucia, M, Maccagni, G, Madaro, F, Maitan, S, Mancarella, S, Manuele, R, Mapelli, M, Maragna, R, Marcucci, R, Maresca, G, Marongiu, S, Marotta, C, Marra, L, Mastroianni, F, Mazzitelli, M, Mengozzi, A, Menichetti, F, Meschiari, M, Milic, J, Minutolo, F, Molena, B, Mussini, C, Musso, M, Odone, A, Olivieri, M, Palimodde, A, Pasi, E, Pesavento, R, Petri, F, Pinchera, B, Pivato, C, Poletti, V, Ravaglia, C, Rossato, M, Rossi, M, Sabena, A, Salinaro, F, Sangiovanni, V, Sanrocco, C, Scoppettuolo, G, Scorzolini, L, Sgariglia, R, Simeone, P, Trecarichi, E, Vettor, R, Vianello, A, Vinceti, M, Virano, A, Vocciante, L, Iacoviello, L, and De Caterina, R

Subjects
0301 basic medicine, Male, Physiology, Middle Aged, Renin-Angiotensin System, Angiotensin-Converting Enzyme Inhibitors, 030204 cardiovascular system & hematology, ACE-I, ARB, COVID-19, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, mortality, sartans, Severity of Illness Index, Renin-Angiotensin System, 0302 clinical medicine, Risk Factors, 80 and over, Medicine, Hospital Mortality, Sartan, Aged, 80 and over, Incidence (epidemiology), Incidence, Hazard ratio, Angiotensin Receptor Antagonist, Middle Aged, Hospitalization, Antihypertensive Agent, Italy, Meta-analysis, Hypertension, Sartans, Molecular Medicine, Female, Risk assessment, Human, medicine.medical_specialty, Angiotensin converting enzyme inhibitors, Angiotensin receptor blockers, Mortality, Coronavirus disease 2019 (COVID-19), Risk Assessment, Article, COVID−19, 03 medical and health sciences, Angiotensin Receptor Antagonists, Meta-Analysis as Topic, Internal medicine, Severity of illness, Humans, Angiotensin receptor blocker, Antihypertensive Agents, Aged, Pharmacology, business.industry, Risk Factor, Angiotensin-Converting Enzyme Inhibitor, Confidence interval, 030104 developmental biology, COVID-19, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, mortality, sartans, Observational study, Angiotensin converting enzyme inhibitor, business
Abstract

Objective The hypothesis that been set forward that use of Renin Angiotensin Aldosterone System (RAAS) inhibitors is associated with COVID−19 severity. We set-up a multicenter Italian collaboration (CORIST Project, ClinicalTrials.gov ID: NCT04318418 ) to retrospectively investigate the relationship between RAAS inhibitors and COVID−19 in-hospital mortality. We also carried out an updated meta-analysis on the relevant studies. Methods We analyzed 4069 unselected patients with laboratory-confirmed SARS-CoV-2 infection and hospitalized in 34 clinical centers in Italy from February 19, 2020 to May 23, 2020. The primary end-point in a time-to event analysis was in-hospital death, comparing patients who received angiotensin-converting–enzyme inhibitors (ACE I) or angiotensin-receptor blockers (ARB) with patients who did not. Articles for the meta-analysis were retrieved until July 13th, 2020 by searching in web-based libraries, and data were combined using the general variance-based method. Results Out of 4069 COVID−19 patients, 13.5% and 13.3% received ACE-I or ARB, respectively. Use of neither ACE-I nor ARB was associated with mortality (multivariable hazard ratio (HR) adjusted also for COVID−19 treatments: 0.96, 95% confidence interval 0.77–1.20 and HR = 0.89, 0.67–1.19 for ACE-I and ARB, respectively). Findings were similar restricting the analysis to hypertensive (N = 2057) patients (HR = 1.00, 0.78–1.26 and HR = 0.88, 0.65–1.20) or when ACE-I or ARB were considered as a single group. Results from the meta-analysis (19 studies, 29,057 COVID−19 adult patients, 9700 with hypertension) confirmed the absence of association. Conclusions In this observational study and meta-analysis of the literature, ACE-I or ARB use was not associated with severity or in-hospital mortality in COVID−19 patients.

Published
2020

30. Arrhythmic profile and 24-hour QT interval variability in COVID-19 patients treated with hydroxychloroquine and azithromycin

Author

Filippo Donato, Davide Ceccato, Raffaele Pesavento, Angelo Avogaro, Matteo Parolin, Alberto Cipriani, Federico Capone, Cristiano Sarais, Pietro Maffei, Alois Saller, Paola Fioretto, L. Previato, Roberto Vettor, Alessandro Zorzi, Dario Gregori, and Sabino Iliceto

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Combination therapy, Long QT syndrome, 030204 cardiovascular system & hematology, Azithromycin, QT interval, Sudden death, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, cardiovascular diseases, 030212 general & internal medicine, Coronavirus, COVID-19, Severe acute respiratory syndrome, Ventricular arrhythmia, business.industry, Hydroxychloroquine, medicine.disease, Cardiology, Cardiology and Cardiovascular Medicine, business, circulatory and respiratory physiology, medicine.drug, Holter ecg
Abstract

Background Hydroxychloroquine and azithromycin combination therapy is often prescribed for coronavirus disease 2019 (COVID-19). Electrocardiographic (ECG) monitoring is warranted because both medications cause corrected QT-interval (QTc) prolongation. Whether QTc duration significantly varies during the day, potentially requiring multiple ECGs, remains to be established. Methods We performed 12‑lead ECGs and 12‑lead 24-h Holter ECG monitoring in all patients aged Results Out of 126 patients, 22 (median age 64, 82% men) met the inclusion criteria. ECG after therapy showed longer QTc-interval than before therapy (450 vs 426 ms, p = .02). Four patients had a QTc ≥ 480 ms: they showed higher values of aspartate aminotransferase (52 vs 30 U/L, p = .03) and alanine aminotransferase (108 vs 33 U/L, p Conclusion Therapy with hydroxychloroquine and azithromycin prolongs QTc interval in patients with COVID-19, particularly in those with high levels of transaminases. Because QTc duration remains stable during the 24 h, multiple daily ECG are not recommendable.

