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Di Felice G, D’Alessandro A, Pastore A, Mariani M, Fintini D, Aureli A, Pezzi S, Montemari AL, Rocco BB, Borseti A, Onetti Muda A, Manco M, Porzio O. Plasminogen Activator Inhibitor-1 and Vitamin D Association in the Overweight and Obese Pediatric Population. Nutrients 2023; 15:3717. [PMID: 37686748 PMCID: PMC10489928 DOI: 10.3390/nu15173717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Childhood overweight and obesity have been described by the World Health Organization as noncommunicable diseases and among the greatest public health threats since they have reached epidemic proportions. A child with obesity risks becoming an adult with obesity and developing metabolic and hemostatic disorders which are the basis for the development of coronary heart diseases. Recently, a number of clinical reports have demonstrated that both an increase in plasminogen activator inhibitor-1 (PAI-1) and a deficiency in 25OH-vitamin D3 (VD) are associated with an increase in thrombotic episodes. METHODS PAI-1 and VD levels were measured in 259 clinically overweight and obese children aged between 2 and 18 years enrolled in the Nutritional Education Program of the Bambino Gesù Children's Hospital and Research Institute of Rome (Italy) and 80 normal-weight subjects. RESULTS We observed increased HOMA-IR, PAI-1, and other inflammation indices associated with decreased VD levels when compared to normal-weight children. CONCLUSIONS Our results demonstrated that overweight and obesity are correlated with higher levels of the inflammation index. Moreover, our patients show high PAI-1 and low VD levels, confirming the high thrombotic risk in our pediatric population.
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Affiliation(s)
- Giovina Di Felice
- Clinical Laboratory Unit, IRCCS “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy
| | | | - Anna Pastore
- Research Area of Management Innovations, Diagnostics and Clinical Pathways, IRCCS “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy
| | - Michela Mariani
- Endocrinology Unit, University Pediatric Clinical Department, IRCCS “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy
| | - Danilo Fintini
- Endocrinology Unit, University Pediatric Clinical Department, IRCCS “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy
| | - Alessia Aureli
- Endocrinology Unit, University Pediatric Clinical Department, IRCCS “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy
| | - Simona Pezzi
- Clinical Laboratory Unit, IRCCS “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy
| | - Anna Lisa Montemari
- Clinical Laboratory Unit, IRCCS “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy
| | | | - Andrea Borseti
- Clinical Laboratory Unit, IRCCS “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy
| | - Andrea Onetti Muda
- Research Area of Management Innovations, Diagnostics and Clinical Pathways, IRCCS “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy
| | - Melania Manco
- Research Unit of Multifactorial and Complexes Phenotype Diseases, IRCCS “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy
| | - Ottavia Porzio
- Clinical Laboratory Unit, IRCCS “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy
- Department of Experimental Medicine, Tor Vergata University, 00133 Rome, Italy
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Upreti P, Gongati SR, Pandey N, Saad M, Vittorio T. Exploring the Causal Relationship Between Arterial and Venous Thromboembolism: A Case Series With Review of Literature. Cureus 2023; 15:e37660. [PMID: 37214035 PMCID: PMC10198765 DOI: 10.7759/cureus.37660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/23/2023] Open
Abstract
Venous thromboembolism (VTE) occurs due to venous stasis or low flow state within the blood vessels, resulting in subsequent fibrin and platelet aggregation leading to thrombosis. Arterial thrombosis affects various arteries including coronaries and is primarily due to platelet aggregation with little fibrin deposition leading to thrombosis. Although both arterial and venous thrombosis are considered as separate entities, some studies have suggested an association between them despite having distinctive causative factors. We retrospectively reviewed patients at our institution who were admitted with acute coronary syndrome (ACS) and underwent cardiac catheterization over a decade between 2009 and 2020 to look for patients who had both venous thromboembolic events and ACS. Here, we report a case series of three such patients who were found to have both VTE and coronary arterial thrombosis. However, it is unclear if having one of venous vs arterial clot increases the risk of having other vascular conditions, and further studies are needed to evaluate this hypothesis in the near future.
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Affiliation(s)
- Prakash Upreti
- Internal Medicine, Rochester Regional Health, Rochester, USA
- Internal Medicine, BronxCare Health System, Bronx, USA
| | | | | | - Muhammad Saad
- Cardiology, BronxCare Health System Affiliated with the Icahn School of Medicine at Mount Sinai, Bronx, USA
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Jiang Y, Zhu Y, Xiang Z, Sasmita BR, Wang Y, Ming G, Chen S, Luo S, Huang B. The prognostic value of admission D-dimer level in patients with cardiogenic shock after acute myocardial infarction. Front Cardiovasc Med 2023; 9:1083881. [PMID: 36698952 PMCID: PMC9868698 DOI: 10.3389/fcvm.2022.1083881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Background Shock is associated with the activation of the coagulation and fibrinolytic system, and D-dimer is the degradation product of cross-linked fibrin. However, the prognostic value of D-dimer in patients with cardiogenic shock (CS) after acute myocardial infarction (AMI) remains unclear. Methods We retrospectively analyzed the data of consecutive patients with CS complicating AMI. The primary endpoint was 30-day mortality and the secondary endpoint was the major adverse cardiovascular events (MACEs) including 30-day all-cause mortality, ventricular tachycardia/ventricular fibrillation, atrioventricular block, gastrointestinal hemorrhage, and non-fatal stroke. Restricted cubic spline (RCS) analyses were performed to assess the association between admission D-dimer and outcomes. A multivariable Cox regression model was performed to identify independent risk factors. The risk predictive potency with D-dimer added to the traditional risk scores was evaluated by C-statistics and the net reclassification index. Results Among 218 patients with CS complicating AMI, those who died during the 30-day follow-up presented with worse baseline characteristics and laboratory test results, including a higher level of D-dimer. According to the X-tile program result, the continuous plasma D-dimer level was divided into three gradients. The 30-day all-cause mortality in patients with low, medium, and high levels of D-dimer were 22.4, 53.3, and 86.2%, respectively (p < 0.001 for all). The 30-day incidence of MACEs was 46.3, 77.0, and 89.7%, respectively (p < 0.001). In the multivariable Cox regression model, the trilogy of D-dimer level was an independent risk predictor for 30-day mortality (median D-dimer cohort: HR 1.768, 95% CI 0.982-3.183, p = 0.057; high D-dimer cohort: HR 2.602, 95% CI 1.310-5.168, p = 0.006), a similar result was observed in secondary endpoint events (median D-dimer cohort: HR 2.012, 95% CI 1.329-3.044, p = 0.001; high D-dimer cohort: HR 2.543, 95% CI 1.452-4.453, p = 0.001). The RCS analyses suggested non-linear associations of D-dimer with 30-day mortality. The enrollment of D-dimer improved risk discrimination for all-cause death when combined with the traditional CardShock score (C-index: 0.741 vs. 0.756, p difference = 0.004) and the IABP-SHOCK II score (C-index: 0.732 vs. 0.754, p difference = 0.006), and the GRACE score (C-index: 0.679 vs. 0.715, p difference < 0.001). Similar results were acquired after logarithmic transformed D-dimer was included in the risk score. The improvements in reclassification which were calculated as additional net reclassification index were 7.5, 8.6, and 12.8%, respectively. Conclusion Admission D-dimer level was independently associated with the short-term outcome in patients with CS complicating AMI and addition of D-dimer brought incremental risk prediction value to traditional risk prediction scores.
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Immunothrombosis and the Role of Platelets in Venous Thromboembolic Diseases. Int J Mol Sci 2022; 23:ijms232113176. [PMID: 36361963 PMCID: PMC9656618 DOI: 10.3390/ijms232113176] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 12/05/2022] Open
Abstract
Venous thromboembolism (VTE) is the third leading cardiovascular cause of death and is conventionally treated with anticoagulants that directly antagonize coagulation. However, recent data have demonstrated that also platelets play a crucial role in VTE pathophysiology. In the current review, we outline how platelets are involved during all stages of experimental venous thrombosis. Platelets mediate initiation of the disease by attaching to the vessel wall upon which they mediate leukocyte recruitment. This process is referred to as immunothrombosis, and within this novel concept inflammatory cells such as leukocytes and platelets directly drive the progression of VTE. In addition to their involvement in immunothrombosis, activated platelets can directly drive venous thrombosis by supporting coagulation and secreting procoagulant factors. Furthermore, fibrinolysis and vessel resolution are (partly) mediated by platelets. Finally, we summarize how conventional antiplatelet therapy can prevent experimental venous thrombosis and impacts (recurrent) VTE in humans.
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Sykora D, Firth C, Girardo M, Bhatt S, Tseng A, Chamberlain A, Liedl D, Wennberg P, Shamoun FE. Peripheral artery disease and the risk of venous thromboembolism. VASA 2022; 51:365-371. [DOI: 10.1024/0301-1526/a001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Summary: Background: Peripheral artery disease (PAD) impacts 3–12% of patients worldwide and is characterized by endothelial dysfunction and inflammatory pathways which are also common to venous thromboembolism (VTE), but there is a paucity of evidence regarding VTE risk in PAD patients. We investigated whether PAD is an independent risk factor for VTE. Patients and methods: We reviewed medical records of patients undergoing ABI studies at Mayo Clinic from 01/1996-02/2020. We classified patients by ABI (low [<1.0], normal [1.0–1.4], or elevated [>1.4]), as well as by specific low ABI subgroup: severely reduced (ABI: 0.00–0.39), moderately reduced (0.40–0.69), mildly reduced (0.70–0.90), and borderline reduced (0.91–0.99). The primary outcome was incident VTE event (acute lower extremity deep vein thrombosis or pulmonary embolism) after ABI measurement. Multivariable Cox proportional regression was used to calculate hazard ratios (HR) with 95% confidence intervals (CI) after adjusting for age, sex, active smoking, cancer, previous VTE, thrombophilia, anticoagulation, and revascularization. Results: 39,834 unique patients (mean age 66.3±14.3 years, median follow-up 34 months) were identified. 2,305 VTE events occurred in patients without PAD (13.0%), 2,218 in low ABI patients (13.0%), and 751 in elevated ABI patients (14.8%). After risk factor adjustment, VTE risk was modestly increased for PAD overall (HR: 1.12, 95% CI [1.06, 1.18]), including low ABI (HR: 1.11, 95% CI [1.04, 1.18]) and elevated ABI groups (HR: 1.15, 95% CI [1.04, 1.26]), compared to patients without PAD. The greatest VTE risk was in severely low ABI patients (HR: 1.46, 95% CI [1.31, 1.64]). Conclusions: In a large longitudinal cohort, we present strong clinical evidence of PAD, with low and elevated ABI, as an independent VTE risk factor, with the highest risk seen in patients with severely low ABI. Continued research is required to further investigate this relationship and its intersection with functional performance status to optimize VTE risk reduction or anticoagulation strategies in the PAD population.
