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1. Comparative clinical prognosis of massive and non‐massive pulmonary embolism: A registry‐based cohort study

Author

Blondon, Marc, Jimenez, David, Robert‐Ebadi, Helia, Del Toro, Jorge, Lopez‐Jimenez, Luciano, Falga, Conxita, Skride, Andris, Font, Llorenç, Vazquez, Fernando Javier, Bounameaux, Henri, Monreal, Manuel, Prandoni, Paolo, Brenner, Benjamin, Farge‐Bancel, Dominique, Barba, Raquel, Di Micco, Pierpaolo, Bertoletti, Laurent, Schellong, Sebastian, Tzoran, Inna, Reis, Abilio, Bosevski, Marijan, Malý, Radovan, Verhamme, Peter, Caprini, Joseph A, My Bui, Hanh, Adarraga, MD, Agud, M, Aibar, J, Aibar, MA, Alfonso, J, Amado, C, Arcelus, JI, Baeza, C, Ballaz, A, Barba, R, Barbagelata, C, Barrón, M, Barrón‐Andrés, B, Blanco‐Molina, A, Botella, E, Camon, AM, Castro, J, Caudevilla, MA, Cerdà, P, Chasco, L, Criado, J, de Ancos, C, de Miguel, J, Demelo‐Rodríguez, P, Díaz‐Peromingo, JA, Díez‐Sierra, J, Díaz‐Simón, R, Domínguez, IM, Encabo, M, Escribano, JC, Falgá, C, Farfán, AI, Fernández‐Capitán, C, Fernández‐Reyes, JL, Fidalgo, MA, Flores, K, Font, C, Francisco, I, Gabara, C, Galeano‐Valle, F, García, MA, García‐Bragado, F, García‐Mullor, MM, Gavín‐Blanco, O, Gavín‐Sebastián, O, Gil‐Díaz, A, Gómez‐Cuervo, C, González‐Martínez, J, Grau, E, Guirado, L, Gutiérrez, J, Hernández‐Blasco, L, Jara‐Palomares, L, Jaras, MJ, Jiménez, D, Joya, MD, Jou, I, Lacruz, B, Lecumberri, R, Lima, J, Lobo, JL, López‐Brull, H, López‐Jiménez, L, López‐Miguel, P, López‐Núñez, JJ, López‐Reyes, R, López‐Sáez, JB, Lorente, MA, Lorenzo, A, Loring, M, Madridano, O, Maestre, A, Marchena, PJ, Martín del Pozo, M, Martín‐Martos, F, Martínez‐Baquerizo, C, Mella, C, Mellado, M, Mercado, MI, Moisés, J, Morales, MV, Muñoz‐Blanco, A, Muñoz‐Guglielmetti, D, Muñoz‐Rivas, N, Nart, E, Nieto, JA, Núñez, MJ, Olivares, MC, Ortega‐Michel, C, Ortega‐Recio, MD, Osorio, J, Otalora, S, Otero, R, Parra, P, Parra, V, Pedrajas, JM, Pellejero, G, Pérez‐Jacoiste, A, Peris, ML, Pesántez, D, Porras, JA, Portillo, J, Reig, L, Riera‐Mestre, A, Rivas, A, Rodríguez‐Cobo, A, Rodríguez‐Matute, C, Rogado, J, Rosa, V, Rubio, CM, Ruiz‐Artacho, P, Ruiz‐Giménez, N, Ruiz‐Ruiz, J, Ruiz‐Sada, P, Sahuquillo, JC, Salgueiro, G, Sampériz, A, Sánchez‐Muñoz‐Torrero, JF, Sancho, T, Sigüenza, P, Sirisi, M, Soler, S, Suárez, S, Suriñach, JM, Tiberio, G, Torres, MI, Tolosa, C, Trujillo‐Santos, J, Uresandi, F, Usandizaga, E, Valle, R, Vela, JR, Vidal, G, Vilar, C, Villares, P, Zamora, C, Gutiérrez, P, Vázquez, FJ, Vanassche, T, Vandenbriele, C, Verhamme, P, Hirmerova, J, Malý, R, Salgado, E, Benzidia, I, Bertoletti, L, Bura‐Riviere, A, Crichi, B, Debourdeau, P, Espitia, O, Farge‐Bancel, D, Helfer, H, Mahé, I, Moustafa, F, Poenou, G, Schellong, S, Braester, A, Brenner, B, Tzoran, I, Amitrano, M, Bilora, F, Bortoluzzi, C, Brandolin, B, Ciammaichella, M, Colaizzo, D, Dentali, F, Di Micco, P, Giammarino, E, Grandone, E, Mangiacapra, S, Mastroiacovo, D, Maida, R, Mumoli, N, Pace, F, Pesavento, R, Pomero, F, Prandoni, P, Quintavalla, R, Rocci, A, Siniscalchi, C, Tufano, A, Visonà, A, Vo Hong, N, Zalunardo, B, Kalejs, RV, Maķe, K, Ferreira, M, Fonseca, S, Martins, F, Meireles, J, Bosevski, M, Zdraveska, M, Mazzolai, L, Caprini, JA, Tafur, AJ, Weinberg, I, Wilkins, H, and Bui, HM

Published
2021
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5. D-dimer levels and risk of recurrence following provoked venous thromboembolism: findings from the RIETE registry

Author

Avnery, O, Martin, M, Ellis, MH, Adarraga, MD, Aibar, MA, Aibar, J, Amado, C, Arcelus, JI, Ballaz, A, Barba, R, Barron, M, Barron-Andres, B, Bascunana, J, Blanco-Molina, A, Camon, AM, Canas, I, Carrasco, C, Castro, J, de Ancos, C, del Toro, J, Demelo, P, Diaz-Peromingo, JA, Falga, C, Farfan, AI, Fernandez-Capitan, C, Fernandez-Criado, MC, Fernandez-Nunez, S, Fidalgo, MA, Font, C, Font, L, Freire, M, Gallego, M, Garcia, MA, Garcia-Bragado, F, Garcia-Morillo, M, Garcia-Raso, A, Gavin, O, Gayol, MC, Gil-Diaz, A, Gomez, V, Gomez-Cuervo, C, Gonzalez-Martinez, J, Grau, E, Gutierrez, J, Hernandez-Blasco, LM, Iglesias, M, Jara-Palomares, L, Jaras, MJ, Jimenez, R, Jimenez-Castro, D, Jimenez-Lopez, J, Joya, MD, Lima, J, Llamas, P, Lobo, JL, Lopez-Jimenez, L, Lopez-Miguel, P, Lopez-Nunez, JJ, Lopez-Reyes, R, Lopez-Saez, JB, Lorente, MA, Lorenzo, A, Loring, M, Madridano, O, Maestre, A, Marchena, PJ, del Pozo, MM, Martin-Guerra, JM, Martin-Romero, M, Mellado, M, Monreal, M, Morales, MV, Munoz, N, Nieto-Cabrera, MA, Nieto-Rodriguez, JA, Nunez-Ares, A, Nunez, MJ, Olivares, MC, Otalora, S, Otero, R, Pedrajas, JM, Pellejero, G, Perez-Rus, G, Peris, ML, Porras, JA, Rivas, A, Rodriguez-Davila, MA, Rodriguez-Hernandez, A, Rubio, CM, Ruiz-Artacho, P, Ruiz-Ruiz, J, Ruiz-Torregrosa, P, Ruiz-Sada, P, Sahuquillo, JC, Salazar, V, Samperiz, A, Sanchez-Munoz-Torrero, JF, Sancho, T, Soler, S, Sopena, B, Surinach, JM, Tolosa, C, Torres, MI, Trujillo-Santos, J, Uresandi, F, Valle, R, Vidal, G, Villares, P, Gutierrez, P, Vazquez, FJ, Vilaseca, A, Vanassche, T, Vandenbriele, C, Verhamme, P, Hirmerova, J, Maly, R, Salgado, E, Benzidia, I, Bertoletti, L, Bura-Riviere, A, Debourdeau, P, Farge-Bancel, D, Hij, A, Mahe, I, Moustafa, F, Schellong, S, Braester, A, Brenner, B, Ellis, M, Tzoran, I, Sharif-Kashani, B, Barillari, G, Bilora, F, Bortoluzzi, C, Bucherini, E, Ciammaichella, M, Dentali, F, Di Micco, P, Di Pangrazio, M, Maida, R, Mastroiacovo, D, Pace, F, Pallotti, G, Parisi, R, Pesavento, R, Prandoni, P, Quintavalla, R, Rocci, A, Siniscalchi, C, Tufano, A, Visona, A, Hong, NV, Gibietis, VL, Skride, A, Strautmane, S, Bosevski, M, Zdraveska, M, Bounameaux, H, Fresa, M, Mazzolai, L, Ney, B, Caprini, J, Bui, HM, and Pham, KQ

Subjects
venous thromboembolism recurrence, d-dimer, provoked venous thromboembolism
Abstract

Background Patients with venous thromboembolism (VTE) secondary to transient risk factors may develop VTE recurrences after discontinuing anticoagulation. Identifying at-risk patients could help to guide the duration of therapy. Methods We used the RIETE database to assess the prognostic value of d-dimer testing after discontinuing anticoagulation to identify patients at increased risk for recurrences. Transient risk factors were classified as major (postoperative) or minor (pregnancy, oestrogen use, immobilization or recent travel). Results In December 2018, 1655 VTE patients with transient risk factors (major 460, minor 1195) underwent d-dimer measurements after discontinuing anticoagulation. Amongst patients with major risk factors, the recurrence rate was 5.74 (95% CI: 3.19-9.57) events per 100 patient-years in those with raised d-dimer levels and 2.68 (95% CI: 1.45-4.56) in those with normal levels. Amongst patients with minor risk factors, the rates were 7.79 (95% CI: 5.71-10.4) and 3.34 (95% CI: 2.39-4.53), respectively. Patients with major risk factors and raised d-dimer levels (n = 171) had a nonsignificantly higher rate of recurrences (hazard ratio [HR]: 2.14; 95% CI: 0.96-4.79) than those with normal levels. Patients with minor risk factors and raised d-dimer levels (n = 382) had a higher rate of recurrences (HR: 2.34; 95% CI: 1.51-3.63) than those with normal levels. On multivariate analysis, raised d-dimers (HR: 1.74; 95% CI: 1.09-2.77) were associated with an increased risk for recurrences in patients with minor risk factors, not in those with major risk factors. Conclusions Patients with raised d-dimer levels after discontinuing anticoagulant therapy for VTE provoked by a minor transient risk factor were at an increased risk for recurrences.

