151
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Systematic review and meta-analysis of test accuracy for the diagnosis of suspected pulmonary embolism. Blood Adv 2021; 4:4296-4311. [PMID: 32915980 DOI: 10.1182/bloodadvances.2019001052] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/02/2020] [Indexed: 11/20/2022] Open
Abstract
Pulmonary embolism (PE) is a common, potentially life-threatening yet treatable condition. Prompt diagnosis and expeditious therapeutic intervention is of paramount importance for optimal patient management. Our objective was to systematically review the accuracy of D-dimer assay, compression ultrasonography (CUS), computed tomography pulmonary angiography (CTPA), and ventilation-perfusion (V/Q) scanning for the diagnosis of suspected first and recurrent PE. We searched Cochrane Central, MEDLINE, and EMBASE for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. 2 investigators screened and abstracted data. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. We pooled estimates of sensitivity and specificity. The review included 61 studies. The pooled estimates for D-dimer sensitivity and specificity were 0.97 (95% confidence interval [CI], 0.96-0.98) and 0.41 (95% CI, 0.36-0.46) respectively, whereas CTPA sensitivity and specificity were 0.94 (95% CI, 0.89-0.97) and 0.98 (95% CI, 0.97-0.99), respectively, and CUS sensitivity and specificity were 0.49 (95% CI, 0.31-0.66) and 0.96 (95% CI, 0.95-0.98), respectively. Three variations of pooled estimates for sensitivity and specificity of V/Q scan were carried out, based on interpretation of test results. D-dimer had the highest sensitivity when compared with imaging. CTPA and V/Q scans (high probability scan as a positive and low/non-diagnostic/normal scan as negative) both had the highest specificity. This systematic review was registered on PROSPERO as CRD42018084669.
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152
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Diagnosis of deep vein thrombosis of the lower extremity: a systematic review and meta-analysis of test accuracy. Blood Adv 2021; 4:1250-1264. [PMID: 32227213 DOI: 10.1182/bloodadvances.2019000960] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/21/2020] [Indexed: 01/25/2023] Open
Abstract
Deep vein thrombosis (DVT) of the lower extremities can be associated with significant morbidity and may progress to pulmonary embolism and postthrombotic syndrome. Early diagnosis and treatment are important to minimize the risk of these complications. We systematically reviewed the accuracy of diagnostic tests for first-episode and recurrent DVT of the lower extremities, including proximal compression ultrasonography (US), whole leg US, serial US, and high-sensitivity quantitative D-dimer assays. We searched Cochrane Central, MEDLINE, and EMBASE for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. Two investigators screened and abstracted data. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. We pooled estimates of sensitivity and specificity. The review included 43 studies. For any suspected DVT, the pooled estimates for sensitivity and specificity of proximal compression US were 90.1% (95% confidence interval [CI], 86.5-92.8) and 98.5% (95% CI, 97.6-99.1), respectively. For whole-leg US, pooled estimates were 94.0% (95% CI, 91.3-95.9) and 97.3% (95% CI, 94.8-98.6); for serial US pooled estimates were 97.9% (95% CI, 96.0-98.9) and 99.8% (95% CI, 99.3-99.9). For D-dimer, pooled estimates were 96.1% (95% CI, 92.6-98.0) and 35.7% (95% CI, 29.5-42.4). Recurrent DVT studies were not pooled. Certainty of evidence varied from low to high. This systematic review of current diagnostic tests for DVT of the lower extremities provides accuracy estimates. The tests are evaluated when performed in a stand-alone fashion, and in a diagnostic pathway. The pretest probability of DVT often assessed by a clinical decision rule will influence how, together with sensitivity and specificity estimates, patients will be managed.
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153
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Systematic review and meta-analysis of outcomes in patients with suspected deep vein thrombosis. Blood Adv 2021; 4:2779-2788. [PMID: 32569377 DOI: 10.1182/bloodadvances.2020001558] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/16/2020] [Indexed: 11/20/2022] Open
Abstract
After deep vein thrombosis (DVT) is diagnosed, prompt evaluation and therapeutic intervention are of paramount importance for improvement in patient-important outcomes. We systematically reviewed patient-important outcomes in patients with suspected DVT, including mortality, incidence of pulmonary embolism (PE) and DVT, major bleeding, intracranial hemorrhage, and postthrombotic sequelae. We searched the Cochrane Central Register of Controlled Trials, Ovid Medline, Embase for eligible studies, references lists of relevant reviews, registered trials, and relevant conference proceedings. Two investigators screened and abstracted data. Nine studies with 5126 patients were included for lower extremity DVT. Three studies with 500 patients were included for upper extremity DVT. Among patients with lower extremity DVT, 0.85% (95% confidence interval [CI], 0% to 2.10%) and 0% developed recurrent DVT and PE, respectively, at 3 months. Among patients with upper extremity DVT, 0.49% (95% CI, 0% to 1.16%) and 1.98% (95% CI, 0.62% to 3.33%) developed recurrent DVT and PE, respectively, at 3 months. No major bleeding events were reported for those anticoagulated, which is lower than in other systematic reviews. For both upper and lower extremity DVT, low pretest probability patients with a negative D-dimer had a comparable incidence of VTE at 3 months (∼1%) as patients with a negative ultrasound (US). At higher pretest probabilities, negative US testing with or without serial US appears to be the safer option. In this review, we summarized the outcomes of patients evaluated by various diagnostic pathways. In most instances, there was significant limitation due to small population size or lack of direct evidence of effects of using a specific pathway. This systematic review was registered at PROSPERO as CRD42018100502.
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154
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Wiercioch W, Nieuwlaat R, Dahm P, Iorio A, Mustafa RA, Neumann I, Rochwerg B, Manja V, Alonso-Coello P, Ortel TL, Santesso N, Vesely SK, Akl EA, Schünemann HJ. Development and application of health outcome descriptors facilitated decision-making in the production of practice guidelines. J Clin Epidemiol 2021; 138:115-127. [PMID: 33992716 DOI: 10.1016/j.jclinepi.2021.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 04/06/2021] [Accepted: 04/21/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Stakeholders involved in developing recommendations need to have a common understanding of health outcomes and the perspective of affected individuals. In this paper we report on the development and application of health outcome descriptors (HODs) to inform decision-making by panels developing guideline recommendations. STUDY DESIGN AND SETTING Ten American Society of Hematology guideline panels addressing the management of venous thromboembolism developed HODs, rated their importance and health utility, applied them to prioritize outcomes, and to balance potential benefits and harms to formulate recommendations. RESULTS It was feasible to involve 18 panelists in developing 127 HODs. There was high agreement (82%) across the ten panels about outcomes perceived as critical or important for decision-making. Panelists' utility ratings of the outcomes were strongly correlated with panelists' outcome importance ratings (Pearson's r=-0.88). HODs were incorporated into Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence-to-decision (EtD) frameworks to support a shared understanding of health outcomes in panel deliberations. CONCLUSION HODs serve as a valuable tool to promote an explicit, common understanding of health outcomes during clinical guideline development and across different stakeholders. They are helpful across multiple steps of guideline development to facilitate panels' judgements, aiming to avoid variable implicit interpretations of health outcomes.
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Affiliation(s)
- Wojtek Wiercioch
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Robby Nieuwlaat
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, USA; Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS USA
| | - Ignacio Neumann
- Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Veena Manja
- Department of Surgery, University of California Davis, CA, USA; Department of Medicine, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Thomas L Ortel
- Departments of Medicine and Pathology, Duke University Medical Center, Durham, NC, USA
| | - Nancy Santesso
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Sara K Vesely
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Internal Medicine, American University of Beirut, Lebanon
| | - Holger J Schünemann
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Institut für Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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155
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Riva JJ, Bhatt M, Brunarski DJ, Busse JW, Martins CC, Xie F, Schünemann HJ, Brozek JL. Guidelines that use the GRADE approach often fail to provide complete economic information for recommendations: A systematic survey. J Clin Epidemiol 2021; 136:203-215. [PMID: 33984495 DOI: 10.1016/j.jclinepi.2021.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/11/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Little is known about how developers and panel members report cost and cost effectiveness considerations in GRADE guideline Evidence-to-Decision (EtD) frameworks. A systematic survey was conducted to explore approaches and factors contributing to variability in economic information reporting. STUDY DESIGN AND SETTING Guideline organization websites were systematically searched to create a convenience sample of guidelines. Reviewers screened published EtD frameworks and generated frequencies of reporting approaches. We used thematic analysis to summarize factors related to variability of economic information reporting. RESULTS We included 142 guidelines. The overall rate of reporting economic information was high (91%); however, there was variability across completion of predefined EtD Likert-type judgments (70%), noting information as not identified across EtD framework domains (57%), and providing remarks to justify recommendations (38%). Six themes contributing to variability emerged, related to: intervention, population, payor, provider, healthcare resource use, and economic model building factors. Only 2 guidelines performed a GRADE certainty appraisal of economic outcomes. CONCLUSION Completing predefined EtD Likert-type judgments, specifically reporting a literature review approach, study selection criteria and economic model building limitations, as well as linking these to recommendation justification remarks are potential areas for improved use, adoption and adaptation of recommendation, and transparency of GRADE EtD frameworks.
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Affiliation(s)
- John J Riva
- Department of Family Medicine, McMaster University, 100 Main Street West, 6th Floor, Hamilton, Ontario, Canada L8P 1H6; Michael G. DeGroote Cochrane Canada and McMaster GRADE Centres, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Meha Bhatt
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - David J Brunarski
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Jason W Busse
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada; Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, Ontario, Canada
| | - Carolina C Martins
- Department of Pediatric Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Feng Xie
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada; Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Holger J Schünemann
- Michael G. DeGroote Cochrane Canada and McMaster GRADE Centres, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, Hamilton, Ontario, Canada; Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jan L Brozek
- Michael G. DeGroote Cochrane Canada and McMaster GRADE Centres, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, Hamilton, Ontario, Canada
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156
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Yuen HLA, Tran H, Chunilal S. Upper Extremity Deep Vein Thrombosis: Current Knowledge and Future Directions. Semin Thromb Hemost 2021; 47:677-691. [PMID: 33971684 DOI: 10.1055/s-0041-1725116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Upper extremity deep vein thrombosis (UEDVT) has been increasing in incidence due to the escalating use of central venous catheters such as peripherally inserted central catheters. UEDVT can be primary idiopathic or secondary to pacemaker leads, intravascular catheters or cancer. In comparison to conventional venous thromboembolism such as lower limb deep vein thrombosis or pulmonary embolism the risk factors, investigations, and management are not well defined. We review current evidence in primary and secondary UEDVT, highlighting areas in need of further research. We also explore the entity of venous thoracic outlet syndrome, which is said to be a risk factor for recurrent primary UEDVT and is the rationale behind surgical interventions.
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Affiliation(s)
- Hiu Lam Agnes Yuen
- Monash Haematology, Monash Health, Melbourne, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Huyen Tran
- Department of Medicine, Monash University, Melbourne, Australia
| | - Sanjeev Chunilal
- Monash Haematology, Monash Health, Melbourne, Australia.,Department of Medicine, Monash University, Melbourne, Australia
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157
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Diagnosis of deep vein thrombosis of the upper extremity: a systematic review and meta-analysis of test accuracy. Blood Adv 2021; 4:2516-2522. [PMID: 32511715 DOI: 10.1182/bloodadvances.2019001409] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 04/30/2020] [Indexed: 11/20/2022] Open
Abstract
Upper extremity deep vein thrombosis (UEDVT) accounts for ≤10% of DVT and can be associated with morbidity and mortality. Accurate diagnosis and treatment are necessary for safe and effective patient management. We systematically reviewed the accuracy of D-dimer and duplex ultrasonography (US) for the evaluation of suspected first-episode UEDVT. We searched the Cochrane Central Register, OVID MEDLINE, EMBASE, and PubMed for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. We included prospective cross-sectional and cohort studies that evaluated test accuracy. Two investigators independently screened and collected data. The risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies 2 and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. We pooled estimates of sensitivity and specificity. The review included 9 studies. The pooled estimates for D-dimer sensitivity and specificity were 0.96 (95% confidence interval [CI], 0.87-0.99) and 0.47 (95% CI, 0.43-0.52), respectively. The pooled estimates for duplex US sensitivity and specificity were 0.87 (95% CI, 0.73-0.94) and 0.85 (95% CI, 0.72-0.93), respectively. Certainty of evidence was moderate. In this review, we summarized the test accuracy (sensitivity and specificity) of D-dimer and duplex US for this indication. The sensitivity and specificity of the tests found in the present review should be considered in the context of whether they are used alone or in combination, which is dependent on the prevalence of disease in the population, the clinical setting in which the patient is being evaluated, cost, potential harms, and patient outcomes. This study was registered at PROSPERO as Systematic Review Registration Number CRD42018098488.
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158
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Robert-Ebadi H, Robin P, Hugli O, Verschuren F, Trinh-Duc A, Roy PM, Schmidt J, Fumeaux T, Meyer G, Hayoz D, Carron PN, Salaun PY, Sarasin F, Rutschmann O, Le Gal G, Righini M. Impact of the Age-Adjusted D-Dimer Cutoff to Exclude Pulmonary Embolism: A Multinational Prospective Real-Life Study (the RELAX-PE Study). Circulation 2021; 143:1828-1830. [PMID: 33939529 DOI: 10.1161/circulationaha.120.052780] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Helia Robert-Ebadi
- Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Switzerland (H.R.-E., M.R.)
| | - Philippe Robin
- Service de Médecine Nucléaire, EA 3878 (GETBO), Centre Hospitalier Régional et Universitaire de Brest, Université de Bretagne Occidentale, France (P.R., P.-Y.S.)
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital and University of Lausanne, Switzerland (O.H., P.-N.C.)
| | - Franck Verschuren
- Department of Acute Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Institute of Experimental and Clinical Research, Brussels, Belgium (F.V.)
| | | | - Pierre-Marie Roy
- Emergency Department, Centre Hospitalier Universitaire d'Angers, Institut MIOVASC, UMR (CNRS 6015-INSERM 1083), Université d'Angers, France (P.-M.R.)
| | - Jeannot Schmidt
- Centre Hospitalier Universitaire de Clermont- Ferrand, France (J.S.)
| | - Thierry Fumeaux
- Hôpital de Nyon, Groupe Hospitalier de l'Ouest Lémanique, Nyon, Switzerland (T.F.)
| | - Guy Meyer
- Hôpital Européen Georges Pompidou, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S 970, France (G.M.)
| | - Daniel Hayoz
- Hôpital Cantonal de Fribourg, Switzerland (D.H.)
| | - Pierre-Nicolas Carron
- Emergency Department, Lausanne University Hospital and University of Lausanne, Switzerland (O.H., P.-N.C.)
| | - Pierre-Yves Salaun
- Service de Médecine Nucléaire, EA 3878 (GETBO), Centre Hospitalier Régional et Universitaire de Brest, Université de Bretagne Occidentale, France (P.R., P.-Y.S.)
| | - François Sarasin
- Emergency Department, Geneva University Hospitals, Switzerland (F.S., O.R.)
| | - Olivier Rutschmann
- Emergency Department, Geneva University Hospitals, Switzerland (F.S., O.R.)
| | | | - Marc Righini
- Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Switzerland (H.R.-E., M.R.)
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159
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Thanavaro J. Diagnosis of venous thromboembolism using clinical pretest probability rules, D-dimer assays, and imaging techniques. Nurse Pract 2021; 46:15-22. [PMID: 33882038 DOI: 10.1097/01.npr.0000742900.78322.f9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Venous thromboembolism is a significant clinical entity that includes two associated medical disorders: deep vein thrombosis and pulmonary embolism. The goal of this article is to describe the optimal approach to evaluating venous thromboembolism including pretest probability clinical decision rules and appropriate testing to ensure an accurate diagnosis.