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Affiliation(s)
- Daniel Sykora
- Mayo Clinic School of Graduate Medical Education, Rochester, MN, USA
| | - Christine Firth
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ, USA
| | - Marlene Girardo
- Department of Biomedical Statistics and Informatics, Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ, USA
| | - Shubhang Bhatt
- Mayo Clinic School of Graduate Medical Education, Scottsdale, AZ, USA
| | - Andrew Tseng
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - David Liedl
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Paul Wennberg
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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Gan Y, Zhao Y, Li G, Ye H, Zhou Y, Hou C, Wang L, Guo J, Li C. Risk Factors and Outcomes of Acute Myocardial Infarction in a Cohort of Antiphospholipid Syndrome. Front Cardiovasc Med 2022; 9:871011. [PMID: 35865377 PMCID: PMC9294316 DOI: 10.3389/fcvm.2022.871011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Antiphospholipid syndrome (APS) is a disorder associated with thromboembolic diseases, including acute myocardial infarction (AMI). Given that AMI is a relatively common condition with poor prognostic features, identification of risk factors for AMI in APS is important. Methods A retrospective cohort study was performed consisting of 332 patients with APS, and 239 patients with thrombotic APS were finally included. Patients were followed up in the outpatient department for 5 years. Clinical data and laboratory parameters were analyzed to identify the risk factors for AMI in APS. The primary and secondary clinical outcomes were all-cause mortality and recurrence of thrombosis, respectively. Results AMI was observed in 12.1% (29/239) of patients with APS. Compared to patients without AMI, patients with AMI had multiple organ thrombosis (55.1 vs. 34.3%, p = 0.029), recurrent thrombosis (58.6 vs. 34.3%, p = 0.011), a higher incidence of atherosclerosis (62.1 vs. 23.8%, p < 0.001), higher neutrophil count (×109/L) [4.68 (3.25, 8.17) vs. 3.71 (2.64, 5.80), p = 0.036], longer QT interval (ms) [438 ms (423, 454) vs. 425 ms (410, 446), p = 0.016], and fewer venous thrombosis events (27.6 vs. 63.3%, p < 0.001). Multivariate logistic regression analysis (adjusted for age and gender) identified several factors that were positively associated with AMI, including multiple organ thrombosis [odds ratio (OR) 8.862, 95% confidence interval (CI): 1.817–43.212, p = 0.007), atherosclerosis (OR 5.397, 95%CI: 1.943–14.994, p = 0.001), and elevated neutrophil count (>6.3 ×109/L) (OR 3.271, 95%CI: 1.268–8.440, p = 0.014). The venous thrombosis was negatively associated with AMI (OR 0.106, 95%CI: 0.036–0.314, p < 0.001). Kaplan–Meier analysis revealed that the recurrence rates of arterial thrombosis differed significantly between patients with AMI and those without AMI [hazard ratio (HR) = 3.307, p = 0.038]. Conclusion Atherosclerosis, multiple organ thrombosis, an increased number of neutrophils are variables positively associated with AMI in APS, and venous thrombosis had a negative association with AMI. AMI only predicts the subsequent recurrence of arterial thrombosis. These findings suggest that distinct pathophysiological mechanisms may exist and contribute to the development of venous or arterial thrombotic APS.
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Affiliation(s)
- Yuzhou Gan
- Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
- Center of Clinical Immunology, Peking University, Beijing, China
| | - Yawei Zhao
- Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
- Center of Clinical Immunology, Peking University, Beijing, China
- Department of Rheumatology and Immunology, Luohe Central Hospital, Luohe, China
| | - Gongming Li
- Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
- Center of Clinical Immunology, Peking University, Beijing, China
- Department of Rheumatology, Linyi Traditional Chinese Medicine Hospital, Linyi, China
| | - Hua Ye
- Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
- Center of Clinical Immunology, Peking University, Beijing, China
| | - Yunshan Zhou
- Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
- Center of Clinical Immunology, Peking University, Beijing, China
| | - Chang Hou
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Lan Wang
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Jianping Guo
- Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
- Center of Clinical Immunology, Peking University, Beijing, China
| | - Chun Li
- Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
- Center of Clinical Immunology, Peking University, Beijing, China
- *Correspondence: Chun Li
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Hess CN, Szarek M, Anand SS, Bauersachs RM, Patel MR, Debus ES, Nehler MR, Capell WH, Beckman JA, Piazza G, Henkin S, Bura-Rivière A, Lawall H, Roztocil K, Hsia J, Muehlhofer E, Berkowitz SD, Haskell LP, Bonaca MP. Rivaroxaban and Risk of Venous Thromboembolism in Patients With Symptomatic Peripheral Artery Disease After Lower Extremity Revascularization. JAMA Netw Open 2022; 5:e2215580. [PMID: 35731517 PMCID: PMC9218845 DOI: 10.1001/jamanetworkopen.2022.15580] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Prior studies have observed an association between the burden of atherosclerotic vascular disease and the risk of venous thromboembolism (VTE). The association is not well described in peripheral artery disease (PAD) after lower extremity revascularization (LER). OBJECTIVE To describe the risk of, factors associated with, and outcomes after VTE, as well as the association of low-dose rivaroxaban plus antiplatelet therapy with VTE after LER. DESIGN, SETTING, AND PARTICIPANTS This global, multicenter cohort study used data from the Vascular Outcomes Study of ASA (acetylsalicylic acid) Along With Rivaroxaban in Endovascular or Surgical Limb Revascularization for PAD (VOYAGER PAD) randomized clinical trial, which enrolled patients from 2015 to 2018 with median follow-up of 28 months. Participants included patients with PAD undergoing LER. Patients with an indication for therapeutic anticoagulation were excluded. Data were analyzed from September 2020 to September 2021. EXPOSURE Randomization to rivaroxaban 2.5 mg twice daily or placebo on a background of aspirin 100 mg daily; short-term clopidogrel was used at the discretion of the treating physician. MAIN OUTCOMES AND MEASURES Symptomatic VTE was a prespecified secondary outcome and prospectively collected. RESULTS Among 6564 patients (median [IQR] age, 67 [61-73] years; 4860 [74.0%] men), 66 patients had at least 1 VTE. The 3-year rate of VTE in patients receiving placebo was 1.7%, and the pattern of risk was linear (year 1: 0.5%; year 2: 1.1%). After multivariable modeling, weight (hazard ratio [HR], 3.04; 95% CI, 1.09-8.43), hypertension (HR, 2.11; 95% CI, 0.91-4.89), prior amputation (HR, 2.07; 95% CI, 0.95-4.53), and older age (HR, 1.81; 95% CI, 1.06-3.11) were associated with increased risk of VTE. VTE was associated with risk of subsequent mortality (HR, 7.22; 95% CI, 4.66-11.19). Compared with aspirin alone, rivaroxaban plus aspirin was associated with lower VTE risk (HR, 0.61; 95% CI, 0.37-0.998; P = .047), with benefit apparent early and sustained over time. This association was not modified by use of clopidogrel at randomization (without clopidogrel: HR, 0.55; 95% CI, 0.29-1.07; with clopidogrel: HR, 0.69; 95% CI, 0.32-1.48; P for interaction = .67). CONCLUSIONS AND RELEVANCE In this cohort study, there was continuous risk for VTE after LER in patients with PAD, with greater risk in patients who were older and had obesity and those with more severe PAD, as reflected by prior amputation. Low-dose rivaroxaban plus aspirin was associated with lower VTE risk compared with aspirin alone, with benefits apparent early and continued over time. The spectrum of venous and arterial thrombotic events and overall benefits of more potent antithrombotic strategies for prevention should be considered after LER for PAD.
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Affiliation(s)
- Connie N. Hess
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora
- CPC Clinical Research, Aurora, Colorado
| | - Michael Szarek
- CPC Clinical Research, Aurora, Colorado
- The State University of New York Downstate Health Sciences University, Brooklyn
| | - Sonia S. Anand
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | - Rupert M. Bauersachs
- Department of Vascular Medicine, Klinikum Darmstadt, Darmstadt, and Center for Thrombosis and Hemostasis, University of Mainz, Mainz, Germany
| | - Manesh R. Patel
- Duke Clinical Research Institute, Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - E. Sebastian Debus
- Department of Vascular Medicine, Vascular Surgery–Angiology–Endovascular Therapy, University of Hamburg-Eppendorf, Hamburg, Germany
| | - Mark R. Nehler
- CPC Clinical Research, Aurora, Colorado
- University of Colorado School of Medicine, Department of Surgery, Aurora
| | - Warren H. Capell
- CPC Clinical Research, Aurora, Colorado
- Division of Endocrinology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Joshua A. Beckman
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gregory Piazza
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stanislav Henkin
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Holger Lawall
- Praxis für Herzkreislaufkrankheiten und Akademie für Gefäßkrankheiten, Ettlingen, Germany
| | - Karel Roztocil
- Department of Transplantational Surgery, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Judith Hsia
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora
- CPC Clinical Research, Aurora, Colorado
| | | | - Scott D. Berkowitz
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora
- CPC Clinical Research, Aurora, Colorado
- Division of Hematology, Department of Medicine, University of Colorado School of Medicine, Aurora
| | | | - Marc P. Bonaca
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora
- CPC Clinical Research, Aurora, Colorado
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Bereczky Z, Gindele R, Fiatal S, Speker M, Miklós T, Balogh L, Mezei Z, Szabó Z, Ádány R. Age and Origin of the Founder Antithrombin Budapest 3 (p.Leu131Phe) Mutation; Its High Prevalence in the Roma Population and Its Association With Cardiovascular Diseases. Front Cardiovasc Med 2021; 7:617711. [PMID: 33614741 PMCID: PMC7892435 DOI: 10.3389/fcvm.2020.617711] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/22/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Antithrombin (AT) is one of the most important regulator of hemostasis. AT Budapest 3 (ATBp3) is a prevalent type II heparin-binding site (IIHBS) deficiency due to founder effect. Thrombosis is a complex disease including arterial (ATE) and venous thrombotic events (VTE) and the Roma population, the largest ethnic minority in Europe has increased susceptibility to these diseases partly due to their unfavorable genetic load. We aimed to calculate the age and origin of ATBp3 and to explore whether the frequency of it is higher in the Roma population as compared with the general population from the corresponding geographical area. We investigated the association of ATBp3 with thrombotic events in well-defined patients' populations in order to refine the recommendation when testing for ATBp3 is useful. Methods and Results: Prevalence of ATBp3, investigated in large samples (n = 1,000 and 1,185 for general Hungarian and Roma populations, respectively) was considerably high, almost 3%, among Roma and the founder effect was confirmed in their samples, while it was absent in the Hungarian general population. Age of ATBp3—as calculated by analysis of 8 short tandem repeat sequences surrounding SERPINC1—was dated back to XVII Century, when Roma migration in Central and Eastern Europe occurred. In our IIHBS cohort (n = 230), VTE was registered in almost all ATBp3 homozygotes (93%) and in 44% of heterozygotes. ATE occurred with lower frequency in ATBp3 (around 6%); it was rather associated with AT Basel (44%). All patients with ATE were young at the time of diagnosis. Upon investigating consecutive young (<40 years) patients with ATE (n = 92) and VTE (n = 110), the presence of ATBp3 was remarkable. Conclusions: ATBp3, a 400-year-old founder mutation is prevalent in Roma population and its Roma origin can reasonably be assumed. By the demonstration of the presence of ATBp3 in ATE patients, we draw the attention to consider type IIHBS AT deficiency in the background of not only VTE but also ATE, especially in selected populations as young patients without advanced atherosclerosis. We recommend including the investigation of ATBp3 as part of thrombosis risk assessment and stratification in Roma individuals.