Published
2020

31. Cardiac injury and mortality in patients with Coronavirus disease 2019 (COVID-19): insights from a mediation analysis

Author

Angelo Avogaro, Davide Ceccato, Leonardo Molinari, Sabino Iliceto, Federico Capone, Cristiano Sarais, Alois Saller, Filippo Donato, Paola Fioretto, Raffaele Pesavento, Dario Gregori, Roberto Vettor, L. Previato, and Alberto Cipriani

Subjects
Male, medicine.medical_specialty, Cardiac troponin, Coronavirus disease 2019 (COVID-19), Im - Commentary, COVID-19, Cardiac injury, Coronavirus 2019, Lactic dehydrogenase, 030204 cardiovascular system & hematology, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Internal Medicine, medicine, Humans, In patient, 030212 general & internal medicine, Hospital Mortality, Aged, Female, Heart Injuries, Italy, Mediation Analysis, SARS-CoV-2, business.industry, Prognosis, medicine.disease, Comorbidity, Im - Original, Cohort, Emergency Medicine, business, Kidney disease
Abstract

Backgrounds Patients at greatest risk of severe clinical conditions from coronavirus disease 2019 (COVID-19) and death are elderly and comorbid patients. Increased levels of cardiac troponins identify patients with poor outcome. The present study aimed to describe the clinical characteristics and outcomes of a cohort of Italian inpatients, admitted to a medical COVID-19 Unit, and to investigate the relative role of cardiac injury on in-hospital mortality. Methods and results We analyzed all consecutive patients with laboratory-confirmed COVID-19 referred to our dedicated medical Unit between February 26th and March 31st 2020. Patients’ clinical data including comorbidities, laboratory values, and outcomes were collected. Predictors of in-hospital mortality were investigated. A mediation analysis was performed to identify the potential mediators in the relationship between cardiac injury and mortality. A total of 109 COVID-19 inpatients (female 36%, median age 71 years) were included. During in-hospital stay, 20 patients (18%) died and, compared with survivors, these patients were older, had more comorbidities defined by Charlson comorbidity index ≥ 3(65% vs 24%, p = 0.001), and higher levels of high-sensitivity cardiac troponin I (Hs-cTnI), both at first evaluation and peak levels. A dose–response curve between Hs-cTnI and in-hospital mortality risk up to 200 ng/L was detected. Hs-cTnI, chronic kidney disease, and chronic coronary artery disease mediated most of the risk of in-hospital death, with Hs-cTnI mediating 25% of such effect. Smaller effects were observed for age, lactic dehydrogenase, and d-dimer. Conclusions In this cohort of elderly and comorbid COVID-19 patients, elevated Hs-cTnI levels were the most important and independent mediators of in-hospital mortality.

Published
2020

32. Ultrasound elastography is useful to distinguish acute and chronic deep vein thrombosis

Author

Matteo Giorgi-Pierfranceschi, Josè Vitale, Francesco Dentali, M Mochi, Nicola Mumoli, Antonino Mazzone, Fulvio Pomero, Walter Ageno, Raffaele Pesavento, Daniela Mastroiacovo, and Marco Cei

Subjects
Male, elastography, Duplex ultrasonography, medicine.medical_specialty, diagnosis, Deep vein, Femoral vein, 030204 cardiovascular system & hematology, Likelihood ratios in diagnostic testing, deep vein thrombosis, 030218 nuclear medicine & medical imaging, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Positive predicative value, medicine, Humans, Prospective Studies, cardiovascular diseases, Thrombus, Prospective cohort study, Venous Thrombosis, accuracy, ultrasound, business.industry, Hematology, Middle Aged, medicine.disease, Thrombosis, medicine.anatomical_structure, Italy, Acute Disease, Chronic Disease, Elasticity Imaging Techniques, Female, Radiology, business
Abstract

Essentials Ultrasound elastography uses tissue deformation to assess the relative quantification of its elasticity. Compression and duplex ultrasonography may be unable to correctly determine the thrombus age. Ultrasound elastography may be useful to distinguish between acute and chronic deep vein thrombosis. The exact determination of the thrombus age could have both therapeutic and prognostic implications. BACKGROUND: Background Ultrasound elastography (UE) imaging is a novel sonographic technique that is commonly employed for relative quantification of tissue elasticity. Its applicability to venous thromboembolic events has not yet been fully established; in particular, it is unclear whether this technique may be useful in determining the age of deep vein thrombosis (DVT). Thus, the aim of this study was to assess the role of UE in distinguishing acute from chronic DVT. Methods Consecutive patients with a first unprovoked acute and chronic (3 months old) DVT of the lower limbs were analyzed. Patients with recurrent DVT or with a suspected recurrence were excluded. The mean elasticity index (EI) values of acute and chronic popliteal and femoral vein thrombosis were compared. The accuracy of the EI in distinguishing acute from chronic DVT was also assessed by measuring the sensitivity, specificity, positive and negative predictive values, and likelihood ratios. Results One-hundred and forty-nine patients (mean age 63.9 years, standard deviation 13.6; 73 males) with acute and chronic DVT were included. The mean EI of acute femoral DVT was higher than that of chronic femoral DVT (5.09 versus 2.46), and the mean EI of acute popliteal DVT was higher than that of chronic popliteal DVT (4.96 versus 2.48). An EI value of > 4 resulted in a sensitivity of 98.9% (95% confidence interval [CI] 93.3-99.9), a specificity of 99.1% (95% CI 94.8-99.9), a positive predictive value of 91.1% (95% CI 77.9-97.1), a negative predictive value of 98.6% (95% CI 91.3-99.9), a positive likelihood ratio of 13.23 (95% CI 93-653) and a negative likelihood ratio of 0.001 (95% CI 0.008-0.05) for acute DVT. Conclusions UE appears to be a promising technique for distinguishing between acute and chronic DVT. Larger prospective studies are warranted to confirm our preliminary findings.