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Affiliation(s)
- Joanne Thanavaro
- Joanne Thanavaro is Associate Dean for Graduate Education at St. Louis University Trudy Busch Valentine School of Nursing, St. Louis, Mo
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160
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Gardiner C, Coleman R, de Maat MPM, Dorgalaleh A, Echenagucia M, Gosselin RC, Ieko M, Kitchen S. International Council for Standardization in Haematology (ICSH) laboratory guidance for the verification of haemostasis analyser-reagent test systems. Part 2: Specialist tests and calibrated assays. Int J Lab Hematol 2021; 43:907-916. [PMID: 33876567 DOI: 10.1111/ijlh.13550] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 12/28/2022]
Abstract
Before a new method is used for clinical testing, it is essential that it is evaluated for suitability for its intended purpose. This document gives guidance for the performance, verification and implementation processes required by regulatory and accreditation bodies. It covers the planning and verification of specialist haemostatic tests, including factor assays, D-dimers, direct anticoagulants and thrombophilia testing.
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Affiliation(s)
- Chris Gardiner
- Haemostasis Research Unit, University College London, London, U.K
| | - Robyn Coleman
- Department of Haematology, Sullivan Nicolaides Pathology, Bowen Hills, QLD, Australia
| | - Moniek P M de Maat
- Department of Haematology, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Akbar Dorgalaleh
- Department of Hematology and Blood Transfusion, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Marión Echenagucia
- Centro Nacional de Hemofilia, Banco Municipal de Sangre del Distrito Capital, Caracas, Venezuela
| | - Robert C Gosselin
- Thrombosis and Hemostasis Center, University of California, Davis Health System, Sacramento, CA, USA
| | - Masahiro Ieko
- Department of Hematology/Clinical Laboratory, Iwate Prefectural Chubu Hospital, Kitakami, Japan
| | - Steve Kitchen
- Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital, Sheffield, U.K
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161
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Liu W, He L, Zeng W, Yue L, Wei J, Zeng S, Wang X, Gong Z. Peripherally inserted central venous catheter in upper extremities leads to an increase in D-dimer and deep vein thrombosis in lower extremities. Thromb J 2021; 19:24. [PMID: 33836784 PMCID: PMC8035721 DOI: 10.1186/s12959-021-00275-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 03/22/2021] [Indexed: 11/15/2022] Open
Abstract
Background The purpose of this study is to elucidate the association between peripherally inserted central venous catheter (PICC) in upper extremities and lower extremity deep venous thrombosis (LEDVT) by observing the changes in D-dimer. Methods This was a retrospective cohort study with 3452 patients (104 inserted with PICCs and 3348 without PICC) enrolled at the neurology department from April 1, 2017 to April 1, 2020. The patients underwent color Doppler ultrasound (CDU) and D-dimer examinations. LEDVT-related factors and D-dimer value were analyzed before and after PICC insertion. The predictive value of D-dimer for LEDVT was also evaluated. Results Univariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 9 times and promoted the increase of D-dimer by 5 times. After risk adjustment, multivariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 4 times and tripled the risk of D-dimer increase. The concentration of D-dimer was significantly increased after PICC insertion. D-dimer was unsuitable for excluding venous thrombosis in patients inserted with PICCs. Conclusions PICC insertion increases the level of D-dimer and the risk of LEDVT. The risks of venous thrombosis need to be assessed in patients inserted with PICCs to ensure the expected clinical outcomes.
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Affiliation(s)
- Wanli Liu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Lianxiang He
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Wenjing Zeng
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Pharmacy, Xiangya Hospital, National Clinical Research Center for Geriatric Disorders, Central South University, Hunan, 410008, Changsha, People's Republic of China
| | - Liqing Yue
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Jie Wei
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Pharmacy, Xiangya Hospital, National Clinical Research Center for Geriatric Disorders, Central South University, Hunan, 410008, Changsha, People's Republic of China
| | - Shuangshuang Zeng
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Pharmacy, Xiangya Hospital, National Clinical Research Center for Geriatric Disorders, Central South University, Hunan, 410008, Changsha, People's Republic of China
| | - Xiang Wang
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Pharmacy, Xiangya Hospital, National Clinical Research Center for Geriatric Disorders, Central South University, Hunan, 410008, Changsha, People's Republic of China
| | - Zhicheng Gong
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China. .,Department of Pharmacy, Xiangya Hospital, National Clinical Research Center for Geriatric Disorders, Central South University, Hunan, 410008, Changsha, People's Republic of China.
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162
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Moor J, Baumgartner C, Méan M, Stalder O, Limacher A, Rodondi N, Aujesky D. Validation of the 2019 European Society of Cardiology Risk Stratification Algorithm for Pulmonary Embolism in Normotensive Elderly Patients. Thromb Haemost 2021; 121:1660-1667. [PMID: 33823559 DOI: 10.1055/a-1475-2263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The 2019 European Society of Cardiology (ESC) guidelines recommend evaluation for right ventricular dysfunction in all normotensive patients with acute pulmonary embolism (PE). We compared the predictive performance of the 2019 and 2014 ESC risk stratification algorithms and the Pulmonary Embolism Severity Index (PESI). METHODS We performed a posthoc analysis of normotensive patients aged ≥ 65 years with acute PE from a prospective cohort. The primary outcome was overall mortality; secondary outcomes were PE-related mortality and adverse outcomes (PE-related death, cardiopulmonary resuscitation, intubation, catecholamine use, recurrent venous thromboembolism) at 30 days. We assessed outcomes in intermediate-high, intermediate-low, and low-risk groups according to the 2019 and 2014 ESC algorithms and the PESI. Discriminative power was compared using the area under the receiver operating characteristic curve (AUC). RESULTS Among 419 patients, 14 (3.3%) died (7 from PE) and 16 (3.8%) had adverse outcomes within 30 days. The 2019 ESC algorithm classified more patients as intermediate-high risk (45%) than the 2014 ESC algorithm (24%) or the PESI (37%), and only 19% as low risk (32% with 2014 ESC or the PESI). Discriminatory power for overall mortality was lower with the 2019 ESC algorithm (AUC: 63.6%), compared with the 2014 ESC algorithm (AUC: 71.5%) or the PESI (AUC: 75.2%), although the difference did not reach statistical significance (p = 0.063). Discrimination for PE-related mortality and adverse outcomes was similar. CONCLUSION While categorizing more patients in higher risk groups, the 2019 ESC algorithm for PE did not improve prediction of short-term outcomes compared with the 2014 ESC algorithm or the PESI.
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Affiliation(s)
- Jeanne Moor
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christine Baumgartner
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marie Méan
- Division of General Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | | | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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163
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Okello CD, Mulumba Y, Omoding A, Ddungu H, Orem J. Survival of patients with cancer associated thrombosis at the Uganda Cancer Institute. Ecancermedicalscience 2021; 15:1212. [PMID: 33912237 PMCID: PMC8057783 DOI: 10.3332/ecancer.2021.1212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Indexed: 12/24/2022] Open
Abstract
Background The occurrence of venous thromboembolism (VTE) in patients with cancer leads to a reduced life expectancy. There is an increased incidence of cancer and its associated mortality in Uganda. We described the survival and characteristics of patients with cancer associated thrombosis (CAT) in a tertiary oncology centre in Uganda. Methods We performed a retrospective study on patients with CAT at the Uganda Cancer Institute (UCI) using a homogenous purposive sampling method. Results One hundred and eleven patients with documented VTE were included in the analysis. At entry, the mean age was 52.4 years, and 69 were female. Ninety eight had deep venous thrombosis, while 12 had pulmonary embolism. The most common cancer diagnoses were haematologic (30), gynaecologic (20) and prostate (17) cancers. Treatment regimens included anticoagulation with low-molecular weight heparin (LMWH) (72) and combined LMWH with warfarin (22). The median overall survival (OS) was 6.3 months, with a 1-year survival rate of 41.5%. Patients with significantly increased hazard of mortality were those with upper gastrointestinal (UGI) malignancies, colorectal and breast cancers. Patients with a body mass index of 25–29.9 kg/m2 (overweight) had a slightly reduced hazard of mortality. Conclusion The OS of patients with CAT at the UCI is short. Most patients with CAT presented with advanced stage cancers and at a relatively young age. Patients with UGI, colorectal and breast cancers had increased hazards of mortality, whereas those who were overweight had a slight reduction in the hazard of mortality.
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Affiliation(s)
- Clement D Okello
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
| | - Yusuf Mulumba
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
| | - Abrahams Omoding
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
| | - Henry Ddungu
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
| | - Jackson Orem
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
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164
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Abreu SC, Tavares V, Carneiro F, Medeiros R. Venous thromboembolism and prostate cancer: what about genetic markers? Pharmacogenomics 2021; 22:365-373. [PMID: 33749329 DOI: 10.2217/pgs-2020-0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim & methods: To review the existing literature concerning the relationship between venous thromboembolism (VTE) and prostate cancer (PC) and explore the putative biological and clinical implications of VTE genetic markers on PC patients by screening the PubMed database. Results: Considering the roles of VTE genome-wide association studies-identified genetic determinants in disease development in the general population, these variants might also underlie the susceptibility for PC-related VTE. Therefore, they could help to identify those with a positive benefit-to-harm ratio for thromboprophylaxis approaches during cancer therapy management, thereby improving patient's prognosis. Conclusion: Future studies are mandatory to explore the relationship between VTE and PC and dissect the predictive value of VTE genome-wide association studies-identified genetic determinants in PC patients, given their clinical implications.
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Affiliation(s)
- Sofia Coelho Abreu
- Oncology Department, Portuguese Institute of Oncology, Porto, 4200 072, Portugal
| | - Valéria Tavares
- Molecular Oncology & Viral Pathology Group, Research Center of Portuguese Institute of Oncology, Porto, 4200 072, Portugal.,Research Department, Portuguese League Against Cancer of Northern Region, Porto, 4200 172, Portugal
| | - Filipa Carneiro
- Oncology Department, Portuguese Institute of Oncology, Porto, 4200 072, Portugal
| | - Rui Medeiros
- Molecular Oncology & Viral Pathology Group, Research Center of Portuguese Institute of Oncology, Porto, 4200 072, Portugal.,Research Department, Portuguese League Against Cancer of Northern Region, Porto, 4200 172, Portugal.,Faculty of Health Sciences, CEBIMED, Fernando Pessoa University, Porto, 4200 150, Portugal
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165
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van Twist DJL, Luu IHY, Kroon FPB, Mostard RLM, Buijs J. Pulmonary Embolism in COVID-19: The Actual Prevalence Remains Unclear. Radiology 2021; 299:E254. [PMID: 33724068 PMCID: PMC7971425 DOI: 10.1148/radiol.2021204671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Rémy L M Mostard
- and Pulmonology Zuyderland Medical Centre, PO Box 5500, 6130 MB Sittard, the Netherlands
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166
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Abstract
This review aims to describe the epidemiology, pathophysiology, risk factors, presentation, complications, evaluation/diagnosis, and treatment of upper extremity deep vein thrombosis (UEDVT). Upper extremity deep vein thrombosis (UEDVT) accounts for 6% of cases of deep vein thrombosis (DVT). It can lead to swelling and discomfort in that extremity and can be complicated by pulmonary embolism, post-thrombotic syndrome, and recurrence of DVT. Evaluation can begin with a dichotomized Constans score and fibrin degradation product testing. Diagnosis is typically made with compression ultrasound. Anticoagulation is the mainstay of therapy. Primary UEDVT is known as Paget Schroetter Syndrome (PSS) which occurs due to venous thoracic outlet syndrome (vTOS). Anticoagulation, thrombolysis, and decompression of the venous thoracic outlet are used for treatment but the optimal strategy remains to be elucidated. Secondary UEDVT are most commonly caused by indwelling catheters and malignancy. There is an ongoing realization that UEDVT are more than simply 'leg clots in the arm.' Given the increasing incidence, research needs to be done to further our understanding of this disease state, its evaluation, and its treatment.
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Affiliation(s)
- Oneib Khan
- Lankenau Medical Center - Internal Medicine, Wynnewood, PA, USA
| | - Ashley Marmaro
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - David A Cohen
- Mainline Healthcare Internal Medicine at Lankenau Medical Center, Sidney Kimmel Medical College, Wynnewood, PA, USA
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167
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Cuker A, Tseng EK, Nieuwlaat R, Angchaisuksiri P, Blair C, Dane K, Davila J, DeSancho MT, Diuguid D, Griffin DO, Kahn SR, Klok FA, Lee AI, Neumann I, Pai A, Pai M, Righini M, Sanfilippo KM, Siegal D, Skara M, Touri K, Akl EA, Bou Akl I, Boulos M, Brignardello-Petersen R, Charide R, Chan M, Dearness K, Darzi AJ, Kolb P, Colunga-Lozano LE, Mansour R, Morgano GP, Morsi RZ, Noori A, Piggott T, Qiu Y, Roldan Y, Schünemann F, Stevens A, Solo K, Ventresca M, Wiercioch W, Mustafa RA, Schünemann HJ. American Society of Hematology 2021 guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19. Blood Adv 2021; 5:872-888. [PMID: 33560401 PMCID: PMC7869684 DOI: 10.1182/bloodadvances.2020003763] [Citation(s) in RCA: 266] [Impact Index Per Article: 88.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/18/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19)-related critical illness and acute illness are associated with a risk of venous thromboembolism (VTE). OBJECTIVE These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in decisions about the use of anticoagulation for thromboprophylaxis for patients with COVID-19-related critical illness and acute illness who do not have confirmed or suspected VTE. METHODS ASH formed a multidisciplinary guideline panel and applied strict management strategies to minimize potential bias from conflicts of interest. The panel included 3 patient representatives. The McMaster University GRADE Centre supported the guideline-development process, including performing systematic evidence reviews (up to 19 August 2020). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment. RESULTS The panel agreed on 2 recommendations. The panel issued conditional recommendations in favor of prophylactic-intensity anticoagulation over intermediate-intensity or therapeutic-intensity anticoagulation for patients with COVID-19-related critical illness or acute illness who do not have confirmed or suspected VTE. CONCLUSIONS These recommendations were based on very low certainty in the evidence, underscoring the need for high-quality, randomized controlled trials comparing different intensities of anticoagulation. They will be updated using a living recommendation approach as new evidence becomes available.
