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Bonnefoy PB, Prevot N, Mehdipoor G, Sanchez A, Lima J, Font L, Gil-Díaz A, Llamas P, Aibar J, Bikdeli B, Bertoletti L, Monreal M. Ventilation/perfusion (V/Q) scanning in contemporary patients with pulmonary embolism: utilization rates and predictors of use in a multinational study. J Thromb Thrombolysis 2021; 53:829-840. [PMID: 34611738 DOI: 10.1007/s11239-021-02579-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2021] [Indexed: 12/12/2022]
Abstract
Ventilation/perfusion (V/Q) imaging and computed tomography pulmonary angiography (CTPA) are common tools for acute pulmonary embolism (PE) diagnosis. Limited contemporary data exist about the utilization of each modality, including the predictors of using V/Q versus CTPA. We used the data from patients diagnosed with PE using V/Q or CTPA from 2007 to 2019 in Registro Informatizado Enfermedad ThromboEmbolica, an international prospective registry of patients with venous thromboembolism. Outcomes was to determine the trends in utilization of V/Q vs. CTPA and, in a contemporary subgroup fitting with current practices, to evaluate predictors of V/Q use with multivariable logistic regression. Among 26,540 patients with PE, 89.2% were diagnosed with CTPA, 7.1% with V/Q and 3.7% with > 1 thoracic imaging modality. Over time, the proportional use of V/Q scanning declined (13.9 to 3.3%, P < 0.001). In multivariable analysis, heart failure history (odds ratio [OR]:1.5; 95% confidence interval [CI] 1.14-1.98), diabetes ([OR 1.71; 95% CI 1.39-2.10]), moderate and severe renal failure (respectively [OR 1.87; 95% CI 1.47-2.38] and [OR 9.36; 95% CI 6.98-12.55]) were the patient-level predictors of V/Q utilization. We also observed an influence of geographical and institutional factors, partly explained by time-limited V/Q availability (less use over weekends) and regional practices. Use of V/Q for the diagnosis of PE decreased over time, but it still has an important role in specific situations with an influence of patient-related, institution-related and logistical factors. Local and regional resources should be evaluated to improve V/Q accessibility than could benefit for this population.
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Affiliation(s)
| | - Nathalie Prevot
- Service de Médecine Nucléaire, CHU de Saint-Etienne, 42055, Saint-Étienne, France.,INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, 42055, Saint-Etienne, France
| | - Ghazaleh Mehdipoor
- Department of Medicine, Peconic Bay Medical Center, Northwell Health, Riverhead, NY, USA.,Cardiovascular Research Foundation (CRF), New York, NY, USA
| | - Alicia Sanchez
- Service de Médecine Nucléaire, CHU de Saint-Etienne, 42055, Saint-Étienne, France
| | - Jorge Lima
- Department of Pneumonology, Hospital Universitario de Valme, Sevilla, Spain
| | - Llorenç Font
- Department of Haematology, Hospital de Tortosa Verge de La Cinta, Tarragona, Spain
| | - Aída Gil-Díaz
- Department of Internal Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, Spain
| | - Pilar Llamas
- Department of Haematology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Jesús Aibar
- Department of Internal Medicine, Hospital Clínic, Barcelona, Barcelona, Spain
| | - Behnood Bikdeli
- Department of Medicine, Peconic Bay Medical Center, Northwell Health, Riverhead, NY, USA.,Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, USA
| | - Laurent Bertoletti
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, 42055, Saint-Etienne, France.,Service de Médecine Vasculaire Et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France.,INSERM, CIC-1408, CHU Saint-Etienne, 42055, Saint-Etienne, France.,F-CRIN INNOVTE Network, Saint-Etienne, France
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias I PujolBadalona, Barcelona, Universidad Católica de Murcia, Barcelona, Spain
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Hospitalization for venous thromboembolic disease management: a 10 years Registry in Buenos Aires, Argentina. J Thromb Thrombolysis 2021; 52:1187-1194. [PMID: 33900521 DOI: 10.1007/s11239-021-02459-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 10/21/2022]
Abstract
Venous thromboembolism (VTE) is the most frequent cause of preventable mortality in hospitalized patients and the third leading cause of mortality due to vascular diseases. We aim to describe patients with VTE who required hospitalization, their clinical characteristics, management and evolution after discharge. Prospective cohort which included patients with acute and symptomatic VTE who required hospitalization in a single tertiary center for their management in a 10 years´ period (between 2006 and 2016). Patients were included at the time of VTE diagnosis; we collected baseline characteristics, risk stratification and initial therapeutic approach. They were periodically, prospectively and systematically followed up to evaluate recurrence, bleeding and/or death. Time-to-event analysis was performed for these outcomes related to evolucion after discharge. 3457 confirmed VTE episodes were included for the analysis (1985 DVT, 930 PE and 542 DVT + DVT), corresponding to 3157 patients. Most were elderly, the median age was 68 years (SD 16) with a predominance of women 57% (1955). Most frequent predisposing factors were immobility (45%), active cancer (35%), recent surgery (33%), obesity (26%), recent hospitalization (22%) and previous VTE (21%). One-fourth of pulmonary embolism had sPESI 0 points. Mortality, recurrence and bleeding rates within 30 days were 14%, 10% and 5% respectively. High proportion of VTE require hospitalization for their management, even PE with low sPESI. Mortality and complication remain elevated. We encourage the development and maintenance of more VTE registries in Latin America, to fully understand local characteristics of this disease.