Published
2018
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33. Thrombophilia as a predictor of persistent residual vein thrombosis

Author

Luca Spiezia, Daniela Tormene, Raffaele Pesavento, Laura Salmaso, Paolo Simioni, and Paolo Prandoni

Subjects
Diseases of the blood and blood-forming organs, RC633-647.5
Abstract

To compare the probability of leg vein recanalization between carriers and non-carriers of thrombophilia after an episode of deep vein thrombosis (DVT) of the lower extremities, we reviewed the clinical records of 472 patients with proximal DVT who were diagnosed with thrombophilia, and had long-term ultrasound scanning. One hundred and thirty-seven patients (29.0%) were carriers of thrombophilia. After adjusting for age, sex, DVT localization and modality of presentation, the hazard ratio of vein recanalization in thrombophilic compared with non-thrombophilic patients was 0.49 (95% CI, 0.38 to 0.63). These findings suggest that thrombophilia is an independent predictor of persistent residual vein thrombosis.

Published
2008
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34. Metabolic syndrome and hyperhomocysteinemia in patients with deep vein thrombosis: a case-control study

Author

Francesco Dentali, Walter Ageno, Erica Romualdi, Raffaele Pesavento, Angelo Ghirarduzzi, and Paolo Prandoni

Subjects
Diseases of the blood and blood-forming organs, RC633-647.5
Abstract

We evaluated the prevalence of the metabolic syndrome (MS) and of hyperhomocysteinemia in patients with unprovoked deep vein thrombosis (DVT) and in controls. The MS and hyperhomocysteinemia were significantly more prevalent in DVT patients than in controls. However, only the MS resulted independently associated with DVT, and the coexistence of both risk factors did not increase the magnitude of the association.

Published
2007
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35. Endothelial dysfunction in patients with spontaneous venous thromboembolism

Author

Rino Migliacci, Cecilia Becattini, Raffaele Pesavento, Giovanni Davi, Maria Cristina Vedovati, Giuseppe Guglielmini, Emanuela Falcinelli, Giovanni Ciabattoni, Fabio Dalla Valle, Paolo Prandoni, Giancarlo Agnelli, and Paolo Gresele

Subjects
Diseases of the blood and blood-forming organs, RC633-647.5
Abstract

Background and Objectives A high incidence of atherosclerotic lesions and cardiovascular events has been reported in patients with spontaneous venous thromboembolism. Endothelial dysfunction is an early marker of atherosclerosis and has predictive value for ischemic events. We have evaluated endothelial function in patients with a history of spontaneous venous thromboembolism.Design and Methods Patients with a history of symptomatic, objectively confirmed, spontaneous venous thromboembolism were included in a case-control study. Exclusion criteria were any known risk factors for cardiovascular diseases, other conditions associated with endothelial dysfunction, estro-progestinic therapy or pregnancy. Controls were age-(±5 years) and sex-matched subjects with the same exclusion criteria but without previous venous thromboembolism. Endothelial function was evaluated by the non-invasive measurement of flow-mediated vasodilation of the brachial artery and of plasma markers of endothelium activation; platelet activation parameters were also measured.Results Twenty-eight cases (8 females; mean age 59±15 years) and 28 controls (8 females; mean age 58±15) were studied. Flow-mediated vasodilation was 3.5±0.6% in cases (95% CIs: 2.2 to 4.8) and 5.7±0.6% (4.2 to 6.8) in controls (p=0.015). Brachial artery blood flow and hyperemic blood flow did not differ between the two groups. Plasma von Willebrand factor and soluble P-selectin levels were significantly higher in patients with venous thromboembolism, while plasma soluble CD40 ligand and urinary 11-dehydro-TxB2 levels were similar in cases and controls.Interpretation and Conclusions Patients with spontaneous venous thromboembolism have endothelial dysfunction, unlike age- and sex- matched controls. This finding suggests that spontaneous venous thromboembolism may be a condition associated with an enhanced risk of atherosclerosis.

Published
2007
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36. The risk of recurrent venous thromboembolism after discontinuing anticoagulation in patients with acute proximal deep vein thrombosis or pulmonary embolism. A prospective cohort study in 1,626 patients

Author

Paolo Prandoni, Franco Noventa, Angelo Ghirarduzzi, Vittorio Pengo, Enrico Bernardi, Raffaele Pesavento, Matteo Iotti, Daniela Tormene, Paolo Simioni, and Antonio Pagnan

Subjects
Diseases of the blood and blood-forming organs, RC633-647.5
Abstract

Background and Objectives While it has long been recognized that patients with acute unprovoked deep vein thrombosis (DVT) or pulmonary embolism (PE) have a higher risk of recurrent venous thromboembolism (VTE) than that of patients with secondary thrombosis, whether other clinical parameters can help predict the development of recurrent events is controversial. The aim of this investigation was to assess the rate of recurrent VTE after withdrawal of vitamin K antagonists, and to identify clinical parameters associated with a higher likelihood of recurrence.Design and Methods We followed, up to a maximum of 10 years, 1626 consecutive patients who had discontinued anticoagulation after a first episode of clinically symptomatic proximal DVT and/or PE. All patients with clinically suspected recurrent VTE underwent objective tests to confirm or rule out the clinical suspicion.Results After a median follow-up of 50 months, 373 patients (22.9%) had had recurrent episodes of VTE. The cumulative incidence of recurrent VTE was 11.0% (95% CI, 9.5–12.5) after 1 year, 19.6% (17.5–21.7) after 3 years, 29.1% (26.3–31.9) after 5 years, and 39.9% (35.4–44.4) after 10 years. The adjusted hazard ratio for recurrent VTE was 2.30 (95% CI, 1.82–2.90) in patients whose first VTE was unprovoked, 2.02 (1.52–2.69) in those with thrombophilia, 1.44 (1.03–2.03) in those presenting with primary DVT, 1.39 (1.08–1.80) for patients who received a shorter (up to 6 months) duration of anticoagulation, and 1.14 (1.06–1.12) for every 10-year increase of age. When the analysis was confined to patients with unprovoked VTE the results did not change.Interpretation and Conclusions Besides unprovoked presentation, other factors independently associated with a statistically significant increased risk of recurrent VTE are thrombophilia, clinical presentation with primary DVT, shorter duration of anticoagulation, and increasing age.