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Affiliation(s)
- Adam Cuker
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Eric K Tseng
- St. Michael's Hospital, Division of Hematology/Oncology, University of Toronto, Toronto, ON, Canada
| | - Robby Nieuwlaat
- Michael G. DeGroote Cochrane Canada Centre
- McGRADE Centre, and
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Pantep Angchaisuksiri
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Kathryn Dane
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD
| | - Jennifer Davila
- Children's Hospital at Montefiore, Division of Pediatric Hematology, Oncology, and Cellular Therapies, Albert Einstein College of Medicine, Bronx, NY
| | - Maria T DeSancho
- Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY
| | - David Diuguid
- Department of Medicine, College of Physicians and Surgeons and
| | - Daniel O Griffin
- Division of Infectious Diseases, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
- Research and Development at United Health Group, Minnetonka, MN
- Prohealth NY, Lake Success, NY
| | - Susan R Kahn
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Frederikus A Klok
- Thrombosis and Hemostasis, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Alfred Ian Lee
- Section of Hematology, School of Medicine, Yale University, New Haven, CT
| | - Ignacio Neumann
- Department of Internal Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ashok Pai
- Division of Hematology and Oncology, Kaiser Permanente, Oakland/Richmond, CA
| | - Menaka Pai
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Marc Righini
- Division of Angiology and Hemostasis, Faculty of Medicine, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Kristen M Sanfilippo
- Department of Medicine, Washington University School of Medicine St. Louis, St. Louis, MO
| | - Deborah Siegal
- Department of Medicine and
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Imad Bou Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Mary Boulos
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Rana Charide
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Matthew Chan
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Karin Dearness
- Library Services, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Andrea J Darzi
- Michael G. DeGroote Cochrane Canada Centre
- McGRADE Centre, and
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Philipp Kolb
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Luis E Colunga-Lozano
- Department of Clinical Medicine, Health Science Center, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Razan Mansour
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Gian Paolo Morgano
- Michael G. DeGroote Cochrane Canada Centre
- McGRADE Centre, and
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Rami Z Morsi
- Department of Neurology, University of Chicago, Chicago, IL
| | - Atefeh Noori
- Michael G. DeGroote Cochrane Canada Centre
- McGRADE Centre, and
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- The Michael G. DeGroote National Pain Center, McMaster University, Hamilton, ON, Canada
| | - Thomas Piggott
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Yuan Qiu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Yetiani Roldan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Finn Schünemann
- Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
| | - Adrienne Stevens
- Michael G. DeGroote Cochrane Canada Centre
- McGRADE Centre, and
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Karla Solo
- Michael G. DeGroote Cochrane Canada Centre
- McGRADE Centre, and
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Matthew Ventresca
- Michael G. DeGroote Cochrane Canada Centre
- McGRADE Centre, and
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Wojtek Wiercioch
- Michael G. DeGroote Cochrane Canada Centre
- McGRADE Centre, and
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Reem A Mustafa
- Michael G. DeGroote Cochrane Canada Centre
- McGRADE Centre, and
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Internal Medicine, Division of Nephrology, University of Kansas Medical Center, Kansas City, KS; and
| | - Holger J Schünemann
- Michael G. DeGroote Cochrane Canada Centre
- McGRADE Centre, and
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Institute for Evidence in Medicine, Medical Center/Faculty of Medicine, University of Freiburg, Freiburg, Germany
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168
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Cuker A, Tseng EK, Nieuwlaat R, Angchaisuksiri P, Blair C, Dane K, Davila J, DeSancho MT, Diuguid D, Griffin DO, Kahn SR, Klok FA, Lee AI, Neumann I, Pai A, Pai M, Righini M, Sanfilippo KM, Siegal D, Skara M, Touri K, Akl EA, Bou Akl I, Boulos M, Brignardello-Petersen R, Charide R, Chan M, Dearness K, Darzi AJ, Kolb P, Colunga-Lozano LE, Mansour R, Morgano GP, Morsi RZ, Noori A, Piggott T, Qiu Y, Roldan Y, Schünemann F, Stevens A, Solo K, Ventresca M, Wiercioch W, Mustafa RA, Schünemann HJ. American Society of Hematology 2021 guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19. Blood Adv 2021. [PMID: 33560401 DOI: 10.1182/blood-advances.2020003763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19)-related critical illness and acute illness are associated with a risk of venous thromboembolism (VTE). OBJECTIVE These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in decisions about the use of anticoagulation for thromboprophylaxis for patients with COVID-19-related critical illness and acute illness who do not have confirmed or suspected VTE. METHODS ASH formed a multidisciplinary guideline panel and applied strict management strategies to minimize potential bias from conflicts of interest. The panel included 3 patient representatives. The McMaster University GRADE Centre supported the guideline-development process, including performing systematic evidence reviews (up to 19 August 2020). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment. RESULTS The panel agreed on 2 recommendations. The panel issued conditional recommendations in favor of prophylactic-intensity anticoagulation over intermediate-intensity or therapeutic-intensity anticoagulation for patients with COVID-19-related critical illness or acute illness who do not have confirmed or suspected VTE. CONCLUSIONS These recommendations were based on very low certainty in the evidence, underscoring the need for high-quality, randomized controlled trials comparing different intensities of anticoagulation. They will be updated using a living recommendation approach as new evidence becomes available.
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Affiliation(s)
- Adam Cuker
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Eric K Tseng
- St. Michael's Hospital, Division of Hematology/Oncology, University of Toronto, Toronto, ON, Canada
| | - Robby Nieuwlaat
- Michael G. DeGroote Cochrane Canada Centre
- McGRADE Centre, and
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Pantep Angchaisuksiri
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Kathryn Dane
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD
| | - Jennifer Davila
- Children's Hospital at Montefiore, Division of Pediatric Hematology, Oncology, and Cellular Therapies, Albert Einstein College of Medicine, Bronx, NY
| | - Maria T DeSancho
- Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY
| | - David Diuguid
- Department of Medicine, College of Physicians and Surgeons and
| | - Daniel O Griffin
- Division of Infectious Diseases, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
- Research and Development at United Health Group, Minnetonka, MN
- Prohealth NY, Lake Success, NY
| | - Susan R Kahn
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Frederikus A Klok
- Thrombosis and Hemostasis, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Alfred Ian Lee
- Section of Hematology, School of Medicine, Yale University, New Haven, CT
| | - Ignacio Neumann
- Department of Internal Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ashok Pai
- Division of Hematology and Oncology, Kaiser Permanente, Oakland/Richmond, CA
| | - Menaka Pai
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Marc Righini
- Division of Angiology and Hemostasis, Faculty of Medicine, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Kristen M Sanfilippo
- Department of Medicine, Washington University School of Medicine St. Louis, St. Louis, MO
| | - Deborah Siegal
- Department of Medicine and
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Imad Bou Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Mary Boulos
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Rana Charide
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Matthew Chan
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Karin Dearness
- Library Services, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Andrea J Darzi
- Michael G. DeGroote Cochrane Canada Centre
- McGRADE Centre, and
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Philipp Kolb
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Luis E Colunga-Lozano
- Department of Clinical Medicine, Health Science Center, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Razan Mansour
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Gian Paolo Morgano
- Michael G. DeGroote Cochrane Canada Centre
- McGRADE Centre, and
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Rami Z Morsi
- Department of Neurology, University of Chicago, Chicago, IL
| | - Atefeh Noori
- Michael G. DeGroote Cochrane Canada Centre
- McGRADE Centre, and
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- The Michael G. DeGroote National Pain Center, McMaster University, Hamilton, ON, Canada
| | - Thomas Piggott
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Yuan Qiu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Yetiani Roldan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Finn Schünemann
- Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
| | - Adrienne Stevens
- Michael G. DeGroote Cochrane Canada Centre
- McGRADE Centre, and
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Karla Solo
- Michael G. DeGroote Cochrane Canada Centre
- McGRADE Centre, and
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Matthew Ventresca
- Michael G. DeGroote Cochrane Canada Centre
- McGRADE Centre, and
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Wojtek Wiercioch
- Michael G. DeGroote Cochrane Canada Centre
- McGRADE Centre, and
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Reem A Mustafa
- Michael G. DeGroote Cochrane Canada Centre
- McGRADE Centre, and
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Internal Medicine, Division of Nephrology, University of Kansas Medical Center, Kansas City, KS; and
| | - Holger J Schünemann
- Michael G. DeGroote Cochrane Canada Centre
- McGRADE Centre, and
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Institute for Evidence in Medicine, Medical Center/Faculty of Medicine, University of Freiburg, Freiburg, Germany
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169
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Nickel CH, Kellett J, Cooksley T, Lyngholm LE, Chang S, Imfeld S, Bingisser R, Brabrand M. The Diagnoses and Outcomes of Emergency Patients With an Elevated D-Dimer Over the Next 90 Days. Am J Med 2021; 134:260-266.e2. [PMID: 32663451 PMCID: PMC7354269 DOI: 10.1016/j.amjmed.2020.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/18/2020] [Accepted: 06/06/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND It is not known what diagnoses are associated with an elevated D-dimer in unselected patients attending emergency departments (ED), nor have their associated outcomes been determined. METHODS This was a prospective observational study of 1612 unselected patients attending a Danish ED, with 100% follow-up for 90 days after presentation. RESULTS The 765 (47%) ED patients with an elevated D-dimer level (ie, ≥ 0.5 mg/L) were more likely to be admitted to hospital (P <.0001), re-present to health services (P = .02), and die within 90 days (8.1% of patients, P <.0001). Only 10 patients with a normal D-dimer level (1.2%) died within 90 days. Five had chronic obstructive pulmonary disease and infection, and 5 had cancer (4 of whom also had infection). Venous thromboembolism, infection, neoplasia, anemia, heart failure, and unspecified soft tissue disorders were significantly associated with an elevated D-dimer level. Of the 72 patients with venous thromboembolism, 20 also had infection, 8 had cancer, and 4 had anemia. None of the patients with heart failure, stroke, or acute myocardial infarction with a normal D-dimer level died within 90 days. CONCLUSIONS In this study, nearly half of all patients attending the ED had an elevated D-dimer level, and these patients were more likely to be admitted to hospital and to re-present to health services or die within 90 days. In this unselected ED patient population, elevated D-dimer levels were found to not only be significantly associated with venous thromboembolism, but to also be associated with infection, cancer, heart failure, and anemia.
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Affiliation(s)
| | - John Kellett
- Department of Emergency Medicine, Hospital of South West Jutland, Denmark.
| | - Tim Cooksley
- Department of Acute Medicine, The Christie, Manchester, United Kingdom
| | - Le E Lyngholm
- Department of Emergency Medicine, Hospital of South West Jutland, Denmark
| | - Simon Chang
- Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark and Department of Clinical Biochemistry, Hospital of South West Jutland, Denmark
| | - Stephan Imfeld
- Department of Angiology, University Hospital Basel, Switzerland
| | | | - Mikkel Brabrand
- Department of Emergency Medicine, Hospital of South West Jutland, Denmark; Department of Emergency Medicine, Odense University Hospital, Denmark
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Suh YJ, Hong H, Ohana M, Bompard F, Revel MP, Valle C, Gervaise A, Poissy J, Susen S, Hékimian G, Artifoni M, Periard D, Contou D, Delaloye J, Sanchez B, Fang C, Garzillo G, Robbie H, Yoon SH. Pulmonary Embolism and Deep Vein Thrombosis in COVID-19: A Systematic Review and Meta-Analysis. Radiology 2021; 298:E70-E80. [PMID: 33320063 PMCID: PMC7745997 DOI: 10.1148/radiol.2020203557] [Citation(s) in RCA: 270] [Impact Index Per Article: 90.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/13/2020] [Accepted: 11/04/2020] [Indexed: 01/08/2023]
Abstract
Background The association of pulmonary embolism (PE) with deep vein thrombosis (DVT) in patients with coronavirus disease 2019 (COVID-19) remains unclear, and the diagnostic accuracy of D-dimer tests for PE is unknown. Purpose To conduct meta-analysis of the study-level incidence of PE and DVT and to evaluate the diagnostic accuracy of D-dimer tests for PE from multicenter individual patient data. Materials and Methods A systematic literature search identified studies evaluating the incidence of PE or DVT in patients with COVID-19 from January 1, 2020, to June 15, 2020. These outcomes were pooled using a random-effects model and were further evaluated using metaregression analysis. The diagnostic accuracy of D-dimer tests for PE was estimated on the basis of individual patient data using the summary receiver operating characteristic curve. Results Twenty-seven studies with 3342 patients with COVID-19 were included in the analysis. The pooled incidence rates of PE and DVT were 16.5% (95% CI: 11.6, 22.9; I2 = 0.93) and 14.8% (95% CI: 8.5, 24.5; I2 = 0.94), respectively. PE was more frequently found in patients who were admitted to the intensive care unit (ICU) (24.7% [95% CI: 18.6, 32.1] vs 10.5% [95% CI: 5.1, 20.2] in those not admitted to the ICU) and in studies with universal screening using CT pulmonary angiography. DVT was present in 42.4% of patients with PE. D-dimer tests had an area under the receiver operating characteristic curve of 0.737 for PE, and D-dimer levels of 500 and 1000 μg/L showed high sensitivity (96% and 91%, respectively) but low specificity (10% and 24%, respectively). Conclusion Pulmonary embolism (PE) and deep vein thrombosis (DVT) occurred in 16.5% and 14.8% of patients with coronavirus disease 2019 (COVID-19), respectively, and more than half of patients with PE lacked DVT. The cutoffs of D-dimer levels used to exclude PE in preexisting guidelines seem applicable to patients with COVID-19. © RSNA, 2020 Supplemental material is available for this article. See also the editorial by Woodard in this issue.
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Affiliation(s)
- Young Joo Suh
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.J.S.); Medical Research Collaborating Center (H.H.) and Department of Radiology (S.H.Y.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (M.O.); Department of Radiology, Cochin Hospital, Assistance Publique–Hôpitaux de Paris Centre, Paris, France (F.B., M.P.R.); Department of Diagnostic Radiology, Papa Giovanni XXIII, Bergamo, Italy (C.V.); Department of Radiology, Military Hospital Begin, Saint Mande, France (A.G.); Resuscitation Center, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale U1285, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8576–Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France (J.P.); Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1011–European Genomic Institute for Diabetes, Lille, France (S.S.); Institute of Cardiometabolism and Nutrition, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition 1166, Paris, France; Intensive Medicine–Resuscitation Department, Institut de Cardiologie, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France (G.H.); Department of Internal Medicine, Centre Hospitalier Universitaire de Nantes, Nantes, France (M.A.); Angiology Unit, Hôpital Fribourgeois–Hôpital Cantonal, Fribourg, Switzerland (D.P.); Multipurpose Resuscitation Service, Centre Hospitalier Victor Dupouy, Argenteuil, France (D.C.); Department of Intensive Care Medicine, Centre Hospitalier du Valais Romand de l’Hôpital du Valais (site de Sion), Sion, Switzerland (J.D., B.S.); and Department of Radiology, King’s College Hospital National Health Service Foundation Trust, London, England (C.F., G.G., H.R.)
| | - Hyunsook Hong
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.J.S.); Medical Research Collaborating Center (H.H.) and Department of Radiology (S.H.Y.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (M.O.); Department of Radiology, Cochin Hospital, Assistance Publique–Hôpitaux de Paris Centre, Paris, France (F.B., M.P.R.); Department of Diagnostic Radiology, Papa Giovanni XXIII, Bergamo, Italy (C.V.); Department of Radiology, Military Hospital Begin, Saint Mande, France (A.G.); Resuscitation Center, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale U1285, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8576–Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France (J.P.); Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1011–European Genomic Institute for Diabetes, Lille, France (S.S.); Institute of Cardiometabolism and Nutrition, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition 1166, Paris, France; Intensive Medicine–Resuscitation Department, Institut de Cardiologie, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France (G.H.); Department of Internal Medicine, Centre Hospitalier Universitaire de Nantes, Nantes, France (M.A.); Angiology Unit, Hôpital Fribourgeois–Hôpital Cantonal, Fribourg, Switzerland (D.P.); Multipurpose Resuscitation Service, Centre Hospitalier Victor Dupouy, Argenteuil, France (D.C.); Department of Intensive Care Medicine, Centre Hospitalier du Valais Romand de l’Hôpital du Valais (site de Sion), Sion, Switzerland (J.D., B.S.); and Department of Radiology, King’s College Hospital National Health Service Foundation Trust, London, England (C.F., G.G., H.R.)
| | - Mickaël Ohana
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.J.S.); Medical Research Collaborating Center (H.H.) and Department of Radiology (S.H.Y.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (M.O.); Department of Radiology, Cochin Hospital, Assistance Publique–Hôpitaux de Paris Centre, Paris, France (F.B., M.P.R.); Department of Diagnostic Radiology, Papa Giovanni XXIII, Bergamo, Italy (C.V.); Department of Radiology, Military Hospital Begin, Saint Mande, France (A.G.); Resuscitation Center, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale U1285, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8576–Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France (J.P.); Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1011–European Genomic Institute for Diabetes, Lille, France (S.S.); Institute of Cardiometabolism and Nutrition, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition 1166, Paris, France; Intensive Medicine–Resuscitation Department, Institut de Cardiologie, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France (G.H.); Department of Internal Medicine, Centre Hospitalier Universitaire de Nantes, Nantes, France (M.A.); Angiology Unit, Hôpital Fribourgeois–Hôpital Cantonal, Fribourg, Switzerland (D.P.); Multipurpose Resuscitation Service, Centre Hospitalier Victor Dupouy, Argenteuil, France (D.C.); Department of Intensive Care Medicine, Centre Hospitalier du Valais Romand de l’Hôpital du Valais (site de Sion), Sion, Switzerland (J.D., B.S.); and Department of Radiology, King’s College Hospital National Health Service Foundation Trust, London, England (C.F., G.G., H.R.)