Published
2020

6. Venous Thromboembolism in Patients With Autoimmune Disorders: Findings From the RIETE Registry

Author

Sada, PR, Lopez-Nunez, JJ, Samperiz, A, Soto, MJ, Pedrajas, JM, Porras, JA, Peris, ML, Debourdeau, P, Pace, F, Monreal, M, Adarraga, MD, Agud, M, Aibar, MA, Alfonso, J, Amado, C, Arcelus, JI, Ballaz, A, Barba, R, Barbagelata, C, Barron, M, Barron-Andres, B, Blanco-Molina, A, Camon, AM, Canas, I, Carrasco, C, Castro, J, Cerda, P, de Ancos, C, del Toro, J, Demelo, P, Diaz-Pedroche, C, Diaz-Peromingo, JA, Diaz-Simon, R, Encabo, M, Escribano, JC, Esposito, F, Falga, C, Farfan, I, Fernandez-Capitan, C, Fernandez-Criado, MC, de Roitegui, KF, Fidalgo, MA, Font, C, Font, L, Furest, I, Garcia, MA, Garcia-Bragado, F, Garcia-Raso, A, Gavin-Blanco, O, Gavin-Sebastian, O, Gayol, MC, Gil-Diaz, A, Gomez, V, Gomez-Cuervo, C, Gonzalez-Martinez, J, Grau, E, Gutierrez, J, Hernandez-Blasco, LM, Iglesias, M, Jara-Palomares, L, Jaras, MJ, Jimenez, D, Jimenez, R, Joya, MD, Jou, I, Lecumberri, R, Lima, J, Llamas, P, Lobo, JL, Lopez-Jimenez, L, Lopez-Miguel, P, Lopez-Reyes, R, Lopez-Saez, JB, Lorente, MA, Lorenzo, A, Loring, M, Lumbierres, M, Madridano, O, Maestre, A, Marchena, PJ, del Pozo, MM, Martin-Fortea, P, Martin-Martos, F, Martin-Romero, M, Martinez-Baquerizo, C, Martinez-Garcia, MA, Martinez-Gonzalez, L, Mella, C, Mellado, M, Montesa, C, Morales, MV, Nieto, JA, Nunez, MJ, Olivares, MC, Olivera, PE, Otalora, S, Otero, R, Panadero-Macia, M, Pellejero, G, Perez-Ductor, C, Perez-Rus, G, Riera-Mestre, A, Rivas, A, Rodriguez-Cobo, A, Rodriguez-Hernandez, A, Rosa, V, Rubio, CM, Ruiz-Artacho, P, Ruiz-Ruiz, J, Ruiz-Sada, P, Sahuquillo, JC, Sala-Sainz, MC, Salgueiro, G, Saanchez-Munoz-Torrero, JF, Sancho, T, Soler, S, Suarez, S, Surinach, JM, Tolosa, C, Torres, MI, Trujillo-Santos, J, Uresandi, F, Valle, R, Vela, JR, Vidal, G, Vilar, C, Villares, P, Gutierrez, P, Vazquez, FJ, Vilaseca, A, Vanassche, T, Vandenbriele, C, Verhamme, P, Hirmerova, J, Maly, R, Celis, G, Salgado, E, Benzidia, I, Bertoletti, L, Bura-Riviere, A, Farge-Bancel, D, Helfer, H, Hij, A, Mahe, I, Moustafa, F, Schellong, S, Braester, A, Brenner, B, Tzoran, I, Sharif-Kashani, B, Barillari, G, Bilora, F, Bortoluzzi, C, Brandolin, B, Ceccanti, G, Ciammaichella, M, Dentali, F, Di Micco, P, Imbalzano, E, Landolfi, R, Lessiani, G, Maida, R, Mastroiacovo, D, Pesavento, R, Pomero, F, Prandoni, P, Quintavalla, R, Rocci, A, Siniscalchi, C, Tufano, A, Visona, A, Hong, NV, Zalunardo, B, Gibietis, V, Kigitovica, D, Skride, A, Bosevski, M, Zdraveska, M, Bounameaux, H, Fresa, M, Mazzolai, L, Ney, B, Reis, A, Caprini, JA, and Bui, HM

Subjects
recurrences, anticoagulant therapy, venous thromboembolism, bleeding, autoimmune disorders
Abstract

Patients with autoimmune disorders are at an increased risk of venous thromboembolism (VTE), but this association has not been consistently evaluated. We used the RIETE (Registro Informatizado Enfermedad Trombo Embolica) database to compare the rates of VTE recurrences, major bleeding, and death during the course of anticoagulation, according to the presence or absence of autoimmune disorders. Of 71 625 patients with VTE recruited in February 2018, 1800 (2.5%) had autoimmune disorders. Median duration of anticoagulant therapy was slightly longer in patients with autoimmune disorders (median, 190 vs 182 days; P = .001). On multivariable analysis, patients with autoimmune disorders had a similar risk of VTE recurrences (hazard ratio [HR]: 0.93; 95% confidence interval [CI]: 0.68-1.27) or major bleeding (HR: 1.07; 95% CI: 0.82-1.40) and a lower risk to die (HR: 0.66; 95% CI: 0.54-0.81) than those without autoimmune disorders. Patients with giant cell arteritis had the highest rates of major bleeding (8.6 events per 100 patient-years) and the lowest rate of recurrences (zero). In other subgroups, the rates of both events were more balanced. During anticoagulation, patients with or without autoimmune disorders had similar rates of VTE recurrences or major bleeding. However, there were some differences between subgroups of patients with autoimmune disorders.

Published
2020

7. Systolic blood pressure and mortality in acute symptomatic pulmonary embolism

Author

Quezada, A, Jimenez, D, Bikdeli, B, Moores, L, Porres-Aguilar, M, Aramberri, M, Lima, J, Ballaz, A, Yusen, RD, 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, JA, Bui, HM, Adarraga, MD, Agud, M, Aibar, MA, Alfonso, J, Amado, C, Arcelus, JI, Azcarate-Aguero, P, Barbagelata, C, Barron, M, Barron-Andres, B, Blanco-Molina, A, Camon, AM, Canas, I, Carrasco, C, Castro, J, Cerda, P, Chasco, L, de Ancos, C, del Toro, J, Demelo, P, Diaz-Peromingo, JA, Diaz-Simon, R, Elias-Hernandez, T, Escribano, JC, Falga, C, Farfan, AI, Fernandez-Capitan, C, Fernandez-Criado, MC, de Roitegui, F, Fidalgo, MA, Font, C, Font, L, Furest, I, Garcia, MA, Garcia-Bragado, F, Garcia-Morillo, M, Garcia-Raso, A, Gavin-Blanco, O, Gavin-Sebastian, O, Gayol, MC, Gil-Diaz, A, Gomez, V, Gomez-Cuervo, C, Gonzalez-Martinez, J, Grau, E, Gutierrez, J, Hernandez-Blasco, LM, Iglesias, M, Jara-Palomares, L, Jaras, MJ, Joya, MD, Jou, I, Lacruz, B, Lecumberri, R, Llamas, P, Lobo, JL, Lopez-Jimenez, L, Lopez-Miguel, P, Lopez-Nunez, JJ, Lopez-Reyes, R, Lopez-Saez, JB, Lorente, MA, Lorenzo, A, Loring, M, Lumbierres, M, Madridano, O, Maestre, A, Marchena, PJ, del Pozo, M, Martin-Fortea, P, Martin-Martos, F, Martinez-Garcia, MA, Martinez-Gonzalez, L, Mellado, M, Moises, J, Montesa, C, Morales, MV, Nieto, JA, Nunez, MJ, Olivares, MC, Olivera, PE, Otalora, S, Otero, R, Panadero-Macia, M, Pedrajas, JM, Pellejero, G, Perez-Ductor, C, Perez-Jacoiste, A, Perez-Rus, G, Peris, ML, Porras, JA, Riera-Mestre, A, Rivas, A, Rodriguez-Cobo, A, Rodriguez-Hernandez, A, Rosa, V, Rubio, CM, Ruiz-Artacho, P, Ruiz-Ruiz, J, Ruiz-Sada, P, Sahuquillo, JC, Sala-Sainz, MC, Salgueiro, G, Samperiz, A, Sanchez-Camara, S, Sanchez-Martinez, R, Sanchez-Munoz-Torrero, JF, Sancho, T, Soler, S, Suarez, S, Surinach, JM, Tiberio, G, Tolosa, C, Torres, MI, Trujillo-Santos, J, Uresandi, F, Valero, B, Valle, R, Vela, JR, Vidal, G, Villares, P, Gutierrez, P, Vazquez, FJ, Vilaseca, A, Vanassche, T, Vandenbriele, C, Hirmerova, J, Salgado, E, Benzidia, I, Bura-Riviere, A, Debourdeau, P, Helfer, H, Hij, A, Mahe, I, Moustafa, F, Braester, A, Sharif-Kashani, B, Barillari, G, Bilora, F, Bortoluzzi, C, Brandolin, B, Ciammaichella, M, Dentali, F, Imbalzano, E, Landolfi, R, Maida, R, Mastroiacovo, D, Mumoli, N, Pace, F, Pesavento, R, Pomero, F, Quintavalla, R, Rocci, A, Siniscalchi, C, Tufano, A, Visona, A, Hong, NV, Zalunardo, B, Kalejs, RV, Skride, A, Strautmane, S, Zdraveska, M, Mazzolai, L, Caprini, J, Tafur, AJ, and RIETE Investigators