Published
2007
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37. ANMCO Position Paper: long-term follow-up of patients with pulmonary thromboembolism

Author

Michele Massimo Gulizia, Franco Casazza, Giuseppe Favretto, Andrea Maria D'Armini, Antonella Tufano, Valentina Grazioli, Carlo D'Agostino, Nicoletta Corrieri, Cecilia Becattini, Gualtiero Palareti, Loris Roncon, Michele D'Alto, Amedeo Bongarzoni, Pietro Zonzin, Giovanni Di Minno, Iolanda Enea, Piergiuseppe Agostoni, Laura Scelsi, Maria Grazia De Natale, Lucia Filippi, Michele Azzarito, Francesca Bux, Nicola D’Amato, Walter Ageno, Raffaele Pesavento, D'Agostino, DIEGO CARLO, Zonzin, Pietro, Enea, Iolanda, Gulizia, Michele Massimo, Ageno, Walter, Agostoni, Piergiuseppe, Azzarito, Michele, Becattini, Cecilia, Bongarzoni, Amedeo, Bux, Francesca, Casazza, Franco, Corrieri, Nicoletta, D'Alto, Michele, D'Amato, Nicola, D'Armini, Andrea Maria, De Natale, Maria Grazia, Di Minno, Giovanni, Favretto, Giuseppe, Filippi, Lucia, Grazioli, Valentina, Palareti, Gualtiero, Pesavento, Raffaele, Roncon, Lori, Scelsi, Laura, and Tufano, Antonella

Subjects
medicine.medical_specialty, Prognosi, Long term follow up, Disease, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Deep vein thrombosi, Deep vein thrombosis, Consensus document, Prognosis, Pulmonary embolism, Treatment, Venous thromboembolism, medicine, 030212 general & internal medicine, cardiovascular diseases, Intensive care medicine, business.industry, Articles, medicine.disease, equipment and supplies, Venous thrombosis, Position paper, Chronic thromboembolic pulmonary hypertension, Occult cancer, Cardiology and Cardiovascular Medicine, business
Abstract

Venous thromboembolism (VTE), including pulmonary embolism and deep venous thrombosis, is the third most common cause of cardiovascular death. The management of the acute phase of VTE has already been described in several guidelines. However, the management of the follow-up (FU) of these patients has been poorly defined. This consensus document, created by the Italian cardiologists, wants to clarify this issue using the currently available evidence in VTE. Clinical and instrumental data acquired during the acute phase of the disease are the cornerstone for planning the FU. Acquired or congenital thrombophilic disorders could be identified in apparently unprovoked VTE during the FU. In other cases, an occult cancer could be discovered after a VTE. The main targets of the post-acute management are to prevent recurrence of VTE and to identify the patients who can develop a chronic thromboembolic pulmonary hypertension. Knowledge of pathophysiology and therapeutic approaches is fundamental to decide the most appropriate long-term treatment. Moreover, prognostic stratification during the FU should be constantly updated on the basis of the new evidence acquired. Currently, the cornerstone of VTE treatment is represented by both the oral and the parenteral anticoagulation. Novel oral anticoagulants should be an interesting alternative in the long-term treatment.

Published
2017

38. The optimal duration of anticoagulant therapy after unprovoked venous thromboembolism – still a challenging issue

Author

Giovanna Elmi, Raffaele Pesavento, and Giuseppe Di Pasquale

Subjects
medicine.medical_specialty, Time Factors, medicine.drug_mechanism_of_action, Factor Xa Inhibitor, Hemorrhage, 030204 cardiovascular system & hematology, Risk Assessment, Drug Administration Schedule, Dabigatran, 03 medical and health sciences, 0302 clinical medicine, Recurrence, Risk Factors, Humans, Medicine, 030212 general & internal medicine, Intensive care medicine, Blood Coagulation, Aspirin, business.industry, Patient Selection, Anticoagulants, Idarucizumab, Venous Thromboembolism, Sulodexide, Surgery, Treatment Outcome, Systematic review, Anticoagulant therapy, Cardiology and Cardiovascular Medicine, business, Venous thromboembolism, medicine.drug
Abstract

Abstract. As about 50 % of patients with unprovoked venous thromboembolism (VTE) will develop new episodes after discontinuing therapy, indefinite treatment is suggested in patients with low or moderate bleeding risk. Baseline and post-baseline factors can help clinicians to identify patients at high risk of recurrence, who require extended treatment. Residual vein obstruction and D-dimer assay have been shown to be suitable methods for assessing the risk of VTE recurrences after a first unprovoked VTE. In treatment for VTE the use of direct oral anticoagulants (DOAC) is growing instead of the standard adjusted dose of vitamin K antagonists. The DOAC safety profile has recently been strengthened with systematic reviews and meta-analyses. Idarucizumab is only approved for the reversal of dabigatran etexilate; intravenous antidotes for factor Xa inhibitors are under development. Their advent is of great interest. In the extended treatment of VTE sulodexide has been demonstrated to significantly decrease the risk of recurrences with an excellent safety profile. Aspirin is substantially less effective than oral anticoagulants in preventing recurrences but could play a role among patients who decided to stop anticoagulants. In conclusion, for the secondary prevention of VTE several options are available, without a recognised best choice regarding the treatment duration and the choice of drugs. An individual strategy taking into account risk of recurrence, bleeding risk, therapeutic options, and patient preferences is appropriate.