| | - Florian Bompard
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.J.S.); Medical Research Collaborating Center (H.H.) and Department of Radiology (S.H.Y.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (M.O.); Department of Radiology, Cochin Hospital, Assistance Publique–Hôpitaux de Paris Centre, Paris, France (F.B., M.P.R.); Department of Diagnostic Radiology, Papa Giovanni XXIII, Bergamo, Italy (C.V.); Department of Radiology, Military Hospital Begin, Saint Mande, France (A.G.); Resuscitation Center, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale U1285, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8576–Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France (J.P.); Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1011–European Genomic Institute for Diabetes, Lille, France (S.S.); Institute of Cardiometabolism and Nutrition, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition 1166, Paris, France; Intensive Medicine–Resuscitation Department, Institut de Cardiologie, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France (G.H.); Department of Internal Medicine, Centre Hospitalier Universitaire de Nantes, Nantes, France (M.A.); Angiology Unit, Hôpital Fribourgeois–Hôpital Cantonal, Fribourg, Switzerland (D.P.); Multipurpose Resuscitation Service, Centre Hospitalier Victor Dupouy, Argenteuil, France (D.C.); Department of Intensive Care Medicine, Centre Hospitalier du Valais Romand de l’Hôpital du Valais (site de Sion), Sion, Switzerland (J.D., B.S.); and Department of Radiology, King’s College Hospital National Health Service Foundation Trust, London, England (C.F., G.G., H.R.)
| | - Marie-Pierre Revel
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.J.S.); Medical Research Collaborating Center (H.H.) and Department of Radiology (S.H.Y.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (M.O.); Department of Radiology, Cochin Hospital, Assistance Publique–Hôpitaux de Paris Centre, Paris, France (F.B., M.P.R.); Department of Diagnostic Radiology, Papa Giovanni XXIII, Bergamo, Italy (C.V.); Department of Radiology, Military Hospital Begin, Saint Mande, France (A.G.); Resuscitation Center, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale U1285, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8576–Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France (J.P.); Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1011–European Genomic Institute for Diabetes, Lille, France (S.S.); Institute of Cardiometabolism and Nutrition, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition 1166, Paris, France; Intensive Medicine–Resuscitation Department, Institut de Cardiologie, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France (G.H.); Department of Internal Medicine, Centre Hospitalier Universitaire de Nantes, Nantes, France (M.A.); Angiology Unit, Hôpital Fribourgeois–Hôpital Cantonal, Fribourg, Switzerland (D.P.); Multipurpose Resuscitation Service, Centre Hospitalier Victor Dupouy, Argenteuil, France (D.C.); Department of Intensive Care Medicine, Centre Hospitalier du Valais Romand de l’Hôpital du Valais (site de Sion), Sion, Switzerland (J.D., B.S.); and Department of Radiology, King’s College Hospital National Health Service Foundation Trust, London, England (C.F., G.G., H.R.)
| | - Clarissa Valle
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.J.S.); Medical Research Collaborating Center (H.H.) and Department of Radiology (S.H.Y.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (M.O.); Department of Radiology, Cochin Hospital, Assistance Publique–Hôpitaux de Paris Centre, Paris, France (F.B., M.P.R.); Department of Diagnostic Radiology, Papa Giovanni XXIII, Bergamo, Italy (C.V.); Department of Radiology, Military Hospital Begin, Saint Mande, France (A.G.); Resuscitation Center, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale U1285, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8576–Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France (J.P.); Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1011–European Genomic Institute for Diabetes, Lille, France (S.S.); Institute of Cardiometabolism and Nutrition, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition 1166, Paris, France; Intensive Medicine–Resuscitation Department, Institut de Cardiologie, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France (G.H.); Department of Internal Medicine, Centre Hospitalier Universitaire de Nantes, Nantes, France (M.A.); Angiology Unit, Hôpital Fribourgeois–Hôpital Cantonal, Fribourg, Switzerland (D.P.); Multipurpose Resuscitation Service, Centre Hospitalier Victor Dupouy, Argenteuil, France (D.C.); Department of Intensive Care Medicine, Centre Hospitalier du Valais Romand de l’Hôpital du Valais (site de Sion), Sion, Switzerland (J.D., B.S.); and Department of Radiology, King’s College Hospital National Health Service Foundation Trust, London, England (C.F., G.G., H.R.)
| | - Alban Gervaise
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.J.S.); Medical Research Collaborating Center (H.H.) and Department of Radiology (S.H.Y.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (M.O.); Department of Radiology, Cochin Hospital, Assistance Publique–Hôpitaux de Paris Centre, Paris, France (F.B., M.P.R.); Department of Diagnostic Radiology, Papa Giovanni XXIII, Bergamo, Italy (C.V.); Department of Radiology, Military Hospital Begin, Saint Mande, France (A.G.); Resuscitation Center, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale U1285, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8576–Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France (J.P.); Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1011–European Genomic Institute for Diabetes, Lille, France (S.S.); Institute of Cardiometabolism and Nutrition, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition 1166, Paris, France; Intensive Medicine–Resuscitation Department, Institut de Cardiologie, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France (G.H.); Department of Internal Medicine, Centre Hospitalier Universitaire de Nantes, Nantes, France (M.A.); Angiology Unit, Hôpital Fribourgeois–Hôpital Cantonal, Fribourg, Switzerland (D.P.); Multipurpose Resuscitation Service, Centre Hospitalier Victor Dupouy, Argenteuil, France (D.C.); Department of Intensive Care Medicine, Centre Hospitalier du Valais Romand de l’Hôpital du Valais (site de Sion), Sion, Switzerland (J.D., B.S.); and Department of Radiology, King’s College Hospital National Health Service Foundation Trust, London, England (C.F., G.G., H.R.)
| | - Julien Poissy
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.J.S.); Medical Research Collaborating Center (H.H.) and Department of Radiology (S.H.Y.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (M.O.); Department of Radiology, Cochin Hospital, Assistance Publique–Hôpitaux de Paris Centre, Paris, France (F.B., M.P.R.); Department of Diagnostic Radiology, Papa Giovanni XXIII, Bergamo, Italy (C.V.); Department of Radiology, Military Hospital Begin, Saint Mande, France (A.G.); Resuscitation Center, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale U1285, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8576–Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France (J.P.); Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1011–European Genomic Institute for Diabetes, Lille, France (S.S.); Institute of Cardiometabolism and Nutrition, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition 1166, Paris, France; Intensive Medicine–Resuscitation Department, Institut de Cardiologie, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France (G.H.); Department of Internal Medicine, Centre Hospitalier Universitaire de Nantes, Nantes, France (M.A.); Angiology Unit, Hôpital Fribourgeois–Hôpital Cantonal, Fribourg, Switzerland (D.P.); Multipurpose Resuscitation Service, Centre Hospitalier Victor Dupouy, Argenteuil, France (D.C.); Department of Intensive Care Medicine, Centre Hospitalier du Valais Romand de l’Hôpital du Valais (site de Sion), Sion, Switzerland (J.D., B.S.); and Department of Radiology, King’s College Hospital National Health Service Foundation Trust, London, England (C.F., G.G., H.R.)
| | - Sophie Susen
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.J.S.); Medical Research Collaborating Center (H.H.) and Department of Radiology (S.H.Y.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (M.O.); Department of Radiology, Cochin Hospital, Assistance Publique–Hôpitaux de Paris Centre, Paris, France (F.B., M.P.R.); Department of Diagnostic Radiology, Papa Giovanni XXIII, Bergamo, Italy (C.V.); Department of Radiology, Military Hospital Begin, Saint Mande, France (A.G.); Resuscitation Center, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale U1285, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8576–Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France (J.P.); Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1011–European Genomic Institute for Diabetes, Lille, France (S.S.); Institute of Cardiometabolism and Nutrition, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition 1166, Paris, France; Intensive Medicine–Resuscitation Department, Institut de Cardiologie, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France (G.H.); Department of Internal Medicine, Centre Hospitalier Universitaire de Nantes, Nantes, France (M.A.); Angiology Unit, Hôpital Fribourgeois–Hôpital Cantonal, Fribourg, Switzerland (D.P.); Multipurpose Resuscitation Service, Centre Hospitalier Victor Dupouy, Argenteuil, France (D.C.); Department of Intensive Care Medicine, Centre Hospitalier du Valais Romand de l’Hôpital du Valais (site de Sion), Sion, Switzerland (J.D., B.S.); and Department of Radiology, King’s College Hospital National Health Service Foundation Trust, London, England (C.F., G.G., H.R.)
| | - Guillaume Hékimian
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.J.S.); Medical Research Collaborating Center (H.H.) and Department of Radiology (S.H.Y.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (M.O.); Department of Radiology, Cochin Hospital, Assistance Publique–Hôpitaux de Paris Centre, Paris, France (F.B., M.P.R.); Department of Diagnostic Radiology, Papa Giovanni XXIII, Bergamo, Italy (C.V.); Department of Radiology, Military Hospital Begin, Saint Mande, France (A.G.); Resuscitation Center, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale U1285, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8576–Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France (J.P.); Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1011–European Genomic Institute for Diabetes, Lille, France (S.S.); Institute of Cardiometabolism and Nutrition, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition 1166, Paris, France; Intensive Medicine–Resuscitation Department, Institut de Cardiologie, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France (G.H.); Department of Internal Medicine, Centre Hospitalier Universitaire de Nantes, Nantes, France (M.A.); Angiology Unit, Hôpital Fribourgeois–Hôpital Cantonal, Fribourg, Switzerland (D.P.); Multipurpose Resuscitation Service, Centre Hospitalier Victor Dupouy, Argenteuil, France (D.C.); Department of Intensive Care Medicine, Centre Hospitalier du Valais Romand de l’Hôpital du Valais (site de Sion), Sion, Switzerland (J.D., B.S.); and Department of Radiology, King’s College Hospital National Health Service Foundation Trust, London, England (C.F., G.G., H.R.)
| | - Mathieu Artifoni
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.J.S.); Medical Research Collaborating Center (H.H.) and Department of Radiology (S.H.Y.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (M.O.); Department of Radiology, Cochin Hospital, Assistance Publique–Hôpitaux de Paris Centre, Paris, France (F.B., M.P.R.); Department of Diagnostic Radiology, Papa Giovanni XXIII, Bergamo, Italy (C.V.); Department of Radiology, Military Hospital Begin, Saint Mande, France (A.G.); Resuscitation Center, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale U1285, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8576–Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France (J.P.); Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1011–European Genomic Institute for Diabetes, Lille, France (S.S.); Institute of Cardiometabolism and Nutrition, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition 1166, Paris, France; Intensive Medicine–Resuscitation Department, Institut de Cardiologie, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France (G.H.); Department of Internal Medicine, Centre Hospitalier Universitaire de Nantes, Nantes, France (M.A.); Angiology Unit, Hôpital Fribourgeois–Hôpital Cantonal, Fribourg, Switzerland (D.P.); Multipurpose Resuscitation Service, Centre Hospitalier Victor Dupouy, Argenteuil, France (D.C.); Department of Intensive Care Medicine, Centre Hospitalier du Valais Romand de l’Hôpital du Valais (site de Sion), Sion, Switzerland (J.D., B.S.); and Department of Radiology, King’s College Hospital National Health Service Foundation Trust, London, England (C.F., G.G., H.R.)
| | - Daniel Periard
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.J.S.); Medical Research Collaborating Center (H.H.) and Department of Radiology (S.H.Y.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (M.O.); Department of Radiology, Cochin Hospital, Assistance Publique–Hôpitaux de Paris Centre, Paris, France (F.B., M.P.R.); Department of Diagnostic Radiology, Papa Giovanni XXIII, Bergamo, Italy (C.V.); Department of Radiology, Military Hospital Begin, Saint Mande, France (A.G.); Resuscitation Center, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale U1285, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8576–Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France (J.P.); Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1011–European Genomic Institute for Diabetes, Lille, France (S.S.); Institute of Cardiometabolism and Nutrition, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition 1166, Paris, France; Intensive Medicine–Resuscitation Department, Institut de Cardiologie, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France (G.H.); Department of Internal Medicine, Centre Hospitalier Universitaire de Nantes, Nantes, France (M.A.); Angiology Unit, Hôpital Fribourgeois–Hôpital Cantonal, Fribourg, Switzerland (D.P.); Multipurpose Resuscitation Service, Centre Hospitalier Victor Dupouy, Argenteuil, France (D.C.); Department of Intensive Care Medicine, Centre Hospitalier du Valais Romand de l’Hôpital du Valais (site de Sion), Sion, Switzerland (J.D., B.S.); and Department of Radiology, King’s College Hospital National Health Service Foundation Trust, London, England (C.F., G.G., H.R.)
| | - Damien Contou
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.J.S.); Medical Research Collaborating Center (H.H.) and Department of Radiology (S.H.Y.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (M.O.); Department of Radiology, Cochin Hospital, Assistance Publique–Hôpitaux de Paris Centre, Paris, France (F.B., M.P.R.); Department of Diagnostic Radiology, Papa Giovanni XXIII, Bergamo, Italy (C.V.); Department of Radiology, Military Hospital Begin, Saint Mande, France (A.G.); Resuscitation Center, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale U1285, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8576–Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France (J.P.); Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1011–European Genomic Institute for Diabetes, Lille, France (S.S.); Institute of Cardiometabolism and Nutrition, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition 1166, Paris, France; Intensive Medicine–Resuscitation Department, Institut de Cardiologie, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France (G.H.); Department of Internal Medicine, Centre Hospitalier Universitaire de Nantes, Nantes, France (M.A.); Angiology Unit, Hôpital Fribourgeois–Hôpital Cantonal, Fribourg, Switzerland (D.P.); Multipurpose Resuscitation Service, Centre Hospitalier Victor Dupouy, Argenteuil, France (D.C.); Department of Intensive Care Medicine, Centre Hospitalier du Valais Romand de l’Hôpital du Valais (site de Sion), Sion, Switzerland (J.D., B.S.); and Department of Radiology, King’s College Hospital National Health Service Foundation Trust, London, England (C.F., G.G., H.R.)
| | - Julie Delaloye
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.J.S.); Medical Research Collaborating Center (H.H.) and Department of Radiology (S.H.Y.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (M.O.); Department of Radiology, Cochin Hospital, Assistance Publique–Hôpitaux de Paris Centre, Paris, France (F.B., M.P.R.); Department of Diagnostic Radiology, Papa Giovanni XXIII, Bergamo, Italy (C.V.); Department of Radiology, Military Hospital Begin, Saint Mande, France (A.G.); Resuscitation Center, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale U1285, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8576–Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France (J.P.); Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1011–European Genomic Institute for Diabetes, Lille, France (S.S.); Institute of Cardiometabolism and Nutrition, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition 1166, Paris, France; Intensive Medicine–Resuscitation Department, Institut de Cardiologie, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France (G.H.); Department of Internal Medicine, Centre Hospitalier Universitaire de Nantes, Nantes, France (M.A.); Angiology Unit, Hôpital Fribourgeois–Hôpital Cantonal, Fribourg, Switzerland (D.P.); Multipurpose Resuscitation Service, Centre Hospitalier Victor Dupouy, Argenteuil, France (D.C.); Department of Intensive Care Medicine, Centre Hospitalier du Valais Romand de l’Hôpital du Valais (site de Sion), Sion, Switzerland (J.D., B.S.); and Department of Radiology, King’s College Hospital National Health Service Foundation Trust, London, England (C.F., G.G., H.R.)