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Affiliation(s)
- Zsuzsanna Bereczky
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Réka Gindele
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Szilvia Fiatal
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Marianna Speker
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tünde Miklós
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László Balogh
- Department of Cardiology and Cardiovascular Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Mezei
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsuzsanna Szabó
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Róza Ádány
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Magyar Tudományos Akadémia - Debrecen Public Health Research Group, University of Debrecen, Debrecen, Hungary
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Valeriani E, Porreca E, Weitz JI, Schulman S, Candeloro M, Di Nisio M. Impact of concomitant antiplatelet therapy on the efficacy and safety of direct oral anticoagulants for acute venous thromboembolism: Systematic review and meta-analysis. J Thromb Haemost 2020; 18:1661-1671. [PMID: 32202042 DOI: 10.1111/jth.14807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/14/2020] [Accepted: 03/17/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Direct oral anticoagulants (DOACs) are recommended over vitamin K antagonists (VKAs) for the treatment of venous thromboembolism (VTE). Concomitant antiplatelet therapy may potentiate the antithrombotic effects of DOACs. OBJECTIVES We evaluated the impact of concomitant antiplatelet therapy on the efficacy and safety of DOACs. PATIENTS/METHODS MEDLINE, EMBASE, and Clinicaltrial.gov were searched for randomized controlled trials of DOACs for the treatment of acute VTE. The efficacy outcome was symptomatic recurrent VTE and VTE-related death; the primary safety outcome was major bleeding. RESULTS Six randomized controlled trials included 26 924 patients of whom 3550 (13.2%) received concomitant antiplatelet therapy, mainly aspirin (67.7%). Concomitant antiplatelet therapy did not reduce the incidence of recurrent VTE and VTE-related death with any oral anticoagulant (odds ratio [OR] 1.17; 95% confidence interval [CI], 0.92-1.48), with DOACs (OR 1.21; 95% CI, 0.86-1.71), or VKAs alone (OR 1.16; 95% CI, 0.77-1.73). Compared with no antiplatelet therapy, concomitant antiplatelet therapy was associated with a higher risk of major bleeding in patients with any oral anticoagulant (OR 1.79; 95% CI, 1.22-2.63), DOACs (OR 1.89; 95% CI, 1.04-3.44), or VKAs (OR 1.73; 95% CI, 1.16-2.59). In patients receiving concomitant antiplatelet therapy, there were no statistically significant differences in efficacy or safety outcomes with DOACs or VKAs (OR 0.99; 95% CI, 0.64-1.51, and OR 0.68; 95% CI, 0.32-1.45, respectively). CONCLUSIONS Concomitant use of antiplatelet therapy with oral anticoagulants does not appear to affect the risk of recurrent VTE and increases the risk of major bleeding.
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Affiliation(s)
- Emanuele Valeriani
- Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - Ettore Porreca
- Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - Jeffrey I Weitz
- Department of Medicine, McMaster University and the Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
| | - Sam Schulman
- Department of Medicine, McMaster University and the Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Matteo Candeloro
- Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - Marcello Di Nisio
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
- Department of Medicine and Ageing Sciences, "G. D'Annunzio" University, Chieti-Pescara, Italy
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10
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Schwartz GG, Steg PG, Szarek M, Bittner VA, Diaz R, Goodman SG, Kim YU, Jukema JW, Pordy R, Roe MT, White HD, Bhatt DL. Peripheral Artery Disease and Venous Thromboembolic Events After Acute Coronary Syndrome: Role of Lipoprotein(a) and Modification by Alirocumab: Prespecified Analysis of the ODYSSEY OUTCOMES Randomized Clinical Trial. Circulation 2020; 141:1608-1617. [PMID: 32223446 PMCID: PMC7242174 DOI: 10.1161/circulationaha.120.046524] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Supplemental Digital Content is available in the text. Patients with acute coronary syndrome are at risk for peripheral artery disease (PAD) events and venous thromboembolism (VTE). PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors reduce lipoprotein(a) and low-density lipoprotein cholesterol (LDL-C) levels. Our objective was to ascertain whether PCSK9 inhibition reduces the risk of PAD events or VTE after acute coronary syndrome, and if such effects are related to levels of lipoprotein(a) or LDL-C.
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Affiliation(s)
- Gregory G Schwartz
- Division of Cardiology, University of Colorado School of Medicine, Aurora (G.G.S.)
| | - Philippe Gabriel Steg
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, France (P.G.S.).,INSERM-1148, Paris, France (P.G.S.)
| | - Michael Szarek
- State University of New York, Downstate School of Public Health, Brooklyn (M.S.)
| | | | - Rafael Diaz
- Estudios Cardiológicos Latinoamérica, Instituto Cardiovascular de Rosario, Argentina (R.D.)
| | - Shaun G Goodman
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (S.G.G.).,St. Michael's Hospital, University of Toronto, ON, Canada (S.G.G.)
| | | | | | | | - Matthew T Roe
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (M.T.R.)
| | - Harvey D White
- Green Lane Cardiovascular Services Auckland City Hospital, New Zealand (H.D.W.)
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
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11
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Xu RG, Ariëns RAS. Insights into the composition of stroke thrombi: heterogeneity and distinct clot areas impact treatment. Haematologica 2020; 105:257-259. [PMID: 32005654 DOI: 10.3324/haematol.2019.238816] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Rui-Gang Xu
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Robert A S Ariëns
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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12
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Incidence of major adverse cardiovascular events among patients with provoked and unprovoked venous thromboembolism: Findings from the Registro Informatizado de Enfermedad Tromboembólica Registry. J Vasc Surg Venous Lymphat Disord 2019; 8:353-359.e1. [PMID: 31784355 DOI: 10.1016/j.jvsv.2019.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/12/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Overlap exists between the risk factors for coronary artery disease and venous thromboembolism (VTE). However, a paucity of data is available on the incidence of major acute cardiovascular events (MACE) and major adverse limb events (MALE) among patients presenting with VTE. Moreover, it is unknown whether the rate of cardiovascular outcomes differs among patients with unprovoked vs provoked VTE. METHODS We analyzed the data from 2009 to 2017 in the Registro Informatizado de Enfermedad Tromboembólica registry, an ongoing, multicenter, international registry of consecutive patients with a diagnosis of objectively confirmed VTE. The query was restricted it to patients with data entry for the arterial outcomes. The baseline prevalence of coronary artery disease risk factors was compared between patients with provoked (ie, immobility, cancer, surgery, travel >6 hours, hormonal causes) and unprovoked VTE. After the initial VTE event, we followed up patients for the composite primary outcome of incident MACE (ie, stroke, myocardial infarction, unstable angina) and/or MALE (ie, major limb events). We used the χ2 test for baseline associations and a Cox proportional hazard for multivariate analysis. We used IBM SPSS, version 24 (IBM Corp, Armonk, NY) for statistical analysis. A P value of <.05 was considered statistically significant. RESULTS We analyzed the data from 41,259 patients with VTE, of whom 22,633 (55.6%) had experienced a provoked VTE. During follow-up, the patients with provoked VTE were more likely to develop MACE or MALE than were patients with unprovoked VTE (hazard ratio [HR], 1.3; 95% confidence interval [CI], 1.1-1.5). The association of arterial events with recent immobility (HR, 1.4; 95% CI, 1.5-12.1) and cancer (HR, 1.7; 95% CI, 1.4-1.9) was strong. After adjusting for multiple conventional cardiovascular risk factors, provoked VTE, compared with unprovoked VTE, was significantly associated with an increased hazard for MACE (HR, 1.4; 95% CI, 1.1-1.7). Cancer remained a significant adjusted predictor for both MACE (HR, 1.7; 95% CI, 1.4-2.1) and MALE (HR, 2.1; 95% CI 1.01-4.6) in those with provoked VTE. CONCLUSIONS Among patients with VTE, provoked cases, specifically those with cancer-associated VTE, have an increased risk of major arterial events.
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13
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Emerging Role of Vitamin D and its Associated Molecules in Pathways Related to Pathogenesis of Thrombosis. Biomolecules 2019; 9:biom9110649. [PMID: 31653092 PMCID: PMC6920963 DOI: 10.3390/biom9110649] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 12/30/2022] Open
Abstract
Vitamin D, besides having an essential role in calcium and bone metabolism, also acts as a mediator of many non-calcemic effects through modulations of several biological responses. Vitamin D exists in its two major forms, vitamin D2, or commonly known as ergocalciferol, and vitamin D3, or commonly known as cholecalciferol. Both of these forms bind to vitamin D-binding protein to get transported to all vital target organs, where it serves as a natural ligand to vitamin D receptors for enabling their biological actions. Clinical reports corroborating vitamin D deficiency with an increase in thrombotic episodes implicate the role of vitamin D and its associated molecule in the regulation of thrombosis-related pathways. Thrombosis is the formation and propagation of a blood clot, known as thrombus. It can occur either in the arterial or the venous system resulting in many severe complications, including myocardial infarction, stroke, ischemia, and venous thromboembolism. Vitamin D, directly or indirectly, controls the expression of several genes responsible for the regulation of cellular proliferation, differentiation, apoptosis, and angiogenesis. All of these are the processes of potential relevance to thrombotic disorders. This review, thus, discussed the effects of vitamin D on pathways involved in thrombosis, such as hemostatic process, inflammatory pathway, and endothelial cell activation, with a focus on the molecular mechanisms associated with them.
