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Lambert C, Maitland H, Ghanima W. Risk-based and individualised management of bleeding and thrombotic events in adults with primary immune thrombocytopenia (ITP). Eur J Haematol 2024; 112:504-515. [PMID: 38088207 DOI: 10.1111/ejh.14154] [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: 09/27/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 03/19/2024]
Abstract
Although bleeding is one of the main symptoms of primary immune thrombocytopenia (ITP), risk factors for bleeding have yet to be fully established. Low platelet count (PC; <20-30 × 109 /L) is generally indicative of increased risk of bleeding. However, PC and bleeding events cannot be fully correlated; many other patient- and disease-related factors are thought to contribute to increased bleeding risk. Furthermore, even though ITP patients have thrombocytopenia and are at increased risk of bleeding, ITP also carries higher risk of thrombotic events. Factors like older age and certain ITP treatments are associated with increased thrombotic risk. Women's health in ITP requires particular attention concerning haemorrhagic and thrombotic complications. Management of bleeding/thrombotic risk, and eventually antithrombotic therapies in ITP patients, should be based on individual risk profiles, using a tailored, patient-centric approach. Currently, evidence-based recommendations and validated tools are lacking to support decision-making and help clinicians weigh risk of bleeding against thrombosis. Moreover, evidence is lacking about optimal PC for achieving haemostasis in invasive procedures settings. Further research is needed to fully define risk factors for each event, enabling development of comprehensive risk stratification approaches. This review discusses risk-based and individualised management of bleeding and thrombosis risk in adults with primary ITP.
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Affiliation(s)
- Catherine Lambert
- Hemostasis and Thrombosis Unit, Division of Hematology, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Hillary Maitland
- Division of Hematology and Oncology, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Waleed Ghanima
- Department of Hemato-oncology, Østfold Hospital, Oslo University, Oslo, Norway
- Department of Hematology, Institute of Clinical Medicine, Oslo University, Oslo, Norway
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Fan J, Shang Y, Shen F, Huang Q, Wang Z, Han Y, Zhao J. Assessment of Risk Factors and Cognitive Level Associated with Venous Thrombosis Patients in a Coexistence of Multiple Diseases Study in Shanghai. Int J Gen Med 2022; 15:1609-1618. [PMID: 35210832 PMCID: PMC8859870 DOI: 10.2147/ijgm.s339583] [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: 09/20/2021] [Accepted: 01/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Venous thrombosis (VTE) is a high-incidence disease that affects different systems of the body, but no comparative studies have been conducted to explore its incidence in different systems in patients with the coexistence of multiple diseases. Primary care is a medical institution that has the first contact with patients’ conditions. The majority of outpatients suffer from multiple diseases, and they are more prone to VTE, which is of significance and requires investigation. At the same time, we observed that the primary care patients’ cognition level of VTE is insufficiency at present, and the prevention and management of VTE in China is still in its infancy. Most studies focus on whether doctors and nurses are clear about the diagnosis and manifestations of VTE, however, few studies on patients’ cognitive level and influencing factors of symptoms and prevention of VTE. Therefore, it is necessary to study the causes of cognitive deficiency of VTE from the perspective of patients, conduct targeted cognitive and behavioral interventions, and finally achieve the purpose of improving the effect of VTE prevention and management. Aim This study aimed to explore the risk factors, cognitive level and cognitive potential influence factors of VTE in outpatients of primary care in Shanghai, as well as which diseases, are more likely to promote occurrence of VTE among patients with multiple diseases. Methods A total of 710 patients were included in the analysis. Shanghai in China is divided into urban and suburban areas by their geographical location, and a random sample of 10 primary care areas was investigated, including 5 urban areas and 5 suburban areas. The Padua scale and the VTE cognitive level-related knowledge test scale were used for the investigation. Statistical software was used to conduct univariate Pearson correlation analysis and multivariate logistic regression analysis for VTE high-risk factors among outpatients of primary care. Furthermore, the high-risk factors for VTE and the types of chronic disease in patients with multiple diseases were subjected to subgroup analyses. t-test was used to statistically analyze cognitive level of VTE and the potential influence factors related to the patients’ VTE cognitive level. Results Univariate analysis of risk factors for VTE in 710 outpatients showed that age (χ2=83.895, P<0.001), education (χ2=8.324, P=0.004), region (χ2=63.936, P<0.001), chronic disease (χ2=18.198, P<0.001) and the coexistence of multiple diseases (χ2=61.347, P<0.001) were the main risk factors for VTE risk in patients. Logistic multivariate regression analysis showed that age, region, chronic diseases and the coexistence of multiple diseases were independent risk factors for VTE risk in patients. The correlation between high risk of VTE in patients with multiple diseases and various types of chronic diseases was further analyzed by logistic multivariate regression. The results showed that diabetes mellitus (OR=1.636 [95% CI, 1.030–2.599], P=0.037), cerebral infarction (OR=8.484 [95% CI, 4.615–15.597], P<0.001), coronary heart disease (OR=2.987 [95% CI, 1.699–5.252], P<0.001), intracerebral hemorrhage (OR=15.130 [95% CI, 4.707–48.630], P<0.001), respiratory diseases (OR=3.470, [95% CI, 1.428–8.43], P=0.006) and malignant tumors (OR=4.576, [95% CI, 1.85–11.315], P=0.001) were independent risk factors for VTE among patients with co-existing diseases, and the risks from high to low were cerebral hemorrhage>cerebral infarction>malignant tumor>respiratory system disease>coronary heart disease> diabetes. In addition, patients’ age (t=6.869, P<0.001), region (t=3.420, P<0.001), education level (t=−7.341, P<0.001), chronic disease (t=5.875, P<0.001), BMI (t=6.404, P=0.012), smoking (t=4.152, P=0.042) were related to the VTE cognitive level. Conclusion General practitioners should pay close attention to independent risk factors for VTE among patients in routine outpatient care, especially patients with co-existing diseases with independent risk for VTE, placing them high risk of VTE. At the same time, health education and other measures should be strengthened to improve the patients’ awareness and cognitive level of VTE to prevent the occurrence of VTE and its related complications.