Published
2017
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39. Outcome after discontinuing anticoagulant therapy in women with venous thromboembolism during hormonal use

Author

Ángeles Blanco-Molina, Raffaele Pesavento, C. Tolosa, Ángel Sampériz, Javier Trujillo-Santos, Lucia Mazzolai, Rita Duce, Conxita Falga, Manuel Monreal, and Vladimir Rosa

Subjects
Adult, medicine.medical_specialty, Hormone Replacement Therapy, medicine.medical_treatment, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Recurrence, Risk Factors, Internal medicine, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Gynecology, Pregnancy, business.industry, Anticoagulants, Cancer, Hormone replacement therapy (menopause), Venous Thromboembolism, Hematology, Middle Aged, equipment and supplies, medicine.disease, Pulmonary embolism, Treatment Outcome, Anticoagulant therapy, Hormonal therapy, Female, business, Venous thromboembolism, Follow-Up Studies, Hormone
Abstract

Introduction Whether women developing venous thromboembolism (VTE) while using hormonal therapy should be classified as having “unprovoked” or “provoked” VTE is controversial. Methods We used the RIETE (Registro Informatizado Enfermedad TromboEmbolica) database to compare the rate of symptomatic VTE recurrences after discontinuing anticoagulation in 3 subgroups of women aged ≤ 50 years without cancer, pregnancy or puerperium: (1) those with hormonal therapy and no additional risk factors (hormonal users only); (2) those with unprovoked VTE; and (3) those with additional risk factors, with or without hormonal therapy. Results As of March 2016, 1513 women had been followed-up for at least one month after discontinuing anticoagulation. Of these, 654 (43%) were hormonal users only, 390 (26%) had unprovoked VTE and 469 (31%) had transient risk factors with or without hormonal therapy. After discontinuing anticoagulation, the rate of VTE recurrences in women with hormonal use only (2.44 per 100 patient-years; 95% CI: 1.53–3.69) was significantly lower than in those with unprovoked VTE (6.03; 95% CI: 3.97–8.77) and similar to those with transient risk factors (2.58; 95% CI: 1.50–4.13). Interestingly, the rate of VTE recurrences presenting as pulmonary embolism in women with hormonal use only (0.55 per 100 patient-years; 95% CI: 0.18–1.29) was similar to those with transient risk factors (0.46; 95% CI: 0.09–1.33) and 4-fold lower than in women with unprovoked VTE (2.23; 95% CI: 1.07–4.10). Conclusions After discontinuing anticoagulation, the rate of VTE recurrences in hormonal users only was significantly lower than in women with unprovoked VTE and similar to the rate in women with additional risk factors.

Published
2017
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40. Why optional inferior vena cava filters are not always retrieved? A real world 19 years experience in a Swiss tertiary care university hospital

Author

Giacomo Buso, Salah-Dine Qanadli, Raffaele Pesavento, Marco Fresa, Luca Calanca, Adriano Alatri, and Lucia Mazzolai

Subjects
medicine.medical_specialty, Vena Cava Filters, Vena Cava, Inferior, 030204 cardiovascular system & hematology, Real life setting, Tertiary care, Inferior vena cava, 03 medical and health sciences, 0302 clinical medicine, Internal Medicine, Medicine, Humans, In patient, 030212 general & internal medicine, Device Removal, Retrospective Studies, business.industry, Tertiary Healthcare, Mortality rate, General surgery, Filter retrieval, University hospital, Hospitals, Treatment Outcome, medicine.vein, business, Pulmonary Embolism, Venous thromboembolism, Switzerland
Abstract

inferior vena cava filters (IVCF) are widely used to prevent thromboembolic events in patients not suitable for anticoagulation (AC). Although new generations of filters are optional and therefore retrievable, most of them become permanent. Aim of our study was to evaluate real life IVCF management in a tertiary hospital including retrieval rates and reasons for permanent filtering.Electronic charts from patients receiving IVCF in a Swiss university hospital, during 1999-2017, were retrospectively identified. Patients were classified in two groups, according to filter retrieval (RG) or not (NRG). Type and reasons of filter placement were assessed. Retrieval, complications, and mortality rates were calculated. Reasons of non-retrieval were analyzed.920 patients received an IVCF during 1999-2017. Filters were retrieved in 372 patients (40.65%). Subjects in the NRG were significantly older, more chronically ill, and presented higher mortality rate at 12 months following filter insertion (29.60% vs. 4.30%; p 0.001). Reasons for non-retrieval included lack of follow-up (22.34%), persistent contraindications to AC (20.51%), technical issues (17.40%), and severe morbidity with short life expectancy (17.22%). Overall, complication rates after filter placement was 18.58%. Most reported complication was filter thrombosis (15.60%).In a real life setting, optional IVCF are still too often left in place indefinitely. Need for a systematic follow-up to ensure prompt filter retrieval is warranted. IVCF are not retrieved mostly in chronically and more severely ill patients, likely accounting for higher mortality in these subjects.

Published
2019

41. Residual pulmonary vascular obstruction and recurrence after acute pulmonary embolism: protocol for a systematic review and meta-analysis of individual participant data

Author

Francis Couturaud, Benjamin Planquette, Pierre-Yves Le Roux, Philippe Robin, Raffaele Pesavento, Maggie Eddy, Marc Carrier, Grégoire Le Gal, Pierre-Yves Salaun, Lindsey Sikora, Marc A. Rodger, CHRU Brest - Service de médecine nucléaire (CHU - BREST - Med Nucléaire), 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), Thrombosis Program, University of Ottawa [Ottawa], Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), and Centre Hospitalier de Versailles André Mignot (CHV)

Subjects
Male, pulmonary embolism, Deep vein, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, Cardiovascular Medicine, law.invention, lung scintigraphy, 0302 clinical medicine, Randomized controlled trial, law, Recurrence, Protocol, 030212 general & internal medicine, Prospective cohort study, ComputingMilieux_MISCELLANEOUS, Venous Thrombosis, recurrent venous thromboembolism, General Medicine, Venous Thromboembolism, Prognosis, Thrombosis, 3. Good health, Pulmonary embolism, medicine.anatomical_structure, Pulmonary Veins, Research Design, Meta-analysis, Female, Adult, Diagnostic Imaging, medicine.medical_specialty, Ventilation-Perfusion Scan, Adolescent, MEDLINE, Arterial Occlusive Diseases, Pulmonary Artery, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, residual pulmonary vascular obstruction, medicine, Humans, Intensive care medicine, Watchful Waiting, business.industry, Anticoagulants, medicine.disease, Discontinuation, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