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14
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Simes J, Robledo KP, White HD, Espinoza D, Stewart RA, Sullivan DR, Zeller T, Hague W, Nestel PJ, Glasziou PP, Keech AC, Elliott J, Blankenberg S, Tonkin AM. D-Dimer Predicts Long-Term Cause-Specific Mortality, Cardiovascular Events, and Cancer in Patients With Stable Coronary Heart Disease: LIPID Study. Circulation 2019; 138:712-723. [PMID: 29367425 DOI: 10.1161/circulationaha.117.029901] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND D-dimer, a degradation product of cross-linked fibrin, is a marker for hypercoagulability and thrombotic events. Moderately elevated levels of D-dimer are associated with the risk of venous and arterial events in patients with vascular disease. We assessed the role of D-dimer levels in predicting long-term vascular outcomes, cause-specific mortality, and new cancers in the LIPID trial (Long-Term Intervention with Pravastatin in Ischaemic Disease) in the context of other risk factors. METHODS LIPID randomized patients to placebo or pravastatin 40 mg/d 5 to 38 months after myocardial infarction or unstable angina. D-dimer levels were measured at baseline and at 1 year. Median follow-up was 6.0 years during the trial and 16 years in total. RESULTS Baseline D-dimer levels for 7863 patients were grouped by quartile (≤112, 112-173, 173-273, >273 ng/mL). Higher levels were associated with older age, female sex, history of hypertension, poor renal function, and elevated levels of B-natriuretic peptide, high-sensitivity C-reactive protein, and sensitive troponin I (each P<0.001). During the first 6 years, after adjustment for up to 30 additional risk factors, higher D-dimer was associated with a significantly increased risk of a major coronary event (quartile 4 versus 1: hazard ratio [HR], 1.45; 95% confidence interval, 1.21-1.74), major cardiovascular disease (CVD) event (HR, 1.45; 95% confidence interval, 1.23-1.71) and venous thromboembolism (HR, 4.03; 95% confidence interval, 2.31-7.03; each P<0.001). During the 16 years overall, higher D-dimer was an independent predictor of all-cause mortality (HR, 1.59), CVD mortality (HR, 1.61), cancer mortality (HR, 1.54), and non-CVD noncancer mortality (HR, 1.57; each P<0.001), remaining significant for deaths resulting from each cause occurring beyond 10 years of follow-up (each P≤0.01). Higher D-dimer also independently predicted an increase in cancer incidence (HR, 1.16; P=0.02).The D-dimer level increased the net reclassification index for all-cause mortality by 4.0 and venous thromboembolism by 13.6. CONCLUSIONS D-dimer levels predict long-term risk of arterial and venous events, CVD mortality, and non-CVD noncancer mortality independent of other risk factors. D-dimer is also a significant predictor of cancer incidence and mortality. These results support an association of D-dimer with fatal events across multiple diseases and demonstrate that this link extends beyond 10 years' follow-up.
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Affiliation(s)
- John Simes
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (J.S., K.P.R., D.E., W.H., A.C.K.)
| | - Kristy P Robledo
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (J.S., K.P.R., D.E., W.H., A.C.K.)
| | - Harvey D White
- Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand (H.D.W., R.A.S.)
| | - David Espinoza
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (J.S., K.P.R., D.E., W.H., A.C.K.)
| | - Ralph A Stewart
- Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand (H.D.W., R.A.S.)
| | | | - Tanja Zeller
- University Heart Centre Hamburg, Germany (T.Z., S.B.)
| | - Wendy Hague
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (J.S., K.P.R., D.E., W.H., A.C.K.)
| | - Paul J Nestel
- Baker Heart and Diabetes Institute, Melbourne, Australia (P.J.N.)
| | - Paul P Glasziou
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia (P.P.G.)
| | - Anthony C Keech
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (J.S., K.P.R., D.E., W.H., A.C.K.)
| | - John Elliott
- Department of Medicine, University of Otago, Christchurch, New Zealand (J.E.)
| | | | - Andrew M Tonkin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (A.M.T.)
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15
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De Stefano V, Rossi E, Carobbio A, Ghirardi A, Betti S, Finazzi G, Vannucchi AM, Barbui T. Hydroxyurea prevents arterial and late venous thrombotic recurrences in patients with myeloproliferative neoplasms but fails in the splanchnic venous district. Pooled analysis of 1500 cases. Blood Cancer J 2018; 8:112. [PMID: 30420642 PMCID: PMC6232117 DOI: 10.1038/s41408-018-0151-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/19/2018] [Accepted: 10/25/2018] [Indexed: 12/25/2022] Open
Abstract
We collected 1500 patients with myeloproliferative neoplasms (MPN) and arterial or venous thrombosis (935/565), pooling three independent cohorts previously reported. Long-term treatment with antiplatelet drugs or vitamin K-antagonists (VKA) was given to 1391 (92.7%) patients; 975 (65%) patients received hydroxyurea (HU). We recorded 348 recurrences (venous in 142 cases) over 6075 patient-years, with an incidence rate of 5.7 per 100 pt-years (95% CI 5.1-6.4). The site of the first thrombosis predicted the site of recurrence. Independent factors influencing the rate of novel arterial thrombosis were HU (HR 0.67, 95% CI 0.46-0.98), antiplatelet treatment (HR 0.54, 95% CI 0.35-0.82), and VKA (HR 0.58, 95% CI 0.35-0.96). On the contrary, the recurrence of venous thromboses was significantly diminished only by VKA (HR 0.60, 95% CI 0.37-0.95), while HU prevented late but not early recurrences after venous thrombosis at common sites. Of note, we failed to demonstrate a positive effect of HU in the prevention of recurrent splanchnic vein thrombosis. In conclusion, in MPN patients, HU plays a role in the prevention of arterial thrombosis, together with aspirin and VKA, whereas its action in the prevention of recurrent venous thrombosis is uncertain. Such findings call for future studies to optimize and personalize secondary prophylaxis after MPN-related thrombosis.
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Affiliation(s)
- Valerio De Stefano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Elena Rossi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Arianna Ghirardi
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Silvia Betti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Guido Finazzi
- Division of Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Alessandro M Vannucchi
- CRIMM-Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliera Universitaria Careggi, and Department Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Tiziano Barbui
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
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17
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Sznajder M, Dzikowska-Diduch O, Kurnicka K, Roik M, Wretowski D, Pruszczyk P, Kostrubiec M. Increased systemic arterial stiffness in patients with chronic thromboembolic pulmonary hypertension. Cardiol J 2018; 27:742-748. [PMID: 30234892 DOI: 10.5603/cj.a2018.0109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 09/13/2018] [Accepted: 03/18/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of venous thromboembolism (VTE) resulting from non-dissolving thromboemboli in the pulmonary arteries. Previous observations indicate a higher prevalence of atherosclerosis and cardiovascular risk factors in patients with VTE and CTEPH. The purpose of the present study was to evaluate the arterial stiffening assessed by pulse wave velocity (PWV), a marker of arterial stiffness, in CTEPH patients in comparison with a matched control group (CG). METHODS The study group consisted of 26 CTEPH patients (9 male and 17 female, age 69 ± 10 years) and 22 CG (10 male, 12 female, age 67 ± 8 years). In all subjects a physical examination, carotid-femoral PWV and transthoracic echocardiography were performed. Right heart catheterization was done in all CTEPH. RESULTS Chronic tromboembolic pulmonary hypertension patients had significantly higher PWV than CG (10.3 ± 2.5 m/s vs. 9 ± 1.3 m/s, p < 0.05), even though systolic blood pressure was higher in CG (120 ± 11 vs. 132 ± 14 mmHg, p = 0.002). PWV correlated only with age and pulmonary vascular resistance (PVR) in CTEPH (r = 0.45, p = 0.03 and r = 0.43, p = 0.03, respectively). Arterial stiffening defined as PWV > 10 m/s was found in 11 (42%) CTEPH patients and in 5 (23%) cases from CG (p = 0.13). CTEPH patients with PWV > 10 m/s were older (74 ± 8 vs. 66 ± 10 years, p < 0.05), had decreased oxygen saturation (SaO2 89 [73-96]% vs. 96 [85-98]%, p < 0.01) and tended to have higher PVR (8.1 [3.1-14.0] vs. 5.2 [3.1-12.7] HRU, p = 0.10). CONCLUSIONS Arterial stiffness, assessed with PWV, is increased in CTEPH. The elevated PWV is associated with older age, lower SaO2 and higher PVR in CTEPH.
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Affiliation(s)
- Monika Sznajder
- Department of Internal Medicine and Cardiology with Venous Thromboembolism Center, Medical University of Warsaw, 4 Lindleya St, 02-005 Warsaw, Poland
| | - Olga Dzikowska-Diduch
- Department of Internal Medicine and Cardiology with Venous Thromboembolism Center, Medical University of Warsaw, 4 Lindleya St, 02-005 Warsaw, Poland
| | - Katarzyna Kurnicka
- Department of Internal Medicine and Cardiology with Venous Thromboembolism Center, Medical University of Warsaw, 4 Lindleya St, 02-005 Warsaw, Poland
| | - Marek Roik
- Department of Internal Medicine and Cardiology with Venous Thromboembolism Center, Medical University of Warsaw, 4 Lindleya St, 02-005 Warsaw, Poland
| | - Dominik Wretowski
- Department of Internal Medicine and Cardiology with Venous Thromboembolism Center, Medical University of Warsaw, 4 Lindleya St, 02-005 Warsaw, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology with Venous Thromboembolism Center, Medical University of Warsaw, 4 Lindleya St, 02-005 Warsaw, Poland
| | - Maciej Kostrubiec
- Department of Internal Medicine and Cardiology with Venous Thromboembolism Center, Medical University of Warsaw, 4 Lindleya St, 02-005 Warsaw, Poland.