| | - Bienvenido Sanchez
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.J.S.); Medical Research Collaborating Center (H.H.) and Department of Radiology (S.H.Y.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (M.O.); Department of Radiology, Cochin Hospital, Assistance Publique–Hôpitaux de Paris Centre, Paris, France (F.B., M.P.R.); Department of Diagnostic Radiology, Papa Giovanni XXIII, Bergamo, Italy (C.V.); Department of Radiology, Military Hospital Begin, Saint Mande, France (A.G.); Resuscitation Center, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale U1285, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8576–Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France (J.P.); Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1011–European Genomic Institute for Diabetes, Lille, France (S.S.); Institute of Cardiometabolism and Nutrition, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition 1166, Paris, France; Intensive Medicine–Resuscitation Department, Institut de Cardiologie, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France (G.H.); Department of Internal Medicine, Centre Hospitalier Universitaire de Nantes, Nantes, France (M.A.); Angiology Unit, Hôpital Fribourgeois–Hôpital Cantonal, Fribourg, Switzerland (D.P.); Multipurpose Resuscitation Service, Centre Hospitalier Victor Dupouy, Argenteuil, France (D.C.); Department of Intensive Care Medicine, Centre Hospitalier du Valais Romand de l’Hôpital du Valais (site de Sion), Sion, Switzerland (J.D., B.S.); and Department of Radiology, King’s College Hospital National Health Service Foundation Trust, London, England (C.F., G.G., H.R.)
| | - Cheng Fang
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.J.S.); Medical Research Collaborating Center (H.H.) and Department of Radiology (S.H.Y.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (M.O.); Department of Radiology, Cochin Hospital, Assistance Publique–Hôpitaux de Paris Centre, Paris, France (F.B., M.P.R.); Department of Diagnostic Radiology, Papa Giovanni XXIII, Bergamo, Italy (C.V.); Department of Radiology, Military Hospital Begin, Saint Mande, France (A.G.); Resuscitation Center, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale U1285, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8576–Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France (J.P.); Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1011–European Genomic Institute for Diabetes, Lille, France (S.S.); Institute of Cardiometabolism and Nutrition, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition 1166, Paris, France; Intensive Medicine–Resuscitation Department, Institut de Cardiologie, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France (G.H.); Department of Internal Medicine, Centre Hospitalier Universitaire de Nantes, Nantes, France (M.A.); Angiology Unit, Hôpital Fribourgeois–Hôpital Cantonal, Fribourg, Switzerland (D.P.); Multipurpose Resuscitation Service, Centre Hospitalier Victor Dupouy, Argenteuil, France (D.C.); Department of Intensive Care Medicine, Centre Hospitalier du Valais Romand de l’Hôpital du Valais (site de Sion), Sion, Switzerland (J.D., B.S.); and Department of Radiology, King’s College Hospital National Health Service Foundation Trust, London, England (C.F., G.G., H.R.)
| | - Giorgio Garzillo
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.J.S.); Medical Research Collaborating Center (H.H.) and Department of Radiology (S.H.Y.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (M.O.); Department of Radiology, Cochin Hospital, Assistance Publique–Hôpitaux de Paris Centre, Paris, France (F.B., M.P.R.); Department of Diagnostic Radiology, Papa Giovanni XXIII, Bergamo, Italy (C.V.); Department of Radiology, Military Hospital Begin, Saint Mande, France (A.G.); Resuscitation Center, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale U1285, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8576–Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France (J.P.); Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1011–European Genomic Institute for Diabetes, Lille, France (S.S.); Institute of Cardiometabolism and Nutrition, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition 1166, Paris, France; Intensive Medicine–Resuscitation Department, Institut de Cardiologie, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France (G.H.); Department of Internal Medicine, Centre Hospitalier Universitaire de Nantes, Nantes, France (M.A.); Angiology Unit, Hôpital Fribourgeois–Hôpital Cantonal, Fribourg, Switzerland (D.P.); Multipurpose Resuscitation Service, Centre Hospitalier Victor Dupouy, Argenteuil, France (D.C.); Department of Intensive Care Medicine, Centre Hospitalier du Valais Romand de l’Hôpital du Valais (site de Sion), Sion, Switzerland (J.D., B.S.); and Department of Radiology, King’s College Hospital National Health Service Foundation Trust, London, England (C.F., G.G., H.R.)
| | - Hasti Robbie
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.J.S.); Medical Research Collaborating Center (H.H.) and Department of Radiology (S.H.Y.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (M.O.); Department of Radiology, Cochin Hospital, Assistance Publique–Hôpitaux de Paris Centre, Paris, France (F.B., M.P.R.); Department of Diagnostic Radiology, Papa Giovanni XXIII, Bergamo, Italy (C.V.); Department of Radiology, Military Hospital Begin, Saint Mande, France (A.G.); Resuscitation Center, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale U1285, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8576–Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France (J.P.); Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1011–European Genomic Institute for Diabetes, Lille, France (S.S.); Institute of Cardiometabolism and Nutrition, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition 1166, Paris, France; Intensive Medicine–Resuscitation Department, Institut de Cardiologie, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France (G.H.); Department of Internal Medicine, Centre Hospitalier Universitaire de Nantes, Nantes, France (M.A.); Angiology Unit, Hôpital Fribourgeois–Hôpital Cantonal, Fribourg, Switzerland (D.P.); Multipurpose Resuscitation Service, Centre Hospitalier Victor Dupouy, Argenteuil, France (D.C.); Department of Intensive Care Medicine, Centre Hospitalier du Valais Romand de l’Hôpital du Valais (site de Sion), Sion, Switzerland (J.D., B.S.); and Department of Radiology, King’s College Hospital National Health Service Foundation Trust, London, England (C.F., G.G., H.R.)
| | - Soon Ho Yoon
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.J.S.); Medical Research Collaborating Center (H.H.) and Department of Radiology (S.H.Y.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (M.O.); Department of Radiology, Cochin Hospital, Assistance Publique–Hôpitaux de Paris Centre, Paris, France (F.B., M.P.R.); Department of Diagnostic Radiology, Papa Giovanni XXIII, Bergamo, Italy (C.V.); Department of Radiology, Military Hospital Begin, Saint Mande, France (A.G.); Resuscitation Center, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale U1285, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8576–Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France (J.P.); Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1011–European Genomic Institute for Diabetes, Lille, France (S.S.); Institute of Cardiometabolism and Nutrition, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition 1166, Paris, France; Intensive Medicine–Resuscitation Department, Institut de Cardiologie, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France (G.H.); Department of Internal Medicine, Centre Hospitalier Universitaire de Nantes, Nantes, France (M.A.); Angiology Unit, Hôpital Fribourgeois–Hôpital Cantonal, Fribourg, Switzerland (D.P.); Multipurpose Resuscitation Service, Centre Hospitalier Victor Dupouy, Argenteuil, France (D.C.); Department of Intensive Care Medicine, Centre Hospitalier du Valais Romand de l’Hôpital du Valais (site de Sion), Sion, Switzerland (J.D., B.S.); and Department of Radiology, King’s College Hospital National Health Service Foundation Trust, London, England (C.F., G.G., H.R.)
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Panahi L, Udeani G, Horseman M, Weston J, Samuel N, Joseph M, Mora A, Bazan D. Review of Medical Therapies for the Management of Pulmonary Embolism. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:110. [PMID: 33530544 PMCID: PMC7912594 DOI: 10.3390/medicina57020110] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 12/12/2022]
Abstract
Traditionally, the management of patients with pulmonary embolism has been accomplished with anticoagulant treatment with parenteral heparins and oral vitamin K antagonists. Although the administration of heparins and oral vitamin K antagonists still plays a role in pulmonary embolism management, the use of these therapies are limited due to other options now available. This is due to their toxicity profile, clearance limitations, and many interactions with other medications and nutrients. The emergence of direct oral anticoagulation therapies has led to more options now being available to manage pulmonary embolism in inpatient and outpatient settings conveniently. These oral therapeutic options have opened up opportunities for safe and effective pulmonary embolism management, as more evidence and research is now available about reversal agents and monitoring parameters. The evolution of the pharmacological management of pulmonary embolism has provided us with better understanding regarding the selection of anticoagulants. There is also a better understanding and employment of anticoagulants in pulmonary embolism in special populations, such as patients with liver failure, renal failure, malignancy, and COVID-19.
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Affiliation(s)
- Ladan Panahi
- Department of Pharmacy Practice, Texas A&M Rangel College of Pharmacy, 1010 W Ave B, Kingsville, TX 78363, USA; (M.H.); (J.W.); (N.S.); (M.J.); (A.M.); (D.B.)
| | - George Udeani
- Department of Pharmacy Practice, Texas A&M Rangel College of Pharmacy, 1010 W Ave B, Kingsville, TX 78363, USA; (M.H.); (J.W.); (N.S.); (M.J.); (A.M.); (D.B.)
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Venous Thromboembolism. Fam Med 2021. [DOI: 10.1007/978-1-4939-0779-3_88-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Al-Zaher N, Vitali F, Neurath MF, Goertz RS. The Positive Rate of Pulmonary Embolism by CT Pulmonary Angiography Is High in an Emergency Department, Even in Low-Risk or Young Patients. Med Princ Pract 2021; 30:37-44. [PMID: 32911479 PMCID: PMC7923846 DOI: 10.1159/000511464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 09/09/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The clinical presentation of pulmonary embolism (PE) can be various and misleading. We analyzed patients with suspicion of PE and subsequently performed computed tomography pulmonary angiography (CTPA) in an emergency department of Internal Medicine, focusing on patient groups in which PE might be underestimated in the emergency setting, such as young patients and patients with low clinical probability. MATERIAL AND METHODS In 2016 and 2017, all patients receiving a CTPA for investigation of PE were retrospectively evaluated for clinical parameters (age, symptoms, and vital parameters) and D-dimers. The Wells score was calculated. RESULTS CTPA was performed in 323 patients (158 female and 165 male; mean age 62 years). The leading symptoms for admission were dyspnea or chest pain; 62% showed intermediate or high risk for PE, calculated by applying the Wells score. In 123 (38%) of all patients, a PE was proved and pathologic age-adjusted D-dimers were found in 97.6%. Thirty of 121 (25%) patients with low risk according to Wells score had a PE. Deep vein thrombosis was verified in 67/123 (55%) patients; 43% (15/35) of all suspicions for PE in patients <40 years were positive with 4/15 (26%), showing a central PE. Younger patients (<40 years) with PE presented more often with tachycardia or tachypnea and chest pain or dyspnea than elderly patients with PE. CONCLUSION CTPA frequently proves a PE in patients with suspicion of PE in an emergency department of Internal Medicine. If PE is suspected and CTPA performed accordingly, the presence of PE is quite common even in low-risk patient groups (Wells score) or in young patients <40 years with chest pain or dyspnea.
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Affiliation(s)
- Nizam Al-Zaher
- Department of Internal Medicine 1, Friedrich-Alexander-University Erlangen-Nurnberg, Erlangen, Germany
| | - Francesco Vitali
- Department of Internal Medicine 1, Friedrich-Alexander-University Erlangen-Nurnberg, Erlangen, Germany
| | - Markus F Neurath
- Department of Internal Medicine 1, Friedrich-Alexander-University Erlangen-Nurnberg, Erlangen, Germany
| | - Ruediger S Goertz
- Department of Internal Medicine 1, Friedrich-Alexander-University Erlangen-Nurnberg, Erlangen, Germany,
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Yang C, Zeng HH, Huang J, Zhang QY, Lin K. Predictive roles of D-dimer for mortality of patients with community-acquired pneumonia: a systematic review and meta-analysis. J Bras Pneumol 2021; 47:e20210072. [PMID: 34932717 PMCID: PMC8836614 DOI: 10.36416/1806-3756/e20210072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/22/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To explore the predictive roles of D-dimer for the mortality of patients with community-acquired pneumonia (CAP). METHODS This was a systematic review and meta-analysis. We searched the following databases: PubMed, EMBASE, Web of Science, Ovid MEDLINE, and Cochrane Library from their inception to July 26, 2020. Studies exploring the relationship between blood D-dimer levels and CAP-related mortality were selected. In this meta-analysis, we calculated mortality rates, sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios. RESULTS The search identified 1,073 articles, 8 of which (a total of 2,126 patients) were included in this meta-analysis. The pooled mortality rate of the overall sample was 0.10 (95% CI, 0.08-0.14). The levels of blood D-dimer in the nonsurvivors were significantly higher than those in the survivors (weighted mean difference = 1.03 mg/L [95% CI, 0.81-1.26]; p < 0.00001). The area under the summary ROC curve for the optimal cutoff value of D-dimer as a predictor of mortality was 0.848 (SE = 0.046), and the pooled negative likelihood ratio for D-dimer within the normal range was 0.24 (95% CI, 0.11-0.53). CONCLUSIONS Blood D-dimer might be helpful for the initial assessment of mortality risk of patients with CAP. D-dimer levels within the normal range indicate low risk of mortality. Because of the small sample size in our study, our findings should be further explored and validated in future studies with larger sample sizes.
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Affiliation(s)
- Cheng Yang
- . Department of Pulmonary and Critical Care Medicine, Meizhou People’s Hospital, Meizhou, Guangdong, China
| | - Han-Hua Zeng
- . Department of Pulmonary and Critical Care Medicine, Meizhou People’s Hospital, Meizhou, Guangdong, China
| | - Juan Huang
- . Department of Pulmonary and Critical Care Medicine, Meizhou People’s Hospital, Meizhou, Guangdong, China
| | - Qian-Yun Zhang
- . Department of Pulmonary and Critical Care Medicine, Meizhou People’s Hospital, Meizhou, Guangdong, China
| | - Kun Lin
- . Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China
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Solitano V, Fiorino G, D'Amico F, Peyrin-Biroulet L, Danese S. Thrombosis in IBD in the Era of JAK Inhibition. Curr Drug Targets 2020; 22:126-136. [PMID: 32881668 DOI: 10.2174/1389450121666200902164240] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 01/06/2023]
Abstract
Patients with inflammatory bowel diseases (IBD) have an increased risk of thrombosis. The interaction between inflammation and coagulation has extensively been studied. It is well-- known that some drugs can influence the haemostatic system, but several concerns on the association between therapies and increased risk of thrombosis remain open. While biologics seem to have a protective role against thrombosis via their anti-inflammatory effect, some concerns about an increased risk of thrombosis with JAK inhibitors have been raised. We conducted a literature review to assess the association between biologics/small molecules and venous/arterial thrombotic complications. An increased risk of venous and arterial thrombosis was found in patients treated with corticosteroids, whereas anti-TNFα were considered protective agents. No thromboembolic adverse event was reported with vedolizumab and ustekinumab. In addition, thromboembolic events rarely occurred in patients with ulcerative colitis (UC) after therapy with tofacitinib. The overall risk of both venous and arterial thrombosis was not increased based on the available evidence. Finally, in the era of JAK inhibitors, the treatment should be individualized by evaluating the pre-existing potential thrombotic risk balanced with the intrinsic risk of the medication used.