Subjects
Male, Cardiac & Cardiovascular Systems, Blood Pressure, 030204 cardiovascular system & hematology, GUIDELINES, THERAPY, 0302 clinical medicine, Cause of Death, EPIDEMIOLOGY, 030212 general & internal medicine, Prospective Studies, Registries, RISK, Aged, 80 and over, OUTCOMES, Pulmonary embolism, Survival Rate, Systolic blood pressure, Acute Disease, Cardiology, Female, Cardiology and Cardiovascular Medicine, Life Sciences & Biomedicine, Major bleeding, circulatory and respiratory physiology, medicine.medical_specialty, Canada, Systole, DIAGNOSIS, 03 medical and health sciences, Internal medicine, MANAGEMENT, medicine, Humans, In patient, cardiovascular diseases, Mortality, Aged, VENOUS THROMBOEMBOLISM, Science & Technology, business.industry, Odds ratio, medicine.disease, Confidence interval, United States, THROMBOSIS, Increased risk, Blood pressure, Spain, Cardiovascular System & Cardiology, PROGNOSTICATION, Pulmonary Embolism, business, Venous thromboembolism
Abstract

BACKGROUND: The optimal cutoff for systolic blood pressure (SBP) level to define high-risk pulmonary embolism (PE) remains to be defined. METHODS: To evaluate the relationship between SBP levels on admission and mortality in patients with acute symptomatic PE, the current study included 39,257 consecutive patients with acute symptomatic PE from the RIETE registry between 2001 and 2018. Primary outcomes included all-cause and PE-specific 30-day mortality. Secondary outcomes included major bleeding and recurrent venous thromboembolism (VTE). RESULTS: There was a linear inverse relationship between admission SBP and 30-day all-cause and PE-related mortality that persisted after multivariable adjustment. Patients in the lower SBP strata had higher rates of all-cause death (reference: SBP 110-129 mmHg) (adjusted odds ratio [OR] 2.9; 95% confidence interval [CI], 2.0-4.2 for SBP 190 mmHg). Consistent findings were also observed for 30-day PE-related death. CONCLUSIONS: In patients with acute symptomatic PE, a low SBP portends an increased risk of all-cause and PE-related mortality. The highest mortality was observed in patients with SBP

Published
2019

8. Natural history of patients with venous thromboembolism and hereditary hemorrhagic telangiectasia. Findings from the RIETE registry

Author

Riera-Mestre, A, Mora-Lujan, JM, Trujillo-Santos, J, Del Toro, J, Nieto, JA, Pedrajas, JM, Lopez-Reyes, R, Soler, S, Ballaz, A, Cerda, P, 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, JA, Bui, HM, Adarraga, MD, Agud, M, Aibar, MA, Alcalde-Manero, M, Alfonso, J, Amado, C, Arcelus, JI, Barbagelata, C, Barron, M, Barron-Andres, B, Blanco-Molina, A, Camon, AM, Canas, I, Castro, J, de Miguel, J, del Toro, J, Demelo, P, Diaz-Pedroche, C, Diaz-Peromingo, JA, Dominguez, I, Escribano, JC, Falga, C, Fernandez-Capitan, C, Fernandez-Criado, MC, Fidalgo, MA, Flores, K, Font, C, Font, L, Furest, I, Garcia, MA, Garcia-Bragado, F, Garcia-Raso, A, Gavin-Bianco, O, Gavin-Sebastian, O, Gil-Diaz, A, Godoy-Diaz, D, Gomez, V, Gomez-Cuelvo, C, Gonzalez-Martinez, J, Grau, E, Guirado, L, Gutierrez, J, Hernandez-Blasco, LM, Jara-Palomares, L, Jaras, MJ, Jimenez, D, Joya, MD, Jou, I, Lalueza, A, Lecumberri, R, Lima, J, Llamas, P, Lobo, JL, Lopez-Jimenez, L, Lopez-Meseguer, M, Lopez-Miguel, P, Lopez-Nunez, JJ, Lopez-Saez, JB, Lorente, MA, Loring, M, Lumbierres, M, Madridano, O, Maestre, A, Marchena, PJ, Martin-Martos, F, Martinez-Baquerizo, C, Martinez-Garcia, MA, Mellado, M, Moises, J, Morales, MV, Munoz-Bianco, A, Nunez, MJ, Olivares, MC, Olivera, PE, Ortega, C, Osorio, J, Otalora, S, Otero, R, Panadero-Macia, M, Parra, V, Pellejero, G, Perez-Ductor, C, Perez-Rus, G, Penis, ML, Pesantez, D, Porras, JA, Rivas, A, Rodriguez-Cobo, A, Rodriguez-Matute, C, Rosa, V, Rubio, CM, Ruiz-Artacho, P, Ruiz-Sada, P, Sahuquillo, JC, Sala-Sainz, MC, Salgueiro, G, Samperiz, A, Sanchez-Martinez, R, Sanchez-Munoz-Torrero, JF, Segui, E, Suarez, S, Surinach, JM, Tolosa, C, Torres, MI, Uresandi, F, Valero, B, Valle, R, Vidal, G, Aar, C, Villares, P, Gutierrez, P, Vazquez, FJ, Vilaseca, A, Vanassche, T, Vandenbriele, C, Hirmerova, J, Salgado, E, Benzidia, I, Bura-Riviere, A, Debourdeau, P, Courtois, MC, Helfer, H, Hij, A, Mahe, I, Moustafa, F, Braester, A, Bilora, F, Bortoluzzi, C, Ciammaichella, M, Dentali, F, Fermi, P, Imbaizano, E, Lodigiani, C, Maida, R, Mastroiacovo, D, Mumoli, N, Pace, F, Pesavento, R, Pomero, F, Quintavalla, R, Rocci, A, Rota, L, Siniscalchi, C, Tiraferri, E, Tufano, A, Visona, A, Hong, NV, Zalunardo, B, Kalejs, RV, Kigitovica, D, Skride, A, Zdraveska, M, Mazzola, L, Capnini, JA, Tafur, AJ, Vanassche, T, Verhamme, P, Riera-Mestre, A., Mora-Lujan, J. M., Trujillo-Santos, J., Del Toro, J., Nieto, J. A., Pedrajas, J. M., Lopez-Reyes, R., Soler, S., Ballaz, A., Cerda, P., 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., Agud, M., Aibar, M. A., Alcalde-Manero, M., Alfonso, J., Amado, C., Arcelus, J. I., Barbagelata, C., Barron, M., Barron-Andres, B., Blanco-Molina, A., Camon, A. M., Canas, I., Castro, J., De Miguel, J., Demelo, P., Diaz-Pedroche, C., Diaz-Peromingo, J. A., Dominguez, I. M., Escribano, J. C., Falga, C., Fernandez-Capitan, C., Fernandez-Criado, M. C., Fidalgo, M. A., Flores, K., Font, C., Font, L., Furest, I., Garcia, M. A., Garcia-Bragado, F., Garcia-Raso, A., Gavin-Blanco, O., Gavin-Sebastian, O., Gil-Diaz, A., Godoy-Diaz, D., Gomez, V., Gomez-Cuervo, C., Gonzalez-Martinez, J., Grau, E., Guirado, L., Gutierrez, J., Hernandez-Blasco, L. M., Jara-Palomares, L., Jaras, M. J., Jimenez, D., Joya, M. D., Jou, I., Lalueza, A., Lecumberri, R., Lima, J., Llamas, P., Lobo, J. L., Lopez-Jimenez, L., Lopez-Meseguer, M., Lopez-Miguel, P., Lopez-Nunez, J. J., Lopez-Saez, J. B., Lorente, M. A., Loring, M., Lumbierres, M., Madridano, O., Maestre, A., Marchena, P. J., Martin-Martos, F., Martinez-Baquerizo, C., Martinez-Garcia, M. A., Mellado, M., Moises, J., Morales, M. V., Munoz-Blanco, A., Nunez, M. J., Olivares, M. C., Olivera, P. E., Ortega, C., Osorio, J., Otalora, S., Otero, R., Panadero-Macia, M., Parra, V., Pellejero, G., Perez-Ductor, C., Perez-Rus, G., Peris, M. L., Pesantez, D., Porras, J. A., Rivas, A., Rodriguez-Cobo, A., Rodriguez-Matute, C., Rosa, V., Rubio, C. M., Ruiz-Artacho, P., Ruiz-Sada, P., Sahuquillo, J. C., Sala-Sainz, M. C., Salgueiro, G., Samperiz, A., Sanchez-Martinez, R., Sanchez-Munoz-Torrero, J. F., Segui, E., Suarez, S., Surinach, J. M., Tolosa, C., Torres, M. I., Uresandi, F., Valero, B., Valle, R., Vidal, G., Vilar, C., Villares, P., Gutierrez, P., Vazquez, F. J., Vilaseca, A., Vanassche, T., Vandenbriele, C., Hirmerova, J., Salgado, E., Benzidia, I., Bura-Riviere, A., Debourdeau, P., Courtois, M. C., Helfer, H., Hij, A., Mahe, I., Moustafa, F., Braester, A., Bilora, F., Bortoluzzi, C., Ciammaichella, M., Dentali, F., Ferrazzi, P., Imbalzano, E., Lodigiani, C., Maida, R., Mastroiacovo, D., Mumoli, N., Pace, F., Pesavento, R., Pomero, F., Quintavalla, R., Rocci, A., Rota, L., Siniscalchi, C., Tiraferri, E., Tufano, A., Visona, A., Vo Hong, N., Zalunardo, B., Kalejs, R. V., Kigitovica, D., Skride, A., Zdraveska, M., Mazzolai, L., and Tafur, A. J.