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Affiliation(s)
- Pavel Poredos
- Department of Vascular Disease, University Medical Centre Ljubljana & The Medical Faculty of The University of Ljubljana, Division of Internal Medicine, Ljubljana, Slovenia
| | - Mateja K. Jezovnik
- Center for Advanced Cardiopulmonary Therapies and Transplantation, Health Science Center at Houston, University of Texas, Houston, TX, USA
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Deguchi H, Navarro S, Payne AB, Elias DJ, Dowling NF, Austin HD, España F, Medina P, Hooper WC, Griffin JH. Low level of the plasma sphingolipid, glucosylceramide, is associated with thrombotic diseases. Res Pract Thromb Haemost 2017; 1:33-40. [PMID: 29202121 PMCID: PMC5703432 DOI: 10.1002/rth2.12018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Essentials Minor abundance plasma lipids, eg, glucosylceramide, can modulate blood coagulation reactions This lipid was measured in plasmas of 1 myocardial infarction and 2 venous thrombosis populations Low plasma glucosylceramide levels were found in each population compared to matched controls Low plasma glucosylceramide levels are associated with venous and arterial thrombosis
Background One previous pilot study suggested the association of low plasma glucosylceramide (GlcCer) levels with venous thrombosis (VTE) risk. Objective We aimed to confirm and evaluate the association of low plasma GlcCer levels with VTE and myocardial infarction (MI) occurrence, respectively. Patients and Methods We evaluated the association of GlcCer in two independent case‐control studies of Caucasian VTE populations (N=210 and 636) and one case‐control study of Caucasian MI patients (N=345). Result Plasma GlcCer levels in VTE patients were lower compared to controls in two independent VTE populations (5.0 vs 5.8 μg/mL, P=.003 for the Scripps registry, and 5.6 vs 6.0 μg/mL, P=.001 for the Valencia registry, respectively). A low plasma GlcCer level (below tenth percentile of controls) was associated with increased VTE occurrence (odds ratio [OR]=3.7 [95% CI, 1.8‐7.9] for Scripps registry and OR=2.1 [95% CI, 1.3‐3.3] for Valencia registry, respectively). For the MI study, the median GlcCer plasma level was lower in MI patients than in controls (4.3 vs 5.6 μg/mL, P<.001), and a low level of GlcCer (below tenth percentile of control) was associated with higher MI occurrence (OR=7.7, [95% CI, 4.3‐13.8]). Conclusion Lower concentration of GlcCer was associated with VTE occurrence in 2 independent studies and also with MI occurrence in 1 study.
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Affiliation(s)
- Hiroshi Deguchi
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - Silvia Navarro
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA.,Haemostasis, Thrombosis, Atherosclerosis and Vascular Biology Research Group, La Fe Medical Research Institute, Valencia, Spain
| | - Amanda B Payne
- Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Division of Blood Disorders, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Darlene J Elias
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA.,Scripps Clinic and Scripps Green Hospital, La Jolla, CA, USA
| | - Nicole F Dowling
- Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Division of Blood Disorders, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Harland D Austin
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Francisco España
- Haemostasis, Thrombosis, Atherosclerosis and Vascular Biology Research Group, La Fe Medical Research Institute, Valencia, Spain
| | - Pilar Medina
- Haemostasis, Thrombosis, Atherosclerosis and Vascular Biology Research Group, La Fe Medical Research Institute, Valencia, Spain
| | - W Craig Hooper
- Division of Blood Disorders, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John H Griffin
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
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20
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Damanti S, Artoni A, Lucchi T, Mannucci PM, Mari D, Bergamaschini L. A thrombotic storm. Intern Emerg Med 2017; 12:69-73. [PMID: 27878662 DOI: 10.1007/s11739-016-1577-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/15/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Sarah Damanti
- Geriatric Unit IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Medical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
| | - Andrea Artoni
- A.Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Tiziano Lucchi
- Geriatric Unit IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pier Mannuccio Mannucci
- A.Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Mari
- Geriatric Unit IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Medical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Luigi Bergamaschini
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milan, Italy
- A.S.P. Pio Albergo Trivulzio, Milan, Italy
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Puurunen MK, Enserro D, Xanthakis V, Larson MG, Benjamin EJ, Tofler GH, Wollert KC, O'Donnell CJ, Vasan RS. Biomarkers for the prediction of venous thromboembolism in the community. Thromb Res 2016; 145:34-9. [DOI: 10.1016/j.thromres.2016.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/24/2016] [Accepted: 07/12/2016] [Indexed: 12/22/2022]
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Puurunen MK, Gona PN, Larson MG, Murabito JM, Magnani JW, O'Donnell CJ. Epidemiology of venous thromboembolism in the Framingham Heart Study. Thromb Res 2016; 145:27-33. [PMID: 27442716 PMCID: PMC5385100 DOI: 10.1016/j.thromres.2016.06.033] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/27/2016] [Accepted: 06/29/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Reports of the crude incidence of venous thromboembolism (VTE) in Western countries vary widely. Data regarding risk factors, incidence and recurrence of VTE from deeply-phenotyped community-based cohort studies are needed. OBJECTIVES To study the incidence, associated mortality, and predisposing factors of VTE in the prospective, longitudinal community-based Framingham Heart Study. PATIENTS/METHODS The study sample consisted of the Framingham Heart Study Original, Offspring, Third Generation, and Omni cohorts (N=9754). Incidence rates (IR) were standardized to the 2000 US population. Cox proportional hazards regression models were used to study risk factor associations. RESULTS During 1995-2014 (total follow-up time 104,091 person-years [median 9.8 (range 0-20) years]), 297 incident VTE events were observed. Age-adjusted IR of VTE was 20.3/10,000 (95% CI 17.9-22.6). Of the events 120 (40%) were pulmonary embolism (PE) and 177 (60%) were deep venous thrombosis (DVT); 29% were unprovoked, 40% provoked, and 31% cancer-related. Cancer-related VTE was associated with high mortality at 30days (24.2%), 1year (66.3%), and 5years (75.6%). In multivariable models, age and obesity, but no other traditional cardiovascular risk factors, were significantly associated with VTE (hazard ratio [HR] per 10-year increase in age 1.69, 95% CI 1.48-1.92; HR for obesity (BMI≥30kg/m(2)) 1.88, 95% CI 1.44-2.45). CONCLUSIONS We provide data on the epidemiology of VTE. VTE is associated with significant mortality, and prognosis after cancer-related VTE is particularly poor. Traditional cardiovascular risk factors beyond age and obesity are not associated with VTE.
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Affiliation(s)
- Marja K Puurunen
- Framingham Heart Study of Boston University School of Medicine and NHLBI, Framingham, MA, USA
| | | | - Martin G Larson
- Framingham Heart Study of Boston University School of Medicine and NHLBI, Framingham, MA, USA; Department of Mathematics and Statistics, Boston University, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Joanne M Murabito
- Framingham Heart Study of Boston University School of Medicine and NHLBI, Framingham, MA, USA; Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Jared W Magnani
- Framingham Heart Study of Boston University School of Medicine and NHLBI, Framingham, MA, USA; Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Christopher J O'Donnell
- Framingham Heart Study of Boston University School of Medicine and NHLBI, Framingham, MA, USA; NHLBI Division of Intramural Research, Bethesda, MD, USA; Cardiology Section, Department of Medicine, Boston Veteran's Administration Healthcare, Boston, MA, USA.
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De Caterina R, D'Ugo E, Libby P. Inflammation and thrombosis - testing the hypothesis with anti-inflammatory drug trials. Thromb Haemost 2016; 116:1012-1021. [PMID: 27535617 DOI: 10.1160/th16-03-0246] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 07/16/2016] [Indexed: 12/17/2022]
Abstract
The hypothesis of atherosclerosis as an inflammatory process has been a leitmotiv in cardiology for the past 20 years, and has now led to the launch of clinical trials aimed at testing whether drugs that primarily target inflammation can reduce cardiovascular events. Inflammation indeed drives all phases of atherosclerosis, from inception, through progression, and ultimately acute thrombotic complications (plaque rupture and probably plaque erosion). Since plaque rupture and erosion cause most acute coronary syndromes, appropriately tuned anti-inflammatory treatments should limit myocardial infarction and cardiovascular death. Beyond interrupting inflammation-related plaque disruption, such treatments might, however, also ameliorate the propensity to thrombosis once the trigger (plaque rupture or erosion) has occurred. Several lines of evidence support this view: experimental data document the role of inflammation in platelet activation, tissue factor-mediated coagulation, hyperfibrinogenaemia, impaired activity of natural anticoagulants (including those expressed by endothelial cells), and reduced fibrinolytic activity. Supporting evidence also derives from the involvement of inflammation in venous thrombosis, a process that commonly occurs in the absence of traditional risk factors for atherosclerosis but is associated with several inflammatory diseases including obesity. Ongoing trials, in addition to evaluating effects on primary outcomes, will afford the opportunity to probe the possibility that anti-inflammatory interventions that yield salutary changes in biomarkers of the thrombotic/fibrinolytic balance also translate into reduction of clinical events.
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Affiliation(s)
- Raffaele De Caterina
- Raffaele De Caterina, MD, PhD, Institute of Cardiology, "G. d'Annunzio" University - Chieti, C/o Ospedale SS. Annunziata, Via dei Vestini, 66013 Chieti, Italy, Tel.: +39 0871 41512, Fax: +39 0871 402817, E-mail:
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Kang BW, Bae JH, Nah DY, Chung JW, Jo BJ, Park JG. Endovascular treatment of acute limb ischemia due to thrombotic occlusion of the suprainguinal artery. KOSIN MEDICAL JOURNAL 2016. [DOI: 10.7180/kmj.2016.31.1.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Acute limb ischemia (ALI) is a serious condition requiring prompt intervention due to a sudden decrease in limb perfusion threatening limb viability. Treatment of ALI depends on the clinical status of the affected limb and patient comorbidities. Surgical therapy has been the historical standard of care for restoring limb perfusion; however, percutaneous endovascular intervention has been shown to be a promising treatment option in selected patients of ALI at high surgical risk. We report on a case of a 75-year-old man with ALI caused by thrombotic occlusion of the suprainguinal artery, successfully treated with endovascular therapy including stent insertion and thrombus aspiration and catheter-directed urokinase infusion in view of the clinical findings and imaging studies.
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Bell EJ, Folsom AR, Lutsey PL, Selvin E, Zakai NA, Cushman M, Alonso A. Diabetes mellitus and venous thromboembolism: A systematic review and meta-analysis. Diabetes Res Clin Pract 2016; 111:10-8. [PMID: 26612139 PMCID: PMC4752919 DOI: 10.1016/j.diabres.2015.10.019] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/21/2015] [Accepted: 10/12/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED Diabetes mellitus (DM) may be a risk factor for venous thromboembolism (VTE) but results are inconsistent. AIM We conducted a systematic review and meta-analysis of epidemiologic studies to quantify the association between DM and VTE. METHODS AND RESULTS We included studies identified in PubMed, Web of Science, and CINAHL through 07/31/2014. We identified 19 studies that met our selection criteria. We pooled RRs using a random-effects model: the pooled RR for the association of DM with VTE was 1.10 (95% CI: 0.94-1.29). Between-study heterogeneity was explored with a forest plot, funnel plot, meta-regression, and a stratified analysis. Between-study heterogeneity was observed and not explained by study design, method of DM assessment, or degree of adjustment for confounding. Sensitivity analyses omitted one study at a time to assess the influence of any single study on the pooled estimate. These analyses indicated that one large study was highly influential; when this study was excluded, the pooled estimate increased and just reached statistical significance: 1.16 (95% CI: 1.01-1.34). CONCLUSIONS This meta-analysis suggests either no association or a modest positive one between DM and VTE in the general population. DM is unlikely to play a major role in VTE development.