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Riera-Mestre A, Mora Luján J, Sanchez Martínez R, Torralba Cabeza M, Patier de la Peña J, Juyol Rodrigo M, Lopez Wolf D, Ojeda Sosa A, Monserrat L, López Rodríguez M, Alonso Cotoner C, Beneyto Florido M, Fernández A, Gil Sánchez R, García Morillo J, Gómez Cerezo J, Gómez del Olmo V, Iglesias P, Juyol Rodrigo M, Lopez Osle N, López Rodríguez M, López Wolf D, Moreno de la Santa García M, Ojeda Sosa A, Patier de la Peña J, Perez Garcia M, Riera-Mestre A, Sánchez Martínez R, Torralba Cabeza M, Zarrabeitia Puente R. Computerized registry of patients with hemorrhagic hereditary telangiectasia (RiHHTa registry) in Spain: Objectives, methods, and preliminary results. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Riera-Mestre A, Mora Luján JM, Sanchez Martínez R, Torralba Cabeza MA, Patier de la Peña JL, Juyol Rodrigo MC, Lopez Wolf D, Ojeda Sosa A, Monserrat L, López Rodríguez M. Computerized registry of patients with hemorrhagic hereditary telangiectasia (RiHHTa Registry) in Spain: Objectives, methods, and preliminary results. Rev Clin Esp 2018; 218:468-476. [PMID: 30177223 DOI: 10.1016/j.rce.2018.07.002] [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: 06/02/2018] [Revised: 07/08/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Hereditary hemorrhagic telangiectasia (HHT) is a rare disease with autosomal dominant inheritance that causes systemic vascular affectation. MATERIAL AND METHOD After development a multicentric Spanish national registry, called RiHHTa, main clinical manifestations and diagnostic procedures of the first patients introduced are described. RESULTS 141 patients were included, of which 91 (64.5%) were women. The mean age at diagnosis was 42 years. Mutations in the ACVRL1 gene predominated over the ENG gene. The initial symptom was recurrent epistaxis in 130 (92.2%) patients and in three (2.1%), brain abscess. Pulmonary arteriovenous (AV) fistula were detected in 36 (45%) of the 79 patients who underwent thoracic CT angiography. The contrast echocardiography detected very few bubbles (grade I) or none, in 36 (45%) of these 79 affected patients. In 43 (67.2%) of the 64 patients with an abdominal CT angiography, hepatic vascular malformations were detected, mostly telangiectasias, AV and arterio-portal fistula, and extrahepatic in 14 (10%) subjects. More than half of the patients were screened for the presence of brain arteriovenous malformations which was found in 3.9% of them. The upper part of the intestinal tube was the most (95%) affected region. CONCLUSION The RiHHTa Registry allows improving the management of patients with HHT. An inadequate use of thoracic CT angiography and the usefulness of abdominal CT angiography has been detected in order to define subtypes of hepatic vascular involvement and detect extrahepatic vascular involvement.
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Affiliation(s)
- A Riera-Mestre
- Unidad de Telangiectasia Hemorrágica Hereditaria, Servicio de Medicina Interna, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, Barcelona, España; Grupo de Trabajo en Enfermedades Minoritarias, Sociedad Española de Medicina Interna.