Subjects
0301 basic medicine, Registrie, lcsh:Medicine, 030105 genetics & heredity, Research & Experimental Medicine, THERAPY, 0302 clinical medicine, Pharmacology (medical), Registries, Telangiectasia, EPISTAXIS, Genetics (clinical), Venous Thrombosis, Embòlia pulmonar, Genetics & Heredity, OUTCOMES, FACTOR-VIII, General Medicine, Heparin, Hemorrhagic hereditary telangiectasia, Middle Aged, Pulmonary embolism, Rare diseases, Natural history, Venous thrombosis, Medicine, Research & Experimental, Deep venous thrombosis, Telangiectasia, Hereditary Hemorrhagic, medicine.symptom, Malalties rares, Life Sciences & Biomedicine, medicine.drug, Human, Venous thromboembolism, Adult, medicine.medical_specialty, Hemorrhage, Therapeutics, HHT, 03 medical and health sciences, Internal medicine, medicine, Humans, cardiovascular diseases, Risk factor, Deep venous thrombosi, Aged, Tromboflebitis, Bleeding episodes, Science & Technology, business.industry, Research, lcsh:R, Thrombophlebitis, medicine.disease, Terapèutica, equipment and supplies, business, Rare disease, 030217 neurology & neurosurgery, RENDU-OSLER-WEBER
Abstract

BACKGROUND: Limited data exist about the clinical presentation, ideal therapy and outcomes of patients with hereditary hemorrhagic telangiectasia (HHT) who develop venous thromboembolism (VTE). METHODS: We used the data in the RIETE Registry to assess the clinical characteristics, therapeutic approaches and clinical outcomes during the course of anticoagulant therapy in patients with HHT according to initial presentation as pulmonary embolism (PE) or deep venous thrombosis (DVT). RESULTS: Of 51,375 patients with acute VTE enrolled in RIETE from February 2009 to January 2019, 23 (0.04%) had HHT: 14 (61%) initially presented with PE and 9 (39%) with DVT alone. Almost half (47.8%) of the patients with VTE had a risk factor for VTE. Most PE and DVT patients received low-molecular-weight heparin for initial (71 and 100%, respectively) and long-term therapy (54 and 67%, respectively). During anticoagulation for VTE, the rate of bleeding events (major 2, non-major 6) far outweighed the rate of VTE recurrences (recurrent DVT 1): 50.1 bleeds per 100 patient-years (95%CI: 21.6-98.7) vs. 6.26 recurrences (95%CI: 0.31-30.9; p = 0.020). One major and three non-major bleeding were epistaxis. No patient died of bleeding. One patient died shortly after being diagnosed with acute PE. CONCLUSIONS: During anticoagulation for VTE in HHT patients, there were more bleeding events than VTE recurrences. Most bleeding episodes were non-major epistaxis. ispartof: ORPHANET JOURNAL OF RARE DISEASES vol:14 issue:1 ispartof: location:England status: published

Published
2019

9. Prediction of early mortality in patients with cancer-associated thrombosis in the RIETE Database

Author

Fuentes, HE, Tafur, AJ, Caprini, JA, Alatri, A, Trujillo-santos, J, Farge-bancel, D, Rosa, V, Font, L, Vilaseca, A, Monreal, M, Adarraga, MD, Aibar, MA, Aibar, J, Amado, C, Aranda, C, Arcelus, JI, Ballaz, A, Barba, R, Barillari, G, Barron, M, Barron-Andres, B, Bascunana, J, Benzidia, I, Bertoletti, L, Blanco-Molina, A, Bilora, F, Bortoluzzi, C, Bosevski, M, Bounameaux, H, Braester, A, Brandolin, B, Brenner, B, Bucherini, E, Bui, HM, Bura-Riviere, A, Camon, AM, Carrasco, C, Castro, J, Cesta, A, Ciammaichella, M, Cruz, JA, de Ancos, C, del Toro, J, Demelo, P, Dentali, F, Diaz-pedroche, MD, Diaz-Peromingo, JA, Di Micco, P, Di Pangrazio, M, Ellis, M, Encabo, M, Falga, C, Falvo, N, Farfan, AI, Fernandez-Capitan, C, Fidalgo, MA, Font, C, Fresa, M, Furest, I, Garcia, MA, Garcia-Braoado, F, Garcia-Morillo, M, Garcia-Raso, A, Gavin, O, Gil-Diaz, A, Gomez, V, Gomez-Cuervo, C, Gonzalez-Martinez, J, Grandone, E, Grau, E, Guijarro, R, Gutierrez, J, Gutierrez, P, Hernandez-Blasco, L, Hu, A, Hirmerova, J, Imbalzano, E, Jara-Palomares, L, Jaras, MJ, Jimenez, D, Jou, I, Joya, MD, Krstevski, G, Lessiani, G, Lima, J, Llamas, P, Lobo, JL, Lopez-Jimenez, L, Lopez-Miguel, P, Lopez-Nunez, JJ, Lopez-Reyes, R, Lopez-Saez, JB, Lorente, MA, Lorenzo, A, Loring, M, Lumbierres, M, Mahe, I, Maida, R, Maly, R, Manrique-Abos, I, Marchena, PJ, Martin-Fernandez, M, Martin-Guerra, JM, Martin-Romero, M, Mastroiacovo, D, Mazzolai, L, Mellado, M, Merah, A, Morales, MD, Moustafa, F, Ney, B, Nieto, JA, Nunez, MJ, Olivares, MD, Otalora, S, Otero, R, Pace, F, Parisi, R, Pedrajas, JM, Pellejero, G, Perez-Ductor, C, Perez-Jacoiste, A, Perez-Rus, G, Peris, ML, Pesavento, R, Pesce, ML, Porras, JA, Prandoni, P, Quinta-Valla, R, Riesco, D, Rivas, A, Rocci, A, Rodriguez-Davila, MA, Rodriguez-Hernandez, A, Rubio, CM, Ruiz-Alcaraz, S, Ruiz-Artacho, P, Ruiz-Ruiz, J, Ruiz-Sada, P, Ruiz-Torregrosa, P, Sahuquillo, JC, Sala-Sainz, C, Salgado, E, Samperiz, A, Sanchez-Munoz-Torrero, JF, Sancho, T, Sanoja, ID, Siniscalchi, C, Skride, A, Soler, S, Sotgiu, P, Soto, MJ, Surinach, JM, Tiraferri, E, Tonello, D, Torres, MI, Tufano, A, Tzoran, I, Uresandi, F, Usandizaga, E, Valle, R, Vanassche, T, Vandenbriele, C, Vazquez, FJ, Verhamme, P, Villalobos, A, Visona, A, Hong, NV, Yoo, HH, and Zdraveska, M

Subjects
Neoplasms, Thrombosis, Mortality, premature
Abstract

Background: Proper risk stratification of patients for early mortality after cancer-associated thrombosis may lead to personalized anticoagulation protocols. Therefore, we aimed to derive and validate a scoring system to predict early mortality in this population. To this end, we selected patients with active cancer and thrombosis from the Computerized Registry of Patients with Venous Thromboembolism database. Methods: The main outcome was all cause mortality within the month following a thrombotic event. We used a simple random selection to split arc data in a derivation and a validation cohort. In the derivation cohort, we used recursive partitioning and binary logistic regression to identify groups at risk and to determine the likelihood of the primary outcome. The risk score was developed based on odds ratios from the final multivariate model, and then tested in the validation cohort. Results: In 10,025 eligible patients, we identified 6 predictors of 30-day mortality: leukocytosis >= 11.5x109/L; platelet count = 7). The AUC for the overall score was 0.74, and using a cutoff >= 7 points, the model had a negative predictive value of 94.4%, a positive predictive value of 23.1%, a sensitivity of 73.3%, and a specificity of 64.6% in the validation cohort. Conclusions: Our validated risk model may assist physicians in the selection of patients for outpatient management, and perhaps anticoagulant, considering expanding anticoagulation options.

Published
2019

10. Frequency and prognostic impact of acute kidney injury in patients with acute pulmonary embolism. Data from the RIETE registry

Author

Murgier, M, Darmon, M, Zeni, F, Valle, R, Del Toro, J, Llamas, P, Mazzolai, L, Villalobos, A, Monreal, M, Brenner, B, Farge-Bancel, D, Barba, R, Di Micco, P, Bertoletti, L, Tzoran, I, Reis, A, Bounameaux, H, Maly, R, Verhamme, P, Bosevski, M, Caprini, JA, Adarraga, MD, Aibar, MA, Aibar, J, Alfonso, M, Amado, C, Aranda, C, Arcelus, JI, Ballaz, A, Barron, M, Barron-Andres, B, Bascunana, J, Blanco-Molina, A, Camon, AM, Carrasco, C, Cruz, AJ, del Pozo, R, del Toro, J, Diaz-Pedroche, MC, Diaz-Peromingo, JA, Encabo, M, Falga, C, Fernandez-Capitan, C, Fidalgo, MA, Font, C, Font, L, Furest, I, Garcia, MA, Garcia-Bragado, F, Garcia-Morillo, M, Garcia-Raso, A, Gavin, O, Gomez, V, Gonzalez-Martinez, J, Grau, E, Guijarro, R, Gutierrez, J, Isern, V, Jara-Palomares, L, Jaras, MJ, Jimenez, D, Jimenez, J, Jou, I, Joya, MD, Lalueza, A, Lima, J, Lobo, JL, Lopez-Jimenez, L, Lopez-Miguel, P, Lopez-Reyes, R, Lopez-Saez, JB, Lorente, MA, Lorenzo, A, Loring, M, Lumbierres, M, Madridano, O, Marchena, PJ, Martin-Martos, F, Martin-Romero, M, Morales, MV, Nieto, JA, Nunez, A, Nunez, MJ, Olivares, MC, Otalora, S, Otero, R, Pedrajas, JM, Pellejero, G, Perez-Ductor, C, Peris, ML, Pesce, ML, Porras, JA, Riesco, D, Rivas, A, Rodriguez-Davila, MA, Rosa, V, Rubio, CM, Ruiz-Artacho, P, Sahuquillo, JC, Sala-Sainz, MC, Samperiz, A, Sanchez-Munoz-Torrero, JF, Sancho, T, Soler, S, Soto, MJ, Surinach, JM, Tolosa, C, Torres, MI, Trujillo-Santos, J, Uresandi, F, Usandizaga, E, Vela, J, Vidal, G, Gutierrez, P, Vazquez, FJ, Vilaseca, A, Vanassche, T, Vandenbriele, C, Hirmerova, J, Salgado, E, Benzidia, I, Bura-Riviere, A, Hij, A, Merah, A, Mahe, I, Moustafa, F, Braester, A, EllisM, Bilora, F, Bortoluzzi, C, Brandolin, B, Bucherini, E, Cattabiani, C, Ciammaichella, M, Dentali, F, DiMicco, P, Giorgi-Pierfranceschi, M, Grandone, E, Imbalzano, E, Maida, R, Mastroiacovo, D, Ngoc, V, Pace, F, Pallotti, G, Parisi, R, Pesavento, R, Prandoni, P, Quintavalla, R, Rocci, A, Romualdi, R, Siniscalchi, C, Sotgiu, P, Tiraferri, E, Tonello, D, Tufano, A, Visona, A, Skride, A, Krstevski, G, Zdraveska, M, and Caprini, J