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Affiliation(s)
- Elizabeth J Bell
- Division of Epidemiology & Community Health, University of Minnesota, USA.
| | - Aaron R Folsom
- Division of Epidemiology & Community Health, University of Minnesota, USA
| | - Pamela L Lutsey
- Division of Epidemiology & Community Health, University of Minnesota, USA
| | - Elizabeth Selvin
- Division of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Neil A Zakai
- Department of Medicine, Division of Hematology/Oncology, University of Vermont, USA
| | - Mary Cushman
- Department of Medicine, Division of Hematology/Oncology, University of Vermont, USA
| | - Alvaro Alonso
- Division of Epidemiology & Community Health, University of Minnesota, USA
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Carruzzo P, Méan M, Limacher A, Aujesky D, Cornuz J, Clair C. Association between smoking and recurrence of venous thromboembolism and bleeding in elderly patients with past acute venous thromboembolism. Thromb Res 2015; 138:74-79. [PMID: 26688323 DOI: 10.1016/j.thromres.2015.11.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/28/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND While the association between smoking and arterial cardiovascular events has been well established, the association between smoking and venous thromboembolism (VTE) remains controversial. OBJECTIVES To assess the association between smoking and the risk of recurrent VTE and bleeding in patients who have experienced acute VTE. PATIENTS/METHODS This study is part of a prospective Swiss multicenter cohort that included patients aged ≥65years with acute VTE. Three groups were defined according to smoking status: never, former and current smokers. The primary outcome was the time to a first symptomatic, objectively confirmed VTE recurrence. Secondary outcomes were the time to a first major and clinically relevant non-major bleeding. Associations between smoking status and outcomes were analysed using proportional hazard models for the subdistribution of a competing risk of death. RESULTS Among 988 analysed patients, 509 (52%) had never smoked, 403 (41%) were former smokers, and 76 (8%) current smokers. After a median follow-up of 29.6months, we observed a VTE recurrence rate of 4.9 (95% confidence interval [CI] 3.7-6.4) per 100 patient-years for never smokers, 6.6 (95% CI 5.1-8.6) for former smokers, and 5.2 (95% CI 2.6-10.5) for current smokers. Compared to never smokers, we found no association between current smoking and VTE recurrence (adjusted sub-hazard ratio [SHR] 1.05, 95% CI 0.49-2.28), major bleeding (adjusted SHR 0.59, 95% CI 0.25-1.39), and clinically relevant non-major bleeding (adjusted SHR 1.21, 95% CI 0.73-2.02). CONCLUSIONS In this multicentre prospective cohort study, we found no association between smoking status and VTE recurrence or bleeding in elderly patients with VTE.
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Affiliation(s)
- Philippe Carruzzo
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
| | - Marie Méan
- Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland; Department of Internal Medicine, University Hospital, Lausanne, Switzerland
| | - Andreas Limacher
- Clinical Trials Unit Bern, Department of Clinical Research, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland
| | - Jacques Cornuz
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Carole Clair
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
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Mattiuzzi C, Cervellin G, Franchini M, Lippi G. Fish Intake and Venous Thromboembolism: A Systematic Literature Review. Clin Appl Thromb Hemost 2015; 22:309-13. [PMID: 25962392 DOI: 10.1177/1076029615585992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Diet plays an important role in modulating the risk of arterial and venous thrombosis. Several lines of evidence attest that consumption of fish and its compounds, especially omega-3 fatty acids, may be effective to decrease the cardiovascular risk. Since the pathogenesis of arterial and venous thrombosis share some common aspects, we performed a systematic review of published clinical studies that investigated the association between fish intake and venous thrombosis. An electronic search was carried out in Medline, Scopus, and ISI Web of Science using the key words "fish" OR "seafood" AND "venous thromboembolism" OR "deep vein thrombosis" OR "pulmonary embolism", with no language or date restriction. Overall, 6 studies (5 prospective and 1 case-control) were finally identified. In only 1 small case-control study, a larger intake of total fish was found to be negatively associated with the risk of venous thromboembolism. No association was found in 4 large prospective studies, whereas a positive association was observed in the remaining. No substantial difference was also noticed between intake of fatty or lean fish. Taken together, the current epidemiological evidence does not support the existence of a significant effect of total fish consumption on the risk of venous thromboembolism.
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Affiliation(s)
- Camilla Mattiuzzi
- Service of Clinical Governance, General Hospital of Trento, Trento, Italy
| | | | - Massimo Franchini
- Department of Hematology and Transfusion Medicine, C. Poma Hospital, Mantova, Italy
| | - Giuseppe Lippi
- Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma, Parma, Italy
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Wolberg AS, Rosendaal FR, Weitz JI, Jaffer IH, Agnelli G, Baglin T, Mackman N. Venous thrombosis. Nat Rev Dis Primers 2015; 1:15006. [PMID: 27189130 DOI: 10.1038/nrdp.2015.6] [Citation(s) in RCA: 190] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Venous thromboembolism (VTE) encompasses deep-vein thrombosis (DVT) and pulmonary embolism. VTE is the leading cause of lost disability-adjusted life years and the third leading cause of cardiovascular death in the world. DVT leads to post-thrombotic syndrome, whereas pulmonary embolism can cause chronic pulmonary hypertension, both of which reduce quality of life. Genetic and acquired risk factors for thrombosis include non-O blood groups, factor V Leiden mutation, oral contraceptive use, hormone replacement therapy, advanced age, surgery, hospitalization and long-haul travel. A combination of blood stasis, plasma hypercoagulability and endothelial dysfunction is thought to trigger thrombosis, which starts most often in the valve pockets of large veins. Animal studies have revealed pathogenic roles for leukocytes, platelets, tissue factor-positive microvesicles, neutrophil extracellular traps and factors XI and XII. Diagnosis of VTE requires testing and exclusion of other pathologies, and typically involves laboratory measures (such as D-dimer) and diagnostic imaging. VTE is treated with anticoagulants and occasionally with thrombolytics to prevent thrombus extension and to reduce thrombus size. Anticoagulants are also used to reduce recurrence. New therapies with improved safety profiles are needed to prevent and treat venous thrombosis. For an illustrated summary of this Primer, visit: http://go.nature.com/8ZyCuY.
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Affiliation(s)
- Alisa S Wolberg
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, 819 Brinkhous-Bullitt Building, Chapel Hill, North Carolina 27599-7525, USA.,McAllister Heart Institute, University of North Carolina at Chapel Hill, USA
| | - Frits R Rosendaal
- Department of Clinical Epidemiology and Department of Thrombosis and Hemostasis, Leiden University Medical Center, The Netherlands.,K.G. Jensen Thrombosis Research and Expertise Center, University of Tromsø, Norway
| | - Jeffrey I Weitz
- Department of Medicine and Department of Biochemistry and Biomedical Sciences, McMaster University, and Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Iqbal H Jaffer
- Department of Medicine and Department of Biochemistry and Biomedical Sciences, McMaster University, and Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Giancarlo Agnelli
- Division of Internal and Cardiovascular Medicine, Stroke Unit, University of Perugia, Italy
| | - Trevor Baglin
- Department of Haematology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Nigel Mackman
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, 819 Brinkhous-Bullitt Building, Chapel Hill, North Carolina 27599-7525, USA.,McAllister Heart Institute, University of North Carolina at Chapel Hill, USA.,K.G. Jensen Thrombosis Research and Expertise Center, University of Tromsø, Norway.,Department of Medicine, University of North Carolina at Chapel Hill, USA
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Subsequent arterial ischemic events in patients receiving anticoagulant therapy for venous thromboembolism. J Vasc Surg Venous Lymphat Disord 2015; 3:135-41.e1. [PMID: 26993830 DOI: 10.1016/j.jvsv.2014.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 11/03/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Patients with acute venous thromboembolism (VTE) are at increased risk for the development of subsequent arterial ischemic events unrelated to the diagnosis of VTE. Accurate identification of VTE patients at increased risk for ischemic events during the course of anticoagulation may help to select those who would potentially benefit from concomitant therapy with anticoagulants and antiplatelets. METHODS We used the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) Registry to assess the rate and severity of subsequent ischemic events (ie, stroke, myocardial infarction, lower limb amputation, or mesenteric ischemia) appearing during the course of anticoagulant therapy and tried to identify risk factors for these events. RESULTS From February 2009 to March 2014, 23,370 patients were recruited: 12,397 initially presenting with pulmonary embolism (PE) and 10,973 with deep venous thrombosis. During the course of anticoagulation (mean, 9.2 months), 597 patients developed recurrent VTE, 652 bled, 162 had ischemic events (stroke, 86; myocardial infarction, 53; limb amputation, 13; mesenteric ischemia, 11), and 2063 died. Of these, 29 patients died of recurrent PE, 83 of bleeding, and 53 of the ischemic events. On multivariable analysis, cancer (hazard ratio [HR], 1.77; 95% confidence interval [CI], 1.21-2.61), chronic lung disease (HR, 1.54; 95% CI, 1.05-2.26), renal insufficiency (HR, 1.72; 95% CI, 1.25-2.36), anemia (HR, 1.54; 95% CI, 1.11-2.14), prior artery disease (HR, 1.84; 95% CI, 1.29-2.64), and diabetes (HR, 1.58; 95% CI, 1.10-2.27) independently predicted the risk for ischemic events. Most of these variables also predicted major bleeding (cancer, chronic lung disease, renal insufficiency, anemia, and prior artery disease) or recurrent PE (cancer, chronic lung disease, anemia, and prior artery disease). CONCLUSIONS In patients receiving anticoagulation for VTE, the mortality due to PE recurrences was lower than the mortality due to ischemic events. Most independent predictors for ischemic events were also predictors for major bleeding and for recurrent PE.