| | - J M Mora Luján
- Unidad de Telangiectasia Hemorrágica Hereditaria, Servicio de Medicina Interna, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; Grupo de Trabajo en Enfermedades Minoritarias, Sociedad Española de Medicina Interna
| | - R Sanchez Martínez
- Grupo de Trabajo en Enfermedades Minoritarias, Sociedad Española de Medicina Interna; Servicio de Medicina Interna, Hospital General Universitario de Alicante, Alicante, España
| | - M A Torralba Cabeza
- Grupo de Trabajo en Enfermedades Minoritarias, Sociedad Española de Medicina Interna; Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J L Patier de la Peña
- Grupo de Trabajo en Enfermedades Minoritarias, Sociedad Española de Medicina Interna; Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, España
| | - M C Juyol Rodrigo
- Grupo de Trabajo en Enfermedades Minoritarias, Sociedad Española de Medicina Interna; Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, España
| | - D Lopez Wolf
- Grupo de Trabajo en Enfermedades Minoritarias, Sociedad Española de Medicina Interna; Servicio de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - A Ojeda Sosa
- Grupo de Trabajo en Enfermedades Minoritarias, Sociedad Española de Medicina Interna; Servicio de Medicina Interna, Hospital Insular Universitario de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
| | - L Monserrat
- Grupo de Trabajo en Enfermedades Minoritarias, Sociedad Española de Medicina Interna; Health in Code, A Coruña, España
| | - M López Rodríguez
- Grupo de Trabajo en Enfermedades Minoritarias, Sociedad Española de Medicina Interna; Servicio de Medicina Interna, Hospital Central de la Cruz Roja, Madrid, España
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Cohen AT, Gitt AK, Bauersachs R, Fronk EM, Laeis P, Mismetti P, Monreal M, Willich SN, Bramlage P, Agnelli G, Prefer In Vte Scientific Steering Committee And The Prefer In Vte Investigators OBOT. The management of acute venous thromboembolism in clinical practice. Results from the European PREFER in VTE Registry. Thromb Haemost 2017; 117:1326-1337. [PMID: 28405675 PMCID: PMC6291854 DOI: 10.1160/th16-10-0793] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 03/22/2017] [Indexed: 01/30/2023]
Abstract
Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in Europe. Data from real-world registries are necessary, as clinical trials do not represent the full spectrum of VTE patients seen in clinical practice. We aimed to document the epidemiology, management and outcomes of VTE using data from a large, observational database. PREFER in VTE was an international, non-interventional disease registry conducted between January 2013 and July 2015 in primary and secondary care across seven European countries. Consecutive patients with acute VTE were documented and followed up over 12 months. PREFER in VTE included 3,455 patients with a mean age of 60.8 ± 17.0 years. Overall, 53.0% were male. The majority of patients were assessed in the hospital setting as inpatients or outpatients (78.5%). The diagnosis was deep-vein thrombosis (DVT) in 59.5% and pulmonary embolism (PE) in 40.5%. The most common comorbidities were the various types of cardiovascular disease (excluding hypertension; 45.5%), hypertension (42.3%) and dyslipidaemia (21.1%). Following the index VTE, a large proportion of patients received initial therapy with heparin (73.2%), almost half received a vitamin K antagonist (48.7%) and nearly a quarter received a DOAC (24.5%). Almost a quarter of all presentations were for recurrent VTE, with >80% of previous episodes having occurred more than 12 months prior to baseline. In conclusion, PREFER in VTE has provided contemporary insights into VTE patients and their real-world management, including their baseline characteristics, risk factors, disease history, symptoms and signs, initial therapy and outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Giancarlo Agnelli
- Giancarlo Agnelli, Stroke Unit and Division of Cardiovascular Medicine, Department of Internal Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Via Dottori Sant' Andrea delle Fratte, 06126 Perugia, Italy, Tel.: +39 075 578 6424, Fax: +39 075 578 2346, E-mail:
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Pesavento R, Amitrano M, Trujillo-Santos J, Di Micco P, Mangiacapra S, López-Jiménez L, Falgá C, García-Bragado F, Piovella C, Prandoni P, Monreal M. Fondaparinux in the initial and long-term treatment of venous thromboembolism. Thromb Res 2015; 135:311-7. [DOI: 10.1016/j.thromres.2014.11.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/24/2014] [Accepted: 11/30/2014] [Indexed: 10/24/2022]
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Borobia A, Fernández Capitán C, Iniesta Arandia N, García de Paso P, Valero Recio J, Bizighescu M, Carcas Sansuan A. Riesgo de enfermedad tromboembólica y estudio de utilización de tromboprofilaxis en pacientes médicos hospitalizados y al alta hospitalaria. Rev Clin Esp 2009; 209:15-20. [DOI: 10.1016/s0014-2565(09)70353-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Blanco-Molina A, Palma I, Rubio C, Suárez C, Barba R, Gutiérrez MR. [Venous thromboembolism in patients with neurosurgical process or stroke. A prospective analysis from the RIETE registry]. Med Clin (Barc) 2004; 123:416-8. [PMID: 15482715 DOI: 10.1016/s0025-7753(04)74537-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE We studied the characteristics of thromboembolic disease in patients who have suffered a deep venous thrombosis or a pulmonary thromboembolism with the occurrence, two months before, of a neurosurgical process or a stroke. PATIENTS AND METHOD We analyzed the variables of 57 patients who underwent a neurosurgical operation and those of 86 patients who suffered a stroke. These variables were included in the Computerised Records of Thromboembolic Disease. RESULTS The average age was of 62.3 (1.9) for neurosurgical and 71.7 (1.5) for stroke patients (p < 0.001). Prophylaxis was previously applied to 31.6% of neurosurgical patients and to 37.2% of patients in the stroke group. Most patients were treated with low molecular weight heparin during the acute phase of the illness. In both groups, 50% of deaths was associated with thromboembolic disease. The proportion of deceases was related to the associated disease and it was significantly higher in the stroke group (18% versus 4.2% in the neurosurgical group, p = 0.028). CONCLUSIONS In our study, thromboembolic disease was responsible of 50% of deaths. Stroke patients make up a group with a bad prognosis due to their older age and higher frequency of associated pathology; they have a higher risk of death.
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