Subjects
Risk, Pulmonary embolism, Bleeding, Mortality, Biomarkers, Acute kidney injury
Abstract

Rationale: Acute kidney injury (AKI) is associated with a poor outcome. Although pulmonary embolism(PE) may promote AKI through renal congestion and/or hemodynamic instability, its frequency and influence on outcome in patients with acute PE have been poorly studied. Methods: The frequency of AKI (defined according to the "Kidney Disease: Improving Global Outcomes" definition) at baseline and its influence on the 30-day mortality was evaluated in patients with acute PE from the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry. We used multivariate analysis to assess whether the presence of AKI influenced the risk for 30-day death. Results: The study included 21,131 patients, of whom 6222 (29.5%) had AKI at baseline: 4385 patients (21%) in stage 1, 1385 (6.5%) in stage 2 and 452 (2%) in stage 3. The proportion of patients with high-risk PE in those with no AKI, AKI stage 1, AKI stage 2 or AKI stage 3 was: 2.8%, 5.3%, 8.8% and 12%, respectively (p < 0.001). After 30 days, 1236 patients (5.9%) died. Overall mortality was 4% in patients with no AKI, 8.4% in AKI stage 1, 14% in AKI stage 2 and 17% in AKI stage 3 (all p < 0.001). AKI was independently associated with an increased risk of all-cause death at 30 days (odds ratio = 1.25; 95% CI: 1.02-1.54). Conclusions: One in every 3-4 patients with acute PE had AKI at baseline. The presence of AKI independently predicted 30-day mortality. This study suggests that AKI may deserve to be evaluated as a prognostic factor in patients with acute PE. (C) 2019 Elsevier B.V. All rights reserved.

Published
2019

11. Venous thromboembolism in young adults: Findings from the RIETE registry

Author

Lacruz, B, Tiberio, G, Latorre, A, Villalba, JC, Bikdeli, B, Hirmerova, J, Lorenzo, A, Mellado, M, Canas, I, Monreal, M, Adarraga, MD, Agud, M, Agudo, P, Aibar, MA, Aibar, J, Amado, C, Arcelus, JI, Ballaz, A, Barba, R, Barron, M, Barron-Andres, B, Bascunana, J, Bolado, C, Blanco-Molina, A, Camon, AM, Carrasco, C, Castro, J, de Ancos, C, del Toro, J, Demelo, P, Diaz-Simon, R, Diaz-Peromingo, JA, Encabo, M, Falga, C, Farfan, AI, Fernandez-Capitan, C, Fernandez-Criado, MC, Fernandez-Ovalle, H, Fidalgo, MA, Font, C, Font, L, Furest, I, Garcia, MA, Garcia-Bragado, F, Garcia-Morillo, M, Garcia-Raso, A, Gavin, O, Gaya-Manso, I, Gayol, MC, Gil-Diaz, A, Gomez, V, Gomez-Cuervo, C, Gonzalez-Martinez, J, Grau, E, Gutierrez, J, Hernandez-Blasco, LM, Iglesias, M, Jara-Palomares, L, Jaras, MJ, Jimenez, D, Jou, I, Joya, MD, Lalueza, A, Lima, J, Llamas, P, Lobo, JL, Lopez-Jimenez, L, Lopez-Miguel, P, Lopez-Nunez, JJ, Lopez-Reyes, R, Lopez-Saez, JB, Lorente, MA, Loring, M, Madridano, O, Maestre, A, Marchena, PJ, Martin, M, Martin-Fortea, MP, Martin-Guerra, JM, Martinez-Gonzalez, L, Melia, C, Montesa, C, Morales, MV, Nieto, MA, Nieto, JA, Nunez, MJ, Olivares, MC, Otalora, S, Otero, R, Ovejero, A, Pedrajas, JM, Pellejero, G, Perez-Ductor, C, Perez-Pinar, M, Perez-Rus, G, Penis, ML, Porras, JA, Redrado, J, Rivas, A, Rodriguez-Galan, I, Rodriguez-Hernandez, A, Rubio, CM, Ruiz-Artacho, P, Ruiz-Ruiz, J, Ruiz-Sada, P, Sahuquillo, JC, Sala-Sainz, MC, Salazar, V, Salgueiro, G, Samperiz, A, Sanchez-Camara, S, Sanchez-Munoz-Torrero, JF, Sancho, T, Soler, S, Surinach, JM, Tolosa, C, Torres, MI, Trujillo-Santos, J, Uresandi, F, Valle, R, Vidal, G, Villares, P, Gutierrez, P, Vazquez, FJ, Vilaseca, A, Vanassche, T, Vandenbriele, C, Verhamme, P, Yoo, HHB, Maly, R, Salgado, E, Benzidia, I, Bertoletti, L, Bura-Riviere, A, Debourdeau, P, Farge-Bancel, D, Hij, A, Mahe, I, Merah, A, Moustafa, F, Schellong, S, Braester, A, Brenner, B, Ellis, M, Tzoran, I, Sharif-Kashani, B, Barillari, G, Bilora, F, Bortoluzzi, C, Brandolin, B, Ciammaichella, M, Dentali, F, Di Micco, P, Grandone, E, Maida, R, Mastroiacovo, D, Pace, F, Parisi, R, Pesavento, R, Prandoni, P, Quintavalla, R, Rocci, A, Siniscalchi, C, Sotgiu, P, Tufano, A, Visona, A, Hong, NV, Gibietis, V, Kigitovica, D, Skride, A, Bosevski, M, Bounameaux, H, Mazzolai, L, Caprini, J, Bui, HM, and Pham, KQ

Subjects
Young, Anticoagulants, Outcomes, Venous thromboembolism
Abstract

Background: Little is known on the clinical characteristics, risk factors and outcomes during anticoagulation in young patients with acute venous thromboembolism (VTE). Methods: We used data from the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry to assess the clinical characteristics, risk factors and outcomes during anticoagulation in VTE patients aged 10-24 years. Data were separately analyzed according to initial presentation and gender. Results: Of 76,719 patients with VTE, 1571 (2.0%) were aged 10-24 years. Of these, 989 (63%) were women and 669 (43%) presented with pulmonary embolism (PE). Most women were using estrogens (680, 69%) or were pregnant (101, 10%), while 59% of men had unprovoked VTE. Women were more likely to present with PE (48% vs. 34%). The majority (87%) of PE patients had Sat O-2 levels >= 90% at baseline. The vast majority (97%) of PE patients were at low risk according to the PESI score, many (90%) at very low risk. During the course of anticoagulation (median, 192 days), 40 patients had VTE recurrences, 17 had major bleeding and 10 died (3 died of PE). Women had as many VTE recurrences as major bleeds (15 vs. 14 events), while men had many more VTE recurrences than major bleeding (25 vs. 3 events). Conclusions: VTE is associated with low risk of short-term mortality in young adults. Noticeable gender differences exist in the risk factor profile and the risk of VTE recurrences and major bleeding in the course of anticoagulation.

Published
2019

12. Statin and all-cause mortality in patients receiving anticoagulant therapy for venous thromboembolism. Data from the RIETE registry