BackgroundIn patients with a first, unprovoked venous thromboembolism (VTE), the optimal duration of anticoagulant therapy (AT) is controversial due to tightly balanced risks and benefits of indefinite anticoagulation. The objective of this study is to assess among patients with a first acute pulmonary embolism (PE) who received ≥3 months of AT and thereafter had a planar lung scan, whether residual pulmonary vascular obstruction (RPVO) is associated with VTE recurrence after discontinuation of AT.Methods and analysisWe will conduct a systematic review with a meta-analysis of individual participant data of contemporary studies evaluating the prognostic significance of RPVO in patients with a first acute PE. We will search from inception to 24 January 2018, PubMed, Medline, Embase and Cochrane’s Central Registry for Randomized Controlled Trials, CENTRAL for randomized controlled trials and prospective cohort studies. Two reviewers will conduct all screening and data collection independently. The methodological quality and risk of bias of eligible studies will be carefully and rigorously assessed using the Risk Of Bias In Non-randomised Studies of Interventions tool. The primary objective will be to assess the relationship between RPVO on ventilation–perfusion scan after completion of at least 3 months of AT after an acute PE event, and the risk of an objectively confirmed symptomatic recurrent VTE (including deep vein thrombosis or PE) or death due to PE. The secondary objectives will include the assessment of the optimal RPVO cut-off and the risk of recurrent VTE, as well as the relationship between the relative change in RPVO between PE diagnosis and at discontinuation of AT (≥3 months) and risk of recurrent VTE.Ethics and disseminationThis study of secondary data does not require ethics approval. It will be presented internationally and published in the peer-reviewed literature.PROSPERO registration numberCRD42017081080.

Published
2018
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42. Lights and Shadows of Distal Deep Vein Thrombosis

Author

Cristiano Bortoluzzi, Giuseppe Camporese, Enrico Bernardi, Ngoc Vo Hong, Raffaele Pesavento, Roberto Parisi, and Pierpaolo Di Micco

Subjects
Venous thrombosis, medicine.medical_specialty, medicine.anatomical_structure, business.industry, Deep vein, medicine, In patient, Radiology, medicine.disease, business, Thrombosis, Venous thromboembolism
Abstract

Distal deep venous thrombosis (DDVTs) is one of the “grey” areas of venous thromboembolism. There is a great heterogeneity in the diagnostic and therapeutic strategies between all the diagnostic centers. Studies doesn’t clarify the problem so it is not clear yet if there is any advantage in diagnosing and consequentially treating all the IDDVT. The 2012 ACCP guidelines suggested clinical observation for 2 weeks over initial anticoagulation (grade 2C) in patients with acute IDDVT without severe symptoms or risk factors for extension.

Published
2018
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43. A prospective validation of the Bova score in normotensive patients with acute pulmonary embolism

Author

Loris Roncon, Enrico Bernardi, Alice Spinazzè, Deisy Barrios, Francesco Dentali, Fulvio Morello, Gabriele Viviani, Claudio Poggioni, Iolanda Enea, Sara Giatti, E. Bucherini, Fabrizio Bottino, Peiman Nazerian, Andrés Quezada, M. Vastola, Simone Vanni, L. Sardo, Sofia Barbar, Francesco Crocco, S. Barbar, G. De Morelli, A. Dall' Arche, S. Brescianini, F. Morello, Claudio Picariello, Nicola Mumoli, Raffaele Pesavento, Paolo Prandoni, Eugenio Bucherini, F. Stea, David Jiménez, Massimo Puato, I. Enea, and Carlo Bova

Subjects
Male, medicine.medical_specialty, Hemodynamics, 030204 cardiovascular system & hematology, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Clinical endpoint, Humans, Female, Prognosis, Prospective Studies, Pulmonary Embolism, Hematology, Stage (cooking), Prospective cohort study, business.industry, medicine.disease, Confidence interval, Pulmonary embolism, Increased risk, 030228 respiratory system, Risk assessment, business
Abstract

The Bova score has shown usefulness in the identification of intermediate-high risk patients with acute pulmonary embolism (PE), but lacks prospective validation. The aim of this study was to prospectively validate the Bova score in different settings from the original derivation cohort.Consecutive, normotensive patients with acute PE recruited at 13 academic or general hospitals were stratified, using their baseline data, into the three Bova risk stages (I-III). The primary outcome was the 30-day composite of PE-related mortality, hemodynamic collapse and non-fatal PE recurrences in the three risk categories.In the study period, 639 patients were enrolled. The primary end point occurred in 45 patients (7.0%; 95% Confidence Intervals, 5.2%-9.3%). Risk stage correlated with the PE-related complication rate (stage I, 2.9%; stage II, 17%; stage III, 27%). Patients classified as stage III by the Bova score had a 6.5-fold increased risk for adverse outcomes (3.1-13.5, p 0.001) compared with stages I and II combined. Rescue thrombolysis increased from stage I to stage III (0.6%, 12% and 15% respectively). All-cause mortality (5.3%) did not substantially differ among the stages.The Bova score accurately stratifies normotensive patients with acute PE into stages of increasing risk of 30-day PE-related complications.

Published
2018

45. ESVM integrated care pathways – a call for action

Author

Lucia Mazzolai, Adriana Visonà, Zsolt Pecsvarady, Claudio Cimminiello, D. Olinic, Elias Johansson, and Raffaele Pesavento

Subjects
Action (philosophy), Nursing, Delivery of Health Care, Integrated, business.industry, MEDLINE, Medicine, Cardiology and Cardiovascular Medicine, business, Integrated care
Published
2019
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46. Prevention and treatment of the chronic thromboembolic pulmonary hypertension