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Lichte P, Kobbe P, Almahmoud K, Pfeifer R, Andruszkow H, Hildebrand F, Lefering R, Pape HC. Post-traumatic thrombo-embolic complications in polytrauma patients. INTERNATIONAL ORTHOPAEDICS 2015; 39:947-54. [PMID: 25690923 DOI: 10.1007/s00264-015-2698-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 01/27/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Thrombo-embolic events after trauma are considered to be life-threatening complications. Our aim was to determine the incidence of arterial and venous thrombo-embolic events (TE) in severely-injured trauma patients, and its associated risk factors by using a large trauma registry. METHODS Patients' data from the TraumaRegister DGU® (TR-DGU) were screened for TE (DVT [symptomatic deep vein thrombosis], PE [symptomatic pulmonary embolism], MI [myocardial infarction], and stroke) through the clinical course of severely injured adult trauma patients from January 2005 to December 2012. Univariate analysis was used to compare the clinical outcomes (endpoints: mortality, ICU and hospital length of stay, ventilator days), and a multivariate regression analysis was used to assess the independent risk factors associated with each TE event. RESULTS From a cohort of 40,846 trauma patients, 1122 (2.8%) patients developed a TE during their post-traumatic clinical course (313, 0.8% DVT; 425, 1.0% PE; 160, 0.4% MI and 231, 0.6% stroke). ICU length of stay [LOS], total LOS, days on mechanical ventilation, and incidence of multiple organ failure (MOF) and sepsis were significantly increased in patients with TE complications. Injury severity, major pelvic injury, and one or more operations were found to be independent risk factors for the development of DVT. Age ≥ 60 years, male gender, and more than one operation were risk factors for PE development. For MI age was the only significant risk factor. The occurrence of a stroke is increased in patients with an age ≥ 60 years, major head injury (AIS head ≥ 3), and more than one operation. Finally, mortality rates were significantly higher in the TE group when compared to the non-TE cohort (21.8% vs. 12.7%; p < 0.001). CONCLUSION TE complications were associated with longer ICU and hospital stay as well as a higher mortality. Overall, age and repeated operations were the most important risk factors for the development of TE events.
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Affiliation(s)
- Philipp Lichte
- Department of Orthopaedic Trauma Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany,
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Hernández-Boluda JC, Arellano-Rodrigo E, Cervantes F, Alvarez-Larrán A, Gómez M, Barba P, Mata MI, González-Porras JR, Ferrer-Marín F, García-Gutiérrez V, Magro E, Moreno M, Kerguelen A, Pérez-Encinas M, Estrada N, Ayala R, Besses C, Pereira A. Oral anticoagulation to prevent thrombosis recurrence in polycythemia vera and essential thrombocythemia. Ann Hematol 2015; 94:911-8. [PMID: 25680896 DOI: 10.1007/s00277-015-2330-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 02/01/2015] [Indexed: 12/20/2022]
Abstract
It is unclear whether anticoagulation guidelines intended for the general population are applicable to patients with polycythemia vera (PV) and essential thrombocythemia (ET). In the present study, the risk of thrombotic recurrence was analyzed in 150 patients with PV and ET treated with vitamin K antagonists (VKA) because of an arterial or venous thrombosis. After an observation period of 963 patient-years, the incidence of re-thrombosis was 4.5 and 12 per 100 patient-years under VKA therapy and after stopping it, respectively (P < 0.0005). After a multivariate adjustment for other prognostic factors, VKA treatment was associated with a 2.8-fold reduction in the risk of thrombotic recurrence. Notably, VKA therapy offset the increased risk of re-thrombosis associated with a prior history of remote thrombosis. Both the protective effect of VKA therapy and the predisposing factors for recurrence were independent of the anatomical site involved in the index thrombosis. Treatment periods with VKA did not result in a higher incidence of major bleeding as compared with those without VKA. These findings support the use of long-term anticoagulation for the secondary prevention of thrombosis in patients with PV and ET, particularly in those with history of remote thrombosis.
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Affiliation(s)
- Juan-Carlos Hernández-Boluda
- Hematology and Medical Oncology Department, Hospital Clínico Universitario, Avd. Blasco Ibáñez 17, 46010, Valencia, Spain,
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Barmparas G, Jain M, Mehrzadi D, Melo N, Chung R, Bloom M, Ley EJ, Margulies DR. Aspirin Increases the Risk of Venous Thromboembolism in Surgical Patients. Am Surg 2014. [DOI: 10.1177/000313481408001002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The risk of venous thromboembolism (VTE) for patients taking an antiplatelet agent is largely unknown. This study aimed to investigate the association between antiplatelet agent use before admission with the risk of in-hospital VTE in surgical intensive care unit (ICU) patients. A retrospective review of all patients admitted to the surgical ICU at a Level I trauma center over 30 months was performed. Patients who underwent diagnostic imaging for VTE were selected. Patients were divided based on whether or not antiplatelet agents were used before admission (APTA vs NAPTA). The primary outcome was VTE occurrence. A forward logistic regression model was used to identify factors independently associated with the primary outcome. During the study period, 461 (24%) patients met inclusion criteria: 70 (15%) APTA and 391 (85%) NAPTA. After adjusting for confounding factors, APTA patients were at a significantly higher risk for developing VTE (59 vs 40%; adjusted odds ratio, 1.8; 95% confidence interval, 1.0 to 3.0; adjusted P = 0.04). Whether or not antiplatelet agents were resumed during the hospital stay and the day on which they were resumed did not affect VTE risk. In conclusion, surgical ICU patients receiving antiplatelet agents before admission are at a significantly higher risk for development of VTE.
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Affiliation(s)
- Galinos Barmparas
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Monica Jain
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Devorah Mehrzadi
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nicolas Melo
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Rex Chung
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Matthew Bloom
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eric J. Ley
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel R. Margulies
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
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Nour M, Scalzo F, Liebeskind DS. Ischemia-reperfusion injury in stroke. INTERVENTIONAL NEUROLOGY 2014; 1:185-99. [PMID: 25187778 DOI: 10.1159/000353125] [Citation(s) in RCA: 220] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Despite ongoing advances in stroke imaging and treatment, ischemic and hemorrhagic stroke continue to debilitate patients with devastating outcomes at both the personal and societal levels. While the ultimate goal of therapy in ischemic stroke is geared towards restoration of blood flow, even when mitigation of initial tissue hypoxia is successful, exacerbation of tissue injury may occur in the form of cell death, or alternatively, hemorrhagic transformation of reperfused tissue. Animal models have extensively demonstrated the concept of reperfusion injury at the molecular and cellular levels, yet no study has quantified this effect in stroke patients. These preclinical models have also demonstrated the success of a wide array of neuroprotective strategies at lessening the deleterious effects of reperfusion injury. Serial multimodal imaging may provide a framework for developing therapies for reperfusion injury.
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Affiliation(s)
- May Nour
- Departments of Neurology and Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Calif., USA
| | - Fabien Scalzo
- Departments of Neurology and Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Calif., USA
| | - David S Liebeskind
- Departments of Neurology and Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Calif., USA
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Rühl H, Müller J, Wäschenbach J, Oldenburg J, Dewald O, Pötzsch B. Short-term venous stasis induces fibrinolytic activation but not thrombin formation. J Atheroscler Thromb 2014; 21:1260-70. [PMID: 25069814 DOI: 10.5551/jat.24216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Venous stasis is a well-known risk factor for the development of venous thromboembolism. It is likely that stasis increases the risk of thrombosis by inducing hypercoagulability via the hypoxic procoagulant activation of endothelial and mononuclear cells and the accumulation of activated clotting factors. However, increased rates of thrombin formation have not been demonstrated in response to venous stasis in vivo. METHODS In this study, we used the venous occlusion (VO) test to determine, if stasis triggers thrombin formation in healthy individuals (n=25) and patients with additional thrombotic risk factors, such as inherited thrombophilia (n=19) and symptomatic atherosclerosis (n=15). Thrombin formation was monitored by measuring plasma levels of free thrombin using a highly sensitive oligonucleotide enzyme capture assay (OECA) in addition to the plasma levels of prothrombin fragment 1+2 (F1+2) and thrombin-antithrombin-complexes (TAT). The plasma levels of activated protein C (APC) were additionally measured using an APC-OECA. RESULTS VO induced a significant (p<0.05) increase in the levels of tissue-type plasminogen activator and plasmin-α2-antiplasmin-complexes. In all three cohorts, the majority of samples obtained during VO showed no quantifiable thrombin or APC levels. Consistent with these findings F1+2 and TAT did not change. CONCLUSIONS We conclude that short-term venous stasis induces a profibrinolytic response due to the activation of endothelial cells, but not a prothrombotic response, even in the presence of additional thrombophilic risk factors. Furthermore, our results support the hypothesis that the stasis-induced profibrinolytic activation of endothelial cells occurs independently from thrombin formation.
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Affiliation(s)
- Heiko Rühl
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn
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Páramo Fernández JA. Trombosis venosa y arterial: semejanzas e implicaciones clínicas. Med Clin (Barc) 2014; 143:20-1. [DOI: 10.1016/j.medcli.2013.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 07/25/2013] [Indexed: 11/16/2022]
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van der Stoep M, Korporaal SJA, Van Eck M. High-density lipoprotein as a modulator of platelet and coagulation responses. Cardiovasc Res 2014; 103:362-71. [DOI: 10.1093/cvr/cvu137] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Maitrot-Mantelet L, Horellou M, Massiou H, Conard J, Gompel A, Plu-Bureau G. Should women suffering from migraine with aura be screened for biological thrombophilia?: Results from a cross-sectional French study. Thromb Res 2014; 133:714-8. [DOI: 10.1016/j.thromres.2014.01.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/21/2014] [Accepted: 01/21/2014] [Indexed: 11/28/2022]
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Use of aspirin for the prevention of lower extremity deep venous thrombosis. J Vasc Surg Venous Lymphat Disord 2014; 2:230-9. [PMID: 26993195 DOI: 10.1016/j.jvsv.2013.10.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/09/2013] [Accepted: 10/27/2013] [Indexed: 01/13/2023]
Abstract
Whereas aspirin is recommended and widely used to prevent arterial thrombosis, its role in the prevention of deep venous thrombosis is not well defined. Aspirin is well accepted, easy to manage with few risks and low cost, and thus ideal for thromboprophylaxis if evidence shows it is effective. Recent guidelines and large studies were reviewed. Recent guidelines include aspirin as an acceptable thromboprophylactic agent after hip and knee orthopedic surgery despite continued publication of underpowered and contradictory studies. Two large randomized controlled trials pooled together suggest that low-dose (100 mg) aspirin is a reasonable alternative to prevent recurrence of venous thromboembolism (VTE) in patients who have been treated for a first episode of unprovoked VTE. We suggest that the current practice using aspirin to prevent thromboembolism include cautious discussion of the benefits and risks of this agent before use in a patient until precise clarification of dosage and treatment length is available. Despite inclusion of aspirin in the guidelines for orthopedic surgery, there is little evidence to support its use for primary prevention of VTE. Until definitive unbiased trials are published, we suggest that aspirin remain a realistic option to use for secondary prevention of VTE, especially compared with the option of using no prophylaxis.