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Affiliation(s)
- Virginia Solitano
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Gionata Fiorino
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Point-of-Care Testing for D-Dimer in the Diagnosis of Venous Thromboembolism in Primary Care: A Narrative Review. Cardiol Ther 2020; 10:27-40. [PMID: 33263839 PMCID: PMC8126530 DOI: 10.1007/s40119-020-00206-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Indexed: 11/02/2022] Open
Abstract
Venous thromboembolism (VTE) is regarded as a significant cause of mortality and disability, affecting 1-2 per 1000 people annually, presenting with a relatively wide range of symptoms, which can pose a diagnostic challenge. Historically, people in whom VTE is suspected will have been taken to hospital for diagnosis and treatment; however, a high proportion of patients are found not to have VTE. Concerns have been expressed about potential delays in treatment, with the risk of additional morbidity and disability, and death. Diagnostic strategies are typically based on the use of a clinical prediction rule to determine the pre-test probability, complemented with a measurement of D-dimer, with confirmation by imaging assessment. This narrative review explores the literature on the use of point-of-care testing (POCT) for the measurement of D-dimer, as part of a clinical decision rule, for the diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE) in the primary care setting. In the two main prospective management (validation) studies that included D-dimer POCT or similar technologies, with a total cohort of 1600 participants, DVT was ruled out in 49% of patients, with a false negative rate of 1.4%, whereas PE was ruled out in 45% of patients, with a false negative rate of 1.5%. This suggests that uptake of POCT D-dimer in primary care has the potential to reduce the number of referrals to hospitals for imaging confirmatory investigation, with consequent cost savings. Thus, adopting POCT for D-dimer in primary care can offer clinical and cost benefits, particularly when quantitative POCT assays are being used. Furthermore, POCT should be undertaken in collaboration with the local laboratories to ensure the harmonisation of D-dimer methods and quality assurance to improve the diagnosis of VTE.
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Serrao A, Ballotta L, Dragoni F, Pallotta A, Chistolini A. Secondary prophylaxis of venous thromboembolism with direct oral anticoagulants (DOACs) in patients with major congenital thrombophilia. Thromb Res 2020; 196:539-540. [DOI: 10.1016/j.thromres.2020.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/12/2020] [Indexed: 11/25/2022]
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Javaudin F, Seon J, Le Bastard Q, Cabiot A, Pes P, Arnaudet I, Allain M, Le Conte P. Evaluation of short training session for venous limited compression ultrasonography: prospective multicenter study. Ultrasound J 2020; 12:5. [PMID: 32016592 PMCID: PMC6997306 DOI: 10.1186/s13089-020-0155-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/24/2020] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Venous limited compression ultrasonography (VLCU) is recommended in case of suspicion of deep venous thrombosis (DVT). Current training pathways are rather long and include experiential phase. This aim of this study was to investigate the efficacy of a short training session for VLCU without experiential phase. The training session was applied in residents without previous ultrasound skills. Program included operation of ultrasound device and interpretation of venous images. Included patients were older than 18 years and had a suspicion of DVT. After realization of VLCU using usual technique, residents reported the dynamic compressibility of the femoral and popliteal veins, the presence or not of a visible thrombus, self-reported difficulty and duration. Patients then underwent a whole leg ultrasonography (WLCU) in the local laboratory which was blinded to VLCU results. The main criterion was the negative-predictive value (NPV) of VLCU for the absence of proximal DVT diagnosed with WLCU. Secondary criteria were VLCU diagnostic performances, rate of inability to conclude, difficulty and duration. For a NPV of 95 ± 6%, the needed number of patients was 96. This study was approved by the ethical committee.
Results
102 patients were analyzed. 46 residents were trained. A DVT was diagnosed by WLCU in 18 patients (prevalence of 17.6% [95% CI 11–26%]). VLCU detected 15 DVT (NPV of 96% [95% CI 89–99%]). The positive likelihood ratio was 9.9, the negative likelihood ratio 0.19 and Cohen’s Kappa 0.62 [95% CI 0.52–0.71]. The sensitivity was 83% [CI 95% 60–94%] and specificity 88% [CI 95% 79–93%]. The mean number of VLCU by residents was 2.3 ± 2.1, median 2 (minimum 1, maximum 8). Mean duration was 3.4 min, difficulty was 3.7 ± 2.
Conclusion
The principal objective, NPV 96% [95% CI 89–99%], was achieved. However, this short training session was inadequate to allow ruling-out a DVT with sufficient security. Thus, the experiential phase seems to be essential.
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Barbhaiya M, Zuily S, Ahmadzadeh Y, Amigo MC, Avcin T, Bertolaccini ML, Branch DW, de Jesus G, Devreese KMJ, Frances C, Garcia D, Guillemin F, Levine SR, Levy RA, Lockshin MD, Ortel TL, Seshan SV, Tektonidou M, Wahl D, Willis R, Naden R, Costenbader K, Erkan D. Development of a New International Antiphospholipid Syndrome Classification Criteria Phase I/II Report: Generation and Reduction of Candidate Criteria. Arthritis Care Res (Hoboken) 2020; 73:1490-1501. [PMID: 33253499 DOI: 10.1002/acr.24520] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/24/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE An international multidisciplinary initiative, jointly supported by the American College of Rheumatology and European Alliance of Associations for Rheumatology, is underway to develop new rigorous classification criteria to identify patients with high likelihood of antiphospholipid syndrome (APS) for research purposes. The present study was undertaken to apply an evidence- and consensus-based approach to identify candidate criteria and develop a hierarchical organization of criteria within domains. METHODS During phase I, the APS classification criteria steering committee used systematic literature reviews and surveys of international APS physician scientists to generate a comprehensive list of items related to APS. In phase II, we reviewed the literature, administered surveys, formed domain subcommittees, and used Delphi exercises and nominal group technique to reduce potential APS candidate criteria. Candidate criteria were hierarchically organized into clinical and laboratory domains. RESULTS Phase I generated 152 candidate criteria, expanded to 261 items with the addition of subgroups and candidate criteria with potential negative weights. Using iterative item reduction techniques in phase II, we initially reduced these items to 64 potential candidate criteria organized into 10 clinical and laboratory domains. Subsequent item reduction methods resulted in 27 candidate criteria, hierarchically organized into 6 additive domains (laboratory, macrovascular, microvascular, obstetric, cardiac, and hematologic) for APS classification. CONCLUSION Using data- and consensus-driven methodology, we identified 27 APS candidate criteria in 6 clinical or laboratory domains. In the next phase, the proposed candidate criteria will be used for real-world case collection and further refined, organized, and weighted to determine an aggregate score and threshold for APS classification.
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Affiliation(s)
- Medha Barbhaiya
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Stephane Zuily
- Vascular Medicine Division and Regional Competence Center for Rare Auto-Immune Diseases, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, Nancy, France
| | | | | | - Tadej Avcin
- Children's Hospital, University Medical Center, University of Ljubljana, Ljubljana, Slovenia
| | | | | | | | | | | | | | - Francis Guillemin
- CIC Clinical Epidemiology, APEMAC and CHRU, Inserm, Université de Lorraine, Nancy, France
| | - Steven R Levine
- Downstate Stroke Center, State University of New York Downstate Health Sciences University, Kings County Hospital Center, and Maimonides Medical Center/Jaffe Stroke Center, Brooklyn, New York
| | - Roger A Levy
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil, and GlaxoSmithKline, Upper Providence, Pennsylvania
| | - Michael D Lockshin
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | | | | | | | - Denis Wahl
- Vascular Medicine Division and Regional Competence Center for Rare Auto-Immune Diseases, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, Nancy, France
| | | | | | | | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
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Signorelli SS, Oliveri Conti G, Fiore M, Cangiano F, Zuccarello P, Gaudio A, Ferrante M. Platelet-Derived Microparticles (MPs) and Thrombin Generation Velocity in Deep Vein Thrombosis (DVT): Results of a Case-Control Study. Vasc Health Risk Manag 2020; 16:489-495. [PMID: 33273818 PMCID: PMC7705281 DOI: 10.2147/vhrm.s236286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 06/15/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction The role of platelets (Ps) and platelet-derived microparticles (MPs) in venous thromboembolism (VTE) is still being debated. Methods We measured MPs, velocity of thrombin formation (PiCT) and phospholipid generation (PLPs) in 40 patients with unprovoked deep vein thrombosis (DVT), who were compared with 40 healthy controls. Results MPs were higher in DVT (7.12 nM; 25th–75th percentile 5.26–9.12) than in controls (5.45 nM; 25th–75th percentile 1.67–8.96) (p = 0.19). PiCT velocity was lower in DVT (1.87 sec; 25th–75th percentile 1.75–1.93 sec) compared with controls (1.95 sec; 25th–75th percentile 1.84–2.24 sec) (p = 0.04). PLPs were higher in DVT (77.03 µg/mL; 25th–75th percentile 72.12–103.59 µg/mL) compared with controls (68.65 µg/mL, 25th–75th percentile 55.31–78.20 µg/mL) (p = 0.02). Discussion We hypothesize that MPs could be integrated with the lab network assay in evaluating Ps’ role as an activated procoagulative condition. We encourage research on Ps and P-derived microvesicle pathways in patients with unprovoked DVT and not only in patients with cancer-induced DVT.
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Affiliation(s)
| | - Gea Oliveri Conti
- Department of Medical, Surgical Sciences and Advanced Technologies, G.F. Ingrassia, University of Catania, Catania, Italy
| | - Maria Fiore
- Department of Medical, Surgical Sciences and Advanced Technologies, G.F. Ingrassia, University of Catania, Catania, Italy
| | - Federica Cangiano
- Department of Medical, Surgical Sciences and Advanced Technologies, G.F. Ingrassia, University of Catania, Catania, Italy
| | - Pietro Zuccarello
- Department of Medical, Surgical Sciences and Advanced Technologies, G.F. Ingrassia, University of Catania, Catania, Italy
| | - Agostino Gaudio
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Margherita Ferrante
- Department of Medical, Surgical Sciences and Advanced Technologies, G.F. Ingrassia, University of Catania, Catania, Italy
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Bistervels IM, Scheres LJJ, Spijker R, Middeldorp S, van Mens TE. Diagnostic tests for pregnancy-related deep vein thrombosis. Hippokratia 2020. [DOI: 10.1002/14651858.cd013794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ingrid M Bistervels
- Amsterdam UMC, University of Amsterdam, Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Reproduction and Development; Amsterdam Netherlands
| | - Luuk JJ Scheres
- Amsterdam UMC, University of Amsterdam, Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Reproduction and Development; Amsterdam Netherlands
- Department of Internal Medicine; Radboud UMC; Nijmegen Netherlands
| | - René Spijker
- Cochrane Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University; Utrecht Netherlands
- Amsterdam UMC, University of Amsterdam, Medical Library, Amsterdam Public Health; Amsterdam Netherlands
| | - Saskia Middeldorp
- Amsterdam UMC, University of Amsterdam, Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Reproduction and Development; Amsterdam Netherlands
| | - Thijs E van Mens
- Amsterdam UMC, University of Amsterdam, Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Reproduction and Development; Amsterdam Netherlands
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Baumgartner C, Klok FA, Carrier M, Limacher A, Moor J, Righini M, Beer JH, Peluso M, Rakovic D, Huisman MV, Aujesky D. Clinical Surveillance vs. Anticoagulation For low-risk patiEnts with isolated SubSegmental Pulmonary Embolism: protocol for a multicentre randomised placebo-controlled non-inferiority trial (SAFE-SSPE). BMJ Open 2020; 10:e040151. [PMID: 33444199 PMCID: PMC7678381 DOI: 10.1136/bmjopen-2020-040151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The clinical significance of subsegmental pulmonary embolism (SSPE) is currently unclear. Although growing evidence from observational studies suggests that withholding anticoagulant treatment may be a safe option in selected patients with isolated SSPE, most patients with this condition receive anticoagulant treatment, which is associated with a 90-day risk of recurrent venous thromboembolism (VTE) of 0.8% and major bleeding of up to 5%. Given the ongoing controversy concerning the risk-benefit ratio of anticoagulation for isolated SSPE and the lack of evidence from randomised-controlled studies, the aim of this clinical trial is to evaluate the efficacy and safety of clinical surveillance without anticoagulation in low-risk patients with isolated SSPE. METHODS AND ANALYSIS SAFE-SSPE (Surveillance vs. Anticoagulation For low-risk patiEnts with isolated SubSegmental Pulmonary Embolism, a multicentre randomised placebo-controlled non-inferiority trial) is an international, multicentre, placebo-controlled, double-blind, parallel-group non-inferiority trial conducted in Switzerland, the Netherlands and Canada. Low-risk patients with isolated SSPE are randomised to receive clinical surveillance with either placebo (no anticoagulation) or anticoagulant treatment with rivaroxaban. All patients undergo bilateral whole-leg compression ultrasonography to exclude concomitant deep vein thrombosis before enrolment. Patients are followed for 90 days. The primary outcome is symptomatic recurrent VTE (efficacy). The secondary outcomes include clinically significant bleeding and all-cause mortality (safety). The ancillary outcomes are health-related quality of life, functional status and medical resource utilisation. ETHICS AND DISSEMINATION The local ethics committees in Switzerland have approved this protocol. Submission to the Ethical Committees in the Netherlands and Canada is underway. The results of this trial will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04263038.
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Affiliation(s)
- Christine Baumgartner
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Frederikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Marc Carrier
- Department of Medicine, The Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, Ontario, Canada
| | | | - Jeanne Moor
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marc Righini
- Division of Angiology and Haemostasis, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Jürg-Hans Beer
- Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland
| | - Martina Peluso
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Damiana Rakovic
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Yamagata K, Fukuzawa S, Uchida F, Ishibashi-Kanno N, Yanagawa T, Bukawa H. Is Preoperative Plate-Lymphocyte Ratio a Predictor of Deep Vein Thrombosis in Patients With Oral Cancer During Surgery? J Oral Maxillofac Surg 2020; 79:914-924. [PMID: 33197415 DOI: 10.1016/j.joms.2020.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/05/2020] [Accepted: 10/11/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Detecting deep vein thrombosis (DVT) is necessary to reduce the morbidity of venous thromboembolism, and platelet-lymphocyte ratio (PLR) is a novel marker for predicting DVT. This study aimed to investigate the association between preoperative PLR and risk of developing DVT in patients receiving surgical treatment of oral cancer. PATIENTS AND METHODS We designed a retrospective cohort study, and the source of study sample was patients with oral cancer and who underwent surgery between 2015 and 2019. Patients were excluded if they did not undergo surgical treatment and had preoperative DVT and history of hypercoagulable disorders. The primary predictor variable was PLR. We calculated the receiver operating characteristic curve and area under the curve to determine the best-defined risk groups. The best cutoff value for PLR was 187.4 (area under the curve, 0.772; sensitivity, 75.0%; specificity, 74.2%; P = .002). The primary outcome variable was DVT, and the other variables were patient characteristics, blood examination data, and therapeutic data. A logistic regression analysis was used to adjust the effects of potential confounders. RESULTS A total of 101 patients were included in this study, and DVT was observed in 12 (11.9%) patients. Free flap reconstructive surgery was performed in 8 of the 12 (66.7%) patients in the DVT group. Statistical analyses showed that DVT was significantly associated with PLR (≤187.4 vs >187.4; P = .001). Logistic multivariate analysis of the preoperative parameters identified the following 2 independent predictive factors for DVT: PLR (≤187.4 vs >187.4) (odds ratio, 13.735; 95% confidence interval, 2.950 to 63.944; P = .001) and free flap reconstructive surgery (odds ratio, 6.584; 95% confidence interval, 1.504 to 28.822; P = .012). CONCLUSIONS High PLR (>187.4) and free flap reconstructive surgery, considered as preoperative predictive factors, were associated with DVT.