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Affiliation(s)
- Jian Fan
- Department of General Practice, Changhai Hospital, Naval Military Medical University, Shanghai, 200433, People’s Republic of China
| | - Yan Shang
- Department of General Practice, Changhai Hospital, Naval Military Medical University, Shanghai, 200433, People’s Republic of China
| | - Fei Shen
- Yinhang Community Healthcare Center, Shanghai, 200433, People’s Republic of China
| | - Qiaowen Huang
- Zhaoxiang Community Healthcare Center, Shanghai, 200433, People’s Republic of China
| | - Ziyu Wang
- Department of General Practice, Changhai Hospital, Naval Military Medical University, Shanghai, 200433, People’s Republic of China
| | - Yiping Han
- Department of Respiratory and Critical Care Medicine, Changhai Hospital, Naval Military Medical University, Shanghai, 200433, People’s Republic of China
- Yiping Han, Department of Respiratory and Critical Care Medicine, Changhai Hospital, Naval Military Medical University, Shanghai, 200433, People’s Republic of China, Email
| | - Jiayi Zhao
- Department of General Practice, Changhai Hospital, Naval Military Medical University, Shanghai, 200433, People’s Republic of China
- Correspondence: Jiayi Zhao, Department of General Practice, Changhai Hongkou Hospital, Shanghai, 200081, People’s Republic of China, Email
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Halboup AM, Alzoubi KH, Mohamed Ibrahim MI, Syed Sulaiman SA, Almahbashi Y, Al-Arifi S, Mohammed S, Othman G. Awareness and Perception of Hospitalized Patients on Thromboembolism and Thromboprophylaxis: A Cross-Sectional Study in Sana'a-Yemen. Patient Prefer Adherence 2022; 16:1649-1661. [PMID: 35846872 PMCID: PMC9285849 DOI: 10.2147/ppa.s368839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/06/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Patients' awareness toward VTE and thromboprophylaxis is critical for medication adherence. This study aimed to evaluate the patient's awareness and perception towards VTE and its prophylaxis and to assess patient's satisfaction towards the information given by the medical staff. PARTICIPANTS AND METHODS A cross-sectional survey was conducted among hospitalized patients who received VTE prophylaxis in public and private hospitals in Sana'a, Yemen. Besides sociodemographic variables, participants' awareness and perception of VTE and its prophylaxis were evaluated. Variables' association with VTE awareness were analyzed using univariable and multivariable logistic regression using SPSS. RESULTS A total of 396 of the hospitalized patients agreed to participate in the study, with 31% (n = 121) have ever heard about VTE. The multivariable logistic regression findings revealed that the participants who did not have a profession had OR = 17.182 (P < 0.001) of being unaware of VTE compared with those who had one. Participants who did not have a personal history of VTE had OR = 7.580 (P < 0.001) of being unaware of DVT/PE compared with the participants who had a personal history of VTE. Male participants had OR = 2.839 (P < 0.005) of being unaware of DVT/PE compared with female participants. Participants who were illiterate had OR = 2.832 (P < 0.022) of being unaware of DVT/PE compared with participants with a higher level of education. CONCLUSION The study revealed lack of awareness and perception of VTE and its prophylaxis among hospitalized patients in Yemen. The patients who are unaware of the disease have wrong perception about their role in DVT prophylaxis. Patient's education must be considered in healthcare setting to improve patient's health outcomes.