Author

Raffaele Pesavento and Paolo Prandoni

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Hypertension, Pulmonary, Training level, Hematology, Disease, 030204 cardiovascular system & hematology, Balloon, medicine.disease, Pulmonary hypertension, Riociguat, Pulmonary embolism, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Internal medicine, Angioplasty, Chronic Disease, medicine, Cardiology, Humans, Pulmonary pathology, business, medicine.drug
Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon and late complication of pulmonary embolism resulting from misguided remodelling of residual pulmonary thromboembolic material and small-vessel arteriopathy. CTEPH is the only form of pulmonary hypertension (PH) potentially curable by pulmonary endarterectomy (PEA). Unfortunately, several patients have either an unacceptable risk-benefit ratio for undergoing the surgical intervention or develop persistent PH after PEA. Novel medical and endovascular therapies can be considered for them. The soluble guanylate cyclase stimulator riociguat is recommended for the treatment of patients with inoperable disease or with recurrent/persistent PH after PEA. Other drugs developed for the treatment of other forms of PH, as prostanoids, phosphodiesterase-5 inhibitors and endothelin receptor antagonists have been used in the treatment of CTEPH, with limited benefit. Balloon pulmonary angioplasty is a novel and promising technique and is progressively emerging from the pioneering phase. Highly specialized training level and complex protocols of postoperative care are mandatory to consolidate the technical success of the surgical and endovascular intervention.

Published
2017

47. [Use of rivaroxaban in real-life treatment of venous thromboembolism: results of the TEV Survey, an Italian epidemiological study]

Author

Raffaele, Pesavento and Ido, Iori

Subjects
Male, Epidemiologic Studies, Italy, Rivaroxaban, Health Care Surveys, Humans, Female, Venous Thromboembolism, Middle Aged, Factor Xa Inhibitors
Abstract

Rivaroxaban is a direct and selective inhibitor of factor Xa. The randomized clinical trials EINSTEIN evaluated the efficacy and safety of rivaroxaban for the treatment of venous thromboembolism (VTE) proving that the drug was non-inferior to standard treatment. The aim of this survey was to describe how rivaroxaban was used in a group of "real-life" patients with VTE.Between June and October 2014, physicians collected aggregate data, through an online questionnaire, on consecutive patients affected by VTE and treated with rivaroxaban in the previous 6 months. Descriptive statistics were performed on the collected data.A total of 345 questionnaires were filled out. The mean age of patients was 62 years, with a low prevalence of concomitant diseases and/or pharmacological treatments. Deep vein thrombosis was diagnosed in 90% of patients and pulmonary embolism in 47%; only 48% was hospitalized. Rivaroxaban was prescribed at the recommended doses and/or regimen in no more than 60% of cases. In 96% of patients, the initial therapeutic plan did not require changes. Adherence to the therapeutic plan and overall patient satisfaction with therapy were high.Rivaroxaban was found easy to use and was highly appreciated by patients.

Published
2017

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

Author

C. Pérez-Ductor, Raffaele Pesavento, Barry M. Brenner, Silvia Soler, Paolo Prandoni, Luciano López-Jiménez, Pierpaolo Di Micco, S. Nieto, Renzo Poggio, Inna Tzoran, T. Bueso, Alicia Lorenzo, Carmen Fernández-Capitán, F. García-Bragado, D. Riesco, Thomas Vanassche, M. Papadakis, J. del Toro, N. Ruiz-Giménez, M.J. Núñez, F. Martín-Martos, Mark M. Levy, Benjamin Brenner, J.A. Porras, G. Vidal, V. Gómez, A. Braester, Cristina Perez Ductor, R. Barba, R. Valle, Bernardo Sopeña, Lidia Luciana Rota, J.C. Sahuquillo, E. Tiraferri, J.M. Martín-Antorán, M.S. Sousa, Conxita Falga, Jose Gutierrez, Ángeles Blanco-Molina, J.M. Suriñach, H. Bounameaux, Isabelle Mahé, María del Carmen Díaz-Pedroche, Philip S. Wells, B. Pagán, Agustina Rivas, J. Bascuñana, G. Antonucci, Carme Font, Antonella Tufano, Maurizio Ciammaichella, S. Otalora, Ángel Sampériz, J. González, R. Maida, Giovanni Barillari, Andris Skride, P. Di Micco, Manuel Monreal, M.J. Jaras, Alessandra Bura-Rivière, F. Pace, Diego Tonello, Remedios Otero, R. Malý, L. Bertoletti, R. Lecumberri, M.A. Aibar, K. Champion, D. Kigitovica, J. Binetti, M.L. Peris, M.A. Rodríguez-Dávila, Adriana Visonà, L. Guirado, Miguel Martín, Abílio Reis, P. Gallego, O. Reig, G. Pérez, Hervé Decousus, Daniel H. Newton, E. Salgado, P. Prandoni, Laurent Bertoletti, Peter Verhamme, Luke G. Wolfe, Javier Trujillo-Santos, M.A. García, M.A. Fidalgo, Paola Ferrazzi, Pablo Javier Marchena, J. Villalta, M.A. Lorente, Elvira Grandone, O. Sanz, M.C. Sala-Sainz, F. Bilora, M. Bosevski, I. Cañas, Vladimir Rosa, David Jiménez, Juan I. Arcelus, E. Grau, B. Zalunardo, Beatriz Valero, Luis Jara-Palomares, Manuel Monreal Bosch, José María Pedrajas, Pedro Ruiz-Artacho, B. Barrón-Andrés, Fernando Uresandi, E. Rosillo-Hernández, M.D. Joya, Rita Duce, L. Font, C. Tolosa, Francesco Dentali, I. Manrique-Abos, F. Carmona, Andreas Erdmann, Antoni Riera-Mestre, L. Hernández-Blasco, Nuria Chic, J.B. López-Sáez, J. Vela, J. Hirmerova, A. Grimón, G. Hernández-Comes, D. Farge-Bancel, C. Fernández-Aracil, Raquel López-Reyes, Raúl Sánchez, Michael F. Amendola, J.A. Nieto, A. Merah, I. Tzoran, J.L. Ribeiro, E. Drucka, Lucia Mazzolai, Radovan Malý, María Belén Alfonso, José Luis Lobo, M. Zdraveska, I. Pérez, Marijan Bosevski, Manolis Papadakis, Raquel Barba, R. Aranda, A.R. Ramos, R. del Pozo, M. Barrón, A. Hij, R. Agüero, Ramón Lecumberri, Corrado Lodigiani, Henri Bounameaux, A. Culla, A. Núñez, J.A. Díaz-Peromingo, and Barbara Ney