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Affiliation(s)
- Kenji Yamagata
- Associate Professor, Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Satoshi Fukuzawa
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Fumihiko Uchida
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Naomi Ishibashi-Kanno
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Toru Yanagawa
- Professor, Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroki Bukawa
- Professor, Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Costa OS, Baker WL, Roman-Morillo Y, McNeil-Posey K, Lovelace B, White CM, Coleman CI. Quality evaluation of case series describing four-factor prothrombin complex concentrate in oral factor Xa inhibitor-associated bleeding: a systematic review. BMJ Open 2020; 10:e040499. [PMID: 33154059 PMCID: PMC7646359 DOI: 10.1136/bmjopen-2020-040499] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/05/2020] [Accepted: 10/18/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION As oral factor Xa (oFXa) inhibitor use has increased, so has publication of case series describing related bleeding managed with four-factor prothrombin complex concentrate (4F-PCC). OBJECTIVE This review aimed to identify case series describing 4F-PCC management of oFXa inhibitor-related bleeding and appraise their methodological and reporting quality. DESIGN We searched Medline and EMBASE (1 January 2011 to 31 May 2020) to identify series of ≥10 patients with oFXa inhibitor-related major bleeding given off-label 4F-PCC. Case series were evaluated using a validated tool adapted for this topic. The tool addressed patient selection, bleed/outcome ascertainment, causal/temporal association and reporting. RESULTS We identified 14 case series. None had ≥100 patients (range=13-84), three were prospective, two detailed appropriate inclusion criteria and four noted consecutive inclusion. While 12 series provided clear/appropriate methods for diagnosis of intracranial haemorrhage (ICH); none did so for extracranial bleeds and it was not clear whether bleeding was adjudicated in any. Haemostatic effectiveness, thrombosis and mortality were together evaluated in 12 series, but only seven used validated methods to evaluate/diagnosis haemostasis in ICH, six in gastrointestinal bleeds, five in other bleeds and three in thrombosis. Independent adjudication of haemostasis (n=1) and thrombosis (n=2) was infrequent. Thirty-day follow-up for mortality and thrombosis was noted in five and seven series. Anticoagulation measurement/levels in at least some patients were conveyed in three series. Few series provided data on anticoagulant agent/dose (n=4), time from anticoagulant (n=4), time-to-reversal (n=7), baseline (n=7) or change (n=0) in neurologic function. CONCLUSIONS Although many case series describe off-label use of 4F-PCC for oFXa inhibitor-related bleeding, methodological flaws and/or poor reporting necessitates caution in interpretation.
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Affiliation(s)
- Olivia S Costa
- Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Connecticut, USA
- Evidence-Based Practice Center, Hartford Hospital, Hartford, Connecticut, USA
| | - William L Baker
- Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Connecticut, USA
- Evidence-Based Practice Center, Hartford Hospital, Hartford, Connecticut, USA
| | - Yuani Roman-Morillo
- Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Connecticut, USA
- Evidence-Based Practice Center, Hartford Hospital, Hartford, Connecticut, USA
| | - Kelly McNeil-Posey
- Health Economics and Outcomes Research, Portola Pharmaceuticals Inc, South San Francisco, California, USA
| | - Belinda Lovelace
- Health Economics and Outcomes Research, Portola Pharmaceuticals Inc, South San Francisco, California, USA
| | - C Michael White
- Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Connecticut, USA
- Evidence-Based Practice Center, Hartford Hospital, Hartford, Connecticut, USA
| | - Craig I Coleman
- Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Connecticut, USA
- Evidence-Based Practice Center, Hartford Hospital, Hartford, Connecticut, USA
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Giorgi-Pierfranceschi M, Paoletti O, Pan A, De Gennaro F, Nardecchia AL, Morandini R, Dellanoce C, Lombi S, Tala M, Cancelli V, Zambelli S, Bosio G, Romanini L, Testa S. Prevalence of asymptomatic deep vein thrombosis in patients hospitalized with SARS-CoV-2 pneumonia: a cross-sectional study. Intern Emerg Med 2020; 15:1425-1433. [PMID: 32840805 PMCID: PMC7445816 DOI: 10.1007/s11739-020-02472-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/05/2020] [Indexed: 12/13/2022]
Abstract
The association between coronavirus disease 2019 (COVID-19) pneumonia and venous thrombotic disorders is still unclear. We assessed the association between COVID-19 infection-related pneumonia and proximal deep-vein thrombosis (DVT) in a cohort of patients admitted to our hospital during the European outbreak in the front line of Cremona, Lombardy. In a single-center cross-sectional study, all patients hospitalized for more than 5 days in Internal Medicine Department with confirmed COVID-19 pneumonia received 2-point compressive ultrasound assessment (CUS) of the leg vein system during a single day. Ninety-four percent of patients received enoxaparin as standard pharmacological prophylaxis for venous thromboembolism. The presence of DVT was defined as incompressibility of popliteal or common femoral vein. Out of 121 patients with COVID-19 pneumonia (mean age 71.8, 66.3% males) hospitalized on March 31st, 70 stayed in hospital for over 5 days and 66 of them underwent CUS of deep venous system of the legs. The presence of asymptomatic DVT was found in 9 patients (13.6%). No symptomatic DVT was found. Patients with DVT showed mean age = 75.7 years, mean D-dimer levels = 4.02 ng/ml and all of them received enoxaparin for thromboprophylaxis, except one. Computed tomography pulmonary angiogram confirmed pulmonary embolism in five patients. One every seven patients with COVID-19-related pneumonia, hospitalized for more than 5 days, had asymptomatic proximal DVT and half of them had confirmed PE despite standard pharmacological thromboprophylaxis. This observational study suggests the need of an active surveillance through CUS in patients hospitalized with acute SARS-COV-2 and underline the need of a more intense thromboprophylaxis.
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Affiliation(s)
| | - Oriana Paoletti
- Haemostasis and Thrombosis Center, Hospital of Cremona, Cremona, Italy
| | - Angelo Pan
- Department of Infectious Disease, Hospital of Cremona, Cremona, Italy
| | - Fabio De Gennaro
- Department of Internal Medicine, Hospital of Cremona, Viale Concordia 1, 26100, Cremona, Italy
| | - Anna Laura Nardecchia
- Department of Internal Medicine, Hospital of Cremona, Viale Concordia 1, 26100, Cremona, Italy
| | | | - Claudia Dellanoce
- Haemostasis and Thrombosis Center, Hospital of Cremona, Cremona, Italy
| | - Samuele Lombi
- Department of Internal Medicine, Hospital of Cremona, Viale Concordia 1, 26100, Cremona, Italy
| | - Maurizio Tala
- Haemostasis and Thrombosis Center, Hospital of Cremona, Cremona, Italy
| | - Vanessa Cancelli
- Haemostasis and Thrombosis Center, Hospital of Cremona, Cremona, Italy
| | - Silvia Zambelli
- Haemostasis and Thrombosis Center, Hospital of Cremona, Cremona, Italy
| | - Giancarlo Bosio
- Department of Pneumology, Hospital of Cremona, Cremona, Italy
| | - Laura Romanini
- Department of Radiology, Hospital of Cremona, Cremona, Italy
| | - Sophie Testa
- Haemostasis and Thrombosis Center, Hospital of Cremona, Cremona, Italy
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Le Roux PY, Robin P, Tromeur C, Davis A, Robert-Ebadi H, Carrier M, Le Gal G, Salaun PY. Ventilation/perfusion SPECT for the diagnosis of pulmonary embolism: A systematic review. J Thromb Haemost 2020; 18:2910-2920. [PMID: 33433051 DOI: 10.1111/jth.15038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/07/2020] [Accepted: 07/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ventilation/perfusion (V/Q) single-photon emission computed tomography (SPECT) has largely replaced conventional planar V/Q scan in nuclear medicine departments for pulmonary embolism (PE) diagnosis. However, the diagnostic performance of the test and its role in the diagnostic management of acute PE are still a matter of debate. OBJECTIVE The primary aim was to establish the diagnostic accuracy (sensitivity, specificity) of V/Q SPECT for PE diagnosis. The secondary aim was to review the clinical outcomes of patients investigated for PE suspicion with a standardized algorithm based on V/Q SPECT. METHODS We conducted a systematic review of diagnostic accuracy and management outcome studies involving patients evaluated with V/Q SPECT for suspected acute PE. We searched from inception to June 23, 2020, MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for diagnostic accuracy studies, randomized controlled trials, and observational cohort studies. The methodological quality and risk of bias of eligible studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and the Risk of Bias in Nonrandomized Studies of Interventions tools. RESULTS We identified 13 accuracy studies and one prospective outcome study. Eleven diagnostic accuracy studies were deemed at high risk of bias in at least two of the four domains of QUADAS-2 evaluation and a further two studies raised concerns regarding the applicability of results, precluding the meta-analysis for accuracy indices. The only prospective cohort study demonstrated critical risk of bias. CONCLUSIONS Although V/Q SPECT has been widely implemented in daily clinical practice, the exact diagnostic performance of V/Q SPECT for PE is still unknown. This systematic review clearly identifies knowledge gaps and sets the agenda for future research.
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Affiliation(s)
- Pierre-Yves Le Roux
- Service de médecine nucléaire, CHRU de Brest, EA3878 (GETBO), Université de Brest, Brest, France
| | - Philippe Robin
- Service de médecine nucléaire, CHRU de Brest, EA3878 (GETBO), Université de Brest, Brest, France
- Department of Medicine, University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Cécile Tromeur
- Département de Médecine Interne et Pneumologie, CHRU de Brest, EA3878 (GETBO), Université de Brest, Brest, France
| | - Alexandra Davis
- Library and Learning Centre, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Helia Robert-Ebadi
- Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Marc Carrier
- Department of Medicine, University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Grégoire Le Gal
- Department of Medicine, University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Centre d'investigation clinique CIC 1412, CHRU de Brest, Brest, France
| | - Pierre-Yves Salaun
- Service de médecine nucléaire, CHRU de Brest, EA3878 (GETBO), Université de Brest, Brest, France
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Cuker A. Development and use of clinical practice guidelines on venous thromboembolism. Transl Res 2020; 225:1-8. [PMID: 32434007 DOI: 10.1016/j.trsl.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/02/2020] [Accepted: 05/05/2020] [Indexed: 11/26/2022]
Abstract
Venous thromboembolism (VTE) is a common disorder associated with substantial morbidity and mortality. It may be encountered by clinicians in virtually all medical specialties and healthcare settings. A large number of clinical practice guidelines (CPGs) on VTE have been published in recent years to support clinicians in delivering high-quality care for the prevention, diagnosis, and management of VTE. Essential elements of CPGs include a guideline panel composed of content experts from multiple disciplines, methodologists, and representatives from key affected groups; a systematic review of evidence; consideration of patient subgroups and patient values and preferences; management of conflicts of interest; an explanation of the relationship between alternative care options and health outcomes; and rating of the quality of evidence and strength of recommendations. These elements enhance the transparency and trustworthiness of CPGs and set them apart from other types of clinical guidance documents. The objectives of this narrative review are to summarize methods used to develop CPGs and to provide guidance to end-users on how to interpret recommendations and apply them in clinical practice. While much of the content of this review applies to CPGs in general, irrespective of disease focus, a number of examples specific to VTE are included.
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Affiliation(s)
- Adam Cuker
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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188
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Current Challenges in Diagnosis of Venous Thromboembolism. J Clin Med 2020; 9:jcm9113509. [PMID: 33138326 PMCID: PMC7693569 DOI: 10.3390/jcm9113509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/17/2020] [Accepted: 10/27/2020] [Indexed: 02/05/2023] Open
Abstract
In patients with suspected venous thromboembolism, the goal is to accurately and rapidly identify those with and without thrombosis. Failure to diagnose venous thromboembolism (VTE) can lead to fatal pulmonary embolism (PE), and unnecessary anticoagulation can cause avoidable bleeding. The adoption of a structured approach to VTE diagnosis, that includes clinical prediction rules, D-dimer testing and non-invasive imaging modalities, has enabled rapid, cost-effective and accurate VTE diagnosis, but problems still persist. First, with increased reliance on imaging and widespread use of sensitive multidetector computed tomography (CT) scanners, there is a potential for overdiagnosis of VTE. Second, the optimal strategy for diagnosing recurrent leg deep venous thrombosis remains unclear as is that for venous thrombosis at unusual sites. Third, the conventional diagnostic approach is inefficient in that it is unable to exclude VTE in high-risk patients. In this review, we outline pragmatic approaches for the clinician faced with difficult VTE diagnostic cases. In addition to discussing the principles of the current diagnostic framework, we explore the diagnostic approach to recurrent VTE, isolated distal deep-vein thrombosis (DVT), pregnancy associated VTE, subsegmental PE, and VTE diagnosis in complex medical patients (including those with impaired renal function).
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189
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Safety of a strategy combining D-dimer testing and whole-leg ultrasonography to rule out deep vein thrombosis. Blood Adv 2020; 4:5002-5010. [PMID: 33057634 DOI: 10.1182/bloodadvances.2020002173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/23/2020] [Indexed: 11/20/2022] Open
Abstract
Guidelines for the diagnostic workup of deep vein thrombosis (DVT) recommend assessing the clinical pretest probability before proceeding to D-dimer testing and/or compression ultrasonography (CUS) if the patient has high pretest probability or positive D-dimer. Referring only patients with positive D-dimer for whole-leg CUS irrespective of pretest probability may simplify the workup of DVT. In this prospective management outcome study, we assessed the safety of such a strategy. We included consecutive outpatients referred to the Emergency Department at Østfold Hospital, Norway, with suspected DVT between February 2015 and November 2018. STA-Liatest D-Di Plus D-dimer was analyzed for all patients, and only patients with levels ≥0.5 µg/mL were referred for CUS. All patients with negative D-dimer or negative CUS were followed for 3 months to assess the venous thromboembolic rate. One thousand three hundred ninety-seven patients were included. Median age was 64 years (interquartile range, 52-73 years), and 770 patients (55%) were female. D-dimer was negative in 415 patients (29.7%) and positive in 982 patients (70.3%). DVT was diagnosed in 277 patients (19.8%). Six patients in whom DVT was ruled out at baseline were diagnosed with DVT within 3 months of follow-up for a thromboembolic rate of 0.5% (95% confidence interval, 0.2-1.2). A simple diagnostic approach with initial stand-alone D-dimer followed by a single whole-leg CUS in patients with positive D-dimer safely ruled out DVT. We consider this strategy to be a valuable alternative to the conventional workup of DVT in outpatients. This trial was registered at www.clinicaltrials.gov as #NCT02486445.
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Abstract
Focusing on the current state of the art, this article (a) describes recent advances in the understanding of the pathogenesis of venous thromboembolism (VTE), (b) discusses current approaches for the prevention, diagnosis and treatment of VTE, (c) outlines the role of aspirin for VTE prevention and treatment, and (d) highlights the unmet needs in VTE management and describes novel approaches to address them.
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Affiliation(s)
- Noel C Chan
- Thrombosis and Atherosclerosis Research Institute and McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey I Weitz
- Thrombosis and Atherosclerosis Research Institute and McMaster University, Hamilton, Ontario, Canada
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191
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Piggott T, Baldeh T, Akl EA, Junek M, Wiercioch W, Schneider R, Langendam MW, Meerpohl J, Brozek JL, Schünemann HJ. Supporting effective participation in health guideline development groups: The Guideline Participant Tool. J Clin Epidemiol 2020; 130:42-48. [PMID: 32987163 DOI: 10.1016/j.jclinepi.2020.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 07/18/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Health guidelines are a key knowledge translation tool produced and used by numerous stakeholders worldwide. Effective participation in guideline development groups or development groups is crucial for guideline success, yet little guidance exists for members of these groups. In this study, we present the Guideline Participant Tool (GPT) to support effective participation in guideline groups, in particular those using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. STUDY DESIGN AND SETTING We used a mixed methods and iterative approach to develop a tool to support guideline participation. We used the findings of a published systematic review to develop an initial list of items for considerations for guideline participants. Then, we refined this list through key informant interviews with guideline chairs, sponsors, and participants. Finally, we validated the GPT in three guideline groups with 26 guideline group members. RESULTS The initial list of items based on 37 articles from the existing systematic review included 15 themes and 61 items for a draft tool. Ten key informant interviews helped us refine the list to include the following themes: selection of participants, guideline group process, and tool format. 26 respondents completed the validation survey from three guideline groups. Refinement of the tool ultimately generated a GPT with 33 items for participant consideration before, during, and in follow-up to guideline group meetings. CONCLUSION The GPT contains helpful guidance for all guideline participants, particularly those without previous guideline experience. Future research should further explore the need for additional tools to support guideline participants and identify and develop strategies for improving guideline members' participation in guideline groups. This work will be incorporated into INGUIDE.org guideline training and credentialing efforts by the Guidelines International Network and McMaster University.