Author

Siniscalchi, C, Quintavalla, R, Rocci, A, Riera-Mestre, A, Trujillo-Santos, J, Surinach, JM, Jara-Palomares, L, Bikdeli, B, Moustafa, F, Monreal, M, Adarraga, MD, Agud, M, Aibar, MA, Alfonso, J, Amado, C, Arcelus, JI, Ballaz, A, Barba, R, Barbagelata, C, Barron, M, Barron-Andres, B, Blanco-Molina, A, Camon, AM, Canas, I, Carrasco, C, Castro, J, Chasco, L, Cerda, P, Demelo, P, Diaz-Peromingo, JA, Elias-Hernandez, T, Encabo, M, Escribano, JC, Falga, C, Farfan, AI, Fernandez-Capitan, C, Fernandez-Criado, MC, Fidalgo, MA, Font, C, Font, L, Furest, I, Galian, JD, Garcia, MA, Garcia-Bragado, F, Garcia-Raso, A, Gavin, O, Gayol, MC, Gil-Diaz, A, Gomez, V, Gomez-Cuervo, C, Gonzalez-Martinez, J, Grau, E, Gutierrez, J, Hernandez-Blasco, LM, Iglesias, M, Jaras, MJ, Jimenez, D, Jimenez, R, Joya, MD, Jou, I, Lalueza, A, Lecumberri, R, Lima, J, Llamas, P, Lobo, JL, Lopez-Jimenez, L, Lopez-Miguel, P, Lopez-Nunez, JJ, Lopez-Reyes, R, Lopez-Saez, JB, Lorente, MA, Lorenzo, A, Loring, M, Lumbierres, M, Madridano, O, Maestre, A, Marchena, PJ, del Pozo, MM, Martin-Fortea, P, Martin-Martos, F, Martinez-Garcia, MA, Martinez-Gonzalez, L, Mella, C, Mellado, M, Montesa, C, Morales, MV, Nieto, JA, Nunez, MJ, Olivares, MC, Olivera, PE, Ortega-Michel, C, Otalora, S, Otero, R, Panadero-Macia, M, Pedrajas, JM, Pellejero, G, Perez-Ductor, C, Perez-Jacoiste, A, Perez-Rus, G, Penis, ML, Pesantez, D, Porras, JA, Rivas, A, Rodriguez-Cobo, A, Rodriguez-Hernandez, A, Rubio, CM, Ruiz-Artacho, P, Ruiz-Ruiz, J, Ruiz-Sada, P, Sahuquillo, JC, Sala-Sainz, MC, Salazar, V, Salgueiro, G, Samperiz, A, Sanchez-Munoz-Torrero, JF, Sancho, T, Soler, S, Suarez, S, Tolosa, C, Torres, MI, Uresandi, F, Valle, R, Vela, JR, Vidal, G, Villares, P, de Ancos, C, del Toro, J, Gutierrez, P, Vazquez, FJ, Vilaseca, A, Vanassche, T, Vandenbriele, C, Verhamme, P, Yoo, HHB, Hirmerova, J, Maly, R, Salgado, E, Benzidia, I, Bertoletti, L, Bura-Riviere, A, Debourdeau, P, Farge-Bancel, D, Helfer, H, Hij, A, Mahe, I, Schellong, S, Braester, A, Brenner, B, Tzoran, I, Sharif-Kashani, B, Barillari, G, Bilora, F, Bortoluzzi, C, Brandolin, B, Ciammaichella, M, Dentali, F, Di Micco, P, Imbalzano, E, Landolfi, R, Maida, R, Mastroiacovo, D, Pace, F, Pesavento, R, Pomero, F, Prandoni, P, Tufano, A, Ventresca, A, Visona, A, Hong, NV, Zalunardo, B, Gibietis, V, Kigitovica, D, Skride, A, Bosevski, M, Bounameaux, H, Mazzolai, L, Caprini, J, and Bui, HM

Subjects
Venous thomboembolism, Fatal bleeding, Statins, Death all-causes, Fatal pulmonary embolism
Abstract

Background: The clinical outcomes during the course of anticoagulation in patients with venous thromboem-bolism (VTE) using statins remain controversial. Methods: We used the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry to compare the risk for VTE recurrences, major bleeding or death during anticoagulation, according to the use of statins at baseline. We used propensity score-matching (PSM) to adjust for confounding variables. Results: From February 2009 to January 2018, 32,062 VTE patients were included. Of these, 7,085 (22%) were using statins. Statin users were 10 years older (73 +/- 11 vs. 63 +/- 19 years, respectively) and more likely to have comorbidities or to be using antiplatelets or corticosteroids at baseline than non-users. During the course of anticoagulation (median, 177 days), 694 patients developed VTE recurrences, 848 bled and 3,169 died (fatal pulmonary embolism 176, fatal bleeding 121). Statin users had a similar rate of VTE recurrences (hazard ratio [HR]: 0.98; 95%CI: 0.82-1.17), a higher rate of major bleeding (HR: 1.29; 95%CI: 1.11-1.50) and a similar mortality rate (HR: 1.01; 95%CI: 0.93-1.10) than non-users. On PSM analysis, statin users had a significantly lower risk for death (HR: 0.62; 95%CI: 0.48-0.79) and a similar risk for VTE recurrences (HR: 0.98; 95%CI: 0.61-1.57) or major bleeding (HR: 0.85; 95%CI: 0.59-1.21) than non-users. Conclusions: During anticoagulation for VTE, patients using statins at baseline had a lower risk to die than nonusers.

Published
2019

13. Vena cava filters in patients presenting with major bleeding during anticoagulation for venous thromboembolism

Author

Mellado, M, Trujillo-Santos, J, Bikdeli, B, Jimenez, D, Nunez, MJ, Ellis, M, Marchena, PJ, Vela, JR, Clara, A, Moustafa, F, Monreal, M, Adarraga, MD, Aibar, MA, Alfonso, M, Arcelus, JI, Ballaz, A, Banos, P, Barba, R, Barron, M, Bascunana, J, Blanco-Molina, A, Camon, AM, Carrasco, C, Chasco, L, Cruz, AJ, Del, PR, Del, TJ, Diaz-Pedroche, MC, Diaz-Peromingo, JA, Encabo, M, Falga, C, Fernandez-Aracil, C, Fernandez-Capitan, C, Fidalgo, MA, Font, C, Font, L, Furest, I, Garcia, MA, Garcia-Bragado, F, Garcia-Morillo, M, Garcia-Raso, A, Garcia-Sanchez, I, Gavin, O, Gomez, C, Gomez, V, Gonzalez, J, Grau, E, Guijarro, R, Guirado, L, Gutierrez, J, Hernandez-Blasco, L, Hernando, E, Isern, V, Jara-Palomares, L, Jaras, MJ, Joya, MD, Lima, J, Llamas, P, Lobo, JL, Lopez-Jimenez, L, Lopez-Reyes, R, Lopez-Saez, JB, Lorente, MA, Lorenzo, A, Loring, M, Lumbierres, M, Madridano, O, Maestre, A, Martin, M, Martin-Martos, F, Morales, MV, Nieto, JA, Olivares, MC, Otalora, S, Otero, R, Pedrajas, JM, Pellejero, G, Perez-Ductor, C, Peris, ML, Pons, I, Porras, JA, Riera-Mestre, A, Rivas, A, Rodriguez-Davila, MA, Rodriguez-Galan, I, Rosa, V, Rubio, CM, Ruiz-Artacho, P, Sahuquillo, JC, Sala-Sainz, MC, Samperiz, A, Sanchez-Artola, B, Sanchez-Martinez, R, Sancho, T, Soler, S, Soto, MJ, Surinach, JM, Tolosa, C, Torres, MI, Uresandi, F, Usandizaga, E, Valero, B, Valle, R, Vela, J, Vidal, G, Villalobos, A, Xifre, B, Vazquez, FJ, Vilaseca, A, Vanassche, T, Vandenbriele, C, Verhamme, P, Yoo, HHB, Wells, P, Hirmerova, J, Maly, R, Salgado, E, Benzidia, I, Bertoletti, L, Bura-Riviere, A, Falvo, N, Farge-Bancel, D, Hij, A, Merah, A, Mahe, I, Quere, I, Braester, A, Brenner, B, Tzoran, I, Antonucci, G, Bilora, F, Bucherini, E, Cattabiani, C, Ciammaichella, M, Dentali, F, Di Micco, P, Doddi, M, Duce, R, Giorgi-Pierfranceschi, M, Grandone, E, Imbalzano, E, Lessiani, G, Maggi, F, Maida, R, Mastroiacovo, D, Pace, F, Pesavento, R, Poggio, R, Prandoni, P, Quintavalla, R, Rocci, A, Siniscalchi, C, Tiraferri, E, Tonello, D, Visona, A, Zalunardo, B, Gibietis, V, Skride, A, Vitola, B, Zdraveska, M, Bounameaux, H, Calanca, L, Fresa, M, and Mazzolai, L

Subjects
Male, medicine.medical_specialty, Vena Cava Filters, Inferior vena cava filter, Hemorrhage, 030204 cardiovascular system & hematology, Lower risk, Statistics, Nonparametric, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Thromboembolism, Anticoagulants, Bleeding, Mortality, Vena cava filter, Venous thromboembolism, Internal Medicine, medicine, Humans, Registries, 030212 general & internal medicine, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Mortality rate, Heparin, Middle Aged, Surgery, Clinical trial, Treatment Outcome, Propensity score matching, Emergency Medicine, Female, business, Major bleeding, medicine.drug
Abstract

The association between inferior vena cava filter (IVC) use and outcome in patients presenting with major bleeding during anticoagulation for venous thromboembolism (VTE) has not been thoroughly investigated. We used the RIETE registry to compare the 30-day outcomes (death, major re-bleeding or VTE recurrences) in VTE patients who bled during the first 3 months of therapy, regarding the insertion of an IVC filter. A propensity score matched (PSM) analysis was performed to adjust for potential confounders. From January 2001 to September 2016, 1065 VTE patients had major bleeding during the first 3 months of anticoagulation (gastrointestinal 370; intracranial 124). Of these, 122 patients (11%) received an IVC filter. Patients receiving a filter restarted anticoagulation later (median, 4 vs. 2 days) and at lower doses (95 +/- 52 IU/kg/day vs. 104 +/- 55 of low-molecular-weight heparin) than those not receiving a filter. During the first 30 days after bleeding (after excluding 246 patients who died within the first 24 h), 283 patients (27%) died, 63 (5.9%) had non-fatal re-bleeding and 19 (1.8%) had recurrent pulmonary embolism (PE). In PSM analysis, patients receiving an IVC filter (n = 122) had a lower risk for all-cause death (HR 0.49; 95% CI 0.31-0.77) or fatal bleeding (HR 0.16; 95% CI 0.07-0.49) and a similar risk for re-bleeding (HR 0.55; 95% CI 0.23-1.40) or PE recurrences (HR 1.57; 95% CI 0.38-6.36) than those not receiving a filter (n = 429). In VTE patients experiencing major bleeding during the first 3 months, use of an IVC filter was associated with reduced mortality rates. Clinical Trial Registration NCT02832245.