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Vardi M, Piazza G, Pencina MJ, Burke DA, Lei L, Goldhaber SZ, Cutlip DE. Risk assessment to predict arterial and venous events in patients undergoing percutaneous coronary intervention. Clin Appl Thromb Hemost 2014; 20:478-83. [PMID: 24431382 DOI: 10.1177/1076029613517166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Atherosclerosis and venous thromboembolism (VTE) share common risk factors. We set to assess the strength of the association between atherosclerosis risk factors and disease manifestation, and VTE, in patients with coronary artery disease undergoing percutaneous coronary intervention. We pooled data from 6 global randomized controlled trials assessing coronary stenting (ENDEAVOR and SIRIUS programs), developed separate risk scores to predict major adverse cardiac and cerebrovascular events (MACCEs: cardiac death, myocardial infarction, and stroke) and VTE, and compared their performance. The 5-year rates of MACCE and VTE were 10.8% and 2.04%, respectively. Selected predictors for MACCE performed equally well in predicting VTE (area under the receiver-operating characteristic curve [AUC] 0.651 vs 0.672), and selected predictors for VTE performed equally well in predicting MACCE (AUC 0.699 vs 0.620). Ejection fraction and age were associated with both MACCE and VTE. These findings support the concept of overlapping pathophysiology of VTE and atherothrombosis.
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Affiliation(s)
- Moshe Vardi
- Harvard Clinical Research Institute, Boston, MA, USA
| | - Gregory Piazza
- Cardiovascular Division, Brigham and Women Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | | | - David A Burke
- Harvard Clinical Research Institute, Boston, MA, USA Cardiology Division, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Lanyu Lei
- Harvard Clinical Research Institute, Boston, MA, USA
| | - Samuel Z Goldhaber
- Cardiovascular Division, Brigham and Women Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Donald E Cutlip
- Harvard Clinical Research Institute, Boston, MA, USA Harvard Medical School, Boston, MA, USA Cardiology Division, Beth Israel Deaconess Medical Center, Boston, MA, USA
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41
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Difference in fibrinolytic capacity in young patients with venous thrombosis or ischaemic stroke. Blood Coagul Fibrinolysis 2014; 25:61-6. [DOI: 10.1097/mbc.0b013e328364c473] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Carotid Atherosclerosis Predicts Future Myocardial Infarction But Not Venous Thromboembolism. Arterioscler Thromb Vasc Biol 2014; 34:226-30. [DOI: 10.1161/atvbaha.113.302162] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Andrei MC, Andercou O, Andercou A. Change in the lower limb deep venous flow in peripheral atherosclerotic arterial disease. CLUJUL MEDICAL 2014; 87:40-2. [PMID: 26527995 PMCID: PMC4462412 DOI: 10.15386/cjm.2014.8872.871.mca1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 02/21/2014] [Accepted: 02/24/2014] [Indexed: 11/24/2022]
Abstract
Aim This prospective study was undertaken to determine how peripheral atherosclerotic disease influences the flow in the deep veins of the leg. Material and method Thirty one subjects with peripheral atherosclerotic disease and 23 age matched control subjects were studied. The popliteal vein flow velocity was measured at rest and during reactive hyperemia by means of color duplex ultrasound scanning. Patient age, ankle-brachial index (ABI) and the presence of risk factors for venous thrombosis were also recorded. Results There was a negative correlation between the ankle-brachial index and venous flow velocity among subjects with peripheral arterial disease (p=0.001). There was a negative correlation between dyslipidemia and resting venous flow velocity (p=0.049). During reactive hyperemia, venous flow velocity increased less in subjects with peripheral arterial disease than it did in control subjects (p=0.007). The subjects with dyslipidemia showed no changes in venous flow velocity in reactive hyperemia measurements (p=0.908). Conclusion Increasing the venous flow velocity in peripheral arterial disease, may confer some protection against the deep venous thrombosis.
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Affiliation(s)
| | | | - Aurel Andercou
- 2nd Surgical Department, County Emergency Hospital, Cluj-Napoca
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Impact of experimental type 1 diabetes mellitus on systemic and coagulation vulnerability in mice acutely exposed to diesel exhaust particles. Part Fibre Toxicol 2013; 10:14. [PMID: 23587270 PMCID: PMC3641025 DOI: 10.1186/1743-8977-10-14] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 04/12/2013] [Indexed: 01/10/2023] Open
Abstract
Background Epidemiological evidence indicates that diabetic patients have increased susceptibility to adverse cardiovascular outcomes related to acute increases in exposures to particulate air pollution. However, mechanisms underlying these effects remain unclear. Methods To evaluate the possible mechanisms underlying these actions, we assessed the systemic effects of diesel exhaust particles (DEP) in control mice, and mice with streptozotocin–induced type 1 diabetes. Four weeks following induction of diabetes, the animals were intratracheally instilled (i.t.) with DEP (0.4 mg/kg) or saline, and several cardiovascular endpoints were measured 24 h thereafter. Results DEP caused leukocytosis and a significant increase in plasma C-reactive protein and 8-isoprostane concentrations in diabetic mice compared to diabetic mice exposed to saline or non-diabetic mice exposed to DEP. The arterial PO2 as well as the number of platelets and the thrombotic occlusion time in pial arterioles assessed in vivo were significantly decreased following the i.t. instillation of DEP in diabetic mice compared to diabetic mice exposed to saline or non-diabetic mice exposed to DEP. Both alanine aminotransferase and aspartate transaminase activities, as well as the plasma concentrations of plasminogen activator inhibitor and von Willebrand factor were significantly increased in DEP-exposed diabetic mice compared to diabetic mice exposed to saline or DEP-exposed non-diabetic mice. The in vitro addition of DEP (0.25-1 μg/ml) to untreated mouse blood significantly and dose-dependently induced in vitro platelet aggregation, and these effects were exacerbated in blood of diabetic mice. Conclusion This study has shown that systemic and coagulation events are aggravated by type 1 diabetes in mice, acutely exposed to DEP and has described the possible mechanisms for these actions that may also be relevant to the exacerbation of cardiovascular morbidity accompanying particulate air pollution in diabetic patients.
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Cancer-related coagulopathy (Trousseau's syndrome): review of the literature and experience of a single center of internal medicine. Clin Exp Med 2013; 13:85-97. [PMID: 23456539 DOI: 10.1007/s10238-013-0230-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 02/13/2013] [Indexed: 12/21/2022]
Abstract
Venous thromboembolism (VTE) occurs roughly in one out of five cancer patients and is the second cause of death in this population. When all cancer patients are considered together, a sevenfold increased risk for VTE has been calculated. Over the last 20 years, a number of risk factors have been recognized. These have been used in several risk assessment models aimed at identifying high-risk patients who are therefore candidates for thromboprophylaxis. An easily applicable and reliable risk score is based on the cancer site, hemoglobin levels, pre-chemotherapy platelet and leukocyte counts as well as body mass index. The additional measurement of two biomarkers, namely D-dimer and soluble P-selectin, may improve estimates of the cumulative VTE probability. A variable incidence of VTE has been determined in patients with specific types of malignancy, with the highest odds in those with pancreatic cancer followed by head and neck tumors. In terms of histotype, the risk of VTE is significantly higher in patients with adenocarcinoma than in those with squamous cell carcinoma and in patients with high-grade versus low-grade tumors. Cancer therapy may also be responsible for VTE; specifically, the presence of an indwelling central venous catheter, immunomodulatory drugs such as thalidomide and lenalidomide, monoclonal antibodies, such as bevacizumab, erythropoiesis-stimulating agents and hormonal therapy with tamoxifen place patients at higher risk. The pathogenesis of cancer-related VTE is poorly understood but is likely to be multifactorial. "Virchow's triad," comprising stasis consequent to a decreased blood flow rate, an enhanced blood clotting tendency such as accompanies inflammation and growth factor expression, and structural modifications in blood vessel walls, is thought to play a central role in the induction of VTE. The prophylaxis and treatment of VTE are based on well-established drugs such as vitamin K antagonists and unfractionated and low-molecular-weight heparins as well as on an expanding group of new oral anticoagulants, including fondaparinux, rivaroxaban, apixaban and dabigatran. Furthermore, aspirin has been shown to prevent arterial thrombosis and to reduce the rate of major vascular events. Guidelines for the general management of VTE in cancer patients and in those with an indwelling central venous catheter have been recently developed with the aim of selecting the most rational therapeutic approach for each clinical situation. The main features of VTE based on our own observations of 92 cancer patients and 159 patients with non-neoplastic disease are briefly described herein.
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Ando H, Otoda T, Ookami H, Nagai Y, Inano A, Takamura T, Ushijima K, Hosohata K, Matsushita E, Saito T, Kaneko S, Fujimura A. Dosing time-dependent effect of raloxifene on plasma plasminogen activator inhibitor-1 concentrations in post-menopausal women with osteoporosis. Clin Exp Pharmacol Physiol 2013; 40:227-32. [DOI: 10.1111/1440-1681.12055] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 01/10/2013] [Accepted: 01/11/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Hitoshi Ando
- Division of Clinical Pharmacology; Department of Pharmacology; School of Medicine; Jichi Medical University; Shimotsuke; Japan
| | | | - Hitoshi Ookami
- Department of Orthopedics; Shin-Kaminokawa Hospital; Kaminokawa; Japan
| | | | - Akihiro Inano
- Hokuriku Clinical Research Supporting Center; Kanazawa; Japan
| | - Toshinari Takamura
- Department of Disease Control and Homeostasis; Kanazawa University Graduate School of Medical Science; Kanazawa; Japan
| | - Kentarou Ushijima
- Division of Clinical Pharmacology; Department of Pharmacology; School of Medicine; Jichi Medical University; Shimotsuke; Japan
| | - Keiko Hosohata
- Division of Clinical Pharmacology; Department of Pharmacology; School of Medicine; Jichi Medical University; Shimotsuke; Japan
| | - Eiki Matsushita
- Department of Internal Medicine; Kahoku Central Hospital; Tsubata; Japan
| | | | - Shuichi Kaneko
- Department of Disease Control and Homeostasis; Kanazawa University Graduate School of Medical Science; Kanazawa; Japan
| | - Akio Fujimura
- Division of Clinical Pharmacology; Department of Pharmacology; School of Medicine; Jichi Medical University; Shimotsuke; Japan
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