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Affiliation(s)
- Abdulsalam M Halboup
- Department of Clinical Pharmacy and Pharmacy Practice University of Science and Technology, Sana’a, Yemen
| | - Karem H Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | - Yasmin Almahbashi
- Department of Clinical Pharmacy and Pharmacy Practice University of Science and Technology, Sana’a, Yemen
| | - Shaima Al-Arifi
- Department of Clinical Pharmacy and Pharmacy Practice University of Science and Technology, Sana’a, Yemen
| | - Sarah Mohammed
- Department of Clinical Pharmacy and Pharmacy Practice University of Science and Technology, Sana’a, Yemen
| | - Gamil Othman
- Department of Clinical Pharmacy and Pharmacy Practice University of Science and Technology, Sana’a, Yemen
- Correspondence: Gamil Othman, Department of Clinical Pharmacy and Pharmacy practice, University of Science and Technology, Sana’a, Yemen, Tel +967774960247, Email
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Périchou J, Ranchon F, Herledan C, Huot L, Larbre V, Carpentier I, Lazareth A, Karlin L, Beny K, Vantard N, Schwiertz V, Caffin AG, Baudouin A, Sesques P, Brisou G, Ghesquières H, Salles G, Rioufol C. Immunomodulatory drugs in multiple myeloma: Impact of the SCARMET (Self CARe and MEdication Toxicity) educational intervention on outpatients' knowledge to manage adverse effects. PLoS One 2020; 15:e0243309. [PMID: 33275634 PMCID: PMC7717911 DOI: 10.1371/journal.pone.0243309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/18/2020] [Indexed: 12/18/2022] Open
Abstract
Long-term multiple myeloma therapy by immunomodulatory drugs (IMiDs) raises the question of management of adverse effects. The aim of this study is to assess the impact of an educational session for patients on the acquisition of knowledge to manage hematologic and thromboembolic adverse effects of IMiDs. In this prospective single-center study, patients attended an educational session with a hospital clinical pharmacist and a nurse. The primary endpoint was the patient's level of knowledge for the management of IMiDs adverse effects, assess with a dedicated questionnaire administered before the session then 1 and 6 months after. Assessment of knowledge was combined with self-assessment of certainty. The secondary endpoints were adherence and IMiD treatment satisfaction. 50 patients were included. Patient knowledge increased at 1 month (p<0.001) despite a loss of knowledge at 6 months (p<0.05). Six months after the educational intervention, the number of patients with skills considered satisfactory by the pharmacist and nurse increased (p<0.01). Most patients showed satisfactory adherence, with medication possession ratio ≥ 80%. The Self CARe and MEdication Toxicity (SCARMET) study highlighted the impact of multidisciplinary follow-up in multiple myeloma patients to improve knowledge of toxicity self-management.
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Affiliation(s)
- Juliette Périchou
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | - Florence Ranchon
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | - Chloé Herledan
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | - Laure Huot
- Département de la Recherche Clinique et de l’Innovation, Cellule Innovation, Hospices Civils de Lyon, Lyon, France
| | - Virginie Larbre
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | | | - Anne Lazareth
- Hematology Department, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Lionel Karlin
- Hematology Department, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Karen Beny
- Pharmacie Centrale, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Nicolas Vantard
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | - Vérane Schwiertz
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | - Anne Gaelle Caffin
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | - Amandine Baudouin
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | - Pierre Sesques
- Hematology Department, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Gabriel Brisou
- Hematology Department, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Hervé Ghesquières
- Hematology Department, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Gilles Salles
- Hematology Department, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Centre de Recherche en Cancérologie de Lyon, INSERM 1052 CNRS 5286, Université Lyon 1, Lyon, France
| | - Catherine Rioufol
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
- * E-mail:
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Guo M, Lu L, Sun Y, Li L, Wu M, Lang J. Comprehensive functional exercises with patient education for the prevention of venous thrombosis after major gynecologic surgery: A randomized controlled study. Thromb Res 2019; 178:69-74. [PMID: 30991240 DOI: 10.1016/j.thromres.2019.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/09/2019] [Accepted: 04/10/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To explore the functional exercises of deep breathing and lower limb motions for the prevention of venous thrombosis in patients undergoing major surgery for gynecologic malignancy. METHODS All eligible patients admitted to the gynecologic oncology unit were randomized into the study and control groups. A comprehensive set of functional exercises was provided to the study group under the instruction and supervision of medical staff. All patients received pre- and postoperative educational material, followed by questionnaires about the patient's perception and satisfaction of the material, and all indicated prophylactic medications were administered. RESULTS In total, 132 patients were randomized, and 62 and 53 patients in the study and control groups, respectively, were included in the final analysis. Venous thrombosis, identified by symptoms and/or postoperative ultrasound, was found in 9 (17.0%) and 2 (3.2%) patients in the control and study groups, respectively, which was significantly different (p = 0.012), and most of these instances (9/11, 81.8%) were intramuscular vein thrombosis. The incidence of venous thromboembolism (VTE) was not significantly different (1 [1.9%] versus 1 [1.6%]) between the two groups. In the regression model, functional exercise was the only factor associated with venous thrombosis (odds ratio 0.170, 95% confidence interval 0.035-0.815, p = 0.032) adjusted with diagnosis and surgical parameters. The detailed educational material had improved the perception and satisfaction of patients about the prevention of VTE. CONCLUSION In a phase 3, single-center randomized controlled study, a comprehensive set of functional exercises combining deep breathing and lower limb motions would significantly decrease the risk of venous thrombosis in patients undergoing major surgery for gynecologic malignancy, especially the risk of intravascular thrombosis.
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Affiliation(s)
- Miao Guo
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Ling Lu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Yu Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Lei Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China.
| | - Ming Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China.
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
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