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Affiliation(s)
- Thomas Piggott
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Tejan Baldeh
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Mats Junek
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Rita Schneider
- Department of Nuclear Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Miranda W Langendam
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Amsterdam, Netherlands
| | - Joerg Meerpohl
- Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Jan L Brozek
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada; Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Medicine, McMaster University, Hamilton, Canada.
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192
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Piera Carbonell A, Frías Vargas M, García Vallejo O, García Lerín A, Cabrera Ferriols MA, Peiró Morant J, Carrasco Carrasco E. [COVID-19 and thromboprophylaxis: Recommendations for our clinical practice in Primary Care]. Semergen 2020; 46:479-486. [PMID: 33046353 PMCID: PMC7500906 DOI: 10.1016/j.semerg.2020.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/16/2020] [Accepted: 07/30/2020] [Indexed: 12/14/2022]
Abstract
El nuevo coronavirus (SARS-CoV-2) es el responsable de un síndrome respiratorio agudo severo (SARS). Entre sus manifestaciones puede desarrollar una enfermedad trombótica, tanto venosa como arterial, debido a la inflamación excesiva que afecta al sistema vascular, con activación plaquetaria y disfunción endotelial, entre otros mecanismos. La trombosis se asocia a la infección producida por el SARS- CoV-2, aumentando su gravedad y confiriendo un peor pronóstico. Nuestra actuación como Médicos de Familia puede aportar acciones importantes en el manejo y control de esta severa complicación. Teniendo en cuenta que muchos de nuestros pacientes ya reciben terapia antitrombótica o anticoagulante, el hecho de que puedan desarrollar una infección por COVID-19 tendrá implicaciones para la elección, la dosificación y el control en su tratamiento. En este documento, revisamos, con la información actualmente disponible, la relación entre enfermedad producida por el SARS-CoV-2 y trombosis, así como su manejo con un enfoque centrado en Atención Primaria.
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Affiliation(s)
| | | | | | | | - M A Cabrera Ferriols
- Centro de Salud San Vicente del Raspeig, San Vicente del Raspeig, Alicante, España
| | - J Peiró Morant
- Centro de Salud Ponent, Andratx, Mallorca, Illes Balears, España
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193
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Shi S, Cheng J, Chen H, Zhang Y, Zhao Y, Wang B. Preoperative and intraoperative predictors of deep venous thrombosis in adult patients undergoing craniotomy for brain tumors: A Chinese single-center, retrospective study. Thromb Res 2020; 196:245-250. [PMID: 32919179 DOI: 10.1016/j.thromres.2020.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Brain tumor resection by craniotomy is associated with a high risk of deep vein thrombosis (DVT). This study evaluated the incidence and preoperative and intraoperative risk factors for DVT within 30 days of surgery. METHODS The analysis included: 1) basic clinical variables (patient age, sex, body mass index [BMI], tumor location, and tumor histology); 2) blood test results before operation, such as leukocytes, platelets, and coagulation parameters; and 3) surgical factors (total amount of blood lost, anesthesia mode, and surgery duration). RESULTS Of the 1670 patients, 206 (12.34%) had DVT and nine (0.54%) had both DVT and pulmonary embolism (PE) after surgery. Preoperative and intraoperative factors independently associated with DVT/PE were: older age 46-55 years (odds ratio [OR]: 2.87; 95% confidence interval [CI]: 1.83-4.50; P < 0.001), age 56-65 years (OR: 5.24; 95% CI: 3.27-8.40; P < 0.001), age > 65 years (OR: 6.00; 95% CI: 3.45-10.45; P < 0.001), BMI (OR: 1.03; 95% CI: 1.00-1.05; P = 0.029), activated partial thromboplastin time [APTT] (OR: 0.91; 95% CI: 0.86-0.95; P = 0.000), D-dimer (OR: 1.69; 95% CI: 1.23-2.34; P = 0.001), high-grade glioma (OR: 2.09; 95% CI: 1.28-3.40; P = 0.003), glio-neuronal (OR: 3.30; 95% CI: 1.28-8.47; P = 0.013), craniopharyngioma (OR: 2.16; 95% CI: 1.13-4.10; P = 0.019), and surgery duration (OR: 1.82; 95% CI: 1.27-2.60; P = 0.001). CONCLUSIONS Older age, BMI, preoperative APTT, D-dimer, tumor histology, and surgery duration independently increased the risk of developing postoperative DVT/PE. These findings provide prognostic information that will guide therapies aimed at minimizing the development of DVT/PE during hospitalization.
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Affiliation(s)
- Shuhai Shi
- Department of Critical Care Medicine, Sanbo Brain Hospital, Capital Medical University, 100093 Beijing, China
| | - Jingli Cheng
- Department of Neurosurgery, First Affiliated Hospital of Baotou Medical College, 014010 Baotou, Inner Mongolia Autonomous Region, China
| | - Haoliang Chen
- Department of Medical Information, Sanbo Brain Hospital, Capital Medical University, 100093 Beijing, China
| | - Yunxin Zhang
- Department of Critical Care Medicine, Sanbo Brain Hospital, Capital Medical University, 100093 Beijing, China
| | - Ying Zhao
- Department of Critical Care Medicine, Sanbo Brain Hospital, Capital Medical University, 100093 Beijing, China
| | - Baoguo Wang
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, 100093 Beijing, China.
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194
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Robert-Ebadi H, Righini M. D-dimer: Well beyond diagnosis! JOURNAL DE MEDECINE VASCULAIRE 2020; 45:239-240. [PMID: 32862979 PMCID: PMC7343641 DOI: 10.1016/j.jdmv.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 06/11/2023]
Affiliation(s)
- H Robert-Ebadi
- Division of angiology and hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - M Righini
- Division of angiology and hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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195
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Controversy and Debate Series on Core Outcome Sets: The SOLAR (Standardized Outcomes Linking Across StakeholdeRs) system and hub and spokes model for direct core outcome measures in health care and its relation to GRADE. J Clin Epidemiol 2020; 125:216-221. [DOI: 10.1016/j.jclinepi.2020.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/05/2020] [Indexed: 01/06/2023]
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196
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van Dam LF, Gautam G, Dronkers CEA, Ghanima W, Gleditsch J, von Heijne A, Hofstee HMA, Hovens MMC, Huisman MV, Kolman S, Mairuhu ATA, Nijkeuter M, van de Ree MA, van Rooden CJ, Westerbeek RE, Westerink J, Westerlund E, Kroft LJM, Klok FA. Safety of using the combination of the Wells rule and D-dimer test for excluding acute recurrent ipsilateral deep vein thrombosis. J Thromb Haemost 2020; 18:2341-2348. [PMID: 32613731 PMCID: PMC7497055 DOI: 10.1111/jth.14986] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/20/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The diagnostic accuracy of clinical probability assessment and D-dimer testing for clinically suspected recurrent deep vein thrombosis (DVT) is largely unknown. AIM To evaluate the safety of ruling out acute recurrent DVT based on an unlikely Wells score for DVT and a normal D-dimer test. METHODS This was a predefined endpoint of the Theia study in which the diagnostic accuracy of magnetic resonance direct thrombus imaging in acute recurrent ipsilateral DVT was validated. The Wells rule and D-dimer test, performed as part of the study protocol, were not used for management decisions. The primary outcome of this analysis was the incidence of recurrent DVT at baseline or during 3-month follow-up for patients with an unlikely Wells score and a normal D-dimer test. RESULTS Results of both Wells score and D-dimer tests were available in 231 patients without anticoagulant treatment. The recurrent DVT prevalence was 45% (103/231). Forty-nine patients had an unlikely Wells score and normal D-dimer test, of whom 3 (6.1%, 95% confidence interval [CI] 1.3%-18%) had recurrent DVT at baseline/follow-up, yielding a sensitivity of 97% (95% CI 92%-99%) and specificity of 36% (95% CI 28%-45%). Thus, if clinical probability scoring and D-dimer testing would have been applied, radiological imaging could have been omitted in 21% of patients with a diagnostic failure rate of 6.1%. CONCLUSION By applying clinical probability scoring and D-dimer testing, radiological imaging could be spared in one fifth of patients with suspected recurrent ipsilateral DVT. However, the high failure rate does not support implementation of this strategy in daily practice.
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Affiliation(s)
- Lisette F. van Dam
- Department of Thrombosis and HemostasisLeiden University Medical CenterLeidenthe Netherlands
| | - Gargi Gautam
- Department of Clinical SciencesKarolinska InstituteDanderyd HospitalStockholmSweden
| | - Charlotte E. A. Dronkers
- Department of Thrombosis and HemostasisLeiden University Medical CenterLeidenthe Netherlands
- Department of Internal MedicineHaaglanden Medical CenterThe Haguethe Netherlands
| | - Waleed Ghanima
- Department of Internal MedicineØstfold Hospital TrustØstfoldNorway
- Department of HaematologyInstitute of Clinical MedicineUniversity of OsloOsloNorway
| | | | - Anders von Heijne
- Department of Clinical SciencesKarolinska InstituteDanderyd HospitalStockholmSweden
| | - Herman M. A. Hofstee
- Department of Internal MedicineHaaglanden Medical CenterThe Haguethe Netherlands
| | | | - Menno V. Huisman
- Department of Thrombosis and HemostasisLeiden University Medical CenterLeidenthe Netherlands
| | - Stan Kolman
- Department of Vascular MedicineDiakonessenhuisUtrechtthe Netherlands
| | | | - Mathilde Nijkeuter
- Department of Vascular MedicineUniversity Medical Center UtrechtUtrechtthe Netherlands
| | | | | | | | - Jan Westerink
- Department of Vascular MedicineUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Eli Westerlund
- Department of Clinical SciencesKarolinska InstituteDanderyd HospitalStockholmSweden
| | - Lucia J. M. Kroft
- Department of RadiologyLeiden University Medical CenterLeidenthe Netherlands
| | - Frederikus A. Klok
- Department of Thrombosis and HemostasisLeiden University Medical CenterLeidenthe Netherlands
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Abstract
Pulmonary embolism is a common and potentially fatal cardiovascular disorder that must be promptly diagnosed and treated. The diagnosis, risk assessment, and management of pulmonary embolism have evolved with a better understanding of efficient use of diagnostic and therapeutic options. The use of either clinical probability adjusted or age adjusted D-dimer interpretation has led to a reduction in diagnostic imaging to exclude pulmonary embolism. Direct oral anticoagulation therapies are safe, effective, and convenient treatments for most patients with acute venous thromboembolism, with a lower risk of bleeding than vitamin K antagonists. These oral therapeutic options have opened up opportunities for safe outpatient management of pulmonary embolism in selected patients. Recent clinical trials exploring the use of systemic thrombolysis in intermediate to high risk pulmonary embolism suggest that this therapy should be reserved for patients with evidence of hemodynamic compromise. The role of low dose systemic or catheter directed thrombolysis in other patient subgroups is uncertain. After a diagnosis of pulmonary embolism, all patients should be assessed for risk of recurrent venous thromboembolism to guide duration of anticoagulation. Patients with a venous thromboembolism associated with a strong, transient, provoking risk factor can safely discontinue anticoagulation after three months of treatment. Patients with an ongoing strong risk factor, such as cancer, or unprovoked events are at increased risk of recurrent events and should be considered for extended treatment. The use of a risk prediction score can help to identify patients with unprovoked venous thromboembolism who can benefit from extended duration therapy. Despite major advances in the management of pulmonary embolism, up to half of patients report chronic functional limitations. Such patients should be screened for chronic thromboembolic pulmonary hypertension, but only a small proportion will have this as the explanation of their symptoms. In the remaining patients, future studies are needed to understand the pathophysiology and explore interventions to improve quality of life.
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Affiliation(s)
- Lisa Duffett
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lana A Castellucci
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Melissa A Forgie
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Yamagata K, Fukuzawa S, Ishibashi-Kanno N, Uchida F, Yanagawa T, Bukawa H. The Association between D-Dimer and Prognosis in the Patients with Oral Cancer. Dent J (Basel) 2020; 8:dj8030084. [PMID: 32756384 PMCID: PMC7558716 DOI: 10.3390/dj8030084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022] Open
Abstract
D-dimer levels are reported to relate with tumor stage, prognosis, and lymph node involvement, as well as overall survival (OS) in patients with solid tumors. The purpose of this study was to investigate association between the value of D-dimer and the prognosis of oral cancer (OC). We designed a retrospective cohort study and enrolled a sample of patients who were diagnosed with OC and treated with surgery and/or radiotherapy. The predictor was the D-dimer and outcome variable was OS. Other variables included age, neutrocyte count, neutrophil lymphocyte ratio (NLR), C-reactive protein (CRP), and management. Differences in OS rate were analyzed by log-rank test. A Cox proportional hazards model was used to adjust for the effects of potential confounders. Differences with a P value less than 0.05 were considered statistically significant. In 88 patients with OC, D-dimer median value for the predicting OS was 0.7 µg/mL. There was a significant difference in OS when patients were stratified according to D-dimer, with an OS rate of 77.8% for patients with low D-dimer (<0.7), and 57.3% with high D-dimer (≥0.7) (p = 0.035). Univariate analyses revealed close correlations between OS and age, neutrocyte count, NLR, CRP, and D-dimer (<0.7 and ≥0.7). Cox multivariate analysis identified management (mainly surgery vs. radiotherapy) (HR 3.274, 95% CI 1.397–7.676; p = 0.006) as independent predictive factors for OS. There was a significant difference in OS when patients were stratified according to D-dimer with low (<0.7) and high D-dimer (≥0.7) (p = 0.035). Though, as a predictive factor, management was associated with OS.
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199
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Elmi G, Rinaldi ER, Domanico A, Aluigi L. Calf deep vein thrombosis – clinical relevance, diagnostic approaches and therapeutic options. VASA 2020; 49:359-366. [DOI: 10.1024/0301-1526/a000869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Summary. Isolated distal deep vein thromboses (IDDVT) represent up to 50 % of legs deep vein thromboses (DVT). However, since their natural history is to date unknown, the need to diagnose and treat them is a matter of debate. The diagnostic strategy based on the assessment of pre-test probability and D-dimer demonstrated a scarse efficiency for IDDVT. The choice between a proximal and a complete ultrasonographic approach should be guided by the clinical context, the local expertise and the patient characteristics. Randomized and observational studies have analyzed the need of therapy and compared different regimens of anticoagulation, with conflicting results. Systematic reviews and meta-analyses tend to support the usefulness of an anticoagulant treatment, even if the optimal dose and duration are not still defined. A careful stratification of the patient’s profile, taking into account risk factors for proximal extension, recurrence and bleeding should address the therapeutic approach, which must always be discussed with an adequately informed patient. Further studies aimed to clarify the natural history of IDDVT, and to assess safety and efficacy of lower intensity and shorter duration protocols are urgently needed.
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Affiliation(s)
- Giovanna Elmi
- Medical Department, Ultrasound Program, Maggiore Hospital, Azienda USL of Bologna, Italy
| | - Elisa Rebecca Rinaldi
- Medical Department, Ultrasound Program, Maggiore Hospital, Azienda USL of Bologna, Italy
| | - Andrea Domanico
- Medical Department, Ultrasound Program, Maggiore Hospital, Azienda USL of Bologna, Italy
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Li J, Wang D, Wang W, Jia J, Kang K, Zhang J, Zhao X. In-hospital venous thromboembolism is associated with poor outcome in patients with spontaneous intracerebral hemorrhage: A multicenter, prospective study. J Stroke Cerebrovasc Dis 2020; 29:104958. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.104958] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022] Open
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