Published
2019

14. Mortality after pulmonary embolism in patients with diabetes. Findings from the RIETE registry

Author

de Miguel-Diez, J, Lopez-de-Andres, A, Jimenez-Trujillo, I, Hernandez-Barrera, V, Jimenez-Garcia, R, Lorenzo, A, Pedrajas, JM, Visona, A, Lopez-Miguel, P, Monreal, M, Adarraga, MD, Aibar, MA, Aibar, J, Alfonso, M, Amado, C, Aranda, C, Arcelus, JI, Ballaz, A, Barba, R, Barron, M, Barron-Andres, B, Bascunana, J, Blanco-Molina, A, Camon, AM, Carrasco, C, Cruz, AJ, del Toro, J, Diaz-Pedroche, MC, Diaz-Peromingo, JA, Falga, C, Fernandez-Capitan, C, Fidalgo, MA, Font, C, Font, L, Furest, I, Garcia, MA, Garcia-Bragado, F, Garcia-Morillo, M, Garcia-Ortega, A, Gavin, O, Gomez, V, Gonzalez-Martinez, J, Grau, E, Guijarro, R, Guirado, L, Gutierrez, J, Hernandez-Blasco, L, Isern, V, Jara-Palomares, L, Jaras, MJ, Jimenez, D, Jimenez, J, Jou, I, Joya, MD, Lalueza, A, Lima, J, Lobo, JL, Lopez-Jimenez, L, Lopez-Reyes, R, Lopez-Saez, JB, Lorente, MA, Loring, M, Lumbierres, M, Madridano, O, Marchena, PJ, Martin-Martos, Morales, MV, Nieto, JA, Nunez, A, Nunez, MJ, Olivares, MC, Otalora, S, Otero, R, Pellejero, G, Perez-Ductor, C, Perez-Jacoiste, A, Penis, ML, Pesce, ML, Porras, JA, Riesco, D, Rivas, A, Rodriguez-Davila, MA, Rosa, V, Rubio, CM, Ruiz-Artacho, P, Sahuquillo, JC, Sala-Sainz, MC, Samperiz, A, Sanchez-Munoz-Torrero, JF, Sancho, T, Soler, S, Soto, MJ, Surinach, JM, Tolosa, C, Torrents, A, Torres, MI, Trujillo-Santos, J, Uresandi, F, Usandizaga, E, Valle, R, Vela, J, Vidal, G, Villalobos, A, Gutierrez, P, Vazquez, FJ, Vilaseca, A, Vanasschc, T, Vandenbriele, C, Verhamme, P, Hirmerova, J, Maly, R, Salgado, E, Benzidia, I, Bertoletti, L, Bura-Riviere, A, Farge-Bancel, D, Hij, A, Merah, A, Mahe, I, Moustafa, F, Braester, A, Brenner, B, Ellis, M, Tzoran, I, Bilora, F, Bortoluzzi, C, Brandolin, B, Bucherini, E, Cattabiani, C, Ciammaichella, M, Dentali, F, Di Micco, P, Giorgi-Pierfranceschi, M, Grandone, E, Imbalzano, E, Maida, R, Mastroiacovo, D, Ngoc, V, Pace, F, Parisi, R, Pesavento, R, Prandoni, P, Quintavalla, R, Rocci, A, Siniscalchi, C, Sotgiu, P, Tiraferri, E, Tufano, A, Zalunardo, B, Kalejs, R, Skride, A, Vitola, B, Bosevski, M, Zdraveska, M, Ii, B, Fresa, M, Mazzolai, L, Caprini, J, and Bui, HM

Subjects
Cardiovascular events, Type 2 diabetes mellitus, Pulmonary embolism, Comorbidity, Mortality
Abstract

Background: Among patients presenting with pulmonary embolism (PE), those with diabetes are at increased risk to die than those without diabetes. The reasons have not been identified. We used the RIETE (Registro Informatizado Enfermedad Trombo Embolica) database to compare the mortality rate and the causes of death during anticoagulation in patients with PE according to the presence or absence of diabetes. Methods: A matched retrospective cohort study from consecutively enrolled patients in RIETE, from 179 hospitals in 24 countries. For each patient with diabetes we selected two patients with no diabetes matched by age, sex and year of diagnosis of the PE. Results: As of September 2017, there were 2010 PE patients with diabetes and two age-and-gender matched controls. Mean age was 74 +/- 11 years, 46% were men. Patients with diabetes were more likely to have comorbidities, to be using antiplatelets and to have more severe PE. During anticoagulation (median, 219 days), patients with diabetes had a higher mortality (hazard ratio [HR]: 1.45; 95% confidence intervals [CI]: 1.25-1.67) and a higher rate of arterial ischemic events (HR: 2.89; 95%CI: 1.71-4.94) than those without diabetes. On multivariable analysis, diabetes was not associated with an increased risk for death (HR: 1.26; 95%CI: 0.97-1.63). We also failed to find differences according to the use of antiplatelet drugs concomitantly. Conclusions: In our cohort of patients with PE, diabetes was not an independent predictor for death. The influence of arterial events or antiplatelet drugs (if any) was low.

Published
2019

16. Outcomes during anticoagulation in patients with symptomatic vs. incidental splanchnic vein thrombosis

Author

Universitat Rovira i Virgili, Tufano A, Ageno W, Di Micco P, Niglio A, Rosa V, Ballaz A, Braester A, Rubio CM, Isern V, Imbalzano E, Monreal M, RIETE Investigators, Universitat Rovira i Virgili, and Tufano A, Ageno W, Di Micco P, Niglio A, Rosa V, Ballaz A, Braester A, Rubio CM, Isern V, Imbalzano E, Monreal M, RIETE Investigators

Abstract

© 2018 Elsevier Ltd Introduction: Current guidelines recommend the use of anticoagulant therapy in patients with symptomatic splanchnic vein thrombosis (SVT) and suggest no routine anticoagulation in those with incidental SVT. Methods: We used the RIETE (Registro Informatizado Enfermedad Trombo Embólica) registry to assess the rate and severity of symptomatic venous thromboembolism (VTE) recurrences and major bleeding events appearing during the course of anticoagulation in patients with symptomatic or incidental SVT. Results: In March 2017, 521 patients with SVT were recruited. Of them, 212 (41%) presented with symptomatic SVT and 309 had incidental SVT. Most (93%) patients received anticoagulant therapy (median, 147 days). During the course of anticoagulation, 20 patients developed symptomatic VTE recurrences (none died) and 26 had major bleeding (fatal bleeding, 5). On multivariable analysis, patients with incidental SVT had a non-significantly higher risk for symptomatic VTE recurrences (adjusted hazard ratio [HR]: 2.04; 95%CI: 0.71–5.88) and a similar risk for major bleeding (HR: 1.12; 95%CI: 0.47–2.63) than those with symptomatic SVT. Active cancer was associated with at increased risk for VTE recurrences (HR: 3.06; 95%CI: 1.14–8.17) and anaemia (HR: 4.11; 95%CI: 1.45–11.6) or abnormal prothrombin time (HR: 4.10; 95%CI: 1.68–10.1) were associated with at increased risk for major bleeding. Conclusions: The rates of recurrent SVT and major bleeding were similar between patients with incidental or symptomatic SVT. Because the severity of bleeding complications during anticoagulation may outweigh the severity of VTE recurrences in both groups, further studies should identify those SVT patients who benefit from anticoagulant therapy.

Published
2018

17. External validation of the PE-SARD risk score for predicting early bleeding in acute pulmonary embolism in the RIETE Registry.

Author

Chopard R, Bertoletti L, Piazza G, Jimenez D, Barillari G, Llamas P, Rubio CM, Aujayeb A, Monreal M, and Meneveau N

Subjects
Humans, Reproducibility of Results, Risk Factors, Hemorrhage diagnosis, Hemorrhage etiology, Registries, Pulmonary Embolism complications, Pulmonary Embolism diagnosis, Pulmonary Embolism epidemiology
Abstract

Introduction: The PE-SARD score (syncope, anemia, renal dysfunction) was developed to predict the risk of major bleeding in the acute phase of pulmonary embolism (PE)., Methods: We analyzed data from 50,686 patients with acute PE included in the RIETE registry to externally validate the PE-SARD score. We calculated the overall reliability of the PE-SARD score, as well as discrimination and calibration for predicting the risk of major bleeding at 30 days. The performance of PE-SARD was compared to the BACS and PE-CH models., Results: During the first 30 days, 640 patients (1.3 %) had a major bleeding event. The incidence of major bleeding within 30 days was 0.6 % in the PE-SARD-defined low-risk group, 1.5 % in the intermediate-risk group, and 2.5 % in the high-risk group, for an OR of 2.22 (95 % CI, 2.02-2.43) for the intermediate-risk group (vs low-risk group), and 3.94 for the high-risk group (vs low-risk group). The corresponding sensitivity was 81.1 % (intermediate/high vs low risk), and specificity was 85.9 % (95 % CI, 85.8-86.1) (low/intermediate vs high risk). The applicability of PE-SARD was consistent across clinically relevant patient subgroups and over shorter time periods of follow-up (i.e., 3 and 7 days). The C-index was 0.654 and calibration was excellent. The PE-SARD bleeding score improved the major bleeding risk prediction compared with the BACS and PE-CH scores., Conclusions: The PE-SARD score identifies PE patients with a higher risk of bleeding, which could assist providers for potentially adjusting PE management, in a framework of shared decision-making with individual patients., Competing Interests: Declaration of competing interest RC, GB, PL, CR, AA and NM have no conflict of interest to declare. GP has received research support from Bristol-Myers Squibb/Pfizer Alliance, Bayer, Janssen, Alexion, Amgen and Boston Scientific Corporation, and consulting fees from Pfizer, Boston Scientific Corporation, Janssen, Prairie Education and Research Cooperative, NAMSA, and Amgen. MM has received research support from Sanofiand Rovi Laboratorios, and consulting fees from Sanofi and Bristol. DJ has served as a speaker for Bristol-Myers Squibb and Sanofi. LB reports grant from Bayer; personal fees and non-financial support from BMS-Pfizer; personal fees and non-financial support from Léo-Pharma; grants, personal fees and non-financial support from MSD; non-financial support from Johnson and Johnson; non-financial support from Opalia-Recordati; personal fees and non-financial support from Viatris; outside the submitted work., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Published
2024
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18. The effect of a toothpaste containing oleanolic acid in reducing plaque and gingivitis: a proof-of-concept randomized trial.