Subjects
Adult, Male, medicine.medical_specialty, Multivariate analysis, Adolescent, Hemorrhage, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Catheterization, Peripheral, 03 medical and health sciences, Immobilization, Young Adult, 0302 clinical medicine, Recurrence, Aged, Aged, 80 and over, Catheterization, Peripheral, Female, Humans, Middle Aged, Neoplasms, Pulmonary Embolism, Registries, Upper Extremity Deep Vein Thrombosis, Venous Thromboembolism, 80 and over, Medicine, cardiovascular diseases, Young adult, Prospective cohort study, business.industry, Odds ratio, medicine.disease, Thrombosis, Confidence interval, Surgery, Pulmonary embolism, Venous thrombosis, 030228 respiratory system, Cardiology and Cardiovascular Medicine, business
Abstract

We sought to determine the risk factors for subsequent bleeding and recurrent venous thromboembolism (VTE) events following isolated noncatheter-associated upper extremity deep venous thrombosis (non-CA-UEDVT) to better inform future treatment decisions for this group of patients.The RIETE registry (Registro Informatizado de Enfermedad TromboEmbólica [Computerized Registry of Patients with Venous Thromboembolism]) is a prospective international registry of patients with objectively confirmed symptomatic VTE. Patients with a symptomatic, isolated, proximal UEDVT from March 2001 through March 2015 were analyzed. Any patient with an indwelling catheter or pacemaker lead at the DVT site and at the time of thrombosis was considered to have a CA-UEDVT and was excluded. Patient and treatment characteristics such as age, gender, comorbidities, VTE risk factors, treatment drug, and duration were collected. Outcomes examined included recurrent DVT, subsequent pulmonary embolism (PE), and hemorrhage. Multivariate analysis was performed using stepwise logistic regression.Of the 1100 patients who met the study criteria, 580 (53%) were male. The mean age of the patients was 50 ± 20 years, and overall patient survival at 1 year was 85%. Recurrent VTE occurred in 59 patients (5.4%). Of these, 46 patients (4%) had recurrent DVT, 10 (0.9%) had a PE following UEDVT diagnosis, and 3 (0.3%) had both. PE was fatal in three patients (0.3%). Bleeding occurred in 50 patients (4.5%), major bleeding in 19 patients (1.7%), and fatal bleeding in 6 patients (0.5%). On multivariate analysis, malignant disease was associated with VTE recurrence (odds ratio [OR], 2.00; 95% confidence interval [CI], 1.04-3.45; P .04), whereas hemorrhage was associated with age (OR, 1.03; 95% CI, 1.01-1.05; P = .002) and malignant disease (OR, 2.53; 95% CI, 1.34-4.76; P .005). Hemorrhage and recurrent VTE were also significantly associated (OR, 2.79; 95% CI, 1.16-6.76; P .03).PE following non-CA-UEDVT is rare. Malignant disease was associated with VTE recurrence. Age and malignant disease were associated with hemorrhage, and VTE recurrence was associated with hemorrhage. Further prospective studies should be undertaken to best determine length of anticoagulation treatment for the varied populations of patients with UEDVT.

Published
2017

49. [PP.09.19] LONG-TERM WELL-CONTROLLED BLOOD PRESSURE LEVELS AND CAROTID ELASTICITY IN YOUNG HYPERTENSIVE SUBJECTS

Author

Paolo Palatini, C. Fania, Massimo Puato, Paolo Pauletto, Raffaele Pesavento, and Marcello Rattazzi

Subjects
Ldl cholesterol, medicine.medical_specialty, hypertension, Physiology, business.industry, vascular compliance, medicine.disease, Arterial stiffness, Vascular compliance, Blood pressure, BP, carotid intima-media thickness (IMT), Internal medicine, Arterial stiffness, hypertension, carotid distensibility, vascular compliance, carotid intima-media thickness (IMT), BP, LDL-cholesterol, Internal Medicine, Cardiology, medicine, LDL-cholesterol, Elasticity (economics), Cardiology and Cardiovascular Medicine, business, carotid distensibility
Published
2017

50. Intima-media thickness remodelling in hypertensive subjects with long-term well-controlled blood pressure levels

Author

Paolo Palatini, Giovanni Boschetti, Raffaele Pesavento, M. Zanon, Marcello Rattazzi, Claudio Fania, Elisabetta Benetti, Paolo Pauletto, Massimo Puato, and Elisabetta Faggin

Subjects
Adult, Male, medicine.medical_specialty, hypertension, Pharmacological therapy, Carotid arteries, Blood Pressure, 030204 cardiovascular system & hematology, Vascular Remodeling, Carotid Intima-Media Thickness, Muscle hypertrophy, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Internal Medicine, medicine, Humans, 030212 general & internal medicine, intima-media thickness, business.industry, ultrasound, Ultrasound, General Medicine, Middle Aged, Carotid artery, Media layer, Blood pressure, Intima-media thickness, Cohort, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

Aim of this study was to evaluate in a long follow-up the carotid artery remodelling in a cohort of young hypertensive subjects having good blood pressure (BP) control. We studied 20 grade I hypertensives (HT) by assessing the B-mode ultrasound of mean carotid intima-media thickness (mean-IMT) and maximum IMT (M-MAX) in each carotid artery segment (common, bulb, internal), bilaterally. We compared their ultrasound measurements with those recorded 5 and 10 years earlier. While the first 5-year follow-up was observational, in the second 5-year follow-up, lifestyle modifications and/or pharmacological therapy were started to obtain well-controlled BP levels. Office BP was measured at the time of the ultrasound studies and every 6 months during the follow-up. BP levels were: 10 years 144/91 mmHg, 5 years 143/90 mmHg and 129 ± 79 mmHg at the time of the study. In the first 5-year observational follow-up, both mean-IMT and M-MAX increased (Δ 0.116 and Δ 0.165 mm, respectively, p

Published
2017

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