Author

Ramírez GM, Villar CC, Saraiva L, Benítez CG, Rubio CM, Malheiros ZM, Stewart B, Kilpatrick L, and Romito GA

Subjects
Dental Plaque Index, Double-Blind Method, Humans, Toothpastes therapeutic use, Dental Plaque prevention & control, Gingivitis prevention & control, Oleanolic Acid therapeutic use
Abstract

Objectives: To assess the safety and efficacy of an oleanolic acid (OA)-containing toothpaste in reducing gingival inflammation and plaque in patients with gingivitis., Methods: This proof-of-concept parallel, double-blind, randomized controlled clinical trial included 99 patients. Following a 1-week washout, patients were randomized into three groups: OA group (fluoride toothpaste containing 0.1% OA and placebo mouthwash); negative control (fluoride toothpaste and placebo mouthwash); and CHX group (fluoride toothpaste and 0.12% chlorhexidine mouthwash). Patients were clinically assessed at inclusion, pre-washout visit, baseline and after 4 days, 1 week and 2 weeks of twice-daily use of the products. Patients received a diary for documentation of bleeding on brushing and provided unstimulated saliva samples., Results: After two weeks, all groups showed significant reductions in all clinical parameters. The CHX group exhibited significantly greater reductions in gingival index and interproximal gingival index scores at week 2, as compared to patients in the negative control (p = 0.04). In contrast, reductions in gingival index scores did not differ between CHX and OA groups and between OA and negative control groups at week 2. The CHX group had significantly greater reductions in plaque index scores at day-4, 1-week and 2-week evaluations, as compared to the negative control and OA groups. The frequency of adverse events was similar among the groups. None of the groups reduced salivary transferrin levels. Finally, the OA group had the lowest percentage of self-reported bleeding events., Conclusion: OA toothpaste failed to provide antiplaque and antigingivitis effects superior to those of a fluoride toothpaste after 2 weeks of use., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Published
2021
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19. Impact of sex, age, and risk factors for venous thromboembolism on the initial presentation of first isolated symptomatic acute deep vein thrombosis.

Author

Barco S, Klok FA, Mahé I, Marchena PJ, Ballaz A, Rubio CM, Adarraga MD, Mastroiacovo D, Konstantinides SV, and Monreal M

Subjects
Acute Disease, Adult, Age Factors, Aged, Aged, 80 and over, Humans, Middle Aged, Prospective Studies, Risk Factors, Sex Factors, Young Adult, Venous Thromboembolism epidemiology, Venous Thrombosis epidemiology
Abstract

Background and Aims: Sex-specific differences exist for the initial presentation of acute venous thromboembolism (VTE): men are more likely to present with proximal deep vein thrombosis (DVT) in the lower limbs (versus pulmonary embolism [PE] or isolated distal DVT [IDDVT]) than women. We studied in detail the influence of sex, age, and VTE risk factors on the initial presentation of IDDVT versus proximal DVT., Methods: A total of 24,911 patients with a first episode of objectively diagnosed acute symptomatic lower-limb DVT (without symptomatic PE) were enrolled in RIETE (years 2000-2017) and included in the present analysis., Results: A total of 4266 (17.1%) patients had IDDVT. No trend for more IDDVT diagnoses was observed over time. Women aged 40-69 had a higher proportion of IDDVT, especially between 40 and 49 years (+6.7%; 95CI +3.7%; +9.9%), whereas men had more often proximal DVT. The presenting location of first acute DVT depended on sex, age, and the prevalence and type of VTE risk factors. Recent surgery was independently associated with a diagnosis of IDDVT in both women and men, whereas active cancer and pregnancy were associated with proximal DVT., Conclusions: The interaction between age and VTE risk factors influences the presenting location (distal versus proximal) of the first acute lower-limb DVT observed in women and men. Our observations extend to IDDVT the concept that different clinical manifestations of acute VTE may not fully share the same pathophysiological mechanisms: this contributes to explain sex-specific prognostic differences., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Published
2019
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20. Outcomes during anticoagulation in patients with symptomatic vs. incidental splanchnic vein thrombosis.

Author

Tufano A, Ageno W, Di Micco P, Niglio A, Rosa V, Ballaz A, Braester A, Rubio CM, Isern V, Imbalzano E, and Monreal M

Subjects
Anticoagulants pharmacology, Female, Humans, Male, Middle Aged, Recurrence, Treatment Outcome, Anticoagulants therapeutic use, Hemorrhage etiology, Splanchnic Circulation physiology, Venous Thrombosis drug therapy
Abstract

Introduction: Current guidelines recommend the use of anticoagulant therapy in patients with symptomatic splanchnic vein thrombosis (SVT) and suggest no routine anticoagulation in those with incidental SVT., Methods: We used the RIETE (Registro Informatizado Enfermedad Trombo Embólica) registry to assess the rate and severity of symptomatic venous thromboembolism (VTE) recurrences and major bleeding events appearing during the course of anticoagulation in patients with symptomatic or incidental SVT., Results: In March 2017, 521 patients with SVT were recruited. Of them, 212 (41%) presented with symptomatic SVT and 309 had incidental SVT. Most (93%) patients received anticoagulant therapy (median, 147 days). During the course of anticoagulation, 20 patients developed symptomatic VTE recurrences (none died) and 26 had major bleeding (fatal bleeding, 5). On multivariable analysis, patients with incidental SVT had a non-significantly higher risk for symptomatic VTE recurrences (adjusted hazard ratio [HR]: 2.04; 95%CI: 0.71-5.88) and a similar risk for major bleeding (HR: 1.12; 95%CI: 0.47-2.63) than those with symptomatic SVT. Active cancer was associated with at increased risk for VTE recurrences (HR: 3.06; 95%CI: 1.14-8.17) and anaemia (HR: 4.11; 95%CI: 1.45-11.6) or abnormal prothrombin time (HR: 4.10; 95%CI: 1.68-10.1) were associated with at increased risk for major bleeding., Conclusions: The rates of recurrent SVT and major bleeding were similar between patients with incidental or symptomatic SVT. Because the severity of bleeding complications during anticoagulation may outweigh the severity of VTE recurrences in both groups, further studies should identify those SVT patients who benefit from anticoagulant therapy., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Published
2018
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21. Maternal influence on feeding site selection of male and female lambs.

Author

Wesley RL, Cibils AF, Black-Rubio CM, Pollak ER, and Utsumi SA

Subjects
Animals, Female, Male, Sex Characteristics, Social Behavior, Weaning, Animal Husbandry, Behavior, Animal, Feeding Behavior, Sheep, Domestic growth & development, Sheep, Domestic physiology
Abstract

We conducted an experiment to determine whether early-life social learning of feeding site selection in lambs was sex-specific. Sixteen ewes and their new born lambs were used in a controlled experiment. Eight ewe-lamb pairs included a male lamb and the remaining eight a female lamb. All pairs were individually exposed to an experimental arena containing a safe and unsafe artificial feeding site (SFS, UFS) each consisting of nine bowls which contained either ground Bermuda grass hay (SFS) or ground alfalfa hay (UFS). The bowls in UFS were surrounded by bright orange traffic cones (visual cues). Half the ewes were trained with controlled electric shock to avoid UFS. Thus, pairs were randomly assigned to: (1) shock aversion training (SAT) to mothers of male lambs (MS); (2) SAT to mothers of female lambs (FS); (3) no aversion training (NAT, control) to mothers of male lambs (MC); and (4) NAT (control) to mothers of female lambs (FC). None of the lambs were subjected to SAT. During training, testing, extinction, and retraining ewe-lamb pairs were exposed to the arena together. Ewes were then removed from the experiment and two additional extinction phases were conducted with weaned lambs alone. Fear conditioning elicited UFS avoidance of both the trained ewes (means±s.e.m. % times observed in UFS during testing phase: FC=95.3±1.70; MC=94.4±4.87; FS=1.6±1.63; MS=0 ±0; P<0.01) and their naïve lambs (FC=83.8±6.07%; MC=76.6±6.56%; FS=30.4±7.90%; MS=33.9±9.23%; P<0.01). UFS avoidance in lambs occurred regardless of sex and tended to persist after weaning (% times observed in UFS during 1st post-weaning extinction phase: FC=92.6±4.50%; MC=89.8±6.09%; FS=45.1±10.57%; MS=43.5±10.42%; P=0.06). Fear conditioning in mothers appeared to alter sex-related differences in mother-infant behavioral synchrony by increasing and decreasing feeding synchrony of male and female lambs, respectively (FC: r=0.52, P<0.01; MC: r=-0.02, P=0.86; FS: r=0.14, P=0.26; MS: r=0.46, P<0.01). During the extinction phase mothers of ram lambs were observed feeding more often (FC=85.0±2.33%; MC=92.7±1.45%; FS=47.3±8.81%; MS=72±5.68%; P=0.02) and standing less often than ewes with daughters (FC=7.3±2.40%; MC=2.7±0.83%; FS=39.3±9.04%; MS=18.0±5.29%; P=0.06). This study suggests that social conditioning at an early age could be a viable tool to induce learning of feeding site avoidance in female and male lambs alike.

Published
2014
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22. The role of real time 3D TEE in defining the anatomy of atrial septal defects and modifying the therapeutic approach.

Author

Melgarejo I, Orozco D, Nuñez F, Rubio CM, and Lang R

Subjects
Adult, Echocardiography, Three-Dimensional, Heart Atria anatomy & histology, Heart Septal Defects, Atrial surgery, Heart Septum anatomy & histology, Humans, Male, Echocardiography, Transesophageal, Heart Atria diagnostic imaging, Heart Septal Defects, Atrial diagnostic imaging, Heart Septum diagnostic imaging
Published
2012
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